非胸外伤性纵隔报肿发病机理探讨及外科治疗

目的 为了总结非胸外伤性纵隔气肿的外科治疗经验，并探讨其发病机理。方法对６４例非胸外伤性纵隔气肿进行了回顾性分析，对其发病机理，分类和外科治疗进行了讨论。结果 对张力性纵隔气肿和４岁以下非张力性纵隔气肿采取前给隔引流术，对４岁以上非张力性纵隔气肿采取颈、胸部皮下组织积气区域留置粗针头予以排气；临床上均获得满意疗效。结论（１）非胸外伤性纵隔气肿多为继发性的，在进行外科治疗的同时，应加强牟发疾病的治疗     

非胸外伤性纵隔气肿的外科治疗

作者总结了４８例非胸外伤性纵隔气肿的外科治疗经验,此症远较外伤性少见。主要由于小儿肺炎、哮喘、痢疾等疾病引起。作者认为：（１）非胸外伤性纵隔气肿多为继发性,在进行外科治疗的同时,应加强原发疾病的治疗。（２）对非胸外伤性纵隔气肿应根据其临床症状的轻重和不同年龄采取不同的外科治疗方法,可获得满意疗效。     

肝移植术后卡氏肺孢子菌肺炎伴自发性纵隔气肿一例

自发性纵隔气肿（spontaneous pneumomediastinum,SPM）是指非外伤性和医源性的纵隔内出现气体聚集的一种继发性疾病,根据纵隔气肿有无张力又可分为张力性纵隔气肿和非张力性纵隔气肿。多数SPM为非张力性纵隔气肿,症状较轻,容易被临床医师所忽视。     

厚朴三物汤加味治疗外伤性腹胀

厚朴三物汤加味治疗外伤性腹胀解放军第１８７医院（海口５７１１５９）符气华笔者自１９９３年８月～１９９４年６月用厚朴三物汤加味治疗外伤后腹胀病人２０例，效果满意，现报告如下。临床资料本组２０例均为住院病人，男１６例，女４例；年龄７２岁～１５岁；胸腰椎骨...     

股前外侧带蒂皮瓣顺行转移修复大粗隆部褥疮

１９９１年以来，我们应用旋股外侧动作者单位：７３００５０　兰州市，兰州军区总医院脊柱外科（张功林，葛宝丰，张军华，王清）；白银市第二人民医院骨科（李兴勇）脉降支发出的肌皮动脉穿支，或肌间隙皮支为血供的股前外侧皮瓣，行带蒂顺行移植修复大粗隆部褥疮，取得了满意效果，现报道如下。临床资料本组５例，其中男４例，女１例。年龄２４～４０岁，平均３４岁。均为外伤性胸腰椎骨折伴截瘫的病例，完全性截瘫４例，不完全性截瘫１例。损伤平面：胸１１者２例，胸１２者２例，腰１者１例。４例为单侧大粗隆部褥疮，１例为双侧，共６…     

大黄粉外敷治疗骨折并发张力性水泡

大黄粉外敷治疗骨折并发张力性水泡福建省永春县中医院（３６２６０１）郑跃进，郑小燕近年来，用单味大黄粉外敷治疗骨折后并发张力性水泡５２例，疗效满意，现介绍如下。一般资料本组男３１例，女２１例；年龄５～２０岁２２例，２１～４０岁１８例，４１岁以上１２例；...     

胸腔镜外科的临床应用：附19例报告

作者介绍１９例胸腔镜外科治疗的体会，病种和方法包括：自发性气胸１０例，用肺切割器行肺大、小切除；自发性血气胸１例，用钛夹作断裂索带钳闭止血；晚期恶性胸水者４例，用滑方粉喷洒，行胸膜固定：肺部肿块４例，分别行肺楔形切除（３例）和肺叶切除术（１例）。以上病例近期疗效满意。作者对国内开展胸腔镜手术提出一些讨论意见。     

张力性纵隔气肿16例急诊处理体会

目的探讨张力性纵隔气肿的诊断及急诊治疗经验。方法16例外伤致张力性纵隔气肿患者,均经临床和影像学检查确诊。急诊行床旁纵隔切开减压引流术。结果本组有1例死于腹腔脏器大出血,其余15例治愈,未发生胸腔感染及纵隔感染。随访4个月～2年,全组无纵隔气肿复发。结论张力性纵隔气肿要积极减压治疗,采取前纵隔切开置管引流排气,患者症状缓解快,排气充分,是一种良好的治疗方法。对于有气胸的纵隔气肿,首先行胸腔闭式引流,然后视纵隔气肿消退与否采取是否引流排气。     

