Diagnosis and treatment of pulmonary embolism

The tactics of treatment and diagnosis used in 130 patients with embolism of the pulmonary artery (EPA) are discussed. All of them were examined by angiopulmonography including the method of selective contrast. Angiographic symptoms of EPA were found in 90 patients. The authors propose a clinical classification of EPA based on the state of central hemodynamics. Fifty nine of the 90 patients with EPA were treated by thrombolytic drugs (streptase, avelysin, streptolyase). Good effects were noted in 79%, which was confirmed by control angiopulmonography. Twenty patients were given heparin therapy. Embolectomy from the pulmonary artery was fulfilled in 14 patients (15,6%) by various techniques. Lethality was 42,8%. General lethality was 20%.     

腹主动脉骑跨栓塞的诊断与治疗

目的探讨腹主动脉骑跨栓塞的诊断及治疗。方法回顾分析12例患者的临床资料。2例无手术价值,行保守治疗,10例行经双侧股动脉逆行Fogarty导管取栓术,其中1例术中因病情恶化终止手术。结果死亡4例。存活8例中2例出现骨筋膜室综合征及急性肾功能衰竭,截肢1例。随访0.5～7年,2例死于心脏病,2例再发急性下肢动脉栓塞。结论早期诊断、早期手术,尽快恢复肢体血流,同时注意原发病和并发症的治疗是提高疗效,降低病死率和致残率的关键。     

脂肪栓塞综合征的诊治体会

脂肪栓塞综合征（fat embolism syndrome,FES）是骨折特别是多发性骨折及关节置换术中严重的并发症之一,它在骨折中的发病率约占7％,但其病死率高。2005年至2008年在我院、广州军区广州总医院及四川空军总医院收治的外伤患者中18例发生脂肪栓塞综合征,死亡2例,16例治愈。因此对本病早期诊断、早期治疗、预防其发生、尽可能降低病死率就显得非常重要。现就该病的诊治报告如下。     

Echocardiographic detection and treatment of intraoperative air embolism

A real-time two-dimensional echocardiogram was used to detect the presence of an air embolism in patients undergoing neurosurgical procedures in the sitting position. The technique could with good sensitivity detect the appearance of a single air bubble intraoperatively, thus allowing early intervention to prevent development of further air emboli. Two types of air embolism could be differentiated; the single-bubble type and the "stormy-bubble" type. The single-bubble type was observed during skin and muscle incisions, craniotomy, and brain lesion excision. Further embolism development was prevented by electrocoagulation and application of bone wax. The stormy-bubble type occurred during dura and muscle incisions and was prevented by electrocoagulation, reflection of the dura, or suturing the affected muscle. The routine use of a Swan-Ganz catheter for removal of air embolism by suction proved effective for the treatment of the stormy-bubble type of air embolism. Masking the operative field with saline-soaked cotton strips was of moderate benefit in the stabilization of the single-bubble type of air influx, but proved to be of little value in controlling the entrance of the stormy-bubble type.     

脉管性疾病的诊断和治疗

脉管性疾病包括血管瘤和脉管畸形两大类（Mulliken和Glowacki1982年首先进行了生物学分类，经过多年临床实践，1995年Waner和Snen又修改了此分类，这一新分类已被国际脉管病研究会推荐为国际统一分类），系来源于血管或淋巴管的肿瘤或畸形。临床上大多数患者为脉管畸形，真性脉管瘤比例较小。发病部位以口腔颌面部多见，尽管没有恶性肿瘤那样的生物学行为，但其造成难以接受的颜面部畸形、凶险的出血倾向等影响患者容貌美观并严重威胁其生活质量。本文就脉管性疾病的诊断和治疗情况作一综述。     

血运障碍性肠梗阻的诊断与治疗

血运障碍性肠梗阻病情凶险,误诊率及病死率均较高。早期诊断,及时恢复受累肠管血运是改善其预后的关键因素。目前临床检查方法有多种,CT以其诊断率高达90%以及无创的优势而取代血管造影成为血运障碍性肠梗阻确定性诊断的首选方法。治疗方法的选择因病因不同而不同,动脉栓塞者多需手术治疗,静脉血栓形成者以抗凝治疗为主。     

外科手术后肺动脉栓塞的诊治

肺动脉栓塞(Pulmonary Embolism,PE)是西方国家常见疾病,也是手术后常见的并发症。据近年流行病学调查,美国每年PE新发病例数约60万人,每年有6万人死亡,是疾病死亡的第三位原因,仅次于肿瘤和心肌梗塞,其中约1/5发生于手术后,占手术后死亡总数的15％～25％。我国PE发病可能少于西方国家,但绝不是少见病。术后发生PE,涉及外科各个领域,如骨科,普通外科,泌尿外科,心胸外科,神经外科及妇产科、某些介入治疗等,尤其是下肢骨关节手术,发生率可达50％。随着近年来对PE病因学、诊断学和治疗学等研究的不断深人,其死亡率和致残率有望进一步下降。本文就目前外科术后发生PE及其诊治作一综述。     

