56例十二指肠溃疡急性穿孔手术治疗的临床疗效观察

目的　观察十二指肠溃疡急性穿孔不同术式的临床疗效 ,探讨基层医院的术式选择。方法　对 1982年以来收治的十二指肠溃疡急性穿孔 5 6例病人行手术治疗。其中行单纯缝合修补术 4 0例 ,胃大部分切除术毕 -Ⅱ式 9例 ,其中幽门旷置术 2例。穿孔缝合修补术后行选择性胃迷走神经切断术 (SV)加幽门成型术 3例 ,高选择性迷走神经切断术 (HSV) 4例。对 5 6例病人进行 1～ 5年随访观察并对手术及术后疗效做回顾性分析比较。结果　单纯性缝合修补术无死亡病人 ,平均手术时间 4 6min ,平均住院时间 8d ,明显短于胃大部分切除术、SV和HSV加修补术 (P <0 .0 1) ,术后 3～ 6个月的溃疡愈合率 96 % (36 / 4 0 ) ,术后 1、3、5年溃疡复发率为 10 %、2 0 %、2 5 % ,与SV和HSV中修补术相比无显著差异 (P >0 .0 5 ) ,远期并发症的发生率 7 5 % (3/ 4 0 )明显低于三者 (P <0 .0 5 )。溃疡病史的长短、术式选择和手术质量与溃疡复发有一定的影响 ,而与穿孔的大小无关。结论　十二指肠溃疡急性穿孔单纯缝合修补术操作简单、安全、并发症少 ,而术后再结合正规的内科治疗 ,效果满意 ,是基层医院最好的选择术式。     

完全内窥镜下的房室间隔缺损修补术

目的　报告完全内窥镜下房室间隔缺损修补术 1 2 5例的结果。方法　 2 0 0 0年 6月～ 2 0 0 2年 8月 ,于右侧胸壁打孔内窥镜下房室间隔缺损修补手术 1 2 5例。直接缝合 1 1 3例 ,涤纶补片修补 1 2例 ,同时行三尖瓣成形 2 2例 ,右室流出道狭窄解除 2例。结果　术中扩大切口 3例 ,室缺残余漏 1例 ,二次开胸止血 2例 ,手术时间 2 .1～ 5 .6h ,平均 (3 .1± 0 .6)h。体外循环时间 38～ 1 68min ,平均 (78± 2 5)min ;升主动脉阻闭时间 9～ 56min ,平均 (2 5± 8)min。术后患者恢复顺利 ,治疗效果满意。结论　完全内窥镜下的房室间隔缺损修补术是可行的、安全的。     

疝气的几种治疗比较

目的比较传统缝合手术、腹腔镜疝气修补术与无张力疝修补术的治疗效果。方法以2006年1月~2011年12月的疝气患者91例,随机分为传统缝合手术组(对照组1)、腹腔镜疝气修补术(对照组2)、无张力疝修补术(比较组),观察比较两组的治疗效果。结果双层修补装置的无张力疝修补术组手术时间、术中出血量、住院时间和术后并发症的发生率明显优于对照组(P﹤0.O1)。     

原发性十二指肠损伤的诊断与术式选择

目的　探讨原发性十二指肠损伤的临床特点和选择合适的治疗方法。方法　对 1990 - 2 0 0 2年 10月收治经手术证实的原发性十二指肠损伤 2 2例作回顾性分析。单纯缝合修补、空肠逆行插管十二指肠减压及空肠造口术 6例 ,修补加空肠Roux -Y吻合术 10例 ,对端吻合并空肠逆行插管十二指肠减压及空肠造口、胆总管“T”型管引流术 2例 ,十二指肠憩室化手术 4例。结果　单纯十二指肠损伤 4例 ,合并伤 18例 (81 8% )共 2 8处 ;其中合并 2个脏器损伤 6例 ,3个脏器损伤 2例 ;治愈 2 0例 ,死亡 2例 (9 1% ) ;术后有并发症 6例 (30 % )。结论　掌握十二指肠损伤的临床特点 ,提高术中探查的确诊率 ,根据伤情选择合理的术式 ,十二指肠腔内彻底有效的减压引流 ,是减少并发症、提高治愈率的重要因素。     