腰椎滑脱症和胸腰椎骨折的内固定器研制及其临床应用

目的：为了提高脊柱内固定器的复位效果。方法：通过对腰椎滑脱症发病机理的探讨和３１８例胸腰椎骨折治疗的分析，作者设计了一种用于治疗腰椎滑脱症和胸腰椎骨折的新型内固定器（ＳＦ内固定器）。结果：经４２例胸腰椎骨折和１７例腰椎滑脱症临床应用，其中４１例获６个月以上随访（６～３８个月，平均１３．４个月），效果满意，操作简便，值得推广。     

血腑逐瘀汤治疗脊髓型颈椎病32例

血腑逐瘀汤治疗脊髓型颈椎病３２例山东省交通医院（２５００３１）黄抗美笔者自１９８９年～１９９２年应用血腑逐瘀汤治疗脊髓型颈椎病３２例，疗效满意，报告如下。临床资料本组男１４例，女１８例；年龄４７～７３岁；病史１５天～４个月；双下肢无力、步态蹒跚者８例...     

继发性胆汁性肝硬变门脉高压症的诊断和治疗

目的 探讨继发性胆汁性肝硬变门脉高压症的诊断和治疗。方法 对我院近16年来收治的25例该病患者作回顾性研究,按原发病分为4组;肝胆管结石13例、术后胆管狭窄6例、胆道恶性肿瘤4例、其他2例。分析其临床及病理资料,并予随访。结果 25例均经临床诊断,4例还经病理证实。非手术治疗8例;手术治疗17例,均针对原发病,1例同时行脾切除、胃底静脉离断术。手术治疗和非手术治疗的好转出院率分别为64.7%和37.5%,院内死亡率分别为17.6%和12.5%。结论 该病的诊断主要依靠其特征性临床表现;治疗首先应针对原发性,争取早期手术解除胆道梗阻;对合并食管胃底静脉曲张破裂出血者手术须慎重。     

全髋关节置换术中大转子骨折的原因与治疗

目的探讨全髋关节置换术及翻修术中股骨大转子骨折的原因与治疗方法。方法对1996年5月至2005年1月,471髋行全髋关节置换及96例全髋关节翻修术发生大转子骨折及大转子截骨不愈合的14例患者进行回顾性分析。其中大转子骨折11例,截骨不愈合3例。2例保守治疗,12例采用螺钉或克氏针加张力带钢丝固定的方法治疗。结果术后随访5~64个月,平均25个月。14例患者全部愈合。Harris评分从术前平均48分恢复到术后随访时平均90分。结论骨质疏松、髋内翻、髋脱位及股骨颈截骨不当等因素是全髋关节置换术及翻修术中股骨大转子骨折的主要原因。采用螺钉或克氏针加张力带钢丝固定的方法治疗效果良好。     

Clinical features of medical pneumomediastinum.

PURPOSE: The clinical features of pneumomediastinum are clarified. METHODS: Eight patients with pneumomediastinum, caused by other than trauma or operative, diagnostic, or therapeutic trouble (medical pneumomediastinum), were studied retrospectively. RESULTS: There were seven men and one woman with an average age of 17.5 years. The incidence was about 1:320 in thoracic surgical inpatients. The causes were bronchial asthma in three patients, physical exertion in one, and forced swallowing in one. There were three spontaneous cases. The chief complaints were dyspnea in five patients including three patients with bronchial asthma, chest pain in two, and pharyngeal pain in one. Subcutaneous emphysema was observed in all patients. Hamman's sign was audible in only one patient. Roentgenologically, subcutaneous emphysema was observed in all patients. Pneumomediastinum parallel to the heart was observed in five patients. The continuous diaphragm sign was detected in three patients. Five patients were prohibited from eating and drinking excluding those with pneumomediastinum due to bronchial asthma, considering the esophageal origin. Prophylactic antibiotics were prescribed for all patients. Pneumomediastinum improved within 7 days in all patients. The mean length of hospitalization was 7.8 days, ranging from 4 to 13 days.CONCLUSION: In consideration of air of the esophageal origin, non per oral was prescribed. With the prevention of mediastinitis using antibiotics, all patients recovered. Emergency endoscopic examination was unnecessary.     

