食管癌切除食管胃颈部吻合术后吻合口并发症分析

我院自１９７９～１９９１年共行食管癌切除，食管胃颈部吻合术１０８７例。术后吻合口并发症９２例，发生率８．５％，其中吻合口瘘５．６％、吻合口狭窄２．７％、吻合口颈动脉瘘０．２％。讨论了颈部吻合口并发症的原因和预防措施。     

Impact response of periodontal tissues

A new impact response method using a fracture of a pencil-lead to produce an excitation pulse is proposed. Impact excitations (rectangular pulse, triangular pulse and half-sine pulse) are strictly given in physical and mathematical definitions and complete solutions to the impact excitations are provided for Noyes' model of the human tooth. When a relatively long triangular pulse is applied to Noyes' model, which can express the physical characteristic of periodontal tissues, a sinusoidal damped vibration of a single degree-of-freedom model is approximately obtained. The acceleration response is characterised by the physical parameters (T, δ and A_o) and mechanical elements (m₁, c₁ and k) of which a single degree-of-freedom model is composed. By means of this method, the values of the parameters and elements in the cases of healthy maxillary, healthy mandibular and pathological mandibular incisors are obtained. The single degree-of-freedom model can express the high-frequency spectra of Noyes' model. The pathological tooth is characterised by a longer damped time constant and a larger acceleration maximum. This impact response method can effectively be applied to clinical diagnosis in view of the physical parameters and mechanical elements which have been derived.     

开颅术后张力性气颅

报告１９８８年１２月～１９９２年１２月开颅术后张力性气颅５例，男４，女１．５例中３例治愈，２例死亡。开颅术后张力性气颅产生的主要原因是颅内占位性病变切除后，脑脊液丢失，使颅内压降低，甚至呈负压状态，外界的气体从切口进入颅内的腔隙，ＣＴ扫描或颅骨Ｘ线平片可以确定诊断，钻孔置管排气是活疗张力性气颅的有效方法，作者探讨了预防此种并发症发生的措施。     

抗心磷脂抗体定性定量方法在抗磷脂综合征疗效评价中的应用

目的探讨抗磷脂综合征(APS)患者治疗前后的抗心磷脂抗体(ACA)的定性定量水平及其对妊娠结局的影响,比较ACA定量与定性的准确性和灵敏度。方法对我院门诊APS孕妇40例,用定性定量方法监测治疗前后ACA的变化及对治疗后妊娠结局的影响。结果(1)定量方法检测治疗前的ACA-IgG和ACA-IgM滴度分别为(67.63±2.53)U和(49.40±3.64)U;治疗后的ACA-IgG和ACA-IgM滴度分别为(23.87±1.54)U和(21.60±2.59)U,两者比较,治疗后的ACA滴度水平显著低于治疗前水平(P<0.01)。定性方法检测APS孕妇,治疗后ACA转阴率为75%。(2)40例孕妇经治疗均娩出正常新生儿,ACA定量转阴组的妊娠并发症发生率(0.6%)较未转阴组(14.3%)显著降低(P<0.01)。ACA定性定量同时阴性组的妊娠并发症发生率(0.9%)较定性阴性而定量阳性组(7.1%)显著降低(P<0.05)。(3)治疗后30例孕妇ACA定性转阴,但其ACA-IgG和ACA-IgM滴度分别为(27.63±6.05)和(20.13±5.60)U/ml。结论ACA定性与定量均能准确有效的监测ACA水平,反映疗效及预测预后;ACA定量是一种较定性更准确灵敏的诊断监测方法。     

胆道穿孔的诊治体会

目的探讨胆道穿孔的病因、诊断及处理措施。方法对1985-2003年收治的41例胆道穿孔病例进行回顾性分析。结果41例均行手术治疗，2例死亡，其余均治愈。结论胆道在感染和梗阻情况下容易发生胆道穿孔，胆囊疾病合并胆管疾病并发感染时易发生胆囊穿孔，治疗胆道穿孔应根据病变和其并发症采用不同的手术治疗措施。     

Gadolinium-based balloon angioplasty for pulmonary artery stenosis in an infant with a right isomerism.

We report here the first described case of utilizing gadolinium-based contrast material as the contrast agent during a catheter intervention treatment for pulmonary artery stenosis. The patient, a male infant with complex heart disease associated with a right isomerism, had a history of severe allergic reaction to iodine-containing contrast agents. A combination of digital subtraction angiography and a gadolinium contrast agent, however, provided us with good-quality images both before and after balloon angioplasty without any associated complications. This method should therefore be considered as an alternative angiographic procedure in children with a high risk of iodine-related allergic complications.     

