带血管蒂胸骨翻转术治疗漏斗胸86例

目的总结采用带血管蒂胸骨翻转术治疗先天性漏斗胸86例的经验和体会。方法全组均采用保留双乳内动脉和腹直肌血管，行胸骨180°翻转，翻转后将保留的双乳内动脉及腹肌血管置于胸骨前。结果本组病例术后均有明显效果，胸骨无缺血坏死，肺不张或肺感染6例，胸腔积液2例，均痊愈出院。术后住院9～20d，（平均16天）随访1～13年无一复发。结论改良胸骨翻转术治疗先天性漏斗胸的近远期效果满意。     

带血管蒂胸骨翻转治疗漏斗胸的护理

漏斗胸病因目前尚不十分清楚 ,文献报道与胸骨发育过短、肋软骨过长、膈肌中心腱索牵拉等使胸骨向后凹陷的因素有关。它使胸腔容积的胸廓前后径减少 ,从而压迫心脏 ,减小肺运动幅度 ,随年龄增长畸形加重而出现胸痛、胸闷、心悸、运动耐量受限等症状。手术是目前矫治畸形有效办法[1] 。术前充分的准备 ,术后严密的观察以及精心有效的护理措施 ,可避免各种并发症的发生 ,保证手术治疗的成功。现将我们护理 16例的体会报告如下。1　临床资料我科自 1992 - 0 4～ 1998- 0 6应用带血管蒂胸骨翻转术治疗漏斗胸 16例 ,男 11例 ,女 5例 ,年龄 3～ 16…     

胸骨悬吊治疗漏斗胸18例

传统的漏斗胸手术治疗方法有肋骨成形法、胸骨抬举法及胸骨翻转法,各有优点及不足之处。1987～1998年,我们收治漏斗胸18例,采用胸骨悬吊法治疗,效果较好。1　临床资料1.1　一般情况　男13例,女5例;年龄2～16岁,平均7岁。漏斗胸贮水36～162ml,平均71ml。心电图T波低平14例,倒置2例;肺功能均有不同程度受损;X线胸片示心脏均向左移位,侧位片椎、胸骨间隙3.2～7.7cm,平均5.1cm。漏斗胸指数<0.2者1例,0.2～0.3者13例,>0.3者4例。1.2　手术方法　全麻气管内插管控制呼吸。自凹陷胸骨正中线纵向切开至骨膜,沿肋骨前间隙用电刀向两侧分离至凹陷肋骨…     

改良Nuss手术矫治16例漏斗胸

目的探讨无胸腔镜辅助下改良的Nuss手术矫治漏斗胸的方法和疗效。方法16例漏斗胸患儿在无胸腔镜辅助下,双侧胸壁做横行切口,将塑型矫形板由右胸壁经胸骨后穿至左胸壁,翻转矫形板,将胸骨抬起矫正胸骨凹陷,钢板单侧固定于肋骨。结果16例均顺利完成手术,手术平均时间46min,无术中并发症。缝伤口前充分鼓肺排出胸腔内气体,未放置胸腔闭式引流。术后1例并发轻度皮下气肿,2d后自行消失。术后住院5—7d。16例随访1～32个月,均无不适,活动量如常,其中2例已取出Nuss钢板,矫形效果满意。结论改良的无胸腔镜辅助下Nuss手术矫治漏斗胸,具有切口小、美观、手术创伤小、方法简化、手术时间短等优点,值得推广应用。     

改良Nuss手术治疗小儿漏斗胸

目的介绍非胸腔镜辅助下改良Nuss手术治疗小儿漏斗胸的方法及疗效。方法采用改良的Nuss手术治疗34例漏斗胸惠儿,均在非胸腔镜辅助下,双侧胸壁做横行切口,将塑型矫形板由左胸壁经胸骨后穿至右胸壁,翻转矫形板,将胸骨抬起矫正胸骨凹陷,钢板单侧固定于肋骨。结果所有34例均顺利完成手术,手术时间35-60min,术中出血平均少于8ml,无一例输血,术后并发气胸1例,皮下积气3例,左侧固定片滑脱1例。术后住院天数约6-8d。矫形效果评定31例为优,3例为良,差0例。全部病例均获随访,随访时间5-21个月,均无明显不适,无钢板移位,矫形效果满意。结论非胸腔镜辅助下改良Nuss手术安全易行、创伤小、手术时间短、术后恢复快、近期矫形效果好。     

