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71.
食管癌切除术后不同重建途径吻合口瘘的原因及预防 总被引:21,自引:3,他引:18
目的了解食管癌切除术后经不同径路重建,发生吻合口瘘的情况;探讨系统性淋巴结清扫后,经胸骨后胃代食管颈部吻合口瘘发生率较高的原因及预防方法。方法1105例行食管癌切除术的患者,229例经左胸行胸内吻合(A组),716例经右胸食管床胃代食管行颈部吻合(B组),160例予以系统性淋巴结清扫术后经胸骨后行颈部吻合(C组)。分析比较不同手术径路的3组患者术后吻合口瘘发生的情况。结果吻合口瘘发生率分别为:A组5/229(2.2%)、B组85/716(11.9%)、C组31/160(19.4%),C组吻合口瘘发生率显著高于A、B组(P<0.01和P<0.05)。比较C组不同重建方式吻合口瘘发生率显示,手工吻合与器械吻合(22.2%与11.6%,P=0.133)、全胃重建与管状胃重建(25%与15.6%,P=0.146)间吻合口瘘发生率无明显差异,而延长胃肠减压管留置时间至术后7d,吻合口瘘发生率由23.3%降至9.1%(P<0.05)。结论胸骨后胃代食管吻合口瘘发生率较高的主要原因,是前纵隔内的胃体受压、冲击吻合口所致;通过延长胃肠减压管留置时间能有效减少瘘的发生。 相似文献
72.
73.
体部表面线圈磁共振成像对肛瘘的术前诊断价值 总被引:1,自引:0,他引:1
目的:探讨体部表面线圈MRI对肛瘘的术前诊断价值。材料和方法:回顾性分析42例肛瘘患者,均于术前进行非增强MRI检查,将MRI结果与手术结果对照。结果:MRI诊断结果与手术结果一致,其中23例为括约肌间型,5例经括约肌型,5例括约肌上型,9例括约肌外型,所有病例中有12例可见肛周脓肿形成。结论:MRI作为一种安全、准确的肛瘘检查方法,对于肛瘘的术前诊断具有非常重要的价值。 相似文献
74.
M. Dujovny K. V. Slavin M. S. Luer G. Hernandez-Avila J. I. Ausman 《Acta neurochirurgica》1995,133(1-2):83-86
Summary Different methods have been used in the evaluation and monitoring of the cerebral oxygen supply during neuro-interventional therapies. Attenuation of near-infrared light by the chromophores oxyhemoglobin and deoxyhemoglobin have shown to be useful in the study of the cellular oxygen metabolism and oxygen delivery to the brain. Transcranial cerebral oximetry (TCCO) has the advantage of providing real-time information regarding regional brain oxygen saturation (rSO2) by using wavelengths in the near-infrared range.We present a patient with a carotid cavernous fistula who underwent balloon occulusion and concurrent continuous TCCO monitoring. TCCO was found to be a useful tool providing immediate rSO2 values during the angiographic and interventional procedures. Initial balloon occlusion of a carotid cavernous fistula resulted in partial occlusion of the internal carotid artery lumen causing an immediate decrease in rSO2 which correlated with angiographic findings. Subsequent reocclusion of the fistula produced a slower and smaller degree of decrease in rSO2 with clinical improvement in the patient. Changes in rSO2 were detected before any adverse clinical event was observed. TCCO was reliable, safe, sensitive, and provided a real-time assessment tool for the monitoring of brain oxygen supply in a patient undergoing a neuroendovascular procedure. 相似文献
75.
硬脑膜动脉海绵窦瘘的眼眶CT表现,DSA检查及栓塞治疗 总被引:3,自引:1,他引:2
笔者分析了5例硬脑膜动脉海绵窦瘘伴突眼,结膜充血的病例,全部经CT及DSA检查,同时进行了栓塞治疗,经随访7-9个月未见复发,主要CT表现为:(1)眼球突出,结膜充血;(2)眼上静脉扩张;(3)海绵窦增大;(4)眼外肌增厚:(5)眶尖软组织肿胀。并讨论了诊断鉴别诊断,DSA检查及有关治疗问题。 相似文献
76.
The mortality of neonates with oesophageal atresia in the Third World remains high because of delays in presentation and diagnosis. Lack of appropriate intensive care facilities is a further contributing factor. Caudothoracic epidural anaesthesia was used during surgical repair of oesophageal atresia in 35 patients in an attempt to minimise the need for post-operative ventionally support. This group was compared with 36 patients whose surgery was performed under general anaesthesia. The age at the time of referral, sex ratio, and weight were comparable in both groups. Using the Waterson classification, a greater number of poorer prognostic patients were seen in the epidural group (P <0.02). In all Waterson risk categories fewer patients required ventionally support post-operatively, which was statistically significant (P <0.01) when all categories were combined. We are encouraged by our results and believe this technique has a rôle in the management of neonates undergoing major surgery, both where neonatal intensive care exist or is deficient as in many parts of the Third World. 相似文献
77.
Two cases of staphylococcal lung disease in young infants are described. In each instance a life-threatening bronchopleural fistula in the acute phase was successfully managed by thoracotomy and suture repair.
Offprint requests to: A. W. Auldist 相似文献
78.
29例复发性甲状舌管囊肿和瘘中.男性20例,女性9例。复发次数1~4次,以2年或2年以内复发居多。作者对复发的有关因素进行了讨论,并且提出术中注射亚甲蓝显示瘘管,以利完全切除。 相似文献
79.
Ryuji Takaki Tsutomu Nishiyama Masao Sekiya Shin Ishizawa Akira Junicho Yoshiyuki Fujishiro Yutaka Yabuzaki 《International journal of urology》1997,4(1):97-98
A 60-year-old Japanese man was hospitalized because of urinary leakage from the anus on October 3, 1994. Retrograde urethrography detected a fistula between the bulbous urethra and the rectum. Urethrocystoscopy revealed a tumor on the urethrorectal fistula. Tumor biopsy showed a well differentiated adenocarcinoma. Cystourethrectomy with fistulectomy, and ileal conduit urinary diversion were performed. Pathological examination revealed primary adenocarcinoma in the fistula with invasion to the prostatic urethra and bladder wall. The patient showed no evidence of a recurrence as of August, 1996. 相似文献
80.
Summary An infant with pulmonary arteriovenous fistulas is described. Surgical ligation of the fistulas and limited resection of paraenchyma from the right lung was followed at 11 months of age, by successful steel coil embolization of residual fistulas. 相似文献