改良超滤对婴幼儿心脏手术输血的影响

目的　观察改良超滤技术在婴幼儿体外循环心血管手术中对输血及术后出血的影响。方法　 6 0例接受体外循环下心血管手术的先天性心脏病患儿 ,均分为对照组 (不接受任何超滤 )、常规超滤组 (CUF组 )和改良超滤组 (MUF组 )。观察术中库血用量、血浆用量、血球压积的变化及术后2 4h出血量 ,并用SSPS/PC进行统计学处理。结果　MUF组库血用量、血浆用量、术后 2 4h出血量显著低于对照组和CUF组 (P <0 0 1) ,且滤出水量明显多于CUF组 (P <0 0 1)。结论　在婴幼儿心血管手术中 ,改良超滤可有效排出体内水分 ,提高血球压积 ,明显减少输血及术后出血 ,是节约用血的重要手段之一。     

Treatment of gingival lichen with free palatal grafts

BACKGROUND: Recalcitrant gingival erythematous lichen planus/lichenoid lesions comprise a considerable therapeutic problem. The objective of this study was to evaluate the therapeutic effect of grafting keratinized oral palatal mucosa to the sites of gingival lichen. METHODS: In 12 patients 20 grafts were transplanted to buccal gingival lesions. Mean age of the patients was 59.8 +/- 7.1 years (range 46-71 years). The mean observation time was 32 +/- 32.7 months (range 5-97 months). RESULTS: On a 4-point clinical grade scale (0-3), 12 (60%) transplants showed complete healing grade 3, six (30%) grade 2 and two (10%) grade 1. CONCLUSIONS: Using oral mucosal grafts from the palatal mucosa for the treatment of recalcitrant erythematous gingival lichen planus/lichenoid lesions seems to be a promising treatment modality.     

经尿道电切与气化切割和激光治疗前列腺增生症的疗效比较

目的 :比较经尿道电切前列腺术 (TURP) ,经尿道前列腺气化切除术 (TUVP)及经尿道接触式激光前列腺切除术 (TULP)的治疗效果。方法 :在 30 0 0例前列腺增生症患者中 ,按三种术式各随机抽取 2 0例术前条件具有可比性的患者 ,进行疗效比较。结果 :3种术式患者手术前后前列腺症状评分 (IPSS)、生活质量评分(QOL)、最大尿流率 (MFR)、剩余尿 (PVR)比较均得到显著改善 (P <0 .0 1) ,3组之间相比差异无显著性意义(P >0 .0 5 )。手术时间 :TUVP及TURP组明显短于TULP组 (P <0 .0 1) ,术中失血量及术后置管时间 :TUVP及TULP组明显少于TURP组 (P <0 .0 1)。TURP组术后继发感染、出血、暂时性尿失禁发生率少于TUVP及TULP组。结论 :3种术式治疗效果相同 ;TUVP操作简单、安全 ,对初学者来说尤其适宜 ;TURP仍为治疗BPH的金标准术式     

Evaluation of specialized laparoscopic suturing and tying devices.

BACKGROUND: Laparoscopic suturing and tying constitute advanced minimally invasive surgery skills. Developing proficiency in the standard methods with needle drivers is often an arduous process. Recent advances in laparoscopic instrumentations has allowed for easier methods of suturing and tying. This study investigated the hypothesis that the use of a specialized suturing device and a specialized tying device allows inexperienced medical students to suture and tie laparoscopically. METHODS: Preclinical medical students who had not received any training in open or laparoscopic surgery were included in this investigation. Each student was given a 5-minute demonstration of a specialized suturing device and a specialized tying device. The medical students were not allowed to deploy either device before actual use. After the demonstration, each student was given the device to use in a porcine model. Times were recorded and a subjective grade was given for each student. RESULTS: Twenty medical students were involved in this study. All medical students were able to complete the task of suturing and tying. The average time to suture was 104.6 seconds and the average time to tying was 31.2 seconds. The average subjective performance grade was 90 (out of 100). CONCLUSION: Specialized devices are easy to learn and use for laparoscopic suturing and tying with minimal instruction even for inexperienced medical students. Even surgeons who are not well versed in laparoscopic surgery should be able to suture and tie with certain laparoscopic instruments.     

骨水泥和种植体同期植入修复颌骨和牙列缺损的实验研究

目的：探讨高分子材料和种植体同期植入缺损区进行同步骨缺损修复和牙列缺损修复的可行性。方法：以4只杂种狗为研究对象，制备下颌骨长约2．5cm的缺损的动物模型(保留下颌骨下缘)，将骨水泥(聚甲基丙烯酸酯)植入骨缺损，同时将牙种植体植入骨水泥中并调整长轴方向，立即关闭术创。至术后3个月摄X线片，然后处死动物，局部巨检以了解骨水泥同骨组织的结合情况，并制备骨组织切片进行苏木精一伊红染色和甲苯胺蓝染色，以了解植入材料周边骨的生长情况及其对植入材料的反应。结果：术后3个月X线检查见骨缺损区充满骨水泥，骨水泥周边的骨小梁清晰，未见骨吸收或炎症表现，形成良好的骨-骨水泥界面，种植体则依赖其表面的螺纹结构与骨水泥间紧密的机械性嵌合而牢固的成为一体，植入的骨水泥块与周边天然骨结合紧密，无松动现象。植入材料周边局部脱钙骨的苏木精-伊红染色和甲苯胺蓝染色见骨结构正常，同时骨-骨水泥界有新骨形成。结论：骨水泥作为颌骨修复替代材料同期植入种植体是可行的。     

