再手术治疗腰椎间盘突出症临床分析

目的 探讨腰椎间盘突出症再手术原因及处理对策。方法 对31例腰椎间盘突出症再手术的病例进行回顾分析。结果 再手术原因主要为术前诊断及定位错误，椎间盘切除不彻底，对神经根管狭窄认识不足，脊柱稳定结构破坏 多节段椎间盘突出症遗漏，椎管瘢痕粘连等。结论 腰椎间盘突出症手术前诊断及定位需准确，髓核切除要干净，并松解神经根，必要时扩大神经根管，注意维持脊柱神经稳定结构，多节段椎间盘突出术前应斟酌取舍。     

Patello-femoral complications associated with total knee arthroplasty

The patello-femoral articulation accounts for a significant number of the complications that occur after total knee replacements and which require re-operation. These include problems with stability, component wear, fracture, loosening, and osteonecrosis. With careful attention to prosthetic design and surgical technique, these complications can be minimized. Guest Lecture presented at the 26th meeting of the Japanese Society for Replacement Arthroplasty in Tokyo on February 2, 1996     

Evaluation of 118 Thyroid Cancer Patients Who Underwent a Re-operation after Local Resection

OBJECTIVE To evaluate the incidence of residual thyroid cancer and cervical lymph node metastasis following a previous local resection for thyroid cancer, and to discuss methods of a reoperation.METHODS From 1994～2005, 118 patients with thyroid cancer who had previously been treated with a nodule-resection or subtotal Iobectomy in other hospitals underwent a surgical re-operation.RESULTS The incidence of residual cancer at the primary site was 38.1%. The lymph node metastasis rate at the central area was 39.8%.The rate of lymph node metastasis in patients with enlarged lymph nodes in the ipsilateral internal jugular chain was 37.5%. The rate of laryngeal recurrent nerve injury was 15.2% in other hospitals while that of the second operation in our hospital was 1.6%.CONCLUSION Nodule-resection or subtotal Iobectomy alone is not indicated for patients with thyroid cancer because of the high rate of local residual cancer. It is important to be familiar with the anatomy of the laryngeal recurrent nerve for thyroid surgery. Exploration to the central area is necessary for differentiated thyroid cancer.     

基于信息化的手术分级及非计划再手术管理智能实时监控研究

目的探索通过开发基于信息化的手术分级及非计划再手术管理智能实时监控系统,以提高手术管理的质量和效率。方法通过上海市嘉定区南翔医院开发的“南翔医院手术及非计划再手术智能监控系统1.0”,对,手术及非计划再手术进行实时监控。结果与传统的手术检查模式相比,基于信息化的手术分级及非计划再手术管理智能实时监控更为及时、有效,有助于提高检查效率和质量。结论基于信息化的手术分级及非计划再手术管理智能实时监控已具备现实可能性,可以将事后监控前伸,提高手术监管的效率和质量,对提高医疗质量、确保手术安全也能起到有效的作用。     

胆肠吻合术后吻合口狭窄45例临床分析和再处理

目的探讨胆肠吻合术后胆肠吻合口狭窄的原因,以提高外科治疗水平。方法回顾性分析2000～2006年收集的45例病人行胆肠内引流手术发生胆肠吻合口狭窄再手术的资料,总结临床经验教训。结果45例病人中41例再手术治疗,其中39例行胆管空肠端侧Roux-en-Y吻合,1例行带蒂空肠瓣胆道修补重建术,1例更换U管;3例采取非手术治疗(其中1例为肝移植术后),1例家属放弃治疗(肝门部胆管癌复发),随访0.5～5年,5例(5/41)病人出现胆道感染症状,其中1例(1/41)为右肝残余结石。结论胆肠吻合术后吻合口狭窄主要原因首先为吻合方式不当,其次是病灶未能很好清除、引流不畅,再者应为吻合技术欠佳及使用材料不当。     

Varied patterns of postoperative course of disappearance of hemifacial spasm after microvascular decompression

