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33.
急诊左半结肠一期切除吻合术25例治疗体会 总被引:4,自引:1,他引:3
目的探讨急诊左半结肠切除一期肠吻合的可行性。方法腹腔探查完后,用布带结扎横结肠,游离肠系膜后,于预切除肠段的上端切开作肠外减压,挤压排空粪便,切除病变肠管,端端吻合,术后作肛管扩张,停留肛管引流,胃肠减压。结果全部病人预期痊愈出院,无发生吻合口漏和腹腔污染。结论该法有利于吻合口的愈合,增加左半结肠一期切除吻合的安全性,减少第2次手术痛苦,可推荐为左半结肠急诊切除一期吻合的良好方法。 相似文献
34.
目的:探讨大肠癌术后早期炎性肠梗阻的特点及治疗方法;方法:分析10例大肠癌术后出现早期炎性肠梗阻的临床表现并进行综合保守治疗;结果:10例患者保守治疗全部成功;结论:术后早期炎性肠梗阻是一种非细菌性炎性肠梗阻,以发生在术后早期,腹胀、呕吐明显,腹痛轻或无为主要临床特点,治疗应采用保守治疗。 相似文献
35.
Hitoshi Taguchi Koh Yamada Hideo Matsumoto Akira Kato Toshihiro Imanishi Koh Shingu 《Journal of anesthesia》1997,11(3):173-178
Purpose Several case reports indicate critical respiratory complications in relation to the double-lumen endobronchial tube (DLT).
A prospective survey for the airway problems in using the DLT is presented.
Methods One hundred adult patients undergoing thoracotomy for lung cancer were investigated. Tube malposition and airway obstruction
were searched using a fiber-optic scope. The endobronchial cuff was positioned just below the trachcal carina while the trachea
was intubated with a DLT (Rüsch). The distances of displacement, from the tracheal carina to the bronchial cuff, were measured
during anesthesia using an epidural catheter, which had marks every 5 mm. The distances for correcting the tube position were
measured at both the bronchial cuff and the level of the teethPaO2,PaCO2 andSPO2 were also measured.
Results Malposition (displacement over 5 mm from the correct position) was found in 42 patients, and 40 of them were in a withdrawal
direction, occurring at the postural change and during one-lung ventilation, especially during manipulation of the lung hilum.
Correcting distances at the level of the teeth were 15.3–3-times longer than those at the bronchial cuff. Airway deformities
and gradual withdrawal of the bronchial cuff were found in association with surgical manipulation. Obstruction occurred at
the tips of the tracheal tube in four patients and the bronchial tube in six patients, and at the tip of both in two patients.
Hypoxemia (PaO2<60 mmHg) occurred in four patients and hypercapnea (PaCO2>60 mm Hg) in two patients.
Conclusion Most of the DLT obstructions were associated with withdrawal malposition. Great attention to DLT displacement and airway deformity
is advised. 相似文献
36.
37.
Summary Obturator hernias comprise a rare group of abdominal hernias. They are often diagnosed when the small bowel has become obstructed
and the patients are operated on without the causes of the obstruction being known. Although many techniques for closure of
the defect are available, there is no agreement at the present time as to which is the procedure of choice. 相似文献
38.
Background: For patients with incurable malignant gastric outlet obstruction and cholestasis, laparoscopic gastrojejunostomy combined
with endoscopic biliary stent placement seems to offer a minimally invasive palliation.
Methods: We retrospectively analyzed the data of 16 patients submitted to laparoscopic gastrojejunostomy. Laparoscopic gastroenterostomy
was performed as an antecolic, side-to-side gastrojejunostomy with enteroenterostomy. In 12 patients cholestasis was relieved
preoperatively by stent placement via endoscopy (n= 6, 37.5%), percutaneous access (n= 5, 31%) or bilioenteric anastomosis (n= 1, 6.25%). One patient needed a percutaneous Yamakawa prosthesis postoperatively.
Results: Mean operative time was 126 min. There were no intraoperative complications. In one patient conversion to open surgery became
necessary because of extensive adhesions. The only postoperative complication was bleeding from a trocar site requiring reintervention;
there was no mortality. Median postoperative hospital stay was 7 days. Delayed gastric emptying was observed in 3 (18.7%)
patients. Median survival was 87 days after the operation. All patients died from their primary disease but could maintain
oral intake during the remaining survival time.
Conclusions: We conclude that laparoscopic gastrojejunostomy and endoscopic or percutaneous biliary stenting provide a good functional
result while impairing the quality of life only to a minimal extent.
Received: 7 May 1996/Accepted: 12 December 1996 相似文献
39.
162例气管插管患者的气道管理 总被引:16,自引:2,他引:14
笔者通过报道162例气管插管患者的气道管理,阐述痰痂形成的原因:(1)气道干燥,湿化不够。(2)吸痰管插入深度不够,吸痰不彻底。管理措施:(1)用金霉素眼膏润滑吸痰管,使之易于插入,保证吸痰管插入深度超过插管远端3-5cm。(2)预防气道干燥,注重湿化效果,重视吸痰环节。认为气囊不需定时放气,只需不定时调整气囊压力。 相似文献
40.
目的探讨输尿管镜气压弹道碎石治疗输尿管结石的效果。方法2004年2月~2005年3月,我们对185例输尿管结石(其中伴肾绞痛96例)采用输尿管镜取石或气压弹道碎石进行总结和分析。结果失败12例,其中6例改开放手术,6例术后3d行体外冲击波碎石。一次碎石成功率93.5%(173/185),其中上段结石为75.0%(24/32),中段为95.8%(46/48),下段为98.1%(103/105)。肾绞痛者成功率为100%(96/96)。术中输尿管损伤率2.9%(5/173),其中3例(1.7%)中转开放手术。术后肾绞痛1例。全组随访6~12个月,平均10.2月,无复发。结论输尿管镜气压弹道碎石安全有效,并发症少,是治疗输尿管中下段结石的首选方法,尤其对肾绞痛者疗效更好。 相似文献