心脏包虫病手术治疗二例

患者 2例均为男性.年龄分别为24岁和31岁.国籍分别为摩尔多瓦和土耳其(临床资料为德国心脏中心).1例患者于体检时发现右心房有囊性占位性病变,心脏超声心动图及CT示囊肿大小约6.0 cm×5.0 cm×4.5 cm.另1例患者有心悸、晕厥史2年,心脏超声心动图及CT示左心室侧壁有一囊性占位性病变,大小约7.0 cm×6.5 cm×5.5 cm,囊内有子囊结构(图1).     

心脏包虫病手术治疗的麻醉处理

包虫病是人畜共患的地方性寄生虫病,好发于肝脏、肺脏及其他器官组织。心脏及心包包虫病罕见,仅占总发病率的0.5%～2.0%[1]。心脏包虫若同时合并其他脏器包虫,则麻醉的危险性增加,对麻醉的处理要求更高。现将我院1978～2005年收治的16例心脏包虫病手术治疗的麻醉处理经验总结如     

心脏包虫病患者手术治疗的麻醉处理

包虫病为人畜共患的地方性寄生虫病，在我国主要流行于西北五省区和西藏、内蒙古自治区。包虫病是细粒棘球绦虫虫卵随犬粪排出，污染环境，通过粪口传播，虫卵在十二指肠内孵化为六钩蚴穿过肠壁经门静脉入血而感染人体，多发于肝脏、肺脏及其他器官组织，而心脏包虫病罕见，仅占发病患者的0．5％～2．0％，现将本院13例心脏包虫病患者手术治疗的麻醉处理经验总结如下。     

脑包虫病患者的术后观察与护理

目的 探讨脑包虫病患者术后的观察与护理方法.方法 对37例脑包虫病患者行手术治疗,术后给予密切病情观察及护理.结果 37例患者手术均成功,无1例出现并发症,均痊愈出院.随访6个月至4年,无复发.结论 术后密切观察患者的病情变化,做好伤口与引流管、并发症以及用药观察与护理及出院指导,是减少术后并发症,提高手术成功率,促进患者早日康复的关键.     

脑包虫病患者的术后观察与护理

目的探讨脑包虫病患者术后的观察与护理方法。方法对37例脑包虫病患者行手术治疗,术后给予密切病情观察及护理。结果 37例患者手术均成功,无1例出现并发症,均痊愈出院。随访6个月至4年,无复发。结论术后密切观察患者的病情变化,做好伤口与引流管、并发症以及用药观察与护理及出院指导,是减少术后并发症,提高手术成功率,促进患者早日康复的关键。     

心脏粘液瘤手术前后的护理

心脏原发性肿瘤比较少见,但70％～80％属于良性肿瘤,而在心脏良性肿瘤中最多见者为粘液瘤,该病手术效果及预后均比较理想。我院自1991年7月～2002年12月共收治心房粘液瘤30例(其中1例同时合并右房粘液瘤),术后均获得满意效果。现将其手术前后的护理体会总结如下。     

心脏手术患者术中安置临时起搏器的护理

Ⅲ度房室传导阻滞，窦性停搏等心律失常是体外循环心脏手术患者常见而又严重的并发症，与术中低温、麻醉、传导束水肿及手术损伤等因素有关，安置起搏器是最有效且可靠的防治手段。我科１９９７～１９９８年对１０例心脏手术患者于术中安置临时起搏器，护理如下。１临床资...     

心脏外伤急诊体外循环下心脏修补术的手术配合

对10例心脏外伤急诊手术病人在体外循环直视下行心脏修补术,同时予抗休克处理,结果全部病人均抢救成功.认为手术室护士做好抗休克及手术的准备与配合,对抢救成功有重要作用.     

