National survey on the management of primary hyperparathyroidism by Swiss endocrinologists

Background From the endocrine surgeon’s perspective, it is important to know how endocrinologists manage patients with primary hyperparathyroidism (pHPT). The aim of this survey was to evaluate the preoperative diagnostic workup and referral pattern for parathyroidectomy by Swiss endocrinologists. Materials and methods The survey was conducted by mailing a questionnaire to all members of the Swiss Society for Endocrinology and Diabetes in spring 2005. Results The questionnaire was sent back by 68 of 124 endocrinologists (55%). The median annual case volume of patients with pHPT was 6 (range 1–50). The mean fraction of these patients referred for surgery was 59 ± 24%. This fraction was significantly higher in the German-speaking part of Switzerland than in the French-speaking part (67 ± 21% vs 51 ± 27%). When considering surgery for asymptomatic pHPT, 62% of the endocrinologists rely routinely on the recommendations of the NIH consensus conference and 86% on the subsequent guidelines of the workshop in 2002. Sixty-seven percent of the endocrinologists routinely perform localization studies before possible referral for surgical exploration. Typically, they consisted of an ultrasonography of the neck (93%) and a ^99mTc-MIBI scintigraphy (80%). The impact of the availability of a minimally invasive surgical procedure on the number of patients referred for surgery seems to be considerable. Sixty-one percent of the participants would expand the indication for surgery if the operation could be done by a limited surgical approach. Conclusions In a relevant fraction of patients with pHPT, endocrinologists still do not regard curative therapy as mandatory. Surprisingly, there are significant cultural differences concerning referral patterns to surgery between the German-speaking and the French-speaking parts of Switzerland. Minimally invasive procedures seem to lower the threshold for referral for surgical therapy. This work was presented at the 2nd Biennial Congress of the ESES, May 2006, Krakow, Poland.     

单臂外固定支架联合腓肠肌内侧头肌皮瓣治疗胫腓骨骨折合并大面积皮肤撕脱伤

目的探讨单臂外固定支架联合腓肠肌内侧头肌皮瓣治疗胫腓骨骨折合并胫前大面积皮肤撕脱伤的疗效。方法18例患者先进行急诊清创,采用单臂AO外固定支架固定骨折、腓肠肌内侧头肌皮瓣局部旋转覆盖外露胫骨。撕脱的皮肤修成全厚皮片回植供皮区,其中5例仍有缺损,另取同侧大腿全厚皮片移植。结果均无感染,15例旋转皮瓣完全成活,2例皮瓣远端表皮坏死,经换药治愈,1例皮瓣远端全层坏死,经植皮治愈。撕脱皮片回植13例成活,5例小部分坏死,其中3例经换药治愈,2例经中厚皮片植皮愈合。5例大腿皮片完全成活。平均随访19.5(10~36)个月,骨折平均愈合时间4(3.5~6)个月。所有患者行走正常,3例膝关节屈伸活动受限,4例踝关节屈伸受限。结论采用单臂外固定支架联合腓肠肌内侧头肌皮瓣治疗胫腓骨骨折合并胫前大面积皮肤撕脱伤,疗效肯定。     

胸腔镜下胸交感神经干切断术治疗手汗症(附300例报告)

目的总结胸腔镜胸交感神经干切断术300例的临床经验。方法分析2003年1月至2006年1月经胸腔镜胸交感神经干T_2～T_4切断术治疗手汗症的临床资料。以患侧手掌皮肤温度较术前升高1℃～3℃或更高,转干燥者为有效。手掌皮肤温度较术前增加小于1℃仍为潮湿者为无效。结果300例手术均获成功,术后患者手掌多汗症状消失,双手转为干燥温暖状,术后掌温升高(2.8±0.8)℃;282例术后随访1～36个月无一例复发,术后转移代偿性多汗60例占21.2%。结论胸交感神经干切断术是治疗手汗症安全、微创和有效的方法。     

