胸腔镜或头灯光源辅助的小切口胸腰椎前路手术

目的：探讨胸腔镜或头灯光源辅助下小切口胸腰椎前路病灶清除和重建术的疗效及并发症。方法：63例胸腰椎疾病患者，胸腰椎爆裂性骨折25例，胸腰椎结核28例（均伴有腰椎冷脓肿或死骨），胸腰椎转移性肿瘤6例，嗜酸性肉芽肿1例，动脉瘤样骨囊肿1例，胸椎间盘突出症2例。神经功能Frankel分级：A级4例，B级4例，C级5例．D绒8例，E级42例。采用胸腔镜光源辅助下小切口手术35例，头灯光源辅助下小切口手术28例。病灶清除重建植骨术24例，病灶清除植骨钉板内固定39例。结果：切口长度5．7cm，平均5．8cm。平均手术时间210min，平均术中小血量650ml。术后神经功能A级4例，B级1例，C级2例，D级10例。E级46例。并发胸腔积液2例，肺不张2例，脑脊液漏1例，股外侧皮神经或肋间神经损害7例，经治疗均治愈。42例获半年～2年，平均1.1年随访，无植骨脱出或内固定失效，植骨均获愈合，畸形得到矫正，结核无复发，1例转移性肿瘤复发。结论：光源辅助下小切口腰腰椎前路手术克服了常规开胸手术切口长、创伤大、术后恢复慢等缺点，同时也克服了标准“锁孔”胸腔镜技术操作口过小、完全镜下操作、技术要求高、不易推广等缺点．是并发症较少、便于推广的较安全微创技术。     

Protective effect of albumin on lung injury in traumatic/ hemorrhagic shock rats

Objective. To determine the effect of albumin administration on lung injury in traumatic/hemorrhagic shock （T/HS） rats. Methods： Forty-eight adult Sprague-Dawley rats were divided into three groups randomly （ n = 16 in each group） ： Group A, Group B, Group C. In Group A, rats underwent laparotomy without shock. In Group B, rats undergoing T/HS were resuscitated with their blood plus lactated Ringer＇s （twice the volume of shed blood ）. In Group C, rats undergoing T/HS were resuscitated with their shed blood plus additional 3 ml of 5% human albumin. The expression of polymorphonuclear neutrophils CD18/CD11b in jugular vein blood was evaluated. The main lung injury indexes （the activity of myeloperoxidase and lung injury score） were measured. Results： Significant differences of the expression of CD18/11b and the severity degree of lung injury were found between the three groups. （P〈0.05）. The expression of CD18/CD11b and the main lung injury indexes in Group B and Goup C incresed significantly compared with those in Group A （P 〈0.05）. At the same time, the expression of CD18/CD11b and the main lung injury indexes in Group C decreased dramatically, compared with those in Group B （ P 〈0.05 ）. Conclusions ： The infusion of albumin during resuscitation period can protect lungs from injury and decrease the expression of CD18/CD11b in T/HS rats.     

老年腹股沟疝无张力修补术与传统修补术的比较

目的 比较无张力腹股沟疝修补术与传统腹股沟疝修补术在老年患者中应用的临床结果、术后生活质量和经济开支。方法 自2000～2001年60岁以上的老年患者42例行腹股沟疝无张力修补术与42例行传统腹股沟疝修补术者，分类比较。结果　无张力腹股沟疝修补术对于老年患者在复发率、术后镇痛、手术时间和术后下地时间方面均明显优于传统腹股沟疝修补术。结论　无张力腹股沟疝修补术运用在老年患者中，近远期效果均优于传统修补手术。     

不同剂量罗库溴铵在颅脑手术中的肌松效应

目的比较罗库溴铵不同剂量配伍在颅脑手术麻醉诱导和维持中的肌松效应。方法择期颅脑手术患者45例,年龄20~60岁,随机分为三组,每组15例。诱导时分别接受罗库溴铵0.6mg/kg(Ⅰ组)、0.75mg/kg(Ⅱ组)和0.9mg/kg(Ⅲ组)。记录拇指肌诱发颤搐反应的抑制过程和恢复过程,在肌松作用消退25%时,三组分别追加罗库溴铵0.6、0.45和0.3mg/kg。评价给药前后血液动力学的波动及肌松起效时间、提供插管条件、肌松维持时间、恢复时间、总时效等效能指标。结果Ⅲ组拇指肌颤搐抑制5%的时间明显短于Ⅰ组和Ⅱ组(P<0.05),但达到最大抑制时间三组无显著性差异(P>0.05);插管条件Ⅲ组优秀率明显较Ⅰ、Ⅱ组高(P<0.05,P<0.01);诱导量恢复5%及25%的时间Ⅲ组明显延长(P<0.01)。三组维持量起效时间及维持时间比较有极显著性差异(P<0.01),但诱导量加维持量总时效无显著性差异;给药前后三组血液动力学变化无显著性差异(P>0.05)。结论罗库溴铵在颅脑手术麻醉中建议使用0.9mg/kg诱导,0.3mg/kg维持。     

