胰腺假性囊肿超声引导经皮引流治疗的临床价值

目的探讨超声引导经皮引流治疗胰腺假性囊肿(Pancreatic Pseudocyst,PPC)的临床价值。方法采用超声引导经皮引流治疗PPC 10例,其中单纯穿刺抽液1例,置管引流9例。结果1例因囊腔与主胰管相通,改行开腹囊肿空肠Roux-Y吻合术,余9例囊肿消失或明显减小。引流时间5-80天,平均26天,无并发症发生。10例随访6-30个月,平均14个月。按照疗效评价标准结果:治愈6例,显效2例,有效1例,复发1例,总有效率90%。结论超声引导经皮穿刺抽液或置管引流是治疗PPC一种简单可行的方法,具有创伤小,并发症少,可早期实施、多部位同时进行、可重复治疗等优点。     

不同血栓抽吸方法治疗急性ST段抬高心肌梗死的比较

目的：探讨不同血栓抽吸方法治疗急性ST段抬高心肌梗死的临床疗效。方法随机选取2011—2015年在该院就诊的90例急性ST段抬高心肌梗死患者作为研究的对象给患者行经皮冠状动脉介入治疗(PCI)在手术中采用抽吸导管抽吸血栓。所有患者在手术中使用手动抽吸导管,并将患者使用抽吸方式的不同分为3个小组：A组(单独Diver抽吸导管抽吸)、B组(单独Export抽吸导管抽吸)和C组(两种导管组合),每组各30例患者,比较3组患者血流分级(TIMI)以及治疗半年后心血管并发症的发生率。结果经皮冠状动脉介入术中3组患者的血流分级0级的患者C组患者5例,占16.7%,其余各组在术前和术后血流分级差异无统计学意义,P>0.05。结论血栓抽吸导管组合的方式治疗急性ST段抬高心肌梗死患者不能有效的降低患者的发病率。     

细菌性肝脓肿及膈下脓肿的超声引导穿刺治疗

对49例细菌性肝脓肿及膈下脓肿患者在超声直视引导下行穿刺抽脓；对脓液黏稠正有坏死组织块、抽脓不彻底的患者置管引流，每日冲洗。有48．98％(24／49)的患者行1次抽脓治疗，24、49％(12／49)行2次，8．16％(4／49)行3次，4．08％(2／49)行4次穿刺抽脓；另14．29％(7／49)行置管引流。所有患者均治愈出院，治疗后1、3、6个月随访肝内无脓腔。这表明细菌性肝脓肿及膈下脓肿的超声引导穿刺抽脓、置管引流是一种有效、可靠的治疗方法。     

重症急性胰腺炎各期经皮穿刺置管引流疗效

目的 探讨重症急性胰腺炎经皮穿刺置管引流治疗的时机及临床价值.方法 回顾性分析采用经皮穿刺(置管)引流术治疗的125例重症急性胰腺炎病例资料.所有患者在CT及床边B超引导下行经皮穿刺引流术.结果 首次穿刺引流时间距发病1~46(11.0±7.9)d,每例置管次数0~11次,平均3.2次,留置引流管时间0~128(27.1±16.6)d.共107例(107/125,85.6%)患者接受经皮穿刺(置管)引流或后期中转开腹手术治疗后康复,18例(18/125,14.4%)死亡.21例(21/117,17.9%)在行经皮穿刺置管引流后3~32(19.8±9.0) d接受开放手术治疗、16例(16/21,76.2%)最终获得治愈、5例(5/21,23.8%)死亡.穿刺置管引流总体有效率为70.9%(83/117),1周内为79.4%(27/34),1~2周为75.9%(22/29),2~4周为63.2%(24/38),4周后为62.5%(10/16);各阶段置管并发症发生例数分别为5、8、7、4(P=0.595);各阶段死亡例数为5(14.7%)、4(13.7%)、7(18.4%)、2(12.5%)(P=0.932).结论 在遵循指南的基础上,观察患者的临床表现、置管引流有效性等更为重要;早期穿刺置管引流的最终有效率较高,安全、不增加感染率,但差异无统计学意义;后期不排斥中转开放手术治疗,但指征需进一步探究.     

