咽旁间隙神经鞘瘤诊断及手术入路选择

目的探讨咽旁间隙神经鞘瘤的诊断与手术入路方式的选择。方法对咽旁间隙神经鞘瘤患者14例病历资料进行回顾性分析,术前根据CT和MRI判断肿瘤与扁桃体包膜距离关系及肿瘤主体位置考虑手术径路,与扁桃体包膜距离≤1cm、肿瘤主体突入到口内者行经口内径路,与扁桃体包膜距离1cm、瘤体主体突向外侧者经颈外径路,手术径路与肿瘤大小关系不大。经口内径路4例,颈外径路10例。结果所有患者均获得顺利手术,术后随访6个月～6年均未见复发。结论颈部CT、MRI及DSA是诊断及鉴别诊断的良好手段,手术径路取决于肿瘤与扁桃体包膜的距离及肿瘤主体位置,无论采取何种径路,均无严重的并发症。     

腹腔镜下十二指肠吻合术治疗新生儿十二指肠梗阻

Objective To evaluate the feasibility and indication of laparoscopie duodenoduoden-ostorny for neonates with congenital duodenal obstruction- Methods From May 2004 to Feburary 2008,6 newborns with duodenal obstruction underwent exploratory laparoscopy. With a lower-pressure pneumoperitoneum of 5～8 mmHg and a suspending suture for right liver elevator, the procedure was performed using 3 cannulas of 3.3 mm to 5.5 mm diameter. Under the laparoscopic vision, the cause of duodenal obstruction was diagnosed and a sutured anastomosis was performed after the duodenum mo-bilized. Results Findings at laparoscopy included duodenal diaphragm in 3 cases,annular pancreas in 2 cases, and preduodenal portal vein in 1 case. Three cases with duodenal diaphragmatic stenosis were en-countered a partial excision of the diaphragm after vertical incision of the anterior part of duodenum followed laparoscopically by a transverse suture. A diamond-shaped side-to-side duodenoduodenal anas-tomosis was successfully carried out in 2 cases of annular pancreas through a laparoseopic approach, but a duodenojejunostomy was converted to mini-laparotomy during the laparoscopic course of a predu-odenal portal vein. The average operative time was 102 16.5 min (85～135 min). Visualization was ex-cellent, and there were no intraoperative complications. Feedings were started on postoperative day 3 to 5. All cases were on full feedings after 8 to 10 days. Follow-up upper gastrointestinal tests showed no evidence of stricture or obstruction. Conclusions The duodenoduodenostomy with laparoseopy can be performed in neonates securely and appropriated for a full-term newborn with tolerance CO2 pneumo-peritoneum. It provides an excellent and micro-invasive way to evaluate and treat congenital duodenal obstruction.     

青岛地区1306例甲状腺癌的临床病理特征分析

背景与目的：甲状腺癌(thyroid cancer,TC)发病率在全球范围不断攀升,但存在地区差异。该研究旨在探讨青岛这一典型东部沿海城市的TC发病情况和临床病理特点,以及该地区近年来甲状腺手术疾病谱的变化。方法：回顾性分析青岛大学附属医院2014年行甲状腺切除术的2251例甲状腺结节患者,对其中1306例TC患者的临床病理特征进一步统计分析,并与该院前期数据及美国Surveillance Epidemiology End Results(-SEER)数据库比较。结果：随着该院甲状腺手术例数的逐年上升,其中TC的比例亦由2010年的34.8%上升至2014年的59.0%。TC高发于20～54岁年龄段,较SEER数据库前移(U=2289,P=0.000),男女比例为1∶2.80,其中超重和肥胖者占50.2%。78.2%的TC患者初诊时无明显临床症状或体征,16.6%已有可看到或摸到的甲状腺结节,仅有5.2%因声音嘶哑或其他压迫症状就诊。2014年微小癌占该院TC的61.7%,较2010年(37.7%)明显增多。该院TC伴有颈部淋巴结转移者比例明显高于SEER数据库(49.5%vs 26%,χ2=11.806,P=0.001),且微小癌伴有颈部淋巴结转移率亦高达31.3％。TC各病理类型所占比例分别为：乳头状癌97.5%、滤泡癌1.1%、髓样癌1.0%、未分化癌0.5%,乳头状癌比例略高于SEER数据库(U=4654.5,P=0.055)。结论：青岛地区甲状腺手术逐年增多,TC术前诊断准确率逐年提高。该地区TC发病呈相对年轻化、超重化及高淋巴结转移趋势。微小癌比率增高提示该地区筛查及体检等预防意识的普及,微小癌中较高的淋巴结转移率提示该地区微小癌的侵袭性不容忽视。     

The ‘beating-heart butterfly technique’ for repair of basal post-infarction ventricle septum defect

Ischaemic ventricular septal defect is a serious complication of acute myocardial infarction with poor outcome. We present the ‘beating-heart butterfly’ technique to close the ventricular septal defect with a double-layered pericardial patch sewn to the intact septum under beating-heart cardiopulmonary bypass in 4 highest-risk patients. This technique combined with a liberal postoperative mechanical circulatory support and open-chest treatment allowed excellent results with 12 months of survival in all patients.     

