T2交感神经链夹闭术与加切断术治疗头面多汗症效果对比

目的对比T2交感神经链夹闭术与夹闭加切断术两种方法治疗头面多汗症的疗效及并发症.方法2003年1月至2005年8月将31例接受手术治疗的头面多汗症病人分2组,分别采取T2交感神经链单纯夹闭（单纯夹闭组12例）和T2交感神经夹闭加第2肋骨表面的交感神经链切断（夹闭切断组19例）.所有病人术后定期接受电话问卷式随访.结果两组病人随访1～31个月,平均12个月,单纯夹闭与夹闭切断组头汗有效率为92%与100%.夹闭组有2例,每例各一侧术后头汗改善差,二次手术行患侧T2交感神经链切断后,头面多汗消失;两组病人中重度代偿多汗发生率为83%与84%,均未出现眼睑下垂;两组总体满意度优良者分别为92%和95%.结论T2交感神经链夹闭加切断较单纯夹闭治疗头面多汗症,疗效更加稳定,不增加并发症发生率与程度,是手术治疗头汗症更合理的选择.     

328例老年性白内障临床分析

老年性白内障是老年人致盲的主要原因 ,手术治疗可使患者恢复视力。但是随着年龄的增长 ,全身合并症及眼部其它合并症也相应增加 ,因而增加了手术风险性。我们对 32 8例在我院行白内障手术的老年患者进行分析如下。1　临床资料1 1　一般资料　 32 8例白内障患者行手术治疗377只眼 ,男 2 0 4例、女 1 2 4例 ,年龄 60～ 84岁 ,平均 68± 7 7岁。随访 3个月～ 2 5年。 32 8例中患有高血压 1 0 3例 ,糖尿病 37例 ,冠心病 35例 ,肺心病 2 8例 ,脑血管病 2 5例 ,陈旧性心肌梗塞 1 3例及其它如哮喘、风湿性心脏病、肾功能不全等。1 2　术前眼部…     

全胸腔镜肺叶切除与开胸肺叶切除治疗Ⅰ期非小细胞肺癌效果比较

目的 与开胸肺叶切除对比,探讨全胸腔镜(VATS)下肺叶切除治疗早期肺癌的安全性和有效性.方法 回顾分析2002年1月至2008年1月接受肺叶切除的165例Ⅰ期非小细胞肺癌病人,VATS组41例,开胸组124例.对比两组术前、术中、术后近期情况.结果 两组在年龄、性别分布、术前主要合并症、肺功能、手术切除的肺叶、术后病理类型、分期等方面差异无统计学意义(P<0.05).VATS组与开胸组相比,手术时间(195±57)min对(224±54)min(P<0.05);术中出血(227±153)ml对(349±158)ml(P<0.05);淋巴结清扫组数4.1±1.3对4.5±1.5(P<0.05);术后胸引流总量(1595±1038)ml对(1828±1074)ml(P<0.05);术后肺炎发生率4.9%对12.1%(P<0.05);1年无瘤生存率Ⅰ A期均为100%,ⅠB期分别为90.0%和91.3%(P>0.05);住院费用(4.6±1.1)万元对(3.5±1.1)万元.结论 两种术式在治疗早期肺癌具有相似的完全性和彻底性,VATS肺叶切除术较开胸肺叶切除术的手术时间略短,术中出血略少,术后肺炎发生率略低,但平均住院费用略高.     

新斯的明穴位注射治疗产后便秘的临床观察

目的 探讨治疗产后便秘的最好方法.方法 将会阴侧切平产分娩后便秘的产妇随机分为3组,A组给开塞露治疗,B组给肌肉注射新斯的明,C组给新斯的明穴位注射加开塞露肛门注入.观察各组用药后的效果.结果 C组用药后起效快,无1例复发.结论 C组治疗方法是治疗产后便秘的最好办法,提高了产妇的生活质量.     

