西藏地区内镜下垂体瘤切除术后并发症分析

目的 探讨西藏地区神经内镜经鼻-蝶窦入路垂体瘤切除术术后并发症原因、治疗方法及预防。方法 统计分析2021年8月—2022年8月在西藏自治区人民医院经神经内镜经鼻-蝶窦入路垂体瘤切除术的15例患者的临床资料,回顾性分析垂体瘤术后并发症及恢复情况等。结果 术后发生脑脊液鼻漏10例,后期治愈8例,2例经再次行内镜下封堵后治愈;患者术后暂时性尿崩症8例,予以去氨加压素片治疗,同时给予维持电解质平衡,治疗后症状缓解。术后甲状腺功能减退3例,予以左旋甲状腺素片替代治疗3～9个月,复查激素恢复正常。结论 神经内镜经鼻-蝶窦入路垂体瘤切除术具有视野清晰,对于减少手术创伤、术后快速恢复、了解术后并发症的病因、充分的术前评估、掌握并发症的机理、术中仔细操作和术后监测,对于减少术后并发症的发生,提高治疗效果。     

治疗儿童腺样体肥大不同术式的疗效比较

通过临床资料观察比较了治疗儿童腺样体肥大有不同手术方法,认为用70°鼻内镜经口配合动力系统切除腺样体的手术是治疗儿童腺样体肥大的很好的术式,值得推广。     

微创时代 镜中乾坤——访同济大学附属东方医院外科学教授朱江帆

专家简介:朱江帆,同济大学附属东方医院外科学教授、主任医师、博士生导师。他长期从事肝胆外科的临床与实验研究,和微创外科技术的临床与研究。在国内首先开展了内镜辅助甲状腺切除、手助的腹腔镜脾切除与断流术、腹腔镜手术治疗重症胰腺炎等开创性手术。尤其是近年与国外同行同步、在国内最先开展了经脐入路内镜手术的研究。在世界上首先提出了TUES作为这一技术的术语。近年专注于肥胖症与代谢病的外科治疗。     

内镜黏膜下剥离术治疗大肠侧向发育型肿瘤的临床应用

目的:探讨内镜黏膜下剥离术(ESD)治疗大肠侧向发育型肿瘤(直径≥20 mm)的临床价值。方法:选取2013年1月至2018年1月诊断为大肠侧向发育型肿瘤(直径≥20 mm)30例患者为研究对象,行ESD治疗,记录并分析ESD操作时间、病灶大小、出血及穿孔例数、病理类型、镜下分型、随访结果等指标。结果:内镜下大肠侧向发育型肿瘤形态分型主要以颗粒均一型、结节混合型为主,腺管开口主要以Ⅲ型和IV型两种类型为主。30例大肠侧向发育型肿瘤均经ESD一次性完整切除,病灶直径大小20 mm～35 mm,平均(26.57±4.55)mm;ESD操作时间30 min～180 min,平均(81.57±31.63)min;术中穿孔1例,穿孔例3.3%,经金属钛夹夹闭保守治疗后可恢复,无需外科手术;术中出血2例,经氩离子凝固术(APC)处理后均能止血;30例均无术后迟发性出血。28例患者经3～6月随访,复查肠镜创面恢复良好,均无复发,2例患者失访。结论;对于直径≥20mm的大肠侧向发育型肿瘤,内镜黏膜下剥离术(ESD)治疗是安全有效的,可以一次性完整切除病灶,出血及穿孔发生率、病灶复发率低,值得临床推广应用。     

胆囊三角“优先后入路”解剖在基层医院腹腔镜胆囊切除中的应用

目的分析胆囊三角"优先后入路"解剖在基层医院腹腔镜胆囊切除中的应用及效果。方法选取洛扎县人民医院2018年3月至2020年3月普外科收治的120例结石性胆囊炎患者,根据随机数字表法将入选对象分为两组,分别为观察组(n=60,采用胆囊三角优先后入路腹腔镜胆囊切除术治疗方式)与对照组(n=60,采用胆囊三角入路腹腔镜胆囊切除术治疗方式)。比较两组手术时间、中转开腹情况、肠功能恢复时间、胆道损伤情况、术中出血量、住院时间。结果 120例患者中,女性84例(70%),男性36例(30%)。平均年龄46.5岁。对照组平均手术时间为128±17min,观察组平均手术时间为114±10min。在对照组中,10%的人转换为开放,而观察组为1.5%.术中出血量,对照组23.29±3.87ml,观察组18.95±4.35。对照组胆道损伤发生率为3.3%,观察组为0。对照组患者的平均住院时间为3.7±5.3天,观察组为2.1±0.3天。结论在基层医院腹腔镜胆囊切除中应用胆囊三角"优先后入路"解剖治疗结石性胆囊,有利于缩短手术时长,减少术中出血量,降低术后并发症风险,加速患者的康复进程。     

