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1.
目的:探讨糖尿病小切口胆囊切除(MC)术前非胰岛素准备的可行性。方法:1996-1999年40例Ⅱ型糖尿病MC患据术前控制血糖的方法分成非胰岛素组和胰岛素组。比较其围手术期血糖、Na^ 、K^ 、二氧化碳结合力(CO2CP),观察MC术前非胰岛素准备对术后并发症的影响。结果:MC术前非胰岛素准备比胰岛素准备更能使糖尿病MC患术前血糖控制稳定,而不增加其术后并发症发生率。结论:非胰岛素准备是一简单、有效、易被接受的适合于糖尿病MC患术前控制血糖的方法。  相似文献   

2.
目的 探讨糖尿病小切口胆囊切除(MC)术前非胰岛素准备的可行性。方法1996-1999年40例Ⅱ型糖尿病MC患者据术前控制血糖的方法分成非胰岛素组和胰岛素组。比较其围手术期血糖、Na+、K+、二氧化碳结合力(CO2CP),观察MC术前非胰岛素准备对术后并发症的影响。结果MC术前非胰岛素准备比胰岛素准备更能使糖尿病MC患者术前血糖控制稳定,而不增加其术后并发症发生率。结论 非胰岛素准备是一简单、有效、易被接受的适合于糖尿病MC患者术前控制血糖的方法。  相似文献   

3.
小切口胆囊切除不同方法的探讨   总被引:8,自引:0,他引:8  
本院 1 994年 4月~ 2 0 0 1年 4月间共施行小切口胆囊切除术 1 5 5 8例 ,术中根据胆囊病变情况 ,分别采用逆行法、顺行 +逆行法、改良法切除胆囊 ,效果理想 ,现总结如下。1 临床资料1 .1 一般资料本组男 5 92例 ,女 996例 ;年龄 4~ 89岁 ,平均48岁。胆囊内结石 1 470 ,其中急性胆囊炎 5 8例 ,慢性萎缩性胆囊炎 1 0 2例 ;无结石性慢性胆囊炎 2 1例 ,胆囊息肉 67例。并存冠心病 1 8例 ,高血压 72例 ,糖尿病 2 9例 ,肝硬化 1 2例。1 .2 胆囊切除方式术前胆囊常规 B超定位 ,选择胆囊底体表投影的中点为切口外侧点 ,作 4~ 5 cm右上腹斜行…  相似文献   

4.
预防小切口胆囊切除后并发症   总被引:4,自引:0,他引:4  
杨昌平 《普外临床》1997,12(1):19-19
  相似文献   

5.
术前B超定位在小切口胆囊切除术选择切口中的价值   总被引:1,自引:0,他引:1  
目的 探讨术前B超定位在小切口胆囊切除术选择切口中的价值。方法 对95例小切口胆囊切除术前B超定位,了解胆囊大小,腹壁厚度,标记胆囊底、胆囊颈在腹壁上投影位置。结果 本组暴露满意率94.7%(90/95)。82例采用胆囊底与胆囊颈腹壁投影连续切口。11例采用“两孔法”,2例延长切口。术中视野清楚,三管关系清晰。总并发症5.3%(5/95),无严重并发症发生。结论 根据术前B超个体化选择切口是一种简便,有效的方法。  相似文献   

6.
随着医学技术的发展,治疗胆囊结石的方法很多,向着创伤小、疗效好、恢复快、安全性高、术后并发症少的方向发展。我院白2002年5月至2006年5月开展微小切口胆囊切除术56例,取得了满意效果,现报道如下:  相似文献   

7.
报道1995年5月~2001年10月小切口胆囊切除术208例,并发症10例,并发症率4.8%(10/208),其中腹腔内出血1例,胆总管横断1例,胆漏2例,胆总管残留结石3例,胆囊管残留过长3例.认为小切口胆囊切除术应慎用.  相似文献   

8.
目的比较腹腔镜胆囊切除术与小切口胆囊切除术两种术式治疗胆囊结石的临床疗效。方法选取2009年5月至2012年6月我院行手术治疗胆囊结石患者120例,其中60例行腹腔镜胆囊切除术作为实验组,小切口胆囊切除术手术治疗60例作为对照组。观察并比较两组临床疗效结果。结果实验组术中出血量少于对照组,手术时间、胃肠道功能恢复时间及术后住院时间短于对照组,两组比较,差异有统计学意义(P0.05);对照组、观察组术后并发症发生率分别为21.7%、8.3%,差异有统计学意义(P0.05)。结论腹腔镜胆囊切除术具有创伤小、恢复快、住院时间短和并发症少等优点,值得临床推广。  相似文献   

