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1.
尿路结石是泌尿外科占第一位的常见疾病,其中尿酸结石约占总发病率的13%,纯尿酸结石是最常见的阴性结石,碱化尿液可望完全溶解[1].本文观察溶石疗法16例尿酸结石的疗效及探讨其机理.1材料与方法1.1一股资料1994年3月至1998年11月收治尿酸结石16例,男14例,女2例,年龄18至67岁,平均sl岁.结石位于肾脏7例,均为多发性,最大3.0X3.Zcm,最小1.2XI.文m;位于输尿管3例,大小1.0XI.入m至0.8X0.scm;膀眈结石6例,均为多发性椭圆形,直径0.5至1.6cm.1.2方法诊断:患者均作IVU+KUB及B超检查.KUB均阴性,而IVU见充…  相似文献   

2.
肝内胆管结石是我国常见病,但其病变复杂,临床治疗具有一定难度。目前肝内胆管结石的治疗原则为“解除梗阻、清除病灶、取净结石、通畅引流”,治疗肝内胆管结石最有效的方法是外科手术。现代医学的发展使肝内胆管结石的外科治疗手段多样化,微创外科治疗理念深入人心。本文主要就近年肝内胆管结石的外科治疗研究进行综述。  相似文献   

3.
十二指肠镜下治疗胆管结石的护理   总被引:1,自引:0,他引:1  
目的总结十二指肠镜下行逆行胰胆管造影、乳头括约肌切开、取石、鼻胆管引流术等方法,并针对该手术进行术前、术中、术后的密切观察及护理,以促进患者尽快恢复。方法对46例胆总管结石患者行十二指肠镜下乳头括约肌切开、取石、鼻胆管引流术,治愈胆管结石。术前对患者进行耐心细致的心理护理及检查准备工作,术中严密观察生命体征变化及护理,术后进行心理护理、基础护理、病情观察及鼻胆管的护理等,并采取相应的护理措施,预防并发症。结果46例患者全部治愈,其中2例并发胰腺炎经治疗3-7d内治愈,5例行第二次取石,1例行第三次取石。结论十二指肠镜下治疗胆管结石,疗效好,风险小,并且经过细心的观察及护理,减少了并发症,促进了患者的早日康复。  相似文献   

4.
内镜技术在胆总管结石治疗中的应用   总被引:6,自引:0,他引:6  
目的 探讨经内镜括约肌切开 (EST)和内镜乳头气囊扩张 (EPBD)治疗胆总管结石的临床应用价值 ;方法 经EST和EPBD治疗胆总管结石 4 2 9例 ,其中原发性胆总管结石 178例 ,胆道术后胆总管残留或复发性结石 2 5 1例 ;单颗结石 2 2 5例 ,2颗结石 12 8例 ,3颗或 3颗以上结石 76例 ;对于 <10mm结石采用EPBD治疗 ,>10mm采用EST ;结果治疗成功 4 2 1例占 98 1% ,失败 8例 ;其中 98例经内镜治疗后结石自然排出 ,2 88例采用网篮或取石球囊取出结石 ,30例采用碎石网篮碎石后排出 ,5例经震波碎石后取出 ;36 / 4 2 9例经 2~ 3次再次取石后取净 ;总的并发症 3.0 % ,其中消化道出血 2例 ,胆管炎 4例 ,胰腺炎 7例 ;12 8例术后行胃肠钡餐X线检查 ,12 0例胆道内无钡剂返流 ,3例胆道内有积气 ,5例有钡剂返流入胆道 ;结论 EST和EPBD安全、有效 ,并发症少 ,是目前治疗胆总管结石的重要手段  相似文献   

5.
肝内胆管结石治疗模式的探讨   总被引:2,自引:0,他引:2  
目的 探讨多路微创技术治疗肝内胆管结石的疗效。方法 回顾性分析单纯手术(A组)与多路微创技术(B组)两种治疗模式治疗肝内胆管结石的疗效。结果 B组病人在术后恢复,残余结石方面均优于A组。结论 多路微创技术治疗肝内胆管结石具有手术创伤小,取石率高,残余结石率低的优点。值得推广。  相似文献   

