腹膜后入踣手术治疗胰腺坏死并感染的安全性及疗效分析

目的 探讨腹膜后入路手术治疗胰腺坏死并感染的方法、安全性及疗效.方法 分析2008年1月至2013年3月9例重症急性胰腺炎（serious acute pancreatitis,SAP）发生胰腺坏死并感染在局麻或者全麻下实施了腹膜后入路胰腺坏死组织清除引流术患者的临床资料.5例经过1次手术,4例经过2次手术;8例首次手术为双侧清除引流,1例为单侧.结果 术后患者全身中毒症状迅速缓解,无任何并发症发生,首次手术时间60～80 min,平均（73±5.7） min,随访期间8例患者症状均完全消失,无复发,1例患者于术后6周死于心肌梗塞.结论 对于重症急性胰腺炎发生胰腺坏死并感染的患者,腹膜后入路行胰腺坏死组织清除引流术是直接、安全、有效、可行的治疗方法.     

超声引导经皮胆囊穿刺置管引流术在老年急性胆囊炎中的应用

目的　探讨超声引导经皮胆囊穿刺置管引流术 (PGCD)在老年人急性胆囊炎中的应用价值。方法　回顾性分析了超声引导下PGCD在 1组 16例老年人急性胆囊炎中的应用的临床资料 ,并与同期 18例接受了胆囊切除术和 8例手术胆囊造瘘术的急性胆囊炎老年患者的资料相比较。结果　胆囊切除术组和胆囊造瘘术组的手术并发症率和死亡率以及平均住院天数分别为 38.9%、12 .5 %和 11.1%、12 .5 %以及 2 2 .4天与 32 .0天 ,而PGCD组的并发症率和死亡率均为 0 ,平均住院 16 .3天 ,其中胆囊切除术组和胆囊造瘘术组的手术并发症率和平均住院天数明显高于PGCD组 ,P <0 .0 5。结论　超声引导下PGCD是治疗老年人急性胆囊炎的有效、安全和简便的方法。     

两种不同途径胆道金属支架植入治疗恶性阻塞性黄疸的对比研究

目的 比较经内镜逆行胰胆管造影术(ERCP)途径与经皮肝胆管引流术(PTCD)途径胆道金属支架植入治疗恶性阻塞性黄疸(MOJ)的临床效果.方法 选取2010年6月-2015年6月行胆道金属支架植入治疗的MOJ患者136例,其中经ERCP途径53例(ERCP组),经PTCD途径83例(PTCD组).比较两组的手术成功率、有效率、术后并发症发生率、住院时间及手术费用.结果 ①低位梗阻中ERCP组和PTCD组的手术成功率分别为97.7％和95.8％,差异无统计学意义(P＞0.05);高位梗阻中ERCP组的手术成功率明显低于PTCD组(77.8％和98.3％),差异有统计学意义(P＜0.05);②ERCP组和PTCD组总有效率分别为(88.7％和90.3％),差异无统计学意义(P＞0.05);低位梗阻中ERCP组有效率明显高于PTCD组(93.2％和83.3％),差异有统计学意义(P＜0.05);高位梗阻中ERCP组有效率明显低于PTCD组(66.7％和93.2％),差异有统计学意义(P＜0.05);③ERCP组总并发症发生率明显低于PTCD组(7.5％和15.7％),差异有统计学意义(P＜0.05);低位梗阻中和ERCP组并发症发生率低于PTCD组(4.5％和29.2％),差异有统计学意义(P＜0.05);高位梗阻中ERCP组并发症发生率明显高于PTCD组(22.2％和10.2％),差异有统计学意义(P＜0.05);④ERCP组和PTCD组住院时间分别为(13.67±.2.25)d和(19.75±3.78)d,差异有统计学意义(P＜0.05);ERCP组PTCD组的手术花费分别为(23 764.23±2 437.76)元和(24 863.45±2 983.37)元,差异无统计学意义(P＞0.05).结论 经ERCP和经PTCD途径胆道金属支架植入治疗MOJ均可取得显著的临床疗效,对于低位梗阻患者而言经ERCP更有优势,对于高位梗阻患者而言经PTCD途径更有优势.     

