内支架置入对食管良恶性狭窄姑息性治疗的临床应用

目的 采用内支架置入的方法对食管良恶性狭窄和食管瘘患者进行姑息性治疗,观察并比较进口支架和国产支架的临床应用情况。方法 20例食管癌所致食管狭窄患者中,手术后吻合口狭窄3例,合并食管－气管瘘4例,食管－纵 隔瘘1例。置入进口支架10个;国产支架10个。对4例食管造影显示完全梗阻和7例严重狭窄的患者,先行球囊扩张,后置入支架。9例直接置入。结果 15例单纯食管狭窄患者置入支架后,进食情况明显改善,5例合并瘘者置入带膜支架后,瘘口消失。分别随访2个月至2年。1例20d后死于消化道大出血。3例6个月后再次出现狭窄,1例行放射治疗,2例第2次置入支架。其余患者均未出现明显的进食障碍。结论 食管内支架置入术简单、安全、近期疗效明显,无严重并发症,是食管癌性狭窄和食管瘘的一种良好的姑息性治疗方法。国产支架与进出口支架疗效相仿,值得临床推广应用。     

食管内支架应用技术

目的：探讨金属内支架对于治疗食管病变的应用技术及临床疗效。材料与方法：采用ｓｔｅｎｔ技术对５３例食管病变施行了食管内支架置入术。其中食管良性狭窄４例，术后吻合口狭窄１８例，恶性狭窄２５例，癌性食管－气管瘘６例，结果：记忆合金支架在食管内全部释放成功。良恶性狭窄病人术后即可进食，食管－气管瘘的病人术后瘘口堵塞成功，肺部感染得以控制。结论：食管内支架置入术对于治疗食管良性病变疗效显著、安全可靠、值得推     

食管手术后介入治疗方法的选择(附50例报告)

目的：探讨食管手术后，吻合口狭窄的介入治疗方法的选择。方法：回顾性总结50例食管手术后吻合口狭窄和瘘的人和治疗效果及方法。结果：23例吻合口狭窄处和瘘口区支架置入，27例行气囊扩张，治疗效果均较满意。结论：食管手术后吻合口狭窄或吻合口瘘的介入治疗，效果十分明显，此再次手术更有价值。     

恶性食道纵膈胸膜瘘覆膜支架置入治疗

目的：探讨食道覆膜支架置入治疗恶性食管纵膈瘘胸膜瘘的疗效、禁忌症。方法：收集5例食管纵膈瘘胸膜瘘患者采用食道覆膜支架置入术治疗并随访、总结。结果：5倒患者术后摄影均见食道支架位置良好。1例患者于术后10小时上厕所后突发呕血家属拒绝治疗后死亡。其余4例患者术后食道造影见病灶狭窄部位均有不同程度的改善，造影剂均未见外漏。2周、1月、2月后食道造影复查，3例患者食道支架均未发现移位及狭窄，造影剂均未见漏入纵膈及胸腔。结论：（1）覆膜支架对晚期食道癌伴纵膈瘘胸膜瘘的姑息疗法安全、有效，对提高病人的生活质量是一个好的方法。（2）发现短期内食管纵膈瘘胸膜瘘瘘口明显扩大或CT见原发性食道癌病灶内较长的液化坏死区者为食道支架置入术相对禁忌症。     

覆膜内支架在食管癌术后吻合口瘘中的应用

目的：观察覆膜内支架在食管癌术后吻合口瘘中的应用效果。方法：15例中、晚期食管癌术后3－21天出现吻合口瘘。瘘口直径0．8－2．1cm。将180cm长交换导丝经口送入胃内，沿导丝送入支架输送系统，将直径1．8cm的双喇叭覆聚氨脂膜的镍钛记忆合金食管内支架的中点置于瘘口平面，透视下缓慢释放支架，后撤出输送系统和导丝。结果：全部病例均一次放置成功，技术成功率为100％。13例患者一次堵瘘成功，患者在支架置入术后3－7天进半流质食物，15天后进普食，其余2例病情改善。结论：覆膜双喇叭记忆合金内支架为封堵食管癌术后吻合口瘘最有效的方法之一。     

