胰腺手术后胰瘘患者非手术治疗的护理进展

胰瘘是指胰腺手术后腹腔液体经引流部位或切口流出超过5 d,引流液中淀粉酶的浓度高于正常血清淀粉酶上限3倍以上,液体量大于10ml/d[1];多发生在胰腺手术后3～10d[2].胰瘘是胰腺术后最常见的并发症,发生率2%～28%[3-7];是导致住院时间延长,住院费用增加,引起其他并发症的主要原因.目前有资料显示对胰瘘进行非手术治疗有效率可达到85%～90%[8-9].     

基于耦合剂造影三维容积内插屏气检查(3D-VIBE)动态增强技术诊断直肠阴道瘘

目的探讨基于超声耦合剂造影三维容积内插屏气检查(3D-VIBE)动态增强(DCE)MRI对直肠阴道瘘(RVF)的诊断价值。方法回顾性分析23例经手术或肠镜证实的RVF患者,术前均接受MR检查,扫描前分别向肛管、阴道灌入适量超声耦合剂,而后采集矢状位、冠状位和轴位T1WI、轴位T2WI、轴位脂肪抑制T2WI、DWI和3D-VIBE DCE-MRI,记录瘘口数量、开口位置、瘘管支数及周围软组织病变情况,并与手术及肠镜结果进行对比。结果 23例患者中,12例经手术治疗,11例接受肠镜检查,共发现26个瘘口、27支瘘管,6例合并周围脓肿,3例存在放射状损伤。超声耦合剂造影+3D-VIBE DCE-MRI对于瘘口、瘘管的显示率及诊断周围脓肿、放射性损伤的准确率均高于各常规序列(P均<0.05)。结论基于超声耦合剂造影3D-VIBE DCE-MRI对RVF诊断价值较高。     

1例食管癌术后颈部吻合口瘘合并多重耐药菌感染患者的护理

正食管癌是消化道常见的恶性肿瘤,其首选治疗方法是进行手术。我国食管癌以胸中段、鳞癌居多,食管癌根治术多选用Ivor-Lewis、McKeown术式,为了追求手术效果,不可避免地会造成手术创伤大、术后并发症多[1]。吻合口瘘是食管癌根治术后严重的并发症之一,且颈部吻合口瘘发生率明显高于胸内吻合口瘘,国内食管癌术后颈部吻合口瘘发生率为2.5%～11.6%[2]。颈部吻合口瘘的发生不仅增加了患者的经济负担,还使患者饱受痛苦,大大增加了患者死亡的     

对比MRI与直肠腔内超声诊断直肠阴道瘘

目的 对比分析MRI和直肠腔内超声（ERUS）诊断直肠阴道瘘（RVF）的应用价值。方法 回顾性分析51例术前MRI和ERUS疑诊RVF患者，分别根据病因及复杂程度对瘘管进行分类；以手术结果为标准，比较MRI与ERUS诊断RVF的敏感度、特异度、准确率及其对各种类型RVF的检出率，分析MRI、ERUS诊断结果与手术结果的一致性以及MRI与ERUS二者之间诊断结果的一致性。结果 经手术证实40例存在RVF。MRI诊断RVF的敏感度、特异度、准确率（85.00%、90.90%、86.27%）与ERUS（80.00%、100.00%、84.31%）相比差异均无统计学意义（χ²=0.17、<0.01、<0.01，P均>0.05）。MRI、ERUS诊断结果与手术结果的一致性均较高（Kappa=0.65、0.63，P均<0.05）；二者之间诊断结果的一致性亦较高（Kappa=0.70，P<0.05）。MRI及ERUS对单纯性瘘的检出率均为100%，对复杂性瘘的检出率差异无统计学意义（χ²=0.17，P=0.69）；2种方法相结合，对复杂性瘘的检出率提高至88.57%（31/35）。MRI与ERUS对不同病因所致RVF检出率差异无统计学意义（P均>0.05）。结论 MRI及ERUS均可用于诊断RVF。对单纯性RVF建议以ERUS为首选检查方式。对于复杂性RVF，联合应用二者可提高检出率。     

