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31.
微小切口双重荷包缝合法矫正重度乳头内陷 总被引:7,自引:0,他引:7
目的 介绍一种疗效确切,创伤小,矫正重度乳头内陷的新术式.方法 设计切口位于乳晕第四象限,方向斜向外下方,呈放射状切口,长约1.5 cm,松解乳头基底部,切断牵拉的纤维条索,上提乳头,在距乳头0.8cm和1.5cm处,双重荷包缝合固定.结果 12例乳头内陷患者术后随访1个月至4年,均获得满意疗效.乳头横径、纵径、高度及外观明显改善.结论 该术式矫正乳头内陷具有切口小、创伤轻微、操作简单易行、效果确切、不易复发和并发症少等优点. 相似文献
32.
Stefan Ockert Hardy Schumacher Dittmar Böckler Katrin Malcherek Jochen Hansmann Jens Allenberg 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(6):725-730
Background and aims Since the introduction of endovascular aortic aneurysm repair (EVAR) for aortic aneurysms, the number of juxtarenal aortic
aneurysms (JRA) has been growing steadily due to selection bias (neck morphology for EVAR). This case-match study compares
the perioperative outcome and midterm results of suprarenally clamped JRA with infrarenal aortic aneurysms (AAA).
Methods From 1997 to 2004, patients who received open surgery with suprarenal clamping for JRA were included in the study and compared
to matched patients with infrarenal clamping (AAA). Measurements analyzed were the in-hospital mortality and morbidity. Midterm
results were obtained through clinical investigation and magnetic resonance angiography imaging.
Results Thirty-five patients (mean age, 68.4 years; 30 male and 5 female) received suprarenal cross-clamping for JRA. The overall
in-hospital mortality for JRA and for the controls (AAA) with elective aortic repair was 4.5% (6.1% JRA; 3% AAA, p = 0.058). The morbidity of JRA was elevated according to the rate of pulmonary complications (p = 0.021) and the need for re-operation (p = 0.019). The mean follow-up time was 2.3 years (range, 8–96 months). At follow-up, 28 patients (80%) from the JRA group
and 29 patients from the AAA group (82.9%) were alive.
Conclusion Open aortic surgery for JRA with the need for suprarenal cross-clamping shows a slightly elevated in-hospital mortality rate
without statistical significance and equal midterm mortality results in comparison with infrarenally clamped aortic aneurysms. 相似文献
33.
P. Neary C. Hurson D. O. Briain A. Brabazon D. Mehigan T. V. Keaveny S. Sheehan 《Colorectal disease》2007,9(2):166-172
OBJECTIVE: Colonic infarction is a recognized complication of abdominal aortic aneurysm (AAA) surgery. The clinical difficulty in establishing the diagnosis combined with the patient's poor physiological status is usually associated with a fatal outcome. We assessed our experience with this problem to identify a possible risk factor profile for these patients. METHOD: Patients records were identified from the operative logs, intensive care unit, Hospital Inpatient Enquiry system and vascular unit databases over a 6-year period. RESULTS: A total of 405 patients underwent AAA repair during this period; 140 as emergency ruptures. Nine patients were identified from the databases with known colonic infarction (2.2%). One was a woman. The mean age was 70 years. Seven patients had emergency ruptures (5%). Twenty independent risk factors were analysed using univariate and multivariate logistic regression models. Significant risk factors identified by using a multivariate analysis included the nature of the presenting patient, preoperative hypotension, prolonged cross-clamp time, intra-operative ischaemia and postoperative acidosis. Confirmatory diagnosis was made by colonoscopy in eight patients. One patient survived following the salvage surgery. The mean duration of survival was 10.5 days. The overall mortality was 89% of patients. CONCLUSION: In our unit infrarenal AAA repair has a 2.2% rate of colonic infarction. A definitive diagnosis is best made by colonoscopy. A risk factor profile for the development of colonic infarction may be constructed on the basis of specific clinical parameters. Earlier intervention on the basis of this profile may ultimately reduce the current excessive mortality. 相似文献
34.
目的 总结 17例胸椎骨折患者的特点与诊疗情况 ,为提高此类合并胸外伤患者的疗效提供有效的治疗方案。方法 分析了 17例胸椎骨折患者的临床特点、诊疗经过、近远期随访结果。结果 14例 (82 .4 % )合并肋骨骨折 ,11例 (6 4 .7% )合并血气胸 ,10例 (5 8.8% )合并严重脊髓伤 ,3例 (30 % )远期脊髓伤为有用恢复。结论 胸椎骨折常合并肋骨骨折、血气胸、严重脊髓损伤 ,预后较差 ,为此应重视合并胸外伤的胸椎骨折的围手术期处理 相似文献
35.
Takashi Iwazawa Mitsunobu Imazato Tadashi Ohnishi Yutaka Kimura Hiroshi Yano Takushi Monden 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2004,52(8):386-389
We report adult congenital bronchoesophageal fistula with both symptomatic fistula and asymptomatic one. A 56-year-old woman
with a history of cough after drinking fluids was diagnosed as bronchoesophageal fistula by upper gastrointestinal series
that showed a diverticulum in the middle portion of the esophagus with a fistula between the esophagus and right lower lung.
