滑石粉胸膜粘连术治疗顽固性气胸的护理体会

目的:通过对滑石粉胸膜粘连术治疗顽固性气胸的术前术后护理,使患者积极接受手术,减轻痛苦,预防并发症,早日康复.方法:对16例患者进行观察、护理及康复指导.结果:患者能够积极配合治疗、护理,康复出院.结论:滑石粉胸膜粘连术治疗顽固性气胸操作简单、创伤小,副作用少,通过对患者的心理护理、引流管的护理、并发症的观察和及时外理能够减轻患者痛苦,使其安全渡过治疗期.     

14例顽固性自发性气胸的临床治疗与分析

<正> 我院1989年1月～2003年1月收治反复发作性气胸以及经持续负压吸引2周以上仍然漏气的顽固性气胸14例,全部实施手术治疗,无手术死亡,14例全部治愈。截止2003年1月底经随访观察,无1例复发,现报道分析如下。     

腋下小切口、肺叶悬吊、折叠结扎及综合粘连治疗顽固性气胸

目的 探讨顽固性复发性气胸治疗新术式,评价其治疗效果. 方法 腋下小切口,肺大疱折叠结扎,尽量不缝扎;以干纱布团摩擦脏壁层胸膜,并用过氧化氢冲洗;将相应肺段尽可能与壁层胸膜悬吊,使肺组织基本处于膨胀状态,避免肺过度压缩;术后胸膜腔每日注入5～10 ml 2%利多卡因共3天. 结果 21例（含1例双侧）手术均获成功.手术时间30～60 min,平均45 min.术中出血50～100 ml,平均70 ml.均无并发症.随访6～72个月,平均25个月,气胸无复发. 结论腋下小切口、肺叶悬吊、折叠结扎及综合粘连措施治疗顽固性复发性气胸效果可靠,创伤相对小,切口隐蔽性好,费用低,病人易于接受.     

纤维支气管镜介入治疗耐多药肺结核并发症的护理

对780例耐多药肺结核患者在全麻下经纤维支气管镜介入治疗.76例(占9.7%)发生咯血痰、恶心呕吐、咽喉肿痛、低氧血症、心律失常等并发症,经过治疗护理,全部临床治愈.痰菌阴转675例(86.5%),病灶吸收692例(88.7%),空洞缩小或闭合712例(91.3%),住院21～91(30.0±2.5)d出院.提出完善治疗前准备,严格无菌技术操作原则,术中术后加强监测,针对可能出现的并发症采取有效的防治措施是促进患者康复的保证.     

纤维支气管镜介入治疗耐多药肺结核并发症的护理

对780例耐多药肺结核患者在全麻下经纤维支气管镜介入治疗。76例（占9．7％）发生咯血痰、恶心呕吐、咽喉肿痛、低氧血症、心律失常等并发症。经过治疗护理,全部临床治愈。痰菌阴转675例（86．S％）,病灶吸收692例（88．7％）。空洞缩小或闭合712例（91．3％）,住院21～91（30．0±2．5）d出院。提出完善治疗前准备,严格无菌技术操作原则．术中术后加强监测,针对可能出现的并发症采取有效的防治措施是促进患者康复的保证。     

自发性顽固性气胸的外科治疗（附16例报告）

自发性顽固性气胸的外科治疗（附１６例报告）李志明戴天阳廖斌曾培元我院自１９８９年１０月～１９９５年３月，共收治自发性气胸病人４８例，其中１６例自发性顽固性气胸，经反复胸腔穿刺和多次胸腔闭式引流，疗效甚微，予以开胸手术治疗。现报告如下：１临床资料本组男...     

