局部麻醉施行无张力疝修补术(附357例报告)

目的探讨局部麻醉施行无张力疝修补术治疗腹股沟疝的可行性，并总结临床经验。方法局部麻醉下无张力疝修补术治疗腹股沟疝357例，对麻醉效果及手术时间、并发症和复发率进行回顾性分析。结果病人术中疼痛耐受良好，平均手术时间42min，3～24h内可以下床活动，术后平均住院时间3．6d。术后出现尿潴留2例，切口皮下脂肪液化2例，阴囊积液2例，补片异物反应1例，并发症发生率为1．96％(7／357)。随访2个月～5年未见复发病例。结论局麻下施行无张力疝修补术具有快捷、安全、疗效好和疼痛耐受良好等优点，能明显降低手术并发症、住院时间和住院费用，局麻尤其适合老年人及合并慢性疾患的腹股沟疝患者。     

局麻下善愈补片在腹股沟疝无张力修补术中的应用

目的探讨局麻下善愈补片在腹股沟疝修补术中的应用经验。方法回顾性分析并随访我院近4年来在局麻下施行的善愈补片无张力腹股沟疝修补术104例(114侧),对患者手术前合并症、手术时间、手术方式、术后并发症以及术后住院天数进行综合分析。结果本组患者手术过程顺利,麻醉效果好,术后疼痛耐受好,不需常规应用镇痛药物,并发症少,手术时间平均45min(30～60min),术后住院天数3～7d,术后随访6～24个月无复发。结论局麻下应用善愈补片实施腹股沟疝无张力修补术可行性好,该术式具有简单、安全、并发症少、术后恢复快、费用低等优点,适合于成人各种腹股沟疝的治疗。     

门诊局麻下腹股沟无张力疝修补术58例

目的探讨在门诊局麻下施行无张力疝修补术,治疗腹股沟疝的可行性和安全性。方法回顾性分析2005年9月至2008年8月间,在门诊局麻下所施行的58例无张力疝修补术,总结临床经验。结果手术全部成功,患者术中疼痛耐受良好,平均手术时间39min,10～30min即可下床活动。术后出现尿潴留1例,阴囊积液1例,随访4～37个月无复发病例。结论成人腹股沟疝在门诊局麻下施行无张力疝修补术安全、简单、疼痛轻、恢复快、复发率低,是安全可行的,值得推广应用。     

3 DMax补片应用于前入路腹膜前间隙疝修补术

目的：探讨3 DMax补片用于前入路腹膜前间隙疝修补术的应用技巧。方法回顾性分析2012年10月至2013年10月,江苏省中西医结合医院收治的23例腹股沟疝患者,均在连续性硬膜外间隙阻滞麻醉下行前入路腹膜前间隙疝修补术,分析总结其手术时间、术后并发症、随访术后复发等情况。结果手术时间45～70 min,术后手术区域有轻微的坠胀感6例,未发生切口感染、血清肿、腹膜前间隙血肿等情况。随访1～13个月,未发生慢性疼痛及复发。结论3 DMax补片用于前入路腹膜前间隙疝修补术是安全可行的。     

局麻下同时性双侧腹股沟无张力疝修补术

目的探讨局麻下同时施行双侧腹股沟疝无张力修补术治疗的可行性和安全性。摸索适合我国国情的双侧腹股沟疝的外科处理方式。方法回顾性分析2002年5月至2008年4月在局麻下施行无张力疝修补术的235例患者,其中同时性双侧疝修补96例,分期双侧疝修补27例和单侧疝修补112例。结果所有手术均在局麻下完成,手术方式均为疝环填充式（mesh-plug）无张力疝修补。96例同时性双侧疝修补均由同一医师序列完成双侧修补;同时性双侧修补术平均手术时间（92±23）min,单侧疝修补术平均手术时间（56±21）min,二者比较差异有统计学意义（P〈0.05）。平均住院时间,阴囊积液或血肿,切口感染,尿潴留,术后疼痛,术后6个月内腹股沟区疼痛或不适和术后复发差异无统计学意义（P〉0.05）。结论双侧腹股沟疝可以在局麻下施行同时性无张力疝修补,安全可行,避免了患者行分期手术的痛苦。     

无张力疝修补术治疗腹股沟疝40例体会

目的总结应用聚丙烯网状补片治疗腹股沟疝107例的近期治疗效果。方法使用聚丙烯网状补片对107例各类腹股沟疝患者进行无张力疝修补;观察手术方法、时间、术后患者自主能力恢复、术后伤口疼痛、并发症和复发率。结果107例患者共施行116次lichtenstein无张力疝修补术,单侧疝及双侧疝平均手术时间为45 min和90 min,术后2~6 h下床活动,术后患者疼痛轻,术后1例发生阴囊积液,1例发生皮下血肿,患者均于术后3~5 d痊愈出院,90%病例获随访,随访时间3~14个月,无复发病例。结论无张力疝修补术治疗腹股沟疝有手术方法简单、手术指征广、术后疼痛轻、恢复快、并发症少和复发率低的优点。     

