目的 探讨经皮经肝穿刺胆道引流术（PTCD）联合胆道支架置入术治疗恶性梗阻性黄疸的操作技巧及其临床应用价值。方法 2009年8月至2011年5月期间中国医科大学附属第四医院介入科对39例恶性梗阻性黄疸患者施行了PTCD联合胆道支架置入术，对其临床资料和效果进行回顾性分析。结果 39例患者全部穿刺成功，穿刺成功率为100％。穿刺左叶胆管11例，穿刺右叶胆管19例，左右胆管均行穿刺9例；单纯外引流22例，内外引流17例；引流管保留7～14d后均成功行胆道支架置入术。 33例患者自觉症状有缓解。患者术后14d时，其白蛋白、碱性磷酸酶、丙氨酸转氨酶、总胆红素、直接胆红素和间接胆红素水平均较术前降低（P＜0.05）。术后发生胆道感染3例（7.69％），发生急性胰腺炎4例（10.26％），发生支架脱落移位1例（2.56％），无胆汁性腹膜炎等并发症发生。本组32例患者获访，随访时间为8d～16.5个月，平均9.4个月。随访期间，27例患者死于肿瘤进展及多脏器功能衰竭；5例患者存活，无黄疸加重症状。结论 PTCD联合胆道支架置入术是一种姑息治疗恶性梗阻性黄疸的有效方法，具有简便、有效、安全、可重复性等优点，但需注意其适应证的选择和并发症的预防。
Objective To investigate the safety and effectiveness of the operation of integrate subparagraph, fenestration, exclusion, cut expansion, seton, tube, and drainage (ISFECSTD) to cure complex anal fistula. Methods Using randomized comparison and multicenter parallel experiment, the total number was 240: 120 patients in study group treated by ISFECSTD, and 120 patients in control group treated by extended cutting and seton operation. Then compared the safety and effectiveness between two groups. Results The clinical recovery rate of the study group was significantly higher than that in the control group （Plt;0.05）. The operation time and wound healing time in study group were significantly less than those in control group, and the scar area after wound healing was smaller than that in control group （Plt;0.01）. The decreased extents of anorectal pressures and rectal capacity feeling function after operation in study group were smaller than those in control group (Plt;0.01). Rectal and anal reflex function and healing of the endostoma, stem, and branch in study group were better than those in control group (Plt;0.05, Plt;0.01). Incidence of anal incontinence after operation in study group was significantly less than that in of anus-rectum structure and function, and has the merits of higher cure rate, shorter time of healing, smaller scar, less pain, etc. The method of ISFECSTD is worth being a new standardized operation in the clinical application.
目的 探讨急性胰腺炎继发感染的治疗方法。方法 分析总结我院1998～1999年收治的20例胰腺感染患者，采用经后上腰腹膜后引流及灌洗方法治疗的资料。结果 术后并发症： 残余脓肿2例，消化道出血1例，肠瘘4例，胰瘘6例，经治疗后患者全部治愈。结论 该治疗方法残余感染及死亡率低。
Sixteen cases unresectable carcinoma of the head of the pancreas complicated with jaundice were treated by one stage cholecysto-jejunal and gastro-jejunal loop double anastomosis, the same result of jaundice drainage and prevention of bile reflux were obtained when compared with simple cholecysto-jejunal loop anastomosis, on the other hand, the obstructive symptoms resulting from postoperative cancerous comppression of duodenum and pylorus were avoided as well. The operation is simple with less physiologic disturbance and the patient can lead better postoperative live.