青光眼滤过手术后浅前房的治疗和预防

青光眼滤过手术后浅前房的治疗和预防山东医科大学附属医院（２５００１２）张芳，李运我们统计青光眼滤过手术７２例７６眼．其中原发性青光眼７４眼（急性闭角型青光眼２８眼．慢性闭角型青光眼４４眼．开角型青光眼２眼）．继发青光眼２眼。均在显微镜下行小梁切除术。...     

老年性白内障患者超声乳化及人工晶体植入术

我院自 1997年 5月至 2 0 0 0年 6月对老年性白内障患者施行超声乳化及人工晶体植入术 ,现就手术并发症与相关的老年人疾病进行分析如下。　　一、资料与方法　　 1.一般资料 :老年性白内障患者 5 82例 (6 73眼 ) ,男 374例 (4 2 7眼 ) ,女 2 0 8例 (2 46眼 )。年龄 6 0～ 86岁 ,平均(6 7 4± 8 7)岁 ;其中 6 0～ 6 9岁 2 81例 (334眼 ) ,70～ 79岁2 37例 (2 6 3眼 ) ,80岁以上 6 4例 (76眼 )。Ⅰ级核 6 9眼(10 3% ) ,Ⅱ级核 2 5 3眼 (37 5 % ) ,Ⅲ级核 314眼 (4 6 7% ) ,Ⅳ级核 37眼 (5 5 % )。术前视力为光感～ 0 4。随访3个月～ 3年 …     

甲泼尼龙复合托烷司琼对术后恶心呕吐高危的甲状腺手术患者的预防作用

[目的]探索甲泼尼龙复合托烷司琼对术后恶心呕吐(PONV)高危的甲状腺手术患者的预防作用.[方法]行甲状腺癌根治术的PONV高危患者120例,随机分为四组,每组30例.甲泼尼龙复合托烷司琼组(MT组):手术结束前15 min静注甲泼尼龙40 mg+托烷司琼5 mg;甲泼尼龙组(M组):手术结束前15 min静注甲泼尼龙40 mg;托烷司琼组(T组):手术结束前15 min静注托烷司琼5 mg;对照组(C组):手术结束前15 min静注生理盐水.记录比较术后48 h内恶心呕吐发生情况,使用视觉模拟评分法(VAS)评价PONV的严重程度.[结果]四组患者年龄、体重和手术时间相比较差异无显著性(P＞0.05);与C组和T组比较,MT组拔管至术后2 h(T0～2h)、术后2h至术后6 h(T2 h～6 h)时段PONV发生率和T2 h、T6 h时VAS评分明显降低(P＜0.05);与C组比较,MT组头痛发生率明显降低(P＜0.05),但眩晕、不安和高血糖发生率无明显变化(P＞0.05).[结论]甲泼尼龙复合托烷司琼对PONV高危的甲状腺手术患者有显著的预防作用,且不良反应未见增加.     

全胸腔镜肺叶切除术中转开胸手术指征的探讨

目的为了更好地把握全胸腔镜肺叶切除术中转开胸的时机,探讨全胸腔镜肺叶切除中各种原因中转开胸的手术指征。方法2006年9月至2009年2月共施行全胸腔镜肺叶切除术172例,男88例,女84例;平均年龄58.9岁。术后病理:原发性肺癌133例,肺转移癌或其他恶性肿瘤7例,良性疾病32例。病变位于右肺上叶46例,右肺中叶23例,右肺下叶31例,左肺上叶36例,左肺下叶36例。手术均通过3个切口完成,肺叶解剖性切除和系统性淋巴结清扫的操作顺序与常规开胸手术基本相同。如镜下操作遇纵隔淋巴结粘连或转移、出血等特殊情况,则延长操作口至12～15cm,转为开胸手术。按肿瘤最大径分为最大径≥5cm组和最大径≤3cm组;再按是否中转开胸将患者分为中转开胸组和未开胸组,分别比较两组患者的临床资料。结果全部患者手术顺利,无严重并发症及围手术期死亡发生。全组手术时间185min,术中出血213ml。中转开胸13例,中转开胸率7.6%。其中淋巴结干扰9例,出血4例。开胸后完成肺叶切除12例,全肺切除1例。其中肿瘤最大径≥5cm组16例,手术时间187min,出血203.8ml;最大径≤3cm组98例,手术时间202min,出血231.3ml,两组数据比较差异无统计学意义。中转开胸组13例,平均年龄68.7岁,实体瘤最大径23.8mm;未开胸组159例,平均59.3岁,实体瘤最大径27.8mm,两组年龄差异有统计学意义(P=0.016),而实体瘤最大径差异无统计学意义(P=0.404)。结论淋巴结干扰和出血是主要的中转开胸的原因,肿瘤大小、叶间裂分化情况及胸腔粘连不是常见的中转开胸的原因。     

