带蒂大网膜移植在急性阑尾炎治疗中的应用

带蒂大网膜移植在急性阑尾炎治疗中的应用胶州中心医院（２６６３００）赵文希徐建坏疽穿孔性阑尾炎或阑尾脓肿患者，由于其阑尾根部及阑尾壁充血水肿，脆弱粘连，手术一期切除阑尾时，容易导致肠瘘等严重并发症。为此，我们采用带蒂大网膜移植于阑尾周围并同时切除阑尾的...     

手术治疗合并糖尿病急性阑尾炎效果的临床观察

目的观察急性阑尾炎患者是否合并糖尿病行急诊阑尾切除术治疗的效果,并探讨糖尿病对围术期的影响。方法选择2004—2013年10年间辉南县中医院收治的行急诊阑尾切除术的30例合并糖尿病急性阑尾炎患者为观察组研究对象,随机选择同期收治的行急诊阑尾切除术的30例未合并糖尿病的阑尾炎患者为对照组研究对象,手术选择常规开腹阑尾切除术和腹腔镜阑尾切除术的方法。结果观察组浅表性胃炎低于对照组,坏疽性阑尾炎高于对照组;观察组和对照组术后排气时间分别为（70.2±6.8）和（81.1±7.0）h,观察组术后排气时间（70.2±6.8）h低于对照组（81.1±7.0）h（t=6.11,P〈0.05）;观察组切口感染（8例）低于对照组（2例,χ2=4.32,P〈0.05）;腹腔感染、心律失常和电解质紊乱发生例数差异无统计学意义（P〈0.05）。结论应加强合并糖尿病急性阑尾炎急诊手术治疗时围术期的管理,使患者早日康复。     

特殊类型阑尾炎患者的腹腔镜尾切除术

探讨了大腹腔镜外科手术的适应证范围。方法患急性尾孕妇３例（妊娠２．５－６．５个月），老年患者１２例（６０－７０岁），年幼患者５例（１１－１５岁），胆囊旁阑尾声例，盆腔位阑尾４例，蛔虫性阑尾炎１例，作了腹腔镜阑尾切除术。结果２５例均成功完成手术，手术时间平均３０．５分钟。     

阑尾炎患者阑尾切除181例体会

１９８９年１０月～１９９９年４月,我院行阑尾切除术１８１例。现将阑尾切除的手术时机探讨如下。 一般资料：本组１８１例中,男１２４例,女５７例;年龄５岁～７４岁,平均３１．５岁。其中急性阑尾炎９２例,慢性阑尾炎急性发作 ８８例,慢性阑尾炎（无症状期） １例。 手术情况：发病３天内手术９８例,发病３天后手术８３例。术中探查证实,单纯性阑尾炎９２例,化脓性阑尾炎６１例,坏疽性阑尾炎２８例（其中１１例出现了穿孔）,且在上述病例中有８７例阑尾与肠系膜、肠管或腹膜出现了不同程度的粘连。 结果：本组除１２例出现并…     

内镜逆行阑尾炎治疗术对不典型急性阑尾炎的诊断与治疗价值

目的 探讨内镜逆行阑尾炎治疗术（ERAT）对不典型急性阑尾炎的诊断与治疗价值。方法 2015年1月至2016年12月于江苏省人民医院就诊的所有疑诊为不典型急性阑尾炎的48例患者,按照治疗方法不同分为ERAT组和保守治疗组,比较两组患者最终阑尾切除率。结果 因病情复杂或个人意愿等原因,ERAT组的24例患者中仅17例接受了内镜下治疗,其中16例被诊断为急性阑尾炎,经ERAT治疗后5例因疾病复发行外科阑尾切除,切除率31.3%（5/16）;保守治疗组的24例患者均接受抗生素治疗,20例因再发阑尾炎行外科阑尾切除,其中1例出现阑尾穿孔,切除率83.3%（20/24）。ERAT组的外科切除率较保守治疗组低（?2=11.111,P<0.05）。结论 ERAT对不典型急性阑尾炎具有较高的诊断与治疗价值。     

