手术室应急小组对肝癌破裂出血术后患者生理状况及生活质量的影响

目的 探讨手术室应急小组对肝癌破裂出血术后患者生理状况及生活质量的影响.方法 选取2017年1月至2019年11月间上海市闵行区中心医院收治的75例肝癌破裂出血患者,采用随机数字表法分为观察组(40例)和对照组(35例).两组患者均行正常手术治疗,观察组患者成立手术室应急小组进行围术期护理,比较两组患者术后生理状况、生...     

感染性颈动脉瘤破裂大出血1例

1 临床资料 患者男,59岁,以颈部肿瘤2年伴血性液体渗出1年,急性出血10小时急诊收入院.入院前大便时,颈部肿瘤突然增大,急性出血,急诊来我院求治.既往无肝炎病史.入院查体:T:36.3℃;P:80次/分;BP:140/85mmHg.神清,语利.左颈部有一约5cm×7cm肿瘤,质硬,表面不光滑,有破溃的瘘道,瘘道有血性液体流出.入院后给予病变处纱布压迫止血,但出血情况逐渐加重,约5小时后出血呈喷射状,纱布压迫止血无效,需手指加压.     

The spontaneous course of small abdominal aortic aneurysms. Aneurysmal growth rates and life expectancy

Summary Since abdominal ultrasonography has become a routine diagnostic procedure, increasing numbers of small asymptomatic abdominal aortic aneurysms are detected incidentally. Of 128 patients (108 male, 20 female) with abdominal aortic aneurysms, 96 patients were observed clinically and by repeated ultrasound studies for an average of 3.47 years, adding up to a total observation period of 333 patient-years. Among these 96 patients, 72 had small aneurysms (averaged diameters less than 5 cm). Three of them were lost to follow up. None of the remaining 69 patients died from rupture, 20 died from other causes and 8 patients were successfully operated. Of the patients with a large aneurysm one was lost to follow up. Five patients of the remaining 23 died as a result of rupture, 7 were successfully operated. The average growth rate of small aneurysms was 0.18 cm/year, whereas the larger aneurysms showed a growth rate of 0.28 cm/year (diameter).The survival rate of patients with small aneurysms was 94% after one year, 80% after 3 years, and 73 % after 5 years, indicating that life expectancy is reduced in patients with an aneurysm of the abdominal aorta, but not because of complications of the aneurysm.     

室间隔缺损合并主动脉瓣脱垂及瓦氏窦瘤破裂的外科治疗

目的总结室间隔缺损合并主动脉瓣脱垂及瓦氏窦瘤破裂的治疗体会.方法 118例室间隔缺损患者中合并主动脉瓣脱垂80例,主动脉瓣关闭不全为（＋～＋＋＋）;合并瓦氏窦瘤破裂37例;合并动脉导管未闭3例,三尖瓣关闭不全4例;合并亚急性细菌性心内膜炎7例,合并主动脉-右心室通道1例.结果本组无术后早期死亡,无室间隔缺损残余分流,复查部分病例仍有主动脉瓣关闭不全（＋、＋＋）,2例亚急性细菌性心内膜炎术后3个月再次行主动脉瓣置换术.结论室间隔缺损合并主动脉瓣脱垂及瓦氏窦瘤破裂及早手术治疗总体效果好.术中加强心肌保护、正确处理是治疗     

颅内破裂动脉瘤的手术方式与癫痫发作的关系

目的探讨颅内破裂动脉瘤患者的手术方式对癫痫发作的影响,以及与出血严重程度和患者预后的关系。方法回顾性分析我院神经外科2013年5月至2017年5月手术治疗的颅内破裂动脉瘤患者的临床资料,根据手术方式,患者被分为夹闭组和栓塞组,比较两组的基线特征,并发症和预后,并根据临床分级,比较癫痫发作率和患者预后。结果363例患者行开颅夹闭手术,211例患者行介入栓塞手术,两组的癫痫发作率无明显差异(P=1. 000),但在Hunt-Hess1-3级和改良Fisher 1-2级的患者中,夹闭组的患者癫痫发作率明显更高(P=0. 036; P=0. 013)。在Hunt-Hess 1-3级和改良Fisher 1-2级的患者中,有癫痫发作的比无癫痫发作的预后更差(P=0. 010; P=0. 031)。结论破裂动脉瘤患者在两种手术后癫痫发作率无明显差异,但在临床分级低的患者中,开颅夹闭手术后癫痫发作率更高,且与预后不良相关。     

Understanding intent to treat analyses: An important lesson from the international cooperative study on the timing of aneurysm surgery

Background and purposeIntent-to-treat analyses (ITT) are the best way to analyze randomized clinical trials because they preserve the benefits of randomization: to provide an unbiased assessment of relative treatment effects. Yet they play a more fundamental role, which can be demonstrated with observational studies.MethodsWe use a hypothetical RCT to explain why ITT analyses are more appropriate to analyze RCT results. We review the International Cooperative Study on the Timing of Aneurysm Surgery (ICSTAS), a landmark observational study on the management of ruptured aneurysm patients. We discuss the impact of the ICSTAS lesson on the interpretation of future observational studies using Big Data.ResultsPer-protocol (or as-treated) analyses can be misleading: The ICSTAS study provided ‘as-treated’ results clearly in favour of delayed surgery, while overall management or ITT results showed no difference between early and delayed surgery. A contemporary RCT showed that early surgery was best. ICSTAS’ lesson is that observational studies can provide misleading results when intent-to-treat categories are not predefined in the first place.ConclusionIntent-to treat analyses are the most appropriate way to analyze data, whether from randomized trials or observational studies. This observation has momentous consequences. A science of medical practice is impossible without predefined questions regarding optimal care.     

Mid-term Outcomes of Endovascular Repair of Ruptured Thoraco-abdominal Aortic Aneurysms with Off the Shelf Branched Stent Grafts

Objective

To assess the mid-term outcomes and feasibility of branched endovascular repair (b-EVAR) of ruptured thoracoabdominal aortic aneurysms (rTAAAs).

Ruptured sinus of Valsalva aneurysm associated with noncompaction of the ventricular myocardium.

Rupture of a sinus of Valsalva aneurysm is a rare, but life-threatening cardiac abnormality that requires surgical correction when diagnosed, and is frequently associated with other congenital defects, particularly with ventricular septal defect, aortic valve regurgitation, and bicuspid aortic valve. We present the case of a 21-year-old man who had a ruptured aneurysm of the noncoronary sinus into the right atrium, a ventricular septal defect, a persistent left superior vena cava and a noncompaction of the ventricular myocardium diagnosed by two-dimensional echocardiography. Surgical repair was carried out and the patient made an uneventful recovery.     

颅内动脉瘤破裂出血的手术治疗的进展研究

颅内动脉瘤是血管壁的局部病理性扩张引起的。在受到外力或精神紧张引起的颅内压增高情况下很容易发生破裂出血。颅内动脉瘤破裂造成蛛网膜下腔出血,产生颅内占位效应,造成患者偏瘫,严重时危及患者生命。颅内动脉瘤出血病死率随着时间的推移而增加,动脉瘤破裂出血后早期闭塞与相关治疗很有必要的。该研究从颅内动脉瘤出血的多种手术方式及我国动脉瘤手术治疗现状研究做一下相关介绍。