Esophagoscopy revealed an orifice of the fistula located 27 cm from the incisors. Computed tomography showed chronic inflammatory
change with bronchiectasis in the S6 segment of the right lung. The patient underwent video assisted thoracic surgery that
identified two fistulae without missing a symptomatic one, and both were successfully resected. The fistulae were lined by
squamous epithelium and smooth muscle without evidence of malignancy, infection or chronic inflammation that were histologically
compatible with congenital fistulae. 相似文献
36.
37.
血管内修复术创伤性小,可应用于治疗多种主动脉疾病,如动脉瘤和主动脉夹层。经食管超声心动图(TEE)对主动脉疾病很敏感。术前可通过TEE找到撕裂的内膜片、发现内膜破口、区分类型、区分真假腔及了解心脏状况。术中TEE用于引导导管插至正确位置、观察支架放置过程、监测心功能和室壁运动状况、评价手术疗效。术后随诊通过TEE观察支架内血流情况、检出并发症如内漏等。 相似文献
38.
目的研究两种不同脊柱后路减压方法治疗胸腰段骨折脱位合并脊髓损伤的手术治疗效果。方法回顾分析本院1996年3月~2002年6月收治的胸腰段骨折脱位并脊髓损伤患者76例,按不同减压方法将其分为两组:切除一侧或两侧椎板、椎弓根或部分关节突行侧前方环状减压AF内固定者40例,为直接减压组;体位复位结合AF器械矫正复位36例,为间接减压组。统计学分析,两组资料具有可比性。对术后神经功能恢复情况,按ASIA神经功能评定标准进行评定。中晚期并发症,根据是否有腰背痛,下肢根性痛、麻木无力,两便功能障碍进行评定。生活能力按FIM评定。结果两组病例获6个月~5年随访,结果表明,术前脊髓完全性损伤,术后均无恢复;术前脊髓不完全性损伤,术后两组间比较差异无显著性。中晚期并发症发生,直接减压组高于间接减压组;术后生活自理能力,间接减压组好于直接减压组。结论间接减压手术方法治疗胸腰段骨折脱位合并脊髓损伤不失为一种早期治疗的首选方法。 相似文献
39.
Yoshimasa Sakamoto Kazuhiro Hashimoto Hiroshi Okuyama Shinichi Ishii Takahiro Inoue Katsushi Kinouchi Takayuki Abe 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2005,53(9):465-469
Objective The objective of the present study was to compare long-term results of single aortic valve replacement (AVR) with mechanical
(St. Jude Medical valves: standard) and biologic (the Carpentier-Edwards pericardial) prostheses. Method: Between 1995 and 2002, 95 patients who underwent single AVR with mechanical (n=46) or biologic (n=49) prostheses were enrolled
in this study. The mean age at the operation was 54.0±9.6 years (range: 20 to 69 years) with the mechanical and 68.8±7.1 years
(range: 44 to 85 years) with the biologic prosthesis. Results: The 9-year actuarial survival rate, which was calculated by taking perioperative mortality into account, was 90.3±4.6% for
patients with mechanical valves and 87.6 ±4.8% for patients with bioprostheses, with no difference between the two groups
(p=0.342). The 9-year freedom rate from thromboembolism, reoperation, endocarditis was 94.8+3.6%, 100% and 97.8 ±2.2% for
patients with mechanical valves and 98.0 ±2.0%, 97.5 ±3.4% and 95.0 ±3.4% for those with bioprostheses, respectively. After
9 years, freedom from cardiac death averaged 97.8% in the group with mechanical valves compared with 95.3% in those with bioprostheses
(p=0.541). Conclusion: We conclude that the mid-term durability of the Carpentier-Edwards pericardial valve in the aortic position for the elderly
is excellent. Nevertheless, the risk of tissue valve reoperation progressively increases with time, and a longer follow-up
may be necessary to provide its value compared with the mechanical valves in a country like Japan with a high life expectancy.
(Jpn J Thorac Cardiovasc Surg 2005; 53:465-469) 相似文献
40.
老年腹主动脉瘤非手术治疗的长期超声随访研究 总被引:5,自引:0,他引:5
目的超声随访观察经非手术治疗的老年腹主动脉瘤的发展变化规律。方法超声随访诊断明确、病历及影像学资料完整的老年腹主动脉瘤非手术治疗患者37例,按首次发现时瘤体大小分3组,定期测量并记录各组腹主动脉扩张最明显处横切面直径,计算年增长量。结果37例腹主动脉瘤首次发现时瘤径大小平均为4.68cm,随访年限0.5~11年,平均6.1年,瘤径平均每年增长0.47cm。14例瘤径小于4.0cm,平均年增长0.23cm,15例瘤径小于6.0cm,平均年增长0.37cm,8例瘤径大于6.0cm,平均年增长0.67cm。随访期间死亡5例,其中因动脉瘤破裂死亡2例,破裂前瘤径大小分别为8.35cm、8.91cm。7例随访期间因瘤径短期内明显增大而行腹主动脉瘤腔内支架隔绝术。结论老年腹主动脉瘤瘤径小于6.0cm者随增龄增长缓慢,大于6.0cm者随增龄增长快,应进行积极的外科干预。 相似文献