west china medical publishers
Keyword
  • Title
  • Author
  • Keyword
  • Abstract
Advance search
Advance search

Search

find Keyword "双侧" 52 results
  • Application on The Approach of Transecting Anterior Cervical Muscle Group at Sternal End for Removal of Bilat-eral Huge Thyroid Neoplasm

    Objective To explore the advantage of transection the cervical muscles at sternal end and flip fixed in therapeutic bilateral huge thyroid surgery. Methods The transection of the cervical muscles at sternal end and flip fixed in 53 cases was observation group, 44 cases of the neck white line incision thyroid surgery completed for the control group. The completion of the surgery by the same group of physicians. The operative time, operation field of exposing effect, amount of bleeding in operation, postoperative complications, and postoperative drainage volume were compared between two groups. Results There was no statistically differences of sex, age, disease composition, and tumor size between two groups (P>0.05). Operative time, amount of bleeding, and postoperative drainage volume in observation group were shorter (less) than that in control group (P<0.01). The postoperative complication rate in observation group was lower than that in control group(P=0.04). Surgical field exposure in observation group was better than that in control group (P<0.01). Conclusions The huge bilateral thyroid surgery with the sternal end approach is feasible and simple. The operation field exposure is better than the white line neck incision, complications after operation is less. It is worthy of clinical application.

    Release date: Export PDF Favorites Scan
  • The Clinical Application of TensionFree Repair to Treatment of Hernia

    目的探讨无张力疝修补术在双侧腹股沟疝中的临床应用价值。 方法1999年5月至2002年4月采用无张力疝修补术治疗双侧腹股沟疝25例,其中采用充填法18例, 双层补片5例, 一侧充填一侧双层补片2例。结果全组病例切口均一期愈合, 术后5~7 d出院,随访至今无复发。结论无张力疝修补术具有手术创伤小、痛苦少、术后恢复快等优点, 是治疗双侧腹股沟疝的最佳术式。

    Release date:2016-08-28 04:47 Export PDF Favorites Scan
  • 电视胸腔镜手术治疗双侧肺大泡:同期手术优于分期手术

    目的 探讨电视胸腔镜手术(video-assisted thoracscopic surgery,VATS)在双侧肺大泡切除中的可行性、手术时机及治疗效果。 方法 回顾性分析2001年4月至2011年6月中山大学附属佛山医院佛山市第一人民医院应用电视胸腔镜施行同期或分期手术切除双侧肺大泡患者168例的临床资料,男135例,女 33例;年龄15~68(41.5±10.6)岁。依据手术方式不同分为同期手术组(92例)和分期手术组(76例)。分析两组患者围手术期及远期并发症发生情况,比较行双侧同期肺大泡手术的效果。 结果 168例患者均顺利完成手术,住院时间为7~16(6.6±2.4) d,无术中及术后死亡患者,2例因严重肺粘连中转开胸。术后随访6个月~10年,围手术期并发症同期手术组显著低于分期手术组,差异有统计学意义(P<0.05);远期并发症两组间差异无统计学意义(P>0.05);术后总体并发症同期手术组低于分期手术组,差异有统计学意义(P<0.05)。 结论 VATS同期或分期治疗双侧肺大泡疗效确切,行双侧同期手术效果更佳。

    Release date:2016-08-30 05:45 Export PDF Favorites Scan
  • 尘肺并发双侧自发性气胸21例临床分析

    目的 探讨尘肺并发双侧自发性气胸的诱发因素、临床特点和急救处理方法,以减少误诊和降低死亡率。方法 回顾性分析2006年3月至2012年1月重庆市职业病防治院21例尘肺并发双侧自发性气胸患者的临床资料,男20例,女1例;平均年龄62 (46~65) 岁。发病缓慢者4例,突发起病17例。术前肺压缩程度<30% 6例,30%~50% 10例,>50% 5例。二期尘肺7例,三期14例。所有患者均采用双侧胸腔闭式引流术治疗。 结果 气胸治愈13例,好转5例;1例因持续漏气转外院行电视胸腔镜手术治疗好转出院;2例因早期患者不愿意采用手术治疗,而采用内科保守治疗延误手术时机,致急性呼吸循环衰竭死亡。胸腔引流管平均引流时间10.4 (4~24) d。随访17例,随访时间5~12个月,16例气胸无复发,1例并发右侧少量气胸经保守治疗痊愈,2例失访。 结论 尘肺并发双侧气胸患者多数突然发病,临床症状有时不典型,易误诊,发生严重的缺氧和急性呼吸功能衰竭,从而危及患者生命;对明确诊断者及时行双侧胸腔闭式引流术治疗是救治成功的关键。