善愈补片在腹股沟疝腹膜前修补术中应用的体会

目的探讨善愈补片腹膜前修补腹股沟疝的经验和疗效。方法对56例腹股沟疝患者在持续硬膜外麻醉或局麻下行善愈腹膜前无张力修补术,观察手术时间,术后并发症、平均住院日和近期随访情况。结果本组患者围手术期无死亡,手术时间30～55min,平均40min,所有患者手术后无切口感染,2例出现阴囊水肿,住院时间3～7d,随访9—20个月,无复发,无明显异物感,无术后慢性疼痛。结论善愈腹膜前腹股沟疝无张力修补术是一种安全、可靠的手术方式,尤其适用于疝环或腹横筋膜缺损较大及复发的腹股沟疝患者。     

预裁剪聚丙烯平片行前入路腹膜前无张力疝修补术63例体会

目的探讨预裁剪聚丙烯平片行前入路腹膜前无张力疝修补术的临床应用效果。方法分析我院于2007年3月至2008年5月应用预裁剪聚丙烯平片对63例腹股沟疝患者行前入路腹膜前无张力疝修补术的效果。结果手术时间40—100min,平均52min。术后切口疼痛轻,所有患者术后2—6h均能下床活动。术后阴囊积液1例。术后无感染。术后住院时间2～6d,平均3．4d。随访3～16个月,无1例术后复发、无异物感。补片价格远低于Kugel等开放式腹膜前疝修补定型补片。结论应用预裁剪聚丙烯平片行前入路腹膜前无张力疝修补术是全腹股沟区修补,适合修复各型腹股沟疝。由于操作简便、安全和经济等特点,易于推广。     

局麻下Modified Kugel^TM疝补片在老年腹股沟疝修补术中的应用

目的 探讨局麻下Modified Kugel^TM疝补片在老年腹股沟疝无张力修补术中的应用效果。方法回顾分析2005年4月至2007年5月我科使用巴德公司Kugel^TM疝补片在局麻下修补老年腹股沟疝87例的临床资料（包括手术时间、手术出血量、术后并发症及住院时间）。结果平均手术时间42min，术中平均出血量37．5ml，86例切口甲级愈合，术后下床活动时间平均6．5h，切口疼痛7例，术后出现皮下血肿1例，阴囊水肿3例，局部有异物感2例。随访时间最长39个月，最短3个月，无一例复发。结论局麻下Modified Kuzel^TM疝补片存老年腹股沟疝的应用中优点明显、安全可靠。     

疝环充填式无张力疝修补术与腹膜前入路疝修补术的比较分析(附89例报告)

目的 比较腹膜前入路平片及疝环充填式无张力修补治疗腹股沟疝的疗效.方法 回顾性分析应用平片及疝环充填式无张力修补术两种方法 的手术时间、术后恢复时间、术后并发症及复发率.结果 均获随访,前入路腹膜修补组随访24.7个月,疝环充填式修补组随访25.9个月,两组平均手术时间、住院时间、术后疼痛、阴囊积液及恢复日常生活时间差异无统计学意义(P>0.05),术后异物感疝环充填式3例,腹膜前入路1例,疝环充填式复发1例,前入路腹膜前修补复发3例(P<0.05).结论 在腹股沟疝无张力修补治疗中,提倡治疗的个体化,选择性应用平片及疝环充填式无张力疝修补术.     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Anterior Interosseous Nerve Palsy After Shoulder Arthroscopy Treated With Surgical Decompression: A Case Series and Systematic Review of the Literature

Background: Anterior interosseous nerve (AIN) palsy is a very uncommon cause of upper extremity pain and weakness that comprises less than 1% of all upper extremity nerve palsies. Rarely reported but also mentioned in the literature is AIN palsy after shoulder arthroscopy. Methods: A systematic review of the literature to date using PubMed was conducted to identify patients who suffered AIN palsy after shoulder arthroscopy procedures. Articles included met the following criteria: (1) published in English; (2) primary presentation of the data; (3) patients had undergone shoulder arthroscopy before developing symptoms of AIN palsy; and (4) diagnosis was confirmed with clinical symptoms of AIN palsy. Measured outcomes included patient demographics, specific shoulder procedure, anesthesia procedure, intra-operative patient positioning, intra-operative compressive dressing, intra-operative traction, surgical versus conservative treatment, abnormal findings during decompression procedure, proposed mechanism of injury, and follow-up. Results: The search yielded 6 articles, of which 4 (13 cases) met inclusion criteria. An additional 2 cases were included in this report totaling 15 cases. The average patient age was 49 years (range: 31-64) with 73% males. At average follow-up of 24 months, 67% of patients experienced complete resolution of symptoms—more than half of which underwent surgical decompression. Patients who failed to progress experienced weakness of the flexor digitorum profundus and flexor pollicis longus muscles. Conclusions: Proposed injury mechanisms for AIN palsy after shoulder arthroscopy range from mechanical trauma, compressive hematoma, and direct anesthetic neurotoxicity. Management should be directed by clinical symptoms, imaging, and patient factors with majority of patients expected to have excellent clinical outcomes.     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.     

