复发性腹股沟斜疝临床体会

腹内脏器或组织经腹股沟管突出即为腹股沟斜疝,约占腹股沟疝的90％,是最常见的腹外疝。腹股沟管外环处出现可复性肿块是最重要的临床表现。斜疝不可能自愈,且可能发生嵌顿或绞窄,故应手术治疗。但一周岁以内的患儿,腹壁随生长发育,强度增高,有可能自愈,可暂缓手术。     

膀胱镜下尿道会师术治疗球部尿道损伤

目的:探讨膀胱镜下尿道会师术治疗球部尿道损伤的疗效及相关并发症。方法:选择58例患者,32例行膀胱镜下尿道会师术(Ⅰ组),26例行尿道端端吻合术(Ⅱ组),分别比较二者的平均手术时间、术中出血量、术后平均最大尿流率、术后尿道狭窄发生率及性功能评分。结果:Ⅰ组的手术时间较Ⅱ组明显缩短(30minvs90min),术中出血量少(120mlvs450ml),术后性功能影响少(22分vs16分),尿道狭窄发生率较高(28.1%vs7.7%,P<0.01)但术后平均最大尿流率差异无统计学意义(P>0.5)。结论:膀胱镜下尿道会师术治疗球部尿道损伤的疗效肯定,值得推广,但术后尿道狭窄仍是其主要并发症。     

高血压的急诊处理临床体会

目的：通过总结我院近两年来急诊收治的100例高血压患者的临床治疗案例,总结高血压患者急诊处理的有效方案,为高血压的急诊处理提供临床依据.方法：选取我院急诊科在2012年1月至2014年1月两年间收治的高血压患者100例,总结分析其治疗案例,归纳寻求最为合理有效的处理方案,使患者能及时脱离危险,稳定体征.结果：所有患者经积极的药物治疗后血压均有明显下降（下降20%）,95%的患者血压可得到有效控制（收缩压〈120mmHg,平均动脉压80〈mmHg）.P〈0.05,差异有显著性,具有统计学意义.且伴有严重并发症的患者病情也得到了有效控制.结论：给予高血压急诊的患者有效的药物治疗,可明显控降低患者的血压水平,同时做好高血压危象的处理工作,是保障患者安全的有效措施,有重要的临床价值.     

母乳性黄疸诊治探讨

随着母乳喂养率和母乳性黄疸(BMJ)的认识提高，BMJ发病率也随之提高，并已成为高胆红素血症(高胆)的重要原因。虽然BMJ的危害性不大，但目前尚缺乏较可靠而能普遍实用的实验室检测手段确诊BMJ，如何正确诊治BMJ是产、儿科医生需要认真探讨的问题。我院1999年3月至2001年5月观察到血清胆红素(SB)峰值≥205.2μmol/L的BMJ 143例，现分析报告如下。     

高危患者的激光前列腺切除治疗

前列腺增生为老人常见病，部分病员因严重的糖尿病、高血压、心、肺、肾、脑等脏器的功能不全，而不能进行常见的开放性手术和经尿道前列腺电切手术。随着激光科学的发展，我们自１９９３年３月至１９９７年６月对３０例前列腺增生的高危患者进行了经尿道非接触式激光前列...     

异丙酚对全麻手术病人诱导期肌电图F波的影响

关于静脉麻醉药对脊髓运动神经元兴奋性的影响尚无定论。本研究拟观察不同速率输注异丙酚对肌电图F波的影响，为临床提供参考。     

输出管悬吊可控膀胱术的临床研究

目的 设计一种控尿可靠、导尿容易、并发症少且操作简单的可控性膀胱输出道的手术方法。方法 20例需行可控性尿流改道的思者采用输出道悬吊的手术方法进行治疗。患者中14例为膀胱恶性肿瘤，2例为已行回肠膀胱术(bricker术)者，3例为重症神经源性膀胱，1例为膀胱阴道瘘。结果 术后随访3—24个月，平均14．4个月，所有患者的腹壁造口均可容易地插入16 F导管。术后仅1例控制尿不完全，其余患者均控制尿完全。16例术后3—12个月行尿动力学检查，膀胱充盈时输出管最大内压为64—134cm H2O(1cm H2O＝0．098kPa)，平均为86cmH2O。腹壁造口逆行造影示输出管被固定在腹壁下，无狭窄。结论 输出管悬吊能明显增强缩窄回肠的控制机制，且手术方法简单。     

贝切特综合征伴不完全性远端肾小管性酸中毒1例

贝切特综合征伴不完全性远端肾小管性酸中毒１例邱志亮，乔勇，张芬南通医学院第二附属医院肾内科（２２６００１）贝切特（Ｂｅｈｃｅｔ）综合征系一少见的多系统损害的炎性疾病，临床表现以口腔溃疡、外生殖器溃疡、皮肤损害、眼部炎症和关节炎最为常见，肾脏很少受侵犯...     

