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101.
本文报道了15例感染性心内膜炎(IE)的外科治疗结果。左心IE9例,其中3例合并风湿性心脏病。右心IE6例,均合并先天性室间隔缺损(VSD)。活动性IE13例,静止期IE2例。右心IE的手术方法是修补VSD,剥除三尖瓣上的赘生物并涂以0.5%活力碘,环缩三尖瓣环。左心IE的处理方法为瓣膜置换。手术死亡2例。本文着重对手术时机进行了讨论。 相似文献
102.
Outcome Following Bariatric Surgery in Super versus Morbidly Obese Patients: Does Weight Matter? 总被引:4,自引:2,他引:2
Mark Bloomston MD Emmanuel E Zervos MD Mario A Camps MD Sarah E Goode RN Alexander S Rosemurgy MD 《Obesity surgery》1997,7(5):414-419
Background: Numerous investigators have attempted to identify prognostic indicators for successful outcome following bariatric
surgery. The purpose of this study was to determine whether degree of obesity affects outcome in super obese [>225% ideal
body weight (IBW)] versus morbidly obese patients (160-225% IBW) undergoing gastric restrictive/bypass procedures. Methods:
Since 1984, 157 patients underwent either gastric bypass or vertical banded gastroplasty. Super obese (78) and morbidly obese
(79) patients were followed prospectively, documenting outcome and complications. Results: Super obese patients reached maximum
weight loss 3 years following bariatric surgery, exhibiting a decrease in body mass index (BMI) from 61 to 39 kg/m2 and an average loss of 42% excess body weight (EBW). Morbidly obese patients had a decrease in BMI from 44 to 31 kg/m2 and carried 39% EBW at 1 year. After their respective nadirs, each group began to regain the lost weight with the super obese
exhibiting a current BMI of 45 kg/m2 (61% EBW) versus 34 kg/m2 (52% EBW) in the morbidly obese at 72 months cumulative follow-up. Currently, loss of 50% or more of EBW occurred in 53%
of super obese patients versus 72% of morbidly obese (P < 0.01). Twenty-six percent of super obese patients returned to within 50% of ideal body weight (IBW) while 71% of morbidly
obese were able to reach this goal (P < 0.01). Co-morbidities and complications related to surgery were similar in each group. Conclusions: Super obese patients
have a greater absolute weight loss after bariatric surgery than do morbidly obese patients. Using commonly utilized measures
of success based on weight, morbidly obese patients tend to have better outcomes following bariatric surgery. 相似文献
103.
本文对62例急性高血压脑出血进行了着重于治疗的分析。脑出血病严重威胁患者生命,死亡率高,病残率高。治疗的关键是绝对卧床,避免搬动;积极治疗及控制脑水肿、降低颅内压;头置冰帽以减低脑耗氧量,减轻脑水肿,促进脑细胞功能的恢复;加强护理,预防及治疗并发症是提高患者生存时间及存活率的重要环节;对出血量多、患者一般情况较好者,作者主张手术治疗,清除颅内血肿,可减轻症状,提高存活率及降低病残率。 相似文献
104.
对16例垂体腺瘤采用单侧鼻前庭切口经蝶切除,效果满意,既可减少手术创伤,又缩短了手术距离,且避免了美容缺陷,是一种设计巧妙,较为实用的手术方法,尤其适用于生长激素腺瘤。 相似文献
105.
106.
Duration of postlaparoscopic pneumoperitoneum 总被引:4,自引:0,他引:4
Background: Patients who present with abdominal pain after recent laparoscopic surgery present a diagnostic dilemma when pneumoperitoneum
is present. Previous studies do not define the duration of postlaparoscopic pneumoperitoneum. In this study, we attempted
to define the duration of laparoscopic pneumoperitoneum and to identify factors which affect resolution time.
Methods: We followed 57 patients who underwent laparoscopic cholecystectomy (34), inguinal herniorraphy (20), or appendectomy (three).
Serial abdominal films were taken until all residual gas was resolved.
Results: Thirty patients resolved their pneumoperitoneum within 24 h; 16 patients resolved between 24 h and 3 days; nine patients
resolved between 3 and 7 days; two patients resolved between 7 and 9 days. Mean resolution time for all patients was 2.6 ±
2.1 days. There was no apparent difference in resolution time between the three types of procedures; however, the sample size
may be insufficient. Duration of the pneumoperitoneum did not correlate with gender, age, weight, initial volume of CO2 used, length of time for the procedure, or postoperative complications. Sixteen patients had bile spillage during cholecystectomy
which significantly reduced the duration of postoperative pneumoperitoneum (p < 0.008), resulting in a mean resolution time of 1.3 ± 0.9 days. While 14 patients reported postoperative shoulder pain,
no correlation was found between the presence or duration of shoulder pain and the extent or duration of pneumoperitoneum.
Conclusions: We conclude that the residual pneumoperitoneum following laparoscopic surgery resolves within 3 days in 81% of patients and
within 7 days in 96% of patients. The resolution time was significantly less in patients sustaining intraoperative bile spillage
during cholecystectomy. There was no correlation found between postoperative shoulder pain and the presence or duration of
the pneumoperitoneum.
Received: 22 March 1996/Accepted: 12 July 1996 相似文献
107.
Background: Whether or not laparoscopic cholecystectomy may be performed safely as an outpatient procedure is controversial. In 1993,
a protocol for outpatient laparoscopic cholecystectomy was instituted to determine the benefits and safety of discharging
patients within several hours of surgery.