Empyema thoracis and lung abscess

The case histories of 22 patients with lung abscess and empyema presenting to Hospital University Sains Malaysia (HUSM) between 1984 and 1989 are reviewed. The presenting features of both lung abscess and empyema were similar. The commonest predisposing factor was pneumonia, and the commonest organism isolated was Staphylococcus aureus but in the majority of cases, no causal organisms were identified. All the patients were treated with antibiotics and in addition, closed chest tube drainage was performed initially in all patients with empyema. Three patients with empyema required additional surgical drainage procedures. Death occurred in one patient with empyema and in one patient with lung abscess. The features, aetiology, treatment and outcome of thoracic empyema and lung abscess are discussed.     

Management and outcome of brain abscess in renal transplant recipients

Although infection is the commonest central nervous system complication following renal transplantation, brain abscess is uncommon. Over the last 11 years, five renal transplant recipients who had brain abscesses were treated by computed tomography (CT)-guided stereotactic aspiration. Three patients had a fungal abscess, one a tuberculous abscess and the other had a methicillin-resistant Staphylococcus aureus abscess. One patient required a craniotomy for the excision of a fungal abscess which was persistent after two CT-guided stereotactic aspirations. The survivors in this group are the patient with a tuberculous abscess who is alive and well 5 years after diagnosis, and another with a dematiaceous fungal abscess (phaeohyphomycosis). CT-guided stereotactic surgery is minimally invasive, and can safely be performed in these patients. It often leads to an aetiological diagnosis in renal transplant recipients with brain abscesses. Specific antibiotic management directed towards the causative organism rather than empirical treatment can be instituted following the procedure. Although the ultimate prognosis in these patients is bleak even with specific antibiotic therapy, an occasional patient might have a good outcome with prompt and appropriate therapy.     

Septic bursitis.

In 12 cases of septic bursitis seen during 11 years, 11 patients were men and one patient was a woman, with a mean age of 51.3 years. The olecranon bursa was involved in nine cases. Staphylococcus aureus was grown from nine of ten culture-positive fluids. Bursal fluid WBC counts ranged from 1,550/cu mm to 165,000/cu mm, associated with low glucose levels in two cases, but not in three. Treatment with antibiotics and needle aspiration or surgical drainage was successful.     

超声引导经皮穿刺治疗乳腺脓肿的临床应用

目的评价超声引导下经皮穿刺治疗乳腺脓肿的临床应用价值。方法在超声引导下,对诊断为乳腺脓肿的病人采用经皮穿刺脓肿抽吸法及脓腔置管引流法进行治疗。结果 45例病人共有54个脓肿,22个最大径≤3 cm的脓肿采用脓肿抽吸法治愈21例,1例改行脓腔置管引流后治愈;32个最大径〉3 cm的脓肿实施脓腔置管引流法,治愈30例,切开引流2例。随访41例,复发4例,2例再次行脓腔置管引流治愈,另2例行脓肿切开引流治愈。结论超声引导下穿刺抽吸治疗不超过3 cm的乳腺脓肿与置管引流治疗超过3 cm的乳腺脓肿均是有效的治疗手段。     

Spinal epidural abscess: presentation and treatment. A report of 21 cases.

OBJECTIVE: To examine the presentation, investigative findings, treatment and outcome in patients with spinal epidural abscess. DESIGN AND SETTING: The study was a retrospective analysis of all patients with this condition presenting to the Neurosurgical Units at the Royal Prince Alfred Hospital and Westmead Hospital, Sydney, during the period September 1984 to September 1987. PATIENTS: There was a total of 21 patients with an age range from 7-87 years (mean 47 years). Eleven cases were acute and ten chronic. The causative organism was Staphylococcus aureus in 15 of the 21 cases, the other organisms involved were Mycobacterium tuberculosis, Escherichia coli, Streptococcus and Pseudomonas aeruginosa. INTERVENTIONS: All patients were treated with a combination of surgery (decompression with or without fusion) and prolonged antibiotic administration. RESULTS: Of the 21 patients 11 had a good to excellent outcome while 10 had a poor outcome. CONCLUSION: The main determinant of outcome was the neurological state at presentation emphasising the importance of early diagnosis and prompt treatment.     

