制作动静脉内瘘的外科进展

持久、稳定的血管通路是慢性肾功能衰竭患者维持血液透析、延续生命的首要条件。自1966年动静脉内瘘制作成功后,这项技术被广泛应用于血液透析,并在短短几十年间取得了长足进步。随着手术部位、吻合技术、吻合形式和血管取材的不断改进,其术后并发症大大降低,血管通路的安全性和稳定性逐步提高。目前,动静脉内瘘已成为慢性肾衰患者维持长期血液透析的＂生命线＂。本文总结国内外动静脉内瘘的制作方法及经验体会,阐述如下。     

支具治疗进展型早发性脊柱侧弯的临床研究

目的分析进展型早发性脊柱侧弯(early onset scoliosis,EOS)经支具保守治疗后畸形发展情况,并探讨支具矫形在此类患者中的疗效。方法以战略支援部队特色医学中心脊柱外科接受支具治疗至少2年且影像资料完整的19例EOS患者为研究对象,其中男12例,女7例。根据随访结果分为有效组和无效组,末次随访Cobb角与治疗前相比改善超过10°为治疗有效,未超过10°为治疗无效。支具治疗前、初次治疗后、末次随访时拍摄站立位全脊柱正(侧)位X线片,分别测量冠状位及矢状位畸形角度及平衡。结果19例支具治疗前平均Cobb角(40±10.4)°(20°~55°)、初次治疗后主弯Cobb角(28.15±14.78)°,末次随访主弯Cobb角(31.63±18.04)°,初次治疗后及末次随访均较治疗前明显好转(P<0.05)。两组末次随访时的胸廓宽度及胸椎高度均较支具治疗前明显增加,特发性EOS较先天性EOS治疗效果更好(P<0.05)。另外,顶椎位于胸腰段或腰段较顶椎位于胸段者效果更好(P<0.05)。初次治疗后两组间主弯矫正率差异无统计学意义(P>0.05),末次随访时差异具有统计学意义(P<0.05)。结论对于部分进展型早发性脊柱侧弯,支具治疗可作为保守治疗的选择之一,其中一些病例可得到满意矫形,即使部分病例不能避免手术,支具治疗也可在不影响胸廓发育的前提下适当延后手术时间。     

克氏针固定并皮下神经前置术治疗肱骨髁上骨折疗效分析

目的探讨尺神经皮下前置术在治疗肱骨髁上并尺神经损伤的疗效。方法回顾分析2004～2007年收治的此类患者58例,获得随诊50例,分别行单纯克氏针固定和克氏针固定并尺神经皮下前置术,术后评估优良率,观察尺神经恢复疗效。结果单纯固定组优良率为65%,固定并神经前置组优良率为80%,两组疗效不存在显著差异。结论Ⅰ期行尺神经皮下前置能提高尺神经损伤的恢复率,中重度伴有尺神经损伤的患者神经前置远期恢复更佳;未行神经前置的病例,若后期出现迟发性尺神经炎,可再行探查并皮下前置。     

Weekly cisplatin induction chemotherapy in the treatment of recurrent cervical carcinoma

Sixty-nine patients with recurrent cervical carcinoma were treated with weekly cisplatin induction chemotherapy. A 27% objective response was obtained in 67 evaluable patients. The highest responses were seen in liver (33%), supraclavicular nodes (40%), and lung (48%), whereas only one out of 24 (4.2%) patients with central recurrence responded. Consolidation therapy with cisplatin combinations administered on a monthly basis did not enhance response to cisplatin. Cisplatin induction therapy was well tolerated with minimal toxicity.     

Malignant peritoneal cytology in stage I endometrial adenocarcinoma: the effect of progesterone therapy (a preliminary report)

From February 1982-June 1986, 25 consecutive patients with surgical stage I endometrial adenocarcinoma (no evidence of metastasis at surgery or occult cervical or adnexal involvement on histopathologic review) and malignant peritoneal cytologic washings were treated with progesterone therapy. Twenty-two patients have undergone a second look laparoscopy and repeat cytologic washings, one of those also underwent a third look laparoscopy. Two patients refused second look laparoscopy, and in a third patient laparoscopy was medically contraindicated; all three have no evidence of disease (NED) at 15, 46, and 64 months respectively and are off therapy. Of the 22 patients who underwent second look laparoscopy, 21 (95%) had no macroscopic evidence of recurrent endometrial carcinoma and repeat negative peritoneal cytology; 1 patient (5%) had persistent malignant peritoneal cytology but was NED at third look laparoscopy one year later. All 25 patients are off progesterone therapy and remain clinically NED from 12-64 months. Although progesterone therapy for malignant peritoneal cytology resulted in a 100% reversal of malignant peritoneal cytology to normal in the 22 patients who underwent second or third look laparoscopy and all 25 patients remain clinically NED, the true value of progesterone therapy can only be ascertained by a randomized trial of progesterone versus no therapy.     

Safety and potential hazards in the current applications of ultrasound in obstetrics and gynecology

The safety and potential hazards in the current applications of ultrasound in obstetrics and gynecology are discussed. The author has made an attempt to provide a perspective to enable interpretation of future experimental results in terms of health hazards for humans.