积极稳妥地开展门脉高压症的介入治疗

20世纪70年代,介入放射学开始"介入"到门脉高压症并发症的治疗,第一次突破性的进展是Lunderquist教授开创经皮经肝穿刺门静脉,栓塞曲张的食管胃底静脉(PTE),达到治疗门脉高压引起的消化道出血,临床止血成功率70%～90%.由于门脉压力不能改善,致使术后半年再出血率达38%～70%,2年再出血率71%～90%,而且在肝硬化腹水和门脉血栓形成的病例操作成功率低.     

肝炎后肝硬化并上消化道出血内镜结果分析

肝炎后肝硬化并上消化道出血是消化内科常见急症之一 ,它可直接威胁病人的生命安全 ,是肝炎后肝硬化门脉高压症最常见的并发症。其出血原因除因门静脉高压引起的食道胃底静脉曲张破裂所致之外 ,临床还有相当一部分病人是由门脉高压性胃病(ＰｏｒｔｏｌＨｙｐｅｒｔｅｎｓｉｖｅＧａｓｔｒｏｐａｔｈｙ ,ＰＨＧ)所引起。ＰＨＧ的病人常因胃粘膜炎症、糜烂和溃疡未得到及时有效控制而引发出血 ,这是临床抢救治疗中不可忽视的重要因素。我们收集了近 5年来临床收治的 72例肝炎后肝硬化并上消化道出血病例 (均经急诊内镜检查确诊 ) ,现分析如下 …     

高原地区门静脉高压症并发消化道出血104例输血方式探究

门静脉高压症并发消化道出血原因多为食管一胃底静脉曲张破裂所致。出血迅猛、出血量大,短期内可引起失血性休克致患者死亡,必须立即进行有效的急救,输血是治疗过程中重要的环节。门静脉高压输血势必会加大门静脉压力。掌握不好甚至会诱发出血,在治疗中有矛盾的一面。我院地处高原地区,高原气候所致的特殊生理还影响着对出血量的判断。2001年9月-2006年10月我院共收治门静脉高压症并发消化道出血患者104例,取得了良好的输血和止血效果。     

介入断流术治疗门脉高压上消化道大出血的中远期随访结果

目的 评价介入断流术治疗门静脉高压症食管胃底曲张静脉出血的中、远期疗效.方法 对49例肝硬化门静脉高压症患者施行介入断流术治疗,术后随访6～36个月,分析复发再出血、曲张静脉转归及并发症情况.结果 技术成功率为98.0%(48/49),病死率为2.1%,术后1、6个月和1、2、3年再出血率分别为0、2.1%、12.5%、24.5%、27.9%.复发再出血原因分别为曲张静脉破裂再出血25.0%、门静脉高压性胃病58.3%、消化性溃疡16.7%.结论 介入断流术治疗门静脉高压症上消化道出血是一种简单、安全、有效的方法.     

肝硬化合并食管胃底静脉出血治疗

各种疾病引起的肝脏慢性损伤,其中一部分病例最终发展而成为肝硬化门脉高压形成,并导致侧枝循环建立。侧枝循环的建立是门脉高压发展到一定程度机体对其缓解而产生代偿作用的表现。然而其中食管胃底静脉因其所处的特殊位置及其血管本身特点而易引起破裂出血,血管破裂出血是肝硬     

上消化道出血的诊治现状

上消化道出血是消化内科常见急重症,包括急性非静脉陆张上消化道出血（ANVUGIB）,即屈氏韧带以上的消化道非静脉曲张性疾病引起的出血;食管静脉曲张出血（EGVB）,即由于肝硬化等病变引起的门静脉高压致食管和（或）胃壁静脉曲张,在压力升高或静脉壁发生损伤时曲张静脉破裂出血。近年来,上消化道出血在诊断与治疗方面均取得较大进展。现综述如下。     

门静脉高压症介入断流术与外科断流术的临床对照研究

目的 评价介入断流术与外科断流术治疗肝硬化门静脉高压症食管胃底曲张静脉出血的临床效果.资料与方法 一组为介入科对73例经临床诊断为肝硬化门静脉高压性曲张静脉出血的患者,作经皮穿刺曲张静脉硬化栓塞和部分性脾动脉栓塞治疗.另一组为肝胆外科对98例门静脉高压症患者,行外科断流术.比较两组术后反应和并发症;以及住院时间和治疗费用;追踪随访术后肝功能、复发出血情况和生存状态;首次出血时间和生存时间.结果 (1)介入断流术的并发症:发热(76.9%)、腹痛(58.5%)、腹胀(35.4%),无严重并发症发生;外科断流术术后并发症:死亡(3.1%),呕血或黑便(7.1%),门静脉血栓形成(18.4%),感染包括脓肿、败血症(5.1%)等;(2)介入断流术1、2、3、4、5年的累计复发出血率分别为:18.46%、29.23%、35.38%、38.46%、38.46%;累计生存率分别为:93.85%、90.77%、86.15%、83.08%、81.53%.外科断流术1、2、3、4、5年的累计复发出血率分别为:27.36%、36.72%、42.58%、45.67%、48.93%;累计生存率分别为:79.63%、75.48%、72.32%、70.15%、69.68%.结论 介入断流术治疗门静脉高压曲张静脉出血设计合理、操作简单安全,止血效果明确,尤其适合肝功能B级和C级患者的止血治疗.可改善患者生存质量,延长生存时间.     

肝硬化并发上消化道出血78例病因分析

上消化出血是肝硬化失代偿期最常见的并发症,出血原因大多数由于食管、胃底静脉曲张破裂,但随着急诊胃镜的广泛开展,发现消化性溃疡、门脉高压性胃病,急性出血糜烂性胃炎、食道炎也是引起出血不容忽视病因.     

门脉高压上消化道出血治疗78例分析

目的:研究分析垂体后叶素静脉滴注治疗门脉高压上消化道出血的效果.方法:收集自2011-02～2012-02收治的78例门脉高压上消化道出血患者,其中40例设为研究组,给予垂体后叶素治疗,同期38例门脉高压上消化道出血患者设为对照组,给予三腔两囊管治疗.观察研究组与对照组的止血效果,评估其再发风险.结果:研究组治疗显效29例,有效6例,无效5例,总有效率为87.5%;对照组治疗显效21例,有效8例,无效11例,总有效率为72.5%;研究组的有效率显著高于对照组,P＜0.05,有统计学意义.结论:垂体后叶素静脉滴注治疗门脉高压上消化道出血安全有效,疗效稳定,可广泛使用.     

102例肝硬化并上消化道出血临床诊治分析探讨

目的 探究对肝硬化并上消化道出血患者应采取的科学诊治方式.方法 选取收治的102例患者,对它出血原因进行观察,依照随机方式将其分为常规组和研究组,每组51例.对常规组常规治疗,对研究组在观察疾病病因基础上实施对症治疗.结果 102例患者中,食管静脉曲张破裂导致出血51例(50%).消化性溃疡导致出血16例(15.69%).门脉高压性胃病导致出血27例(26.47%).急性胃黏膜病变导致出血6例(5.88%).胃癌导致出血2例(1.96%).研究组患者的治疗效果明显比常规组患者好,且两组差异具有统计学意义(P<0.05).结论 肝硬化并上消化道出血患者的主要发病原因为食管静脉曲张破裂;消化性溃疡;门脉高压性胃病;急性胃黏膜病变;胃癌,对其实施对症治疗可获取较好效果,改善临床症状,促进患者身体尽快康复痊愈.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.