小儿腹腔镜下疝囊高位结扎术的麻醉处理

目的探讨小儿腹腔镜下疝囊高位结扎术的麻醉处理方法和安全性。方法本组80例腹腔镜下疝囊高位结扎术患儿,ASAⅠ~Ⅱ级,以气管全麻下行术式,入室后连续监测HR、MAP、SpO2、气道峰压(PIP)、PETCO2及体温,并分别记录术前、气腹后5min、气腹后10min、放气后10min的各项监测指标。结果所有患儿麻醉均满意,无一例出现麻醉意外、并发症,CO2气腹后10、20min HR、MAP、PETCO2、PIP显著升高(p<0.05,p<0.01),SpO2无显著变化,放气后10min各项指标与术前相比差异无显著意义。结论面对小儿特殊的解剖、生理和CO2气腹对生理产生的影响,做好术前准备,选择正确的麻醉方法和合适的麻醉药物,维持稳定的循环,小儿可安全实施腹腔镜疝囊高位结扎手术。     

上尿路梗阻性急性肾功能不全内、外引流的选择

目的探讨内、外引流在上尿路梗阻急性肾功能不全时的选择和效果。方法25例各种原因引起的上尿路梗阻（15例肿瘤性梗阻,10例非肿瘤性梗阻）合并急性肾功能不全,分别或先后对12例行输尿管内置双J管（doub le J,D J）内引流15次,对19例行经皮肾穿刺造瘘（percutaneous nephrectomy,PCN）外引流23次。结果引流成功23例,PCN外引流成功率86.9%（20/23）,双J管内引流成功率60.0%（9/15）,PCN术后继发出血1例。结论对于盆腹腔进展期或广泛转移肿瘤导致的梗阻,PCN解除梗阻优于输尿管支架内引流;非肿瘤性梗阻宜先尝试D J内引流。     

改进的内眦赘皮矫治术联合重睑成形术Ⅰ期成形

目的 探讨改进的内眦赘皮矫治术联合切开法重睑成形术的方法及临床效果。方法 根据内眦赘皮的轻重程度及方向，采用改良的“Z”成形术，切除或切断内眦部形成赘皮的异位眼轮匝肌及皮下筋膜组织，联合切开法重睑成形术行Ⅰ期成形。结果 本组68例患者，术后赘皮消失，泪阜显露适中，内眦间距缩短，重睑外形美观自然。其中，36例随访3个月至3年，术后皮肤切口无可见瘢痕，形态稳定，内眦赘皮无复发，效果满意。结论 该手术方法能够充分矫正内眦赘皮的异常结构，而与重睑成形术同期施术效果稳定，具有一定的临床应用价值。     

Laparoscopic cecal ligation and puncture in the rat

Background: We describe a technique of laparoscopic cecal ligation and puncture (CLP) in the rat analogous to open CLP which may facilitate the study of minimally invasive surgery (MIS) and peritonitis. Methods: Forty-four rats were randomized to either laparoscopic or open CLP and their 3-day mortality was recorded. Autopsies were performed for peritoneal fluid cultures, measurement of the length of ligated cecum, and scoring of the degree of cecal necrosis. Results: Laparoscopic CLP required slightly longer operating times compared to open CLP (average 15.6 vs 13.1 min, p= 0.002). Three-day postoperative mortality was 36.4% and 22.7% for open and laparoscopic CLP, respectively (p= NS). There were no differences in the length of ligated cecum or the cecal necrosis score between the open and laparoscopic CLP groups. Conclusion: Laparoscopic CLP is feasible and produces a fecal peritonitis with similar characteristics to those of traditional open CLP. Received: 3 July 1996/Accepted: 7 January 1997     

胎盘血流量下降对大鼠胎仔生长和胎盘结构的影响——宫内生长迟缓动物模型的研究

本实验采用 SD 大鼠,在孕后期行孕鼠一侧子宫动脉中段完全结扎,另一侧作对照.23只孕鼠(150只胎仔)分成未结扎上、下(CU 和 CL)与结扎上、下(LU、LL)四组.结果表明,LU 组宫内胎仔体重、胎盘重、脑肝重均较其它三组有显著下降(P<0.01);LU 组脑/肝重比值及脑/体重比值较其它三组有显著增加(P<0.01).其胎仔呈不均称性宫内生长迟缓(IUGR)。52只胎盘作了光镜观察,12只胎盘作了电镜观察。在已知子宫胎盘血流不足,且胎仔发生 IUGR 的情况下,其胎盘的改变与以往报道的人类 IUGR 胎盘病理改变相一致,从而证实了子宫胎盘血流量下降是 IUGR 发病的重要原因之一。     

双介入并中药治疗胰腺癌35例

对３５例胰癌病人在超声引导下，局部注射纯乙醇顺铂溶液，由肿瘤远端边退针边注射，一般７－１０天注射１次，直至活栓组织中癌细胞转阴为止。并给予“胰宝康泰”辅治疗，该药具有免疫增强作用。本组３５例的半年、１年、２年活率分别为８５．７％、６８．８％、５１．４％，中位生丰了期为１０．３个月，疗效满意。     

Anterior lumbar instrumentation improves correction of severe lumbar Lenke C curves in double major idiopathic scoliosis

Fifteen skeletally immature patients with double major adolescent idiopathic scoliosis with large lumbar curves and notable L4 and L5 coronal plane obliquity were retrospectively studied. Seven patients who underwent anterior release and fusion of the lumbar curve with segmental anterior instrumentation and subsequent posterior instrumentation ending at L3 were compared with eight patients treated with anterior release and fusion without anterior instrumentation followed by posterior instrumentation to L3 or L4. At 4.5 years follow-up (range 2.5-7 years), curve correction, coronal balance and fusion rate were not statistically different between the two groups; however, the group with anterior instrumentation had improved coronal plane, near normalangulation in the distal unfused segment compared with the group without anterior instrumentation. In cases involving severe lumbar curvatures in the context of double major scoliosis, when as a first stage anterior release is chosen, the addition of instrumentation appears to restore normal coronal alignment of the distal unfused lumbar segment, and may in certain cases save a level compared with traditional fusions to L4.     

