胃镜下切除食管较大黏膜下肿物可行性及安全性分析

目的 总结胃镜下内镜黏膜下挖除术(ESE)及经黏膜下隧道肿物切除术(STER)治疗食管黏膜下肿物的安全性和有效性.方法 回顾性分析2013年至2017年解放军联勤保障部队第九○九医院收治的行内镜下治疗的食管较大黏膜下肿物(直径≥3 cm)13例患者,收集随访资料,分析手术效果、安全性及并发症发生情况.结果 13例患者中...     

双钢板垂直和平行放置治疗C型肱骨远端骨折的对比研究

Background Double plate osteosynthesis is the standard treatment for intra-articular fractures of the distal humerus. However, there is still controversy concerning dual plate positions in terms of providing optimal stability. The purpose of this retrospective study was to compare the clinical outcomes in patients with type C intra-articular distal humeral fractures using perpendicular and parallel plating methods.

Methods Between March 2008 and June 2011, a total of 45 patients with type C distal humerus fractures were treated using two different dual plating methods. Of them, 24 patients were treated by perpendicular plating (group I) and 21 patients were treated by parallel plating (group II). The surgical time, blood loss, and union time were compared between the two groups. The flexion-extension arc, the total range of flexion and extension at the end of follow-up were compared between the two groups. The Mayo Elbow Performance Score (MEPS) was used to determine the elbow functional results.

Results All patients were followed up. The mean duration of follow-up was 16 months (range 12–25 months) in group I and 15.5 months in group II (range 12–25 months). There were no significant differences in the surgical time, blood loss, and the bone union time between the two groups. In group I, the mean elbow flexion-extension arc was 101° and the mean MEPS was 85 points. The rate of excellent and good results was 87.5%. In group II, the mean flexion-extension arc was 100° and the mean MEPS was 86.1 points. The rate of excellent and good results was 90.5%. There were no significant differences in the MEPS, flexion-extension arc, and the total range of flexion and extension between the two groups.

Conclusions Perpendicular and parallel plate configurations with the appropriate surgical techniques can provide anatomical reconstruction and stable fixation of type C intra-articular distal humeral fractures and allow early mobilization of the elbow after an operation. The occurrence of post-operative elbow stiffness can be reduced and good outcomes can be obtained.

     

海尔福口服液对O2^-清除率的实验研究

目的:探讨海尔福口服液对超氧阴离子自由基(O2-)的清除效果及其机理。方法:用AP-TEMED系统比色法测定海尔福口服液对O2-的清除率,并与维生素C及金银花提取液作对比分析。结果:海尔福口服液(内含金银花生药0.1g/ml)、金银花水提取液(含生药0.1g/ml)、维生素C(浓度1.0mg/ml)对O2-的清除率分别是(92.71±2.79)、(81.15±3.81)、(92.67±5.46),加样量分别为1.0、0.5、0.25、0.125ml时,它们的相关系数分别为0.9697、0.9959、0.9988,有直线相关关系;三种存放时间不同的金银花提取液对O2-的清除率分别是(81.15±3.81)、(87.70±1.41)、(37.94±11.79),差异显著(P<0.05和<0.01);海尔福口服液生产过程中的不同阶段对O2-的清除率无显著性差异(P>0.05);海尔福口服液的其余主要原料如茯苓、甘草等对O2-的清除率均较低。结论:海尔福口服液及其主要原料之一金银花提取液在体外对O2-均有明显的清除作用,其效果与浓度为1.0mg/ml的维生素C溶液接近;金银花原料短期存放功效无明显变化,长期存放对O2-的清除率明显降低;海尔福口服液在生产过程中的不同阶段对O2-的清除率无明显变化。     

超声技术在颈内静脉穿刺置管术中的应用

超声技术具有操作简便安全,显像实时直接,无创伤、可重复等优点,目前认为将超声技术应用于颈内静脉穿刺置管术中可使穿到颈内静脉的穿刺针数减少、穿刺置管时间缩短、穿刺成功率提高、并发症减少[1～3].尤其在对肥胖和婴幼儿患者等体表标志困难、颈椎及静脉畸形、反复穿刺失败及置管困难可能造成严重并发症时使用,可使颈内静脉穿刺成功率大大提高[4～8] .     