Objective To investigate the method and effectiveness of vacuum seal ing drainage (VSD) combined with debridement for treatment of deep infection after hip or knee replacement. Methods Between September 2006 and May 2010, 13 cases of deep infection after joint replacement surgery were treated, including 5 males and 8 females with an average ageof 62.5 years (range, 56-78 years). Infection occurred at 7 days to 1 year and 2 months (median, 14 days) after joint replacement surgery. The time from infection to admission was 8 days to 4 years and 6 months (median, 21 days). Purulent secretion with or without blood were observed in all patients; sinus formed in 5 cases; and unhealing of incision or drainage opening disunion were observed in 8 cases. The size of skin defect at secretion drainage or sinus opening site was 5 mm × 3 mm to 36 mm × 6 mm; the depth of drainage tunnel or sinus was 21-60 mm. The histopathological examination in 11 patients showed acute infection or chronic infection with acute onset in 10 cases, and tuberculosis in 1 case. In 6 cases of secretion culture, Staphylococcus aureus was isolated from 5 cases. After thorough debridement, wound irrigation was performed during the day and VSD during the night in 10 cases. VSD was merely performed in 3 cases. Results In 1 case after revision total hip arthroplasty, the wound bled profusely with VSD, then VSD stopped and associated with compression bandage, VSD proceeded again 3 days later with no heavy bleeding. All the patient were followed up 1 year to 4 years and 5 months (mean, 2 years and 11 months). Infection were controlled 7-75 days (mean, 43 days) after VSD in 10 cases. In these cases, prosthesis were reserved, no recurrent infection was observed, wound were healed, limb function were reserved. VSD was refused in 1 case because of hypersensitive of the pain at the vacuum site, infection control was failed and amputation at the thigh was proceeded. The effect was not evident in 1 case with tuberculosis infection, then the prosthesis was removed and arthrodesis was proceeded followed by complete union. In 1 case, infection was cured with VSD, recurrent infection happened after 9 months, antibiotic-impregnated cement spacer was used at end, and no recurrence was observed 1 year and 4 months later. Conclusion VSD combined with debridement can drainage deep infection sufficiently, promote wound healing, reduce recurrent infection rate, maximize the possibil ity of prosthesis preservation.
Objective To study the effect of sodium hyaluronate hydrogel in treating residual cavity on body surface after abscess drainage so as to provide new method to speed up the heal ing of residual cavity after body surface abscess drainageand reduce the frequency of dressing change and cl inic nursing workload. Methods From June 2007 to March 2008, 60 outpatients with body surface abscess drainage were randomly divided into hydrogel group (group A, 30 cases) and the control group (group B, 30 cases). In group A, there were 16 males and 14 females aged (49.5 ± 6.1) years, the disease course was (3.8 ± 0.6) days, and the volume of residual cavity was (4.19 ± 1.31) mL. In group B, there were 18 males and 12 females aged (50.2 ± 7.6) years, the disease course was (4.3 ± 0.5) days, and the volume of residual cavity was (4.04 ± 1.22) mL. There was no significant difference between two groups in gender, age, disease course and volume of residual cavity (P gt; 0.05). Residual cavity was smeared with 1 mL/cm2 sodium hyaluronate hydrogel in group A and drained by sal ine gauze in group B, the dressing was changed every two to three days. Residual cavity volume was recorded every four days, and the residual cavity volume, the frequency of out-patient dressing and the heal ing time residual of cavity were compared. Results The volume of residual cavity was (3.11 ± 1.12), (1.75 ± 0.95) and (0.55 ± 0.56) mL in group A, and was (3.39 ± 1.12), (2.64 ± 0.99) and (1.81 ± 0.81) mL in group B at 4, 8 and 12 days after treatment respectively, showing no significant differences at 4 days (P gt; 0. 05), but significant difference at 8 and 12 days (P lt; 0.01). Residual cavity heal ing time was (12.70 ± 2.78) days in group A and (20.27 ± 3.89) days in group B, and the frequency of dressing change was 5.53 ± 1.33 in group A and 9.13 ± 1.81 in group B, indicating significant differences between two groups (P lt; 0.01). Conclusion Sodium hyaluronate hydrogel can promote residual cavity heal ing, reduce the frequency of dressing change of out-patient and decrease the cl inic nursing care workload.
