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1.
目的:评估十二指肠溃疡穿孔行单纯修补或加行壁细胞迷切(PCV)术后常规清除幽门螺杆菌(Hp)的疗效。方法:1994年来,我院收治十二指肠溃疡穿孔51例,其中单纯修补41例,修补加PCV10例。术后均常规予清除Hp治疗,并对术后恢复及溃疡复发情况作一回顾性分析。结果:经2年以上随访,单纯修补或加PCV术后再常规清除Hp,溃疡复发率和再手术率均明显降低。修补加PCV组疗效显著优于单纯修补组(P<0.05);单纯修补组中,急性溃疡穿孔病例的疗效显著优于慢性溃疡穿孔(P<0.05)。结论:单纯修补术后再清除Hp可作为急性溃疡穿孔的理想治疗方案;修补加PCV术后再清除Hp治疗慢性溃疡穿孔可获良好根治溃疡效果。  相似文献   

2.
目的 研究十二指肠溃疡穿孔的两种不同疗法——穿孔修补术加近侧胃迷走神经切断术(PCV)与穿孔修补术加奥美拉唑方案的临床疗效,方法 将1994年1月-1996年12月相继入院的48例十二指肠溃疡穿孔患随机分为A、B两组。A组(21例)在穿孔修补术的基础上.加行PGV。B组(27例)仅作穿孔修补术,术后辅予奥美拉唑方案(即口服奥美拉唑加羟氨苄青霉素加灭滴灵)。术后定期随访。随访结果按Visick标准分级。结果 A组术后半年和2年氨疗效优良(Visick Ⅰ加Ⅱ级)分别为18例(85.7%)和17例(81.0%),溃疡复发(Visick Ⅳ级)分别为1例(4.8%半年)和2例(9.5%2年).B维术后半年和2年疗效优良分别为19例(66.7%)和10例(37.0%),溃疡复发分别为5例(18.5%)和12例(44.5%)A组疗效优于B组(P<0.01)。Hp检测,A组术后半年和两年的Hp阳性率分别为81.0%和85.7%(P>0.05):B组分别为18.5%和51.9%(P<0.01)。结论 十二指肠溃疡穿孔在施行修补术后.应同时加行PCV,以提高时溃疡病的根治效果。  相似文献   

3.
作者采用壁细胞迷切加穿孔修补术(PCV+S)治疗40例十二指肠溃疡穿孔患者。同期采用壁细胞迷切术(PVC)治疗40例慢性十二指肠溃疡。术后1-5年的随访结果表明:急诊PCV+S和择期PCV同样具有显著降酸和促进溃疡愈合作用,远期疗效属VisickI和Ⅱ级者为87.5%,溃疡复发3例,仅1例需再手术。因此PCV+3是值得推荐的手术。  相似文献   

4.
十二指肠溃疡穿孔单纯缝合修补术的临床疗效观察   总被引:22,自引:0,他引:22  
目的观察十二指肠溃疡穿孔行单纯缝合修补术的疗效。方法对1992年以来收治的十二指肠溃疡穿孔118例病人行手术治疗。其中行单纯缝合修补术84例;胃大部分切除术19例,高选择性迷走神经切除加修补术15例。对118例病人的手术及术后情况做回顾性分析。结果单纯缝合修补无手术死亡,平均手术时间42min,平均住院时间9天,均显著短于后二者(P<001)。术后3个月溃疡愈合率为79/83(95%),术后1、3、5年溃疡复发率分别为11%(9/83)、22%(12/54)和25%(4/16),与高选择性迷走神经切除加修补相比,无显著差异(P>005),远期并发症发生率为8%(7/83),亦低于后二者(P<005)。病史长短和术前治疗对术后溃疡愈合与复发有一定影响,而与溃疡穿孔的大小无关。结论十二指肠溃疡穿孔单纯缝合修补操作简单、安全、并发症少,术后结合正规内科治疗,效果满意  相似文献   

