三腔二囊管治疗食管胃底静脉曲张破裂出血的疗效观察

目的评价目前三腔二囊管在肝硬化食管胃底曲张静脉破裂出血时的应用价值。方法收集有呕血症状并经胃镜确诊为食管-胃底静脉曲张破裂出血的肝硬化患者153例,200人次。分成A、B两组。A组治疗措施包括垂体后叶素加H2受体阻断剂联合或不联合三腔二囊管,B组包括SS（生长抑素）加PPI（质子泵抑制剂）联合或不联合三腔二囊管。统计两组患者的出血情况、止血时间、治疗结果以及三腔二囊管的使用情况。结果止血时间两组间无统计学意义;B组三腔二囊管使用例次及第1次出血时的使用率已明显降低,三腔二囊管的压迫时间明显缩短;三腔二囊管止血成功率在A、B两组无统计学意义;联合三腔二囊管治疗组死亡率高于仅用药物治疗组。结论 SS和PPI的联合使用能提高食管-胃底静脉曲张破裂出血的止血率,三腔二囊管不能降低患者的死亡率,故药物治疗可作为的首选方法。     

改进的三腔二囊管压迫止血法的使用价值

三腔二囊管压迫止血法在目前治疗食道静脉曲张破裂大出血中仍是一种确切可靠、经济的方法。但传统的通过外部滑车牵引重物的手段存在不少缺点,从而影响了它的使用及止血效果。我院1998年以来采用改进的三腔二囊管压迫止血法,并对使用效果与传统方法进行比较。现报告如下: 临床资料58例食道静脉曲张患者均胃镜证实有活动性出血。男44例,女14例;年龄29岁-68岁。诊断肝炎后肝硬     

三腔二囊管置入不当致食管狭窄1例

三腔二囊管治疗的常见并发症有鼻翼压迫坏死、窒息、吸入性肺炎、食管下端胃粘膜缺血坏死、食管气管瘘等。由于操作不当致食管粘膜坏死 ,近期内出现食管狭窄 ,甚为罕见。1　病例简介　患者男 ,5 2岁。有乙型病毒性肝炎、肝硬化病史 5年。 2 0 0 0年 2月 6日无诱因呕出鲜红色新     

超常规使用双囊三腔管抢救肝硬化并发症3例

1　典型病例　例 1,男 ,6 0岁 ,先后 4次因血吸虫病肝硬化并发腹水住院治疗 ,曾有两次上消化道出血。第 4次住院于 1988年 6月 14日晚 18时突然头昏恶心 ,血压测不到 ,随即呕出暗红色血 12 0 0ｍｌ,立即补液 ,肌注及静脉点滴止血药 ,经外科会诊认为不宜手术 ,故立即下双囊三腔管 ,呕血立即停止 ,但解血例及柏油样便 3ｄ ,第 6天拔管 ,病情稳定 ,住院共 5 9ｄ病愈出院。随访 5ａ病人情况良好。例 2 ,男 ,45岁 ,诊断肝炎后肝硬化失代偿 ,因上消化道大出血急诊住江西医学院附属第一医院 ,病人出血停止后转来我院。住院后第 3天又出现上消化道大…     

肝硬化食管静脉曲张出血胃镜下套扎治疗的疗效

目的探讨肝硬化食管静脉曲张出血胃镜下套扎临床疗效。方法回顾性分析204例肝硬化食管静脉曲张破裂出血病例,根据治疗方法分为三腔二囊管组（三腔管组）81例和曲张静脉套扎组（套扎组）123例,比较两组止血成功率、病死率、住院时间、并发症发生率、生存时间等。结果套扎组72h止血成功率100％高于三腔管组的84．0％（x^2=21．084,P〈0．01）;套扎组无死亡患者,三腔管组死亡6例（x^2=9．387,P〈0．01）;套扎组住院时间显著少于三腔管组;套扎组并发症为18．7％显著少于三腔管组的63．0％（x^2=41．394,P〈0．01）;术后2W复查,套扎组中度为60．0％（x^2=8．499,P〈0．01）及重度食管静脉曲张的66．2％（x^2=5．343,P〈0．05）均显著低于三腔管组。套扎组上消化道出血复发1次（x^2=30．997,P〈0．01）及2次以上比例显著低于三腔管组（x^2=19．088,P〈0．01）;12个月内病死率显著低于三腔管组（x^2=21．113,P〈0．01）;4年累计生存率（86．6％）显著高于三腔管组（22．3％）。结论肝硬化食管静脉曲张破裂出血套扎成功率高、并发症少、复发率低,是一种有效的治疗方法。     