肠系膜上静脉血栓形成临床特点及预后相关因素分析

目的 探讨肠系膜上静脉血栓形成（SWVT）临床特征、诊治方法,研究预后相关因素。方法 回顾性分析华北理工大学附属医院2005~2015年40例肠系膜上静脉血栓形成患者临床资料。结果 主要症状有腹痛、腹胀、发热及呕吐等。40例患者中,29例行单纯抗凝治疗,11例行手术治疗,6例患者30天内死亡。与30天生存率相关的因素为肠切除和确诊前持续时间。结论 该疾病症状不典型,增强CT对诊断具有重要意义,抗凝为基础,保守治疗无效时手术治疗为主要治疗手段,肠切除和确诊前持续时间是影响SMVT 30天生存率相关因素。     

双入路小切口坏死组织清除术联合持续灌注引流治疗感染性坏死性胰腺炎的临床疗效

目的:探讨双入路小切口坏死组织清除术联合持续灌注引流治疗感染性坏死性胰腺炎（INP）的临床疗效。方法:采用回顾性描述性研究方法。收集2016年4月至2019年7月陆军军医大学大坪医院收治的20例INP病人的临床资料;男11例,女9例;年龄为（42 ±9）岁。20例病人均行双入路小切口坏死组织清除术,联合术后...     

颈部坏死性筋膜炎6例

目的：提高临床医师对颈部坏死性筋膜炎的认识。方法：回顾分析6例颈部坏死 性筋膜炎患者的临床资料及治疗结果。结果：6例患者经手术及药物治疗,5例治愈,1例因并发脓毒血症导致多器官功能衰竭死亡。结论：颈部坏死性筋膜炎 是一种进展迅速、病情凶险的感染性疾病,治疗上以尽早彻底清创、应用广谱抗菌素及支持治疗为主,增加对该病的认识有利于早期诊断,并有利于提高颈部坏死性筋膜炎的疗效。     

第一鳃裂囊肿及瘘管的诊断治疗

目的 探讨先天性第一鳃裂囊肿及瘘管的诊断和治疗方法。方法 回顾性分析18例患者的病例资料,全部病例行手术切除。结果 18例患者中,第一鳃裂瘘 10例,外瘘口均位于耳垂后与乳突之间,内瘘口位于外耳道,其中位于骨与软骨交界处后下壁6例;囊肿8例,其中耳垂后4例,位于下颌角2例,腮腺筋膜内2例。术后病理均确诊为鳃裂囊肿或瘘管,随访未见复发。结论 先天性第一鳃裂囊肿及瘘管临床少见,易误诊、误治;影像学检查是术前确诊的重要依据;合理的手术方案是该病治愈的关键,完整切除囊肿及瘘管是避免复发的重要措施。     

常温下半肝血流阻断在肝内胆管结石术中的应用分析

目的：探讨左肝内胆管结石的治疗方法,提高手术切除率,降低手术风险系数。方法：回顾性总结63例左肝内胆管结石患者在常温下阻断左半肝血流,行左肝叶切除、肝内含石胆管直视下切开取石和肝胆管Roux-en-Y胆肠吻合等手术后,患者术后并发症、肝内胆管结石的复发率、再手术率以及术后患者的肝功能恢复情况等。结果：本组无手术死亡,治愈率82.4%,好转率17.6%,残石率8.3%。并发症23例,胆漏2例,膈下感染4例,切口感染9例,术后转氨酶升高6例,消化道出血2例,全部并发症经非手术治疗全愈。经1～8年随访,复查B超、CT、肝功等检查,随访率87.7%;复发6例,复发率9.52%。结论：该方法可以控制肝切除术中的失血,保留了健侧肝脏的血运,术中及术后对肝功能损伤较轻。是一种比较简单、可行、合理的肝血流阻断方法。     

Treatment of Intervertebral Disc Degeneration

Intervertebral disc degeneration (IDD) causes a variety of signs and symptoms, such as low back pain (LBP), intervertebral disc herniation, and spinal stenosis, which contribute to high social and economic costs. IDD results from many factors, including genetic factors, aging, mechanical injury, malnutrition, and so on. The pathological changes of IDD are mainly composed of the senescence and apoptosis of nucleus pulposus cells (NPCs), the progressive degeneration of extracellular matrix (ECM), the fibrosis of annulus fibrosus (AF), and the inflammatory response. At present, IDD can be treated by conservative treatment and surgical treatment based on patients'' symptoms. However, all of these can only release the pain but cannot reverse IDD and reconstruct the mechanical function of the spine. The latest research is moving towards the field of biotherapy. Mesenchymal stem cells (MSCs) are regard as the potential therapy of IDD because of their ability to self‐renew and differentiate into a variety of tissues. Moreover, the non‐coding RNAs (ncRNAs) are found to regulate many vital processes in IDD. There have been many successes in the in vitro and animal studies of using biotherapy to treat IDD, but how to transform the experimental data to real therapy which can apply to humans is still a challenge. This article mainly reviews the treatment strategies and research progress of IDD and indicates that there are many problems that need to be solved if the new biotherapy is to be applied to clinical treatment of IDD. This will provide reference and guidance for clinical treatment and research direction of IDD.