超声引导下心包置管在急性心包填塞中的应用

目的 探讨实时超声引导下心包置管引流在心脏介入术中并发急性心包填塞的应用价值.方法 对20例在心脏介入术中并发的由超声心动图或及X线透视证实的急性心包填塞患者在实时超声引导下心尖部或心前区置人中心静脉导管抽吸或及引流.结果 20例急性心包填塞患者全部安全有效置管成功,患者经抽吸或引流后症状迅速缓解,得到有效救治.操作简单、快捷、并发症少.结论 急性心包填塞是心脏介入诊疗过程中严重的并发症,及时和有效处理非常重要,在实时超声引导下经皮穿刺心包置管引流是治疗急性心包填塞的有效方法,而且方法简单、安全、有效,便于临床应用.     

CT导引下肝囊性病变穿刺抽吸引流和硬化治疗57例

目的: 探讨CT定位下经皮肝囊性病变穿刺抽吸引流和无水乙醇硬化治疗的疗效及其病理基础. 方法: 在CT导向下对57例共80个肝囊性病变进行穿刺抽吸或引流,根据囊肿性质进行相应的硬化治疗,并随访全部病例. 结果: 治疗后囊肿大小均有变化,囊肿较治疗前缩小1/3者6例,囊肿较治疗前缩小1/3～2/3者24例,囊肿消失者27例. 有效率100%,随访0.5～4 a未发现有复发者,无严重并发症出现. 结论: CT导向下经皮穿刺抽吸引流和注射无水乙醇硬化治疗肝囊性病变安全有效.     

Percutaneous pyeloplasty: an alternative to open surgery

This paper describes the management of five patients with pelviureteric junctional obstruction who were treated by a one-stage percutaneous procedure. In two patients, renal calculi were removed simultaneously. The obstructing strictured area was divided internally by means of a modified endoscopic urethrotomy knife, which was passed through a percutaneous nephrostomy track. The defect was bridged by natural regeneration around a soft splint over six weeks. Four patients achieved a successful result with a shortened hospital stay, minimal morbidity, improved radiological drainage and the avoidance of open surgery. One patient, who had undergone three previous open plastic operations, was still symptomatic, in spite of successful anatomical correction. At exploration, open surgical repair was impossible and a nephrectomy was performed. This new technique appears applicable to selected primary and secondary pelviureteric junctional obstructions in which the obstructing segment is in an anatomically dependent situation.     

药物持续冲洗联合负压引流在难愈性皮肤溃疡患者中的效果研究

目的：探究药物持续冲洗联合负压引流在难愈性皮肤溃疡患者中的效果。方法：选取2013年1月～2015年1月期间我院接收治疗的120例难愈性皮肤溃疡患者为研究对象,采用随机数表法将120例患者分为 A、B、C 三组,各40例。给予 A 组患者重组酸性成纤维细胞生长因子（rh-aFGF）持续冲洗合并负压引流治疗,给予 B 组患者清创手术联合使用 rh-aFGF 对创面进行喷涂,给予 C 组患者清创手术联合常规换药油纱贴覆,并使用纱布将外层包扎。三组患者每日均进行常规换药,疗程均为21d。观察三组患者治疗前的情况和治疗后伤腔容积好转率、深部皮肤溃疡愈合率、治疗过程中皮肤溃疡细菌计数情况。结果：治疗前三组患者的深部组织外露面积、病程和伤腔容积差异不具有统计学意义。治疗后 A 组患者的伤腔容积好转率、深部皮肤溃疡愈合率显著优于其他两组,比较差异具有统计学意义。且治疗后第7天 A 组患者创缘肉芽增生显著,B 组和 C 组患者创缘红肿显著,治疗后第14、21天 A 组患者深部组织外露缩小显著,B 组和 C 组患者创缘红肿加重,溃疡缩小不显著,且出现少量积脓。治疗后第7天 B 组的32例患者和 C 组的28例患者皮肤溃疡能够培育出程度不同的金黄色葡萄球菌、表皮葡萄球菌、奇异变形杆菌、粪链球菌、肺炎克雷白杆菌。治疗后第14天 A 组16例患者中培育出粪链球菌、表皮葡萄球菌、奇异变形杆菌。且第14、21天 B 组和 C 组患者的细菌生长数量显著高于 A 组患者。结论：使用重组酸性成纤维细胞生长因子持续冲洗合并负压引流治疗难愈性皮肤溃疡患者具有较好的临床疗效,可以在临床上进一步推广和使用。     