9.
报道小切口胆量切除术2000例。术中术后发生各种并发症81例(4.05%),其中较严重的胆总管损伤2例(0.1%),术中大出血2例(0.1%).术后漏胆7例(0.35%)、残留胆总管结石6例(0.3%)、近期粘连性肠梗阻3例(0.15%),切口感染55例(2.75%)。遗漏其它腹部疾病6例(03%)。作者认为:小切口胆量切除术的施术者需具备娴熟的传统胆囊切除术经验,此术是安全可行的。  相似文献   

10.
笔者将2000年1月至2001年12月间,所作的小切口胆囊切除手术(MC)共191例,与选择同期所作的腹腔镜胆囊切除手术(LC)98例作对比后,认为MC有较小的创伤、较高的安全性及较广泛的适应证,值得推广。现报告如下。1资料与方法1.1临床资料:2000年1月至2001年12月间共作MC191例。MC年龄组21~77岁,平均52岁;男性92例,女性99例。其中胆囊结石、慢性胆囊炎142例,胆囊息肉13例,急性胆囊炎36例。LC组年龄17~74岁,平均46岁;男性24例,女性74例,40岁以下女性62例。其中胆囊结石、慢性胆囊炎68例,胆囊息肉21例,急性胆囊炎9例。1.2手术方法:MC组采用常规…  相似文献   

11.
梗阻性黄疸患者的围手术期处理及死亡原因的探讨   总被引:7,自引:0,他引:7  
目的 探讨梗阻性黄疸围手术期处理和死亡原因。方法 对 1991年 12月~ 2 0 0 0年 12月间的 12 0例梗阻性黄疸患者进行回顾性分析 ,将 1995年以前的 5 8例患者作为 A组 ,1995年之后的 6 2例做为 B组进行比较研究。并对围手术期处理和死亡原因的探讨进行总结。结果  (1)梗阻性黄疸患者的内毒素血症 ,高胆红素血症及肝功、肾功受损和术后死亡有密切关系。(2 ) B组并发症和术后死亡率分别为 4 0 .3% (2 5 /6 2 ) ;6 5 % (4/6 2 ) ,较 A组并发症 81% (47/5 8)和术后死亡率 2 0 .7% (12 /5 8)有显著降低 (P<0 .0 0 1)。(3)血清胆红素 >342 μmol/L 患者的病死率 (45 .8% )明显高于血清胆红素≤ 342 μm ol/l(8.6 % )患者 (P<0 .0 0 5 )。恶性病例的病死率 (38.1% )也显著高于良性病例 (4.8% ) (P<0 .0 0 5 )。结论 加强围手术期处理 ,选择适当的手术方式可减少梗阻性黄疸患者的手术、术后病死率  相似文献   

12.
1990~1993年期间用替代疗法为42例原发性甲状腺机能亢进症患者作术前处理,取得良好效果,其优越性表现为:①能在甲状腺功能正常时手术;②可减轻甲状腺的血循环,使手术不仅出血少,易进行,更能避免手术并发症;③使甲状腺蓄积的激素处于低水平,不因手术而致血清甲状腺激素升高,从而确保了病情平稳,不会发生甲状腺危象。  相似文献   

13.
多种生长因子促糖尿病患者难愈合性创面愈合的临床研究   总被引:10,自引:2,他引:10  
目的 观察多种生长因子治疗糖尿病难愈合性创面的临床效果,并探讨其可能的机制。方法 将78 例糖尿病患者分为三组,即生理盐水对照组、表皮细胞生长因子( E G F)治疗组、血小板源伤口愈合因子( P D W H F)治疗组。观察治疗后1~8 周创面闭合指数、创面治愈率及组织形态学变化。结果  E G F组、 P D W H F组的创面闭合指数、创面治愈率较对照组明显增加,其肉芽组织毛细血管与成纤维细胞增生、胶原沉积和表皮覆盖明显,尤以溃疡与正常组织交界处明显。组间比较发现, P D W H F的促愈合作用优于 E G F。结论 局部应用多种生长因子可治疗糖尿病难愈合性创面,生长因子单独或配伍使用是改善糖尿病患者创面愈合受阻的有效措施。  相似文献   