特殊类型阑尾炎患者的腹腔镜阑尾切除术

目的　探讨扩大腹腔镜外科手术的适应证范围。方法　患急性阑尾炎的孕妇３ 例（妊娠２．５～６．５ 个月）,老年患者１２例（６０～７０ 岁）,年幼患者５ 例（１１～１５ 岁）,胆囊旁阑尾２ 例,盆腔位阑尾４ 例,蛔虫性阑尾炎１ 例,作了腹腔镜阑尾切除术。结果　２５ 例均成功完成手术,手术时间平均３０．５分钟。１ 例患者术中漏诊直肠上段癌,术后６ 天确诊。并发戳口感染１ 例。结论　腹腔镜阑尾切除术具有创伤小、恢复快及瘢痕小等优点,对孕妇、老年人、小儿、异位阑尾及蛔虫性等特殊类型的阑尾炎,也能体现其优点,值得进一步探索。     

小切口阑尾切除术56例体会

小切口阑尾切除术５６例体会东阿县人民医院（２５２２００）李书成毕晓锋邢秀珍１９９４～１９９６年，我院采用小切口行阑尾切除术５６例，效果满意。临床资料：本组男３７例，女１９例；年龄８～７４岁。急性单纯性阑尾炎３０例，慢性阑尾炎６例，急性化脓性阑尾炎１３...     

糖尿病患者腹腔镜阑尾切除术治疗急性阑尾炎效果的临床观察

目的观察糖尿病与非糖尿病患者腹腔镜阑尾切除术治疗急性阑尾炎效果。方法以2012年1月—2013年12月白城市某医院治疗的50例合并糖尿病的急性阑尾炎患者为研究组,选择同期80例具有可比性的非糖尿病急性阑尾炎患者为对照组,两组患者均采用腹腔镜阑尾切除术进行治疗。结果研究组术后发热天数、抗菌药物使用、住院天数和并发症总发生率均高于对照组（P〈0.01）,术后排气时间差异无统计学意义（P〉0.05）。结论与非糖尿病患者比较,糖尿病患者手术耐受性差,术后并发症发生率较高,应研究有效控制糖尿病患者腹腔镜阑尾切除围术期血糖水平的方案。     

小切口阑尾切除术430例疗效观察

1999年1月～2009年12月,我们共行小切口（〈3cm）阑尾切除术430例,疗效满意。现报告如下。 临床资料：860例患者,男511例、女349例,年龄8—65岁。均元过度肥胖者。急性阑尾炎812例（单纯性阑尾炎392例,化脓性阑尾炎362例,坏疽性阑尾炎58例）,慢性阑尾炎34例,因出国劳务派遣行预防性阑尾切除术14例。     

横切口粘膜下阑尾切除术72例报告

横切口粘膜下阑尾切除术７２例报告邹平县人民医院（２５６２００）孙勇山东医科大学附属医院赵殿昌我院于１９９２～１９９５年行横切口粘膜下阑尾切除术７２例，效果满意。临床资料：本组男４０例，女３２例；发病至手术时间３～１２小时．平均１２．２小时。急性阑尾炎...     

Trousseau Syndrome in a 25-Year-Old Woman with Occult Colon Malignancy,Lynch Syndrome,and Chronic Thromboembolic Pulmonary Hypertension

We present a rare case of thrombosis associated with an occult colon malignancy (Trousseau syndrome) in a 25-year-old woman who also presented with previously unidentified Lynch syndrome and acute-on-chronic thromboembolic pulmonary hypertension. Staged treatment included bilateral pulmonary endarterectomy under deep hypothermic circulatory arrest, followed 11 days later by laparoscopic subtotal colectomy and creation of a primary anastomosis. The patient tolerated both procedures well and recovered normal functional status. Final pathologic analysis of the resected colon mass revealed a pT3N0, stage IIA adenocarcinoma; no adjuvant therapy was administered. At her one-year follow-up visit, the patient was cancer-free, remained on lifelong apixaban anticoagulation, and was undergoing routine monitoring and genetic counseling. This case highlights the need for multidisciplinary management of a patient with severe chronic thromboembolic pulmonary hypertension and a concomitant malignancy.     