上尿路结石合并脓肾的治疗观察

目的 探讨上尿路结石合并脓肾的治疗方法及疗效.方法 选择2004年5月至2010年2月在我科接受诊治的49例上尿路结石梗阻性脓肾患者,采用经尿道输尿管镜碎石取石术并置管内引流22例,经皮肾穿刺造瘘外引流术27例.结果 采用微创内、外引流术中均未出现败血症、感染性休克症状.Ⅱ期行经皮肾镜取石术或开放肾盂、输尿管切开取石术,术中出现寒战、发热等菌血症状者3例(8.3%),3例肾切除术.33例随访3个月～5.5年,所有患肾功能均有不同程度的恢复,未发现患侧肾无功能而采取切肾者.结论 早期诊断、及时引流、解除梗阻是上尿路结石合并脓肾保肾治疗的关键.输尿管镜碎石并留置双J导管及经皮肾穿刺造瘘引流是较好的解除梗阻的方法,安全、并发症较少且为Ⅱ期手术治疗创造良好的条件.

Abstract：

Objective To improve the treatment of pyonephrosis with upper urinary tract calculi (UTC).Methods A total of 49 UTC patients with pyonephrosis were selected at our hospital during May 2004 to February 2010. Among them,22 cases were treated with transurethral ureteroscope lithotripsy followed by tube internal drainage while another 27 cases underwent percutaneous nephrolithotomy.Results No such complications as septicemia and septic shock occurred during the first stage of external and internal drainage.The bacteremic symptoms of chill or fever occurred in 3 cases during the second stage of percutaneous nephrolithotomy and pyelolithotomy/ureterolithotomy(11.1%). There were 3 cases of nephrectomy.A follow-up period of 3 months to 5.5 years showed that all 33 cases had a varying degree of recovered renal functions.And there was no ephrectomy.Conclusion The keys to a successful surgical treatment of pyonephrosis with upper urinary tract calculi are early diagnosis,timely drainage and relief of obstruction. Ureteroscopic lithotripsy,double-J placement and percutaneous nephrostomy drainage are excellent for relieving obstruction.As a safe procedure with minor complications,it creates proper conditions for a second stage operation.     

正中小切口减压结合经皮椎弓根螺钉内固定术的临床应用分析

目的：观察正中小切口减压结合经皮椎弓根螺钉内固定术对胸腰椎压缩性骨折的治疗效果。方法：以2014年3月～2015年6月在我院接受治疗的胸腰椎骨折患者为观察对象。根据其治疗方式小切口组（52例）和开放手术组（48例）。观察两组患者手术一般情况,比较两组患者疗效相关指标和术后并发症发生率的差异。结果：小切口组患者肌肉剥离长度明显较开放手术组短,术中出血量和术后引流量明显较开放手术组少,两组患者手术时间无明显差别;两组患者手术前椎体前缘压缩度、后凸Cobb's角、VAS和ODI得分无明显差别,手术后两组椎体前缘压缩度和后凸Cobb's角较术前均明显改善,且小切口组改善更为明显;手术后1个月和6个月随访结果显示两组患者VAS和ODI得分均较手术前降低,且小切口组的得分均低于开放手术组,差别具有统计学意义;小切口组患者术后感染发生率明显低于开放手术组,两组患者神经根损伤和二次骨折发生率无明显差别。结论：正中小切口减压结合经皮椎弓根螺钉内固定术对胸腰椎骨折有较好的治疗效果,可明显改善患者的相关症状,降低并发症发生率。     