经尿道前列腺电汽化切除加雄激素阻断治疗晚期前列腺癌

目的探讨经尿道前列腺电汽化切除加雄激素阻断治疗晚期前列腺癌的临床疗效。方法对31例前列腺癌晚期(D)患者采用经尿道前列腺电汽化切除及睾丸切除术,术后3~5d口服氟他胺做全雄激素阻断以及氟他胺加达菲林的药物去势治疗。结果随访3~42个月,生存者29例,2例患者生存超过5年,20例超过1年。其中7例骨转移病灶减少,6例骨痛患者治疗后疼痛消失。前列腺特异性抗原(PSA)从术前的75.37μg/L降至1.34μg/L(术后1个月),3个月后降为0.27μg/L。B超、胸片、骨扫描未见新的转移灶。结论经尿道前列腺癌电汽化切除加全雄激素阻断治疗晚期前列腺癌具有较好的临床疗效。     

胃代膀胱术远期疗效观察

目的 探讨胃代膀胱术的远期疗效。方法 对1991年5月至2003年10月30例胃代膀胱术患者的临床资料进行统计分析。其中膀胱肿瘤28例，结核性膀胱挛缩2例。结果 随访8～13年，平均10年。30例全身健康情况良好，日间排尿满意，3例偶有夜间尿失禁。1例术后19个月发生代膀胱穿孔，经抗酸和手术治疗痊愈。30例肾功能正常，无电解质紊乱；24例排尿前后胃泌素及尿液pH检查正常；4例有无症状菌尿。13例代膀胱黏膜活检为慢性炎症，壁细胞减少；9例免疫组化检查G细胞较正常减少。尿动力学检查代膀胱容量及顺应性正常，排尿期贮尿囊压力低于正常。10例行排尿期膀胱造影无输尿管返流，5例B超示肾集合系统轻度扩张。1例低压胃膀胱成形术，1例胃与后尿道逆蠕动吻合，剩余尿分别为150ml和250ml。1例出现血尿尿痛综合征，经抗酸及碱化尿液治疗后缓解。结论 胃代膀胱术远期疗效满意，是一种较好的尿流改道方法。     

经皮腘静脉插管造影术临床应用研究

自1990年起，对38条静脉病变的下肢，通过静脉向近侧插管，将导管置于每对瓣膜下方注入造影剂，观察屏气时造影剂的泄漏量和程度。结果证明，本检测方法能清晰显示下腔静脉和髂静脉，更能定位检测深静脉中各对瓣膜的功能，从而为探讨发病机理、明确诊断和手术方法选择，提供可靠的依据。     

Cortical Thinning Correlates with Cognitive Change in Multiple Sclerosis but not in Neuromyelitis Optica

Objectives

To compare spatial patterns of cortical thickness alterations in neuromyelitis optica (NMO) and multiple sclerosis (MS); and to investigate the correlations between cortical thinning and clinical variables in NMO and MS.

Methods

We studied 23 patients with NMO, 27 patients with MS and 26 healthy controls (HCs). The global, brain region and vertex-based cortical thickness (CTh) were analysed and compared among the three groups. A general linear model was used to investigate the correlations between cortical thinning and clinical measures.

Results

A limited number of cortical regions in visual cortex were found to be significantly thinner in NMO patients than in HCs. The MS patients exhibited more widespread cortical thinning compared with HCs, and significantly greater cortical thinning in the insula and the parahippocampus compared with NMO. The extent of cortical thinning in several brain regions correlated with cognitive measures in MS, but not in NMO.

Conclusions

Neocortical thinning in NMO mainly affects visual cortex, while MS patients show much more extensive cortical thinning. Cognitive changes are correlated with cortical atrophy in MS not in NMO. The substrates of cognitive changes in MS and NMO could therefore be different.

Key Points

? MS patients show much more extensive cortical thinning than NMO. ? Cortical thinning of insula and parahippocampus particularly distinguishes MS from NMO. ? Cognitive changes are correlated with cortical atrophy in MS but not in NMO.     

Laparoscopic repair of hiatus hernia: Does mesh type influence outcome? A meta-analysis and European survey study

Background

Synthetic mesh (SM) has been used in the laparoscopic repair of hiatus hernia but remains controversial due to reports of complications, most notably esophageal erosion. Biological mesh (BM) has been proposed as an alternative to mitigate this risk. The aim of this study is to establish the incidence of complications, recurrence and revision surgery in patients following suture (SR), SM or BM repair and undertake a survey of surgeons to establish a perspective of current practice.

Methods

An electronic search of EMBASE, MEDLINE and Cochrane database was performed. Pooled odds ratios (PORs) were calculated for discrete variables. To survey current practice an online questionnaire was sent to emails registered to the European Association for Endoscopic Surgery.

Results

Nine studies were included, comprising 676 patients (310 with SR, 214 with SM and 152 with BM). There was no significant difference in the incidence of complications with mesh compared to SR (P = 0.993). Mesh significantly reduced overall recurrence rates compared to SR [14.5 vs. 24.5 %; POR = 0.36 (95 % CI 0.17–0.77); P = 0.009]. Overall recurrence rates were reduced in the SM compared to BM groups (12.6 vs. 17.1 %), and similarly compared to the SR group, the POR for recurrence was lower in the SM group than the BM group [0.30 (95 % CI 0.12–0.73); P = 0.008 vs. 0.69 (95 % CI 0.26–1.83); P = 0.457]. Regarding surgical technique 503 survey responses were included. Mesh reinforcement of the crura was undertaken by 67 % of surgeons in all or selected cases with 67 % of these preferring synthetic mesh to absorbable mesh. One-fifth of the respondents had encountered mesh erosion in their career.

Conclusions

Both SM and BM reduce rates of recurrence compared to SR, with SM proving most effective. Surgical practice is varied, and there remains insufficient evidence regarding the optimum technique for the repair of hiatal hernia.