腹部手术后功能性胃排空障碍的诊治

目的探讨腹部手术后功能性胃排空障碍的诊断与治疗方法。方法回顾性分析28例腹部手术后发生功能性胃排空障碍患者的临床资料。结果经非手术治疗后均在12～52d恢复正常胃功能,痊愈出院。其中治疗3周内胃功能恢复22例(78.6%),3周以上胃功能恢复6例(21.4%)。结论科学完善的非手术治疗,可快速有效地恢复腹部手术后功能性胃排空障碍患者的胃功能。     

胃大部切除术后残胃无张力症的诊治体会

目的 探讨胃大部切除术后残胃无张力症(胃排空障碍)的原因、诊断与治疗.方法 分析我院外科1990～2007年32例胃大部切除术后残胃排空障碍的诊疗经过.结果 残胃排空障碍发生于术后4～8d,27例经保守治疗治愈.保守治疗时间8～24d,平均13d.5例因保守治疗无望而中转手术,术中发现残胃排空障碍均与粘连有关,其中4例是与大网膜粘连团块压迫吻合口与输出段空肠有关.结论 胃大部切除术后并发残胃排空障碍多数是功能性的,可经保守治疗治愈,但若经3w以上保守治疗仍未奏效者,应考虑机械性梗阻的存在.胃钡餐(GI)与胃镜检查有助于明确诊断,应尽早中转手术.     

胰十二指肠切除发生胃排空障碍的诊断与外科治疗

目的:探讨胰十二指肠切除术后胃排空障碍的临床表现、发病机理及治疗方法.方法:对46例胰十二指肠切除术后胃排空障碍的患者进行回顾性分析.结果:胃排空障碍均发生于术后7天～13天,所有病人的在排除其他术后并发症、明确诊断后,均经保守治愈出院.结论:准确的诊断、积极有效的围手术期处理是胰十二指肠切除术后胃排空障碍治疗的重要保障.     

胃癌根治术后残胃功能性排空障碍的诊断和治疗

目的:探讨胃癌根治术后残胃功能性排空障碍(FDGE)的病因、诊断及治疗方法。方法:对2004年1月～2008年12月302例胃癌根治术后的病例资料进行回顾性分析。结果:302例患者中有12例出现FDGE,发生率为4.0%。诊断根据临床表现、上消化道造影和胃镜检查确定。其中毕Ⅱ胃肠吻合术患者FDGE的发病率为5.6%,显著高于毕Ⅰ式的2.4%。所有患者经保守治疗后,均于10～36d内治愈。结论:FDGE是胃术后的近期并发症,毕Ⅱ式吻合术后易发。上消化道造影和胃镜检查是诊断本病的重要方法,采用非手术治疗一般均可治愈。     

上消化道穿孔无效中转手术11例临床分析

目的探讨上消化道穿孔保守治疗失败的患者中转手术的时机和临床疗效。方法回顾性分析上消化道穿孔保守治疗12 h后、腹痛腹胀持续加重、出现高热或休克、中转手术治疗的11例患者的临床资料,9例行穿孔修补术,1例行姑息胃癌切除术（胃大部切除术）,1例行根治性远端胃癌切除术。结果中转手术治愈10例,死亡1例。结论上消化道穿孔若早期保守治疗效果差,患者腹膜炎加重症状,应及时手术治疗     

食管胃底静脉曲张破裂出血预后的队列研究

目的探讨影响食管胃底静脉曲张破裂出血患者长期生存的预后因素,评价手术、内镜硬化剂或套扎治疗、经颈静脉肝内门体静脉分流术(TIPS)治疗及联合治疗等干预措施对病人长期生存的影响.方法以回顾性队列研究方式分析了1992～1999年202例以食管胃底静脉曲张破裂出血入院的患者.首次接受干预措施时或因食管胃底静脉曲张破裂出血首次入院为研究起点,死亡、发生肿瘤或研究截止日为终点.平均随访时间34个月.按接受干预措施的不同分为未干预组、手术组、内镜组、TIPS组及联合干预组,比较各组生存曲线;评价影响肝硬化食管静脉曲张破裂出血病人长期生存的预后因素.结果生存率曲线(Kaplan-Meier曲线)分析显示,联合干预组和手术组病人预后明显优于内镜治疗组和无干预组(P<0.05),而内镜治疗组和未干预组无明显差异(P>0.05),联合干预组与手术组也无明显差异.采用Child-Pugh分级分层后显示对于ChildA或ChildB级者,结果相似.而ChildC级病人由于病例数较少无法比较各组之间的差异.Cox比例风险模型的多因素分析显示,4个变量和预后独立相关凝血酶原时间、HBV-DNA、腹水、手术治疗.结论手术治疗或者手术联合其他措施的预防食管静脉曲张治疗能明显改善肝硬化食管静脉曲张破裂出血病人的预后.凝血酶原时间、HBV-DNA、腹水、手术分流与肝硬化食管静脉曲张破裂出血病人的预后有关.     