不同术式治疗高血压脑出血的临床研究

[目的]探讨治疗高血压脑出血(hypertensive intracerebral hemorrhage,HICH)适宜的手术方法,为临床治疗提供依据。[方法]212例高血压脑出血分为开颅组与钻孔引流组,根据术前出血部位、血肿量、意识状况分别采取骨瓣开颅血肿清除术和钻孔穿刺抽吸引流术,观察术后24 h GCS评分、FAM、ADL,了解其预后。[结果]微创钻孔引流平均手术时间(1.0±0.5)h较骨瓣开颅平均手术时间(4.5±1.6)h明显缩短(P<0.05);术后3 d内再出血率微创钻孔引流组6/102(5.88%),开颅组5/110(4.55%)(P>0.05);微创钻孔引流组术后24 h平均GCS评分(12.47±5.16)、FAM(15.34±2.57)、ADL比例(优良76.47%)高于延迟开颅组GCS评分(10.23±4.83)、FAM(12.67±2.18)、ADL(优良55.77%)(P<0.05);微创钻孔引流组死亡22/102(21.57%),开颅组早期术后死亡12/58(20.69%),延迟术后死亡16/52(30.77%),死亡率延迟组高于微创钻孔引流组和早期组(P<0.05)。[结论]严格掌握手术适应证,早期进行微创手术治疗可获得满意效果。     

肝脓肿的介入处理

目的：探讨肝脓肿经皮穿刺介入引流的临床应用及术后拔管的时间窗。方法：回顾分析1999年11月．2007年11月62例肝脓肿住院患者，按照治疗方法不同分为介入治疗组（介入组，32例）和外科治疗组（外科组，30例）介入组在DSA引导下行肝脓肿穿刺引流，抽吸脓液、冲洗脓腔，并留置肝外引流管作持续冲洗及引流；外科组采用外科手术切开引流并留置引流管。结果：介入组的平均住院时间（11．29±1．64）d、留管时间（8．08±1．29）d、并发症0例，与外科组比较，两组差异有统计学意义（P〈0．05），而平均退热时间及有效率方面两组差异无统计学意义（P〉0．05）。结论：肝脓肿的介入治疗对肝组织的损伤较小，并发症少，操作简单，术后拔除外引流管的时间窗以选择在无发热后3d为宜。     

培养阴性化脓性脊柱炎患者的临床特征及预后

目的：分析培养阴性化脓性脊柱炎的临床特征,探讨培养阴性是否影响患者治疗及预后。方法： 回顾性分析北京大学第一医院骨科2010年1月至2015年12月期间收治的化脓性脊柱炎患者共27例,根据病原菌培养结果将患者分为培养阴性组和培养阳性组,对比不同培养结果患者临床特征以及预后情况。结果： 培养阴性率为48.1%（13/27）,培养阳性组病原菌以葡萄球菌为主。统计结果显示,培养阴性组的红细胞沉降率（erythrocyte sedimentation rate, ESR）（P=0.056）、C 反应蛋白（C-reactive protein, CRP）低于培养阳性组,椎旁脓肿的发生率（P=0.046）高于培养阳性组。两组患者年龄、性别、入院疼痛视觉模拟评分(visual analogue scale score, VAS)、危险因素、临床症状、体征和脊柱受累情况差异无统计学意义（P>0.05）。培养阴性组患者行开放清创手术率与培养阳性组患者相比差异无统计学意义（P=0.414）。经治疗后,两组患者住院时间、ESR、CRP下降速度、疼痛缓解情况以及感染复发率差异无统计学意义（P>0.05）。两组患者ESR下降速度均慢于CRP。结论： 化脓性脊柱炎培养阴性患者的ESR、CRP低于培养阳性患者,椎旁脓肿发生率高于培养阳性患者。药物治疗后,两组患者行开放清创手术率、抗生素应用时间、复发率相比差异无统计学意义,培养阴性并不影响化脓性脊柱炎患者的治疗及预后,但培养阴性患者的抗生素抗菌谱广,长时间应用需警惕耐药菌及二重感染。     

心脏直视手术胸骨感染的防治体会

我院１１年间做心内直视手术３７３例，胸骨感染７例（１．８８％）。对７例胸骨感染进行了临床分析，提出了预防措施。早期发现、及时引流、去除异物、负压吸引及药物滴入等措施。可使感染得到控制或治愈。本组１例死于感染消耗衰竭，１例死于无名动脉大出血，其余５例治愈。