乳房X线检查:查还是不查?

正在生活中一个多数人认同的观点是,对疾病应当早查早治,越早查出,治疗的效果越好,尤其是对癌症,因为及早查出,可以利用手术、化疗、放疗和生物疗法等多种手段进行治疗。癌症如果到了晚期,手术就不管用了。然而,这一观念现在正受到挑战,至少在女性     

腹腔镜输卵管结扎术与开腹输卵管结扎术的比较

探讨腹腔镜输卵管绝育术在基层医疗单位临床应用的价值和与开腹输卵管结扎术比较的优势。腹腔镜下输卵管结扎术成功率为100%,开腹输卵管结扎术成功率为96.03%。[1]腹腔镜绝育术比较传统开腹绝育术,其优点手术创伤小,出血少,受术者痛苦小,手术时间短,术后恢复快,腹壁无明显手术瘢痕,是一种理想的微创手术方式。     

基于手术室综合运作成本的手术排程优化

手术室是医院收入和支出的重要部门,其运作管理是医院科学管理的核心环节,因此合理安排手术排程,控制手术室综合运作成本显得尤为重要.为了提升模型的实用性,在调研国内医院手术室运作现状基础上,以最优化手术室综合运作成本为目标函数,考虑完整的手术流程和多种源于国内医护现状的资源约束、手术优先级、及运作约束等实际因素,构建了手术排程的数学模型.在经典蚁群算法基础上,改进设计了新的内外层蚂蚁路径图结构,实现外层蚂蚁选择手术顺序,内层蚂蚁选择对应的资源序列.并以国内某三级甲等医院一天的手术为算例进行计算和算法评价.对比结果表明,此排程算法在排程效率、资源平衡性和手术室综合成本多个指标方面都有优越性.     

术前谈话是门技术活

2012年4月,我妈因为阑尾炎入住了哈尔滨的一家三级甲等医院。按照我的想法,像阑尾炎这类简单平常的小型手术,一般不会出现什么大的风险,很顺利就能过关。可出乎人意料的是,仅仅因为医生在手术之前的一次例行谈话,我和我妈不但被吓出一身冷汗,甚至还险些患上忧郁症。     

孩子先天性耳前瘘管发炎怎么办

vivid803490@sina.com问:我的儿子快4岁了,前几天左脸有点儿红肿,一摸左耳后发现有小包,医生检查后说是先天性耳前瘘管发炎,开了抗生素针剂。经过两天的注射,他脸部的     

Video-assisted thoracoscopic surgery （VATS） for bilateral primary spontaneous pneumothorax

Objective:To review our experience of the treatment of bilateral primary spontaneous pneumothorax (PSP) by video-assisted thoracoscopic surgery (VATS). Materials and methods: Retrospective chart review was followed by an on-clinic or telephone interview. Patients were cared for by one thoracic surgeon in four medical centers or community hospitals in Northern and Central Taiwan. Thirteen patients with bilateral PSP underwent bilateral VATS simultaneously or sequentially from July 1994 to December 2005. Results: Twelve males and one female, with age ranging from 15 to 36 years (mean 23.1 years), were treated with VATS for bilateral PSP, under the indications of bilateral pneumothoracis simultaneously (n=4) or sequentially (n=9). The interval between the first and second contra-lateral VATS procedure for non-simultaneous PSP patients ranged from 7 d to 6 years. Eleven of 13 patients (84.6%) had prominent pulmonary bullae/blebs, and underwent bullae resection with mechanical or chemical pleurodesis. The mean operative time was (45.6±18.3) min (range 25-96 min) and (120.6±28.7) min (range 84-166 min) respectively for the non-simultaneous (second VATS for the recurrence of contralateral side after first VATS) and simultaneous (bilateral VATS in one operation) procedures. There was no postoperative mortality. However, prolonged air leakage (>7 d) occurred in one patient (7.7%) who recovered after conservative treatment. The mean duration of chest tube drainage was 3.1 d and the median follow up period was 3.4 years. Conclusions: VATS is a safe and effective procedure in the treatment of bilateral PSP. Bilateral VATS is only recommended for patients with simultaneously bilateral PSP, because the incidence of recurrence, even with visible bullae, was not so high in my group and in some previous literature. Bilateral VATS in a supine position should only be used in selective cases, because of possible pleural adhesion or hidden bullae on the posterior side.     

替罗非班在急性冠脉综合征PCI围手术期的应用

急性冠状动脉综合征(acute coronary syndrome,ACS)是指冠状动脉内不稳定的动脉粥样斑块破裂或糜烂引起血栓形成所导致的心脏急性缺血综合征.在其治疗措施中,经皮冠脉介入治疗(percutaneous coronary intervention,PCI)占有越来越重要的地位[1],但是PCI时球囊扩张对血管壁产生的压力会引起粥样硬化斑块破裂及内膜、中膜损伤(置入支架更加重血管内皮损伤),引起强烈的血小板活化,促进血小板黏附、聚集和血栓形成.因此,抗血小板治疗不仅是针对ACS治疗的重要策略,而且是预防PCI围术期和术后远期发生血栓事件的重要环节.替罗非班(欣维宁)为一种可逆性非肽类血小板膜GPⅡb/Ⅲa受体拮抗剂,于1998年5月首次在美国应用上市,2004年8月在国内上市,是目前国内唯一的血小板膜GPⅡb/Ⅲa受体拮抗剂[2].其主要通过阻止纤维蛋白原与糖蛋白Ⅱb/ Ⅲa结合,从而阻断血小板的交联及血小板的聚集[3].     

外伤性肝破裂36例诊治体会

在腹部创伤中 ,肝破裂是较常见的 .特别是随着交通业的不断发展 ,外伤性肝破裂的发病率越来越高 ,虽然多数患者经手术治疗得以康复 ,但少数伤员往往死于严重的致命伤 .本文对我们近 10年来收治的 36例外伤性肝破裂诊治体会进行总结 .1　临床资料1.1　一般资料　　本组 36例 ,其中男 2 7例 ,女 9例 .年龄 7～ 5 2岁 ,平均 2 9岁 .受伤原因为交通事故 2 1例 ,挤压伤 6例 ,刀戳伤 5例 ,坠跌伤 3例 ,枪弹伤 (鸟铳自伤 ) 1例 .闭合性伤 30例 ,开放性伤 6例 .合并其他脏器伤者 2 9例 ,合并伤发生率 80 .6 % ,其中合并脑外伤 11例 ,肺挫伤、气胸 8…