漏斗胸畸形程度对心脏形态和位置等影响的螺旋CT评价

目的　评价漏斗胸畸形的螺旋CT表现及胸骨凹陷对心脏形态和位置等的影响。方法　搜集 1999～ 2 0 0 3年行螺旋CT检查并经手术治疗的漏斗胸 32例。在CT图像上 ,观察和测定漏斗胸的胸骨凹陷深度、CT凹陷指数 [左胸矢状内径 (b)与胸椎体前缘至胸骨后缘距离 (a)的比值 ]、心脏旋转角度 (胸椎体前缘至心尖连线与胸矢状线的夹角 )和左下肺静脉干轴线与胸矢状线的夹角 (PV角 ) ,评价它们之间的关系。结果　 32例漏斗胸显示了不同程度的胸骨凹陷 ,平均凹陷深度为 (2 1± 7)mm ,CT凹陷指数 (b/a )为 2 9± 1 8,心脏旋转角为 (5 5 9± 9 8)° ,静脉角为 (49 8± 14 0 )°。胸骨轻度畸形 11例 (b/a <2 4 )、中度 12例 (b/a =2 4～ 2 9)、重度 9例 (b/a >2 9) ,胸骨平均凹陷深度分别为17、2 1、2 7mm ,三者间差异有非常显著性意义 (F =5 39,P <0 0 1) ;心脏旋转角分别为 4 9 7°、5 5 5°和6 6 9° ,三者间差异有非常显著性意义 (F =7 4 4 ,P <0 0 1) ;而PV角分别为 5 8 7°、4 6 5°和 4 2 4° ,三者间差异也有显著性意义 (F =3 33,P <0 0 5 )。随着CT凹陷指数的增加 ,心脏旋转角度也增大 ,两者的相关系数为 0 73(P <0 0 1)。结论　螺旋CT扫描可准确显示漏斗胸的胸骨畸形     

微创Nuss手术治疗成年人漏斗胸37例临床分析

目的总结Nuss手术治疗成年人漏斗胸的临床经验。方法 2012年1月-2013年7月对37例成年人漏斗胸患者行Nuss手术治疗,总结分析临床诊治资料。结果全部顺利完成手术,无死亡等严重并发症发生,留置一根支撑板16例,两根支撑板21例,全组手术时间(93.78±24.98)min;术中出血中位数20(QR 10)ml;术后平均住院天数(7.62±±2.20)d,参照Nuss等的方法评定胸廓形状,获优34例,良3例。结论成年人漏斗胸进行Nuss手术能达到良好的效果,但难度较大。     

改良胸骨抬举术治疗漏斗胸

改良胸骨抬举术操作简单,易掌握,术后无需取出固定材料,患儿易接受,疗效可靠。本文回顾性分析了1998年5月～2002年5月采用自行设计的改良胸骨抬举术治疗12例先天性漏斗胸患儿的临床资料,现将结果报道如下。     

带血管蒂胸骨翻转术治疗漏斗胸

漏斗胸是一种先天性畸形,可导致心肺功能障碍及心理上的变化,故手术矫形是必要的.我科于1989年收治先天性漏斗胸2例,治疗效果满意,报告如下:临床资料:本组2例为男性,年龄1例16岁,1例12岁.幼年时发现胸廓有轻度凹陷畸形,随着年龄     

外伤性动脉破裂的血管内治疗

目的 探讨介入治疗在外伤性动脉破裂出血紧急情况下的使用价值。方法 全组76例均行股动脉穿刺插管选择性血管造影,明确诊断后,13例用气囊导管经血管腔内阻断血流后再行血管修补术;63例用固体栓塞材料闭塞材料闭塞受损伤的动脉,结果 全组经血管内治疗出血立即停止,无并发症,无致残,无死亡,结论气囊导管阻断血流为血管修补手术提供了一条简单易行,安全可靠的术前措施,用血管内栓塞可达到一次性治愈的效果。     

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.