14.
《Renal failure》2013,35(5):669-677
Cardiovascular disease is the major cause of death among patients with end stage renal disease and accounts for about half the deaths among the dialysis population. Several researchers have reported a high prevalence of coronary artery disease among diabetic patients with renal failure and coronary arteriography is often considered an integral part of the pretransplant evaluation of diabetic patients with end stage renal disease. However, very few reports have addressed the question of coronary disease in non-diabetic patients, and the pattern and prevalence of coronary artery disease in non-diabetic patients with end stage renal disease are not well defined. We evaluated the clinical and coronary angiographic findings in 158 consecutive patients (84 diabetic and 74 non-diabetic) with end stage renal disease. The coronary arteries were divided into 16 segments and each segment was analyzed for the presence of coronary disease, which was defined as the presence of ≥ 50% luminal diameter stenosis. Diabetic patients had more adverse risk factors for coronary artery disease, yet there was no significant difference in the prevalence of coronary artery disease between the diabetic and non-diabetic patients (67% vs. 55%, p = 0.15), or in the number of affected coronary artery segments (2.0 vs. 1.4, p = 0.05). Triple vessel coronary artery disease was however, significantly more common among the diabetic subjects (27% vs. 12%, p = 0.005). Non-diabetic patients with end stage renal disease also have a high prevalence of coronary artery disease and may merit as careful investigation of their coronary status as their diabetic counterparts.  相似文献   

15.
高血压病患者围手术期处理   总被引:2,自引:0,他引:2  
作者报道58例外科疾病同时伴有高血压患者的围手术期处理。强调术前适当降低血压,改善心脏功能,将舒张压控制在14kPa以内较为安全;术中严密观察血压变化,并作相应处理;术后充分止痛并继续抗高血压治疗  相似文献   

16.
Background : Foot complications in diabetes incur huge human and medical costs. There is a high incidence of complicated diabetes mellitus in Far North Queensland, particularly in the indigenous communities. Methods : An audit of 51 patients admitted to Cairns Base Hospital from July 1992 to December 1994 with diabetic foot complications requiring surgical intervention was performed. Results : The majority of surgical procedures were for serious infections in neuropathic feet precipitated by minor trauma. Surgical procedures included debridement/drainage, minor amputation, major amputation and arterial bypass. Half of the patients required more than one procedure and/or multiple admissions. Average length of stay was 48 days. Indigenous patients were overrepresented in this audited group. Conclusions : Prevention or minimization of diabetic foot complications can be achieved only through improvement in education and vigilance at all levels of the treatment process from community to hospital. Special attention to the needs of indigenous communities with a high incidence of diabetes must be a feature of any future initiatives.  相似文献   

17.

Background :

Immunological and inflammatory mechanisms play a key role in the development and progression of type 2 diabetes mellitus.

Aim :

To raise the hypothesis that alterations in immunological parameters occur after duodenojejunal bypass surgery combined with ileal interposition without gastrectomy, and influences the insulin metabolism of betacells.

Methods :

Seventeen patients with type 2 diabetes mellitus under clinical management were submitted to surgery and blood samples were collected before and six months after surgery for evaluation of the serum profile of proinflammatory (IFN-γ, TNF-α, IL-17A) and anti-inflammatory cytokines (IL-4, IL-10). In addition, anthropometric measures, glucose levels and insulin use were evaluated in each patient.

Results :

No changes in the expression pattern of proinflammatory cytokines were observed before and after surgery. In contrast, there was a significant decrease in IL-10 expression, which coincided with a reduction in the daily insulin dose, glycemic index, and BMI of the patients. Early presentation of food to the ileum may have induced the production of incretins such as GLP-1 and PYY which, together with glycemic control, contributed to weight loss, diabetes remission and the consequent good surgical prognosis of these patients. In addition, the control of metabolic syndrome was responsible for the reduction of IL-10 expression in these patients.

Conclusion :

These findings suggest the presence of low-grade inflammation in these patients during the postoperative period, certainly as a result of adequate glycemic control and absence of obesity, contributing to a good outcome of surgery.  相似文献   

