门脉高压征门奇静脉断流术后胃破裂的防治

目的:探讨门奇静脉断流术后胃破裂的原因和防治措施.方法:回顾分析1995.1～2003.2月我院65例门脉高压征行门奇静脉断流术 脾切除术后胃破裂的患者.结果:65例患者中2例患者术后发生胃底破裂,1例经二次开腹修补破裂口痊愈,后因肝功能衰竭死亡,另一例二次术后痊愈出院,随访至今无严重并发症出现.结论:门奇静脉断流术 脾切除术中离断脾胃韧带时尽量靠脾侧切断韧带,近胃侧断端贯穿缝扎并包埋于浆膜腔内,术后持续胃肠减压,同时给予止酸保护胃粘膜药物治疗,可有效防止该并发症的发生.     

Investigation of a spherical-section ultrasound phased array for hepatic ablation

A 3D ultrasound thermal model with a 3D finite element representation for modeling the thermal diffusion effects for hepatic ablation induced by spherical-section ultrasound phased array was developed. The model was first validated against available published measured data in rat liver. Using the validated model,effects of blood perfusion and heating schemes on lesion formation were studied for both single focus and split-focus intensity patterns. It was shown that for single focus sonication pattern the short-duration(～2 s) and high-intensity(～1250 W/cm2) heating scheme can completely reduce the cooling effect of the blood perfusion. The lesion shape and size were significantly altered by perfusion for split-focus pattern even with a rapid heating scheme when the focus spacing was larger than 2.4 mm. Underdosed areas might be present between two foci. Prolonging ex-posure time or shortening focus spacing can reduce the cool region between two foci. In addition,the influences of thermal and acoustic parameters were also studied. When the therapy depth is short(<5 cm) ,the lesion size monotonically increases with increasing attenuation coefficient that ranges from 5.4 to 11 Np/(m?MHz) .     

老年人急性胆囊炎急诊腹腔镜胆囊切除术时机探讨

目的：探讨老年人急性胆囊炎急诊腹腔镜胆囊切除术（LC）的可行性及时机。方法：回顾分析86例65岁以上老年人急性胆囊炎急诊LC的临床资料。结果：成功完成LC83例,中转开腹3例,中转开腹率3.49%;无肝外胆管损伤等严重手术并发症发生。发病48h内行LC42例,全部完成LC,无手术并发症;发病48-72h行LC24例,中转开腹1例,术后并发毛细胆管漏1例;发病72h以上行LC20例,中转开腹2例,术后并发毛细胆管漏2例,一过性黄疸2例,全身皮下气肿2例,并发症发生率为30%。全组患者均痊愈出院。结论：老年人急性胆囊炎经合理围手术期处理可安全完成LC,发病48h内行LC成功率高。LC较开腹手术更易治疗伴发病。     

喉癌72例治疗效果分析

本文分析了我院收治的72例喉癌病人的治疗效果,通过对采用全喉切除术、部分喉切除术和单纯放疗患者的三、五年生存率的比较,体会到对T_1T_2期喉癌采用部分喉切除术较好,T_1期可单纯放疗,对触及颈部肿大淋巴结者,应争取一期颈廓清术。     

低位直肠癌经腹肛门拖出切除术疗效分析

袁献宇高贵庭梁松丽河南唐河城郊卫生院173400摘要:本文通过对36例低位直肠癌的资料分析,得出经腹肛门拖出切除低位直肠癌的保肛手术,不但减少并发症,而且又能改善患者的生活质量,成为低位直肠癌的首选术式。     

值得学习的手术

古巴在手术治疗帕金森氏症方面领先，值得美国学习。     

内镜下甲状腺切除19例分析

[目的] 探讨内镜下甲状腺切除的可行性及技术特点。[方法] 回顾性总结19例内镜下甲状腺切除的方法与经验，并对其优缺点进行探讨。[结果] 腺叶全切12例，腺叶大部切除4例。肿块剜除3例，手术全部成功，平均手术时间：乳晕入路194min(140～320min)，胸骨上入路106min(80～150min)。与传统甲状腺手术相比，内镜下甲状腺切除美容效果显著，术后恢复较快。[结论] 内镜下甲状腺切除安全、可行，目前主要适用于甲状腺良性疾病。     

Experiences and benefits of positron emitted tomography-computed tomography （PET-CT） combined with video-assisted thoracoscopic surgery （VATS） in the diagnosis of Stage 1 sarcoidosis

Background： The purpose of this study was to describe our experiences and analyze the benefits of video-assisted thoracoscopic surgery （VATS） combined with positron emitted tomography （PET）-computed tomography （CT） in the diagnosis of patients with early （Stage 1） sarcoidosis. Methods： From 1995 to 2006, seven patients （two males, five females）, with ages ranging from 26 to 58 years, were impressed with Stage 1 sarcoidosis （mediastinal or hilar lymph nodes involvements without lung involvement） by histological examination of intrathoracic lymph nodes （LNs） and/or lung parenchyma taken＇from VATS biopsy. Three of them received PET or PET-CT evaluation. VATS was approached from the right and left side in one and six patients, respectively, according to the locations of their lesions. Results： All the VATS biopsied LNs or lung specimens were adequate for establishing diagnosis. Mediastinal LNs were taken from Groups 3, 4 in four, Group 7 in two, and Groups 5, 6 in one of them. Hilar LNs biopsies were performed in four cases. Lung biopsy was performed in all but two cases. All of them were expressed pathologically or radiologically as Stage 1 sarcoidosis. PET-CT revealed high emission signals over these affected LNs. These patients received oral steroid treatment or follow up only. All of them were followed up from 5 months to 11 years with satisfactory results. Conclusion： VATS biopsy is a minimally invasive, safe and effective procedure. It can be used as a diagnostic altermative of transbronchial lung biopsy （TBLB）, and can harvest larger and more areas of specimens than mediastinoscopy for staging patients with sarcoidosis. PET-CT can provide us more accurate information about the characteristics and localization of these lesions before biopsy. VATS combined with PET-CT can provide more accurate and earlier diagnosis of patients with unknown intrathoracic lesions, including the sarcoidosis.     

Primary tuberculous infection of breast： experiences of surgical resection for aged patients and review of literature

Primary mammary tuberculosis is a rare entity that usually occurs in female of reproductive age. Herein three such patients including two males with ages over 80 years, who underwent surgical resection, are reported. Fine needle biopsy failed to achieve specific diagnosis before surgical operation. All of their conditions got satisfactory improvement and anti-tuberculosis chemotherapy was administered postoperatively. Previous literature related to the epidemiology, diagnosis and treatment for mammary tuberculosis will be also reviewed. Mammary tuberculosis is usually related to breast feeding women and is extremely rare in aged man. The possible mechanisms resulting in this disease in our three patients, including direct extension, reactivation, or transmitted by staffs or peers of the nursing home, would also be discussed.