Fluorescence in the Sclera,Nails, and Teeth Secondary to Favipiravir Use for COVID-19 Infections

Favipiravir, an antiviral agent originally used for influenza infections, has become popular due to its beneficial signals in coronavirus disease. It is currently used in some countries within COVID-19 treatment protocols. This is an initial report of favipiravir-related fluorescence observed in three healthcare providers working in the same ward in our hospital. All three individuals had been diagnosed with COVID-19 two months earlier and were treated with favipiravir. None of the three individuals received hydroxychloroquine or tetracyclines. Wood’s light examination led to an incidental discovery of favipiravir-induced fluorescence involving the sclera, nails, and teeth. In all patients, white linear, square, and band-like specks of fluorescence were noticed on the sclera of both eyes, some teeth, and the proximal part of all fingernails and toenails. Exposure of the eyes to the Wood’s light was for a brief duration of 3 to 5 seconds during examination and photodocumentation. Favipiravir might cause bright white fluorescence of nails, sclera, and teeth, detectable by Wood’s light even two months after its cessation.     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Factors Associated With Reoperation After Silicone Proximal Interphalangeal Joint Arthroplasty

Background: Silicone proximal interphalangeal (PIP) joint arthroplasty has a high revision rate. It has been suggested that persistent ulnar deviation and joint instability influence the durability of PIP silicone arthroplasties. The goal of this study was to evaluate what factors are associated with reoperation after silicone PIP arthroplasty. Methods: We retrospectively evaluated all adult patients who underwent PIP silicone arthroplasty between 2002 and 2016 at one institutional system for inflammatory-, posttraumatic-, and primary degenerative arthritis. After manual chart review, we included 91 patients who underwent 114 arthroplasties. Fingers operated included 14 index, 41 middle, 38 ring, and 21 small fingers. Results: The overall reoperation rate was 14% (n = 16). Non-Caucasian race (P = .040), smoking (P = .022) and PIP silicone arthroplasty for post-traumatic osteoarthritis (P = .021) were associated with reoperation. The 1-, 5- and 10-year implant survival rates were 87%, 85%, and 85%, respectively. Conclusion: Caution should be exercised when considering PIP silicone arthroplasty of the index finger or in patients with post-traumatic osteoarthritis. It may be worthwhile addressing smoking behavior before pursuing silicone PIP arthroplasty.     

血浆凝血因子VIII水平与IgA肾病患者临床病理改变及预后的关系

目的探讨血浆凝血因子VIII(factor VIII,FVIII)水平与IgA肾病(IgAN)患者临床参数及预后的关系。方法收集2016年1月至2016年12月中南大学湘雅二医院确诊的IgAN患者的临床资料。按照时间依赖的受试者工作特征曲线(ROC)得出的血浆FVIII预测IgAN预后的临界值,将患者分为高FVIII组(FVIII>140.50%)和低FVIII组(FVIII≤140.50%),比较两组患者肾活检时基线临床参数的差异。以估算肾小球滤过率(eGFR)下降≥30%或进入终末期肾脏病(ESRD)为终点事件,采用Kaplan-Meier生存曲线及Cox回归方程法分析血浆FVIII水平对IgAN患者预后的影响。结果共93例IgAN患者纳入本研究,中位随访时间为35.15(33.77,36.76)个月,12例(12.90%)患者发生终点事件。高FVIII组患者年龄、血肌酐、尿素氮、血三酰甘油、血总胆固醇、血浆纤维蛋白原、D-二聚体、24 h尿蛋白量、蛋白C、蛋白S和eGFR下降速率高于低FVIII组(均P<0.05);eGFR、血白蛋白、中位随访时间低于低FVIII组(均P<0.05)。Kaplan-Meier生存分析结果显示,与低FVIII组比较,高FVIII组患者肾脏累积生存率降低(χ2=5.635,P=0.018)。在校正收缩压、eGFR、尿蛋白、肾小管萎缩/间质纤维化程度等因素后,多因素Cox回归分析结果显示,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素(HR=4.147,95%CI 1.055~16.308,P=0.042)。结论血浆FVIII水平与IgAN患者临床指标及预后相关,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素。