内镜下乳头括约肌切开术术中、术后出血的诊治探讨

目的探讨内镜下乳头括约肌切开术(endoscopic sphincterotomy,EST)术中、术后出血的原因和治疗方法。方法回顾性分析解放军第四一一医院EST术中、术后出血的12例患者临床治疗过程,总结其经验教训。结果 12例EST术中、术后出血患者中,即时出血9例,迟发性出血3例;渗血9例,搏动性出血3例;轻度出血9例,中度出血2例,重度出血1例。内镜下治疗成功10例(轻度出血9例,中度出血1例),内镜下止血无效行DSA治疗2例(中度出血1例,重度出血1例);并发轻度胰腺炎1例,无其他并发症;全部病例均治愈,无手术及死亡病例。结论 EST术中、术后出血多为渗血和即时出血,出血多为轻度至中度,内镜下治疗多能止血,无效时应及时行DSA或手术治疗。     

支架辅助弹簧圈栓塞颅内动脉瘤围手术期严重神经系统并发症的分析

目的探讨支架辅助弹簧圈栓塞颅内动脉瘤在围手术期严重神经系统并发症的类型和转归。方法回顾性分析2014年1月至2015年7月首都医科大学宣武医院支架辅助弹簧圈栓塞颅内动脉瘤203例患者(其中破裂动脉瘤45例,未破裂动脉瘤158例)中发生围手术期严重神经系统并发症11例患者(13个动脉瘤)的临床资料。结果发生严重神经系统并发症的11例患者接受13枚支架置入治疗,并发症发生率为5.4%(11/203),破裂动脉瘤组严重神经系统并发症发生率为11.1%(5例);未破裂动脉瘤组严重神经系统并发症发生率为3.8%(6例)。破裂动脉瘤组术中动脉瘤破裂出血1例,术后支架内血栓形成1例,发生率均为2.2%;术后再出血2例,发生率为4.4%;麻醉诱导期出血1例,发生率为2.2%。未破裂动脉瘤组术中动脉瘤破裂和术后支架相关缺血各3例,发生率均为1.9%;无麻醉诱导期出血和术后再出血。随访3个月时,格拉斯哥预后评分2分2例,3分1例;8例患者死亡,总病死率为3.9%。结论支架辅助弹簧圈栓塞治疗颅内动脉瘤围手术期可发生支架相关缺血、动脉瘤术中及术后出血等严重神经系统并发症,导致重残甚至死亡,应加强围手术期管理。     

妇科疾病合并高血压的围手术期治疗研究

目的 探究妇科疾病合并高血压患者的围手术期治疗。方法 选择2014年1月至2014年12月我院妇科住院的合并高血压患者130例,对其围手术期治疗及注意事项进行总结。结果 所有患者均于本院手术,其中118例患者术后恢复较好,并无内科或其他并发症发生;8例患者伴随有电解质紊乱,1例高黏血症者发生肺栓塞,3例糖尿病患者发生继发伤口感染,予以抗感染治疗后痊愈出院;患者均未见有血压异常、术中出血以及术后伤口渗血者;所有患者控制良好率为90.8%。结论 妇科疾病合并高血压患者在围手术期治疗时应选择起效快的降压药物,予以抗焦虑、紧张等综合疗法,依据患者病情及时调整围术期治疗,减少并发症的发生。     

门静脉高压症并发上消化道出血的急诊手术治疗

门静脉高压症并发食管及胃底曲张静脉破裂大出血患者29例,均接受急诊手术治疗。断流＋分流术11例,术后门静脉压平均降低7．9cmH2O,发生肝昏迷先兆2例、再出血1例,死亡2例;仅行断流术18例,术后门静脉压平均降低2．1cmH2O,发生再出血4例,元手术死亡者。认为肝硬化门静脉高压症并发上消化道大出血者应不失时机实施手术治疗。延误时机只会使患者全身状况进一步恶化,手术死亡率上升。断流＋分流术降压更明显,再出血率低,但术后脑病发生率及手术死亡率高于断流术;断流术后再出血率较高,但术后脑病发生率及手术死亡率较低,适用于术前肝功能较差的患者。     

