食管癌切除食管胃颈部吻合术后吻合口并发症分析

我院自１９７９～１９９１年共行食管癌切除，食管胃颈部吻合术１０８７例。术后吻合口并发症９２例，发生率８．５％，其中吻合口瘘５．６％、吻合口狭窄２．７％、吻合口颈动脉瘘０．２％。讨论了颈部吻合口并发症的原因和预防措施。     

An audit of pain and vomiting in paediatric day case surgery

Three hundred and thirteen paediatric day case patients were prospectively audited to assess postoperative pain, nausea and vomiting using data sheets completed by nursing staff, anaesthetists and parents. The incidence of nausea and vomiting was 7.3% and was commoner in older children and those who had received opioids. Forty per cent of patients had some degree of postoperative pain; 17% of these patients were scored as having severe pain. Of children who had pain on returning home (31.4%), 85% of these required paracetamol. Fifteen per cent of children had a disturbed night due to pain and/or vomiting after their operation and 28.5% of children had pain on the following day. Boys undergoing circumcision were responsible for a disproportionately high percentage of the severe pain scores. Audit has helped to highlight deficiencies in the service provided and has led staff to try and improve their methods of analgesia.     

开颅术后张力性气颅

报告１９８８年１２月～１９９２年１２月开颅术后张力性气颅５例，男４，女１．５例中３例治愈，２例死亡。开颅术后张力性气颅产生的主要原因是颅内占位性病变切除后，脑脊液丢失，使颅内压降低，甚至呈负压状态，外界的气体从切口进入颅内的腔隙，ＣＴ扫描或颅骨Ｘ线平片可以确定诊断，钻孔置管排气是活疗张力性气颅的有效方法，作者探讨了预防此种并发症发生的措施。     

抗心磷脂抗体定性定量方法在抗磷脂综合征疗效评价中的应用

目的探讨抗磷脂综合征(APS)患者治疗前后的抗心磷脂抗体(ACA)的定性定量水平及其对妊娠结局的影响,比较ACA定量与定性的准确性和灵敏度。方法对我院门诊APS孕妇40例,用定性定量方法监测治疗前后ACA的变化及对治疗后妊娠结局的影响。结果(1)定量方法检测治疗前的ACA-IgG和ACA-IgM滴度分别为(67.63±2.53)U和(49.40±3.64)U;治疗后的ACA-IgG和ACA-IgM滴度分别为(23.87±1.54)U和(21.60±2.59)U,两者比较,治疗后的ACA滴度水平显著低于治疗前水平(P<0.01)。定性方法检测APS孕妇,治疗后ACA转阴率为75%。(2)40例孕妇经治疗均娩出正常新生儿,ACA定量转阴组的妊娠并发症发生率(0.6%)较未转阴组(14.3%)显著降低(P<0.01)。ACA定性定量同时阴性组的妊娠并发症发生率(0.9%)较定性阴性而定量阳性组(7.1%)显著降低(P<0.05)。(3)治疗后30例孕妇ACA定性转阴,但其ACA-IgG和ACA-IgM滴度分别为(27.63±6.05)和(20.13±5.60)U/ml。结论ACA定性与定量均能准确有效的监测ACA水平,反映疗效及预测预后;ACA定量是一种较定性更准确灵敏的诊断监测方法。     

胆道穿孔的诊治体会

目的探讨胆道穿孔的病因、诊断及处理措施。方法对1985-2003年收治的41例胆道穿孔病例进行回顾性分析。结果41例均行手术治疗，2例死亡，其余均治愈。结论胆道在感染和梗阻情况下容易发生胆道穿孔，胆囊疾病合并胆管疾病并发感染时易发生胆囊穿孔，治疗胆道穿孔应根据病变和其并发症采用不同的手术治疗措施。     

Gadolinium-based balloon angioplasty for pulmonary artery stenosis in an infant with a right isomerism.