18.
36例胆道探查T管引流术后并发症的原因及防治   总被引:8,自引:0,他引:8  
目的探讨胆道探查T管引流术后并发症发生的原因及其防治措施。方法对1986~2002年间我院行972例胆道探查T管引流术后发生并发症的36例临床资料作回顾性分析。结果36例并发症中胆瘘或胆汁性腹膜炎20例。胆道出血3例。胆道蛔虫症2例。T管压迫胃十二指肠致不全梗阻1例。T管拔断遗留胆总管内1例。术后胆汁引流量异常2例。术后黄疸急剧加深1例。并发急性胰腺炎2例。T管不能夹闭(胆道结石残留)3例。T管致胆道结石形成1例。本组保守治疗21例(58%),再手术治疗15例(42%)。除1例并发急性坏死性胰腺炎死亡、1例并发低渗性脱水、营养不良自动出院外,其余均痊愈出院。结论发生并发症的原因主要与手术操作技术、术后处理以及患者本身疾病、机体状况等有关。恰当的术中操作与术后处理以及针对患者自身不良因素积极采取相应的治疗是预防术后并发症发生的主要措施。  相似文献   

19.
表皮干细胞在糖尿病创面愈合过程中的动态变化   总被引:2,自引:0,他引:2  
目的 观察糖尿病(diabetes mellitus,DM)大鼠创伤后不同时期表皮厚度、表皮干细胞(epidermalste mcells,ESCs)数量变化和分布特征及创面愈合率等动态变化,探讨ESCs与DM皮肤创面难愈之间的关系。方法 48只Wistar大鼠,雄性,体重180~200g。随机分为DM组和正常对照组,各24只。DM组大鼠制备DM大鼠慢性创面愈合模型。两组大鼠同时用特制打孔器在大鼠背部脊柱两侧约1.5cm制作直径1.8cm、面积2.54cm。的全层皮肤缺损(共计96个创面),分别在致伤后第3、7、14和21天拍摄创面,计算创面愈合率;取创缘及肉芽组织,行HE染色及角蛋白19(keratin19,K19)和β1整合素抗体免疫组织化学染色,显微图像分析系统测量表皮厚度、阳性部分面积及灰度值。结果 致伤后第3、7、14和21天,正常对照组大鼠创面愈合率分别为24.48%±3.37%、50.46%±1.26%、92.82%±2.12%和99.41%±0.66%,而DM组分别为2.43%±1.02%、40.59%±1.65%、80.77%±3.57%和85.40%±0.94%,两组同时期比较差异有统计学意义(P〈0.01)。致伤后第3、7、14和21天,正常对照组表皮厚度分别为26.43±3.21、33.29±3.52、31.53±3.35和26.01±3.19p.m,DM组表皮厚度分别为23.58±2.33、31.02±3.38、33.72±5.49和21.80±4.02p.m,致伤后第3、21天,二者比较差异有统计学意义(P〈0.01)。致伤后第3、7、14和21天,正常对照组K19染色的平均阳性单位(positiveunit,PU)值分别为91.68%、93.14%、72.27%和70.31%,而DM组分别为40.29%、40.79%、29.94%和10.37%;正常对照组β1整合素染色的平均PU值分别为49.60%、91.16%、77.13%和57.17%,DM组分别为38.94%、24.16%、61.36%和38.83%,与正常对照组同时期比较,DM组K19和β1整合素染色的平均PU值都降低,且差异有统计学意义(P〈0.05)。结论 ESCs数量少和活性低可能是DM创面难愈的重要机制之一。  相似文献   

20.
Background  Postoperative morbidity remains a significant clinical problem and may alter long-term outcome particularly after neoadjuvant chemoradiation in patients with locally advanced low rectal cancer. The aim of the present study was to identify a potential long-term effect of postoperative morbidity. Methods  Analysis of prospectively collected data of 90 consecutive patients who underwent neoadjuvant chemoradiation and curative mesorectal excision for locally advanced (cT3/4, Nx, M0/1) adenocarcinoma of the mid and lower third of the rectum during a 7-year period (1996–2002). Results  Major postoperative complications occurred in 17.8% and minor complications in 26.6% of patients. Hospital mortality and 30-day mortality was 0%. Infectious complications were seen in 34.5%. The leading causes of infectious complications were anastomotic leakage and perineal wound infection. Postoperative morbidity was statistically significantly associated with gender (P < 0.05), pre-therapeutic haemoglobin level (P < 0.05), ASA score (P < 0.05), hospitalisation (P < 0.001) and clinical long-time course (P < 0.01). Moreover, early postoperative morbidity was proven as an independent prognostic factor concerning disease-free (P < 0.05) and overall survival (P < 0.05). Conclusion  Early postoperative morbidity in patients with preoperative chemoradiation due to locally advanced low rectal cancer is demonstrated as an independent prognosticator. Gender, pre-therapeutic haemoglobin level and ASA score indicate patients at risk for early postoperative complications and may therefore serve as predictive features.  相似文献   

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