鼻内窥镜下射频治疗鼻后部出血疗效观察

鼻腔后部出血常规均行鼻腔填塞压迫止血。现为减轻患者填塞的痛苦 ,避免漏诊而加重病情。我科自 1999年 10月— 2 0 0 1年 10月采用鼻内窥镜 (国产 )下行射频(西安康普ＸＶＣ Ⅱ型电脑射频治疗仪 )治疗鼻腔深处血管出血 5 0例 ,经 6个月～ 1年随访 ,疗效满意 ,现报告如下。1　临床资料1 1　一般资料　本组 5 0例 ,男 38例 ,女 12例 ;年龄 2 5～70岁。治疗前均行副鼻窦ＣＴ检查 ,均无异常。血常规检查 :正常。其中 4 0例在鼻内窥镜下可查明出血部位 ,10例出血多 ,流速快 ,经凡士林纱条压迫后在鼻内窥镜下可以查到出血部位。1 2　治疗方法　患…     

重症胰腺炎术后自制三腔管应用疗效评价

重症急性胰腺炎 (Severeacutepancreatitis,SAP)系高危急腹症 ,是外科临床中最危重的良性疾病之一。SAP治疗一直是普外研究和争议的热点之一 ,其病程中、后期病死率为4 5 %、15 % [1] 。我院 1989年 9月～ 2 0 0 2年 8月对 2 0 7例急性胰腺炎中 36例SAP进行手术 ,并应用自制三腔管冲洗引流 ,现回顾性分析有关临床资料 ,以评价其效果与价值。1　资料和方法1.1　一般资料　重症胰腺炎 36例 (SAP诊断符合中华医学会外科学会胰腺学组制定的急性胰腺炎的临床诊断及分级标准 ) [2 ] ,男 19例 ,女 17例 ,年龄 34～ 73岁 ,平均 4 9岁 ,胆原性 …     

法国CGR500mAX线机三球管改为二球管使用

法国CGR500mAX线机不要天吊球管进行摄影，使用300T球管对立式滤线器SG370摄影的电路改法如下：     

鼻内窥镜下电凝止血治疗鼻出血62例临床分析

目的观察鼻内窥镜下高频电凝止血治疗鼻出血的临床效果。方法对62例鼻出血患者在鼻内窥镜引导下行高频电凝止血治疗。结果 62例中1次治愈55例（占88.7%）,2次治愈5例（8.1%）,3次以上治愈2例（3.2%）。结论经鼻内窥镜下高频电凝治疗鼻出血具有安全有效、创伤小、并发症少等优点,值得临床推广应用。     

连续航行对舰艇人员健康的影响

目的观察同一舰艇连续航行前后舰艇人员健康状况的变化情况。方法在舰艇连续航行前后对舰艇人员进行一般健康状况检查，同时测试心电图、脑电图、肺功能、血常规、尿常规及血液生化指标。结果一般健康状况检查航行后脉率显著加快，收缩压和舒张压显著下降（P〈0．05），视力、内外科、五官科及皮肤科疾病的种类和数量无明显变化（P〉0．05），心电图航行后窦性心动过缓和窦性心律不齐发生率有明显变化（P〈0．05），脑电图参数中α波幅值、α百分率、α波功率绝对值和慢波数量显著增加（P〈0．01），视觉分辨率、闪光融合频率能力显著下降（P〈0．05），血液生化指标（ALT）航行后有显著增高（P〈0．05）；经过15d的休息调整上述变化可恢复（P〉0．05）；血液中淋巴细胞百分率（Lym％）航行后显著增加（P〈0．01）；其他指标未见明显变化（P〉0．05）。结论连续航行可使舰艇人员出现某些可逆性生理、生化等方面的变化，经休息15～20d后即可恢复，未见器质性改变。     

舰艇舱室中7种非金属材料燃烧时烟雾中主要无机有害气体定量分析

目的 观察舰艇舱室中7种非金属材料燃烧或高温热解时,产生的烟雾中主要有害成分浓度变化,为救治中毒人员和采取防护措施提供依据.方法 将7种常用非金属材料在燃烧试验箱中燃烧,用检测仪器进行定量分析.结果 烟雾中氧气浓度低于安全浓度、一氧化碳和氰化氢浓度超过安全浓度.结论 烟雾气体缺氧以及一氧化碳和氰化氢浓度超标是导致人员中毒的主要因素.     