Summary Background. The precise course of resolution of postoperative residual HFS after a single MVD has not been well categorised quantitatively in the literature. Not all patients with HFS were cured immediately after a single MVD; some of them exhibited a gradual disappearance of the HFS over a period of time. The time course of the gradual resolution of HFS is categorised and the situation of re-exploration in a few patients whose HFS persisted or recurred is determined.Methods. The results of 547 MVDs in 545 Chinese patients were reviewed using the database from the authors personal records between January 1992 and December 2002. Different outcomes were observed and divided into four categories according to the variable convalescent period: type 1, spasm cured immediately; type 2, spasm persisted with milder severity and faded away gradually from 7 days to as long as 2 years; type 3, spasm ceased immediately but recurred after 3 days and ran the same course as in type 2; type 4, failed.Findings. Four hundred and seventy-nine patients followed a type 1 course, which constituted an 87.9% immediate success rate. Forty-one patients (7.5%) followed a type 2 course, including three whose spasm persisted for more than 2 years. Twenty-three patients (4.2%), including one with venous compression, followed a type 3 course with their spasm ceased within three months. All of them had typical vascular loop compression. Another patient with a venous contact failed to respond positively to the first MVD underwent re-operation within 2 months. Re-operation was also performed in one patient four days after the first MVD due to persisting and even more severe spasm. These two patients were categorized type 4 as they failed the first MVD (0.4%). Late recurrence was noted in five patients from 1 to 2 years after the first MVD, only one of whom underwent re-exploration and was then cured again.Conclusions. Approximately 80% of the patients with HFS achieved immediate excellent results after a single MVD, the rest of the patients exhibited residual but usually milder spasms, which resolved gradually over a period of time. According to the patterns of the residual or persisting spasms, the situation and timing of re-exploration can be determined without difficulty. The surgeon should be concerned about missing the responsible vessels in patients with typical HFS who completely failed the first MVD.     

A retrospective analysis of factors influencing re-operation in patients undergoing mechanical valve replacement

Background

We aimed to determine the possible factors leading to re-operation in patients undergoing mechanical valve replacement and to investigate the relationship between valvular thrombus formation and mean platelet volume.

Methods

The medical records of 43 patients with mechanical valve implantation, who were admitted to the Department of Cardiovascular Surgery of Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital between 2000 and 2005 were analysed retrospectively. Data recorded included demographic characteristics, valve type, size and location, implantation position, warfarin use, INR level, additional cardiac intervention, presence of left atrial thrombus, valvular thrombus, pannus formation, perivalvular leak, left atrial aneurysm, platelet count and mean platelet volume (MPV), bleeding after the primary surgery and/or revision of surgery due to other reasons, valve protection, aortic root expansion, presence of valve calcification and infective endocarditis, pre- and postoperative rhythm pattern, brand name of prosthesis, distance of the patient’s house from a cardiac surgery centre, and concomitant non-cardiac systemic diseases.

Results

Mean age was 49.3 years (range 19–78 years). Of the patients, 51% (n = 22) were males and 49% (n = 21) were females. The re-operation mortality was 11.6%. Age, gender, valve type, brand of valve prosthesis, and implantation position were not risk factors for re-operation. The MPV was higher and statistically significant in patients with valvular thrombus during re-operation (p < 0.001). MPV was determined to be an independent risk factor with 85% sensitivity and 87% specificity.

Conclusion

MPV and INR levels should be closely monitored when designing individualised postoperative medical treatment for patients undergoing heart valve re-operation.     

小儿再次心脏手术的配合及护理

随着心脏外科学的发展,小儿心脏再次直视的复杂手术也日益增多。由于患儿体形小,发育不成熟,给再次手术护理带来了一定难度。我院2010年1～12月共完成57例7个月～18岁小儿再次心脏手术,现将护理体会总结如下。1临床资料本组57例,男38例,女19例,年龄7个月～18     

肺切除术后胸腔感染并发延迟性血胸的外科治疗

目的探讨肺外科手术后胸腔感染合并延迟性血胸的外科治疗对策。方法对7例手术后出现胸腔感染及延迟性血胸的患者,均再次手术;按其临床特点和效果进行小结。结果治愈3例,死亡4例,结论肺外科手术后胸腔感染合并血胸是少见的并发症,病情危重,死亡率高,处理困难;外科再手术是有效的治疗手段