上消化道黏膜下肿瘤的内镜诊断与治疗进展

上消化道黏膜下肿瘤(submucusal tumors,SMTs)泛指一类来源于黏膜以下组织的消化道肿瘤,SMTs发病率逐年有所上升,随着消化内镜及超声内镜的广泛运用,上消化道黏膜下肿瘤的发现及诊断水平有了明显的提高。相对传统的手术治疗,SMTs的内镜下微创治疗更有优势,不仅可以高效、安全完整切除病灶,且可以提供完整的病理资料,有利于精确诊断SMTs。     

内镜黏膜下剥离术治疗广基结直肠息肉的临床研究

目的:分析、总结内镜粘膜下剥离术应用到治疗广基结直肠息肉的临床价值。方法:选择自2016年1月—2016年12月在我院进行治疗的患有广基结直肠息肉的患者36例为本次研究对象,分析、总结患者应用内镜粘膜下剥离术(ESD)治疗广基结直肠息肉的的效果及安全性。结果:所有患者均完整剥离病灶,手术平均时间为(55±4)min。术中所有患者的手术创面均有少量出血,应用金属夹夹闭的方法止血;有2例患者出现延迟性出血,行氩气刀电凝止血;穿孔1例,行腹腔镜下穿孔修补术后恢复良好。术后病理显示,管状腺瘤6例、绒毛状腺瘤10例、管状绒毛状腺瘤8例、增生性息肉6例、类癌6例。结论:ESD具有创伤小、费用低、术后恢复快、住院时间短的优点,值得临床推广应用。     

内镜黏膜下剥离术治疗广基结直肠息肉的临床研究

目的:分析、总结内镜粘膜下剥离术应用到治疗广基结直肠息肉的临床价值。方法:选择自2016年1月—2016年12月在我院进行治疗的患有广基结直肠息肉的患者36例为本次研究对象,分析、总结患者应用内镜粘膜下剥离术(ESD)治疗广基结直肠息肉的的效果及安全性。结果:所有患者均完整剥离病灶,手术平均时间为(55±4)min。术中所有患者的手术创面均有少量出血,应用金属夹夹闭的方法止血;有2例患者出现延迟性出血,行氩气刀电凝止血;穿孔1例,行腹腔镜下穿孔修补术后恢复良好。术后病理显示,管状腺瘤6例、绒毛状腺瘤10例、管状绒毛状腺瘤8例、增生性息肉6例、类癌6例。结论:ESD具有创伤小、费用低、术后恢复快、住院时间短的优点,值得临床推广应用。     

浅谈闭孔神经切断方法

目的：探讨不同方法下闭孔神经切断的优缺点；方法：总结我院对20例股骨头坏死及脑瘫后遗症病人行闭孔神经切断的不同入路方法；结果：20例中，行盆腔外闭孔神经切断18例，盆腔内切断2例，单侧切断16例，双侧2例，女性14例，男性6例，均达到手术目的；结论：经盆腔外入路，易暴露，解剖清楚，手术时间短，术中创伤小。应为临床所选择。     

采用EMR技术对消化道息肉诊疗的效果临床研究

目的:研究内镜下黏膜切除术(EMR)能够对消化道息肉起到较好的诊疗效果,并对临床效果进行分析。方法:对某医院2010年5月到2012年6月所发生的消化内镜而检查出的病变患者,进行研究,其中一共80例,对92枚病变进行了EMR治疗,病变的直径不同,分别有51枚4~10 mm、24枚11~20mm、17枚21~30 mm。结果:在所选用的80例患者中,一共检查出41枚息肉,有40枚可以通过第一次进行治疗或是通过再次接受EMR治疗而对病灶进行切除,治愈率比较高,能够达到97.6%,不会对患者造成很大的影响,这些患者都没有出现过穿孔或是感染等十分严重的并发症。结论:采用EMR技术对消化道息肉诊疗确实能够起到实效作用,具有较强的临床研究和应用价值。     