6.
肝内胆管结石的发生率约占胆道结石的13%~20%,因其在肝内胆管,位置较深,易发生感染形成脓肿及狭窄,而且有相当一部分病人是手术后复发,所以治疗难度较大,对于这一类病人最有效的治疗方法就是行手术治疗。1996~1999年我院对17例肝内胆管结石的病人成功地实施了肝叶部分切除,肝内胆管取石Roux-Y胆肠吻合,胆道重建手术,取得了理想的效果,报道如下。  相似文献   

7.
妊娠期胆胰疾病多由胆道梗阻引起,及早解除梗阻、通畅引流最为关键。妊娠期胆胰疾病中胆总管结石最常见,经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatogra-phy, ERCP)是处理胆总管结石的首选方法。常规ERCP需要在X线辅助下完成,尽管大多数专家认为,单次ERCP所需X线照射剂量对孕妇和胎儿的影响不大,但X线照射的安全性仍受到广泛关注和担忧,因此,对妊娠期女性进行无X线ERCP有重要的实用价值。  相似文献   

8.
杨明稳  杨德  张有正  杨东晓  赵海 《医学信息》2009,22(6):1049-1050
目的 总结用肝左外叶切除术治疗肝内胆管结石的经验及疗效.方法 回顾性分析我院近10年来采用肝左外叶切除术治疗原发性肝内胆管结石48例的临床资料、手术方法及术后恢复情况.结果 全组随访6月至8年,其中再发胆管结石2例(占4.17%)胆管炎1例(占2.08%),其余病人无明显胆道症状(占93.7%).结论 肝左外叶切除治疗肝内胆管结石疗效确切.  相似文献   

9.
目的探讨多路微创技术治疗肝内胆管结石的疗效. 方法回顾性分析单纯手术(A组)与多路微创技术(B组)两种治疗模式治疗肝内胆管结石的疗效. 结果 B组病人在术后恢复、残余结石方面均优于A组. 结论多路微创技术治疗肝内胆管结石具有手术创伤小,取石率高,残余结石率低的优点,值得推广.  相似文献   

10.
目的 探讨运用多种微创外科技术在腹腔镜胆总管探查术中的联合应用价值。方法 在腹腔镜超声和术中胆道造影指导下,联合应用腹腔镜,十二指肠镜,胆道镜,对120例肝内外胆管结石病人进行微创外科治疗。结果 120例手术均获成功,无中转开腹或严重并发症发生,术后住院时间明显缩短,而手术时间并无延长,部分残留结石病人经术后胆道镜取净结石,随访2年未见远期并发症。结论 多种微创外科技术联合应用治疗胆石症安全可靠。切实可行,可望成为肝内外胆管结石微创化治疗的有效新途径。  相似文献   

11.
高颖 《医学信息》2018,(10):104-106
目的 探讨消化内镜下局部药物联合去甲肾上腺素治疗上消化道出血临床疗效。方法 选取2014年9月~2017年9月我院收治的上消化道出血患者80例,根据随机数表法分为实验组和对照组,各40例。两组患者入院后均给予吸氧、补液、维持水电解质和酸碱平衡等基础常规治疗,对照组患者使用去甲肾上腺素和云南白药进行治疗,实验组患者在此基础上使用消化内镜下局部用药治疗,观察两组患者治疗总有效率、止血时间、出血量、输血量以及并发症发生情况。结果 实验组总有效率为92.50%,高于对照组的72.50%,差异有统计学意义(P<0.05);实验组止血时间、出血量、输血量分别为(1.26±0.31)d、(187.61±31.17)ml、(392.21±16.23)ml,均少于对照组的(3.94±0.43)d、(326.99±47.23)ml、(569.58±51.16)ml,差异均具有统计学意义(P<0.05);实验组不良反应发生率为7.50%,低于对照组的27.50%,差异有统计学意义(P<0.05)。结论 消化内镜下局部药物联合去甲肾上腺素治疗上消化道出血临床疗效显著,减少患者消化道出血情况,且不良反应较少,值得临床进一步推广。  相似文献   