颈动脉支架置入术后并发症及处理方法

目的探讨颈动脉支架置入术后并发症特点及处理方法。方法收集解放军总医院2012年1月~2014年10月收治的颈动脉狭窄并行颈动脉支架置入术患者92例,分析颈动脉支架置入术后相关并发症及处理方法。结果92例患者均成功置入颈动脉支架,手术成功率为100%,术后残余狭窄率<10%;共有13例患者出现并发症(14.1%),其中术后发生视力下降2例,经提高血压、扩张微循环、营养神经治疗后好转;造影剂过敏反应1例,给予吸氧、补液处理后症状消失;消化道出血2例,给予禁食水,补液及应用抑制胃酸和止血药物等对症处理,出血均得到控制;颈动脉窦综合征5例;脑过度灌注综合征3例,其中颅内出血2例,行开颅手术治疗后死亡1例、植物人1例,另外1例出现头痛,对症处理后症状消失。结论详细的病史采集及完善术前相关检查,掌握并发症的发病原因及临床表现,并给予正确的处理,可以预防和降低并发症的发生。     

肠结核并发肠梗阻再次手术的临床分析（附12例报告）

回顾性分析河南省郑州市第六人民医院2013年12月至2016年8月收治的肠结核并发肠梗阻,进行二次手术治疗的12例患者的临床资料。12例患者中,男7例,女5例,年龄16～63岁,中位年龄32岁;均在术中或术后病理检查证实为肠结核。12例患者再次手术的原因及术式包括：发生完全性肠梗阻6例,其中行开腹肠粘连松解术4例,肠管部分切除一期吻合术2例;发生腹腔或盆腔脓肿无局限倾向而引起腹膜炎2例,均行开腹脓肿清除、腹腔引流术;出现肠穿孔4例,其中行肠管切除一期吻合术3例,腹壁双口造瘘、机体好转后行二期手术1例。12例患者术后均给予规范的抗结核药物治疗,随访6个月均未再次出现肠梗阻。笔者认为,选择合理的手术方式及手术前后正规的抗结核药物治疗是治愈结核性肠梗阻的关键。     

肝细胞癌自发性破裂出血的治疗对策选择（附30例报告）

目的探讨肝细胞癌（HCC）自发破裂出血患者在治疗对策上的选择。方法对本院2008年1月-2011年12月收治的30例HCC破裂出血患者的临床资料进行回顾性分析,其中行Ⅰ期手术9例,急诊经导管肝动脉化疗栓塞术（TACE）治疗21例,TACE治疗后再手术切除10例,其余11例均为单纯TACE治疗,从临床治疗效果进行评价分析。计数资料比较采用卡方检验或Fisher′s检验。结果21例经急诊TACE治疗者止血成功率为100%,其中10例患者TACE治疗后2~5周内进行Ⅱ期手术,术后病理证实均为HCC,术后3个月复查均未见腹腔肿瘤种植转移灶,术后1 年存活率70%（7/10）; 9例行Ⅰ期手术切除的患者中,围手术期内死亡2例,3个月内发生腹腔或切口种植转移者5例（5/7）,术后1 年存活率44.4%（4/9）;11例单纯TACE治疗患者术后1 年存活率为27.3%（3/11）。急诊TACE联合手术切除HCC破裂出血在提高抢救成功率、减少术后并发症及提高患者生存时间上均优于急诊手术切除及单纯的TACE治疗。结论HCC自发性破裂出血患者应首选急诊TACE治疗,再联合手术切除,可以明显提高抢救成功率和手术切除率,并可显著降低肿瘤腹腔种植转移率,延长患者生存时间。     