胆管癌介入治疗进展

胆管癌仅有少数患者可以通过手术而获治愈,近年来我国胆管癌的发病率明显上升。胆管癌的主要临床表现为梗阻性黄疸,未经过治疗的胆管癌自出现临床症状起,平均存活时间约为6个月。Klatshin[1]早就指出,胆管癌大多数患者并非死于肿瘤的广泛转移,主要死因是由于长期胆道梗阻导致的肝肾功能进行性损害或胆道感染、肝脓肿等并发症。故控制肿瘤的生长、维持胆道通畅就成了胆管癌姑息性治疗的关键。以保持胆管通畅为目的的胆道介入治疗在胆管癌的治疗中起着重要作用。一、术前胆道介入治疗许多胆管癌患者就诊时多已出现明显的黄疸,部分患者因胆道…     

外伤性肝破裂顽固性出血:介入治疗一例

1．一般资料：病人男，28岁，因车祸致肝破裂、大出血行外科填塞止血术。术后反复出血再次入院治疗。经引流管造影提示：肝右叶脓肿。B超示肝左右叶交界处一6．5cm×2．7cm大小不规则强回声区。CT示肝右叶一不规则形混杂密度灶，内有分隔，右侧胸腔包裹性积液，示术后肝脓肿形成。[第一段]     

Intrapleural administration of a large amount of diluted fibrin glue for intractable pneumothorax

Objective: Pleurodesis using chemical agents has been applied to high-risk patients with pneumothorax. This treatment, however, is sometimes unsuccessful in patients with intractable pneumothorax. We have developed intrapleural administration of diluted fibrin glue as an effective treatment for such patients.Methods: Fibrin glue was diluted 4-fold with saline and/or contrast media. Pleurodesis with a large amount of the diluted fibrin glue was performed in 55 high risk patients (57 cases, bil.2 patients) with intractable pneumothorax.Results: The air leaks were stopped by administration of the glue in all except 2 patients. During the follow-up period, a recurrence rate of 10.5% was observed. These recurrent pneumothoraces were successfully treated using the same procedure with no further recurrence. Pyrexia (12.3%) and chest discomfort (8.8%) were observed as side effects, and there was no occurrence of severe chest pain or thoracic empyema.Conclusions: These results suggested that intrapleural administration of a large amount of diluted fibrin glue was an effective treatment for intractable pneumothoraces in high-risk patients.     

FK 506 rescue therapy for intractable liver allograft rejection

Abstract Intractable liver allograft rejection remains an important cause of graft loss. In this Present study, we evaluated the role of oral FK 506 in 30 rejection episodes resistant to conventional cyclosporin-based triple immunosuppression in a series of 28 patients. Rejection was reversed in 11 (91.7%) of 12 patients for intractable acute rejection and in 10 (58.8%) of 17 patients for chronic rejection. A progressive decline in serum bilirubin was observed within 14 days in those successfully salvaged and a serum bilirubin of less than 200 μmol/1 at the time of FK 506 conversion in the chronic rejection subgroup was found to be good predictor of response (specificity 100%, sensitivity 60%). New onset diabetes mellitus (29%) and reversible renal impairment (32%) were the commonest adverse events observed. Eleven (52%) of the responding patients successfully discontinued corticosteroid medication and are currently on FK 506 monotherapy. FK 506 therapy has a significant impact in the control of both intractable acute and chronic allograft rejection with an acceptable toxicity profile.     

Insertion of a chest drain for pneumothorax

The insertion of a chest drain, either using the Seldinger technique or as a cut-down for a wide bore tube, is common and relatively straightforward. An appreciation of the anatomy, procedural technique and potential complications is important. The process is outlined here.     

Realistic and affordable lo-fidelity model for learning bronchoscopic transbronchial needle aspiration