5.
高选迷切加胃窦粘膜剥脱术后近远期临床疗效观察   总被引:2,自引:0,他引:2  
目的 观察高选迷切加胃窦粘膜剥脱术(HSV+MA)治疗十二指肠溃疡的疗铲。方法 对实施该术的64例的3 ̄6个月及5-8年临床随访结果及血液胃泌素、胃动素、生长抑素的变化进行了分析总结。结果 全组无死亡病例一3 ̄6个月及5 ̄8年VisickⅠ ̄Ⅱ级者分别为92.3%和92.9%,术后胃酸及胃这让螺杆杆菌感染率与术前比较明显降低,但术后胃液胆酸和细菌总量变化不大;X线钡餐及胃镜检查未发现溃疡复发,术后  相似文献   

6.
目的 观察单纯修补术治疗十二指肠溃疡穿孔的长期疗效。方法 采用小切口和传统开腹单纯修补术治疗十二指肠溃疡穿孔病人84例。术后口服奥美拉唑、呋喃唑酮及阿莫西林1~2周,继续服用奥美拉唑等药物1~2个月,随访3个月~2年。结果 术后3个月内溃疡愈合率为94%(79/84),术后1年、2年复发率分别为3.9%(2/52)及5.2%(1/19)。全组无因溃疡复发而再手术病例。传统开腹组与小切口组住院天数差异有非常显著性。结论 溃疡穿孔单纯修补术简单可靠,配合术后药物治疗,疗效满意,单纯修补术作为治疗十二指肠溃疡穿孔的术式有着重要的临床价值。  相似文献   

7.
患者.女,26岁,体重46kg。先天性心脏病、房间隔缺损(ASD),拟行ASD修补术。术前心电图诊断为三度房室传导阻滞(ⅢA-VB)、结性逸搏心率。超声心动:ASDⅡ孔型33.5mm,三尖瓣中度返流;胸部正位片:肺血多、右房及右室大。术前30分钟肌肉注射阿托品0.5mg、哌替啶50mg。入手术室监护仪连接后HR72次/分,心电图仍为典型皿Ⅲ1-VB(交界部),桡动脉穿刺直接测压(ABP)18.67/10.67kPa。麻醉诱导以静脉注射安定5mg、2.5%硫喷妥钠(SP)10ml、氯胺酮70mg、…  相似文献   

8.
非规则性肝切除及癌栓取除术治疗肝癌合并门静脉癌栓   总被引:10,自引:1,他引:9  
目的 探讨非规则性肝切除及癌栓取除术治疗肝细胞癌(HCC)合并门静脉癌栓(PVTT)的价值。方法 1987年1月至1996年12月采用非规则性肝切除及癌栓取除术治疗HCC合并PVTT的病人62例。其中,40例在术后联合肝动脉化疗(HAC)和门静脉化疗(PVC)。59例随访3年以上。结果 6例在术后3个月内死于肝、肾功能衰竭,56例术后恢复良好。术后1、2、3年的复发率和生存率。在手术后应用HAC和PVC组分别为46.2%、59.0%、79.5%和69.2%、51.3%、30.8%。在未化疗组分别为80.0%、90.0%、100%和30.0%、10.0%、5.0%。结论 非规则性肝切除和癌栓取除术是HCC合并PVTT有效的治疗方法。术后联合HAC和PVC可降低复发率、提高生存率。  相似文献   

9.
目的:评价主动脉瓣替换(AVR)术后左心功能的近期及其远期效果。方法:对1978年12月至1996年12月期间连续129例单纯行AVR的病人进行分析。结果:术前B超示左心室舒张末期内径(LVEDD)、收缩末期内径(LVESD)分别为(64.5±9.3)mm、(44.7±9.9)mm,术后14天至3个月分别为(51.9±7.2)mm、(31.5±4.5)mm(P<0.01);术后1~2年分别为(47.6±6.1)mm、(29.5±5.4)mm(P<0.01)。手术死亡率3.9%。术后随访6个月至16年,平均4.4年,累计随访501病人·年。晚期死亡6例(1.2%病人·年),5年及10年生存率分别为89.3%、77.3%。血栓栓塞及与抗凝有关的出血率分别为0.8%病人·年、1.0%病人·年。结论:AVR术后95%病人的心功能恢复至I或I级,长期效果满意。故主动脉瓣病变、LVEDD扩大并出现症状的病人,应行主动脉瓣替换术。  相似文献   