多节段腰椎间盘突出责任节段的定位及椎间孔镜下治疗的疗效观察

目的:探讨多节段腰椎间盘突出的责任节段的定位方法及椎间孔镜下治疗的疗效观察。方法:从2014年1月至2015年12月,对收治的共32例多节段腰椎间盘突出患者,其中男性18例,女性14例;年龄49~77岁,平均58岁,所有病例均采用选择性神经根封闭术定位责任节段,其中27例患者再据责任节段行椎间孔镜下治疗。术前、术后均采用日本骨科协会(Japanese orthopaedic association.JOA)评分及视觉模拟疼痛评分法(visual analoguescale,VAS)评分对手术效果进行评估。结果:选择神经根封闭术后有5例患者未再行椎间孔镜下治疗,其中有3例患者疼痛减轻不明显,暂不行微创手术;另外2例患者症状明显减轻,拒绝进一步手术。27例患者均顺利完成手术,无感染、神经根损伤等并发症,所有患者术后随访,观察术后1个月、3个月、6个月,VAS评分较术前均明显降低(P0.05),JOA评分较术前均明显增高(P0.05),差异有统计学意义。结论:对于多节段腰椎间盘突出,先选择神经根封闭术明确责任节段,再行椎间孔镜下治疗能有效缓解患者症状,且手术创伤小,并发症少。     

The significance of troponin T and CK-MB release in coronary artery bypass surgery

Measurement of cardiac markers is an index of care standard in the assessment and diagnosis of cardiovascualr disease. Two of the major cardiac markers are Creatine Kinase isoenzyme CK-MB and Troponin T, which are extensively used in the diagnosis of heart disease. The release of Troponin T and creatine kinase isoenzyme (CK-MB) was investigated in 50 coronary artery bypass surgery patients. Measurement of plasma samples was carried out at five different time points, namely before surgery, 1,6,12,24 hours after surgery. The results indicated that CK-MB level were increased by a factor more than four times compared with the upper limit of baseline (befor surgery). Troponin T concentration showed more than six fold over the upper limit of baseline (before surgert) at 1,6,12,24 hours after surgery. In order to assess the significance of the length of the surgical procedure on the release of Troponin T and CK-MB, the surgery patient were divided into two groups according to the length of the surgical procedure: group I was selected on the basis that the surgical procedure they underwent lasted above 90 minutes and group II with a surgical procedure below 90 minutes. Both Troponin T and CK-MB showed a significant increase in-group I compared to group II. To investigate the likelihood that this effect is party due to myocardial infarction during surgery, the patients were divided into two groups: Group A with some sings of myocardial infarction on Q wave of ECG and group B without any change. The results showed approximately a two-fold increase of these markers in-group A compared to group B. Since these markers reach into blood following damage to myocardial their increase in patients with time course surgery of more than 90 minutes and those with a probability of MI during operation, indicating that these patient fall into a high risk group of repeat (MI) after surgery.     

Are we using Thyroid Function Tests Appropriately?

Thyroid function tests are very important for the diagnosis and monitoring of patients with thyroid dysfunction. The guidelines recommend serum thyroid stimulating hormone (TSH) as the single most reliable test to diagnose all common forms of hypothyroidism and hyperthyroidism. The aim of this study was to analyze the ordering pattern for thyroid function tests by physicians and the analysis of results based on the clinical history. The mean age of the patients was 32.5 ± 6.5 years. Majority of samples (87.7% of total) were received from the departments of Medicine and Gynae. Thyroid profiles (47.5%) were ordered more frequently as compared to TSH only (46%). There was no significant difference in the percentage of normal reports for both types of tests. 77.8% of TFT and 76.6% of TSH samples had results within the reference range. The percentage of abnormal results was 13.7% in the patients who were screened for thyroid disorders. There is a need to redefine the case definition for thyroid dysfunction and order the appropriate test in a rational and cost effective manner.     

面向用户需求分析的产品评论用例提取研究

[目的/意义]实现海量产品评论数据的快速分析,帮助产品设计人员高效地获取用户需求,在新产品设计的决策中提供参考。[方法/过程]在特征提取和情感分析的基础上,构造了包括"词+词性+词干+位置+依存关系"等节点特征的条件随机场模型,按照"产品特征、谁、在何种情境下、遇到了什么问题"4个要素,以描述手机屏幕和电池的负面评论为例,从产品评论中提取用例。[结果/结论]模型评估和实证研究表明,所构造的模型可以有效地从评论文本中识别产品特征、使用主体、使用情景和遇到的问题,从而快速构造用例,获取用户需求。     

Linear Analysis of Autonomic Activity and Its Correlation with Creatine Kinase-MB in Overt Thyroid Dysfunctions