经皮冠状动脉介入治疗并发急性心脏压塞的临床分析

目的:分析8例经皮冠状动脉介入治疗(PCI)并发的急性心脏压塞原因、临床表现和治疗结果。方法:2005年1月至2008年12月对5 241例冠心病患者进行了PCI术,8例患者并发急性心脏压塞。采用心包穿刺引流术处理,无效时采用外科手术。结果:急性心脏压塞的发生率为0.15%。8例患者早期均表现为胸闷、血压下降。7例患者行紧急心包穿刺引流,其中2例因引流后仍继续出血而行外科修补手术。1例患者未行心包穿刺引流死亡。结论:急性心脏压塞是PCI术的严重并发症,及时发现和有效救治是十分重要的。     

改良微血管减压术治疗三叉神经痛疗效观察

目的观察改良微血管减压术治疗三叉神经痛的疗效。方法将42例原发性三叉神经痛患者随机分为2组。改良组（11例）采用改良微血管减压术治疗,即术中应用患者自身桥小脑脚硬膜或人工可缝合硬膜将单纯压迫在三叉神经上方或外侧方的血管包裹“悬吊”,从而达到减压目的;对照组（31例）采用传统微血管减压术治疗。结果对照组术后疼痛完全缓解27例,明显缓解2例,轻微缓解1例,未缓解1例;并发面部麻木感5例,外耳道异物感3例,听力下降1例;术后随访复发I例。该良组术后疼痛均完全缓解,无面部麻木等并发症,随访无复发。结论改良微血管减压术治疗三叉神经痛安全有效,且可减少术后复发。     

内镜辅助下微血管减压术治疗三叉神经痛观察

目的探讨神经内镜辅助显微镜技术在微血管减压术治疗原发性三叉神经痛的疗效。方法采用枕下乙状窦后入路微血管减压术治疗原发三叉神经痛患者47例,术中均采用神经内镜配合手术显微镜显露责任血管,分离后用Teflon棉隔开,无责任血管者行感觉神经根部分切断。结果发现责任血管43例,4例未发现责任血管,其中1例蛛网膜粘连严重,术后随访(3~14)月,40例疼痛消失,3例明显减轻,有效率91.49%,并发面部麻木5例,听力下降2例。结论神经内镜配合显微镜技术可避免遗漏责任血管,提高治愈率,有效降低术后并发症,是治疗三叉神经痛安全有效的方法。     

经皮球囊压迫与射频热凝半月神经节治疗老年人原发性三叉神经痛的疗效比较

目的 探讨经皮球囊压迫与射频热凝半月神经节治疗老年人原发性三叉神经痛的疗效.方法 选择原发性三叉神经痛老年患者87例,按治疗方法不同分为两组,经皮球囊压迫半月神经节治疗(球囊压迫组)42例,经皮射频热凝半月神经节治疗(射频热凝组)45例,对两种方法疗效进行分析评价.结果 (1)球囊压迫组和射频热凝组早期有效率分别为92.9%(39/42)和95.6%(43/45),治愈率分别为88.1%(37/42)和88.9%(40/45),两组比较差异无统计学意义(χ2分别为0.292、0.198,均P＞0.05);(2)出现三叉神经抑制反应球囊压迫组69.0%(29/42),多于射频热凝组35.6%(16/45)(χ2=9.759,P＜0.05),其中球囊压迫组1例患者出现心搏骤停;(3)术后两组均有不同程度的颜面部麻木及感觉障碍,球囊压迫组有效39例三支支配区均有麻木;射频热凝组有效43例主要为患支支配区麻木,选择性较高;球囊压迫组咀嚼肌无力的发生率(71.8%)高于射频热凝术组(20.9%),差异有统计学意义(χ2=5.106,P＜0.05); (4)术后随访6个月,两组均无复发病例.结论 经皮球囊压迫和经皮射频热凝术治疗老年人原发性三叉神经痛,都具有微创、高效的优点.经皮球囊压迫在全身麻醉下进行,无需患者配合,具有较高的舒适性,对于无法合作的患者较为合适;而经皮射频热凝术对三叉神经毁损的选择性更强,三叉神经抑制反应较轻,并且对咀嚼肌功能影响较小.