微创心脏手术26例报告

1998年 1月～ 2 0 0 0年 6月 ,我们应用胸部小切口行心脏手术 2 6例 ,取得较好效果 ,现报告如下。1　临床资料1 1　一般资料　本组 2 6例中男 18例 ,女 8例 ,年龄 3～ 4 1岁 ,平均 8岁。动脉导管未闭 6例 ,房间隔缺损 8例 ,室间隔缺损 6例 ,左房粘液瘤 2例 ,不完全心内膜垫缺损 2例 ,风湿性二尖瓣病变 2例。动脉导管未闭取左腋下直切口行导管结扎。其他病例均在体外循环下行矫治术 ,其中房缺直接缝合 5例 ,心包片修补 3例 (合并部分肺静脉异位引流 2例 ) ,室缺直接缝合 4例 ,涤纶补片修补 2例 ,左房粘液瘤切除并房间隔心包补片修补 2例 ,不…     

360例腹部手术切口皮内连续缝合法分析

我院妇产科自 1998年 6月至 2 0 0 1年 11月对腹部手术36 0例患者采取用高分子消毒可吸收性合成线 (polysorb)皮内连续缝合法 ,效果较好 ,现分析报告如下 :1　对象与方法1.1　一般情况36 0例腹部手术中 ,下腹横切口 2 5 9例 ,下腹正中直切口 10 1例 ;所行手术包括子宫切除术 92例 ,附件手术 78例(含腹式双侧输卵管结扎术 ) ,子宫下段剖腹产术 190例 ;合并贫血 16例 ,腹部伤口疤痕 2 4例 ;患者年龄 2 3～ 5 1岁 ,平均 2 8.2岁。1.2　缝合方法按常规腹部手术方法缝合腹膜 ,腹直肌前鞘后 ,1号或4号丝线 (视皮下脂肪厚薄而定 )间断全层缝合皮下…     

主动脉窦瘤破裂合并主动脉瓣关闭不全的外科处理

目的 探讨主动脉窦瘤破裂合并主动脉瓣关闭不全的手术治疗方法.方法 在主动脉窦瘤破裂合并主动脉瓣关闭不全的18例患者中,高位室间隔缺损17例,经右心房和升主动脉根部双切口1例,经右心室和升主动脉根部双切口17例.主动脉瓣置换术6例,主动脉瓣叶悬吊成形术4例,在以补片修补主动脉窦瘤破裂和高位室间隔缺损过程中使主动脉瓣叶复位8例.结果 本组18例中手术死亡1例(5.6%),出院17例.17例经门诊复查或信访1～8年,其中1例死于感染性人造瓣膜心内膜炎.结论 当主动脉窦瘤破裂合并主动脉瓣关闭不全时应尽早手术,术中观察主动脉瓣病变程度,一期矫正瓣膜关闭不全.若瓣膜损伤明显,宜行主动脉瓣置换术.     

“桥”式缝合术在38例阴道后壁脱垂中的应用与分析

目的探讨“桥”式缝合术在阴道后壁脱垂中的应用效果及安全性。方法2004年3月-2007年3月采用自身阴道后壁组织做“桥”式缝合术修补阴道后壁脱垂38例作为观察组与传统经典术式方法修补阴道后壁脱垂38例作为对照组，进行统计学处理比较。结果两组平均手术时间，平均术中出血量，有显著性差异（P〈0．01），手术成功率无显著差异（P〉0．05），术后随访1年术后复发率有显著性差异（P〈0．05）。结论自身阴道后壁组织“桥”式缝合术治疗阴道后壁脱垂，术式简便，效果显著且安全，明显优于传统经典术式阴道后壁修补术。     

严重肝外伤手术治疗的几种术式的选择与评价

目的　探讨严重肝外伤手术治疗术式的选择与评价。方法　分析自 1982 - 2 0 0 3年松花江流域 8所医院手术治疗严重肝外伤 10 0例的临床资料。结果　 10 0例严重肝外伤根据损伤部位及AAST分级标准、损伤程度 ,分别选用 :清创止血加带蒂大网膜填塞缝合术 ;清创、止血、带蒂大网膜缝合加肝动脉结扎术或肝动脉栓塞术 ;肝切除和清创性肝切除术 ;肝切开术 ;肝脏网片包裹术 ;单纯纱布填塞术 ;网膜填塞缝合加肝后腔静脉修补术等。全组治愈率为 91% (91 10 0 ) ,病死率为 9% (9 10 0 )。结论　严重肝外伤治疗困难 ,死亡率高 ;但合理选择术式是成功的关键措施。     

