漏斗胸Nuss手术对比Ravitch手术的Meta分析

1文献来源 Nasr A,Fecteaua A,Wales PW.Comparison of the Nuss and the Ravitch procedure for pectus excavatum repair：A meta-analysis[J].J Pediatr Surg,2010,45（5）：880-886.2证据水平1b。3背景誗漏斗胸是儿童最常见的胸廓畸形（8‰）。誗Nuss手术和Ravitch手术是两种已广泛应用于漏斗胸矫治的手术方式。誗已经发表的对比研究显示这两种手术方式的评估结果不一致。4目的誗应用系统回顾和Meta分析的方法来比较Nuss手术和Ravitch手术治疗漏斗胸的矫治效果。誗评估两种常见手术方式的安全性、手术时间、住院时间及患者满意度。     

Nuss手术围术期进展

漏斗胸即胸骨及胸骨旁肋软骨凹陷畸形,是最常见的一种胸壁畸形,对机体产生一系列的生理和心理影响,常需手术治疗。Nuss手术自1998年报道以来,逐渐成为治疗漏斗胸的标准术式。本文就Nuss手术适应证和禁忌证、术前评估、手术方式和术中监测、复查方式、手术并发症、疗效评价和3D新技术等方面的进展情况进行综述。     

漏斗胸的诊断与外科治疗

漏斗胸是最常见的胸壁畸形,对患者胸壁外观、心肺功能及心理健康均产生影响,应适龄进行手术治疗。目前漏斗胸的手术方式有胸骨上举术、胸骨翻转术、Nuss手术、改良Nuss手术等。应根据患者年龄和漏斗胸的类型作适当选择。本文就漏斗胸的诊断与外科治疗方法进行综述。     

胸腔镜下Nuss手术的麻醉与配合

漏斗胸是指胸骨、肋软骨或部分肋骨向背侧凹陷形成船样或漏斗样畸形,发病率为0.1%～0.3%,是小儿最常见的先天性胸廓畸形[1]。漏斗胸不仅仅是外观畸形,更重要的是凹陷的胸骨有可能压迫心脏和肺脏,从而影响患者的心肺功能和生长发育。漏斗胸患者胸廓畸形明显或已经影响心肺功能者需要进行手术治疗,这是治疗漏斗胸的惟一方法[1～3]。传统的手术纠治方法包括胸骨抬举术或胸骨翻转术等,手术创伤较大、恢复较慢,部分患者畸形纠治不满意或容易复发。1998年,Nuss等[1]首先报道了胸腔镜下漏斗胸纠治手术的方法,该方法具有创伤小、不切骨、手术时     

先天性漏斗胸Nuss术与改良Ravitch术的比较

先天性漏斗胸是一种常见的影响儿童身心健康的疾病,以往国内大多沿用改良Ravitch手术治疗,Nuss手术是一种较新的术式。我院从2001年3月至2005年11月手术治疗先天性漏斗胸共计100例,其中Nuss手术37例,改良Ravitch手术63例。     

改良Ravitch术与Nuss手术治疗漏斗胸的效果对比

目的 对比研究传统改良Ravitch手术与微创Nuss手术治疗小儿漏斗胸.方法 回顾性分析我院2005年1月至2007年12月收治的100例漏斗胸,其中Nuss手术50例,改良Ravitch手术50例,将两种术式一般情况、围术期情况、并发症和术后效果进行比较.结果 全组无1例死亡.100例均顺利完成手术,但平均手术时间、术中出血量、术后平均住院天数Nuss组少于Ravitch组,住院费用、术后并发症、术后疼痛时间Nuss组高于改良Ravitch组.Nuss组并发症发生率为18%,包括2例气胸,2例皮下气肿,皮下积液1例,钢板移位2例,肺不张2例.Ravitch组并发症发生率为4%,分别为肺炎、皮下积液各1例.2组并发症均无严重致命性,且预后良好.结论 如果正确选择手术适应证,微创Nuss手术与改良Ravitch手术矫治小儿漏斗胸均能取得良好的效果.     

漏斗胸的外科治疗

漏斗胸是常见的先天性胸壁畸形,对患者胸壁外观、心肺功能及心理健康均产生影响,应适龄进行手术治疗。目前,漏斗胸的手术方式主要有胸骨上举术、胸骨翻转术、Nuss微创手术、vacuum bell装置无创吸引等,应根据患者年龄和漏斗胸的类型作适当选择。文章就漏斗胸的外科治疗方法与进展进行综述。     

漏斗胸的外科治疗

漏斗胸是常见的先天性胸壁畸形,对患者胸壁外观、心肺功能及心理健康均产生影响,应适龄进行手术治疗.目前,漏斗胸的手术方式主要有胸骨上举术、胸骨翻转术、Nuss微创手术、vacuum bell装置无创吸引等,应根据患者年龄和漏斗胸的类型作适当选择.文章就漏斗胸的外科治疗方法与进展进行综述.     

