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11.
本文通过分析近5年来我院18例女性直肠癌全直肠系膜切除术后直肠阴道痿的临床资料。发现直肠阴道痿多发生于中低位直肠癌行全直肠系膜切除保肛手术的患者。痿的发生与肿瘤的位置、肿瘤的分期、肿瘤距肛门口的距离.以及手术技巧、手术难度、引流方法有关。而与是否进行预防性造口,以及是否采用腹腔镜手术无关。预防上强调应重视术中直肠前壁的锐性分离、结肠直肠吻合以及术后盆腔的负压引流。治疗上应首先进行保守治疗,即肠内营养,阴道冲洗。早期配合肠外营养、及全身或局部抗炎治疗,大部分直肠阴道痿通过保守治疗可以治愈。保守治疗无效时考虑结肠或回肠末端造口。若长期不愈应考虑吻合口肿瘤复发的可能。 相似文献
12.
We are intrigued by the possibility of using digital spectral analysis to detect hemodialysis vascular access stenosis. Such a monitor could be inexpensive, noninvasive, and portable enough to allow continuous monitoring. This report suggests how individuals wishing to conduct such research can use a simple but effective transducer design we have employed, how the data so obtained can be analyzed in the time and frequency domains using inexpensive digital signal processing software available via the Internet, and how data recordings might be shared via the Internet to facilitate collaboration. © 2002 Biomedical Engineering Society.
PAC2002: 8763Df, 8780Tq 相似文献
13.
Significant association of strictures and internal fistula formation in Crohn’s disease 总被引:1,自引:0,他引:1
Oberhuber G Stangl PC Vogelsang H Schober E Herbst F Gasche C 《Virchows Archiv : an international journal of pathology》2000,437(3):293-297
Intestinal inflammation in Crohn’s disease (CD) may be complicated by the occurrence of strictures and fistulae. The pathogenesis
of fistula formation is unknown. We therefore wanted to determine whether mechanical factors might contribute to the development
of fistulae. Furthermore, we tried to define the path of internal fistulae through the muscular layer. For this purpose, surgical
resection specimens from 42 consecutive patients with CD were prospectively studied. In gross examination the whole bowel
was cut into circumferential cross sections 0.3 cm thick. Abnormal areas were histologically examined. Strictures were found
in 38 patients (90.5%), and fistulae were observed in 27 (64.3%) patients. In 11 (40.7%) specimens fistulae were found within
a stricture, in 15 (55.6%) at the proximal end, and in 1 (3.7%) no stricture was found. In 7 (25.9%) cases with fistulae,
herniated mucosa was found within the muscularis propria or the subserosa. In 7 (25.9%) cases a blood vessel was identified
near a fistula traversing the muscularis propria. From these findings we conclude that that mechanical factors may contribute
to fistula formation. This is further supported by the fact that fistulae appear to traverse the muscular layer along piercing
vessels.
Received: 21 January 2000 / Accepted: 7 March 2000 相似文献
14.
王涛赵淑青刘考 《中国卫生质量管理》2022,(12):089-92
目的降低终末期肾病患者动静脉内瘘成熟不良率。方法成立品管圈圈组,通过现状调查、原因解析明确问题真因,从制定动静脉内瘘院前指导规范,建立多学科协作模式;实施“VAP”评估模式,制定围手术期标准化管理流程;构建“互联网 +”智能宣教模式,优化院外延伸服务三方面进行改进。结果终末期肾病患者动静脉内瘘成熟不良率由10.6%降低至3.3%。结论开展品管圈活动降低了终末期肾病患者动静脉内瘘成熟不良率。 相似文献
15.
目的:总结颈部囊肿与瘘管的诊治经验。方法:93例行手术治疗,其中鳃裂囊肿15例,鳃裂瘘管10例,皮样囊肿1例,囊状淋巴管瘤4例,甲状舌骨囊肿37例,甲状舌管瘘管25例,癌性淋巴液囊肿1例,随访1-10年。结果:93例中,囊性淋巴管瘤1例复发后失访,另1例行2次手术,癌性淋巴液囊肿1例半年后死于肺转移,鳃裂瘘管2例3次手术,甲状舌管瘘管1例复发,鳃裂瘘管术后1例迟发性面瘫,一次手术治愈,无术后并发症。结论:颈部囊肿与瘘管的诊断除依据术前检查外,主要是依据术中的发现和术后病理检查。B超、CT等是有效的辅助检查.手段治疗上应彻底切除囊壁与瘘管,避免复发。术中应避免损伤颈部的大血管和神经。甲状舌管瘘管须切除舌骨中段2cm,这是防止术后复发的关键。 相似文献
16.
