经皮内镜下胃造口、空肠造口及十二指肠造口120例临床分析

目的　探讨经皮内镜下胃造口、空肠造口及十二指肠造口的技术操作及适应证。方法2 0 0 1年 5月— 2 0 0 4年 4月间 ,共行 12 0例经皮内镜下胃肠造口 ,其中 75例经皮内镜下胃造口 (PEG) ,4 2例经皮内镜下空肠造口 (PEJ) ,2例经皮内镜下十二指肠造口 (PED) ,1例直接法经皮内镜下空肠造口(DPEJ)。操作均采用经典经腹壁拉出法技术。结果　采用上述方法共行长期肠内营养 88例 ;胃肠减压 2 5例 ;肠内营养联合胆汁回输 5例 ;围手术期应用PEG 2例 ,术前行胃肠减压 ,术后行长期肠内营养。PEG操作时间平均 (9± 4 )min ,PEJ平均 (17± 6 )min ,DPEJ为 2 0min ,2例PED分别为 10和 12min。技术成功率 98 4 % (12 0 / 12 2 )。严重并发症发生率为 0 8% (1/ 12 0 ) ,轻微并发症发生率为 7 5 %(9/ 12 0 )。结论　经皮内镜下胃肠造口操作简便、有效 ,并发症少。     

颈动脉外翻内膜剥脱术治疗颈动脉硬化狭窄

目的观察颈动脉外翻内膜剥脱术治疗颈动脉狭窄的疗效。方法24例颈动脉硬化狭窄患者,其中18例有慢性或一过性脑缺血症状,6例无症状;术前均行彩色超声、数字减影动脉造影(DSA)或CT和MRA扫描检查,颈动脉狭窄程度65％～95％;在颈丛麻醉下行颈动脉外翻内膜剥脱术,手术要点是于颈动脉分叉处斜形切断颈内动脉,外翻颈内动脉剥除有粥样斑块的内膜,同时从颈总动脉切口剥除颈总动脉和颈外动脉增厚的内膜。结果全组无手术死亡,术后随访3～20个月,临床症状均有不同程度改善,一过性脑缺血症状消失,4例仍有轻度慢性脑缺血症状。术后行脑部多普勒超声检查,22例脑部供血有明显改善。结论颈动脉外翻内膜剥脱术是一种安全、有效和合理的手术方式。     

胸腔镜下胸腰段疾病的前路手术及内固定

目的回顾胸腔镜下前路减压、植骨内固定治疗胸腰椎骨折、结核和椎间盘突出症的经验,评价胸腔镜技术在脊柱前路手术中的应用价值。方法收集12例接受胸腔镜下前路手术患者的临床资料,分析操作技术、手术时间、出血量以及功能恢复情况。结果胸腰椎骨折8例;结核3例;椎间盘突出症l例。平均手术时间210min,平均出血量600ml,平均住院时间12d。1例结核患者因严重骨质疏松而放弃内固定,仅作病灶清除植骨术。所有患者随访3—10个月,神经功能恢复与普通开胸前路手术近似,骨折复位良好,植骨块和内固定未发现移位,活动基本恢复正常。结论胸腔镜下脊柱前路手术创伤小,并发症及出血量少,术后恢复快,为胸腰椎前路手术提供了一种安全、有效的操作技术。     

虚拟中国人女Ⅰ号(VCH-FⅠ)臂丛神经可视化初步研究

目的观测“虚拟中国人”(VirtualChineseHuman,VCH)Ⅰ号女性臂丛神经连续横断面的走行,建立臂丛神经的可视化数字模型。方法应用虚拟中国人女Ⅰ号(VCH-FⅠ)数据集,在颈部薄层断面图像上观察臂丛神经与椎管、脊髓、横突孔、椎动脉等结构,应用Amira3.1(TGS)软件对臂丛神经进行计算机三维重建并立体显示。结果在VCH-FⅠ的颈部薄层断面图像上清楚地显示了臂丛神经以及颈段其它的结构,重建的数字化模型可准确的反映臂丛神经的解剖学结构特点。结论VCH-FⅠ数据集能够提供完整精确的臂丛神经解剖,为臂丛神经损伤的影像诊断和外科治疗提供了良好的形态学依据。     

谷氨酰胺颗粒对创伤患者免疫功能影响的多中心、随机、双盲对照研究

目的观察服用谷氨酰胺(GLN)颗粒对创伤、烧伤及大手术患者免疫功能的影响及可能发生的不良反应。方法采用随机、双盲、安慰剂平行对照法,将受试患者分为谷氨酰胺组(GLN组)和安慰剂对照组(P组),每组60例,两组患者采用等氮、等热量的营养支持。GLN组口服或管饲GLN 0.5 g.kg-1.d-1,对照组使用同等剂量的安慰剂(甘氨酸),疗程为7 d。比较两组患者血浆GLN浓度和各项免疫指标的变化,并观察患者肝肾功能的变化及不良反应发生情况。结果伤后患者血浆GLN浓度、多形核粒细胞(PMN)吞噬能力、淋巴细胞亚型比值(CD4/CD8)、白细胞介素2(IL-2)水平明显低于正常值,而免疫球蛋白和补体C3、C4含量变化不明显。与P组相比,GLN组患者用药7 d后血浆GLN浓度明显增高[(593±185)μmol/L和(407±190)μmol/L],增幅达45.7%(P<0.01),GLN组免疫球蛋白A(IgA)含量、IL-2水平、CD4/CD8及PMN吞噬率明显高于P组(P<0.05~0.01),而免疫球蛋白G、M(IgG、IgM)及补体C3、C4含量、血尿常规及肝、肾功能两组差异无统计学意义(P>0.05)。少数患者出现轻微不良反应,如恶心、腹泻和便秘等,两组间差异无统计学意义(P>0.05)。结论服用GLN颗粒能显著提高血浆GLN浓度,明显减轻伤后免疫抑制,提高机体免疫功能,临床应用无明显不良反应。     