骨折后并发脂肪栓塞综合征的诊治

脂肪栓塞综合征 (ｆａｔｅｍｂｏｌｉｓｍｓｙｎｄｒｏｍｅ ,ＦＥＳ)是骨折最严重的并发症之一。笔者对近年我院 5 5 1例创伤性骨折患者进行回顾性总结 ,其中 11例并发ＦＥＳ ,现分析如下。1　材料与方法1.1　病例资料　本组 11例 ,男 7例 ,女4例 ,年龄 17～ 75岁。车祸伤 8例 ,坠落伤 3例。 11例均有长骨干骨折 ,股骨干单发骨折 2例 ,股骨干合并胫腓骨骨折 3例 ,股骨合并骨盆骨折 1例 ,股骨干合并肱骨骨折 2例 ,单发胫腓骨骨折 1例 ,双侧胫腓骨骨折 2例。后 3例入院前经反复手法复位未成功。开放性骨折4例 ,闭合性骨折 7例。受伤至ＦＥＳ出…     

创伤后脂肪栓塞综合征的诊治分析

目的 探讨创伤后脂肪栓塞综合征（FES）的诊治问题。方法 总结分析我院1997年3月至2001年3月所收治的9例临床资料。结果 9例按Sevitt分型：暴发型2例，完全型2例，亚临床型5例。除2例暴发型死亡外其余7例因早期发现并及时正确治疗均治愈。结论 正确认识该病的临床表现和诊断标准，早期及时正确的治疗有助于进一步提高疗效。加强创伤后复苏抢救措施可明显降低FES的发生率。     

Case of vascular air embolism during holmium laser enucleation of the prostate

Vascular air embolism is a rare complication during transurethral surgery. A case of air embolism during holmium laser enucleation of the prostate in a 76‐year‐old man is presented. During the step of morcellation, the patient's blood pressure suddenly oscillated up and down, and end‐tidal CO₂ and arterial saturation decreased. Transesophageal and transthoracic echocardiography showed air collection in the right atrium. It was also discovered that incorrect assembly of the tube from the morcellator caused rapid entrainment of air into the vein. Computed tomography and abdominal X‐ray showed niveau formation in the femoral vein and air collection in the pelvic retroperitoneal space. The patient recovered with careful observation and was discharged 7 days after the operation with no sequelae. This report is presented to remind urologists of this unusual complication that can occur during holmium laser enucleation of the prostate procedures.     

Diagnosis and treatment of vascular brain-stem malformations

Vascular malformations are a common cause of spontaneous brain-stem hemorrhage in young normotensive individuals. These lesions are no longer cryptic. Magnetic resonance (MR) imaging has renewed interest in the treatment of this disorder because of the precise accuracy in diagnosis and localization of these lesions that it affords. The MR image demonstrates characteristic findings of multiple hemorrhages of varying ages surrounded by a hypointense peripheral zone of hemosiderin. Five cases of vascular brain-stem malformation diagnosed with MR imaging are described. The vascular malformations could be demonstrated as "flow void" areas in three cases. Three patients were treated surgically and vascular malformations were confirmed: all three patients improved postoperatively. Two patients were treated nonsurgically; one of these recovered from a second hemorrhage and the other experienced neurological deterioration after a single hemorrhage. High-energy radiotherapy was not effective for the one vascular malformation treated by this method. This experience suggests that surgical exploration should be considered for vascular brain-stem malformations when the diagnosis is confirmed by MR criteria and the clinical course and lesion are both progressive in character.     

肠道血管畸形的诊断和治疗

目的：探讨肠道血管畸形的诊断和治疗方法。方法：对29例肠道血管畸形的临床资料进行回顾性分析。结果：本组以反复性，间歇性血便为主要临床表现，17例患经19例次选择性肠系膜血管造影，7次经纤维结肠镜、2例经单光子发射电子计算机断层扫描（ECT），3例行剖腹探查得以确诊。5例非手术治疗，24例行手术治疗。手术患无死亡，亦未发生术后并发症，随访20例（69．0％），再出血4例，其中非手术组3例，手术组1例，结论：（1）选择性肠系膜血管造影是诊断本病的最佳方法；（2）外科手术是治疗肠道血管畸形出血的最有效方法；（3）术前和术中的准确定位是手术成功的关键。