1例食道癌术后并发吻合瘘患者的护理

我国食道癌的发病率在消化道恶性肿瘤中仅次于胃癌,对于早中期的患者,首选手术治疗法[1]。随着科学的发展,医学手段的不断提高,手术的成功率也逐渐上升,但也有部分患者会出现不同的并发症,如肺部并发症、吻合瘘、肺不张等,而吻合瘘是最严     

彩色多普勒超声在血液透析血管通路中的应用价值分析

目的：探究彩色多普勒超声应用于血液透析血管通路中的应用价值。方法：选取2020年5月—2021年5月绵阳市中心医院收治的64例终末期肾病接受前臂桡动脉-头静脉内瘘维持性血液透析患者开展研究,应用彩色多普勒超声检测动静脉内瘘成熟度和并发症。结果：接受造瘘后患者桡动脉内径（RAD）、桡动脉血流量（RVF）、头静脉管径（CVD）、头静脉血流量（CVF）随着造瘘时间延长而增大,差异均具有统计学意义（P <0.05）;发生并发症后,头静脉、桡动脉和吻合口较通畅患者血流动力学参数差异均存在统计学意义（P <0.05）。结论：通过彩色多普勒超声应用于血液透析血管通路当中,可检测动静脉内瘘成熟度,监测患者病变情况,为防治并发症提供证据。     

肝移植术后并发乳糜瘘患者的临床观察与护理

正腹部手术尤其是上腹部手术术后易发生乳糜性腹水,为富含乳糜微粒的淋巴液积聚在腹腔内所致,称为乳糜瘘[1]。肝移植术后乳糜瘘较为少见,文献报道其发生率为4.65%[2];一旦发生乳糜瘘,会导致患者出现营养不良、水电解质紊乱,且肝移植术后免疫抑制剂的使用增加了患者腹腔感染的风险,甚至会导致死亡等严重后果[3]。因此早期发现、及时治疗及有效护理,具有重要的临床意义。本院对4例肝移植术后乳糜瘘患者进行了细致的临床观察和精心护理,     

恶性梗阻性黄疸患者术后并发症的预防与护理

手术治疗恶性肿瘤导致的梗阻性黄疸，由于手术范围大，患者体质差，虽在围手术期的治疗上取得了很大的进展，但术后并发症发生率仍较高。加强对患者手术前后的护理，术前可改善患者的一般状况，术后可预防并发症的发生。恶性梗阻性黄疸患者术后并发症以胰瘘、胆瘘、肠瘘、上消化道出血多见，除需密切观察患者生命体征的变化外，重要的是观察和护理各种引流管     

经皮内镜下胃和空肠造瘘术治疗食管瘘患者的护理

食管瘘多数发生于食管手术后、食管癌放射治疗后或食管癌晚期.既往多采取手术治疗,患者痛苦大、费用高,且并发症多[1],随着内镜技术的不断发展,内镜下对食管瘘的治疗方法也越来越多.     

低位直肠癌术后直肠阴道瘘的综合治疗分析

直肠阴道瘘(rectovaginal,RVF)是直肠前壁与阴道后壁之间形成的异常通道,又称粪疾[1].临床上表现为粪便不由自主的由阴道溢出及由阴道排气[2].现结合本院2000年10月至2008年10月收治的9 例直肠癌术后直肠阴道瘘患者的临床资料,对其治疗方法与治疗效果进行探讨.现报道如下.     