前列腺导管腺癌临床病理和诊治特点分析

Objective To discuss the pathological and clinical features, diagnosis and treatment of prostatic duct adenocareinoma. Methods The clinical data of nine cases of prostatic duct adeno-carcinoma were retrospectively analyzed, with the average age of 76 (59-106) years. Six cases were presented with dysuresia and/or nocturia, and two of them had the painless gross hematuria. Two pa-tients presented painless gross hematuria as the first symptom. One case was detected the elevated ser-um PSA in a routine healthy examination. Radical prostatectomy (RP) was performed in 1 case;RP and bilateral orchidectomy and external beam radiotherapy (EBRT) were performed in 1 case;5 cases underwent transurethral resection of the prostate (TURP) combined with photoselective vaporization of the prostate (PVP) by green laser and bilateral orchidectomy;1 case underwent TURP combined with PVP;1 case underwent bilateral orchidectomy combined with EBRT. Eight cases took flutamide for 3-45 months. All patients were followed-up according to the scheduled time. Results The op-erations were successfully performed in all 9 patients. The papillary or cauliflower-like tumors infiltra-ted colli culus seminalis and prostate duct nearby. The glands were coated with tall pseudostratified columnar cells. The nuclei were large, dark stained with more frequent mitoses. The positive rates of immunolabelling antibody PSA, AR, PAP were found to be 89%(8/9), 100%(5/5), 100%(5/5) re-spectively. The distribution of Gleason score was 6-7(3 cases), and≥8(6 cases), and a coexisting acinar carcinoma component was identified in 5 cases of the group. Nine cases had a mean follow up for 20(3-48) months. Five cases have developed biochemical recurrence, of whom 3 died of bone metas-tasis and multiple organ failure, and 1 developed lung and bone metastasis. Three cases remained alive without recurrence. The remaining 1 case survives during the follow-up survey for 6 months until now, without examinations due to the old age. Conclusions Duct adenocarcinoma of the prostate presents the low incidence and lacks of typical symptoms in the early stage. Diagnosis was confirmed mainly on the basis of pathology. The tumors tend to have a more advanced stage and a very short term survival rate. The treatment options and management are similar to that of high-grade adenocar-cinoma of the prostate;meanwhile, close follow-up survey should be performed.     

前列腺导管腺癌临床病理和诊治特点分析

Objective To discuss the pathological and clinical features, diagnosis and treatment of prostatic duct adenocareinoma. Methods The clinical data of nine cases of prostatic duct adeno-carcinoma were retrospectively analyzed, with the average age of 76 (59-106) years. Six cases were presented with dysuresia and/or nocturia, and two of them had the painless gross hematuria. Two pa-tients presented painless gross hematuria as the first symptom. One case was detected the elevated ser-um PSA in a routine healthy examination. Radical prostatectomy (RP) was performed in 1 case;RP and bilateral orchidectomy and external beam radiotherapy (EBRT) were performed in 1 case;5 cases underwent transurethral resection of the prostate (TURP) combined with photoselective vaporization of the prostate (PVP) by green laser and bilateral orchidectomy;1 case underwent TURP combined with PVP;1 case underwent bilateral orchidectomy combined with EBRT. Eight cases took flutamide for 3-45 months. All patients were followed-up according to the scheduled time. Results The op-erations were successfully performed in all 9 patients. The papillary or cauliflower-like tumors infiltra-ted colli culus seminalis and prostate duct nearby. The glands were coated with tall pseudostratified columnar cells. The nuclei were large, dark stained with more frequent mitoses. The positive rates of immunolabelling antibody PSA, AR, PAP were found to be 89%(8/9), 100%(5/5), 100%(5/5) re-spectively. The distribution of Gleason score was 6-7(3 cases), and≥8(6 cases), and a coexisting acinar carcinoma component was identified in 5 cases of the group. Nine cases had a mean follow up for 20(3-48) months. Five cases have developed biochemical recurrence, of whom 3 died of bone metas-tasis and multiple organ failure, and 1 developed lung and bone metastasis. Three cases remained alive without recurrence. The remaining 1 case survives during the follow-up survey for 6 months until now, without examinations due to the old age. Conclusions Duct adenocarcinoma of the prostate presents the low incidence and lacks of typical symptoms in the early stage. Diagnosis was confirmed mainly on the basis of pathology. The tumors tend to have a more advanced stage and a very short term survival rate. The treatment options and management are similar to that of high-grade adenocar-cinoma of the prostate;meanwhile, close follow-up survey should be performed.