胸腔镜下腋下小切口切除肺大疱治疗自发性气胸疗效观察

目的：观察胸腔镜下腋下小切口切除肺大疱治疗自发性气胸的疗效。方法：自发性气胸96例,根据CT检查结果、胸膜粘连程度,或患者不愿意接受胸腔镜下小切口肺大疱切除,分为中心静脉穿刺导管胸膜腔内置管抽气和注药组（对照组）21例,胸腔镜下腋下小切口肺大疱切除组（观察组）75例,比较两组疗效和复发率。结果：对照组术后治愈时间4～9天,平均7天,7年内复发率28％;观察组3～5天,平均4天,7年内无复发,两组治愈时间和复发率比较,差异显著（P〈0．05）。结论：胸腔镜下腋下小切口肺大疱切除治疗自发性气胸效果更显著。     

腋下小切口同期切除双侧肺大泡

目的探讨腋下小切口在反复发作的双侧自发性气胸同期手术治疗中的疗效和价值。方法对5例因肺太泡破裂致双侧自发性气胸反复发作，经腋下小切口同期手术治疗的患者进行临床资料回顾分析。结果5例患者均于术后10天内痊愈出院，术后半至一个月恢复学习或工作，随访0．5—2．5年均未见复发。结论腋下小切口同期切除双侧肺太泡治疗反复发作的双侧自发性气胸效果可靠，创伤小，恢复快，费用少，切口隐蔽，值得推广应用。     

电视胸腔镜辅助腋下小切口治疗自发性气胸

目的：探讨电视胸腔镜辅助腋下小切口治疗自发性气胸的临床效果。方法：回顾性分析我院2006-07～2009-0758例自发性气胸患者接受电视胸腔镜辅助腋下小切口治疗的临床资料,并与既往40例自发性气胸患者行常规开胸手术进行比较。结果：观察组所有病例术中均不使用昂贵的一次性材料,均顺利完成手术,无死亡及严重并发症,术后随访5～41个月,无术侧复发。与对照组比较：手术时间、切口疼痛时间、术后住院时间均明显缩短（P〈0.05）,术中失血量及术后总并发症均明显减少（P〈0.05）。结论：电视胸腔镜辅助腋下小切口治疗自发性气胸疗效确切、微创、安全、经济,具有临床应用价值。     

腋下小切口手术治疗自发性气胸的疗效分析

目的：探讨腋下小切口治疗自发性气胸的临床疗效。方法：将100例自发性气胸的患者按照治疗方法的不同分为观察组和对照组,对照组采用传统开胸手术治疗,观察组采用腋下小切口手术治疗,比较两组患者的临床疗效。结果：观察组的手术时间、术后胸腔引流量、住院时间显著少于对照组,术后疼痛评分显著低于对照组（P〈0．05）。两组术后并发症和复发率均无统计学意义（P〉0．05）。结论：腋下小切口手术治疗自发性气胸患者的手术时间短、且创伤小,出血少,疼痛轻,值得临床推广。     

腋下小切口治疗自发性气胸

1996年 1月以来 ,我们采用腋下小切口治疗自发性气胸 2 5例 ,取得满意效果。现报告如下 :1　临床资料1 1　一般情况　本组 2 5例自发性气胸均符合诊断标准 ,其中男 18例 ,女 7例 ;年龄 19～ 6 6岁 ,平均 43 8岁。其中 1例发生气胸 4次 ,5例发生 3次 ,14例发生 2次 ,初次发生 5例。 12例单纯上叶尖段肺大泡 ,3例中叶肺大泡 ,3例下叶肺大泡 ,7例多个肺叶多发性肺大泡。1 2　手术方法　采用气管插管复合麻醉 ,取标准侧卧位 ,自腋下背阔肌前缘斜行向下至腋前线沿肋间作 10～ 12ｃｍ长皮肤切口 ,切开皮下组织 ,稍加游离背阔肌前缘并用拉钩将其向…     

