改良开放性手术治疗巨大良性前列腺增生症

目的探讨巨大良性前列腺增生症的开放性手术治疗方法及效果。方法回顾分析16例巨大良性前列腺增生症,年龄61~88岁,平均74岁。作耻骨上经膀胱前列腺切除术。结果手术均成功;手术时间35~65min,出血量100~200mL,术后前列腺重量为200~520g,平均215g;膀胱冲洗2~3d,拔导尿管5~7d;术后3d再出血1例,经DSA同侧髂内血管栓塞止血成功,排尿困难1例,短期尿失禁1例,其余患者术后均排尿通畅,控尿良好。结论开放性手术治疗巨大良性前列腺增生症,其梗阻解除彻底,是一种合理的治疗方法。恰当的手术方法是提高疗效及降低并发症的关键。     

胃癌累及胰腺的外科治疗与预后(附120例报告)

目的探讨胃癌累及胰腺的外科治疗方法与预后的关系。方法回顾性分析我院1984年6月～2003年10月手术治疗累及胰腺的胃癌120例。结果本组120例中,根治切除组41例,姑息切除组23例,未切除组56例。根治组41例中经病理证实胰腺有癌细胞浸润者30例,占73.2%,淋巴结转移率为85.4%。其中No10、11淋巴结转移率为73.1%。术后102例得到随访,随访率为85%,1、3、5年的生存率分别为:根治切除组为73%、37%、17%,姑息切除组为22%、9%、4%,未切除组为9%、2%、0%。根治切除组1,3年生存率明显高于姑息性切除组和未切除组(P<0.05),5年生存率明显高于未切除组(P<0.01),但与姑息性切除组无显著性差异。姑息性切除组和未切除组1、3年生存率无显著性差异,但5年生存率明显高于未切除组(P<0.01)。结论胃癌累及胰腺的根治切除可提高1,3年生存率,选择合适的适应征是关键。姑息切除有助于改善生存质量,对改善预后意义不大。     

医疗监护技术的现状和发展趋势

本文介绍了医疗监护技术的现状、存在问题和当前的新进展及发展趋势.     

体重、体质指数、腰围和腰臀比对正常成人骨密度的影响

目的探讨体重、体质指数(BMI)和腰围、腰臀比(WHR)对正常成人骨密度的影响。方法采用MarcomMx8000多层螺旋CT测定560例正常成人腰椎松质骨密度,将受试者按年龄不同分为青年组、中年组和老年组,然后在同年龄组根据BMI及腰围的不同将受试者分为肥胖组和正常体重组,分析骨密度与体重、BMI、腰围及WHR的关系。结果①以BMI分组,老年肥胖组BMD高于体重正常组(P<0.05);②以腰围分组,中年女性肥胖组BMD低于非肥胖组(P<0.05);③青年组和中年组BMD与腰围及WHR呈负相关,老年组BMD与体重和BMI呈正相关与腰围和WHR不相关。结论预防骨质疏松症在中青年应提倡运动锻炼,避免肥胖,在老年人不应该过分强调降低体重减少肥胖以避免骨量的丢失。     

Pituitary adenomas: Trans‐sphenoidal experience of 300 cases

Objective: The main aim of the present study was to examine the effectiveness and complication rate of the 1 cm right‐sided unilateral sublabial trans‐sphenoidal surgery for patients with pituitary adenoma equal to or greater than 5 mm in diameter. Method: A total of 350 patients were surgically treated for pituitary adenomas between December 1999 and December 2003 in an academic neurosurgical unit in China. Three hundred patients (86%) were treated with the 1‐cm right‐sided unilateral sublabial trans‐sphenoidal approach. The mean age of patients was 43 years (range 10–78 years) and female patients accounted for 59% of the total. One hundred and ninety‐six (64%) patients had functioning endocrine tumours and 104 (36%) patients had non‐functioning tumours or macroadenomas. Tumours which were outside this simple and basic classification were excluded from the study. Results: There were no operative mortalities. One patient developed hypopituitarism and 16 (5%) developed transient diabetes insipidus that required pituitrin treatment. The remission rate for macroadenoma was 85% and that for microadenoma was 98.5% during a medium term follow‐up of 1–5 years. One hundred and fifteen patients had prolactin secreting tumours and 90.4% achieved endocrine remission. Fifty‐six patients had growth hormone secreting tumours and 75.4% achieved endocrine remission. Preoperatively, one hundred and fifty‐one patients presented with visual impairment and 148 (98%) achieved a documented improvement in visual acuity. The mean duration of hospital stay was 4 days (range 3–7 days). Conclusion: This minimally invasive trans‐sphenoidal surgery for pituitary adenomas could be used as the primary treatment for small pituitary tumours. The effectiveness of the tumour removal and low morbidity rate compare favourably with the conventional sublabial approach as well as the more recently developed endoscopic endonasal approaches.     