12.
Purpose Virtual endoscopy (VE) is a new diagnostic tool that generates 3-dimensional (3D) views of a lumen by exploiting cross-sectional images. The purpose of this study was to evaluate the usefulness of VE as a diagnostic tool in the diseases of the larynx and pharynx. Materials and Methods Twenty-two patients with a mean age of 57 years were included in the study. The patients underwent larynx examination, optical endoscopy (OE), and computed tomography (CT) of the larynx. Later, VE was produced from the CT images. Results Eight patients had larynx carcinoma, a 5-year-old patient had a laryngeal web, a 43-year-old man had fish bone stuck in his submucosal layer, 10 patients were normal, and the remaining two patients were under follow-up for treated nasopharynx carcinoma and had no evidence for recurrence. VE showed the laryngeal tumor in seven patients and the laryngeal web in one patient, but failed to show a plaquelike tumor and the fishbone within the submucosa. Conclusions Our findings suggest that VE is a useful and complimentary method of 3D imaging in the diseases compromising the laryngeal lumen. Furthermore, it may be superior to OE in severe stenosis or obstructions where the endoscope cannot be passed through.  相似文献   

13.
目的 探究鼻内镜术后联合置管冲洗治疗真菌性上颌窦炎安全性和临床效果。方法 选择2013年3月~2017年3月我院用鼻内镜术后行鼻腔冲洗的真菌性上颌窦炎患者840例,随机分为实验组440例和对照组400例。实验组术后配合常规治疗的同时给予生理盐水500 ml置管冲洗术腔,1次/d,持续14 d;对照组则在术后配合常规治疗的同时给予生理盐水500 ml常规冲洗术腔,1次/d,持续14 d。比较两组患者鼻内镜术后1月、2月、3月及6月鼻腔恢复情况。结果 实验组术后第1、2、3及6月痊愈率与对照组比较,差异有统计学意义(P<0.05),第6月实验组痊愈率为45.45%,显著高于对照组的27.50%,差异有统计意义(P<0.05)。结论 真菌性上颌窦炎患者在鼻内镜手术术后,采用常规综合治疗配合置管冲洗术腔,能够很好地把术腔分泌物及痂皮冲出,减轻鼻腔、鼻窦的炎性反应,缩短鼻窦上皮化的时间,恢复保护和防御功能。  相似文献   

14.
Abstract

The effectiveness of two techniques for preparing patients to undergo a stressful medical examination was assessed using observer self-report, and physiological measures of distress during gastrointestinal endoscopy. Patients were either informed about expected sensations, trained in systematic muscle relaxation, or received normal hospital procedures. The influence of coping styles on the effectiveness of information and relaxation techniques was examined for measures of fear, avoidance, emotional control, arousability, and independence.

Information and relaxation interventions reduced heart rate increases and observer ratings of distress during tube insertion. Relaxation training also increased positive mood change following the procedure. Interactions between coping styles and recovery measures suggested patients benefited most from preparation that matched their preferred coping style, but were not harmed by preparation that did not match their preferred style. Discussion focuses on how coping styles may interact with preparation procedures and suggests that the use of coping styles as criteria for excluding patients from certain preparation techniques is inappropriate.  相似文献   

15.
《HIV clinical trials》2013,14(5):403-411
Abstract

Naturally occurring polymorphisms at positions involved in resistance to antiretroviral agents are frequently seen in HIV-1 non-B subtypes. Although they do not seem to affect significantly the susceptibility to antiretroviral drugs in vitro, they may facilitate the selection of different pathways and/or a more rapid emergence of drug resistance and treatment failure under not fully suppressive treatment regimens.  相似文献   