Autonomic activity may be deranged in thyroid dysfunctions and may lead to cardiovascular morbidity and mortality. Myopathy is a common manifestation in thyroid disorders and may be associated with raised serum creatine kinase (CK). We hypothesized that cardiovascular abnormality in thyroid dysfunction may manifest as raised CK-MB. This study was designed to investigate the correlation of CK and its isoform CK-MB with thyroid profile and linear parameters of heart rate variability (HRV). The study was conducted on 35 hypothyroid and hyperthyroid patients each, and 25 age-matched healthy controls. Autonomic activity was assessed by simple short term 5-min HRV. Biochemical evaluation of serum thyroid profile, CK-NAC and CK-MB were estimated in all the subjects. Our results demonstrated low HRV in hypo- as well as hyperthyroid patients. We observed significantly higher serum CK levels in hypothyroid patients when compared to hyperthyroids and controls. However, no significant differences were observed in CK-MB levels in the three groups. Significant positive correlation of CK with TSH and negative correlation with some HRV parameters (LF power, HF power, total power, SDNN, RMSSD) was observed in hypothyroid patients. Whereas correlation of CK-MB with thyroid profile as well as HRV parameters was non-significant in all the groups. Based on the CK and CK-MB findings and their correlation, we conclude that the cardiovascular changes seen in thyroid dysfunctions may primarily be due to autonomic imbalance without apparent cardiac muscle involvement. Whereas, raised CK levels indicate predominantly skeletal muscle involvement in hypothyroid patients.     

Clinical utility of serum thyroglobulin in acute haemorrhage into the thyroid

Seven cases of suspected haemorrhage In pre-existing adenoma or cyst in the thyroid showed serum thyroglobulin (tg) levels phenomenonly elevated. The serum tg leveis reduced remarkably within one to three montha. During this period all patients were treated with thyroxin. It is concluded that serial serum thyroglobulin determinations may be useful in confirming the clinical suspicion of haemorrhage in the thyroid.     

第四脑室室管膜瘤的显微手术治疗

目的探讨第四脑室室管膜瘤的显微手术治疗方法。方法运用显微神经外科技术,采用后颅窝正中人路,切除肿瘤l1例。结果肿瘤全切8例,近全切除2例,大部切除l例。l例死于术后脑干损伤。另1例2年后复发死亡。术后出现脑积水2例,均行脑室-腹腔分流术。结论应用显微外科技术治疗第四脑室肿瘤,手术成功率高。熟悉第四脑室的显微解剖,注意保护脑干功能是手术成功的关键。     

经皮椎体成形术治疗椎体压缩骨折的临床观察

[目的]探讨经皮椎体成形术的临床应用。[方法]回顾性分析椎体压缩骨折患者56例80椎接受椎体成形术治疗后的临床疗效。[结果]术后患者疼痛症状明显减轻,术后3 d及1年的VAS评分较术前差异均有统计学意义(P<0.05);椎体高度恢复明显。[结论]经皮椎体成形术治疗椎体压缩骨折简单快捷、安全有效、疗效显著,临床应用前景良好。     

An audit of total and free thyroxine measurements in screening for hypo and hyperthyroidism in patients using chemiluminescence immunoassay

An audit of 2509 patient specimens analyzed for both total thyroxine (TT4) and free thyroxine (FT4) by the ACS-180 automated chemiluminescence immunoassay analyzer revealed that there were 219 discrepancies (8.7% of the total). A discrepancy was defined as one analyte within its reference range and the other outside. The discrepant results were divided into 4 groups: group A: normal TT4, but decreased FT4, 101 patients (4.0%); group B: increased TT4, normal FT4, 78 patients (3.1%); group C: decreased TT4, normal FT4, 34 patients (1.4%); and group D: normal TT4, increased FT4, 6 patients (0.2%). TSH measurements were available, by a 3^rd generation chemiluminescent assay, in 142 of these patients, and were consistent with the FT4 result in 72 patients, with TT4 in 61 cases and with neither in 9 patients. The clinical diagnosis was investigated in a subgroup of 43 endocrine patients. Thirteen of the 20 endocrine patients in group A were diagnosed as hypothyroid, with a measured serum TSH, in 11 of them, of median 14.6, range 1.2 to 46.2 μlU/ml. Eleven of the 19 endocrine patients in group B were on thyroid replacement, with a measured serum TSH, in 7 of them of <0.01 μlU/ml. The audit of current laboratory practice led to a suggestion to replace the current thyroid function screening strategy of measuring both TT4 and FT4 by the combination of FT4 and TSH. The reasons for the discrepancies and the alternative strategies for screening of thyroid function are discussed.     

薄层CT动态扫描在诊断胰腺癌侵犯血管中的价值

探讨了胰腺癌血管受累的ＣＴ分型与肿瘤手术可切除性的关系．对４３例经手术、病理证实的胰腺癌进行薄层ＣＴ动态扫描，根据确定的ＣＴ标准，观察肿瘤与血管的关系，并与手术结果对照．发现胰腺癌血管受累以Ｃ型最常见，占３７．２％，Ａ型１０例，肿瘤切除率１００％（１０／１０），Ｂ型９例，切除率为７７．８％（７／９），Ｃ型、Ｄ型２４例，均不可切除．表明薄层ＣＴ动态扫描能提高胰腺癌血管受累的诊断正确率，血管受累ＣＴ分型对外科制定手术计划具有一定价值．