先天性心脏病合并漏斗胸手术治疗的护理配合

小儿先天性漏斗胸是一种先天性胸骨凹陷型畸形,占小儿胸壁畸形的90％。目前钢板置人漏斗胸矫治术（NUSS术）为治疗漏斗胸的首选术式[1]。随着技术的不断进步,手术方式逐渐向复杂漏斗胸及漏斗胸合并其他复杂畸形的治疗方向发展,与先天性心脏病相关的漏斗胸是目前手术治疗的热点之一。近年来我院对先天性心脏病相关的漏斗胸患儿采用同期或二期NUSS术治疗,取得了良好的治疗效果,现将护理配合体会报道如下。     

Nuss微创治疗小儿漏斗胸7例

漏斗胸是小儿较常见的先天性胸廓畸形,表现为前胸壁胸骨中下部与其两侧肋软骨异常向下弯曲凹陷呈漏斗状,不仅影响胸廓外观,也影响心肺功能,对小儿的生长发育和心理产生不良影响,目前仍以手术治疗为主.1998年Nuss等[1]报道经胸腔镜辅助下矫形钢板置入胸骨抬举微创术,经过不断完善和改进,使Nuss手术成为治疗漏斗胸的常用术式.2006年9月至2010年3月我院行Nuss手术治疗漏斗胸7例,取得良好效果,现报道如下.     

漏斗胸外科治疗的术式选择

1文献来源 Johnson WR,Fedor D,Singhal S.Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum[J].J Cardiothorac Surg,2014,Feb 7,9（1）：25.doi：10.1186/1749-8090-9-25.2证据水平1b。3背景誗漏斗胸是最常见的先天性胸壁畸形,发病率约1/400,男女比例约为4∶1。漏斗胸对许多患者的生活质量造成不良影响,主要包括生理及心理两大方面。     

Lack of sexual knowledge blamed for HIV/AIDS among Latin American youths

Lack of sexual knowledge is the main culprit for HIV/AIDS among Latin American youths, said Chilean expert Raquel Child, who also blamed the authorities for not doing enough to help youngsters deal with the deadly disease.     

Procalcitonin could be a reliable marker in differential diagnosis of post-implantation syndrome and infection after percutaneous endovascular aortic repair

Background Thoracic endovascular aortic repair （TEVAR） is an emerging treatment moaality, wnicn nas been rapidly embraced by clinicians treating thoracic aortic disease. However, the clinical manifestations of systemic inflammatory response after TEVAR as post-implantation syndrome （PIS） resemble the perioperative infection. This study aimed to evaluate changes and diagnostic value of procalcitonin （PCT） and other traditional inflammatory markers for infections after TEVAR. Methods We conducted a prospective clinical study that enrolled 162 consecutive aortic dissection cases. who underwent TEVAR in our institution between July 2011 and November 2012. The PCT, C-response protein （CRP）, erythrocyte sedimentation rate （ESR） and blood routine examination were monitored before the operation and on days 1, 2, 3 and 5 after the operation. The diagnosis of infection was confirmed by the infection control committee with reference to Hospital Acquired Infection Diagnostic Criteria Assessment, released by the Ministry of Health of the People＇s Republic of China. Results Post endovascular repair of thoracic aorta, PCT changes significantly at different time points （X~2= 13.225, P=0.021）, without significant difference between the PIS group and the control group （0.24±0.04 vs.0.26±0.10, P=0.804）. PCT values were significantly higher in the first day after TEVAR than the preoperative levels （0.18±0.03 vs. 0.11±0.02, P 〈0.001）. Compared with PIS patients, the level of PCT, CRP, White blood cell （WBC） and neutrophil （NEU） in the infection patients elevated significantly （relatively X2=6.062, P=0.048; X2=6.081, P=0.048; X2=11.030, P=0.004; X2=14.632, P=0.001）. According to the ROC analysis, the PCT levels in the first day after TEVAR （AUC=0.785, P=0.012） had better predictive values of infection than WBC, NEU CRP and ESR （AUC=0.720, P=0.040; AUC=0.715, P=0.045; AUC=0.663, P=0.274; AUC=0.502, P=0.991）. The best predictive index was the changes of PCT between preoperative     

Experience and early outcome of treating retrograde type A dissection with primary entry tear in the descending thoracic aorta

Once the ascending aorta gets involved and however farther the dissection extends,it is named type A dissection (TAD),in which the entry tear usually locates in the ascending aorta.But there exists a small subset with primary entry tear in the descending aorta and the dissection process extends back into the ascending aorta,which here we name primary retrograde type A dissection (PRTAD).Operative procedures are far more difficult and extensive for PRTAD and usually result in poor prognosis in the aspects of surgical mortality and survival rate during follow-up.1-3 Kato et al4 and Chang et al5 showed successful method of endovascular repair for PRTAD and recommended it as an alternative to the operative treatment.During March 2008 to August 2010,five continuous patients with PRTAD were admitted into our institution.We here introduce our preliminary experience with medical therapy and thoracic endovascular aortic repair (TEVAR)for treating PRTAD.     