自发性食管破裂的早期诊断及治疗

目的：探讨自发性食管破裂的早期诊断及治疗。方法：回顾性分析我院2004年4月至2007年4月收治的自发性食管破裂患者9例,分析其临床表现及外科治疗方法。结果：早期开胸手术的6例患者治疗效果较好,其中痊愈5例,术后并发吻合口瘘1例。晚期手术患者2例,1例因术后并发脓胸及急性肾功能衰竭而死亡,1例自动出院。保守治疗1例因不能控制的严重感染和中毒性休克而死亡。结论：提高对自发性食管破裂的认识,早期手术是治疗成功的关键。     

上腹部手术后功能性胃排空障碍35例临床分析

目的:探讨综合治疗腹部手术后胃排空障碍的临床疗效。方法:回顾性分析35例腹部手术后功能性胃排空障碍患者的临床资料,用中西医结合的方法综合治疗。结果:功能性胃排空障碍多发生于腹部手术后4～16天,中西医结合保守治疗有效。结论:腹部手术后胃瘫应该采用保守综合治疗,患者疗效显著。     

A Case of Life-threatening Hemorrhagic Shock Due to Spontaneous Rupture of a Leg Varicose Vein

We report a case of massive, life-threatening from a varicose lesion of the right lower extremity. An 81-year-old lady was brought to the emergency room at our hospital because of massive bleeding from her right leg. She had had high ligation of the right saphenous vein at another hospital 2 years ago. After hemostat and transfusion, she recovered from hemorrhagic shock. Three-dimensional enhanced computed tomography angiography revealed a residual right great saphenous vein and recurrent varicose lesion. We performed high ligation of the great saphenous vein and closed all of the residual perforators. The patient was discharged hospital 10 days after the surgery and experienced no bleeding episodes within 8 months after the surgery. Certain high ligation and elimination of perforators of the great saphenous vein in surgery for varicose vein of leg is necessary to prevent lethal bleeding.     

烧伤后上消化道大出血的治疗体会(附4例报告)

目的 探讨烧伤并发上消化道大出血的发生特点、致病因素与预防、治疗方法.方法 回顾分析我院收治的4例烧伤后并发上消化道大出血患者的临床资料.结果 4例患者烧伤面积为25%～95%,首次发生消化道出血的发生时间为伤后3～6d,程度较轻,而大出血的发生时间为伤后11～47d;其中3例植皮术后大出血的发生时间均在术后第2天,麻醉方式均为静脉全身麻醉;大出血发生时输血量为16～52单位(每单位为200ml);2例手术治疗止血成功,1例保守治疗成功,最终治愈;1例保守治疗无效死亡.结论 提高复苏质量、缩短手术和麻醉时间、尽量采用物理降温、认识保守治疗和放射介入治疗的局限性、及时手术是预防和治疗大出血的主要措施.     

胃大部份切除术后残胃无力症的原因及治疗

目的:观察探讨胃大部份切除术后残胃无力症的原因,总结其临床治疗方法及治疗效果.方法:选取我院2009年2月～2011年2月胃大部份切除术后残胃无力症的患者32例,均经X线及相关检查诊断为功能性残胃无力症,随机分为观察组和对照组,对照组在对其发病原因进行综合性分析后对症给予胃肠外营养支持、胃肠减压等治疗,观察组在对照组常规治疗的基础上给予中医治疗,观察对比两组治疗效果.结果:经对症治疗后,32例患者术后在18～46d内症状基本消失,能恢复流质饮食,所有患者均痊愈出院,住院时间平均为31.5d,两组疗效对比差异显著(P＜0.05),具有统计学意义.结论:胃大部份切除术后残胃无力症的原因多以术后饮食改变、精神紧张、高龄、炎症刺激、糖尿病等为主要诱因,一旦经X线确诊后,应及时对症治疗,以保守治疗为原则,尽量缓解患者的精神紧张情绪、给予合理的胃肠外营养支持,避免采取手术治疗,加以中医辅助治疗能促进残胃功能恢复,具有重要的临床意义.     