Large Lipomatous Hypertrophy of the Interventricular Septum

We present the case of a 58-year-old woman who had large lipomatous hypertrophy of the interventricular septum, a condition that is reported very infrequently. Preoperative cardiac magnetic resonance images revealed an inhomogeneous, infiltrating mass that was suppressed in fat-suppression mode. The extensive mass was causing right ventricular dysfunction, so we excised it through a right ventricular approach. The findings on histologic analysis of the mass were consistent with lipomatous hypertrophy. The patient died of septic shock on the 28th postoperative day. In addition to the patient''s case, we discuss the characteristics and diagnosis of this rare entity.     

Conservative Management of Cardiac Hemangioma for 11 Years

Cardiac hemangiomas are benign tumors with an unpredictable natural history. Surgical resection is the treatment of choice; however, conservative management can be an alternative in some patients.We report a case of a left-sided cardiac hemangioma that we managed conservatively for 11 years without obvious major complications in the patient, an adult woman.     

Resolution of Right-Sided Heart Failure Symptoms after Resection of a Primary Ovarian Carcinoid Tumor

Carcinoid tumors are rare neuroendocrine malignancies that typically originate from the gastrointestinal tract. Patients who are diagnosed with carcinoid heart disease generally have poor prognoses because of advanced metastases during staging and few therapeutic options. We present the case of a 61-year-old woman with right-sided heart failure, secondary to carcinoid heart disease caused by a primary ovarian carcinoid tumor. After undergoing surgical resection of the left ovary and fallopian tube, the patient experienced complete resolution of her heart failure symptoms. In addition to the patient''s case, we discuss the diagnosis, nature, and treatment of this rare condition.     

Cardiac Sarcoidosis Presenting as Constrictive Pericarditis

In patients with cardiac sarcoidosis, the sarcoid granulomas usually involve the myocardium or endocardium. The disease typically presents as heart failure with ventricular arrhythmias, conduction disturbances, or both. Constrictive pericarditis has rarely been described in patients with sarcoidosis: we found only 2 reports of this association.We report the case of a 57-year-old man who presented with clinical and hemodynamic features of constrictive pericarditis, of unclear cause. He was admitted for treatment of recurrent pleural effusion. After a complicated hospital course, he underwent pericardiectomy. His clinical and hemodynamic conditions improved substantially, and he was discharged from the hospital in good condition. The pathologic findings, the patient''s clinical course, and his response to pericardiectomy led to our diagnosis of cardiac sarcoidosis presenting as constrictive pericarditis. In addition to the patient''s case, we discuss the nature and diagnostic challenges of cardiac sarcoidosis. Increased awareness of this disease is necessary for its early detection, appropriate management, and potential cure.     

Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

In the modern period of reperfusion, left ventricular free-wall rupture occurs in less than 1% of myocardial infarctions. Typically, acute left ventricular free-wall rupture leads to sudden death from immediate cardiac tamponade. We present the case of a 59-year-old woman who sustained a posterior-wall myocardial infarction and subsequent cardiac arrest with pulseless electrical activity. A bedside transthoracic echocardiogram showed pericardial effusion with cardiac tamponade. Emergency pericardiocentesis yielded 500 mL of blood, and spontaneous circulation returned. Contrast-enhanced echocardiograms revealed inferolateral akinesis and a new, small myocardial slit with systolic extrusion of contrast medium, consistent with left ventricular free-wall rupture. During immediate open-heart surgery, a small hole in an area of necrotic tissue was discovered and repaired. This case highlights the usefulness of bedside contrast-enhanced echocardiography in confirming acute left ventricular free-wall rupture and enabling rapid surgical treatment.     