16.
《HIV clinical trials》2013,14(2):59-69
Abstract

Purpose: Therapeutic drug monitoring (TDM) is the practice of managing plasma drug concentrations. This intervention can potentially improve inadequate antiretroviral dosing in the treatment of HIV infection. Our objective was to review the evidence regarding TDM in HIV management. Method: We searched MEDLINE using the following key words: therapeutic drug monitoring, HIV infection, pharmacokinetics, antiretroviral therapy, protease inhibitors, antiretroviral-naïve, antiretroviral-experienced, and salvage therapy. Inclusion criteria required definition of optimal concentration thresholds and measures of treatment effectiveness at these targets. Results: Our search yielded 39 studies. 11 studies met inclusion criteria. 4 studies compared efficacy of TDM to standard of care (SOC) interventions via randomized clinical trials and were grouped as "interventional." 7 studies retrospectively defined thresholds from observed differences in outcome and were grouped as "observational." 3 interventional studies targeted similar indinavir concentrations (Cmin = 0.10-0.15 mg/L). 2 of these studies increased achievement of target serum levels and percentages of undetectable viral load (23%-41%, p ≤ .009) with TDM implementation. Conclusion: TDM can effectively target antiretroviral threshold concentrations and improve virologic suppression in some cases. Further work is needed to define plasma thresholds and assess the value of TDM in HIV management.  相似文献   

17.
Purpose: The objective of this paper was to develop a computer-aided diagnostic (CAD) tools for automated analysis of capsule endoscopic (CE) images, more precisely, detect small intestinal abnormalities like bleeding. Methods: In particular, we explore a convolutional neural network (CNN)-based deep learning framework to identify bleeding and non-bleeding CE images, where a pre-trained AlexNet neural network is used to train a transfer learning CNN that carries out the identification. Moreover, bleeding zones in a bleeding-identified image are also delineated using deep learning-based semantic segmentation that leverages a SegNet deep neural network. Results: To evaluate the performance of the proposed framework, we carry out experiments on two publicly available clinical datasets and achieve a 98.49% and 88.39% F1 score, respectively, on the capsule endoscopy.org and KID datasets. For bleeding zone identification, 94.42% global accuracy and 90.69% weighted intersection over union (IoU) are achieved. Conclusion: Finally, our performance results are compared to other recently developed state-of-the-art methods, and consistent performance advances are demonstrated in terms of performance measures for bleeding image and bleeding zone detection. Relative to the present and established practice of manual inspection and annotation of CE images by a physician, our framework enables considerable annotation time and human labor savings in bleeding detection in CE images, while providing the additional benefits of bleeding zone delineation and increased detection accuracy. Moreover, the overall cost of CE enabled by our framework will also be much lower due to the reduction of manual labor, which can make CE affordable for a larger population.  相似文献   

18.
Abstract

Implant-associated infections are a challenging problem in surgery. Bacteria in biofilms are difficult to treat as they are less susceptible to antibiotics or antiseptics which require high drug concentrations at the site of infection. We present a novel strategy to concentrate high antibiotic doses systemically at the target site using newly developed antibiotic-functionalized nanoparticles directed by a magnetic drug-targeting system. The important and effective antibiotic gentamicin served as antimicrobial substance and was ionically or covalently attached to magnetic nanoparticles. Subsequently, the particles were characterized thoroughly. Anti-infective properties with regard to Staphylococcus aureus and the degree of cytotoxicity concerning human umbilical vein endothelial cells were determined. The enrichment of the magnetic nanoparticles at the surface of model tubes in circulatory experiments was investigated. We describe a promising technique for the loading of magnetic nanoparticles to treat systemic infections. Gentamicin-coated magnetic nanoparticles reduced bacterial growth even beyond pathologically relevant concentrations within 24 h. Excellent concentration independent biocompatibility was found for the nanoparticles themselves and we demonstrate that the magnetic nanoparticles can be navigated and concentrated on surfaces of model implants using a permanent magnetic field.  相似文献   

19.
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