We report here the first described case of utilizing gadolinium-based contrast material as the contrast agent during a catheter intervention treatment for pulmonary artery stenosis. The patient, a male infant with complex heart disease associated with a right isomerism, had a history of severe allergic reaction to iodine-containing contrast agents. A combination of digital subtraction angiography and a gadolinium contrast agent, however, provided us with good-quality images both before and after balloon angioplasty without any associated complications. This method should therefore be considered as an alternative angiographic procedure in children with a high risk of iodine-related allergic complications.     

Percutaneous Transhepatic Cholangiodrainage as Rescue Therapy for Symptomatic Biliary Leakage Without Biliary Tract Dilation After Major Surgery

Symptomatic biliary leakage following major upper abdominal surgery is a severe complication resulting in increased morbidity and mortality. Treatment options usually include either endoscopic intervention or surgical revision. These options may be burdened by a high perioperative risk for the patient (e.g., patients with severe disease) or simply may not be possible (e.g., nonpreserved gastroduodenal passage). In the past, percutaneous transhepatic cholangiodrainage did only seem to be a viable option for patients with dilated bile ducts. Here, we present our experience in a consecutive series of patients with symptomatic biliary leakage following major upper abdominal surgery and without dilation of the biliary system that underwent percutaneous transhepatic cholangiodrainage. Percutaneous transhepatic cholangiodrainage was feasible in 15 of 18 patients (83.3%). The procedure was technically not possible in three patients (16.7%). In 10 of the 15 patients (66.6%) with feasible percutaneous transhepatic cholangiodrainage, biliary leakage was definitely controlled without the need for surgical revision. Depending on the experience with the interventional procedure, percutaneous transhepatic cholangiodrainage should be considered as an alternative for treatment of symptomatic biliary leakage instead of immediate reoperation. Presented at the Digestive Disease Week 2005 (DDW), Chicago, IL, May 14–19, 2005 (poster presentation).     

远隔性小脑出血

远隔性小脑出血极为罕见，可见于多种类型的神经外科手术，一般出现在手术远隔部位，多分布于单侧或双侧小脑沟、蚓部，小脑上部出血也较为多见。远隔性小脑出血总体预后良好，病死率约为10％～15％。     

Current practice patterns in pancreatic surgery: Results of a multi-institutional analysis of seven large surgical departments in germany with 1454 pancreatic head resections, 1999 to 2004 (german advanced surgical treatment study group)

Despite decreasing mortality rates, morbidity is still high after pancreatic head resection. Comparative data in the United States and Europe show a relationship between hospital volume and mortality. Treatment strategies vary frequently, partially because of the lack of evidence-based data. We performed a multi-institutional analysis in Germany evaluating current numbers, indications, techniques, and complication rates of pancreatic head resection. Questionnaires were completed by seven high-volume surgical departments regarding quantitative and qualitative aspects of pancreatic head resections in the period from 1999 to 2004 (five prospective and two retrospective institutional databases). A total of 1454 pancreatic head resections (944 for malignancy) were reported. Mean annual hospital volume ranged from 14 to 52 (10 to 43 in malignancy). Mortality was between 1.1% and 4.8%, morbidity was between 24% and 46%, and pancreatic leakage was between 9% and 20%. In malignant disease, all centers perform standard lymphadenectomy and regard arterial infiltration as a contraindication for resection. However, the rate of portal vein resection varied from 0% to 28%. No consensus is seen on the type of surgery for malignancy and chronic pancreatitis. After resection for pancreatic cancer less than one fourth of the patients receive adjuvant therapy. The results of our analysis in Germany confirm that pancreatic head resection can be performed with low mortality in specialized units. Variations in indications, operative technique, and perioperative care may demonstrate the lack of evidence-based data and/or personal and institutional experience. The low number of patients receiving adjuvant therapy after resection of pancreatic cancer suggests that more efforts must be made to establish novel adjuvant therapies under randomized study conditions. Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18, 2005 (oral presentation).