小儿阻塞性睡眠呼吸暂停低通气综合征的诊断及治疗

目的探讨基层医院小儿阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的诊断和治疗。方法对临床疑似患儿,用多功能监测仪行夜间持续脉搏氧饱和度和呼吸监测、头颈侧位摄片、纤维鼻咽镜检查,确诊后行手术治疗。结果患儿多有睡眠粗响鼾声、扁桃体和(或)腺样体肥大,呼吸道感染、中耳炎、发育不良及中枢系统并发症的发生率较高。最低氧饱和度(85±7)%,睡眠呼吸暂停指数(apneaindex,AI)≥1者22例,睡眠呼吸暂停低通气指数(apneahypopneaindex,AHI)≥5者30例。在全麻下行扁桃体和腺样体切除术,同时行改良悬雍垂腭咽成形3例,双侧鼓膜切开引流术15例。术后症状及相关指标改善明显。结论便携式多功能监测仪可精确诊断OSAHS,扁桃体和腺样体切除是有效的治疗方法。     

CT导向下125I种子源植入治疗恶性肿瘤

目的:探讨CT导向下125I种子源植入治疗恶性肿瘤的安全性及临床疗效。方法:11例患者14个病灶行CT导向下125I种子源植入,其中原发肿瘤5例,转移瘤6例(9个病灶)。根据治疗计划系统(TPS)计算布源,在CT导向下将18.5~29.6MBq活度的125I种子源相隔1.0~1.5cm多层面植入肿瘤内。术后1~10个月复查CT观察种子源在瘤体内的分布、疗效及有无并发症。结果:随诊CT复查,14个病灶完全缓解(CR)5个;明显缓解(OR)7个;部分缓解(PR)2个;无效(P)0。治疗前后病灶平均大小分别为4.23cm和2.07cm(t=5.018,P<0.01)。未见急性并发症和治疗相关的放射损伤。结论:CT导向下125I种子源植入治疗恶性肿瘤是一种安全、有效的方法,近期疗效肯定。     

短缩-延长肢体治疗胫骨骨缺损合并软组织缺损

目的探索单纯使用Orthofix重建外固定架通过短缩一延长肢体治疗胫骨骨缺损合并软组织缺损的可行性。方法2001年7月～2006年7月收治胫骨骨缺损合并软组织缺损患者39例，其中37例为胫骨感染性骨折不愈合，2例为胫骨开放性骨折（GustiloⅢB型1例，Gustilo ⅢC型1例）。在患肢上安放Orthofix重建外固定架。清创术后小腿胫前内侧软组织平均缺损12cm（6～24cm），胫骨骨缺损平均9cm（4～22cm）。对胫骨骨缺损〈5cm的患者使用一期清创．腓骨截骨．胫骨缺损端加压。对22例胫骨缺损〉5cm的患者采用清创，腓骨截骨．短缩肢体〈5cm。对炎症局限、胫骨截骨部皮肤正常而且远离伤口的患者同期行胫骨截骨术，否则于1．0～1．5个月后二期行胫骨截骨术延长恢复肢体的长度。结果所有患者平均随访14个月（10～44个月）。骨缺损均得以重建，患肢肢体长度与健侧之差小于5mm，骨折愈合，无感染复发，创面均闭合。1例术后出现腓总神经麻痹，术后2个月恢复。4例胫骨缺损患者诉膝部疼痛。5例胫骨蠓损患者出现马蹄内翻足。2例胫骨缺损出现下胫腓分离。1例再骨折。结论使用Orthofix重建外固定架进行短缩．延长肢体是治疗胫骨骨缺损合并软组织缺损的有效方法，但应谨慎使用。对于软组织缺损少的小腿一期短缩的安全限度为3cm，最终短缩6cm。对于软组织缺损较大的急性胫骨开放骨折小腿一期可以短缩9cm。     

腹腔镜辅助小切口甲状腺结节手术的临床应用

Objective To study the feasibility, superiority and experience of minimally invasive laparoscopic-assisted surgery of the thyroid using ultrosonic scalpel. Methods In a period from January, 2006-August, 2008, 56 patients of the department of general surgery, the hospital of Heilongjiang Province were diagnosed as thyroid node. The size of the nodes ranged from 5.0 cm×4.2 cm to 3.5 cm×2.0 cm in uhrosonography. An incision of about 1.5-2.0 cm was made 1.0 cm above the suprasternal notch and the operation was performed with ultrosonic scalpel assisted with laparoscope. Partial thyroideetomy of lateral thyroid was performed in 20 cases, subtotal thyroidectomy in 25 cases, subtotal thyroidectomy of unilateral thyroid and partial thyroidectomy of contralateral thyroid respectively in 1 case, partial thyroidectomy of bilateral thyroid in 10 cases. Results All 56 cases have undergone minimally invasive laparoscopic-assisted surgery successfully in 50-146 min and no complications occurred. Fifty five cases were confirmed to be benign lesion pathologically. Conclusion Laparoscopic-assisted surgery of the thyroid is an effective with a good cosmetic result.     

An analysis of the paradoxical effect of morphine on runway speed and food consumption

A previously reported paradigm in which rats run down a runway for food reward followed by morphine injection was analyzed to assess the utility of the paradigm in studies of opiate reinforcement. One experiment replicated the original report that post-trial morphine caused both an increase in runway speed and a decrease in food consumption (taste aversion) over successive trials, and showed in addition that the increase in runway speed did not occur as a result of food deprivation alone, but required the animals to have consumed food in the goal box. A second study using the quaternary opiate antagonist methyl naltrexone to block the peripheral effects of morphine suggested that the increase in runway speed has a peripheral locus while the taste aversion has a central one. A third experiment in which morphine was microinjected into either the lateral ventricle or the ventral tegmental area supported these observations, in that intracranial morphine failed to result in an increased runway speed, but did produce taste aversion after microinjection into either site. These findings also suggest that the increase in runway speed caused by post-trial morphine in this experiment has a peripheral locus of effect, which is probably distinct from the central effect that supports morphine self-administration and conditioned place preference. Offprint requests to: W.A.CorrigallThe views expressed in this publication are those of the authors and do not necessarily reflect those of the Addiction Research Foundation