肝硬变腹水患者钾钠氯及酸碱失衡

目的研究肝硬变腹水患者的钾、钠、氯及酸碱失衡。方法肝硬变腹水患者１５４例，血Ｋ＋、Ｎａ＋、Ｃｌ－测定采用ＥＥＬ公司自动分析仪及火焰光度计。血气及酸碱度测定采用ＩＬ１３０２型自动微机分析仪。结果低血钾者５７例，高血钾者６例，低血钠者８１例，高血钠者１２例，低血氯者３４例，高血氯者８例。２４例血气及酸碱度测定结果显示，以碱中毒者为主。依次为呼碱、呼碱＋代酸、代酸、代碱、呼酸。本组高血钾、低血钠与Ｃｈｉｌｄ分级、ＢＵＮ、Ｃｒ值相关。从本组资料表明，重症肝硬变腹水患者水盐代谢失衡多为医源性所致，且加重原有失衡。高钾血症、急性低钠血症及高钠血症大多如此，多为住院后发生，常可危及生命。结论肝硬变腹水患者的高钾血症、低钠血症和高钠血症大多在肝肾功能低下，不适当的治疗所致，是影响预后的重要因素     

Benefits and Limitations of Multimodality Imaging in the Diagnosis of a Primary Cardiac Lymphoma

Primary cardiac tumors are far rarer than tumors metastatic to the heart. Angiosarcoma is the primary cardiac neoplasm most frequently detected; lymphomas constitute only 1% of primary cardiac tumors.We present the case of a 55-year-old woman with a recently diagnosed intracardiac mass who was referred to our institution for consideration of urgent orthotopic heart transplantation. Initial images suggested an angiosarcoma; however, a biopsy specimen of the mass was diagnostic for diffuse large B-cell lymphoma. The patient underwent chemotherapy rather than surgery, and she was asymptomatic 34 months later.We use our patient''s case to discuss the benefits and limitations of multiple imaging methods in the evaluation of cardiac masses. Certain features revealed by computed tomography, cardiac magnetic resonance, and positron emission tomography can suggest a diagnosis of angiosarcoma rather than lymphoma. Cardiac magnetic resonance and positron emission tomography enable reliable distinction between benign and malignant tumors; however, the characteristics of different malignant tumors can overlap. Despite the great usefulness of multiple imaging methods for timely diagnosis, defining the extent of spread and the hemodynamic impact, and monitoring responses to treatment, we think that biopsy analysis is still warranted in order to obtain a correct histologic diagnosis in cases of suspected malignant cardiac tumors.     

Primary Cardiac Sarcoidosis with Syncope and Refractory Atrial Arrhythmia: A Case Report and Review of the Literature

We discuss the case of a 38-year-old black man who presented at our hospital with his first episode of syncope, recently developed atrial arrhythmias refractory to pharmacologic therapy, and a left atrial thrombus. He was diagnosed with primary cardiac sarcoidosis characterized by predominant involvement of the epicardium that caused atrial fibrillation and atrial flutter. Histologic analysis of his epicardial lesions yielded a diagnosis of sarcoidosis. This patient''s atrial arrhythmia was successfully treated with a hybrid operation that involved resection of his atrial appendage, an Epicor maze procedure, and radiofrequency ablation during a catheter-based electrophysiologic study. The cardiac sarcoidosis was successfully managed with corticosteroid therapy.Our case report shows that sarcoidosis can initially manifest itself as syncope with new-onset atrial arrhythmia. Sarcoidosis is important in the differential diagnosis because of its progressive nature and its potential for treatment with pharmacologic, surgical, and catheter-based interventions.     

Acute Coronary Thrombosis and Multiple Coronary Aneurysms in a 22-Year-Old Man with the Human Immunodeficiency Virus

The human immunodeficiency virus (HIV) can cause diverse cardiovascular complications. In HIV patients on antiretroviral therapy, the prevalence of myocardial infarction has steadily increased over the years. Young patients who are naïve to antiretroviral therapy and who experience coronary events are not well represented in the medical literature. We describe the case of a 22-year-old man, infected with HIV for 4 years and never treated with antiretroviral therapy, who emergently presented with a non-ST-segment-elevation myocardial infarction. Coronary angiograms revealed thrombosis and multiple coronary artery aneurysms; however, no areas of atherosclerotic stenosis were apparent. He was successfully treated with coronary stenting, antiplatelet therapy, and anticoagulation. Nine months after the initial presentation, he exhibited excellent exercise capacity, and no ischemia was evident. We discuss the various therapeutic approaches in this case.