Background  Transbronchial needle aspiration (TBNA) is used to sample mediastinal abnormalities and lymph node stations for diagnostic purposes and lung cancer staging. The procedure is underused, operator dependent, and reputed to have a steep learning curve. Other difficulties arise from a bronchoscopist’s failure to insert the needle satisfactorily into the target node. The purpose of this study was to evaluate the realism and helpfulness of a lo-fidelity, easily constructed hybrid model used for learning and practicing TBNA. Methods  The model is constructed by attaching a porcine tracheobronchial tree to a Laerdal Airway Model mounted on polyvinyl chloride (PVC) piping. Twelve individuals with various levels of bronchoscopy training and experience were given a 15-min introductory PowerPoint presentation on TBNA strategy and planning, execution, and response to complications. Participants then practiced TBNA alone and with guidance, aided by an assistant, as many times as individually necessary to feel comfortable with the procedure. A five-point Likert scale 8-item questionnaire was then completed. Results  Participants were unanimously positive about their experience (mean scores 4.25–4.91). The model was realistic, provided increased comfort with TBNA techniques, and allowed practice of communication skills. Conclusion  This realistic, affordable, and easily constructed hybrid lo-fidelity airway model allows beginner and experienced bronchoscopists opportunities to learn and practice basic TBNA techniques and team communication skills without placing patients at risk.     

Thoracoscopic treatment of spontaneous pneumothorax in children

Background/purpose

This study describes the authors experience and results with thoracoscopic treatment of spontaneous pneumotrorax (SP) in 22 children.

Methods

A total of 32 thoracoscopic procedures were performed in 22 children. The patients ranged in age from 9 to 21 years at the time of their first thoracoscopy. SP was primary in 9 and secondary in 13 patients. Pleurodesis was performed in all thoracoscopies using talc in 28 and pleural abrasion in 4 procedures. In 2 of these, apical pleurectomy was added to abrasion. Blebectomy was the additional surgical procedure associated with pleurodesis in 4 patients.

Results

Thoracoscopy usually was performed with the patient under general anesthesia. In children with severe respiratory insufficiency, regional anesthesia was used. The mean operative time was 42.6 minutes (range, 8 to 114 minutes). The mean time of postoperative chest tube drainage was 4.6 days (range, 2 to 12 days). Three patients with cystic fibrosis had prolonged air leak lasting longer than 7 days after thoracoscopy. None of them required an additional surgical intervention, and the air leak ceased in 8, 8, and 12 days with continuous suction. One patient required a repeat thoracoscopy for bleeding from an intercostal artery on postoperative day one. The mean follow-up was 4 years (range, 2.5 months to 14 years). There have been 2 partial recurrences (6.25%), both in patients with secondary SP, which were treated by a repeat thoracoscopy and talc pleurodesis.

Conclusions

Thoracoscopic treatment of SP is safe and effective in children. It can be performed under regional anesthesia also in children with severe respiratory insufficiency. Because the complications and recurrences are encountered more frequently in children with an underlying lung disease, special care in surgical manipulation is required in this subgroup of patients with SP.     

难治性癫痫显微外科治疗的疗效分析

目的 报道应用显微外科治疗难治性癫痫的临床效果。方法应用三维痫灶定位诊疗计划对163例顽固性癫痫患者进行术前、术中致痫灶三维精确定位，然后在显微镜下采用几种术式结合的方法手术处理致痫灶、致痫网。术后随访1～2年，回顾性分析显微外科手术治疗的临床效果。结果结果发现术后癫痫发作完全消失52例（31．90％），发作显著改善83例（50．92％），改善较好10例（6．13％），改善较差15例（9．20％），发作无改善3例（1．84％），手术总有效率为88．96％，无效率为11.04％，术后88．96％以上的患者生活质量均有一定程度的提高。结论应用显微外科技术切除癫痫病灶可以明显减少术后并发症，提高临床疗效。     

Contralateral tension pneumothorax during thoracotomy for lung resection

A patient underwent right thoracotomy and upper lobectomy for a mass found on routine chest radiography. He became profoundly cyanosed with a bradycardia and severe reduction in oxygen saturation at completion of surgery. The diagnosis of tension pneumothorax on the contralateral side to surgery was made and treatment instituted. The causes, treatment and implications of such an event during general anaesthesia for lung resection are discussed.     

Insertion of chest drain for pneumothorax

Insertion of chest drain for pneumothorax either through open or Seldinger technique is commonly performed. Clinicians are expected to have a clear understanding of the indications, anatomical landmarks and procedural detail in order to achieve successful patient outcomes. This article will focus on the technical aspect of chest drain insertion.