经脐单孔针式腹腔镜胆囊切除术的临床研究(附98例报告)

目的:探讨经脐单孔针式腹腔镜胆囊切除术的优越性及可行性。方法:回顾分析2010年2月1日至5月31日施行经脐单孔针式腹腔镜胆囊切除术98例的临床资料。结果:98例均成功施行经脐单孔针式腹腔镜胆囊切除术,手术时间平均32.5m in,术后平均住院2.8d,无并发症发生。结论:经脐单孔针式腹腔镜胆囊切除术较传统腹腔镜胆囊切除术手术操作困难,随着器械改进和技术水平的提高,手术时间逐渐缩短;且术后患者康复快,痛苦轻,腹壁无可见手术瘢痕,深得广大患者青睐,值得推广。     

症状性良性前列腺增生对患者配偶生活质量的影响

目的:症状性良性前列腺增生(BPH)引起的下尿路症状(LUTS)及其相关事件不仅影响患者的生活质量,而且影响患者配偶的生活质量。本研究目的是调查手术治疗的症状性BPH患者配偶的生活质量。方法:本组包含50对患者及其配偶,患者经检查符合症状性BPH且准备行手术治疗。患者及其配偶分别自我填写相关问卷,其中患者填写IPSS及BPH影响指数问卷(BPHII),配偶填写包括睡眠、社会活动力、性生活、心理影响、担心前列腺癌、担心前列腺手术、料理家务能力在内的7个问题的问卷,并对相关资料进行统计学分析。结果:患者LUTS可不同程度地造成其配偶睡眠障碍(12%)、社会活动力下降(12%)、性生活衰退(20%)、心理影响(38%)、前列腺癌恐惧(68%)、前列腺手术恐惧(40%)及料理家务能力下降(14%)。但是患者配偶生活质量下降程度与患者IPSS、BPHII评分无相关性(P>0.05)。结论:患者的LUTS及其相关事件在一定程度上降低了其配偶生活质量。但是,患者症状的严重程度与其配偶生活质量无明显相关性。提示症状性BPH患者及其配偶应该了解BPH的相关知识及BPH手术的危险性。     

Topical lidocaine improves conditions for laryngeal mask airway insertion

Purpose

We hypothesized that optimal laryngeal mask airway (LMA?) insertion conditions might be achieved with topical lidocaine and a smaller dose of propofol. In this study, insertion conditions after topical lidocaine 40 mg followed by propofol 2 mg·kg^?1 were compared with propofol 2 mg·kg^?1 or propofol 3 mg·kg^?1 alone.

Methods

Ninety patients were recruited for this randomized prospective double-blind study. One group received four sprays of topical lidocaine (40 mg) over the posterior pharyngeal wall followed by propofol 2 mg·kg^?1 (Group 2PL; n = 30). The other two groups received four sprays of 0.9% normal saline followed by propofol 2 mg·kg^?1 (Group 2P; n = 30) or by propofol 3 mg·kg^?1 (Group 3P; n = 30). The frequency of optimal insertion conditions (successful insertion at the first attempt without adverse responses) and side effects were recorded.

Results

The frequency of optimal insertion conditions was greater in Group 2PL (20/30, 67%) and Group 3P (22/30, 73%) than in Group 2P (11/20, 37%) (P = 0.009). In Group 3P, the mean blood pressure was lower than in the other groups prior to LMA-Classic? insertion (P = 0.003) but was similar after insertion. The incidence of apnea was greater in Group 3P patients (17/30, 57%) than in Group 2P (2/30, 7%) or Group 2PL patients (1/30, 3%) (P < 0.001).

Conclusion

Topical lidocaine 40 mg followed by propofol 2 mg·kg^?1 can provide optimal insertion conditions of the LMA-Classic comparable to those of propofol 3 mg·kg^?1, with fewer hemodynamic changes and a lower incidence of apnea.     

爱惜康缝线在髌骨骨折治疗中的临床应用

[目的]探讨应用爱惜康的各种缝线治疗髌骨骨折的临床疗效。[方法]2005年5月～2009年5月,将运用爱惜康缝线环形缝扎髌骨骨折分为薇乔组、普迪思组、爱惜邦组,共计3组102例。[结果]3组102例患者随访6～18个月,平均13.6个月,骨折全部愈合。以Bostman髌骨骨折疗效评分标准进行评分:分别获得90.00%、96.97%、97.44%的优良率。[结论]爱惜康缝线环形缝扎治疗髌骨骨折是一种较为理想的手术方式,且以爱惜邦为佳。     