腋下小切口微创手术治疗自发性气胸262例

目的寻找一种较理想的治疗自发性气胸的外科微创手术方式。方法自2001年1月～2010年5月对262例自发性气胸患者实行腋下小切口开胸治疗。结果手术时间平均72 min;术中出血平均50 ml,术后胸腔引流液平均200 ml,术后胸腔引流管安置平均2.5 d。全组无输血,住院时间平均8.5 d。经术后观察及6个月～5年随访,术后仅2例复发,疗效满意。结论腋下小切口手术治疗自发性气胸疗效确切,且创伤小,出血少,疼痛轻,手术时间短,术后恢复快。     

胸腔镜辅助小切口手术治疗自发性气胸72例分析

目的观察标准胸腔镜手术与小切口手术相结合治疗自发性气胸的临床效果。方法在腋下第4肋间做-4cm-10cm小切口,在腋中线第7或第8肋间做一探查孔,置入胸腔镜,可单纯手工操作,或使用一次性消耗品操作。结果平均手术时间为90min（30～120min）,术后平均胸腔引流时间3d（2～6d）,术后平均住院8d（6～12d）,发生胸腔并发症7例。无手术死亡病例。结论具有创伤小,恢复快,住院时间短,操作简便灵活,费用低的特点。     

西宁地区自发性气胸微创手术疗效分析

目的:分析西宁地区(海拔2260m)电视胸腔镜(VATS)及腋下小切口(SMT)治疗自发性气胸的手术疗效及术后肺功能改变。方法:分析2002年—2007年间(20~45)岁自发性气胸64例,其中VATS21例、SMT43例,对比分析两组术后肺功能改变、胸液量、胸管留置时间等。结果:两组在术后肺功能、胸腔引流管留置时间、术后镇痛剂的使用率、术后平均住院时间有显著性差别(P<0.05)。结论:西宁地区(海拔2260m)VATS治疗自发性气胸较SMT具有更小创伤和痛苦,术后肺功能改变小、术后恢复快等特点,VATS在西宁地区胸外科有着更为现实的微创意义和发展前景。     

腋下第3肋间置管闭式引流治疗气胸46例

1996年以来 ,我们改变常规气胸第 2肋间或第3肋间锁骨中线置管闭式引流的方法 ,采用腋下第 3肋间置管闭式引流治疗气胸 ,同样取得了良好效果。1　临床资料1 1　一般情况　 4 6例中 ,男 38例 ,女 8例 ;年龄 6～ 78岁 ,平均 4 0 1岁。右侧 2 4例 ,左侧 2 0例 ,双侧 2例。外伤性闭合性气胸 10例 ,自发性气胸 36例 (原发性 2 0例 ;继发性 16例 ,继发于慢性支气管炎肺气肿 10例、肺结核 5例、矽肺 1例 )。主要症状为突发胸痛、气短、咳嗽和不同程度的呼吸困难。Ｘ线胸部平片除显示外伤后肋骨骨折或原有肺部病变征象外 ,全组病例患侧肺被压缩均在…     

高原先天性心脏病心脏微创手术20例

20 0 1年以来 ,我们在浅低温体外循环下 ,采用右腋下直切口微创手术治疗先心病 2 0例 ,均获成功。1　临床资料1 1　一般情况　男 7例 ,女 1 3例 ;年龄 2～1 8岁 ,平均 7岁。藏族 1 5例 ,汉族 5例。体重 1 0～42ｋｇ。经心电图、心脏三位平片、心脏超声心动图检查 ,确诊房间隔缺损 1 0例 ,室间隔缺损 8例 ,肺动脉狭窄 2例。1 2　手术方法　采用 70°左侧卧位 ,将切口相应部位垫高 5ｃｍ。取腋中线切口 (8～ 1 0ｃｍ) ,经第 4肋间入胸。常规建立体外循环 ,预置主动脉灌注排气针 ,头低位(3 0°) ,鼻咽温度降至 3 2～ 3 3℃ ,阻断上、下腔静脉…     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.