Intérêt du Télos dans l'évaluation de la laxité chronique antérieure du genou en pré- et en postopératoire

The objective of our work is to clarify the contribution of knee arthrometer in the diagnosis of the anterior laxity of the knee, to look for the factors of escalation of this pathology, to estimate the objective results and outcomes following of the anterior cruciate ligament surgery. It is about a retrospective study which concerned 78 patients presenting the anterior chronic laxity of the knee, investigated, treated and followed in the M.-T.-Kassab Institute of Orthopaedics over a period of 10 years. The average age of our patients was of 27.6 years with a male ascendancy. The anterior cruciate ligament surgery was realized according to the technique of Kenneth-Jones under arthroscopy. The arthrometer has been used to determine the outcome 6 months after the surgery. Before the surgery, the average anterior translation of the tibia was 15.3 mm, 95% of the patients had 8 mm previous absolute laxity, while the differential was about 4 mm in 87% of the cases in which comparative study could be made. There was a statistically significant correlation between the Lachman's test, the internal meniscus injuries and the delay accident — surgery with the anterior knee laxity in the arthrometer. The postoperative average laxity was bout 8.2 mm and earning was proportional to the importance of the initial tibial translation. The present study demonstrates that arthrometer tests may be an objective complement for the clinical exam, with a diagnostic, previous and therapeutic purpose.     

Place du traitement médicamenteux et des infiltrations dans la prise en charge médicale des lésions de la coiffe des rotateurs

One of the main objectives of medical treatment of rotator cuff lesions is to attenuate or totally relieve pain and allow the patient to access the next phase of functional rehabilitation. Relative rest is desirable. Harmful sports movement should be avoided. Strict immobilization is never indicated. The question is raised as to whether wider use of analgesics would be warranted. The inflammatory nature of rotator cuff tendiopathies remains to be clearly demonstrated and the efficacy of analgesics in this indication would be related more to their intrinsic pain killer action. Analgesics should thus be prescribed prudently and limited to a few days, particularly because of the potential adverse effects. Theoretically, steroidal anti-inflammatory drugs should not be used for tendonitis. Myorelaxing agents could be used in the event of associated muscle contracture. If the patient requires further relief, corticosteroid injections could be considered, taking care to avoid contraindications for intra-articular injections and avoiding any risk of contamination while keeping in mind the possible adverse effects.     

宫颈高度鳞状上皮内瘤变的“即诊即治”策略

目的探讨宫颈高度鳞状上皮内瘤变应用＂即诊即治＂策略的价值。方法选取宫颈细胞学检查为高度鳞状上皮内瘤变（HSIL）,并经阴道镜检查、镜下活检及宫颈电圈切除术（LEEP）治疗的患者76例,按阴道镜RCI评分分成高评分组、低评分组,对组织病理结果及过度治疗率进行回顾性分析。结果 RCI高评分组CINⅡ、Ⅲ及以上病变比例为97.4%,低评分组59.5%,高评分组过度治疗率2.6%,低评分组40.5%（P〈0.001）,不同RCI评分组的过度治疗率差异有统计学意义,高评分组过度治疗率显著低于低评分组。结论对于细胞学为HSIL,经阴道镜检查RCI高评分,提示高度病变的患者,采取＂即诊即治＂策略快速而有效地进行诊治,是较为适宜的;而细胞学检查HISL、RCI低评分者,仍以传统三阶梯方案进行筛查诊治为宜。     

Instabilité antérieure récidivante de l'épaule chez le rugbyman. Résultats d'une série de 85 épaules opérées par la technique de Latarjet avec un recul moyen de sept ans

The stabilization of an unstable chronic shoulder is a difficult challenge in the contact sportsman especially the rugby player. We report our experience of the modified Latarjet procedure with a retrospective series of 85 shoulders (79 rugbymen at 75 months follow-up). It acted all young men with a prevalence of dominant shoulder, occupying all the stations (over-representation of the third lines). Eighty percent presented osseous lesions; the first luxation was traumatic during a tackle. We describe our technique and our postoperative protocol. Seven percent experienced recurrence of their instability after a new traumatism and 67% returned to rugby within 8 months by keeping for some of them a sport practice functional embarrassment (16 patients). Only two mechanical complications were observed, 93% of the patients were satisfied with their intervention.     