成人肝移植术后早期并发急性阑尾炎的诊断和治疗分析

目的探讨肝移植患者术后早期并发急性阑尾炎的临床特点及诊疗经验。方法 7年间笔者单位共实施817例成人尸肝移植,4例术后早期并发急性阑尾炎。笔者回顾性分析该4例患者以及误诊为阑尾炎的另4例患者的临床资料。结果肝移植术后早期急性阑尾炎的发生率为0.49%(4/817)。该4例患者分别于肝移植术后8,13,11,9 d出现急性阑尾炎症状,包括右下腹阵发性疼痛,发热,右下腹压痛、反跳痛,白细胞升高;2例于出现症状当天,2例于症状出现后第2天急诊行阑尾切除术。无阑尾穿孔者。术后病理提示2例为单纯性阑尾炎,2例为化脓性阑尾炎。阑尾炎发病及治疗过程中,未调整免疫抑制剂,肝功能无不良影响。4例术后均顺利恢复,迄今肝移植术后分别存活84,62,40,29个月。其余4例误诊为急性阑尾炎的患者1例为术后9 d十二指肠憩室并穿孔,1例为术后10 d空肠穿孔(术后15 d死亡);2例分别为术后8 d及11 d发生胆瘘,后者术后4个月死亡。结论肝移植术后阑尾炎的患病率低,需与胆瘘、消化道穿孔等并发症鉴别;对于确诊患者应尽早行阑     

视频喉镜在气道管理中应用的进展

视频喉镜是能够提供上呼吸道间接视野的新型气管插管设备。在困难气道管理处理方面．与直接喉镜相比．视频喉镜能够改善声门显露的Cormack—Lehane分级,并能在较短时间内达到相同或更高的气管插管成功率。尽管视频喉镜可获得非常好的声门显露．但是应用视频喉镜时插入和推进气管导管有时可发生失败。到目前为止,尚无确切证据表明在正常或困难气道患者视频喉镜应取代直接喉镜。     

Comparison of serum tumor markers for intrahepatic cholangiocarcinoma and hepatocellular carcinoma

Serum tumor markers such as alpha-fetoprotein (AFP), carcinoembryonic antigen, carbohydrate antigen (CA) 19-9, CA242, and CA50 were analyzed to evaluate their diagnostic values in single and combined tests for distinguishing intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC). Preoperative serum levels of AFP, carcinoembryonic antigen, CA19-9, CA242, and CA50 were measured in 45 ICC and 76 HCC patients. The serum levels and the positive rate of AFP, CA19-9, and CA242 were significantly different between the ICC patients and HCC patients. Although AFP (-) was the most sensitive assay for distinguishing ICC from HCC (91.1%), its specificity was significantly lower than that of CA242 (+) and CA19-9 (+). The combination of AFP (-) and CA242 (+) afforded a high specificity of 94.3 per cent and showed highest accuracy (78.5%). Evaluation of patients without liver cirrhosis also showed similar results. The diagnostic value of CA242 (+) is better than that of CA19-9 (+) and AFP (-) in distinguishing ICC from HCC. Combined detection of AFP (-) and CA242 (+) can improve the specificity and accuracy of diagnosing ICC.     

局部麻醉下的膝关节镜术

[目的]探讨采用局部麻醉行膝关节镜术的方法和效果。[方法]2000～2005年采用局部麻醉的方法行膝关节镜术978例。术前关节腔内注入0．5％利多卡因50～60ml，同时对关节镜入路的皮肤、皮下及关节囊进行逐层浸润麻醉。保留10—15min后连接灌注管道，关节腔内灌注生理盐水（内含。肾上腺素1mg／3000ml），使关节腔充盈扩张。[结果]止痛效果满意，所有病人无明显疼痛或可以忍受，手术均顺利完成，术中视野清晰，无不良反应发生。[结论]绝大多数的膝关节镜手术均可以在局部麻醉下完成，且安全有效，手术费用较低，特别适用于门诊的关节镜手术。因此，作者建议局部麻醉可以作为大多数膝关节镜手术的标准麻醉方法。     

胆管残端双舌瓣在胆肠吻合口狭窄中的应用

目的探讨胆肠吻合口狭窄再次手术的新方法,以降低胆肠吻合口再狭窄的发生率。方法对38例胆肠吻合口狭窄的患者再次行胆管残端双舌瓣空肠一层外翻吻合术,观察手术效果。结果胆管残端双舌瓣空肠一层外翻吻合术使胆肠吻合口直径增大0.5⁰.8倍、吻合时间短、吻合口再狭窄发生率低,效果良好。结论胆管残端双舌瓣空肠一层外翻吻合术操作简单易行,手术时间短,术后效果良好且安全可靠,是有效预防胆肠吻合口再狭窄的手术方式。