心脏瓣膜置换术后的再次手术治疗

心脏瓣膜置换术后可因各种原因引起人工瓣膜功能障碍 ,导致血流动力学紊乱 ,必须再次手术矫正。我们于 1997年 1月至 2 0 0 0年 7月共施行此类再次手术 19例 ,取得较好的效果。现报告如下。资料与方法　本组中男 8例 ,女 11例。年龄 16～ 5 1岁。其中人工瓣膜瓣周漏 7例 ,人工瓣膜心内膜炎 5例 ,人工瓣膜血栓形成 5例 ,生物瓣衰败 2例。再次手术距第 1次手术时间为 2 5ｄ～ 10年。术前心胸比率 0 6 2～ 0 78;心功能ＩＩＩ级6例 ,ＩＶ级 13例。均在全麻、中度低温体外循环下手术 ,取胸骨正中切口 ,经升主动脉插管 16例 ,经股动脉插管 3例 ;…     

肝包虫病的外科治疗

目的　总结肝包虫病 1740例手术治疗的经验 ,特别是对肝包虫性急腹症及其并发症的治疗方法。方法　对 196 0～ 1997年 1740例肝包虫病例资料进行回顾分析。结果　本组主要并发症中 ,感染为 116 9例次 ,内瘘 388例次 ,破裂 2 15例次。术后并发症为胆汁瘘、囊内感染、外囊残腔闭合不全等。本组手术治愈率为 99 4% ,死亡 9例 (0 6 % )。结论　肝包虫对人体损害主要为肝包虫并发症。肝包虫及其并发症的治疗以外科手术为主 ,特别是对肝包虫破裂所致的急腹症应立即手术 ,清除包虫内容物 ,并即时抗休克、抗感染、抗过敏治疗。术后即时给予抗包虫药物治疗。     

Surgical treatment of human echinococcosis

Hydatid disease may affect several organs in the human body and thus represents a major challenge for the general surgeon. The aim of this study was to analyze the multiple clinical presentations of hydatid disease and the surgical options according to the involved organ. The medical records of 272 adult patients operated on for hydatid disease in our department during the period 1970-1996 were retrospectively reviewed. The most commonly involved organ was the liver (204 patients; 75%), followed by the lung (42 patients; 15.4%) and the spleen (14 patients; 5.1%). In 12 patients, the cysts were located in uncommon sites: in the pancreas (4 patients; 1.5%), the gallbladder (2 patients; 0.74%), the kidney, the thyroid gland, the breast, the pericardium, the supraclavicular region and the thigh (1 patient in each case; 0.37%). Clinical symptomatology varied according to anatomic location and pre-operative diagnosis was accomplished with plain abdominal films, ultrasound, computerized tomography and serological tests. The surgical procedures performed included simple closure with drainage, unroofing of the cyst with omentoplasty (for liver cysts), marsupialization, cyst excision, excision of the involved organ or combinations of procedures. Postoperative morbidity was mainly due to septic complications (n = 41), postoperative bleeding (n = 2), deep vein thrombosis (n = 2) and fistulae (n = 13). Four patients died in the early postoperative period (mortality rate, 1.5%) secondary to septic complications (n = 3) and pulmonary embolism (n = 1). During long-term follow-up, 14 patients developed recurrent disease. In conclusion, hydatid disease should be included in the differential diagnosis of cystic masses in solid organs or other anatomic sites, especially in endemic countries. Since there is not an effective medical treatment, surgery still remains the treatment of choice, offering a good clinical result and an acceptable recurrence rate.     

Surgical treatment of pulmonary echinococcosis

Operation with the use of a laser for resection of the external fibrous capsule with re-expansion of the remaining cavity in patients with echinococcosis of the lungs is more effective than operation by capitonnage of the cavity. The main advantages of laser operations were the absence of closed cavities, deformities of bronchi, atelectasic areas of tissue around the fibrous cavity, and disorders of capillary blood flow and bronchial patency. All this allowed poor results of the operation and fatal outcomes in the main group of patients to be avoided.