"药食同治"思想在顽固性功能性便秘治疗中的应用

顽固性功能性便秘是较难治愈的一种便秘类型,临床通常表现为持续性便秘、通便药依赖和(或)通便药治疗无效.近年来随着饮食结构改变、生活节奏加快和受社会心理因素的影响,其发病率逐年上升,严重影响患者的生活质量.姚树坤教授临床治疗顽固性功能性便秘疗效明显,颇具心得.姚教授认为,结合当下人们饮食结构、生活方式及体质变化,目前临床...     

慢性肾脏病知晓率在社区医生中的调查与推广

目的:探索社区医生提高和防治早期CKD的效果和如何减轻疾病对健康的危害,降低医疗费用。方法:对长宁区的周家侨、华阳、新华三家社区卫生服务中心的医生随机抽取90名医生,然后到长宁区各社区进行慢性肾脏病相关知识推广和培训,1年后进行第2次问卷调查。结果:(1)推广知晓情况:推广后的平均分数(80.44±8.74)分明显高于推广前的(64.04±12.89)分,且推广后各分数段人数均明显多于推广前,差异均有统计学意义(P0.01)。(2)对疑似肾损害患者的处置措施:推广前尿检者20名(22.22%),肾功能检查者21名(23.33%),建议专科就诊者25名(27.78%),其他24名(26.67%)。推广后尿检者45名(50.00%),肾功能检查者36名(40.00%),建议专科就诊者4名(4.44%),其他5名(5.56%),推广后社区医生给予尿检、肾功能检查、建议专科就诊、其他等处置措施的人数均明显多于推广前,差异均有统计学意义(P0.01)。(3)评估肾功能指标的选择:推广前选择血肌酐者77名(85.56%),尿素者8名(8.89%),内生肌酐清除率者3名(3.33%),估计肾小球滤过率者2名(2.22%)。推广后选择血肌酐者60名(66.67%),尿素者1名(1.11%),内生肌酐清除率者10名(11.11%),估计肾小球滤过率者19名(21.11%),推广后社区医生选择血肌酐、尿素、内生肌酐清除情况、估计肾小球滤过问题等评估指标的人数均明显多于推广前,差异均有统计学意义(P0.01)。结论:通过此次推广对社区医生的慢性肾脏病知识有所提高,提供了与社区医生互相交流学习的机会。     

巨块型原发性肝癌39例介入治疗

目的观察不能手术切除的巨块型原发性肝癌介入治疗的临床疗效。方法采用超选择肝动脉插管方法进行灌注化疗和栓塞治疗。化疗药物有：阿霉素30～60mg,氟脲嘧啶1g,羟基喜树碱30mg,卡铂200～300mg,顺氯氨铂60～80mg,白介素-2200～300万U;栓塞剂为：40％碘化油、超液态碘化油、明胶海绵。介入治疗次数1～9次不等。结果共39例,病灶缩小超过50％8例（20．5％）病灶增大未超过25％、缩小未超过50％30例（76．9％）,仅1例病灶增大超过50％。生存率为：2,4,6,12,24个月分别为97．4％（38／39）、74．4％（29／39）、43．6％（17／39）、20．5％（8／39）、5．1％（2／39）,中位生存期11个月。结论介入治疗使不能手术的部分中晚期肝癌患者生存期得以延长,生活质量得到提高。     

插管法胰腺空肠端侧吻合预防Whipple手术后胰瘘

目的 评价插管法胰腺空肠端侧吻合预防Ｗｈｉｐｐｌｅ手术后胰腺瘘。方法 采用残胰管内插入导管,空肠壁切开浆肌切开粘膜,吻合时只缝合胰腺断端前后缘与空肠浆肌层切开的前后唇。胰管导管穿透粘膜引入空肠腔内,不必做胰管与空肠粘膜切口缝合,１２例行胰液外引流,１４例内引流。结果 ２６例均无胰瘘发生。结论 插 胰腺空肠端侧吻合手术操作简单,可预防Ｗｈｉｐｐｌｅ手术后胰瘘。