Épicondylites : « les nouveautés en 2007 »

What news for 2007 concerning sportsmen lateral epicondylitis? Concerning biomechanics, we will evaluate the role of the supinatus at the same time we will talk about the complex characteristics of the functionnel unit. An anatomic work has showed in some cases, the involvment of ligment structure that could explain the atypical side of the pain and sometime the failure of the treatment. As for rehabilitation, we will insist on the importance of excentric work. The braces conserve a certain importance. We insist on new therapeutics and mostly on the interest of trinitrine patches. Botulinium toxic is still discussed and the recent study of Hayton does not show any significant difference with placebo injection. An original autologue blood injection in the epicondylitis tendon demonstrates good results and specially in the cases that resist to the corticoid therapeutics. We will talk about our experience. Considering corticoide injections a Crowther publication reveals a significant result compared to choc waves therapy. At last, we will criticize the Smidt study because we believe that the use of fluorite corticoid induce iatrogenic effects. We will conclude this article by our 2007 propositions about the local corticoid indication.     

Analysis of older adults visiting the emergency department with fever as a suspected Covid-19 vaccine-related adverse reaction: A retrospective multicenter study

IntroductionAfter COVID-19 vaccination was initiated, the number of patients visiting the emergency department (ED) with vaccine-related adverse reactions increased. We investigated the clinical features of older adults (aged 65 years and older) visiting the ED with self-reported COVID-19 postvaccination fever.MethodsWe conducted a retrospective observational study at three EDs between March 2021 and September 2021. Patients who reported adverse reactions, fever (≥37.5 °C) and/or febrile sensation or rigors following COVID-19 vaccination were included. The demographic and clinical data of these patients were collected by reviewing their medical records.ResultsA total of 562 patients were selected, and 396 (70.5%) were female. The older adult group included 155 (27.6%) patients, and the median age was 75 (69–79 years). The older adults less frequently had a fever (≥37.5 °C) upon ED presentation (75.5% vs. 85.7%, respectively), used more emergency medical services (43.9% vs. 18.7%, respectively), and visited an ED more frequently during early hours (00:00–06:00) (31% vs. 20.1%, respectively) compared to the younger adults (p = 0.004, p < 0.001 and p = 0.036). Fewer older adults visited an ED within 2 days of fever onset (73.5% vs. 84%) (p = 0.012), and more older adults were admitted for medical conditions other than vaccine-related adverse reactions (32.9% vs. 4.2%) (p < 0.001). Older adults received more thorough testing (laboratory and imaging tests). Among the older adults, the admission rate was associated with age (p = 0.003).ConclusionOlder adults presenting with fever as an adverse reaction following COVID-19 vaccination less frequently had a fever upon visiting the ED, required more ED testing, and had higher admission rates for non-vaccination-related medical conditions.     

Spécificités de la pratique du rugby chez l'enfant

The knowledge of the specificity of the child compared to the adult and his reactions regarding the exercise will make it possible to answer parents questions as well as possible and to accompany the child and the teenager in their sporting practice. Five essential concepts govern the practice of Rugby in the child: 1) the child is not an adult in miniature. It is an organization in constant evolution towards its physical and psychic statute of adult. He has a free will depending on the others; 2) Rugby must remain for him a ludic space, where the motivation must be the first condition; 3) the child is a mosaic of growth cartilages. Traumatic pathology is preferentially a pathology of this structure in the acute traumatisms (epiphysium separation rather than distorsion, muscular apophyse avulsion rather than tear) and under the effect of chronic microtraumatisms (osteochondrosis rather than tendinitis); 4) overtraining will result in a disturbance of one of the factors of the general balance of the organization which it acts of a pain, of against performance, an abnormal tiredness, of a demotivation, a relational disorder (mood, affectivity), of lower school output of which it will be necessary to establish a relationship to the sporting practice; 5) the execution of a sporting gesture must always be modulated as of the appearance of a pain, true alarm.