Ross术后中远期主动脉瓣反流的危险因素分析

Objective To analyze the risk factors of the postoperative mid- and long-term aortic valvular regurgitation after ROSS procedure(pulmanary valve homograft transplantation). Methods Between March 1998 and July 2007,47 patients[25male, 22 female, mean age (13.31±5.79) years, ronge 1-34 years] with aortic valvular disease underwent the Ross procedure at our insti tution. There were 6 patients suffering fron rheumatic heart disease and 41 patients suffering from congenital heart disease. The aver age aortic blood flow velocity was (4.67±3.47) m/s, the average pressure gradient across aortic valve (88.26±58.06)mm Hg, LVEDD (45.53 ±10.78) mm, EF 0.69±0.08. All the patients were followed up in out-patient departement by ultrasonic cardio gram. Multiple logistic regression analysis was performed to find out the risk factors of the postive aortic valvular regurgitation. Results There was no poetoperative death in hospital. The mean follow-up periods was (36.15±22.1) months, rasnge from 12 to 110 months and none long-dated death. Compared with the data recorded in hospital, the diamenters of the aortic sinus and aortic annu lus enlarged significantly, respectively from (26.16±5.10) mm to (32.37±6.84) tam and from (19.41 ～3.98) mm to (23.45± 5.86) mm. The average flow velocity d the homograft (new aortic valve) was(1.39±0.48) m/s, graclient pressure (8.17+6.16) mm Hg. Mild aortic regurgitstion was present in 5 patients (10.6%), moderate aortic tegmgitafion in 2 pmieats (4.3%) and aevere aortic regurgitation in 1 petient (2.1%). The rate of free from regurgitation was 82.9%. Multiple logistic analyses identified the per esence of bicuspid aortic valve, enlargement of aortic annulus and age above 14 years as the risk factors for posterative aortic regurg itation. Conclusion The Ross procedure is a safe and effective procedure with good clinical results in mid-and long-term follow-up. However, the presence of bicuspid aortic valve, enlargement of aortic annulus and age above 14 years preoperatively were identified as the risk factors for postoperative aortic regurgitation.     

急性梗阻性结直肠癌的外科处理

目的探讨急性梗阻性结直肠癌的外科处理方法。方法回顾分析1996—2004年收治的58例结直肠癌并发急性肠梗阻患者的治疗方法。全组58例，一期切除吻合26例，一期切除＋近端结肠造瘘21例，单纯结肠造瘘5例，捷径手术6例。结果住院期间死亡6例，吻合口漏1例，51例恢复顺利，康复出院。结论重视围手术期的处理，根据急性梗阻性结直肠癌患者的全身情况和局部条件合理选择手术方式。     

二尖瓣成形术临床应用542例及随访

目的回顾性总结542例二尖瓣成形术病人的手术疗效和20年随访结果。方法1985年至2006年，542例二尖瓣病变的病人接受二尖瓣成形术，男306例，女236例。474例随访1-240个月，平均（41．03±40．40）个月，随访率90．8％。结果手术死亡20例（3．7％），出院时病人心功能均为Ⅰ级或Ⅱ级。随访死亡20例，再次手术23例；7年、10年和15年生存率分别为91％、88％和70％；7年和10年二次手术免除率分别为94％和86％。结论二尖瓣成形治疗二尖瓣病变，死亡率低，远期效果好。     

改良Norwood手术临床应用

目的总结改良Norwood手术的临床应用经验。方法2004年7月和2005年3月分别为1例7月龄单心室伴左心室流出道梗阻女婴,采用主肺动脉和主动脉弓下缘直接吻合、主动脉肺动脉人工血管分流完成改良Norwood手术;1例出生13 d左心发育不良综合征新生儿,采用主肺动脉和主动脉弓下缘直接吻合、右心室肺动脉人工血管分流完成改良Norwood手术。结果例1术后平稳,动脉压为85～100/25～40mmHg（1 mm Hg=0．133kPa）,动脉血氧饱和度为0．75～0．85,术后第3d撤离辅助呼吸,第11 d出院。例2术后平稳,动脉压为65～80／40～60mmHg,动脉血氧饱和度为0．67～0．89,术后第12 d撤离辅助呼吸,第28 d出院。结论改良Norwood手术的先进方法和技术,值得在我国推广应用。     

腹腔镜治疗妇科急症593例临床分析

目的:探讨腹腔镜治疗妇科急症的可行性、安全性及治疗效果。方法:回顾分析2003年7月至2007年10月我院用腹腔镜治疗593例妇科急症患者的临床资料。结果:593例患者均用腹腔镜完成手术,其中异位妊娠512例,手术时间18～75min,平均32min,术中出血10～70ml,平均25ml;盆腔炎、盆腔脓肿47例,手术时间35～90min,平均49min,术中出血45～130ml,平均84ml;黄体破裂、卵巢内膜囊肿破裂、卵巢囊肿蒂扭转34例,手术时间35～80min,平均52min,术中出血20～85ml,平均65ml;术后住院3～7d,平均4.5d,随访12～36个月无复发。结论:腹腔镜手术治疗妇科急症安全可行,且具有良好的效果。     

腓骨长肌转位修复陈旧性跟腱断裂

陈旧性跟腱断裂手术修复较困难，术后效果与新鲜断裂相比较差，且重建的跟腱由于瘢痕增生而粗大，踝关节活动受限。作者于2000年8月-2003年11月利用腓骨长肌转位重建跟腱术19例，取得满意效果。