Abstract：

Objective To compare the effect of percutaneous balloon compression (PBC) versus percutaneous radiofrequency thermocoagulation treatment (PRFT) on idiopathic trigeminal neuralgia in elderly patients. Methods The 87 patients with idiopathic trigeminal neuralgia were enrolled, 42 patients were treated by PBC (PBC group), and the other 45 patients were treated by PRFT (PRFT group). The effects of two therapies were evaluated after treatment. Results The early response rate (92.9% vs. 95.6%) and cure rate (88.1% vs. 88.9%) of PBC group versus PRFT group had no significant differences (both P＞0.05). The inhibitory response rate of trigeminal nerve was significantly greater in PBC group than in PRFT group after treatment (69.0% vs. 35.6%, P＜0.05), and 1 patient had cardiac arrest in PBC group. The two groups had different degrees of facial numbness and sensory dysfunction. The 39 patients treated by PBC had numbness in three divisions of trigeminal nerve, while 43 patients treated by PRFT had the high selection and showed the main numbness in the ill division of trigeminal nerve. The chewing gravis rate was higher in PBC group than in PRFT group (71.8% vs. 20.9%, P＜0.05). There was no neuralgia recurrence in both groups during 6 monthe′ follow-up. Conclusions The effect of treating the elderly patients with idiopathic trigeminal neuralgia is similar by PBC and PRFT. The PBC therapy under general anesthesia is more convenient for patients who can not cooperate.The PRFT has much higher selectivity in trigeminal nerve damage, lower inhibition rate of the trigeminal nerve, and less influence on the masticatory muscle function.     

显微血管减压治疗脑神经疾病的疗效观察

目的总结显微血管减压术（MVD）治疗原发性脑神经疾病的手术技巧及疗效。 方法选取昆明医科大学第一附属医院微创神经外科自2010年4月至2018年12月采用MVD治疗的832例脑神经疾病患者进行回顾性分析,其中三叉神经痛489例、面肌痉挛338例、舌咽神经痛患者5例,观察其疗效,统计并发症发生率。 结果所有病例随访时间为3~84个月,平均32.5个月,本组无死亡病例及其他严重并发症发生,三叉神经痛患者手术治愈率为98.36%,面肌痉挛手术治愈率为97.93%,舌咽神经痛治愈率为100.00%。 结论MVD是治疗原发性脑神经疾病的可靠方法,熟练的显微外科技术和丰富的手术经验及对于解剖的熟悉程度是手术治疗脑神经疾病的基础。     

显微血管减压术治疗35例原发性三叉神经痛患者疗效分析

目的 探讨显微血管减压术治疗原发性三叉神经痛(PTN)的手术技巧以及手术效果.方法 回顾性分析35例原发性三又神经痛患者显微血管减压术的手术操作、治疗效果以及并发症.结果 术中将微血管隔开、减压后,34例患者疗效显著,无脑脊液漏等严重并发症发生,1例复发.结论 显微血管减压手术是治疗原发性三义神经痛的有效治疗方法.     

Enterovesical fistulas complicating Crohn's disease: clinicopathological features and management

Enterovesical fistula is a relatively rare condition in Crohn's disease. This study was undertaken to examine clinicopathological features and management of enterovesical fistula complicating Crohn's disease. Thirty patients with enterovesical fistula complicating Crohn's disease, treated between 1970 and 1997, were reviewed. Urological symptoms were present in 22 patients; pneumaturia in 18, urinary tract infection in 7, and haematuria in 2. In 5 patients clinical symptoms were successfully managed by conservative treatment, and they required no surgical treatment for enterovesical fistula. Twenty-five patients required surgery. All the patients were treated by resection of diseased bowel and pinching off the dome of the bladder. No patients required resection of the bladder. The Foley catheter was left in situ for an average of 2 weeks after operation. Three patients developed early postoperative complications; two bowel anastomotic leaks, and one intra-abdominal abscess. All these complications were associated with sepsis and multiple fistulas at the time of laparotomy. After a median follow-up of 13 years, 3 patients having postoperative sepsis (anastomotic leak or abscess) developed a recurrent fistula from the ileocolonic anastomosis to the bladder, which required further surgery. In the other 22 patients without postoperative complications there has been no fistula recurrence. In conclusion, the majority of patients with enterovesical fistula required surgical treatment: resection of the diseased bowel and oversewing the defect in the bladder. The fistula recurrence was uncommon, but the presence of sepsis and multiple fistulas at the time of laparotomy increased the incidence of postoperative complications and fistula recurrence.     