目的 探讨改道置管肛外引流术治疗直肠黏膜下脓肿的临床疗效。 方法 2007年5月－2012年5月，将76例直肠黏膜下脓肿患者分为改道置管肛外引流术（治疗组）和传统切开引流术（对照组）治疗，每组各38例，两组患者在年龄、性别比、病程等方面具有可比性。观察两组患者治愈时间、治愈率、随访3个月的复发情况以及肛门直肠压力测定，评价两组患者临床疗效及肛门功能保护情况。 结果 治疗组患者治愈时间为（21.3 ± 6.37）d，对照组为（29.5 ± 4.52）d，治疗组时间明显缩短（t=5.79，P＜0.01）；治疗组治愈率97.3%，对照组为73.6%，差异有统计学差异（χ2=6.81，P＜0. 01）；两组患者随访3个月的肛门功能比较，RRP治疗组为3.48 ± 0.61，对照组3.22 ± 0.79，差异无统计学意义（t=−1.61，P＞0.05）；ARP治疗组为19.05 ± 3.76，对照组为17.55 ± 3.31，差异无统计学意义（t=−1.85，P＞0.05）；ALCT治疗组为36.74 ± 4.70，对照组为37.13 ± 3.90，差异无统计学意义（t=−0.39，P＞0.05）；AMCP治疗组为24.03 ± 5.80，对照组为21.8 ± 4.91，差异无统计学意义（t=−1.61，P＞0.05）。 结论 改道置管肛外引流术治疗直肠黏膜下脓肿可缩短疗程，提高治愈率。
【摘要】 目的 比较钻孔引流尿激酶溶解术和小骨窗开颅术治疗高血压脑出血的疗效。 方法 2008年9月-2009年12月分别接受钻孔引流尿激酶溶解术（A组，n=34）和小骨窗开颅术（B组，n=30）的高血压脑出血患者共64例（出血量30~50 mL，无脑疝），两组患者术前基线指标（如出血量、手术时机、昏迷程度等）比较无统计学意义。比较接受不同术式的两组患者手术时间、术后1个月的近期疗效、术后6个月远期疗效及死亡率。 结果 A组手术时间短于B组，两组比较，有统计学意义（Plt;0.05）。术后1、6个月，A组疗效优于B组，两组比较，有统计学意义（Plt;0.05）。A、B组术后近期和远期死亡率比较，无统计学意义（Pgt;0.05）。 结论 对出血部位在基底节区、出血量在30~50 mL，无脑疝的高血压脑出血患者，钻孔引流尿激酶溶解术的疗效明显优于小骨窗开颅术。【Abstract】 Objective To compare the therapeutic effect of drill drainage-urokinase perfusion (group A) and small bone flap craniotomy on hypertensive intracerebral hemorrhage. Methods A total of 64 patients with hypertensive intracerebral hemorrhage (about 30-50 mL) from September 2008 to December 2009 were collected. The patients underwent drill drainage-urokinase perfusion (group A,n=34) and small bone flap craniotomy (group B,n=30). The therapeutic effects, including operating time, short-term effect within one month, long-term effect six months after operation, operation time, and the rate of rehaemorrhagia and mortality were observed and the results of the two groups were compared. Results The operation time was shorter in group A than that in group B (Plt;0.05); one month and six months after the operation, the therapeutic effects were better in group A than those in group B (Plt;0.05); the difference in mortality between the two groups was not significant (Pgt;0.05). Conclusion The therapeutic effect of drill draiage-urokinase perfusion is better than that of small bone flap craniotomy on the patients with hypertensive intracerebral hemorrhage in basal unclei with bleeding amount of 30-50 mL and without cerebralhern.
目的:探讨双侧慢性硬膜下血肿(BCSDH)的诊断和治疗。方法:对25例老年患者BCSDH的诊断,治疗资料总结分析,全部病例均行CT/或MRI检查。所有患者皆行颅骨钻孔引流术,其中5例单侧钻孔引流,20例双侧钻孔引流。结果:全部病例均治愈,随访未见复发。结论:CT和MRI检查是BCSDH的最佳诊断手段。钻孔引流是BCSDH的有效治疗方法。