Percutaneous Transhepatic Cholangiodrainage as Rescue Therapy for Symptomatic Biliary Leakage Without Biliary Tract Dilation After Major Surgery

Symptomatic biliary leakage following major upper abdominal surgery is a severe complication resulting in increased morbidity and mortality. Treatment options usually include either endoscopic intervention or surgical revision. These options may be burdened by a high perioperative risk for the patient (e.g., patients with severe disease) or simply may not be possible (e.g., nonpreserved gastroduodenal passage). In the past, percutaneous transhepatic cholangiodrainage did only seem to be a viable option for patients with dilated bile ducts. Here, we present our experience in a consecutive series of patients with symptomatic biliary leakage following major upper abdominal surgery and without dilation of the biliary system that underwent percutaneous transhepatic cholangiodrainage. Percutaneous transhepatic cholangiodrainage was feasible in 15 of 18 patients (83.3%). The procedure was technically not possible in three patients (16.7%). In 10 of the 15 patients (66.6%) with feasible percutaneous transhepatic cholangiodrainage, biliary leakage was definitely controlled without the need for surgical revision. Depending on the experience with the interventional procedure, percutaneous transhepatic cholangiodrainage should be considered as an alternative for treatment of symptomatic biliary leakage instead of immediate reoperation. Presented at the Digestive Disease Week 2005 (DDW), Chicago, IL, May 14–19, 2005 (poster presentation).     

Perioperative Complications of the Agility Total Ankle Replacement in 50 Initial, Consecutive Cases

Although functional and clinical outcomes after total ankle arthroplasty have been promising, a steep learning curve has been recognized. In addition, the performance of concomitant hindfoot realignment procedures is controversial. The purpose of this study was to report on a single surgeon's experience with the first 50 total ankle arthroplasty procedures. We wanted to define the characteristics of the learning curve and whether the rate of complications was increased in patients who required complex reconstruction for preexistent foot and ankle deformities. This was a retrospective study of 50 cases with an average follow-up of 24.2 months. The patient population consisted of 18 men and 30 women with an average age of 57.6 years. Twenty-six percent of the cases had concomitant bony realignment procedures, while 20% had prior history of major hindfoot corrective procedures. There were 19 cases with intraoperative malleolar fractures, 12 cases that exhibited some degree of malalignment, and 6 cases of syndesmotic nonunion, and 8 ankles required early component revision. Minor wound complications that resolved with local wound care occurred in 9 cases, while 1 patient had a major wound complication requiring flap coverage. Each of these complications, other than wound complications, decreased with the surgeon's experience. Our results also indicate that the performance of major realignment procedures at the same time of implant arthroplasty is not associated with an increased incidence of complications. The results of this study suggest that total ankle arthroplasty is associated with a learning curve. Perioperative complications may potentially decrease with surgeon experience.     

关节镜下可吸收半月板箭修复膝关节半月板损伤106例疗效观察

目的:观察总结关节镜下可吸收半月板箭修复损伤半月板的术后疗效及术后并发症。对象与方法:采用镜下可吸收半月板箭复位固定法,对106例患者的108个损伤半月板进行修复。通过症状、体征、Tegner和Lysholm评分对半月板缝合修复的临床效果及术后并发症进行了观察,对术后有明显症状、体征的患者进行了关节镜探查。结果:术后随访106例、1~9·5年(平均26±12·3个月)。Tegner评分术后(7·65±2·54)较术前(3·55±1·59)有显著性差异(P<0·001)。Lysholm评分术后(88·55±25·64)较术前(35·46±14·62)有显著性差异(P<0·001)。疗效优61只半月板,占56·5%;良35只半月板,占32·4%;可8只半月板,占7·4%;差4只半月板,占3·7%。总优良率为88·9%。对术后有症状和体征的14例患者进行关节镜再探查,发现4例未愈合,5例部分愈合。术后并发症包括半月板箭固定处的后关节囊刺痛5例。无严重的血管神经损伤,106例患者术后并发症总发生率4·72%。结论:关节镜下可吸收半月板箭修复半月板损伤手术成功率较高,术中和术后风险较小。     

机械振动的成骨效应研究进展

应力是骨形成的“指导性”因素。其机制是近十年来骨科学、生物医学工程及康复医学领域的研究热点。机械振动是力学刺激形式之一。诸多研究表明：振动具有显著的成骨效应,其在骨质疏松的治疗中将会有广阔的应用前景。但是,现有相关研究中,具有成骨效应的振动频率、强度等参数并不一致,尤其是振动的成骨机制不明,相关报道极少,本文对其作一论述,可为更系统、深入地研究及其在临床中的应用提供理论基础。