经椎间孔内镜技术穿刺路径辅助定位器的设计与临床应用

目的 :阐述新型经椎间孔内镜技术穿刺路径辅助定位器(椎间孔镜定位器)的设计原理与使用方法 ,初步探索其对椎间孔镜手术穿刺的准确性、透视次数和手术时间的影响。方法:研制了新型椎间孔镜定位器,其设计原理主要是利用穿刺目标点始终落在直角圆弧圆心的特点实现导向穿刺。我们回顾性分析2015年5月1日~7月10日在我院接受椎间孔镜手术的患者,共纳入54例患者,男23例,女31例。使用椎间孔镜定位器进行穿刺的病例作为A组,使用传统穿刺方法的病例作为B组。记录并比较两组的穿刺次数、透视次数、手术时间和并发症等组间差异。结果:平均穿刺次数A组为1.22±0.57次,B组为5.89±1.91次,两组间具有显著性差异(P0.001)。平均透视次数A组为14.15±2.63次,B组为21.96±4.06次,两组间具有显著性差异(P0.001)。手术时间A组为81.37±10.62min,B组为90.41±14.37min,两组间有显著性差异(P=0.011)。两组之间均无重大并发症的发生,仅A组发现术后椎间盘残留1例,两组间并发症发生率无显著性差异(P=0.313)。结论:新型椎间孔镜定位器可以有效提高椎间孔镜穿刺的准确性,降低透视次数以及有效减少手术时间。     

The impact of exposure route for class-based compounds: a comparative approach of lethal toxicity data in rodent models

Relationships of toxicities from intravenous (i.v.), intraperitoneal (i.p.), subcutaneous (s.c.) and intragastric (i.g.) exposure routes to mice were investigated. Regression analysis showed that the toxicities from i.v. route is strongly correlated with i.p. and s.c. routes, but poorly with i.g. route. Close toxicities from different routes for some compounds indicate that distribution rate is the determining step and dictates chemical concentration at the target site(s). On the other hand, the absorption rate is the determining step for many compounds, which lead to different toxicities between exposure routes. The classified compounds characterized as having either absorption or distribution rate determining step were based upon the comparison of toxicities from the different routes. We found that some aliphatic acids and benzoic acids have lower toxicity values from i.g. route compared to an i.v. route because of poor absorption. Many compounds show low toxic effects from i.g. route than those from other routes because of the first-pass metabolism in the gastrointestinal tract, resulting in the poor relationship for toxicities between i.g. and i.v. or other routes. Stepwise regression analysis showed that physicochemical properties of a compound, such as molecular volume, polarizability and hydrophobicity, significantly affect adsorption rate, which leads to different toxicities based upon exposure routes. Comparison of the toxicities between mice and rats indicate that toxic effect and the toxicokinetic processes in mice are very similar to that in rats. A universal correlation equation has been developed for the toxicities between rats and mice from different exposure routes, which can be applied to predict toxicities across species.     

腰麻注药速度及部位对肠回纳术麻醉的影响

目的分析腰麻不同注药速度及部位对麻醉的影响。方法 150例ASAⅠ^Ⅱ级回结肠造瘘术后肠回纳患者,按注药速度10、15、20 s随机均分为A、B、C三组,每组50例;各组再按注药部位L2Ⅱ级回结肠造瘘术后肠回纳患者,按注药速度10、15、20 s随机均分为A、B、C三组,每组50例;各组再按注药部位L2³、L33、L3⁴不同均分为两亚组,各亚组25例。观察各组麻醉效果和不良反应。结果腰麻注射速度和部位不同,麻醉效果和不良反应随之而变(P<0.05)。结论肠回纳术患者,以L24不同均分为两亚组,各亚组25例。观察各组麻醉效果和不良反应。结果腰麻注射速度和部位不同,麻醉效果和不良反应随之而变(P<0.05)。结论肠回纳术患者,以L2³穿刺15 s注入0.5%左布比卡因2 m L安全优效,可控性好。     

