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微波干扰素结合中药熏洗治疗肛周尖锐湿疣疗效观察

摘要:目的:观察采用微波、干扰素结合自拟消疣汤熏洗中西医结合方法治疗肛周尖锐湿疣的疗效。方法:采用微波、干扰素结合自拟消疣汤(板蓝根、大青叶、紫草、蒲公英、野菊花、马齿苋、黄柏、土茯苓、苦参、薏苡仁、赤芍)熏洗的中西医结合方法治疗本病30例,并设对照组进行对照。结果: 治疗组复发率为10%,治愈率为90%,创面感染率为0,对照组复发率为37.9%,治愈率为62.1%,并有2例并发感染。结论:本治疗方法对肛周尖锐湿疣有提高治愈率,降低复发率并能有效地防止继发感染之功效。

电视胸腔镜手术治疗后纵隔良性神经源性肿瘤

目的　探讨电视胸腔镜手术切除后纵隔良性神经源性肿瘤的临床疗效和价值。 方法　回顾性分析德阳市人民医院2008年3月至2012年4月运用电视胸腔镜手术切除后纵隔良性神经源性肿瘤24例的临床资料，其中男17例、女7例，年龄17～71 （41.25±14.78）岁；分析其安全性、有效性和危险性。 结果　全组24例均顺利完成手术，手术时间（114.25±52.30） min，手术出血量（214.45±123.12） ml，术中、术后输血2例，术后胸腔闭式引流时间（2.75±1.42） d，术后住院时间（7.25±3.26） d。全组24例中，19例在全胸腔镜下完成，3例哑铃型神经源性肿瘤采用胸腔镜联合背部小切口切除，2例中转开胸，中转开胸手术率8.33%。术后轻微并发症3例，无围手术期死亡。术后病理检查示神经鞘瘤10例，神经纤维瘤9例，神经节细胞瘤5例。术后24例均进行了随访，随访时间（21.23±18.56） 个月，全组均生存，无复发。 结论　利用电视胸腔镜手术治疗后纵隔良性神经源性肿瘤安全、有效，但应严格掌握手术适应证及合理的手术方式，熟练掌握电视胸腔镜手术治疗后纵隔良性神经源性肿瘤的手术技巧，能有效地降低手术风险。

电视胸腔镜手术同期治疗双侧原发性自发性气胸的临床分析

目地　探讨应用电视胸腔镜手术同期治疗双侧原发性自发性气胸的可行性、效果及术中、术后注意事项。 方法　回顾分析四川省德阳市人民医院2005年9月至2012年3月应用电视胸腔镜手术同期治疗13例双侧自发性原发性气胸的临床资料及术中、术后处理经验的临床资料，均为男性，年龄15～36 （21.5±3.2） 岁。 结果　全组患者均顺利完成手术，手术时间（102.6±21.4） min，术中出血量（65.2±18.6） ml，术后住院时间（8.6±2.3） d，全组无术中、术后死亡，无严重并发症发生。术后随访3～36个月，其中随访12例，失访1例，无气胸复发。 结论　应用电视胸腔镜手术同期治疗双侧原发性自发性气胸安全、有效，值得临床推广。

上腹部手术后食管癌外科治疗16例

保留后瓣及瓣下结构的二尖瓣置换术

目的 总结保留后瓣及瓣下结构的二尖瓣置换术（MVR）的临床经验，并观察其与常规MVR比较的临床效果。方法 风湿性心瓣膜病患者54例，其中行保留后瓣及瓣下结构的MVR24例（保留二尖瓣后瓣组），行常规MVR30例（常规手术组），观察两组患者术前、术后3个月的左心室舒张期末内径（LVEDD）、左心室射血分数（LVEF）、左心室短轴缩短率（LVFS）等指标。结果 保留二尖瓣后瓣组无死亡患者，常规手术组死亡1例；保留二尖瓣后瓣组术后血管活性药物的用量、种类和呼吸机使用时间较常规手术组减少；术后3个月保留二尖瓣后瓣组LVEDD较常规手术组减小，LVEF较常规手术组增大（P〈0．05）。结论 保留后瓣及瓣下结构的MVR手术操作不复杂，不增加心内手术时间，有可能减少左心室破裂的危险，术中操作仔细可以避免卡瓣，术后心功能恢复较好，更适用于心功能较差、左心室较大的以二尖瓣关闭不全为主的患者。