Role of platelet-rich plasma in articular cartilage lesions

Articular cartilage has only a limited capacity of selfhealing.Once seriously damaged,articular cartilage lesions will not regenerate;and any joint surface damage,if left untreated,will invariably deteriorate and eventually spread to surrounding areas.1 The end result of such a process is often the development of osteoarthritis （OA）,which often occurs in large load-bearing joints,such as knee and femoral joint.So much attention has been focused on how to eliminate symptoms,repair damaged cartilage,restore the integrity of the articular surface,prevent or halt joint degeneration,and improve joint function.But it still remains a challenging problem for orthopedic surgeons.In recent years,the role of growth factors （GFs） on tissue repair has become a hot research topic.The biological effect of GFs on cartilage repair has been well documented in vivo and in vitro.2-4 At present,most GFs are obtained mainly through genetic engineering technology and extracted from the animals;the preparation process is cumbersome,expensive,and inconvenient.     

Percutaneous repair of inadvertent subclavian artery cannulation: a case report

Although catheterization of the subclavian vein is a common procedure, it might be associated with life-threatening complications including accidental cannulation of subclavian artery. Rash sheath removal could result in fatal hemorrhage. We report a case of inadvertent 6F sheath cannulation of the right subclavian artery during a radiofrequency catheter ablation procedure and successful repair of the cannulation by Angio-Seal STS plus （St. Jude Medical, St. Paul, MN, US）, a collagen-base vascular closure device.     

Application of the multi-planar reconstruction in endovascular treatment of type B aortic dissection

Background Although Multi-planar reconstruction （MPR） has been considered a diagnostic imaging technique that observes more perspectives for diseases,few people have applied it surgically.In fact,MPR is also very useful to clinical operation,especially for patients with type B aortic dissection.It helps the surgeon to locate accurately with more information about aortic dissection,so that the safety and effectiveness of operation can be improved.This study examined the application of the MPR in intraoperative DSA imaging for precise positioning by accurately obtaining a crosssection,a spin angle of the coronal plane,and a tilt angle of the sagittal plane in treatment of type B aortic dissection.Methods The conventional and the MPR approaches were compared on positioning the aortic arch for surgery.A group of 40 patients （group A） and another group of 42 patients （group B） was sampled.About the comparison of baseline characteristics,a fourfold table X2 test was conducted on gender,and two independent samples t-test was applied to age between group A and group B.Spin as well as tilt angles for group A were obtained from the patients using both approaches,and their effectiveness was compared with pair t-tests; The MPR data guided stent-grafting in this group.Stent graft placement of group B was based on the conventional approach.Percentages of proximal distributed markers as well as incidences of complications were collected from both groups after stent graft placement.They were also compared with a fourfold table X2 test.Results Gender difference was not found between group A and group B （X2=0.80,P ＞0.05）,and age difference was not statistically significant （F=2.55,homogeneity of variance,t=-1.46,P ＞0.05）.A significant difference was found between the conventional and the MPR approaches for spin angle （t=9.17） as well as tilt angle （t=-2.07）,P ＜0.05.Percentage of proximal distributed markers （5.0％） of group A was significantly lower than that of group B （42.9％）,X2=15.92,P ＜0.05;and incidence of complications （5.0％） of group A was also significant lower than that of group B （21.4％）,X2=4.76,P ＜0.05.Conclusions Application of the MPR facilitated intraoperative angle adaption and led to satisfactory DSA.It is feasible in endovascular treatment of type B aortic dissection,and can effectively and safely guide surgical operations.     

Delayed type IIIb endoleak using AnacondaTM stent graft in abdominal aortic aneurysm repair

Endoleaks are defined as the persistence of blood flow outside the lumen of the endoluminal graft but within an aneurysm sac or the adjacent vascular segment being treated by the graft and classified into 5 categories.     

益智健脑颗粒联合针灸对阿尔茨海默病大鼠学习记忆的影响

目的观察益智健脑颗粒联合针灸对阿尔茨海默病（Alzheimers disease,AD）大鼠学习记忆的影响。方法将大鼠随机分为假手术组（A组）、模型组（B组）、针灸组（C组）、益智＋针灸组（D组）各10只,B、C、D 3组分别以海马CA1区注射β淀粉样蛋白25-35（Aβ25-35）造模,A组注射等量的双蒸水,各组分别治疗20 d后行Morris水迷宫试验,观察大鼠学习记忆能力变化。结果B组较A组的平均潜伏期明显延长,差异具有统计学意义（P〈0.05）;与B组比较,C组、D组的平均潜伏期明显缩短,过台次数增多,差异具有统计学意义（P〈0.05,P〈0.01）;与C组比较,D组的潜伏期缩短,过台次数增多,差异具有统计学意义（P〈0.05）。结论益智健脑颗粒联合针灸能够提高Aβ25-35介导的AD模型大鼠的学习记忆能力。