Methods: The initial 60 outpatient laparoscopic cholecystectomies performed by one surgeon in a hospital-based outpatient teaching
facility between February 1993 to June 1996 were prospectively studied.
Results: Fifty-eight (97%) patients were discharged successfully after an average stay in the recovery room of 3 h. There were no
deaths. Two patients required overnight observation and three patients required readmission. Two patients (3%) had cystic
duct leak. The average hospital stay for all patients undergoing laparoscopic cholecystectomy at the institution (inpatient
and outpatient) decreased from 3.2 to 1.5 days and the average hospital cost decreased from $7,800 to $4,600 during this period.
Conclusion: Laparoscopic cholecystectomy in an outpatient setting is safe and cost-effective in healthy patients.
Received: 3 April 1997/Accepted: 10 June 1997 相似文献
108.
A stratified intraoperative surgical strategy is mandatory during laparoscopic common bile duct exploration for common bile duct stones 总被引:3,自引:0,他引:3
J. F. Gigot B. Navez J. Etienne E. Cambier P. Jadoul P. Guiot P. J. Kestens 《Surgical endoscopy》1997,11(7):722-728
Background: Open exploration and endoscopic sphincterotomy (ES) remain the preferred treatment of common bile duct stones (CBDS). The
recent spread of laparoscopy has worsened the dilemna of choosing between surgical and endoscopic treatment of CBDS. The aim
of this study was to critically evaluate the results of our preliminary experience with laparoscopic common bile duct exploration
(CBDE) for CBDS.
Methods: Ninety-two consecutive patients were prospectively submitted to laparoscopic CBDE. Surgical strategy included an initial
transcystic approach or laparoscopic choledochotomy. Failure of stone clearance was managed by conversion to open CBDE or
by postoperative ES. Electrohydraulic lithotripsy and papillary balloon dilatation were selectively used. Stone clearance
was assessed by choledochoscopy and control cholangiography.
Results: The overall laparoscopic stone clearance in this series was 84% (transcystic route 63% and choledochotomy 93%). Conversion
to laparotomy was mandatory in 12% of the patients because of incomplete stone clearance and in 5% because of intraoperative
complications. Postoperative ES was required in 4% of the patients, giving an overall surgical success rate of 96%. When indicated
(small and limited number of stones located below the cysticocholedochal junction, with a dilated and patent cystic duct)
the transcystic route had the lower success rate, the higher complication rate, and the shorter operative time and postoperative
hospital stay. When indicated (accessible and dilated common bile duct over 7 mm), laparoscopic choledochotomy had the higher
success rate, the lower complication rate, the longer operative time, and the longer postoperative hospital stay, which is
related to associated external biliary drainage. The hospital mortality included two high-risk patients (2%) and the complications
rate was 15%.
Conclusions: Laparoscopic CBDE is safe in selected patients. A stratified intraoperative surgical strategy is mandatory in deciding between
a transcystic route and choledochotomy with specific indications for each approach. When feasible, laparoscopic choledochotomy
is more efficient and safe than the transcystic route, but it is associated with a longer postoperative hospital stay, which
is due to external biliary drainage.
Received: 7 May 1996/Accepted: 19 November 1996 相似文献
109.
G Nanni MD G Balduzzi MD R Capoluongo MD A Scotti MD G Rosso MD C Botta MD P Demichelis MD M Daffara MD E Coppo MD 《Obesity surgery》1997,7(1):26-29
Background: Biliopancreatic diversion (BPD), by ad hoc stomach resection (AHS-BPD) has been accepted as an effective surgical treatment for morbid obesity. Methods: Between 1.1.1992
and 31.7.1996, 59 patients (54 females, five males, mean age 40.3 years, range 23-61 years) underwent AHS-BPD. Mean preoperative
body-weight was 121.2 kg (range 94-160), with a mean body mass index of 48.6 (range 35-64). Three of these patients were converted
from a previous vertical banded gastroplasty to AHS-BPD (one patient with stomach preservation). After at least 36 months
follow-up, seven patients underwent abdominal dermolipectomy (five with associated incisional hernia repair, one with thigh
dermolipectomy). Results: Mean post-operative hospital stay was 13 days (range 10-30 days). Follow-up is currently in progress
in all patients. Excess body weight-loss was 78% in 33 patients with 24 months follow-up, with excellent long-term weight
loss maintenance. Protein deficiency was the main specific complication, encountered in two patients (3.4%). Mortality was
one patient (1.7%), due to pulmonary embolus. Conclusions: This clinical experience supports the effectiveness and safety
of AHS-BPD, despite some criticism. This procedure appears to be suitable for patients with clinically severe obesity who
will poorly tolerate food intake restriction but will accept long-term follow-up. Careful preoperative clinical assessment
and selection of patients who will be reliable in long-term follow-up are the keys to success with AHS-BPD, both in terms
of weight loss and reduction of specific metabolic complications. 相似文献
110.
Unique variant of partial anomalous pulmonary venous connection with intact atrial septum 总被引:1,自引:0,他引:1
Summary Partial anomalous pulmonary venous connections (PAPVCs) are rare in association with an intact atrial septum. However, the diagnosis should be considered in patients with otherwise unexplained findings of left-to-right shunt and right heart enlargement. An unusual variant is presented, which we considered unsuitable for operative repair, based on findings at catheterization. Developmental, hemodynamic, and surgical considerations are discussed. 相似文献