急性胃出血的急诊治疗及效果分析

目的:探讨急性胃出血患者的治疗效果。方法:选择68例急性胃出血患者,根据病情分别采用保守治疗和手术治疗,分别观察两种方法治疗后的效果。结果:急性胃出血患者经治疗后,大部分患者出现痊愈和好转,总有效率达到88.23%,只有8例治疗无效,其中采用手术治疗患者中,2例因为胃出血严重,导致休克及其他功能衰竭导致死亡。其中,由于进行保守治疗的患者病情较轻,因此总有效率高于手术治疗组,痊愈率和好转率达到66.67%和25.93%,均高于手术治疗组。结论:对于急性胃出血患者,要根据具体病情进行相应的治疗,最大限度提高患者治愈率。     

H1N1流感疫苗注射后出现渗出性视网膜脱离伴葡萄膜炎两例

Objective: To report two cases of exudative retinal detachment and uveitis following vaccination of H1N1 influenza. Methods: The data of two patients with exudative retinal detachment and uveitis following vaccination of H1N1 influenza who underwent systemic steroid treatment in our department were retrospectively analyzed. Results: Case1 was a 10-year-old boy and develop vitreous opacity and exudative retinal detachment at 10 days after vaccination of H1N1 influenza. Intravenous use of 500 mg methylprednisolone for 5 days following by oral prednisone (130mg; 5 mg decreasing each week). One month after treatment, vitreous got clear, subretinal fluid disappeared, and his visual acuity increased. Case2 was a 47-year-old female with type2 diabetes. At 2 days after she underwent the vaccination of H1N1 influenza, she suffered from a fever. One month later, she encountered bilateral headache and decreasing vision. Visual acuity was 0.02 (right) and 0.12 (left). In both eyes, mutton fat keratic precipitates, slightly positive Tyndall phenomenon, congestion of optic disc and exudative retinal detachment at posterior pole were observed. Intravenous use of 1000 mg methylprednisolone for 3 days, following by oral prednisone (130mg; 5 mg decreasing each week) was given. One month after treatment, subretinal fluid disappeared while choroidal hyperfluorescence was observed. Her visual acuity was 0.01 and IOP was 14mmHg in both eyes. Conclusions: In the current hot time of worldwide vaccination of H1N1 influenza, ophthalmologist should be aware of this rare complication. Early use of systemic steroid may be associated with a better prognosis.     

Hypernatraemic dehydration after Lucozade.

OBJECTIVE: To emphasise the dangers of inappropriate rehydration fluids in the treatment of gastroenteritis. CLINICAL FEATURES: A two-year-old girl was admitted to hospital in shock and unconscious. She had a 36-hour history of diarrhoeal illness and had received Lucozade. Therapy with this hypertonic fluid resulted in worsening diarrhoea and seizures. On examination she had hypernatraemic dehydration and decorticate posturing. INTERVENTION AND OUTCOME: An intravenous line was inserted, stable plasma protein solution was given, and she was admitted to the intensive care unit. Anticonvulsant and antibiotic therapy were begun. Significant neurological impairment was still evident after 14 days, at which time shw was discharged from hospital. Six months later she had made a good recovery, with no persisting neurological deficit. CONCLUSION: The inappropriate use of hypertonic fluids in gastroenteritis may be associated with significant electrolyte imbalances and neurological sequelae.     