Injury of ~(125)Ⅰ seeds implants to trachea and esophagus of rabbits

Objective To evaluate the impact of 1125 seeds para-tracheal braehytherapy on regional tissue injury in rab-bit models. Methods 42 rabbits were randomized into 7 groups. Group 1 to 6 belong to study groups (in which 1,4,5 and 6 belong to "dose gradient" subgroup, while 2,3 and 4 to "chronologic" subgroup) , while the last group acts as negative con-trol. The activity of seeds in study group were 0.3 mCi in group 1, 0.5 mCi in group 2 to 5, 0.7 mCi in group 5, and 0.9mCi in group 6. False seeds (0 mCi) were used for the negative control. 4 seeds with equal dosage were implanted between trachea and esophagus in each rabbit under general anesthesia. Seeds arrangement was made according to Paris principle. For the tissue injury evaluation, group 2 was sacrificed by the end of first month post-operatively, group 3 at the end of the second month, and group 4 end of the third month. The rest of rabbits were also sacrificed at the end of the third month. Pieces of adjacent e-sophagus and trachea were sampled from each rabbit. Tissue injury features such as inflammation, edema, congestion or fibrosis as evaluated histologically. Results All rabbits were healthy during study period except 5. Histological analysis revealed that trachea samples from all groups had lymphocytas and plasma cells infiltration as signs of chronic inflammation, hut fibrosis was nut clearly visible. There were no differences between study and control groups with respect to inflammation, edema and con-gestion scores. But in groups which received the highest doses of radiation or sacrificed at 60 d showed more eosinophil infiltra-tion and epithelum degeneration, and statistical significance was reached between these groups and control. Esophageal samples had less histological changes compared with trachea. Conclusion Para-tracheal implantation of ~(125)Ⅰ seeds with therapeutic or higher dosage only induce minor and reversible damage to the regional tissue. This implies that ~(125)Ⅰ implants adjacent to trachea or esophagus are clinically safe.     

Risk factors for occult nodal metastasis in patients with stage ⅠA peripheral non-small cell lung cancer

Objective To study the risk factors of mediastinal lymph node metastasis in patients with ≤3 cm peripheral non-small cell lung cancer.Methods From January 2000 to December 2010,a total of 281 patients with NSCLC[152 men and 129 women,aged ( 60.31±12.13) years;≤ 3 cm in diameter]underwent lobectomy or partial resection with systematic mediastinal lymphadenectomy in hospital .Clinical data included age,gender,symptoms,history and quantity of smoking history,history of tumor,family history of tumor,site,diameter,calcification,speculation,border,lobulation,traction of pleural,vascular convergence sign,cavity were collected compaired and analyzed.Single and multi-variate analysis was performed to determine the independent risk of occult N2 nodal involvement.Results Logistic regression analysis show seven clinical characteristics (fleshless( OR:22.262),history of tumor(OR:5.485),diameter( 0R:3.788),density( OR;5.850),traction of pleural (OR:1.371),border ( OR:8.259) and cavity (OR:7.124) were risk factors.Conclusion Fleshless,history of tumor,diameter,density,traction of pleural and the border and cavity were independent predictors of malignancy in patients with ≤3 cm peripheral non-small cell lung cancer.