Spontaneous pneumomediastinum: a rare benign entity

OBJECTIVE: Spontaneous pneumomediastinum usually occurs in young people without an apparent precipitating factor or disease. Thoracic surgeons are involved in the diagnosis and management of this entity because of the potentially life-threatening conditions that either must be treated as an emergency or excluded, such as esophageal perforation or necrotizing mediastinitis. We present our modest experience in treating spontaneous pneumomediastinum. MATERIALS: Between 1988 and 1998 we treated 22 cases of spontaneous pneumomediastinum in 18 male patients and 4 female patients, ranging in age between 12 and 32 years. All traumatic cases were excluded. Retrosternal chest pain was the main symptom the patients presented. In only 11 cases was subcutaneous emphysema present. Chest radiography was diagnostic in all our cases. Computed tomographic scan, when performed, confirmed the diagnosis. An esophagogram was essential to exclude an esophageal rupture. Last, a cardiologic examination especially focusing on pericarditis excluded cardiac disease. RESULTS: Conservative treatment consisted of bed rest, oxygen therapy, and analgesics, which led to rapid resolution of the spontaneous pneumomediastinum. The mean hospital stay ranged between 3 and 10 days. In a follow-up of 3 to 12 years only 1 recurrence was observed. CONCLUSION: Spontaneous pneumomediastinum is usually an undiagnosed benign entity that responds very well to conservative treatment. It should be considered in the differential diagnosis of chest pain, especially in healthy adolescents and young adults.     

193例45岁以下的下肢缺血患者病因及诊治分析

目的 探讨青少年下肢缺血患者的病因、发病特点及诊治方法.方法 回顾性分析 1999年1月至2009年1月收治的193例年龄<45岁的下肢缺血患者的发病情况、治疗方法及手术 预后.其中男性171例,女性22例,年龄13-44岁,平均35岁,平均病程3.6个月.共138例患者行 手术治疗,其中开放手术116例,介入手术17例,联合手术5例.手术患者中诊为易栓症者30例.非易栓症但除外血栓闭塞性脉管炎50例.结果 193 例患者中,病因明确的140例,占总数的72.5%. 有明确易栓症40例,占病因明确患者总数的28.6%.易栓组术后近期通畅率明显低于非易栓组,术 后30 d内一期通畅率分别为70.0%和92.0%(P=0.010),二期通畅率分别为83.3%和98.0%(P= 0.016).术后因血栓复发行二次手术的患者比例,易栓组明显高于非易栓组(30.0%比8.0%,P=0.010).术后16个月随访结果显示,两组一期通畅率(65.0%比75.7%,P=0.392)、二期通畅率(80.0%比91.9%,P=0.192)、截肢率(15.0%比5.4%,P=0.222)差异尚无统计学意义.结论 年龄<45岁的下肢缺血患者中,合并易栓因素导致血液高凝状态的比例较高,同时伴有易栓症的患者术后极易出现血栓复发,外科干预前应对易栓因素进行全面排查并积极控制.     

颈后纵韧带张力性压迫症及手术治疗(附50例分析)

目的　用生物力学的观点认识颈后纵韧带张力性压迫症和手术技巧 ,从而提高临床疗效。方法　对 5 0例颈后纵韧带张力性压迫症患者施行了手术并进行分析。结果　发现颈后纵韧带由于病理性改变所出现的生物力学上的椎管内障碍 ,是影响脊髓功能的一个不可忽视的原因。结论　对于颈椎间盘突出、颈椎管狭窄症及颈前方压迫综合征的患者 ,在颈椎前手术的同时 ,采用彻底的切除该节段变性的颈后纵韧带 ,有较重要的临床应用价值     

Long-term outcome in patients under 40 years after revascularization for chronic lower limb ischaemia.