先天性心脏病继发感染性心内膜炎的外科治疗

目的总结先天性心脏病继发感染性心内膜炎的外科治疗经验。方法手术治疗先天性心脏病合并感染性心内膜炎65例,手术原则是清除感染灶,矫治心脏畸形和恢复瓣膜功能,行室间隔缺损修补52例,动脉导管直视缝合8例,主动脉窦瘤修补2例,法洛四联症根治3例,同期行二尖瓣成形2例,三尖瓣成形12例,肺动脉瓣成形5例,二尖瓣置换2例,主动脉瓣置换3例,三尖瓣置换1例,二尖瓣主动脉瓣置换2例,主动脉根部置换1例。结果1例急诊行法洛四联症根治术后并发低心排综合征死亡;其余患者均痊愈出院。随访60例,随访6个月～10年,无1例死亡及心内膜炎复发。结论先天性心脏病继发感染性心内膜炎者正确选择手术时机及有效的抗生素是提高治愈率的关键。     

心脏内畸形合并感染性心瓣膜炎的外科治疗

目的探讨心脏内畸形合并感染性心瓣膜炎的诊断及外科治疗特点。方法回顾1997年2月-2003年2月10例心脏内畸形合并感染性心瓣膜炎患者的临床资料，其中室间隔缺损4例，主动脉窦瘤破裂2例，右室流出道狭窄1例，二尖瓣关闭不全1例，主动脉瓣二叶瓣畸形2例。感染的心脏瓣膜分别为主动脉瓣4例。三尖瓣4例，肺动脉瓣1例，二尖瓣1例。合并瓣膜赘生物9例次，合并瓣膜穿孔4例次，均行外科手术治疗，清除赘生物及修复穿孔，同时行室间隔缺损修补术、主动脉瓣置换术、二尖瓣置换术、右室流出道加宽补片术1例。结果患者术后7-14d体温及白细胞计数降至正常，应用抗生素28d后痊愈出院，全组无死亡病例。结论心脏内畸形患者并发感染性心瓣膜炎，如发现瓣膜赘生物形成或瓣膜穿孔，应视病情立刻手术或抗感染治疗后手术，术后根据血细菌培养或瓣膜赘生物培养情况应用抗生索28d，预防人工瓣膜及补片再度感染。     

主动脉窦瘤破裂手术治疗的临床体会

目的 总结主动脉窦瘤破裂患者破裂类型及外科治疗经验.方法 对19例主动脉窦瘤破裂患者手术治疗情况进行回顾性分析.合并室间隔缺损10例,主动脉瓣关闭不全6例,其他畸形6例(有的同时合并几种畸型),并发感染性心内膜炎2例.所有患者均及时施行了手术治疗.结果 发生于右冠状动脉窦者15例,其中12例破入右室,3例破入右房;发生于无冠状动脉窦者3例,其中1例破入右室,2例破入右房;发生于左冠状动脉窦者1例,破入左室.全组无手术死亡,1例出现主动脉瓣轻至中度返流,全部患者均痊愈出院.结论 主动脉窦瘤以右冠状动脉窦瘤最常见,且多数破入右室;主动脉窦瘤破裂一经确诊,应尽早手术治疗,以免延误手术时机,合并感染性心内 膜炎尤其如此.

Abstract：

Objective To summarize the ruptured types and surgical treatment experience for rupture of aortic sinus aneurysm. Methods Nineteen cases with aneurysm of aortic sinus were retrospectively analyzed. There were 10 cases with ventricular septal defect,6 cases with aortic valvular incompetence,6cases with other diseases,2 cases complicated by infective endocarditis. All cases underwent operational treatment. Results There were 15 cases of right aneurysm of aortic sinus,including 12 cases among them ruptured into right ventricle,3 cases rupture was penetrated into right atrium.There were 3 cases of null aneurysm of aortic sinus,including 1 case among them ruptured into right ventricle,2 cases ruptured into right atrium. There was 1 case of left aneurysm of aortic sinus, which ruptured into left ventricle. No operative death occurred in all, 1 case with aortic regurgitation light to moderate,and all cases were recovered.Conclusions The right aneurysm of aortic sinus is the most common types,and always rupture into right ventricle. It is important that aneurysm of aortic sinus should be operated as early as possible in order to avoid losing the chance of operation, particular in the patients complicated by infective endocarditis.     