输尿管镜气压弹道碎石治疗输尿管结石110例

目的总结输尿管镜气压弹道碎石治疗输尿管结石的临床效果。方法采用F8/9.8 Wolf硬性输尿管镜、JUN—AIR气压弹道碎石机治疗110例输尿管结石。结果输尿管镜直视下一次碎石成功105例，成功率95．5％（105／110），1～6周内结石全部排净。2例因置镜失败改开放手术，3例输尿管上段结石上移至肾脏行ESWL2例，口服排石药物治疗1例。术后泌尿系感染5例，轻度肉眼血尿1～3d。结论输尿管镜气压弹道碎石是治疗输尿管中、下段结石的有效方法之一，具有碎石率高、安全、并发症少、操作简单的优点。     

内窥镜下额颞部除皱术

目的：探讨内窥镜下额、颞部除皱术的临床应用效果。方法：从2003年到2004年，施行内窥镜下额、颞部除皱术28例。采用额部小切口，在帽状腱膜下和骨膜下平面剥离，用缝线和螺钉固定后推的头皮和额部皮肤。结果：28例患者术后效果满意，且脱发、感觉减退和出血等手术并发症少。结论：内窥镜下额、颞部除皱术同传统面部除皱手术相比具有很多优点，可以推广使用。     

Successful treatment for lung cancer associated with pulmonary sequestration

We encountered a 69-year-old man with lung adenocarcinoma and pulmonary sequestration. The cancer lesion was located in the left upper lobe, with sequestration of the left lower lobe. Left upper lobectomy was performed after induction chemoradiotherapy, but the sequestered lung lobe was preserved because the preoperative respiratory function was poor. Preservation of the sequestered lung during surgery for lung cancer should be considered in patients who have poor respiratory function and no signs of respiratory infection.     

Short-term Results of Laparoscopic Mini-Gastric Bypass

Background: The laparoscopic mini-gastric bypass (MGB) is a modification of Mason's loop gastric bypass, but with a long lesser curvature tube. With weight loss results similar to laparoscopic Roux-en-Y gastric bypass (LRYGBP), the MGB is a simpler operation with a low complication rate. Controversy exists concerning the efficacy and side-effects of this procedure. This report presents the technique of laparoscopic MGB and its results in 423 patients. Methods: From October 2001 to October 2004, 423 consecutive patients (87 males and 336 females) underwent laparoscopic MGB (LMGB) for morbid obesity. Mean age was 30.8 years, preoperative mean weight 120.3 kg and mean BMI 44.2 kg/m². Results: All procedures were completed laparoscopically. Mean operative time was 130.8 minutes, and mean hospital stay was 5.0 days. 18 minor early complications (4.3%) were encountered, and 7 major complications (1.7%) occurred. Marginal ulcers were noted in 34 patients (8.0%) during follow-up, and anemia was found in 41 patients (9.7%). Mean BMI decreased to 29.2 and 28.4 kg/m² at 1-year and 2-year follow-up, with mean excess weight loss 69.3% and 72.2%. The Gastrointestinal Quality of Life Index improved significantly 1 year after the operation. Conclusions: LMGB has a low complication and mortality rate. The learning curve is less steep than for LRYGBP, whereas the efficacy is similar.     

Color Doppler Ultrasound Detection and Classification of the Tangential Hepatic Vein before Laparoscopic Cholecystectomy

Background: Unexpected fatal bleeding from the gallbladder bed during laparoscopic cholecystectomy is often associated with injury to the middle hepatic vein. This paper studies whether preoperative color Doppler ultrasound is effective in reducing the risk of injury. Also a venous classification is suggested. Methods: Between June 1999 and February 2004, 2,146 patients undergoing laparoscopic cholecystectomy by standard method received preoperative color Doppler ultrasound examinations. The closest distance between the hepatic vein and the gallbladder was studied. Also, cases of liver cirrhosis, number of conversions to open cholecystectomy, intraoperative blood loss, operative time, complications, and hospital stay were recorded (group D). At the end of the study, we retrospectively reviewed the same parameter of another 2,146 patients who received laparoscopic cholecystectomy without preoperative color Doppler ultrasound between the period of March 1995 and June 1999 (group ND). Results: In group D, 108 patients had cirrhosis. Four hundred and ninety-six patients (27 cases of cirrhosis) had a closest distance of 1 mm or less between the vein and the gallbladder. There were two conversions to open cholecystectomy, but none related to gallbladder bed bleeding. In group ND, there were five conversions, including four cases of gallbladder bed bleeding from the middle hepatic vein and one case of severe adhesion. The conversion rate was significantly higher. In group ND, the mean intraoperative blood loss in the cases of liver cirrhosis was significantly greater. Also, the operative time of patients with the closest vein and gallbladder distance of 1 mm or less in group D was significantly longer. Conclusions: Color Doppler ultrasound is an effective method for detecting the presence of potential bleeders. Although the operative time will be a bit longer, the operation can be done under meticulous care and complete preparation, so that the conversion rate and the risk of fatal hemorrhage can be reduced, especially in patients with liver cirrhosis.