Direct access to a hospital offering intravenous thrombolysis therapy improves functional outcome of acute ischemic stroke patients

Referral from other hospitals is one of the primary causes of delayed thrombolysis therapy after acute ischemic stroke (AIS). We aimed to evaluate whether direct access to a hospital offering intravenous thrombolysis therapy was associated with good functional outcome in AIS patients treated with thrombolysis. We enrolled patients who received intravenous thrombolysis within 3 hours of symptom onset at our stroke center. We divided these patients into two groups: those with a direct admission to our stroke center and those with indirect admission by referral from other community hospitals. We investigated onset-to-door time and onset-to-recombinant tissue plasminogen activator (rtPA) time according to admission mode. We then assessed the association between a direct admission and favorable outcome at 90 days. A total of 232 patients (mean age of 66.6 years, median National Institutes of Health Stroke Scale score of 10) were included. A total of 48.7% of AIS patients treated with intravenous thrombolytic therapy were transferred from other hospitals. Patients who were directly admitted to our stroke center had a shorter onset-to-door time (61 versus 120 minutes, p < 0.001) and onset-to-rtPA time (103 versus 155 minutes, p < 0.001) than those referred from other hospitals. Direct admission was associated with a good outcome with an odds ratio of 2.03 (95% confidence interval 1.051–3.917, p = 0.035), after adjusting for baseline variables. Thrombolysis after direct admission to a hospital offering intravenous thrombolysis therapy could shorten onset-to-rtPA time and improve stroke outcome in patients with AIS.     

三种途径子宫切除术治疗子宫内膜异位症的临床效果分析

目的比较腹腔镜子宫切除术（LH）、阴式子宫切除术（TVH）与经腹子宫切除术（A11）治疗子宫内膜异位症的临床效果。方法回顾性分析2008年10月至2013年10月于解放军总医院诊断为子宫内膜异位症并行全子宫切除术治疗的232例患者临床资料、其中94例行LH（LH组）,85例行TVH（TVH组）,53例行AH（AH组）。对3组的术前一般情况、临床表现、手术结局及术后并发症等进行比较、结果LH、TVH与AH组手术时间分别为（160±43）、（116±30）和（213±31）min,m血量分别为（295±203）、（112±87）及（856±529）ml,组间两两比较差异均有统计学意义（P〈0．05）;术后件院时间分别为（6．2±2．0）、（7．1±4．6）及（9．4±3．3）d,AH组分别与LH组及TVH组组间比较差异有统计学意义（P〈0．05）;术后发热发生率、脏器损伤率差异无统计学意义（P〉0．05）。结论TVH具有创伤小、住院时间短等优点,在术者经验丰富、充分掌握手术技巧的前提下,对于盆腔粘连严重的子宫内膜异位症患者来说呵能是最好的选择。     

16号尖头与非尖头双腔气囊导尿管在普外私围术期男性患者中的应用效果比较

目的研究16号尖头与非尖头双腔气囊导尿管在普外科围术期男性患者中的应用效果。方法将2012年3月-2013年9月在本院普外科就诊的200例患者纳入研究,随机均分为采用16号非尖头双腔气囊导尿管进行导尿的观察组和采用16号尖头双腔气囊导尿管进行导尿的对照组,观察两组的应用效果。结果观察组患者一次置管成功率明显高于对照组（P〈O．05）;术后疼痛评分,留置过程中出现尿道黏膜损伤（出血）、尿漏、尿管阻塞等并发症发生率明显低于对照组（P〈O．05）。结论16号非尖头双腔气囊导尿管有助于改善导尿情况。