急性脑血管疾病并发意识障碍诊治分析

目的探讨急性脑血管疾病并发意识障碍的临床诊治措施及意义。方法选取我院2009年1月至2012年12月72例急性脑血管病并发意识障碍患者为观察研究对象,依据诊治措施的异同分为观察组(综合诊治护理组)和对照组(常规处置组)各36例,观察两组的临床治疗效果及患者症状改善情况,分析综合诊治护理的特点及意义,指导临床对急性脑血管疾病并发意识障碍的诊治实践。结果 4周后依据卒中量表(NIHSS)评分,格拉斯哥昏迷量表(GCS)评分及并发症发生情况对比,综合诊治护理组的患者在临床治愈效果、并发症等方面好于对照组,两组比较有明显差异(P0.05)。结论急性脑血管疾病并发意识障碍病情危急、凶险、多变,及时的观察诊断病情采取综合诊治护理措施可以最大程度的救治患者,促进脑功能的恢复,具有积极的临床价值。     

Incidence and prevalence of primary biliary cirrhosis in a defined population in Sweden

The incidence and prevalence of antimitochondrial antibody-positive primary biliary cirrhosis (PBC) has been studied within a defined area in Sweden served by one hospital. During the period 1976-1983 the yearly incidence of PBC was 1.4/10(5) inhabitants, and on 31 December 1983 the prevalence was 12.8/10(5) inhabitants. The prevalence is the highest reported so far. At the time of diagnosis half of the patients were clinically asymptomatic. Two of the patients also had celiac disease with osteomalacia responding to a gluten-free diet. Gallstone disease occurred in 30% of the patients. Four patients died--two of liver-related complications, one of colonic carcinoma, and one of staphylococcal septicemia and endocarditis. One further patient, who is still alive, developed hypernephroma. Our results indicate that PBC is a fairly benign disease in most patients, with a slow progress during which they lead a fairly normal life.     

经皮穿刺球囊压迫术治疗肿瘤源性三叉神经痛的疗效分析

目的探讨经皮穿刺球囊压迫术（PBC）治疗肿瘤源性三叉神经痛（TN）的疗效。 方法回顾性分析辽宁省人民医院神经外科自2005年1月至2017年5月行PBC治疗的72例继发性TN患者的临床资料，评估患者术后的短期和长期的疼痛控制情况和并发症情况。 结果短期结果：疼痛完全缓解69例，部分缓解3例；术后面部麻木63例，角膜反射减弱7例，感觉异常但可忍受2例，脑脊液漏1例，角膜炎1例，疱疹2例。失访患者32例，可随访患者40例，平均随访72.1个月（范围10~162个月），其中2例死亡。随访结果：远期疼痛完全缓解28例，部分缓解5例，复发5例，并发症包括面部麻木19例，其中7例较术后无明显变化，12例已经明显减轻或局部麻木，脑脊液漏1例，较前减轻，偶尔会有脑脊液渗出，感觉异常难以忍受1例。 结论PBC是一种简单、安全及有效的治疗方法，针对部分肿瘤源性TN患者，能够起到对开颅手术的有益的补充。     

