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51.
用额肌悬吊术或提上睑肌缩短术治疗78例上睑下垂病例,治愈7眼,基本治愈12眼,矫正不足3眼,矫正过度2眼,笔者认为,术前分析病因;注意提上睑肌肌力的测定;采用适当的手术方法,是手术成功的关键。 相似文献
52.
Japan Pancreatoduodenectomy Study Group Ryo Hosotani Masafumi Kogire Tadahiro Takada Hiroyuki Kato Takahiko Funabiki Masumasa Horisawa Takeshi Morimoto Takukazu Nagakawa Toshimichi Nakayama Itsuo Miyazaki Masayuki Imamura 《Journal of Hepato-Biliary-Pancreatic Surgery》1997,4(3):295-303
Endocrine tumor of the pancreas is potentially malignant. A multicenter analysis of these tumors was conducted to clarity
the present status of their surgical management and the subsequent long-term surgical results. The Japan pancreatoduodenectomy
(JPD) study group carried out the study; 368 patients were enrolled and variables related to tumor characteristics, surgery,
and survival were retrospectively analyzed. There were 222 patients with functioning tumor and 143 patients with nonfunctioning
tumor. Malignant tumor was found in 140 of 368 (38%) of the patients, and 63/140 (45%) of these patients had metastatic lesion;
the most common site of the metastasis was liver 34/136 (25%), followed by regional lymph nodes 26/136 (19%). Pancreatic resection
was performed in 91% of patients with nonfunctional tumor and in 83% of those with malignant tumor, and 73% of the pancreatic
resections were done with lymph node dissection. The overall 5-year actuarial survival rate was 76% in patients with malignant
tumor. The actuarial 5-year survival rate was 93% in the patients without metastasis and 83% in patients who received curative
resection. Multivariate analysis showed that the presence or absence of synchronous metastasis was the sole significant prognostic
factor. The results suggest that: (i) malignant endocrine tumor of the pancreas is a curable malignancy when pancreatic resection
with lymph node dissection is adopted and (ii) that synchronous metastasis is the dominant prognostic factor.
This study was carried out as a group project. The authors' institutions are as follows 相似文献
53.
Mark Hans Emanuel M.D. Augustinus Hart M.Sc. Kees Wamsteker M.D. Frits Lammes M.D. 《Fertility and sterility》1997,68(5):881-886
Objective: To determine the contribution of several variables to fluid loss during transcervical resection of submucous myomas.Design: An observational study using multiple linear regression analyses.Setting: A university-affiliated training hospital and a university department of clinical epidemiology and biostatistics.Patient(s): Patients with submucous myomas.Intervention(s): Transcervical resection of submucous myomas and monitoring of fluid loss.Main Outcome Measure(s): Patient age, uterine enlargement, treatment with GnRH analogues or 8-ornithine-vasopressin, type of anesthesia, number of myomas, intramural extension of the myoma (type of myoma), and operating time were tested as variables.Result(s): Only intramural extension of the myoma and operating time were obviously related to fluid loss. For the other variables, such a relation was weak at best. The relation between fluid loss and operating time was not modified by any of the other variables.Conclusion(s): Because fluid loss is an important limiting factor in the transcervical resection of submucous myomas, special attention should be paid to reduction of the operating time and preoperative assessment of the intramural extension of the myoma to guide appropriate patient selection. 相似文献
54.
瘤体骨切除灭活再植治疗四肢长骨巨细胞瘤 总被引:21,自引:0,他引:21
体内刮除及灭活植骨治疗骨巨细胞瘤(GCT)的复发率高。我科从1986年6月~1996年2月治疗四肢长骨GCT24例。随访11个月~8年4个月。其中7例采用局部切刮体内灭活植骨和(或)骨水泥充填治疗。结果1例感染,6例复发,1例恶变后死于肺转移。作者自1991年1月采用瘤体骨切除,离体灭活再植,与骨残端体内灭活相结合,骨缺损采用自家腓、髂骨移植,L-梯形加压钢板(L-TCP)或梯形加压钢板(TCP)固定治疗17例,其中12例保留关节,5例做膝关节融合。本组无菌创口感染1例,1例复发。在保留关节的12例中9例关节功能恢复优良,1例尚可,2例差。充分说明瘤段骨切除体外灭活再植术疗效确实,复发率低。保留关节术式适于关节破坏较轻(<=1/2)者,结合关节残端体内灭活和有效的骨结构重建,有利于恢复关节功能。如关节面累及>1/2,宜做骨关节端切除,灭活再植,下肢宜做关节融合或人工关节置换术。 相似文献
55.
Richard Simpson Catherine Kennedy Hugh Carmalt Brian McCaughan David Gillett 《ANZ journal of surgery》1997,67(10):717-719
Background : A patient with a solitary pulmonary metastasis who had breast cancer in the past may benefit from pulmonary resection. Methods : Between 1984 and 1996, 17 patients underwent metastatectomy for metastatic breast cancer. There were 15 females and two males whose average age was 59 (range: 40–74 years). The median tumour-free interval after the primary breast-cancer operation was 5.1 years (range: 8 months-18.2 years). Sixteen patients had complete resections, which included six lobectomies and 10 lesser resections. Results : The postoperative mortality was nil and the morbidity rate was 6%. Follow-up was complete in all patients. Recurrent disease developed in four patients and two patients died of their disease. The 5-year survival was 62%. Conclusion : An aggressive surgical approach is warranted in patients with isolated resectable pulmonary metastases from breast cancer. 相似文献
56.