    Release date:2016-08-30 05:46 Export PDF Favorites Scan
  • 改良双侧Glenn手术后早期处理

    目的 总结功能性单心室患者行改良双侧Glenn 术后早期处理经验,为临床提供借鉴。 方法 回顾性分析2009 年1 月至2010 年6 月济南军区总医院共19 例功能性单心室患者行改良双侧Glenn 术的临床资料,其中男10 例,女9 例;年龄3.5 ~ 18.0(7.4±3.3)岁,体重11.5 ~ 70.0( 21.5±12.3) kg;术前经超声心动图和心血管造影检查诊断为功能性单心室19 例,其中合并三尖瓣闭锁4 例,二尖瓣闭锁1 例。术后患者均取半卧位,留置桡动脉、上腔静脉测压管,常规建立下腔静脉输液通路。给予多巴胺、米力农等正性肌力药物,依据上腔静脉压力情况予以吸入伊洛前列环素,后续口服西地那非,并强调联合序贯治疗。控制红细胞积压(HCT)在0.40 左右,血浆白蛋白> 30 g/L。撤离呼吸机后予以抗凝治疗。 结果 全组无死亡,无严重并发症。手术时间(119.0±41.8) min,机械通气时间(6.5±1.9) h,监护室滞留时间( 3.6 ±1.5) d,纵隔心包引流量(13.9±4.2) ml/kg。全组患者动脉血氧饱和度(SaO2)较术前上升28.3%(t=5.13,P=0.000),术后平均肺动脉压(13.6±3.6) mm Hg。 结论 改良双侧Glenn 术对于难以解剖根治及不能Ⅰ期生理矫治的紫绀型复杂先天性心脏病患者效果良好。术后应结合新的手术方式及病理生理特点采取有针对性处理。

    Release date:2016-08-30 05:48 Export PDF Favorites Scan
  • 电视胸腔镜双侧肺减容术21例

    目的 总结电视胸腔镜双侧肺减容术(BLVRS)治疗慢性阻塞性肺气肿(COPE)的临床经验,并观察其疗效。 方法 2009年9月至2010年9月,南京医科大学附属南京医院对21例COPE患者行电视胸腔镜 BLVRS,均为男性,年龄(65.71±9.05)岁。采用电视胸腔镜专用切缝器(Endo-GIA)切除过度充气的肺大泡组织,常规用4-0 Prolene线连续往返缝合。术后观察患者的肺功能、血气分析指标和6 min步行距离(6-MWD)的变化,并与术前进行比较,评价手术疗效。 结果 无围术期死亡,术后住院时间(13.20±4.60) d,胸腔引流时间(5.33±3.67) d。术后持续肺漏气 (5.91±3.52) d 12例,出现急性呼吸衰竭1例,广泛皮下气肿2例,合并肺部感染5例,均经相应的处理治愈。随访21例,随访时间6个月,术后6个月第1秒用力呼气容积[(1.63±0.23) L vs. (1.21±0.17) L]、动脉血氧分压[(77.62±6.98) mm Hg vs. (67.54±8.12) mm Hg]和6-MWD [(430.55±80.49) m vs. (283.48±108.12) m]较术前增加,动脉血二氧化碳分压(PaCO2)、、残气量(RV) 较术前降低(P<0.05)。 结论 电视胸腔镜BLVRS安全、有效,特别对非均质性肺气肿,可明显改善患者的生活质量,近期效果显著。

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 单侧原发性自发性气胸行双侧肺大泡切除术的治疗效果

    摘要: 目的 探讨单侧原发性气胸行双侧肺大泡切除术的可行性及治疗效果,以寻求单侧原发性气胸最有效的治疗方法。 方法 回顾分析我科自2003年3月至2008年12月 413例单侧原发性自发性气胸患者的临床资料和随访结果,其中男371例,女42例;年龄18~41岁,平均年龄27.7岁。气胸位于左侧285例,右侧128例;首次发生气胸252例,再次发生气胸161例;单发性肺大泡65例,多发性肺大泡348例;肺大泡直径≤1cm 361例,直径>1 cm 52例;肺大泡位于肺上叶370例,位于肺中叶或下叶背段43例。采用双侧腋下第3~5肋间小切口行双侧肺大泡切除术282例,在电视胸腔镜下行双侧肺大泡切除术131例。 结果 手术时间110.3±48.4 min,拔除气管内插管时间6.5±1.2 d,住院时间8.1±2.3 d。术后出现复张性肺水肿3例,伤口感染3例,均经相应的治疗治愈;术后二次开胸止血1例。随访287例,随访时间17.0±6.3个月,随访期间所有患者无并发症发生,复查胸部X线片无气胸复发。结论 年轻的单侧自发性气胸患者往往双侧肺都有相对称的病变存在,患者能耐受同期双侧肺大泡切除术,同期双侧肺大泡切除术可根治双侧肺大泡病变,并能有效地预防气胸的复发。

    Release date:2016-08-30 06:01 Export PDF Favorites Scan
  • Midterm and Longterm Clinical Outcome Analysis of Bilateral Internal Mammary Artery Composited Y Grafts for Coronary Artery Bypass Grafting