64排螺旋CT血管成像诊断永存三叉动脉

目的观察64排螺旋CT血管成像（CTA）在诊断永存三叉动脉（PTA）中的价值,提高对该血管变异的认识。方法回顾性分析2734例行头颈64排螺旋CTA检查中的5例PTA患者的影像学资料,分析PrrA的发生率、起源、走行、后循环供血及合并其他血管畸形的情况。结果①PTA的发生率为0．18％（5／2734）,其中3例位于右侧,2例位于左侧。②三叉动脉均起自颈内动脉海绵窦段,血管走行外侧型4例,内侧型1例;按Saltzman分型显示PTA后循环供血情况：I型1例,Ⅱ型1例,Ⅲ型3例。③吻合点近端的基底动脉及双侧椎动脉发育不良3例,吻合点近端基底动脉完全萎缩1例;合并PTA的动脉瘤1例,合并对侧大脑中动脉成窗1例。结论64排CTA能清晰、快速、无创、准确地显示PTA及其走行。在鞍区或鞍上区手术及介入治疗前,了解这种异常血管的有助于制定合理的手术和介入治疗方案,避免因操作不当所致的危险。     

The Long-Term Effective Rate of Different Branches of Idiopathic Trigeminal Neuralgia After Single Radiofrequency Thermocoagulation: A Cohort Study

To evaluate the efficacy of computed tomography (CT) guided single radiofrequency thermocoagualtion (RFT) in 1137 patients with idiopathic trigeminal neuralgia after a follow-up period of 11 years, specially focused on duration of pain relief in different branches of trigeminal nerve, side effect, and complications.Retrospective study of patients with idiopathic trigeminal neuralgia treated with a single CT guided RFT procedure between January 2002 and December 2013.The mean follow-up time was 46.14 ± 30.91 months. Immediate postprocedure pain relief was 98.4%. V2 division obtained the best pain relief rate: 91%, 89%, 80%, 72%, 60%, and 54% at 1, 3, 5, 7, 9, and 11 years, respectively. No statistical difference pairwise comparison was in other groups. The complications included masseter muscle weakness, corneitis, diplopia, ptosis, hearing loss, limited mouth opening, and low pressure headache. Masticatory weakness mostly occurred in patients with V3 branch involvement, while Corneitis and Diplopia all in patients with V1 branch involvement. No mortalities observed during or after RFT.All different branches division of trigeminal neuralgia achieved comparable satisfactory curative effect; V2 obtained the best excellent pain relief, after RFT procedure. Facial numbness is inevitable after RFT, which patients who have pain in all 3 trigeminal divisions and patients who desire no facial numbness should be cautious. Masticatory weakness is mainly related with V3 injured, while Corneitis and Diplopia in patients with V1 injured by RFT.     

Long-term prognosis in patients with bundle branch block complicating acute anteroseptal infarction

In a previous study patients with bundle branch block complicating acute anteroseptal infarction were found to have a high incidence rate of sudden death and late ventricular fibrillation in the first 6 weeks after infarction. Forty-two such consecutive patients were therefore kept within the monitoring area during those 6 weeks. Eighteen (43 percent) of these 42 patients survived and were then followed up for an average of 13 months to assess long-term prognosis and to evaluate whether the in-hospital monitoring period should be extended over 6 weeks. In most of these 18 patients a bifascicular block developed in the acute stage of infarction and in 3 it progressed to transient high degree atrioventricular (A-V) block. Seven of the 18 survivors had potentially lethal complications during the first 6 weeks. Four of these seven underwent aneurysmectomy between 10 and 20 weeks after infarction, and one of them died of a surgical complication. Major cardiac events occurred in 3 of the 17 survivors. None of these patients died during the follow-up period. In one patient complete A-V block developed after aneurysm resection; this was the only patient treated with permanent pacing. Fifteen of the 17 patients were in functional class I or II.These results indicate that (1) patients with bundle branch block complicating acute anteroseptal infarction who survive the first 6 weeks after infarction have a good prognosis during the 1st year, and (2) extension of the in-hospital monitoring period is not necessary. The results further suggest that prophylactic permanent pacing does not affect prognosis in these patients.