Clinical analysis of single mediastinal chest drains in perioperative period after thoracoscopic resection of esophageal carcinoma: A randomized controlled study

ObjectiveTo compare the clinical effect of single mediastinal drainage tube and both mediastinal drainage tube and closed thoracic drainage tube for the patients who received thoracoscopic radical resection of esophageal carcinoma.MethodsWe enrolled 96 esophageal carcinoma patients who received thoracoscopic radical resection from June 2016 to October 2018. Of them, 49 patients were indwelt with both mediastinal drainage tube and closed thoracic drainage tube (a chest & mediastinal drainage group, a CMD group) while the other 47 patients were indwelt with single mediastinal drainage tube (a single mediastinal drainage group, a SMD group). The total drainage volume, intubation time and incidence of postoperative complications (postoperative atelectasis, pulmonary infection, pleural effusion and anastomotic leakage) between the two groups were compared. The pain score and comfort score were also compared between the two groups.ResultsThe total drainage volume and intubation time in the SMD group were not significantly different from those in the CMD group (1 321±421 mL vs. 1 204±545 mL, P=0.541; 6.1±3.7 d vs. 6.4 ±5.1 d, P=0.321). The incidence of postoperative complications (postoperative atelectasis, pulmonary infection, pleural effusion and anastomotic leakage) in the SMD group was not significantly different from that in the CMD group (10.6% vs. 6.1%, P=0.712; 4.3% vs. 10.2%, P=0.656; 6.4% vs. 12.2%, P=0.121; 2.1% vs. 4.1%, P=0.526). The numerical rating scale (NRS) pain scores on the first to the fifth day after surgery and during extubation in the SMD group were significantly lower than those in the CMD group (3.2±2.1 vs. 5.1±2.4, P=0.041; 2.8±0.6 vs. 4.8±1.4, P=0.015; 2.1±0.4 vs. 4.5±0.4, P=0.019; 1.7±0.7 vs. 4.0±0.8, P=0.004; 1.8±0.7 vs. 3.2±1.2, P=0.006; 1.4±0.2 vs. 2.5±3.4, P=0.012). The VAS comfort scores in the SMD group were significantly lower than those in the CMD group (3.6±1.7 vs. 6.6±3.7, P=0.018; 2.9±2.0 vs. 5.1±3.4, P=0.007; 2.1±1.4 vs. 5.5±2.4, P=0.004; 3.0±0.9 vs. 4.6±3.8, P=0.012; 1.8±1.1 vs. 4.2±2.7, P=0.003; 2.4±3.2 vs. 5.3±1.7, P=0.020).ConclusionThe clinical effect of single mediastinal drainage tube in thoracoscopic resection of esophageal carcinoma is similar to that of both mediastinal drainage tube and closed thoracic drainage tube, but it can significantly improve the comfort of the patients.