Gianfranco Donatelli Andrea Spota Fabrizio Cereatti Stefano Granieri Ibrahim Dagher Renaud Chiche Jean-Marc Catheline Guillaume Pourcher Lionel Rebibo Daniela Calabrese Simon Msika Carmelisa Dammaro Hadrien Tranchart Panagiotis Lainas Thierry Tuszynski Filippo Pacini Roberto Arienzo Jean-Marc Chevallier Jean-Loup Dumont 《Surgery for obesity and related diseases》2021,17(8):1432-1439
BackgroundEndoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases.ObjectivesTo evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG.SettingRetrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center.MethodsEID was used as first-line treatment for the management of leaks, fistulae, and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with endoscropic ultrasound (EUS)–guided deployment of DPS or lumen apposing metal stents.ResultsA total of 617 patients (83.3% female; mean age, 43.1 yr) were enrolled in the study for leak (n = 300, 48.6%), fistula (n = 285, 46.2%), and collection (n = 32, 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5%, and 90% for leak, fistula, and collection, respectively. A total of 10 of 547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755), and previous endoscopic treatment (OR 4.818).ConclusionEarly EID for the management of leak, fistula, and post-operative collection after SG seems a safe and effective first-line approach with good long-term results. 相似文献
17.
复发性甲状舌管囊肿(瘘管)的原因探讨和预防措施 总被引:4,自引:0,他引:4
目的:探讨甲状舌管囊肿(瘘管)术后复发的原因和提高手术疗效的措施。方法:对32例甲状舌管囊肿(瘘管)病例(含8例术后复发者),术前感染病例先行抗炎后再手术,准确判定甲状舌管囊肿与舌骨的关系,处理舌骨;术中衔注美蓝液入囊管内示踪,行Sistruk术式,分离小分支,以手术显微下失去示踪小支,手指接触诊疑为残存病灶处,行环形缝扎或电凝,射频等处理。结果:32例均获成功,随访1年以上未见复发。结论:对甲状 相似文献
18.
A case of vesicouterine fistula in a young woman following caesarean section is presented. The diagnosis was established
successfully using heavily T2-weighted MRI which clearly demonstrated fluid within the fistula, obviating the need for conventional
radiographic contrast examination.
Received: 21 October 1998; Revised: 27 January 1999; Accepted: 1 March 1999 相似文献
19.
Summary The association of X-linked mixed deafness with stapes gusher has been recognised for 20 years, and imaging studies by polytomography have shown dilatation of the lateral end of the internal auditory meatus (IAM) in some cases. We have made genetic linkage studies in 7 pedigrees in whom deafness was inherited in an X-linked manner. All patients had a full range of audiometric and vestibular function tests. Thin section high resolution CT in two planes was used to assess the state of the middle and inner ears. We found a distinctive inner ear deformity in some of the deaf males characterised not only by a wide bulbous IAM but more importantly, by deficient or absent bone between the lateral end of the IAM and the basal turn of the cochlea. We believe that this results in a communication between the subarachnoid space in the IAM and the perilymph in the cochlea, leading to perilymphatic hydrops and a gusher if the stapes is disturbed. Moreover, some of the obligate female carriers seem to have a milder form of the same anomaly associated with slight hearing loss. Genetic studies on some of the deaf males with apparently normal inner ear anatomy suggest a different locus on the X chromosome and hence a different pathogenesis for the deafness. 相似文献
20.
Bilateral traumatic caroticocavernous fistulae: total resolution following unilateral occlusion 总被引:1,自引:1,他引:0
Balloon occlusion is the accepted treatment for direct post-traumatic caroticocavernous fistula. We present a case of bilateral
traumatic fistulae associated with a pseudoaneurysm. Resolution of both fistulae occurred following treatment of one of them
by balloon occlusion of the internal carotid artery. This case highlights the importance of considering a more conservative
approach to bilateral fistulae or those associated with a pseudoaneurysm. We review other treatment options.
Received: 1 October 1999/Accepted: 20 October 1999 相似文献