外伤性颈内动脉海绵窦瘘并严重鼻衄的血管内介入治疗

目的 探讨血管内介入治疗外伤性颈内动脉海绵窦瘘(TCCF)合并严重鼻衄的策略和疗效.方法 26例TCCF并严重鼻衄的患者进行了血管内介入治疗,其中24例采用了可脱性球囊栓塞瘘口或闭塞颈内动脉;1例采用解脱式微弹簧圈栓塞;1例采用覆膜支架进行治疗.结果 26例中,9例1次性栓塞了瘘口,假性动脉瘤消失,颈内动脉通畅;15例1次性栓塞了瘘口和闭塞颈内动脉;解脱式微弹簧圈栓塞海绵窦,瘘口基本消失,颈内动脉通畅1例;覆膜支架闭塞瘘口,颈内动脉保持通畅1例.术后26例均未再发生鼻衄.结论 TCCF并严重鼻衄应尽早进行DSA确诊,尽早或急症进行治疗.血管内介入治疗TCCF合并严重鼻衄是一种首选、安全和有效的治疗方法.     

水面舰艇长远航期间舰员心理状况研究

目的 研究水面舰艇长远航期间舰员的心理状况变化情况,为制定合理的心理卫生保健措施提供依据.方法 采用症状自评量表(SCL-90),分别于出航前7 d和出航第77、142、204天时,对执行远航任务的某水面舰艇官兵进行"重复性横断面"团体问卷抽样调查分析,并与中国军人常模作比较.结果 出航前舰员的群体心理状况良好,SCL-90总均分和多项因子分值均明显低于军人常模值(P＜0.05);出航第77天舰员的SCL-90总均分、躯体化、敌对性、偏执、其他因子均分都高于出航前水平(P＜0.05),其中敌对性和偏执因子分明显高于军人常模值(P＜0.01).出航第142天和204天,舰员SCL-90总均分和各因子分值明显回落,仅"其他"因子项均分仍显著高于出航前(P＜0.01).SCL-90筛查阳性率比较显示,出航第77天(15.1%)和出航第204天(20.0%)均明显高于出航前(2.4%)(P＜0.01),而出航第142天(7.7%)与出航前相比差异无统计学意义(P＞0.05).结论 舰员的群体心理状态在长远航早期明显低落,而在中后期经调整适应后趋于常态化;但舰员的个体心理状态在后期出现了明显的分化趋势.

Abstract：

Objective To investigate changes in the nental health status of the ship crew onboard surface naval vessels during a prolonged deployment, so as to provide scientific basis for the development of sound psychological health service measures for the ship crew. Methods Reproducibility and cross - sectional survey were conducted to investigate the emotional status of the ship crew aboard a certain naval surface vessel with symptom check list (SCL-90), 7 days before deployment, and on the 77th, 142nd, and 204th days after deployment during a prolonged ocean - going voyage. The obtained data were compared with the norms of the Chinese servicemen. Results The mental health status of the ship crew was on the whole in good mode before deployment. Total average score and various SCL-90 patterns were obviously lower than the norms of the Chinese servicemen(P＜0. 05 ). On the 77th day after deployment, the psychological state of the ship crew degraded markedly, manifested by the elevation of the SCL-90 total mean score and other scores, such as somatizaion, hostility, crankiness and other factors, when compared with those after deployment( P ＜0. 05 ).Of all the scores, the scores of hostility and crankiness were significantly higher than the norms of the Chinese servicemen( P ＜0. 01 ). Total SCL-90 average score and various factor scores on the 142nd and 204th days after deployment dropped sharply, except that one other factor score of SCL-90 was higher than that before deployment(P ＜0. 01 ). Screening positive rate of SCL-90 indicated that positive rates on the 77th( 15. 1% )and 204th days ( 20% ) were all obviously higher than that of pre - deployment( 2. 4% ) ( P ＜ 0. 01 ). However,no statistical differences could be seen in the scores on 142nd day(7.7% ), when compared with that of predeployment(2. 4% ) ( P ＞ 0. 05 ). Conclusions The psychological status of the ship crew, on the whole,degraded markedly during the initial stage of a prolonged deployment, then, would gradually come to normal with adaptation thereafter. Nevertheless, individual psychological status showed a tendency of obvious differentiation in the late stage of deployment.     

