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991.
992.
2003年2月~2005年2月,我院对23例高龄不稳定型股骨转子间骨折患者采用人工股骨头置换术治疗,取得满意疗效。 相似文献
993.
994.
腹腔镜与开腹直肠癌低位前切除术后吻合口瘘发生率的比较 总被引:4,自引:0,他引:4
目的探讨腹腔镜与开腹直肠癌低位前切除术后吻合口瘘发生率的差异。方法2000年9月至2005年12月由同一组医师连续对距肛缘5~8cm的直肠癌患者实施腹腔镜下根治术(LP术组)53例及传统开腹根治术135例,比较两组和两组内患者造口与未造口者发生吻合口瘘的差异。结果LP术组造口与未造口者吻合口瘘的发生率分别为4.6%(1/22)与6.5%(2/31),χ~2=0.088,P>0.05;差异无统计学意义。OP术组造口与未造口者吻合口瘘的发生率分别为2.3% (1/43)与8.7%(8/92),χ~2=1.024,P>0.05;差异无统计学意义。LP术组与OP术组行造口的患者吻合口瘘发生率比较,P=0.455,差异无统计学意义;LP术组与OP术组未行造口者的吻合口瘘发生率比较,P=0.288,差异也无统计学意义。结论腹腔镜行直肠癌低位前切除术与开腹手术相比,不会增加吻合口痿的发生率。 相似文献
995.
弧形切割吻合器在低位直肠癌超低位前切除术中的应用 总被引:1,自引:0,他引:1
目的总结弧形切割吻合器在低位直肠癌超低位前切除术中的应用价值。方法2005年12月至2006年9月选择56例低位直肠癌患者在全直肠系膜切除和侧方淋巴结清扫的基础上,应用弧形切割吻合器对直肠(肛管)残端进行切割、闭合,用33mm管型吻合器进行超低位结肠-直肠(肛管)吻合术。结果56例低位直肠癌患者术中没有发生切割和闭合不全的病例,吻合口无渗漏。手术后住院时间为(11.2±3.2)d,无死亡者。发生吻合口瘘2例(3.6%),经过局部引流而自然愈合1例,因直肠阴道瘘进行横结肠造口转流1例,无吻合口狭窄。结论弧形切割吻合器在低位直肠癌超低位前切除术中具有切割完整、闭合确实、吻合口瘘发生率低的优点,有良好的应用推广价值。 相似文献
996.
Grit J. Spalding Martin Hartrumpf Tobias Sierig Nils Oesberg Christian Günther Kirschke Johannes M. Albes 《European journal of cardio-thoracic surgery》2007,31(6):1052-1057
Objective: Demographic changes and aggressive platelet inhibition have resulted in a marked increase in blood- and coagulation product expenditure and costs in cardiac surgery. We analyzed ‘bedside’ coagulation test (ROTEM) in order to verify clot forming quality for the purpose of finding a cost-effective treatment path. Methods: Annual treatment costs of all cardiosurgical patients were analyzed before (729 patients) and after (693 patients) implementation of ‘bedside’ ROTEM. Cumulative numbers and costs of platelet concentrates (PltC), fresh frozen plasma (FFP), red blood cell units (RBC), and coagulation factors: pooled coagulation concentrates (PCC), recombinant factor VIIa (rFVIIa), factor XIII (FXIII), and fibrinogen were assessed. Average monthly numbers and costs were compared. Number of resternotomies and early mortality was assessed and compared in both periods. Results: After ROMTEM implementation cumulative RBC expenditure showed 25% decrease while PltC exhibited 50% decrease. FFP expenditure remained unchanged. PCC, FXIII were markedly reduced (−80%) while rFVIIa were entirely omitted. Fibrinogen, however, increased two-fold. Cumulative average monthly costs of all blood products decreased from 66,000€ to 45,000€ (−32%). Coagulation factor average monthly costs decreased from 60,000€ to 30,000€ (−50%) yielding combined savings of 44%. In contrast, average monthly costs for ROTEM were 1.580€. Total number of resternotomies decreased from 6.6% to 5.5% while early mortality (5.9%; 6.0%) remained stable. Conclusion: Cumulative costs for treatment of perioperative coagulation disorders can be reduced by ‘bedside’ ROTEM analysis to achieve a selective substitution management. Saved costs for blood- and coagulation products clearly outweighed the expenses of ROTEM. Adequate differential coagulation management can therefore be cost-effective. 相似文献
997.