食管癌术后吻合口瘘X线造影分析

目的:分析食管癌术后吻合口瘘的X线造影表现,探讨X线造影检查的价值。方法:对58例食管癌术后吻合口瘘患者的X线造影检查资料进行回顾性分析。结果:58例食管癌术后吻合口瘘患者中,吻合口纵隔瘘31例,吻合口胸腔瘘18例,吻合口气管瘘3例,残胃胸腔瘘6例;单发瘘46例,多发瘘12例;瘘口直径小于3mm者34例,3～6mm者19例,大于6mm者5例;术后3d内发生瘘者18例,术后4～15d内发生瘘者37例,术后16～30d内发生瘘者3例。结论:X线造影检查能清晰显示瘘口情况,为早期发现吻合口瘘提供准确可靠的依据,具有重要的诊断价值。     

食管胃吻合口-胸腔瘘的影像学诊断和介入治疗

目的：探讨食管胃吻合口-胸腔瘘的影像学特征及其介入治疗方法。方法：回顾性分析6例具有完整临床资料的食管胃吻合口-胸腔瘘的口服碘水造影及CT表现；透视下，置入蘑菇状覆膜内支架封堵瘘口。结果：6例口服碘水造影显示对比剂均经吻合口溢入胸腔；6例螺旋CT检查，其中5例显示吻合口与胸腔相通，1例瘘口小而未显示。全部病例顺利置入内支架，既完全封堵了瘘口，又解决了进食问题。结论：根据口服碘水造影和螺旋CT征象可以诊断食管胃吻合口-胸腔瘘，置入蘑菇状覆膜内支架封堵瘘口操作简单、安全、近期疗效明显，是一项值得推广的新技术。     

食管金属内支架的临床应用(附37例报告)

目的:评价食管金属内支架临床应用效果。对象与方法:37例病人其中12例食管-胃吻合口狭窄,8例食管癌致食管气管瘘,6例食管癌放疗后狭窄,5例食管癌性狭窄,2例食管癌术后吻合口复发,以及4例贲门失弛缓症,在透视下(24例)或纤维内窥镜下(13例)被置放了国产食管金属内支架。结果:置放食管金属内支架后,全部病人食道梗阻症状均较原来有某种程度的缓解,其中,17例能进普食,15例能进半流食,只有5例需用流食。除1例于术后1周死于并发腹腔内感染外,其余36例于术后6至9个月复查表明,30例一直保持良好状况,仅有6例因食管癌进展或术后吻合口复发而致食管再度出现狭窄,然而经气囊导管再次扩张后,狭窄得以迅速缓解。结论:食管-胃吻合口狭窄,食管癌放疗后狭窄,以及贲门失弛缓症是采用食管金属内支架的最佳适应症。     

置管引流联合医用胶治疗胸腔内吻合口瘘9例

目的评价DSA下置管引流联合医用胶封堵治疗胸腔内吻合口瘘的疗效。方法回顾2016年8月至2018年5月食管癌或胃癌术后胸腔内吻合口瘘的患者9例,分析应用DSA下置管引流联合医用胶封堵治疗吻合口瘘的愈合情况。结果 9例患者均经口服泛影葡胺确诊,3例存在食管气管瘘,所有患者均经鼻成功置入三腔喂养管和引流管,经2~5 d引流后感染症状得到控制,2~3周后复查提示瘘口缩小、瘘道形成。引流量<10 mL/d行造影复查,瘘口<0.5 cm并有瘘道形成时,DSA下经4 F单弯导管使用医用胶与碘化油混合液0.5~2 mL封堵瘘道,所有患者均一次性成功封堵。封堵术后观察1周后正常进食,拔管后痊愈出院,瘘口平均愈合时间35 d。结论 DSA下置管引流联合医用胶治疗胸腔内吻合口瘘可以提高瘘口封堵成功率,有效促进瘘口愈合,为一种有益的尝试。     

经鼻、食管引流及覆膜支架植入术治疗食管-胸腔瘘

目的 探索经鼻、食管引流及覆膜支架植入术治疗食管-胸腔瘘的可行性及临床价值.方法 7例食管胸腔瘘患者采用5 F猪尾巴多侧孔导管经鼻、食管行胸腔引流,并利用食管覆膜内支架封堵食管瘘口.术后经引流导管定时冲洗脓腔,复查脓腔造影.结果 患者一次性植入引流导管及堵瘘支架均获得成功;引流持续12～22 d,平均15 d;拔管前引流管造影提示脓腔明显变小或闭塞、液气胸得到明显控制,拔管后食管造影示瘘口封堵满意、支架完全复张,未见明显移位、狭窄等征象.结论 经鼻、食管引流及覆膜支架植入术治疗食管胸腔瘘,技术上可行,操作简易、安全,临床疗效肯定.     

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.