PKP术中应用低温间断灌注技术治疗周壁破裂型OVCF

目的通过与温度梯度灌注技术进行比较,探讨低温间断灌注技术在经皮椎体后凸成形术治疗椎体周壁破裂型骨质疏松性骨折中的临床价值。方法回顾性分析我院2015年1月至2018年12月期间共60例周壁破损型骨质疏松性椎体骨折患者,均为单椎体骨折,根据骨水泥灌注方法的不同分为温度梯度灌注组30例和低温间断灌注组30例。温度梯度灌注组男6例,女24例;平均年龄为(71.9±6.9)岁;低温间断灌注组男8例,女22例;平均年龄(69.7±7.2)岁。比较两组术前、术后2 d及末次随访时疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI),椎体后凸角,伤椎椎体前缘相对高度,手术时间,骨水泥注射量,骨水泥分布面积比,骨水泥可推注时间(从开始推注到所有骨水泥至团块期晚期不可推注的时间),骨水泥渗漏率。结果温度梯度灌注组术后随访时间平均(15.3±8.4)个月;低温间断灌注组术后随访时间平均(18.6±8.2)个月,两组间比较差异无统计学意义(P>0.05)。两组内术后2 d和末次随访时VAS评分、ODI评分较术前差异均有统计学意义(P<0.05),两组内末次随访时与术后2d相比差异无统计学意义(P>0.05)。术后2 d和末次随访时,两组组间的VAS评分比较差异有统计学意义(P<0.05),其余时间点VAS评分和ODI比较差异无统计学意义(P>0.05)。手术前后及末次随访时,两组组间的伤椎前缘相对高度和伤椎椎体后凸角比较差异均无统计学意义(P>0.05)。两组间手术时间差异无统计学意义(P>0.05),其中低温间断灌注组的骨水泥可推注时间(12.1±1.0)min,显著长于温度梯度灌注组(5.3±1.1)min(P<0.05)。低温间断灌注组的骨水泥灌注量(3.9±0.79)mL,骨水泥分布面积比(0.46±0.10),均优于温度梯度灌注组(3.20±0.67)mL和(0.31±0.07),差异有统计学意义(P<0.05)。低温间断灌注组有2例患者发生骨水泥渗漏,渗漏率6.7%,显著低于温度梯度灌注组的骨水泥渗漏率26.7%(P<0.05)。结论低温间断灌注技术可以有效延长骨水泥可推注时间,有利于提高骨水泥在椎体内的注射量和分布面积,降低骨水泥渗漏率的同时可获得更好的临床疗效。     

PKP术中应用骨水泥温度梯度灌注技术的可行性分析

目的利用骨水泥在不同温度下的凝固特点,探讨采用温度梯度灌注技术降低PKP手术中骨水泥渗漏率的可行性。方法自2013-01-2016-01,采用温度梯度灌注技术行PKP手术治疗骨质疏松性椎体压缩性骨折83例89椎,作为观察组;另选取同期采用传统PKP手术治疗的75例83椎作为对照组,进行两组间的疗效和安全性对比。结果两组患者PKP术后的VAS评分、ODI评分等疗效观察指标,以及伤椎后凸角、伤椎前缘相对高度等影像学指标的改善程度均相对一致(P0.05);观察组骨水泥渗漏率仅为4.49%,显著低于对照组的13.25%,差异有统计学意义(P0.05)。结论在PKP手术中利用骨水泥温度梯度灌注技术,可有效降低其骨水泥渗漏率,进一步提高该手术的安全性。     

Specifics of preoperative care, intraoperative monitoring and postoperative evaluation of patients with thyroid carcinoma

The aim of the study was to show the standards of preoperative management, intraoperative monitoring and postoperative evaluation of patients with thyroid gland carcinoma. It was point out the importance of the preoperative diagnosis of the tumor, and the concurrent diseases. The special attention was paid to difficult airway recognition and resolving this situation. Both, anesthetist's and surgeon's point of view of perioperative and postoperative complications were discussed with special interest on early surgical complications and the need for urgent anesthetic treatment. Criteria for minimal and desirable monitoring of vital functions were suggested in order to prevent, recognize and cure complications. Our conclusions were based on recent references from the world literature and on our own experience in Center for endocrine surgery KCS, Belgrade.     

Skin-sparing and nipple-sparing mastectomy: preoperative, intraoperative, and postoperative considerations

The last several decades have witnessed significant advances in the surgical management of breast cancer. Although many have embraced breast conservation as the procedure of choice, some patients will still opt for mastectomy for a variety of reasons. Recently, the concept of skin sparing mastectomy and immediate breast reconstruction has emerged as an option that provides excellent cosmetic results while being oncologically safe. However, this surgical approach must be considered within a multidisciplinary context, and there are a number of perioperative issues that need to be considered. In addition, newer techniques, which spare the nipple and/or areola, warrant further examination.     