Hisayoshi Suma Hiroaki Tanabe Tokuhisa Uejima Shinya Suzuki Taiko Horii Tadashi Isomura 《European journal of cardio-thoracic surgery》2007,32(6):912-916
Background: To treat advanced heart failure due to idiopathic dilated cardiomyopathy, surgical ventricular restoration with mitral reconstruction was conducted and evaluated. Methods: In 95 patients (81 men, mean age: 54 years), New York Heart Association class III/IV was 44/51, and 33 patients (36%) were inotropic dependent preoperatively. Mitral regurgitation (≥2+) was noted in all patients. All patients underwent left ventriculoplasty (septal anterior ventricular exclusion in 38, partial left ventriculectomy in 57) and mitral reconstruction (repair 53, replacement 42). Fifty-two patients (55%) had concomitant tricuspid repair. Intra-aortic balloon pumping and left ventricular assist device was used in 24 patients and two patients, respectively. Results: Hospital mortality was 11.6% (11 of 95), with 6.6% (5 of 76) in elective and 31.6% (6 of 19) in emergency operations. The ejection fraction and cardiac index increased from 22.3 ± 6.3% to 27.2 ± 8.0% and from 2.3 ± 0.5 ml/m2/min to 2.8 ± 0.5 ml/m2/min, respectively (p < 0.001). The endodiastolic volume index, endosystolic volume index and diastolic dimension decreased from 232.9 ± 56.1 ml/m2 to 160.0 ± 49.8 ml/m2, from 178.9 ± 46.7 ml/m2 to 113.8 ± 44.7 ml/m2 and from 82.0 ± 9.0 mm to 68.9 ± 11.6 mm, respectively (p < 0.001). Late death occurred in 27 patients with 22 cardiac deaths. The mean NYHA class was 1.7 among the survivors. One-, 3- and 5-year survival rates were 72.8%, 61.4% and 50.5%, respectively. In the 62 patients who were non-inotropic dependent preoperatively, 1-, 3-, and 5-year survival rates (81.8%, 73.7% and 62.9%) were significantly better than the inotropic-dependent group (55.3%, 37.3% and 28.0%). Patients with mitral annuloplasty showed a significantly higher 5-year survival rate than patients with mitral valve replacement (59.6% vs 43.6%) in univariate analysis. By application of the exclusion site selection method, the two different ventriculoplasty procedures did not show significant difference in survival rates. Multivariate analysis showed that preoperative inotropes and old age were significant predictors for postoperative mortality. Conclusion: The selected ventriculoplasty in combination with mitral annuloplasty is a useful option for patients with an extremely dilated left ventricle in idiopathic dilated cardiomyopathy. Surgery should be considered before inotropic dependency occurs when prior medical treatment has failed. 相似文献
998.
肝切除技术的研究进展 总被引:4,自引:0,他引:4
肝切除技术已成为治疗各种肝脏良性、恶性肿瘤的最主要方法。文中主要从肝脏切除范围的界定、断肝新技术及腹腔镜肝切除技术这三方面的进展进行综述,从而提高对如何更加完善肝预切除方案和肝脏外科微创化肝脏外科领域里两大研究热点的认识。 相似文献
999.
目的 通过对25例前路手术治疗非连续节段颈椎病的临床资料回顾,探讨非连续节段颈椎病的临床特点和治疗策略.方法 选取25例非连续节段颈椎病人进行前路减压和重建.应用Cage加Cage重建14例;Cage加前路钢板固定7例;Cage加钛网和前路钢板重建4例.并以影像学检查和临床神经学检查随访20例病人的治疗结果.结果 随访时间18个月-6年3个月.平均37个月.应用JOA评分(17分法)评价手术前后的神经功能情况.术前平均评分6.2分(3-8分),术后平均评分11.4分(4-15分).有19例见到影象学融合.6例临床融合.未有内固定松动断裂,椎体间融合器下沉等.结论 对于非连续节段颈椎病,如果交界节段无退变不稳的表现,保留交界节段分别对受累节段进行减压和固定融合,是有效和安全的治疗方法. 相似文献
1000.
目的探讨腹腔镜远端胃癌根治术的可行性及手术方法。方法行腹腔镜远端胃癌根治术15例,D1清扫3例,D2/D2 12例。全部病例均行毕Ⅱ式胃空肠吻合。结果15例成功进行腹腔镜手术。手术时间平均(218.6±31.6)min,术中出血量平均(132.4±21.3)ml,清扫淋巴结平均(33.4±13.6)个。肿瘤近端切缘(6.6±0.9)cm,远端切缘(5.4±0.6)cm,术后肛门排气时间平均(3.5±0.6)d,无手术死亡,无吻合口漏,术后并发肺部感染1例,经治疗后痊愈。术后随访1~10个月,无肿瘤复发或转移。结论腹腔镜远端胃癌根治术能达到与开腹胃癌标准根治术(D2)的淋巴结清扫范围及肿瘤切缘,且具有创伤小、出血少、术后恢复快等优点。 相似文献