21例心内直视术后急性心包填塞的临床分析

目的:分析21例心内直视术后急性心包填塞的临床特点,探讨其发生原因、预防、救治及其二次开胸的早期指征。方法:对1991年1月-2005年12月心内直视术(共1096例)后21例急性心包填塞二次开胸(发生率1．92％)病例进行总结分析。结果:急性心包填塞患者经二次剖胸解除心包填塞后17例痊愈出院,4例死亡,二次剖胸手术死亡率为19．05％。二次剖胸手术者所患疾病包括先天性心脏病6例,瓣膜病13例,大血管手术1例,心脏移植1例。结论:减少心内直视术后出血、渗血是避免术后发生急性心包填塞的关键,早期诊断并尽早行二次剖胸手术可明显降低围手术期死亡率。     

MANAGEMENT OF UNCONTROLLED GLAUCOMA WITH THE MOLTENO SYSTEM

In glaucomatous eyes refractory to medication, laser techniques and conventional drainage surgery, intraocular pressure is often high, and visual loss rapid. In this situation a reliable, robust artificial outflow system is required. Molteno has evolved a plastic tube and plate device combined with a fibrosis suppression medication regimen. Thirty-eight eyes of 32 patients with uncontrolled glaucoma were treated with the Molteno system. Six months after operation mean intraocular pressure had been reduced from 41.0 ± 13.6 to 16.2 ± 5.6 mmHg. Eighteen eyes had pressures of 20 mmHg or less on no hypotensive therapy, 17 on reduced treatment. Three eyes had a pressure of 21 to 35 mmHg on treatment at six months. The 13 aphakic eyes responded as well as 25 phakic eyes. Five eyes with rubeotic glaucoma demonstrated pressures of less than 20 mmHg without therapy, four eyes with traumatic glaucoma required continuing medication with three having pressures below 22 mmHg. Of the seven eyes with uveitic glaucoma, one was lost, two required maintenance therapy; five of six surviving eyes had pressures below 20 mmHg. Fifteen eyes with congenital or juvenile glaucoma achieved pressures below 20 mmHg, three of these with timolol drops, three with timolol and acetazolamide, and nine with no treatment. While seven of seven eyes with refractory primary open-angle glaucoma attained pressures below 20 mmHg. all seven needed continuing mild hypotensive therapy. Eleven eyes underwent a one-stage procedure, while 27 eyes required a two-stage operation. Twenty-eight eyes received fibrosis suppression medication after the second stage, and 24 maintained or improved their preoperative visual acuity. Results have been encouraging: in general the Molteno system is recommended as the second drainage operation in all glaucomatous eyes in which conventional therapy has failed, and as the primary surgical procedure (after laser techniques) in eyes with rubeotic and uveitic glaucoma. Ciliary body destructive procedures should be restricted to control of symptoms in blind eyes.     

Limbus-based versus Fornix-based conjunctival flap in filtering surgery

Summary A randomized prospective study was performed to compare the results of filtering surgery using a Limbusbased versus a Fornix-based conjunctival flap. The wound closure of the Fornix-based flap was performed using a running 10/0 nylon suture at the limbus. No statistical significant difference of IOP regulation was found between the two groups. There was a tendency of reduced occurrence of shallow anterior chamber and of less vascularized filtering blebs in the Fornix-based technique.     

双腔右心室(附四例报告)

本文对我院1983～1985年经手术证实的4例双腔右心室病例,进行了分析讨论。本病除右心导管检查发现肺动脉与右心室有压力阶差移行曲线、右心造影时心腔内显示充盈缺损、超声心动图等检查有助于诊断外,X线心脏平片、心电图、临床症状、体征均无特异性的诊断价值。认为,由于本病多合并室缺,因此对室缺修补时,应常规探查右心室腔,以免漏诊。另外,对本病与法乐氏四联症的鉴别作了较详细的讨论。     

肺外科中单侧肺缺血-再灌注损伤的研究

目的 通过建立新西兰白兔肺外科单侧肺缺血-再灌注损伤动物模型,观察其缺血-再灌注损伤特点.方法 将96只健康新西兰兔随机分成3组:Ⅰ组为对照组(n=36);Ⅱ组为单纯阻断肺动脉组(n=30);Ⅲ组为阻断肺循环组(n=30).术中监测动物血流动力学指标;分别于开胸时(Ⅰ组)、缺血1小时和再灌注1、2、4、6 h(Ⅰ、Ⅱ、Ⅲ组)取肺组织检测MDA;取肺组织作病理学观察,并测定手术侧肺湿/干比.结果 各组动物术中血流动力学指标平稳;在缺血1 h和再灌注1、2、4、6 h,Ⅲ组与Ⅱ组比较,肺湿/干比及肺组织中MDA含量的差异均无统计学意义(P＞0.05),Ⅰ组与Ⅱ、Ⅲ组比较差异有统计学意义(P＜0.05).在相同的时间点,Ⅱ、Ⅲ组呈现相似的肺损伤病理改变,且较为明显的肺损伤均出现在再灌注4h,再灌注6h肺损伤均呈恢复趋势.结论 肺外科中肺动脉阻断和肺循环阻断所致肺缺血一再灌注损伤特点相似,肺外科中肺血管阻断1h是安全的.