    Objective To evaluate midterm and longterm clinical outcome of bilateral internal mammary artery composited Y grafts for coronary artery bypass grafting (CABG), analyze risk factors for late death ,and to improve surgical results. Methods Between January 2000 and May 2004, One hundred and sixtyfive patients underwent bilateral internal mammary artery grafts for CABG, The clinical data, postoperative complications and survival results were retrospectively reviewed and analyzed. The preoperative and postoperative cardiac function was compared. All factors that may have affected the survival were analyzed by logistic regression, to identify significant variables associated with late death. Results Total 561 anastomosis sites of internal mammary arteries were completed with each patient received an average of 3.4 grafts.  There were no perioperative deaths. There were 16 patients with postoperative complications including recurrent angina, myocardial infarction, low cardiac output syndrome, sternal infection and so on. All patients were treated conservatively without reoperation. One hundred sixty patients(97%)were followed up of 5.6±1.2 years, there were 23 late deaths including 10 patients of cardiac related death in which 3 had recurrent myocardial infarction, 4 heart failure, and 3 arrhythmia; 13 patients of nocardiac related death in which 4 upper gastrointestinal hemorrhage, 3 cancer and 6 uncertain cause. 25 patients had major cardiac related events including recurrent angina 18, myocardial infarction 4, repeated revascularization 3. Left ventricular ejection fraction [CM(159mm]was significantly improved as compared with that before operation(54%±6% vs. 43%±12%, Plt;0.05). The 1-, 3-, 5-year actuarial survival rates and eventfree rates were 98.2%±0.3%, 96.2%±0.5%, 90.5%±1.9% and 95.5%±1.2%, 91.3%±2.1%, 86.6%±1.5%, respectively. According to statistical analysis, univariate analyses had proved that advancing age>65 years,diabetes,ejection fraction(EF) less than 30%,the New York Heart Association (NYHA) class Ⅲ/Ⅳ, and low cardiac output syndrome required placement of the intraaortic balloon pump were predictors associated with hospital major adverse cardiac events (Plt;0.05). Those variables entered into the logistic regression model and found to be independent predictors associated with increased late cardiac death included advancing age >65 years(OR=11.6), diabetes (OR=21.4), EF less than 30%(OR=37.5) and NYHA class Ⅲ/Ⅳ(OR=40.2). Conclusion Patients receiving bilateral internal mammary artery composited Y grafts have better longterm survival and reduced cardiac related events. Independent risk factors for late death are NYHA function class Ⅲ/Ⅳ, EF less than 30%, diabetes and advancing age >65 years.

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • Prospective Randomised Neurocognitive Study of Unilateral and Bilateral Antegrade Selective Cerebral Perfusion for Total Aortic Arch Replacement

    ObjectiveTo compare the cerebral protective effect of unilateral and bilateral antegrade selective cerebral perfusion during total aortic arch replacement, particularly with respect to neuropsychological outcome.MethodsFrom June 2003 to March 2004, 16 patients who underwent total aortic arch replacement were randomly allocated to one of two methods of brain protection: unilateral antegrade selective cerebral perfusion (unilateral group, n =8) or bilateral antegrade cerebral perfusion (bilateral group, n =8). Preoperative and postoperative neurological examination, brain computed tomography(CT) scan, and cognitive function tests were performed.ResultsAll patients survived the operations and were discharged from hospital. No new brain infarction occurred. Transient neurologic dysfunction occurred in 1 patient of each group. There were no intergroup differences in the scores of preoperative and post operative cognitive function ( P gt;0.05).ConclusionBoth methods of brain protection for patients undergoing total aortic arch replacement result in favorable and similar effect of brain protection in term of cognitive function provided the circle of Willis is patent and collateral flow is adequate.

    Release date:2016-08-30 06:24 Export PDF Favorites Scan
  • 双侧乳内动脉在冠状动脉旁路移植术中的应用

    目的 总结使用双侧乳内动脉做冠状动脉旁路移植术(CABG)材料的临床经验. 方法 回顾性临床研究42例冠心病患者接受双侧乳内动脉行CABG的方法、适应证和乳内动脉的选择应用. 结果 共完成83个乳内动脉吻合,同时使用桡动脉吻合56个,平均每例患者接受血管移植3.3根(2~6根).术后合并围手术期心肌梗死1例,急性呼吸窘迫综合征(ARDS)2例.本组死亡4例,其中因心力衰竭、心律失常死亡2例,肠穿孔1例,下肢缺血性坏死和败血症1例.随诊12~60个月,除1例心绞痛复发外,其他患者均无症状存活,生活质量明显改善. 结论 使用双侧乳内动脉虽较用大隐静脉做CABG稍复杂,但仍可在适合的病例广泛采用,包括较危重的冠心病、糖尿病、不稳定型心绞痛和左主干病变的患者.乳内动脉所具有的解剖特性能提高移植血管的长期通畅性,极低的再狭窄率,可明显提高患者的生活质量.

    Release date:2016-08-30 06:32 Export PDF Favorites Scan
6 pages Previous 1 2 3 ... 6 Next

Format

Content