腹腔镜治疗粘连性肠梗阻效果观察

目的对应用腹腔镜治疗粘连性肠梗阻的治疗效果进行探讨。方法将80例粘连性肠梗阻患者随机分为研究组和对照组各40例。研究组采用腹腔镜治疗,对照组则采用传统开腹手术治疗。治疗结束后,进行以下方面的对比:术中出血量、手术时间、住院时间长短、拔管时间长短以及肠胃功能恢复时间。结果研究组术中出血量(50.2±20.6)ml,手术时间(68±41)min、住院时间(5.2±1.3)d,拔管时间(3.2±2.4)d,肠胃功能恢复时间(2.0±1.6)d,均优于对照组,两组比较,差异有统计学意义(P0.05)。结论采用腹腔镜治疗法较之于传统开腹治疗粘连性肠梗阻效果更佳,安全可靠,值得临床应用推广。     

先天性结肠闭锁18例诊治分析

目的：探讨结肠闭锁的病因、分类、临床表现、外科治疗及预后。方法收集本院2004年10月至2013年10月收治的18例结肠闭锁患儿临床资料,总结我们在诊疗方面的经验。结果18例患儿中,外院造瘘1例,本院急诊手术17例,均在入院后8～20 h内手术。闭锁部位发生在横结肠8例,升结肠3例,降结肠2例,结肠肝曲2例,结肠脾曲2例,乙状结肠1例。Ⅲ型14例,Ⅰ型2例,Ⅱ型2例。14例行一期肠吻合术,3例行乙状结肠造瘘,1例术中放弃治疗。全组有2例死亡。结论当闭锁发生在近端结肠时应选择回结肠吻合;当闭锁盲端在脾区以远,可以保留回盲部及部分近端结肠行结结肠吻合;如果闭锁盲端超过乙状结肠或患儿一般情况较差时,应先行肠造瘘。     

Bilateral stenting methods for hilar biliary obstructions

OBJECTIVE:

There is no consensus regarding the most appropriate methods (i.e., the side-by-side versus the stent-in-stent technique) for placing bilateral stents for malignant hilar biliary obstructions. We aimed to perform a quantitative review of the published data regarding the clinical efficacy of the side-by-side and stent-in-stent bilateral drainage techniques for hilar biliary obstructions.

METHODS:

A comprehensive search of several databases was conducted and a fixed-effects or random-effects model was used to pool the data from all of the study end-points.

RESULTS:

Four clinical trials were identified. A comparison of the side-by-side and stent-in-stent groups revealed no significant differences with respect to the rates of successful placement, successful drainage, early complications, late complications and stent occlusions. There were also no significant inter-group differences in stent patency and patient survival and no publication bias was observed.

CONCLUSIONS:

The performance of the side-by-side technique appears to be similar to that of the stent-in-stent technique for bilateral drainage in patients with malignant hilar biliary obstructions.     

Delayed right coronary ostial obstruction after J-valve deployment in transcatheter aortic valve implantation: A case report

BACKGROUND Aortic stenosis is the most common valve disease in adults.Transcatheter aortic valve implantation(TAVI)is being increasingly applied for intermediate-to lowrisk patients.Here,we describe an uncommon complication of delayed right coronary obstruction in a transapical TAVI case.CASE SUMMARY A 73-year-old woman with a EuroSCORE II of 1.21%underwent transapical TAVI because of severe aortic stenosis.The surgical procedure was uneventful.However,during routine monitoring after valve placement,the patient had a sudden onset of slow heart rate,the systolic blood pressure dropped sharply from 115 to 60 mmHg,and the central venous pressure abruptly increased from 10 to 33 cmH2O.The patient had a poor response to vasoactive agents.Transesophageal echocardiography revealed poor myocardial contractility,and electrocardiography showed a significant depression of ST-segment.Another angiography was performed immediately,which suggested complete obstruction of the right coronary artery.An emergency protocol was initiated.Cardiopulmonary bypass was established immediately.An aortic biological valve replacement under cardiopulmonary bypass was performed.CONCLUSION Perioperative monitoring,early recognition,and diagnosis of obstruction of coronary arteries in TAVI are important.Transesophageal echocardiography is a useful diagnostic and monitoring tool in this situation.Emergency protocols should be established during TAVI.     

