乳腺结核19例误诊分析

乳腺结核为一种乳腺慢性特异性感染。其临床表现常为乳腺肿块或慢性瘘管形成,易误诊为乳癌、乳腺脓肿或乳腺良性肿瘤等。本院自1989-2000年共收治此病19例,误诊16例,误诊率为84.2％,现就该病误诊原因加以分析报告如下。     

不同气腹压对腹腔镜手术患儿围手术期血气的影响

目的：探讨不同气腹压对腹腔镜手术患儿围手术期血气的影响,为患儿选择适宜的气腹压提供参考,以利于手术顺利进行。方法：收集腹腔镜手术患儿148例,根据年龄分为≤3岁组、4-6岁组、7-12岁组,并对每个年龄组随机分为3个亚组,每个亚组给予不同的气腹压。观察每个亚组间及相同气腹压情况下不同年龄患儿血气变化情况。结果：气腹时各年龄组不同气腹压亚组PetCO2、PaCO2、HR、MAP较气腹前明显升高（P〈0.05）,但在相同年龄组内较高气腹压亚组升高更明显（P〈0.05）,放气后15 min明显下降（P〈0.05）。在相同气腹压条件下,较小年龄的患儿在气腹时PetCO2、PaCO2、HR、MAP变化较明显。结论：在行小儿腹腔镜手术时,应根据年龄选择适宜气腹压,其中≤3岁患儿适宜气腹压为8 mmHg,4-6岁为10 mmHg,7-12岁为12 mmHg;如此既可满足手术视野需要,又可减少气腹对血气的影响并降低相关并发症的发生风险,确保手术顺利完成。     

脐部两孔法腹腔镜手术在儿童小肠出血中的诊断价值及治疗效果

目的探讨脐部两孔法腹腔镜手术在儿童小肠出血中的诊断价值及治疗效果。方法选取2008年1月~2012年6月邹城市人民医院小儿外科收治的小肠出血性疾病患儿33例,所有患儿均行放射性核素扫描(ECT)检查,并结合腹腔镜探查,比较ECT检查与腹腔镜检查的结果。结果21例经ECT检查为阳性的患者,腹腔镜检查均为阳性;12例经ECT检查阴性患儿,经腹腔镜检查,10例为阳性,2例为阴性;31例患儿经手术治疗后均痊愈出院,随访1年未出现明显并发症。ECT及腹腔镜检查均为阴性的患儿2例,术后对症治疗,出血停止后出院。结论怀疑儿童小肠出血时,在排除胃、结肠病变所致的出血情况下,应优先考虑ECT检查确诊,再结合脐部两孔法腹腔镜探查术,可有效地提高诊断准确率,减少开腹探查的盲目性及创伤性,具有较大的临床价值。     

外伤性十二指肠破裂误漏诊5例报告

外伤性十二指肠损伤发病率低,约占3％-5％,其症状隐匿,术前确诊困难,术中漏诊率较高,术后易致十二指肠痿。我院自1982-2000年共收治十二指肠破裂79例。误漏诊5例,3例死亡,报告如下。     

Clinical observation of Zhen’ai needling method in <Emphasis Type="Italic">Nei Jing</Emphasis> (<Emphasis Type="Italic">Classic of Internal Medicine</Emphasis>) on improving quality of life in patients with allergic rhinitis

Objective

To observe the effect of Zhen’ai needling method in Nei Jing (Classic of Internal Medicine) on quality of life in patients with allergic rhinitis (AR).

Methods

A total of 99 patients with AR who met the inclusion criteria were randomized into a conventional needling group (51 cases) and a Zhen’ai needling group (48 cases). The conventional needling group was treated with acupuncture at Zusanli (ST 36), Hegu (LI 4), Juliao (ST 3), Yingxiang (LI 20), Yintang (GV 29), Shangxing (GV 23) and Baihui (GV 20). The Zhen’ai needling group added acupoints of Zhen’ai needling method {Lieque (LU 7), Shanglianquan [Extra, located at 1 cun above Lianquan (CV 23)] and Tianrong (SI 17)} in addition to points in the conventional needling group. The needles were retained for 30 min. The treatment was performed twice a week. All patients were assessed by total nasal symptom score (TNSS), total ocular symptom score (TOSS) and sino-nasal outcome test-20 (SNOT-20) before and after 15 treatments to evaluate the quality of life. The clinical efficacy was evaluated after 15 treatments.

Results

During the treatment, 8 cases dropped out in the conventional needling group and 7 cases in the Zhen’ai needling group. There were no significant differences in TNSS, TOSS and SNOT-20 scores between the two groups before treatment (all P>0.05). After treatment, the total effective rate of the Zhen’ai needling group was 92.7%, versus 88.4% in the conventional needling group. There was no significant difference between the two groups (P>0.05). After treatment, there were no significant differences between the two groups in TNSS and TOSS scores (both P>0.05). The SNOT-20 score of the Zhen’ai needling group was lower than that of the conventional needling group, and the difference was statistically significant (P<0.05). There were statistical differences between the two groups in the scores of cough and nasal reflux (to the throat) of the NOT-20 scale (both P<0.05).

Conclusion

Both Zhen’ai needling method and conventional acupuncture are effective in the treatment of AR. Zhen’ai needling method has a better effect than conventional acupuncture in improving cough and nasal reflux (to the throat) in AR patients.