143例胃肠道间质瘤的外科诊治及预后分析

目的:探讨胃肠道间质瘤的临床病理特征及外科诊治情况,分析影响预后相关因素。方法:回顾性分析经手术治疗的143例患者的临床资料。结果:发生于胃42.7%,小肠35.0%,腹痛不适44.1%,消化道出血或贫血28.0%。131例手术完整切除,免疫组化表型CD117阳性率为98.5%。中位生存时间为64.0个月,1、3、5年生存率分别为89.7%,72.4%和53.4%。手术切除的完整性和危险程度分级是影响预后的独立因素(P0.05)。结论:胃肠道间质瘤术前确诊率较低,手术完整切除是主要治疗手段,伊马替尼治疗晚期患者有一定疗效。影响患者预后的独立因素是肿瘤危险程度分级、手术切除的完整性和伊马替尼治疗。     

浅谈临床医务工作者的美学修养

医学所创造的是健康之美、生命之美、至善之美、仁爱之美.所以从事医学工作之一的临床医务工作者就应该高度重视和体现美学修养.要从职业形象美,沟通语言美、行为举止美四个方面去提升和体现医务工作者的美学修养,只有这样才能更好地为人类的健康保驾护航.     

扩张器在颈部瘢痕挛缩畸形中应用

目的:探讨扩张器在治疗颈部疤痕应用.方法:自2004年以来,我们对38例颈部烧伤后遗留瘢痕的病人在植入扩张器后注水1-3个月后,行扩张皮瓣修复瘢痕创面.结果:共植入41个扩张器,除2个出现并发症,终止扩张外,其余经6个月～1年随访,修复的创面功能及外形均较满意.结论:颈部瘢痕治疗中,应用扩张器是一种治疗效果较好的一种方法.     

手术切除治疗肝脏尾状叶巨大肿瘤

目的 探讨肝脏尾状叶巨大肿瘤的手术切除方法和疗效.方法 回顾分析2000年1月至2007年1月第二军医大学东方肝胆外科医院收治施行肝切除的直径≥10 cm的肝尾状叶巨大肿瘤的临床资料.结果 手术切除尾状叶肿瘤215例,其中巨大肿瘤33例,肿瘤直径10.2～15.3 cm,平均为12.3 cm;肝切除术式包括单纯尾状叶全切除7例,部分尾状叶切除8例,全尾状叶合并其它肝段切除18例.手术时间120～360 min,中位时间为218 min,手术失血量400～7000 ml,中位失血鼍为958 ml;全组无手术病死,术后并发症发生率27%;21例原发性肝癌病人术后1、3、5年生存率为分别为76%、52%、24%,其他良性肿瘤病人术后无复发及病死.结论 肝脏尾状叶巨大肿瘤多可同时累及3个肝门,尽管手术切除难度较大,但疗效满意.     

52例缺血性结肠炎临床诊治分析

目的 探讨缺血性结肠炎(IC)的临床表现及内镜特点,进一步提高对该病的认识.方法 回顾性分析1999年6月至2009年8月52例IC患者的临床表现及内镜所见的相关资料.结果 本组病例中,38例(73.08%)患有血管相关性疾病,临床表现主要为急性腹痛、腹泻、便血三联征.内镜所见:病变部位主要发生在乙状结肠35例(67.31%),病变范围4～35 cm.结论 缺血性结肠炎急性发作时腹痛是其共同临床特点,内镜检查是诊断本病的有效方法.提高对该病的认识,特别是对伴有基础疾病者,应早期进行结肠镜检查,对尽快明确诊断有重要意义.     

不稳定型桡骨远端骨折的手术治疗

目的 探讨不稳定型桡骨远端骨折的手术方法与疗效.方法 自2007年1月至2009年8月手术治疗不稳定型桡骨远端骨折86例,对于简单不稳定骨折(56例)给予掌侧切开显露骨折,直视下复位,安放合适的支撑钢板;对于关节面粉碎的不稳定骨折(30例),先试行闭合手法复位,C型臂X线机透视如复位较满意,则安放外固定支架,再行掌侧入路切开显露骨折,直视下复位,安放合适的支撑钢板.对于桡骨茎突钢板固定困难及尺骨茎突骨折移位明显者(16例),给予切开复位空心钉及克氏针内固定.结果 本组80例患者获得随访,时间6～31个月(平均11个月).按Dienst标准评价疗效:优61例,良16例,差3例,优良率为96.6%.结论 不稳定型桡骨远端骨折应果断实施切开复位,并根据其骨折类型选择不同的固定方式,规范的术中操作以及积极的功能康复是桡骨远端骨折获得理想疗效的关键.     

