Use of heparin in the prevention of thrombotic complications in aged oncologic patients

A method for the prevention of thrombotic complications with heparin was developed during examination of 30 elderly and old-aged patients who underwent operation for gastric carcinoma. It was established that the therapeutic activity of heparin in plasma is maintained for 6 hours after a single subcutaneous injection of 5,000 u. Four injections of this dose of heparin ensures its continuous therapeutic activity for 24 hours in elderly oncological patients. Heparin prevention in a daily dose of 20,000 u is safe from the standpoint of hemorrhagic complications. Under clinical conditions, control of plasma heparin activity may be accomplished by means of activated partial thromboplastin time.     

Use of leukoconcentrate in the treatment of postoperative suppurative complications in cardiosurgical patients with immunosuppression

Skin tests with a complex of antigens have revealed anergy in the postoperative period in 17 out of 116 patients with acquired heart diseases. Postoperative purulent complications were observed in 13 out of them. They were effectively treated by repeated transfusions of concentrations of the donor compatible leukocytes.     

Use of constant electric current in prevention of postoperative bronchopulmonary complications in patients with hiatal hernia

The prophylactics of bronchopulmonary complications was performed by the authors original method of intrapulmonary electrophoresis. It was shown to be effective and allowed the amount of postoperative bronchitis and pneumonia to be reduced from 15-20% to 4.4%.     

门静脉高压症断流术后并发症的防治

目的总结采用断流术治疗门静脉高压症的经验 ,分析术后并发症的发生原因并探讨其防治要点。方法自 1994年 4月～ 2 0 0 2年 7月我院为 2 36例肝硬化门静脉高压症患者施行了断流术 ,对这些病例进行回顾性分析。结果本组 6 5例术后发生并发症 (发生率为 2 7 5 % ) ,包括术后感染 2 4例 (10 2 % )、腹腔内出血 12例 (5 1% )、近期复发上消化道出血 8例 (3 4 % )、大量腹水 12例(5 1% )、急性门静脉血栓形成 7例 (3 0 % )、多器官功能不全综合征 2例 (1 0 % )。住院期间死亡8例 (死亡率为 3 4 % )。主要死亡原因 :腹腔内大出血致失血性休克 (2例 )、肝功能衰竭 (2例 )、重度感染全身衰竭 (4例 )。结论断流术后是否发生并发症主要取决于 :(1)手术适应证和手术时机的把握 ;(2 )手术技巧的掌握 ,术中应做到完全彻底的门奇静脉断流 ;(3)积极有效的围手术期处理。     

颈枕区融合术后并发症的防治

目的总结颈枕区融合术后的并发症,探讨其防治策略。方法回顾性分析1985年1月至2003年1月行颈枕区融合的318例患者,术后出现各种并发症65例次。并发症分为颈枕区并发症(围手术期并发症、中远期并发症)和供骨区并发症进行统计和分析。结果2名医师联系并接待复诊患者,300例获得随访,随访时间1.5～18年,平均6年8个月。单纯融合组并发症15例次,发生率38.5%,1例次神经症状加重、2例次植骨块移位、1例次植骨块吸收以及1例次植骨块不愈合者经翻修而恢复。融合内固定组并发症50例次,发生率19.1%。1例次Simmons钢丝固定术后神经症状加重,采用枕大孔减压颈枕融合Cervifix固定,神经症状明显改善。1例次先天性寰枢椎脱位Axis固定术后椎体移位加重,经口齿突切除、颈枕融合Cervifix固定。1例次Simmons钢丝固定术后3个月发现棘突骨折,行C1,2融合Vetex侧块螺钉固定,3个月后植骨块融合。螺钉方向不当致一过性神经根损伤者术中调整螺钉方向。4枚螺钉退出引起疼痛者取出螺钉。椎动脉损伤者经结扎椎动脉或拧入螺钉而止血。结论颈枕区融合术可发生多种并发症,恰当的处理预后良好。熟悉解剖、掌握技巧是减少并发症的前提,正确选择内固定系统可减少并发症的发生。加压包扎是处理供骨区血肿的有效方法。     

胰十二指肠切除术132例严重并发症的防治

目的总结胰十二指肠切除术(PD)严重并发症的防治经验。方法回顾性分析我院1997年1月至2009年10月间胰十二指肠切除术132例的临床资料,其中经典胰十二指肠切除术91例,保留幽门的胰十二指肠切除术(PPPD)25例,保留幽门和十二指肠升部的胰十二指肠切除术16例,联合门静脉部分切除1例,捆绑式胰肠吻合术28例。全组患者均放置胰管支撑引流,103例肝总管放置T管引流。结果术后胰瘘2例(1.52%),多系统器官功能衰竭死亡1例(0.76%),吻合口出血3例(2.27%),胆瘘2例(1.52%)。其他切口感染6例,胃排空延迟2例,肺部感染1例,腹腔脓肿1例。总体并发症发生率为13.6%。结论胰管内支架安放和肝总管T管引流是预防PD术后严重并发症的关键。及时有效的处理出血、胰瘘、胆瘘可最大限度地降低围手术期死亡率。     

The efficacy of blood culture in postoperative patients

Blood cultures are often obtained in postoperative patients to rule out bloodstream infections. Our study objectives were to determine the efficacy of blood cultures in postoperative patients with suspected sepsis and to determine variables predisposing patients to positive cultures. This was a retrospective study including patients with blood cultures drawn from January to March 2009 at our institution. We recorded demographics, presence of fever (temperature 101.5 degrees F or higher), elevated white blood cell count (12,000/microL or greater), central line, diabetes, intensive care unit admission, postoperative day of blood draw, National Research Council surgical wound classification, and pre- or postoperative antibiotics. Blood cultures were drawn from 150 patients undergoing surgery within 30 days prior. Sixteen had positive cultures and nine were true-positives (6.3%). There was no statistical difference (P > 0.05) between patients with positive and negative cultures except that those with negative cultures were more likely to have received preoperative antibiotics (P = 0.0186). Blood cultures are invasive, expensive tests with low yield. We recommend that blood cultures be drawn in patients not receiving preoperative antibiotics who have undergone surgery more than 4 days before culture.     

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先天性胆管扩张症是一种先天性的胆管发育异常,多在儿童时发病,手术是主要治疗措施。目前手术多采用囊肿切除、肝管空肠吻合术。术后远期并发症包括胆道感染、结石、吻合口狭窄及癌变。临床上应着重预防并发症的发生,出现并发症常需再次手术治疗。     

Surgical treatment of purulent necrotic complications in patients with diabetic foot syndrome]

Results of treatment of 207 patients with purulent-necrotic complications of the diabetic foot syndrome (DFS) were analyzed. Tactics of treatment was determined considering the DFS form presented, stage of the extremity ischemia, character and severity of purulent-inflammatory affection and the patient's homeostasis state. Urgent operation was performed in 79 (38.1%) patients, in 38 (48.1%) of them--amputation of extremity. In late follow-up period 98 (47.3%) patients were operated on, in 76 (75.5%) of them necrectomy or small amputation was performed, allowing to preserve the extremity. Conservative treatment was conducted in 30 (14.5%) patients with trophic ulcers. Application of elaborated program of treatment had permitted to increase the preservation frequency of supporting function of foot from 28.9 to 56.3% and to reduce general lethality from 18.3 to 13.5%.