Katsunobu Kawahara Takeshi Shiraishi Kan Okabayashi Akinori Iwasaki Yasuteru Yoshinaga Kouji Hayashi Jyunichi Yamashita Takayuki Shirakusa 《Surgery today》1997,27(2):163-165
A patient with a recurrent tumor in the trachea adjacent to the right main bronchus was treated by surgical resection 19 months
after undergoing surgery for the primary cancer. The patient had previously undergone right upper lobectomy for T1N0M0 stage
I squamous cell carcinoma. A carinal resection was performed which included 4 rings of the trachea, 2 rings of the righ main
bronchus, and 1 ring of the left main bronchus. Reconstruction consisted of an end-to-end anastomosis of the trachea and left
main bronchus, and an end-to-side anastomosis of the right and left main bronchi. The postoperative course was uneventful,
and at present the patient is healthy 12 months following reoperation. 相似文献
57.
Early experience with laparoscopic abdominoperineal resection 总被引:4,自引:0,他引:4
Background: Laparoscopic abdominoperineal resection (LAPR) has not been fully evaluated as a technique in the treatment of rectal and
anal cancer or inflammatory bowel disease. The purpose of our study was to evaluate the early experience with laparoscopic
abdominoperineal resection at Washington University Medical Center.
Methods: A prospective analysis was performed on the first 21 patients undergoing the procedure at Washington University Medical Center.
Indications for surgery included rectal cancer (14 patients), anal squamous cell cancer (four patients), inflammatory bowel
disease (two patients), and anal melanoma (one patient).
Results: The procedure was converted to open procedure in four patients (19%). The mean (±SEM) operative time and blood loss for completed
and converted LAPR were 239 ± 11 min and 424 ± 43 ml, respectively. Postoperative hematocrit dropped a mean of 8.3% ± 1.2%
SEM; five patients required blood transfusion (24%). Wound complication occurred in four patients (19%; three perineal, one
trocar site). Bowel function returned after a mean of 3 days, and mean postoperative hospital stay for the completed LAPR
group was 5 days. Mild pain was experienced by 81% of patients (17/21) while 19% (4/21) noted moderate pain, usually of the
perineal wound. The mean duration of patient-controlled analgesia use was 2 days. During the 1–44-month follow-up, six patients
(29%) died from cancer (stage III or IV at operation) and only one patient developed local recurrence in the pelvis (5%).
There were no trocar-site implants of cancer. Furthermore, there was no relationship between prior abdominal operations, the
amount of blood loss, postoperative drop of hematocrit, or blood transfusion requirement and the length of hospitalization
or complication rates.
Conclusion: Laparoscopic abdominoperineal resection is a feasible alternative to the conventional open technique in both cancer and colitis
patients.
Received: 23 April 1996/Accepted: 8 July 1996 相似文献
58.
The acromioclavicular joint is a potential source of pain in the shoulder. There are a variety of disorders that can affect this joint, including distal clavicle osteolysis, posttraumatic arthritis, osteoarthritis, and rheumatoid arthritis. Nonoperative treatment for this condition with nonsteroidal medication and activity modification can alleviate the pain. When conservative treatment is exhausted, surgical resection of the distal clavicle is often necessary. Arthroscopic resection of the distal clavicle preserves the acromioclavicular ligaments to prevent postoperative distal clavicle instability. The procedure is performed in either the beach chair or lateral position and requires the use of a shaver, electrocautery, and a burr for soft tissue and debridement and bone resection. 相似文献
59.
急性左半结肠癌梗阻一期切除吻合治疗39例 总被引:1,自引:0,他引:1
魏云志 《天津医科大学学报》2003,9(1):106-107
目的:探讨左半结肠癌致急性肠梗阻的手术处理方法。方法:回顾分析1995-2001年间39例左半结肠癌致肠梗阻一期切除吻合术的外科临床效果。结果:全组39例病人均采用梗阻近端肠管减压灌洗,并留置盲肠造瘘管术后接负压吸引,术后均一期愈合,未出现吻合口漏。随访2例中,1例存活率58%,3年存活率16%,5年存活率8%。结论:严格掌握手术适应症和基本操作,在病情允许时,对左半结肠癌急性肠梗阻行一期切除吻合手术是可行的。 相似文献
60.
Summary. The increasing spectrum of therapeutic options for tumors of the gastrointestinal tract has resulted in a refinement of the
pretherapeutic diagnostic strategies. The diagnostic approach in surgical institutions that are focused on primary surgical
resection will therefore be much less sophisticated than in institutions who propose a selective therapeutic approach based
on the pretherapeutic tumor stage and prognostic parameters. Pretherapeutic assessment of the depth of tumor infiltration,
i. e. the T-category, is essential because most further diagnostic and therapeutic decisions are based on this information.
This can today be achieved with a high degree of accuracy by endoscopy and endoscopic ultrasonography. Early T-stages (T1–2)
are usually an indication for primary surgical resection and, after exclusion of distant metastases, no further diagnostic
studies are required. In patients with locally advanced esophageal, gastric or rectum tumors (T3–4) multimodal therapeutic
concepts should be considered. This usually requires additional diagnostic studies. None of the available diagnostic imaging
modalities today allows satisfactory pretherapeutic assessment of lymph node metastases. The assumed nodular status should
therefore currently not influence therapeutic decisions. Essential is, however, the assessment of distant metastases, since
the documentation of distant tumor spread will change the therapeutic approach to a palliative situation. Detailed histologic
and molecular-biologic assessment of tumor characteristics is growing in importance. This not only provides therapeutically
relevant information regarding tumor grading, but opens the door towards a modern molecular diagnostic approach. It can be
expected that in the near future a vast amount of relevant prognostic information can be obtained from endoscopic tumor biopsies,
which may soon alter our therapeutic concepts.
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