BACKGROUND: In order to find out if surgical or endoluminal treatment changes the long-term results of atherosclerotic occlusive disease in patients of under 40 years of age we reviewed 17 consecutive patients. METHODS: Their mean age was 36.5. Patients with Buerger's disease or inflammatory arteriopathy were excluded. All patients were extremely heavy smokers. The indications for surgical procedures were disabling claudication (less than 100 meters) for 11 patients, rest pain for 4 patients and grangrene of a lower limb for 2 patients. The lesions were aorto-iliac in 12 cases and femoro-popliteal in 5. Ten surgical procedures were performed (5 aorto-femoral bypasses, 1 ilio-femoral bypass associated with an aorto-renal bypass, 2 femoropopliteal bypasses, 1 aorto-iliac endarteriectomy, 1 femoral endarteriectomy). On the other hand there were 7 endoluminal procedures (1 aortic, 4 iliac, 1 femoral and 1 popliteal). RESULTS: The mean follow-up was 97.3+/-50 months (range, from 34 to 216 months). Two patients died by 57 and 132 months respectively. At 5 years the survival rate was 94%; the primary patency rate was 59%; the secondary patency rate was 81% and the limb salvage rate was 94%. At 10 years these rates were respectively 94%, 44%, 54% and 75%. A total of 21 reoperations were performed. During follow-up 11 patients were better, 2 were stable and 4 were worse with 2 limbs lost. CONCLUSIONS: These bad results suggest keeping the surgical and endoluminal indications for patients younger than 40 years with threatened limbs.     

Open lower limb fractures in the elderly

ObjectiveThe aim of this study was to assess the outcomes of open lower limb fractures in patients aged 65 and over. The primary outcome was mortality at 30 days, and the secondary outcome was reoperation.MethodsThis study retrospectively identified patients aged 65 and over, presenting with an open tibia or ankle fracture, over a two-year period. Patient demographics, injury characteristics and surgical interventions were documented. The 30-day and one-year mortality was recorded, as well as any complications encountered.ResultsThere were 88 patients included in the study, with a mean age of 78 years and 66% of patients were female. Of this cohort, 67 patients (76%) had low energy injuries and 64 patients (73%) had Gustillo-Anderson type IIIB injuries. Treatment consisted of a one-stage surgical procedure in 49 patients (56%) and a two-stage procedure in 37 patients (42%), with two patients dying before definitive treatment. Primary wound closure was performed in 23 patients (26%), four patients (5%) had a split skin graft alone, 35 patients (40%) had local flaps, 21 patients (24%) were managed with free flaps and three patients (3%) had primary below knee amputations. The 30-day mortality rate was 10%, the one-year mortality rate was 19% and the reoperation rate was 8%.ConclusionOpen lower limb fractures in the elderly are a life and limb threatening injury, with a similar demographic and mortality profile to hip fracture. This study demonstrates that limb salvage can be achieved in 93% of cases, with treatment performed as a one-stage procedure in 56% of cases.     

老年肾脏病患者临床及病理特征分析

目的分析老年(年龄≥60岁)肾脏病患者临床及肾脏病理特点。 方法收集2010年1月至2016年12月在我科行肾穿刺活检的老年患者742例,对其性别、年龄、原发性疾病、肾脏病理类型及肾穿刺后并发症进行回顾性分析。以卡方检验比较老年患者与青年患者肾活检并发症的发生率,数据采用SPSS 19.0统计学软件处理。 结果①742例老年患者,年龄60～88岁,平均年龄(72.7±11.3)岁;60～74岁637(85.8%),75～88岁105例(14.2%)。男性426例(57.4%)。②患高血压者331例(44.6%);贫血272例(36.7%);高尿酸血症199例(26.8%);低蛋白血症257例(34.6%)。CKD1～5期比例分别为27.4%、33.8%、29.8%、7.1%、1.9%。③与同期行肾活检年龄≤60岁患者比较,老年患者肾穿刺术后肾周大血肿、需要输血、需行肾动脉栓塞等严重出血并发症的风险无统计学差异(χ² ＝0.457、0.108、0.199,P>0.05)。④742例老年患者中,原发性肾小球疾病390例(52.6%),继发性肾小球疾病268例(36.1%),肾小管间质疾病72例(9.7%),其他12例(1.6%)。原发性肾脏疾病以膜性肾病和系膜增生性肾小球肾炎最为常见,分别为30.4%和17.3%;继发性肾脏病中糖尿病肾病占21.3%、高血压肾损害和肿瘤相关性肾损害分别为12.3%和11.9%。 结论老年肾脏病患者高血压、贫血、高尿酸血症发生率高。原发性肾脏病以膜性肾病为多见,继发性肾脏病以糖尿病肾病、肿瘤相关肾损害最为常见。对于老年肾脏病患者均应结合临床,筛查继发病因。对于无肾穿禁忌证的老年肾脏病患者,应积极行肾活检应明确病理类型指导治疗、判断预后。