10.
腹腔镜十二指肠溃疡穿孔粘合修补10例报告广州市红十字会医院普外科(510220)黄时杰雷朝晖我科从1995年5月至1996年4月,行腹腔镜十二指肠溃疡穿孔修补术10例,结果满意。报告如下。1材料与方法本组男8例,女2例,年龄19~82岁(平均49.2...  相似文献   

11.
Objective: To evaluate results of margin convergence versus suture anchors in rotator cuff repair, and to determine which method is mechanically superior. Methods: Eighteen kangaroo shoulders were randomly divided into three groups (n = 6). A full thickness tendon defect 1.0 cm × 1.5 cm in size was created in the supraspinatus tendon at humeral insertion, simulating a massive rotator cuff tear. Three different techniques were employed for rotator cuff repair: (i) Mitek GII suture anchor alone (Group 1); (ii) margin convergence alone (Group 2); and (iii) margin convergence plus Mitek GII suture anchor (Group 3). Combined loads were applied to each specimen. After completion of cyclic loading, the construct was loaded to failure. ANOVA and LSD (Least Significant Difference) multiple comparisons of the means were applied to results. Results: Cyclic load testing showed progressive gap formation in each repaired specimen with increasing cycles. Group 1 reached 50% failure at an average of 34 cycles, Group 2 at 75 cycles and Group 3 at 73 cycles. There were significant difference between Groups 1 and 2, and Groups 1 and 3 (P ≤ 0.001). After 100 loading cycles, the average gap size was 6.8 mm, 6.1 mm and 4.7 mm in Groups 1, 2 and 3, respectively. There was a significant difference between Groups 1 and 3 (P ≤ 0.015). All specimens eventually reached failure. Conclusion: Rotator cuff repairs with margin convergence +/? suture anchor were far stronger than suture anchor alone, both in gap formation and ultimate failure load. However, progressive gap formation with cyclic loading seems inevitable after cuff repair, which may facilitate clinical understanding of the phenomena of re‐tear or residual defect.  相似文献   

12.
目的 探索治疗食管胃底静脉曲张出血的最佳止血术式。方法 对50例食管胃底静脉曲张出血病人实施了栅栏状环扎胃壁加贲门周围血管离断术。标准的Hassab术式离断贲门周围血管,附加平行交锁环扎胃壁浆肌层阻断壁内返流血管。结果 手术平均时间2小时左右,急诊手术近期止血率100%,术后再出血率2.04%;急诊手术死亡率3.45%,择期手术死亡率0;腹水及肝功能均不同程度改善。结论 本手术目的性强,不污染腹腔,操作简单,易于推广。  相似文献   

13.
BACKGROUND: Coated polyglactin 910 suture with triclosan was developed recently in order to imbue the parent suture, coated polyglactin 910, with antibacterial activity against the most common organisms that cause surgical site infections (SSI). Because such alterations could alter the physical properties of the suture, this study sought to compare the intraoperative handling and wound healing characteristics of coated polyglactin 910 suture with triclosan and traditional coated polyglactin 910 suture in pediatric patients undergoing various general surgical procedures. METHODS: This was a prospective, randomized, controlled, open-label, comparative, single-center study. Pediatric patients (age 1-18 years) undergoing various surgical procedures were randomized in a 2:1 ratio to treatment with either coated polyglactin 910 suture with triclosan or coated polyglactin 910 suture. The primary endpoint was the surgeon's assessment of the overall intraoperative handling of coated polyglactin 910 suture with triclosan and traditional coated polyglactin 910 suture without triclosan. The secondary endpoints included specific intraoperative suture handling measures and wound healing assessments. The suture handling measures were (1) ease of passage through tissue; (2) first-throw knot holding; (3) knot tie-down smoothness; (4) knot security; (5) surgical handling; (6) surgical hand; (7) memory; and (8) suture fraying. Assessment of wound healing included the following: Healing progress, infection, edema, erythema, skin temperature, seroma, suture sinus, and pain. Adverse events were recorded. RESULTS: Scores for intraoperative handling were favorable and not significantly different for both sutures, although coated polyglactin 910 suture with triclosan received more "excellent" scores (71% vs. 59%). Wound healing characteristics were comparable for both sutures except for pain on postoperative day 1. Significantly fewer patients treated with polyglactin 910 suture with triclosan reported pain on day 1 than patients who received the other suture (68% vs. 89%, p = 0.01). The overall incidence of adverse events was 18%; none was devicerelated. CONCLUSIONS: Coated polyglactin 910 suture with triclosan performed as well or better than traditional coated polyglactin 910 suture in pediatric patients undergoing general surgical procedures. The incidence of postoperative pain was significantly less in patients treated with coated polyglactin 910 suture with triclosan than the traditional suture. We speculate that polyglactin 910 suture with triclosan, by inhibiting bacterial colonization of the suture, reduced pain that can be an indicator of "subclinical" infection. Coated polyglactin 910 suture with triclosan may be a useful alternative in patients at increased risk of developing SSI.  相似文献   