PVP及PKP治疗中责任椎的选择

目的 探讨PVP(经皮椎体成形术)及PKP(经皮椎体后凸成形术)治疗中责任椎的选择对预后疗效的影响。方法 回顾性研究2007年1月1日至2011年6月1日在我院行PVP或PKP病人276例,其中单椎体者204例病人,双椎体者66例病人,三椎体者6例病人,通过术前认真查体及阅X线片、CT、MRI,选择正确的责任椎,给予PVP或PKP。结果 276例患者术后第2天下地活动,术后1个月恢复伤前生活,无节段血管、脊髓等穿刺损伤,无肺栓塞、血管栓塞等并发症发生。结论 正确选择责任椎,能有效避免手术失败,PVP及PKP能迅速缓解疼痛,恢复部分椎体高度,改善患者生活质量,提高疗效。     

Common bile duct stones: the role of preoperative, intraoperative, and postoperative ERCP

The indications for endoscopic retrograde cholangiopancreatography (ERCP) to demonstrate the presence of common bile duct stones has changed in the era of laparoscopic cholecystectomy. Preoperative ERCP is indicated when there is strong evidence of common bile duct stones, ie, jaundice, cholangitis, ultrasound demonstration of a common bile duct stone, and specific enzyme elevations. Preoperative ERCP is not indicated in mild gallstone pancreatitis. ERCP and endoscopic sphincterotomy as the only treatment regimen is successful in elderly patients with severe comorbid illness who have gallstones and common bile duct stones. Intraoperative ERCP does not play a role in the era of laparoscopic cholecystectomy. Transcystic common duct stone removal or laparoscopic choledochotomy is becoming the approach to common duct stones demonstrated by intraoperative cholangiography. Postoperative ERCP is indicated when intraoperative removal of common bile duct stones is unsuccessful. It is important to note that magnetic resonance cholangiography will play an increasing role and will reduce the indications and frequency of the use of ERCP.     

术前口服阿司匹林对腹腔镜肾肿瘤剜除术术中和术后出血的影响

目的研究术前口服阿司匹林对腹腔镜肾肿瘤剜除术术中和术后出血的影响。方法对52例伴慢性心血管疾病的肾肿瘤患者行腹腔镜肾肿瘤剜除术。术前口服阿司匹林患者共31例,其中长期口服小剂量阿司匹林、术前停服不足1周者18例（1组）;术前停服阿司匹林超过1周者13例（2组）。从未服用阿司匹林患者21例（3组）。对比三组患者的年龄、肾肿瘤大小、部位、手术时间、术中出血量和术后出血情况及术后并发症的发生率。结果三组的年龄、肾肿瘤大小、部位、手术时间和术中出血量差异无显著性意义（P〉0.05）,而1组术后引流管拔除时间明显较2、3组延长,术后引流总量也较多。术后输血事件较2、3组发生率高,术后心血管意外发生率3组较1、2组低。结论术前1周内口服阿司匹林不增加腹腔镜肾肿瘤剜除术术中出血量,但能延长术后出血时间,增加术后发生心血管事件的机率。建议腹腔镜肾肿瘤剜除术患者术前停服阿司匹林至少1周以上。     

术前X线、CT和MRI检查在PKP中的应用价值及疗效观察

目的探讨术前X线片、CT和MRI检查在PKP手术治疗椎体骨折中的应用价值及疗效观察。方法选择自2011-01—2013-12在本院行PKP术治疗48例椎体骨折,术前进行X线片检查、CT和MRI检查,根据MRI确定骨水泥注射区域,根据CT确定冠状面上的进针点和方向,根据X线片确定矢状面上的进针点和方向。统计术前、术后视觉模拟疼痛评分(VAS)和Oswestry功能障碍数(ODI),观察椎体高度恢复情况。结果 48例平均随访12.1个月,平均手术时间为43 min,无一例出现骨水泥渗漏,术前、术后平均椎体高度的差异具有统计学意义(P0.05),平均骨水泥用量2.8 ml,VAS及ODI评分术后明显降低。结论术前通过CT片研究,可以指导进针点和穿刺方向,可以根据需要进行准确穿刺,可以穿刺到需要达到的部位;MRI可以判断椎体骨折的区域、范围,术中将骨水泥直接注射到骨折区域,既可减少骨水泥用量,又可达到缓解疼痛的疗效,术前X线片检查结合CT和MRI检查在PKP中具有重要价值。     

经皮椎体成形及后凸成形术对临近椎间盘退变影响的回顾性分析研究

[目的]探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)和后凸成形术(percutaneous kyphoplasty,PKP)对临近椎间盘退变的可能影响及其程度。[方法]收集2009年6月～2011年2月济宁医学院附属医院脊柱外科收治的胸腰椎骨质疏松压缩骨折患者共146例,其中纳入本研究的具有完整随访资料患者85例,又按治疗方案的不同,分为保守治疗组20例、PVP组42例、PKP组23例,采集入院时、入院后3 d、出院后12个月、出院后24个月的VAS评分(visual analogue scale/score,视觉模拟评分法)、ODI评分(the Oswestry disability index,Oswestry功能障碍指数)和入院时、出院后12个月、出院后24个月的椎间盘指数和MRI指数,将所有数据资料进行归纳、汇总,应用SPSS 17.0统计软件行数据分析。[结果]PVP组和PKP组均能早期、有效地缓解疼痛、减少卧床时间、治疗满意度高,但出院后24个月的VAS评分和ODI评分分析,PVP组和PKP组无统计学差异(P>0.05)。在出院后24个月的椎间盘指数及MRI指数的比较中发现,PVP组和PKP组较保守治疗组均具有统计学差异(P<0.05),PVP组和PKP组较术前均具有统计学差异(P<0.05),且PKP组较PVP组具有统计学差异(P<0.05)。[结论]PVP和PKP均可加速相邻椎间盘退变,且后者影响更为显著。