Essex-Lopresti损伤的生物力学研究

目的 探讨Essex-Lopresti损伤的生物力学机制,为诊治Essex-Lopresti损伤提供生物力学依据.方法 取12具成人新鲜冰冻上肢标本予以处理,先将12具标本("完整状态组")分别在旋前位、旋后位及中立位三种状态下把标本夹持固定于MTS 858生物材料试验机上进行力学测试,恒定加载100 N的压力负荷,每种状态持续30 s后减载.随后将12具标本随机分为2组,6具切除桡骨头为"切头留膜组";另6具切断前臂骨间膜(interosseous membrane,IOM)中间腱性部分为"留头切膜组".每组按上述方法进行生物力学测试.最后将所有标本均切除桡骨头并切断IOM("切头切膜组")按上述方法进行生物力学测试.结果 前臂旋转状态或单纯切断IOM对桡骨纵向位移无影响.单纯切除桡骨头或联合切断IOM和切除桡骨头增加了桡骨的纵向位移.前臂中立位时的桡骨刚度比前臂旋前位大,但比前臂旋后位小.单纯切断IOM对桡骨刚度没有影响,单纯切除桡骨头或联合切断IOM和切除桡骨头则会使桡骨刚度下降.结论 桡骨头骨折合并IOM损伤可能是Essex-Lopresti损伤产生并发症的重要原因,其中桡骨头骨折是Essex-Lopresti损伤主要原因,而IOM损伤是次要原因.桡骨头切除后IOM是维持前臂纵向稳定的主要结构.     

后腹腔镜下冷冻消融治疗小肾肿瘤的初步报告

Objective To present the technique and short-term results of retroperitoneal laparoscopic renal cryoablation for small renal tumors. Methods Ten selected patients cases with 11 renal tumors were included in present study. There were 3 cases of left renal tumor, 6 cases of right renal tumor and 1 case of bilateral renal tumors. Tumors were located at the upper pole (2), middle (6), or lower pole (3). All tumors were located distant from the collecting system, without evidence of metastatic disease. Mean tumor size was 2. 8 cm (range: 1.5-4.0). All the patients were managed with a double freeze-thaw cycle of retroperitoneal laparoscopic renal cryoablation. The preoperative Hb was (137± 21)g/L, ESR was (27±12)mm/1 h, SCr was (92±41)μmol/L, GFR was (42±10)ml/min.All the patients were taken routine biopsies. Results Cryoablation was technically successful in all 10 patients (11 tumors). The mean time of the operations was (101 ± 31) min, and the mean blood loss was (42±21) ml. None of the cases received blood transfusion post-operation. No operative complication was seen. The postoperative hospital stay was (4±2) d. The postoperative Hb was (129 ±18)g/L,ESR was (31±14)mm/1 h,SCr was (95±39)μmol/L,GFR was (40±11)ml/min. There was no statistic change of Hb, ESR, SCr and ECT-GFR after operations(P＞0. 05). The biopsy results revealed that 8 tumors were renal clear cell carcinomas, and 2 tumors were papillary renal cell carcinomas, and 1 tumor was renal angiomyolipoma. All the patients had a minimum follow-up of 6 months (mean 16, range 6 to 21). Follow-up magnetic resonance imaging at 1, 3, and 6 months identified the punched-out, nonenhancing, spontaneously resorbing, renal cryolesions. Follow-up biopsie of the cryoablated tumor site was negative in the only patient who have undergone the biopsy. No evidence of local or port-site recurrence was found, and no metastatic disease. Conclusions Retroperitoneal laparoscopic renal cryoablation for small renal tumors could be an accurate and effective intervention with a relatively low incidence of complications. Critical long-term data regarding laparoscopic renal cryoablation are awaited.     

Clinical efficacy of superselective arterial embolization in the treatment of hemorrhage from malignant gestational trophoblastic tumor

<正>Objective:To evaluate the efficacy of superselective arterial embolization in controlling hemorrhage from malignant gestational trophoblastic tumor. Methods:From February 1990 to January 2008,44 patients with hemorrhage from malignant gestational trophoblastic tumor(including 29 cases of choriocarcinoma and 15 cases of invasive mole) were treated with superselective arterial embolization.The hemorrhage sites included uterus(40 cases),cervical metastasis(1 case) and vaginal metastasis (3 cases). Results:In 41 cases(93.2%),superselective arterial embolization successfully controlled the hemorrhage. Hysterectomy was performed in the 3 failed cases and uterine perforation was revealed by laparotomy.Five patients had normal term delivery after successful superselective arterial embolization and chemotherapy,and two patients are now in the healthy second trimester of pregnancy. Conclusion:Superselective arterial embolization can effectively control the hemorrhage from malignant gestational trophoblastic tumor.     

不规则性肝切除对严重肝外伤的诊治体会

目的探讨不规则性肝切除治疗严重肝外伤的临床价值。方法回顾性分析2003年03月～2009年03月期间在我院行不规则性肝切除术的49例严重肝外伤(Ⅳ、Ⅴ级)患者的临床资料。结果严重肝外伤(Ⅳ、Ⅴ级)49例,均实施不规则性肝切除,其中加行肝后下腔静脉损伤修补1例。治愈43例,死亡6例(12.2%),并发症15例(30.6%)。结论不规则性肝切除是治疗严重肝外伤的有效手段。