14.
BACKGROUND: This study evaluated the in vitro efficacy of poliglecaprone 25 suture with triclosan against gram-positive and gram-negative bacteria. METHODS: Poliglecaprone 25 sutures with and without triclosan were tested for in vitro efficacy against Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, methicillin-resistant Staphylococcus epidermidis (MRSE), Klebsiella pneumoniae, and Escherichia coli by a zone of inhibition assay. The suture also was tested against Escherichia coli in a colonization assay in a dynamic model simulating in vivo conditions. An in vitro triclosan diffusion assay and a sustained efficacy assay were performed by concurrent high-performance liquid chromatography and zone of inhibition assay. To assess stability, antibacterial efficacy testing was performed on samples held more than five months at elevated temperature. RESULTS: Poliglecaprone 25 suture with triclosan demonstrated significant in vitro efficacy against a range of bacteria. The suture sustained in vitro efficacy for 11 days, corresponding to the in vitro triclosan diffusion profile. CONCLUSION: Triclosan reduced in vitro colonization of poliglecaprone 25 suture by several strains of bacteria compared with untreated control sutures.  相似文献   

15.
BACKGROUND: This study evaluated the ability of poliglecaprone 25 suture with triclosan to inhibit bacterial colonization by Escherichia coli and Staphylococcus aureus in mouse and guinea pig models. METHODS: Test and control sutures (3-4 cm) were implanted subcutaneously in the dorsal-lateral regions (control on the left side, test on the right side, approximately 3-5 cm apart) in 10 female Hartley guinea pigs (300-400 g) and 10 Swiss Webster mice (20-35 g) via a 20-gauge catheter. The test material was poliglecaprone 25 suture with triclosan (2-0, undyed), and the control material was poliglecaprone 25 suture (2-0, undyed). In the guinea pig model, each implantation site was challenged directly with 4x10(5) colony-forming units (cfu) of S. aureus, whereas in the mouse model, each implantation site was challenged directly with 1.3x10(7) cfu of E. coli through an indwelling catheter. At 48 h post-implantation, the control and test sutures were explanted, and bacterial enumeration was performed. RESULTS: There was a significant difference (p < 0.05) in the number of bacteria recovered in the study groups 48 h post-implantation. Poliglecaprone 25 suture with triclosan produced a 3.4-log reduction in S. aureus and a 2-log reduction in E. coli compared with standard poliglecaprone 25 suture without triclosan under the same challenge conditions. The difference between the study groups in the number of bacteria recovered was significant (p < 0.05). CONCLUSION: Poliglecaprone 25 suture with triclosan inhibited bacterial colonization of the suture compared with untreated suture after direct in vivo challenge with S. aureus and E. coli in animal models.  相似文献   

16.
ABSTRACT Background: This study evaluated the efficacy of polydioxanone suture with and without triclosan against gram-positive and gram-negative bacteria in vitro and in vivo. Methods: Polydioxanone suture with and without triclosan was tested against Staphylococcus aureus, methicillin-resistant S. aureus (MRSA), S. epidermidis, methicillin-resistant S. epidermidis (MRSE), Klebsiella pneumoniae, and Escherichia coli by a zone of inhibition assay. In vivo evaluations were conducted in guinea pigs and mice in which test and control sutures (3-4 cm long) were implanted subcutaneously in the dorsal-lateral regions (control on left, test on right, 3-5 cm apart) through a 20 gauge catheter. Each implantation site was then challenged directly through the catheter with 4 x 10(5) colony-forming units (CFU) of S. aureus (guinea pigs) or 7 x 10(6) CFU of E. coli (mice). At 48 h post-implantation, the control and test sutures were explanted, and adherent bacteria were counted. Results: Polydioxanone suture with triclosan demonstrated activity against all test organisms in vitro. The antibacterial activity was maintained until the sutures dissolved after 17 to 23 days when tested against E. coli and S. aureus, respectively. Evaluation in animal models demonstrated a 99.9% reduction in S. aureus and a 90% reduction in E. coli relative to controls. Conclusion: Polydioxanone suture with triclosan had activity in vitro against S. aureus, MRSA, E. coli, S. epidermidis, MRSE, and K. pneumoniae that persisted for as long as three weeks. In animal models, polydioxanone suture with triclosan inhibited in vivo colonization by S. aureus and E. coli.  相似文献   