食管癌术后胸胃排空障碍探讨

目的探讨食管癌术后胸胃排空障碍的原因及防治措施。方法对1990-2003年间25例食管癌术后胸胃排空障碍患者的临床资料进行回顾性分析,共占同期食管癌手术的0.9%。结果功能性胃排空障碍18例,均经保守治愈,机械性胃排空障碍7例,经手术治愈无死亡。结论食管癌术后胸胃排空障碍的主要原因为功能性,经保守治疗可治愈,少数为机械性梗阻,则急需及时手术治疗,术中规范的操作可以降低该病的发生率,吻合后再仔细检查吻合口周围及远端情况是预防的重要手段。     

食管癌术后胃排空障碍临床分析

目的:探讨食管癌术后胃排空障碍的原因和治疗.方法:回顾分析6例食管癌除术后功能性和机械性胃排空碍的临床特点,选择手术和非手术治疗的措施.结果:经保守治疗后痊愈4例,行手术探查2例,术中证实为机械性梗阻.1例行胃壁破裂修补术,1例剖胸胃松解.术后均治愈好转出院.结论:食管癌切除术后胃排空障碍可为功能性因素或机械性因素所致.根据其临床表现、X线钡餐或胃镜检查以鉴别,如无绞窄征象应先保守治疗,若无缓解征象应考虑手术探查.     

食管癌术后胃排空障碍的诊断及治疗

目的：探讨食管癌切除术后胸腔胃排空障碍的原因、诊断、治疗及预防。方法：对56例食管癌术后并发胃排空障碍患者采用药物和胃镜下置营养管行肠内营养。结果：56例均得明确诊断,全部治愈。结论：胃肠造影和胃镜检查可明确诊断食管癌术后胃排空障碍,使用非手术的保守治疗可获得治愈。     

Postoperative regression of clubbing at an unexpected rate in a patient with aortic and mitral valve replacement due to infective endocarditis

Pulmonary diseases such as malignancies, empyema, bronchiectasis, digestive tract malignancies, inflammatory bowel diseases, cyanotic congenital heart diseases and infective endocarditis can cause clubbing. We present a 63-year-old female patient with infective endocarditis, who had clubbing that resolved very rapidly after cardiac surgery due to rupture of the mitral papillary muscle. She had persistent fever and in her echocardiographic examination rupture of the papillary muscle of the anterior mitral valve and significant aortic regurgitation was noted. She was scheduled for emergency operation and had debridement and replacement of the mitral and the aortic valves. During the follow-up, she had complaints of pain in the distal parts of the fingers. The convex shape of the nails changed and basal portions were apparently thinner and paler than the previous thickened and discoloured, hyperkeratotic nails. This newly growing tissue rapidly replaced the old thick nails in 3 days.     

胃癌并发急性大出血的临床分析及诊治探讨(附82例报告)

目的 通过对82例胃癌并发大出血的病人进行临床分析，观察其临床特点，探讨改进诊治方法。方法 分析82例胃癌并急性大出血病人的病史，临床表现，病理分型，治疗方法和治疗效果。结果 胃癌并发急性大出血大部分病例发生在进展期胃癌：BorrmannⅡ、Ⅲ型，少数病例发生于进展期胃癌BorrmannⅣ型及早期胃癌Ⅱc、Ⅲ型，而且大部分病灶位于胃体中上部小弯侧的前后壁。24h出血量可达1000ml以上。临床特点主要表现呕血，排柏油样大便或暗红色便，半数病例出现呕血 排柏油样大便并伴有休克征象。结论 胃癌并发急性大出血病人，大部分经保守治疗可使病情稳定或止血。少数出血严重病人经保守治疗无效需直接手术治疗。钡餐及纤维胃镜检查仍是基层医院可靠的诊断手段，手术是首选的治疗方法。     

垂体腺瘤术后低钠血症

目的 探讨垂体腺瘤术后低钠血症的相关因素、发病机制和治疗。方法 回顾性总结了1999年1月至2000年6月期间。在本院神经外科就诊的186例垂体腺瘤患者的临床资料。结果 在186例患者中。有72例(38．7％)术后出现低钠血症。其中43例(59．7％,43／72)出现于术后4—7d;43例(59．7％,43／72)有临床症状;低钠血症与年龄、肿瘤大小和肿瘤类型有关。与性别无关;68例(94．4％,68／72)患者被给予补钠和补充容量治疗,63例(87．5％,63／72)在7d内缓解。结论 垂体腺瘤术后低钠血症多出现于术后l周左右。多见于老年和垂体大腺瘤患者。治疗以补钠和补充容量为主。