Petrous internal carotid aneurysm causing epistaxis: balloon embolization with preservation of the parent vessel

Summary A patient with severe, recurrent posterior epistaxis was shown at angiography to have an aneurysm of the petrous portion of the internal carotid artery (ICA). Since childhood, she had had pain related to eustachian tube blockage by the aneurysm. An endovascular balloon embolization of the aneurysm was successful with preservation of the parent artery. The treatment resulted in resolution of the symtpoms. The report confirms the usefulness of an angiographic protocol in evaluating vascular problems.     

Endovascular Treatment of Persistent Epistaxis due to Pseudoaneurysm Formation of the Ophthalmic Artery Secondary to Nasogastric Tube

We present the case of a 60-year-old man with persistent epistaxis for 20 days that had started 2 weeks after removal of a nasogastric tube placed for an abdominal operation. There was no pathologic finding at selective facial and internal maxillary artery injections. An injury to the ethmoidal branches of the ophthalmic arteries or other arterial origins of bleeding was suspected. The internal carotid artery angiography revealed a pseudoaneurysm of an anterior ethmoidal branch of the left ophthalmic artery. The pseudoaneurysm was occluded with NBCA-histoacryl (25%) injection.     

颈外动脉分支栓塞治疗顽固性鼻衄的临床应用(附67例报告)

目的:研究颈外动脉分支栓塞治疗顽固性鼻衄的临床应用价值。方法:67例难治性鼻衄患者,行颈外动脉分支栓塞治疗。结果:一次性治愈63例(94%),3例行2次治疗治愈(4.5%),1例未成功(1.5%)。未出现严重并发症。结论:颈外动脉分支栓塞治疗顽固性鼻衄安全、疗效明显、并发症发生率低。     

Haemangiopericytoma of the nasal cavity

Haemangiopericytomas (HPC) are rare vascular tumours originating from a pericytes, a term coined by Zimmermann to refer to the main location of this cell line in the pericapillary connective tissue. HPC may arise in any part of the body. We report a 29-year-old man with a histologically proven nasal haemangiopericytoma-like tumour. The lesion was embolised through the ophthalmic artery before it was removed surgically. The main symptoms of nasal HPC are epistaxis and obstruction of the nose. Malignant and benign clinical courses have been described. Local recurrence and metastases may be observed years after initial diagnosis.     

Perioperative image-adapted brachytherapy for the treatment of paranasal sinus and nasal cavity malignancies

PurposeSinonasal malignancies are a rare group of cancers often associated with late presentation and poor prognosis. In the past, there was little progress regarding survival rate, and often, multimodal treatment regimens are required. The aim of this study was to evaluate the clinical outcome of perioperative image-adapted brachytherapy (IABT) as part of a multidisciplinary treatment regimen for the therapy of sinonasal cancer.Methods and MaterialsSince 2006, patients with sinonasal cancer at the University Hospital of Schleswig-Holstein Campus Luebeck, Germany, were offered a multimodal treatment concept including head and neck surgery, perioperative IABT with or without external beam radiation therapy, and chemotherapy. In a retrospective study, such patients were analyzed for survival rate, tumor control, and toxicity of the interdisciplinary treatment.ResultsThirty-five consecutive patients were analyzed. The majority of patients (63%) were treated for a primary tumor and 62% presented with tumor Stages III–IV. The mean follow-up time with IABT was 28 months. Overall survival estimate was 72% after 3 years. Disease-specific survival, disease-free survival, and local control rates were 83%, 63%, and 67%, respectively. On univariate analysis, a significant better disease-free survival rate was found in patients treated for primary, but not recurrent, sinonasal cancer (p = 0.006). The overall treatment toxicities were mainly classified Grade I.ConclusionsInterdisciplinary perioperative IABT is associated with excellent locoregional control and survival rates. IABT is well tolerated and shows low toxicity. Furthermore, visual acuity can be preserved in advanced cases. The implementation of perioperative IABT into multimodal treatment regimens improves the oncologic outcome.