17.
BACKGROUND: This study evaluated the ability of coated polyglactin 910 suture with triclosan (Coated VICRYL Plus Antibacterial) suture to inhibit the colonization of bacteria on the suture after direct in vivo inoculation challenge with Staphylococcus aureus utilizing a guinea pig model. METHODS: One control suture (4-5 cm) and one test suture (4-5 cm) were implanted subcutaneously in the dorsal-lateral regions (control on the left side, test on the right side, approximately 5 cm apart) in 16 female Hartley guinea pigs (300-400 g) via a 20-gauge catheter. Each implantation site was challenged directly with 2.1 x 10(4) colony forming units (cfu) of Staphylococcus aureus through the indwelling catheter. The test material was coated polyglactin 910 suture with triclosan (2-0, dyed), and the control material was coated polyglactin 910 suture (2-0, undyed). At 48 h, suture articles were explanted and a bacterial enumeration assay was performed. RESULTS: There was a significant difference (p < 0.05) in the number of bacteria recovered between the study groups at 48 h post-implantation. The mean recovery for test sutures was 559 cfu, and the mean recovery for control sutures was 16,831 cfu. Coated polyglactin 910 suture with triclosan provided a 30.5-fold (96.7%) reduction in the number of recovered bacteria compared to standard coated polyglactin 910 suture. CONCLUSIONS: This study demonstrates that coated polyglactin 910 suture with triclosan inhibits bacterial colonization of suture after direct in vivo challenge with S. aureus in a guinea pig model.  相似文献   

18.
PURPOSE: To evaluate the efficacy in vitro and in vivo of a new antibacterial suture, polyglactin 910 suture with triclosan, compared with a traditional braided suture, polyglactin (Vicryl), in a validated animal model of orthopedic infection. Our primary goal was to compare the microbiologic effectiveness of the two sutures. The secondary goal was to evaluate histopathologic signs of an inflammatory response. METHODS: We used 20 Sprague-Dawley rats. Samples of Staphylococcus epidermidis were diluted to a 0.5 McFarland concentration (100,000 colony-forming units/mL). A surgical steel suture was placed in the spinous process of the rats, and the deep zone of the incision was contaminated bilaterally. Wounds were closed with one of the sutures. After 16 days, the animals were sacrificed, and the surgical wounds were reopened, with cultures being performed of both the zone adjacent to the implant and the deep region of the wound. We also studied the histopathologic features of the tissue adjacent to the implant. RESULTS: No clinical signs of infection were observed. The culture of the zone adjacent to the implant was positive in nine animals in the polyglactin group vs. three in the polyglactin 910 with triclosan group (p = 0.005). Culture of the deep zone of the wound was positive in ten animals in the polyglactin group vs. six in the polyglactin 910 with triclosan group (p = 0.03). We found predominant polymorphonuclear neutrophil populations in four samples in the polyglactin group vs. two in the polyglactin 910 with triclosan group. CONCLUSIONS: Under simulated conditions of severe intraoperative contamination, the antibacterial suture reduced the number of positive cultures after surgery by 66.6%. Judging from the available clinical information, its use might contribute to reducing the number of infected implants by 25.8%. Human studies are needed to determine the clinical implications of these results.  相似文献   