游离组织皮瓣在头颈外科中的应用

目的 总结游离组织皮瓣在头颈部肿瘤术后修复重建中应用的临床经验,提高患者的生存质量.方法 回顾性分析2007年3月至2009年3月收治的头颈部恶性肿瘤手术治疗的临床资料,36例患者肿瘤切除术后应用游离组织皮瓣进行重建,恢复吞咽及呼吸功能.其中游离股前外侧皮瓣修复28例,游离前臂皮瓣修复8例.结果 游离股前外侧皮瓣移植成功26例,坏死2例.皮瓣血管蒂长8～18 cm,平均12.5 cm.穿支类型:肌皮穿支25例,肌间隙穿支3例.游离前臂皮瓣8例均成功.36例患者均恢复了正常进食.结论 游离组织皮瓣修复技术可靠,成活率高,供区无严重并发症,是头颈部肿瘤术后修复重建理想的修复皮瓣.     

Effective protection against secondary pneumococcal pneumonia by oral vaccination with attenuated Salmonella delivering PspA antigen in mice

Influenza infection followed by pneumococcal infection can cause severe pneumonia and this secondary pneumococcal pneumonia is the most common cause of influenza-associated death. Therefore, vaccination against Streptococcus pneumoniae is highly desirable for reducing the disease burden caused by seasonal epidemic and pandemic influenza. In this study, mice were vaccinated orally with a recombinant attenuated Salmonella vaccine (RASV) strain that delivers pneumococcal surface protein A (PspA) in order to examine protective efficacy against secondary pneumococcal pneumonia. A single dose of oral RASV resulted in attenuated pulmonary inflammation and effective protection against secondary pneumococcal pneumonia. Additionally, oral RASV induced long-term protection against secondary pneumococcal pneumonia. Treatment with an antiviral drug (i.e., oseltamivir) after treatment with RASV further prevented pulmonary inflammation after secondary pneumococcal infection. These results imply that oral RASV can protect mice from secondary pneumococcal infection after influenza infection and that vaccination against respiratory bacterial pathogens is a promising approach for dampening the impact of annual epidemic and pandemic influenza outbreaks.     

Intratumoral injection of attenuated Salmonella vaccine can induce tumor microenvironmental shift from immune suppressive to immunogenic

Attenuated Salmonella vaccines show therapeutic anti-cancer effects, but the underlying mechanism has not been well investigated. In the current study, intratumoral (i.t.) injection of recombinant attenuated Salmonella enterica serovar Typhimurium vaccine (RASV) significantly inhibited Her-2/neu-expressing tumor growth. Although depletion of CD8⁺ cells in RASV-treated mice significantly restored tumor growth, the induction of Her-2/neu-specific cytotoxic T lymphocytes (CTLs) was not well correlated with the generation of the anti-tumor effect. Therefore, we hypothesized that RASV might induce a tumor microenvironmental shift, from immune suppressive to immunogenic, to reduce the suppressive force and finally elicit a successful anti-tumor response. We found that i.t. injection of RASV significantly increased the level of CD11b⁺Gr-1⁺ myeloid cells identified as myeloid-derived suppressor cell (MDSC), but a significant portion of these cells were TNF-α-secreting Ly6-G^high subsets, which can function as antitumor effector cells. We further investigated whether RASV can modulate immunosuppressive Treg cells, and CD4⁺CD25⁺ Foxp3⁺ Tregs was significantly reduced in RASV-treated mice. Thus, i.t. injection of RASV may offer a novel anti-cancer approach by eliciting transformation of immunosuppressive MDSCs into TNF-α-secreting neutrophils and reducing the generation of Treg cells, especially in the presence of tumor-specific CTLs. Collectively, these data will provide us an insight for the development of new anti-tumor approaches to overcome the immunosuppressive environment generated by tumors.     

275例主动脉瓣置换术应用连续缝合法的临床观察

目的探讨主动脉瓣置换中连续缝合方法的应用。方法275例病人主动脉瓣置换采用2/0Prolene线连续缝合法,用3根线265例、1根线10例。同期行二尖瓣置换232例,三尖瓣置换5例,三尖瓣成形112例,升主动脉置换9例,左房血栓清除术32例。结果全组均置入人工机械瓣膜,1例体外循环中发生抑肽酶过敏,需用阿拉明和大剂量激素;1例发生鱼精蛋白过敏再次转流,其他病例手术顺利。无1例住院死亡和严重并发症发生。结论采用连续缝合方法可简化手术操作,减少心肌缺血和转流时间,有利于心肌保护并减少术后并发症。     