育龄期妇女输卵管结扎后上皮细胞超微结构的改变

应用扫描电镜观察9位育龄期妇女正常和结扎后的输卵管上皮。结果表明:在输卵管结扎疤痕两侧各0.5cm处,粘膜上皮细胞的纤毛大量扭曲和粘连,局部上皮纤毛和微绒毛脱落,细胞形态不规则,而在距输卵管结扎疤痕两侧各1.0cm处,上皮细胞的纤毛和微绒毛形态和结构均正常。表明输卵管结扎后上皮的超微结构变化,使卵细胞输送功能丧失,可能是输卵管复通术后不孕的重要原因。因此,施行输卵管复通术时,输卵管疤痕切除的范围应不少于疤痕两侧各0.5cm,以提高输卵管复通率。此外,发现输卵管小孔仅位于输卵管积水处粘膜的分泌细胞间,可能与输卵管浆膜下毛细淋巴管相沟通,与引流输卵管积水有关。在输卵管积水处粘膜的表面纤毛细胞的纤毛大量脱落,微绒毛增生,许多纤毛细胞转变为分泌细胞。提出了形成输卵管积水新的发病机理。     

肛瘘经括约肌间瘘管结扎后肛门功能恢复的相关影响因素分析

目的 探讨肛瘘经括约肌间瘘管结扎后肛门功能的恢复情况及其影响因素。方法 采取病例对照研究方法,选取海口市中医医院2019年1月—2022年8月收治的172例肛瘘患者作为研究对象。统计分析患者手术前后肛门功能恢复情况,根据患者术后3个月的肛门功能恢复情况将其分为良好组140例、不良组32例。比较两组患者的手术指标、术后并发症及基线资料,采用多因素一般Logistic回归分析影响手术后肛门功能恢复的相关因素。结果 良好组手术后创面愈合更早（P <0.05）,疼痛持续时间更短（P <0.05）,总体平均住院总时间短于不良组（P <0.05）。良好组与不良组术后1、2、3个月的Wexner量表评分比较,采用重复测量设计的方差分析,结果 ①不同时间点的Wexner量表评分有差异（P <0.05）;②两组的Wexner量表评分有差别（P <0.05）,良好组Wexner量表评分较不良组低,肛门功能恢复较好。③两组的Wexner量表评分变化趋势有差异（P <0.05）。良好组患者的病程、瘘管长度、Parks分型、术后切口感染率、二次手术率（再次实施清创手术）、治疗依从性（术后用药是否遵从医嘱）、术后机械性刺激率（术后各种外因刺激肛门）与不良组比较,差异均有统计学意义（P <0.05）。多因素一般Logistic回归分析结果显示,肛瘘患者病程［O^R =1.842（95% CI：1.105,3.073）］、瘘管长度［O^R =1.788（95% CI：1.137,2.812）］、术后切口感染［O^R =1.694（95% CI：1.081,2.653）］、再次手术［O^R =1.347（95% CI：1.018,1.783）］、治疗依从性［O^R =1.493（95% CI：1.058,2.108）］是肛瘘患者括约肌间瘘管结扎后肛门功能恢复不良的影响因素（P <0.05）。结论 肛瘘患者经括约肌间瘘管结扎后肛门功能大部分恢复良好,但是肛瘘患者病程较长、瘘管长度较长、出现术后切口感染、术后再次手术、治疗依从性差可能会增大患者术后肛门功能恢复不良的风险。     

Technique and early clinical results of endoscopic variceal ligation (EVL)

Summary Endoscopic variceal ligation (EVL) is a new technique designed to be used instead of sclerotherapy. Small elastic O rings ligate varices resulting in their strangulation and eradication. During a 12-month period, EVL was employed in 53 consecutive patients, of whom 36 (68%) had alcoholic cirrhosis 17 were Child-Pugh class A, 22 class B, and 14 class C. Varices were graded from I to IV and repeat treatments were given at 1–2 week intervals until the varices were eliminated. At follow-up ranging from 6–18 months (mean 11.5), 217 EVL treatment sessions had been performed. Of the 13 patients (24%) who died during the study, 11 died during the index hospitalization. Active bleeding was controlled in 19 of 21 patients (90%). Of 40 survivors 13 patients (33%) had 1–2 (mean 1.4) recurrent variceal bleeds while 34 patients had repeat EVL treatment. Elimination of distal varices was achieved in 26 and 7 had reduction of varices from grade III–IV to grade I–II or less. Eradication required a mean of 4.4 EVL sessions in Child's A and B patients and 7.0 sessions in Child's C patients (P<0.025). No significant treatment-related complications were observed. EVL appears to control active bleeding, is associated with a low incidence of non-bleeding complications, and may be used as an alternative to sclerotherapy.