19.
背景与目的 目前较为常用的腔镜甲状腺手术入路主要有经腋窝入路、经胸乳入路及经口入路等。经腋窝入路相较于其他术式,其利用颈部肌肉的自然间隙建腔,在颈前带状肌深面显露甲状腺并进行手术操作,对颈部功能影响较小,而且无需充CO2,对心脑血管影响较小,因此近年来越来越被临床医生所接受。经腋窝入路腔镜甲状腺手术中寻找胸锁乳突肌肌间隙是该术式的一大难点,在此步骤中较多初学者不能准确定位肌间隙,进而增加了手术时间及创伤。为此,笔者中心对经腋窝无充气腔镜甲状腺手术作了一定的改进,降低术中寻找肌间隙的难度。本研究对该改良术式的近期疗效与安全性进行评估,为其在临床中的应用提供依据。方法 回顾性分析2023年1月—2023年5月江苏省宿迁市第一人民医院甲乳外科收治的46例甲状腺癌患者的临床资料。其中,23例接受改良经腋窝入路免充气腔镜下甲状腺手术(观察组),另23例接受常规经腋窝入路免充气腔镜下甲状腺手术(对照组)。观察组患者术前超声引导下在胸锁乳突肌胸骨部与锁骨部之间的间隙内注水分离,扩大肌间隙,然后缝线定位胸锁乳突肌胸骨部后缘,准确进入肌间隙后,按照常规经腋窝入路腔镜甲状腺手术方法实施手术。结果 两组患者一般资料无明显差异(均P>0.05),具有可比性。观察组平均手术时间明显短于对照组(65.6 min vs. 87.2 min,P<0.05),而两组的术中出血量、术后引流量、中央区清扫淋巴结数及住院时间差异均无统计学意义(均P>0.05)。观察组有1例出现腋窝皮下血肿,经抽液、包扎后改善,余患者均无呼吸困难、声音嘶哑、手足麻木、饮水呛咳等并发症发生。术后3个月,两组患者颈部疼痛评分及颈部损伤指数、吞咽障碍指数比较,差异均无统计学意义(均P>0.05)。所有患者术后均口服左旋甲状腺素钠片行个体化促甲状腺激素(TSH)抑制治疗,随访期间无患者出现复发转移。结论 术前行超声引导下胸锁乳突肌缝线定位联合肌间隙注水分离操作方便、实用,便于术中寻找肌间隙,降低了经腋窝无充气腔镜甲状腺手术整体手术难度,具有较好的临床应用价值。  相似文献   

20.
Xu R  Fang L  Jiang X  Wan Y  Huang S  Jiang K  Lin N  Pan W 《中华外科杂志》2002,40(9):647-649
目的 对比研究修补术联合近侧胃迷走神经切断术 (proximalgastricvagotomy ,PGV)与修补术联合三联疗法 (口服奥美拉唑加羟氨苄青霉素加灭滴灵 )对穿孔性十二指肠溃疡的远期疗效。方法  32 9例十二指肠溃疡急性穿孔患者非随机地接受了A、B不同的治疗方法。A组 1 53例 ,行修补术联合PGV ;B组 1 76例 ,行修补术联合三联疗法。术后 5~ 8年 ,采用信访、电话访问、门诊复查以及与患者所在当地医院合作调查的方式进行随访。随访内容包括症状问诊、胃镜复查、幽门螺杆菌(HP)检测等。随访结果按Visick标准分级。 结果 获得随访 30 1例 ,A组 1 4 2例 ,B组 1 59例。按Visick分级 ,A组Ⅰ级 97例 (68 3 % )、Ⅱ级 1 9例 (1 3 4% )、Ⅲ级 1 3例 (9 2 % )、Ⅳ级 1 3例 (9 2 % ) ;B组Ⅰ级 31例 (1 9 5 % )、Ⅱ级 2 8例 (1 7 6 % )、Ⅲ级 2 4例 (1 5 1 % )、Ⅳ级 76例 (47 8% ) ,2者比较 ,差异有非常显著性意义。 (Z =- 9 81 8,P <0 0 1 )。HP检测 ,A组阳性 1 30例 (91 5 % ) ;B组阳性 94例(59 1 % ) ,2者比较 ,差异有非常显著性意义。 (χ2 =41 438,P <0 0 1 )。 结论 对于穿孔性十二指肠溃疡 ,修补术联合PGV的远期疗效优于修补术联合三联疗法 ,尽管前者的HP阳性率远高于后者。HP感染只是十二指肠溃疡的发病  相似文献   

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