胸腔镜手术治疗胸膜脂肪瘤一例

Prevention and Treatment of Alcohol Withdrawal Syndrome after Esophageal Cancer Surgery

目的　探讨食管癌术后酒精戒断综合征的原因及有效预防治疗措施。 方法　2000年1月－2011年10月共行食管癌手术935例，术后发生酒精戒断综合征16例，患者均为男性，年龄41～67岁，平均54岁。饮酒史16～47年，平均27.8年；每日饮白酒量为250～1 000 g，酒精含量162～590 g，平均321.5 g。所有患者均符合中国精神疾病分类与诊断标准第3版（CCMD-3）酒精戒断综合征诊断标准。在食管癌常规术后治疗的基础上，根据患者谵妄、烦躁、精神失常、昏迷等不同情况应用维生素B族、纳络酮、氟哌啶醇、氯丙嗪、安定、促进脑细胞代谢及补充能量等综合治疗，必要时予以镇静后气管插管呼吸机辅助呼吸。 结果　患者经治疗后戒断症状均完全消失，治疗时间2～10 d，平均5.3 d。13例获随访，随访时间4～18个月，均完全戒酒，其中1例术后8个月死于急性心肌梗死；余12例均恢复良好，且未出现酒精戒断症状。 结论　经合理有效的围手术期处理，食管癌术后酒精戒断综合征发生率可明显降低，详细询问病史，术前术后积极预防并及时给予有效的治疗是治愈的关键。

Analysis of 107 Patients with Multiple Injuries Combined with Thoracic Trauma after the Wenchuan Earthquake by a Frontier Third-class First-grade Hospital

Objective　To summarize the treatment and outcomes of patients with multiple injuries combined with thoracic trauma following the Wenchuan earthquake. Methods　The wounded patients admitted from 12th to 31st May with multiple injuries combined with thoracic trauma after the earthquake were retrospectively analyzed. This includes baseline information, treatments, outcomes and deaths. Results　Liver repair, spleen abscission, decompression and removed of intracranial hematoma ranked the first three of the main reasons for the emergency surgery death of multiple injuries. Heart-lung machine support, trachea cannula and closed drainage of thoracic cavity ranked the first three of the main reasons for the death of thoracic trauma. Moreover, ARDS, fracture of sternum and flail chest ranked the first three of the main reasons for the death of other multiple injuries. All the casualties had the worst situation with high ISS scores. The main death reasons were cerebral wound, peritoneum viscera injuries and the four limbs and pelvis injuries. Besides, the severe thoracic trauma accelerated their death. Conclusion　 Main death reasons for the inpatients with multiple injuries combined with thoracic trauma are hemorrhagic shock and severe cerebral wound. The thoracic trauma degree will increase the risk of their death. The more the injury positions, the higher ISS scores, and the more serious thoracic trauma, the higher mortality rate. Rapid examination and diagnosis, rapied triage and distribution of thoracic trauma can help to create more chances for the further treatment and increase the success rate of rescue.

Uniportal Video-assisted Toracoscopic Surgery for 186 Patients with Benign Toracic Diseases

目的探索单操作孔电视胸腔镜手术治疗胸部良性疾病的有效性和安全性。 方法回顾性分析2008年3月至2013年4月德阳市人民医院单操作孔电视胸腔镜手术治疗胸部良性疾病186例患者的临床资料，其中男101例、女85例，年龄15～65（30.1±5.3）岁。 结果全组患者无围手术期死亡。手术时间18～88（47.2±7.6）min，术中出血量5.0～110.0（49.8±9.4）ml，患者术后住院时间7～16（9.2±2.1）d。2例因致密粘连转为辅助小切口手术。自发性气胸肺大泡切除术后当日及术后1～2 d出现持续肺漏气3例，1例肺漏气持续9 d，1例肺漏气持续10 d，1例肺漏气持续11 d，均经保守治疗治愈。切口脂肪液化4例，换药后治愈。术后肺部感染3例，经加强抗感染后治愈。随访3～24（6.8±3.2）个月，失访18例，总体随访率90.3%（168/186）。随访期间气胸复发4例，气胸压缩肺组织10%～20%，观察5～8 d自行吸收，未再次手术；肺及纵隔良性病变无复发；结核患者术后抗痨治疗12～18个月治愈。 结论单操作孔电视胸腔镜手术治疗胸部良性疾病创伤小，切口美观，患者恢复快，手术安全，对适应证患者可作为手术方式。