刨伤性鼻中隔穿孔12例临床分析

目的探讨创伤性鼻中隔穿孔的，临床表现和治疗效果。方法对12例因为创伤性鼻中隔穿孔的患者观察其临床表现以及手术修补的效果。结果12例患者中经过3月～5年多的观察随访，11例愈合，1例在鼻中隔穿孔的后缘裂开约有2nml缝隙，因为没有症状，未再治疗。结论对因为创伤引起的鼻中隔穿孔，应该根据实际情况进行清创或者修补，兼顾其他外伤的治疗．复合瓣效果好，游离瓣膜可根据情况选用。     

Abdominal aortic aneurysms surgery in over 75 years old patients. Experience in 142 cases treated between 1980-1989

The paper describes the Authors' experience of abdominal aortic aneurysm surgery in over 75-year-old patients. One hundred and forty-two cases were operated over a 10-year period (1980-89). Seventy-two patients were treated electively and 70 underwent emergency surgery following rupture of the aneurysm. Operative mortality during elective surgery was comparable to that in younger patients, whereas the mortality rate during emergency surgery was notably higher than that in under 75-year-old patients. Follow-up confirmed that the life expectancy of operated patients is significantly better than that of patients with untreated abdominal aortic aneurysms.     

Non-incarcerated inguinal hernia in children: operation within 7 days not necessary

OBJECTIVE: To assess the necessity to operate on non-incarcerated inguinal hernia in children within 7 days of diagnosis. DESIGN: Retrospective. METHOD: Data on 360 children, 0-10 years old (104 girls and 256 boys) who were operated on for inguinal hernia between 1 January 1993-31 December 2001 at the St. Elisabeth Hospital in Tilburg, the Netherlands, were collected from the medical records. These data included sex, age, interval between diagnosis and repair, recurrence, incarceration, length of hospitalisation and complications. RESULTS: In the group of 113 children 0-1 years old, 137 inguinal hernias were repaired, ofwhich 16 were incarcerated on presentation. The interval between diagnosis and repair was known in 93 of 121 cases: 37 hernias were repaired within 7 days and 56 at a later stage. In the latter group, there was one case of secondary incarceration (1.8%; 95% CI: 0-5.4). The number needed to treat was 56. In the group of 247 children 1-10 years old, 269 inguinal hernias were repaired, of which 8 were primarily incarcerated. The interval between diagnosis and repair was known in 208 of 261 cases: 34 hernias were repaired within 7 days and 174 at a later stage. In the latter group, 3 hernias incarcerated secondarily (1.7%; 95% CI: 0-3.7). The number needed to treat was 58. In the group of non-incarcerated hernias 1 complication occurred, in the group of incarcerated hernias none. The mean length of hospitalisation of children with non-incarcerated hernia was 0.85 days, and of children with incarcerated hernia 2.4 days. CONCLUSION: In children with a non-incarcerated inguinal hernia who are waiting for an operation, the risk of secondary incarceration and complications is 2% which we do not think is enough reason to carry out an elective hernia-repair procedure within 7 days.     

三维CT指导下颅底重建加硬膜多层修补治疗外伤性脑脊液鼻漏

目的探讨三维螺旋CT影像重建指导下骨性颅底重建及显微镜下硬膜漏口多层修补术治疗前颅窝外伤性脑脊液鼻漏的手术效果。方法回顾分析我院神经外科12例经临床诊断为前颅窝外伤性脑脊液鼻漏患者临床资料,患者先经双排或64排螺旋CT扫描,后在工作站上进行三维重建,显示前颅窝骨折和漏口位置、形态;在三维联动图像上显示漏口与副鼻窦之间的关系,对漏口的大小及窦腔的容积进行了测量;依据CT影像资料进行手术治疗,所有病人均行前额部硬膜外入路,三明治式骨性颅底重建,显微镜下寻找漏口,自身腱膜或人工脑膜无创修补,明胶海绵及耳脑胶加固。结果12例脑脊液鼻漏患者三维CT联动重建发现单纯额窦破口7例,单纯筛窦破口5例,额窦及筛窦双破口2例,破口大小0．5-2．5cm,平均1．75cm;颅内积气9例,无颅内积气5例。12例患者均一次修补成功,随访5—18个月未见复发,未发生颅内感染,1例出现嗅觉缺失。结论三维螺旋CT薄层扫描及颅底重建对前颅窝外伤性脑脊液鼻漏有重要的诊断价值,可以明确前颅底破损的位置、数量、形态及破口与副鼻窦的关系,为指导手术提供影像学依据。“三明治”式前颅底骨性重建及显微镜下寻找并多层修补漏口（“双层三明治”）可临床治愈脑脊液鼻漏。