移植肾输尿管梗阻的超声诊断

目的探讨超声对移植肾输尿管梗阻的诊断价值.方法应用二维超声经腹壁对移植肾输尿管进行检查,发现肾盂扩张积水者,换用高频探头重点扫查输尿管管壁及管腔,并进行动态观察.结果在758例移植肾超声检查中,发现移植肾输尿管梗阻23例.其中狭窄性梗阻14例,结石性梗阻8例,外压性梗阻1例.结论二维超声是诊断移植肾输尿管梗阻的首选方法,对结石性和外压性梗阻可明确诊断,对狭窄性梗阻可结合肾图、经皮造瘘管顺行造影来确诊.     

良性前列腺增生患者膀胱内前列腺突入测定的临床意义

目的探讨良性前列腺增生（BPH）患者前列腺突入膀胱内的程度对膀胱出口梗阻及逼尿肌功能的预测与评价。方法以经腹超声证实前列腺突入膀胱内的BPH患者为研究组,无突入的患者为对照组,分析两组间临床资料及尿动力学检查结果的关系。结果研究组临床资料中,前列腺体积、残余尿量、急性尿潴留及膀胱小梁化的比率与对照组相比差异有统计学意义（p〈0．05）,膀胱内前列腺突入程度与前列腺体积、残余尿量呈正相关（r分别为0．401,0．342,p值分别为0．013,0．0231）;在尿动力学结果中,研究组排尿期最大尿流率（Qmax）、逼尿肌不稳定及低顺应性膀胱的比率与对照组相比差异显著（p〈0．01）,排尿期最大逼尿肌压力（Pdet.max）及梗阻指数显著高于对照组（p〈0．05）,膀胱内前列腺突入程度与Qmax呈负相关（r=-0．284,p=0．045）,与Pdet．max及膀胱出口梗阻指数（BOOI）呈正相关（r分别为0．252,0．456,p值分别为0．041,0．032）。结论前列腺突入膀胱的BPH患者膀胱出口梗阻及膀胱功能受损的程度明显高于无突入患者;经B超测定膀胱内前列腺突入的程度,可以预测及评价膀胱出口梗阻的程度和膀胱功能的改变。     

输尿管镜在急性上尿路梗阻性肾功能衰竭中的临床应用

目的探讨急性上尿路梗阻性肾功能衰竭的治疗方法。方法采用输尿管镜检查,酌情气压弹道碎石,放置双J管内引流治疗76例急性上尿路梗阻性肾功能衰竭患者。结果术后患者血清BUN、SCr均明显下降,尿量不同程度恢复。结论输尿管镜诊治急性上尿路梗阻性肾功能衰竭,具有安全、疗效可靠、损伤小等优点,能同时处理双侧输尿管病变,可作为首选治疗方法。     

儿童鼾症发病原因分析及手术方法改进

目的 分析儿童鼾症的常见发病原因及相应手术方法.方法 对通过询问病史、常规体查及特殊检查确诊为儿童鼾症的患儿,对以上病因所致的儿童鼾症采用相应的手术治疗,以解除患儿呼吸道阻塞.结果 82例惠儿治愈57例,占70%,好转25例,有效率100%.结论 儿童鼾症与成人在病因与治疗方法上,都不尽相同,有一定的特殊性,儿童鼾症在治疗上以手术解除上呼吸道阻塞为主,辅以射频治疗及正压通气等,预后良好.     

节育环逆行植入泪囊术治疗慢性泪囊炎

目的:探索治疗泪道阻塞,慢性泪囊炎的新方法。方法:用节育环逆行植入泪囊后,用药液冲洗泪道2~4周,然后拔出节育环。用本方法治疗108例(117只眼),随访0.5~5年不等。结果:84只眼(71.8%)治愈,18只眼(15.4%)显效,12只眼(10.3%)有效,3只眼(2.5%)无效。无重要并发症。结论:本方法具有操作安全、简便、无痛苦、无并发症,效果好,费用低的优点,值得临床推广。     

大肠癌术后早期肠梗阻的临床特点和治疗

目的探讨大肠癌术后早期肠梗阻的诊断与治疗.方法回顾性分析大肠癌手术424例术后早期肠梗阻32例的临床资料.结果22例经手术探查发现以机械性梗阻占多数(20/22),手术治愈20例,死亡2例,死亡原因均为延误手术时机造成;非手术治愈10例.结论大肠癌手术后早期肠梗阻虽有梗阻症状,但由于术后诸多因素的影响,大多缺乏典型机械性肠梗阻的临床表现,处理应先进行适当时间的非手术治疗,无缓解者再手术.