标准通道和微通道经皮肾镜取石术对血生化指标的影响

目的 探讨标准通道和微通道经皮肾镜术对血生化指标的影响.方法 选择肾结石患者59例,其中标准通道29例,微通道30例.术中监测灌注前、灌注后30 min、60 min、90 min、120 min及术后4h和12h的血电解质、酸碱度(pH)、碱剩余(BE)、血肌酐(Scr)、胱抑素C(Cys C)、肾小球率过滤估算值(eGFR).结果 两组间灌注时间、灌注液用量、灌注液出入差具有显著性差异(P＜0.05);标准通道组术前、中、后各项指标差异均无统计学意义(P＞0.05);微通道组灌注90 min时,Cys C显著升高,差异具有显著性(P＜0.05).灌注120 min时,pH、BE、Scr及eGFR的变化具有显著性(P＜0.05),但术后4h恢复到正常范围.两组间比较,灌注120 min时,pH、BE、Scr及eGFR各项指标均具有显著性差异(P＜0.05).结论 标准通道经皮肾镜取石术对肾结石患者血生化无明显负面影响,而长时间微通道经皮肾镜术可引起血生化明显的变化;建立通道过程中的扩张远低于灌注压对肾功能造成的损害;Cys C是监测肾小球滤过率更敏感的指标,但术后短期内都可恢复到正常范围;对复杂性巨大肾结石采用较大通道为更合理的选择.     

脉冲冲洗加负压封闭引流及开放植骨治疗慢性骨髓炎

<正>慢性骨髓炎是有伤口的骨感染超过6周者,大多数是因急性骨髓炎治疗不当或不及时引起,手术失败率、感染复发率高,治疗周期长且易复发,是临床骨科治疗的难题。传统的治疗手段为至少4～6周静脉抗生素应用及局部清创冲洗或肌皮瓣堵塞治疗,但常难以彻底消除感染。2005年至2009年采用脉冲冲洗加负压封闭引流(vacuum sealing drainage,VSD)并开放植骨治疗慢性骨髓炎,现报告如下。     

腹腔冲洗对根治性全胃切除术后胰瘘转归的影响

目的：探讨预防性放置腹腔冲洗管治疗胃癌D2根治性全胃切除术后胰瘘的有效性和必要性。 方法：将2012年3月—2013年9月间收治的196例胃癌D2根治性全胃切除术患者随机均分为对照组和观察组,对照组患者术毕常规放置腹腔引流管,观察组患者除常规放置腹腔引流管外,于胰腺腹侧上缘放置1根冲洗管,对发生胰瘘患者缓慢滴注生理盐水冲洗胰腺区域。比较两组胰瘘发生率,以及两组胰瘘患者术后腹腔引流液淀粉酶浓度、肠功能恢复时间及住院费用。 结果：两组的胰瘘发生率差异无统计学意义（P>0.05）,但观察组B+C级胰瘘发生率较对照组明显降低（P<0.05）;两组术后胰瘘患者比较,观察组第3天淀粉酶浓度较明显下降,肠功能恢复时间缩短,住院费用明显减少（均P<0.05）,但其他并发症发生率两组间差异无统计学意义（P>0.05）。 结论：放置腹腔冲洗管对胃癌术后胰瘘具有较好的治疗效果,对于术中疑有胰腺损伤的患者建议预防性放置腹腔冲洗管。     

术中结肠灌洗一期治疗梗阻性左半结肠癌58例临床分析

目的探讨术中结肠灌洗在梗阻性左半结肠癌一期切除吻合术中的临床应用效果。方法回顾性分析我院2000年1月至2007年12月期间接受术中结肠灌洗一期治疗梗阻性左半结肠癌58例的临床资料。结果接受一期切除吻合术的病人术后无一例发生吻合口瘘,均痊愈出院。结论只要严格掌握手术适应证,术中行有效结肠灌洗,对梗阻性左半结肠癌行一期切除吻合术是安全、可行的。     

肺切除术后膀胱冲洗预防尿潴留的观察

目的：评价肺切除术后拔除导尿管前膀胱冲洗对预防尿潴留的效果。方法：用掷硬币法将246例全身麻醉肺切除术患者随机分为冲洗组131例,对照组115例。冲洗组在拔除尿管前以生理盐水庆大霉素溶液冲洗,对照组按常规拔管。结果：冲洗组有93例(90．8%)拔除尿管后可自行排尿,对照组为91例(79．1%),经X~2检验P＜0．01,冲洗组有效率高于对照组；拔除尿管后首次排尿时间冲洗组为(1．75±0．75)h,对照组为(2．85±1．05)h,经U检验P＜0．05,冲洗组拔尿管后首次排尿时间短于对照组。结论：肺切除术后留置尿管患者在拔管前行膀胱冲洗可有效预防尿潴留的发生。     

Suction assisted pulse lavage: randomised controlled studies comparing its efficacy with conventional dressings in healing of chronic wounds

Chronic, open, non‐healing wounds pose a continual challenge in medicine as the treatment is variable and there are no documented consistent responses. Although wound aetiologies vary and there are a number of factors that affect chronic wound pathogenesis, wound ischaemia and bacterial colonisation of wounds are the chief concerns among them. Conventionally, pulse lavage has been used primarily as a wound debriding device. To address both the critical factors of wound ischaemia and bacterial burden, a couple of technical points were proposed and applied in this study. The objective of our study was to evaluate pulse lavage therapy's ability to improve the healing rate of chronic wounds compared to that of the traditional saline‐wet‐to‐moist dressings. The study period was from 1 August 2010 to 31 January 2012 and was conducted in our institution. Thirty patients with 31 chronic, non‐healing wounds were enrolled in the study after obtaining proper consent. Subjects were randomised (15 patients each) to the pulse lavage group and the control group. Patients in the test group were subjected to irrigation of their wounds with pulsed lavage at 10 to 15 psi pressure. In the control group, wound was closed by applying moist betadine saline gauze dressings after cleaning with saline. Wounds treated with pulse lavage system significantly reduced in size, had better control of bacterial contamination and had overall faster healing rates. Efficacy of pulse lavage can be increased by correct method of administration of the irrigant.