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误诊为急性心肌炎的心肌梗死一例

Application of Preperitoneal Tension-Ｆree Repair in Inguinal Hernia by Easy Prosthesis D-10

Objective To evaluate the clinical effect of Easy Prosthesis D-10 on open preperitoneal groin tension-free hernioplasty. Methods The operative time, operation-correlated complications, hospital stay and recent follow-up findings of 63 patients underwent preperitoneal groin tension-free hernioplasty were analyzed from October 2006 to April 2008. Results No case died in perioperative period. The average operative time was (47.6±10.5) minutes. None of incision infection and scrotal hydrocele occurred. The average hospital stay was (7.7±2.1) days. During follow-up period of 6 to 24 months, no recurrence, chronic pain and foreign body sensation were found. Conclusion The open preperioneal groin tension-free hernioplasty by Easy Prosthesis D-10 is safe and reliable, especially for the inguinal hernia with large hernia ring or defect of transversalis fascia and recurrent hernia.

腹腔镜与开腹手术治疗腹膜后位阑尾炎的临床疗效比较

目的 比较腹腔镜阑尾切除术（laparoscopic appendectomy，LA）与开腹阑尾切除术（open appendectomy，OA）在腹膜后位阑尾炎治疗中的临床效果。 方法 回顾性分析 2012 年 1 月至 2016 年 12 月期间于笔者所在医院科室接受 LA 或 OA 的 147 例腹膜后位阑尾炎患者的临床资料，比较 LA 和 OA 的临床疗效。 结果 所有病例均未死亡、临床治愈。2 组患者的手术时间和住院费用比较差异均无统计学意义（P>0.05），但 LA 组的肠功能恢复时间、止痛药物使用率、术后感染率及住院时间均低于（短于）OA 组，差异均有统计学意义（P<0.05）。 结论 对于无腹腔镜手术禁忌的腹膜后位阑尾炎患者，LA 较 OA 具有术后疼痛轻、恢复快、并发症少及住院时间短的优点。

Diagnosis and Surgical Treatment of Pulmonary Tuberculosis Complicated by Aspergillus Infection

Objective To investigate diagnosis and treatment strategies of patients with pulmonary tuberculosis （TB） complicated by Aspergillus infection. Methods Clinical data of 38 patients with pulmonary TB complicated by Aspergillus infection who underwent surgical treatment from January 2008 to December 2010 in Chengdu Infectious Disease Hospital were retrospectively analyzed. There were 23 male patients and 15 female patients with their average age of 37.8 （23-59） years. Preoperatively，all the patients received regular anti-TB treatment for more than 2 weeks，and patients with definite Aspergillus infection received anti-Aspergillus therapy for more than 3 days with consultation of infectious disease physicians. After above treatment，26 patients underwent lobectomy，1 patient underwent right pneumonectomy，and 11 patients underwent left pneumonectomy. All the patients were followed up at the outpatient department after discharge. They were evaluated every 2 weeks in the first 3 months，every 1 month after 3 months，and every 6 months after 1 year. During follow-up，they received acid-fast bacillus smear and sputum culture to check Aspergillus，as well as CT chest scan. Results All the patients successfully received surgical resection of the pulmonary lesion without perioperative death or severe complication. Postoperative pathology examination confirmed pulmonary TB with Aspergillosis infection in all the 38 patients，whose basic diseases included TB cavity in 17 patients，TB-destroyed lung in 12 patients，and post-TB bronchiectasis in 9 patients. All the patients were followed up after discharge for 1.5-4.5 years. During follow-up，they received regular anti-TB therapy for adequate duration in addition to antifungal medications such as voriconazole. None of the 38 patients had recurrence of Aspergillus infection or pulmonary TB. One patient had hemoptysis which was controlled after proper treatment during follow-up. Conclusion Missed diagnosis rate of pulmonary TB complicated by Aspergillus infection is high. Surgical resection of the pulmonary lesion and postoperative medication treatment are the most effective treatment strategies for patients with pulmonary TB complicated by Aspergillus infection.

外科手术治疗慢性结核性脓胸的疗效分析

目的　探讨慢性结核性脓胸的治疗方式。 方法 对成都市传染病医院2008年1月至2010年12月收治的184例慢性结核性脓胸进行分组治疗：手术组89例，男52例、女37例，年龄14～66岁，在正规有效抗痨基础上行脓胸清除＋纤维板（增厚的胸膜）剥脱术，术后继续正规抗痨治疗；对照组95例，男61例、女34例，年龄15～68岁，仅采用内科正规有效抗痨治疗，比较两组治疗前后的病情变化。 结果 手术组患者经过手术治疗后脓胸消除，胸廓的塌陷得到遏制，多数患者可以使塌陷胸廓得到改善，肺功能均有明显改善，生活质量得到改善；而对照组患者治疗前后症状无明显改善（3例治疗期间退出研究），反而自觉胸闷、胸痛、气促等症状多有加重，胸廓塌陷更明显，肺功能继续恶化，生活质量变差。治疗结束后两组病例均进行门诊随访1～3年，手术组失访1例，对照组失访2例，随访率98.3%；随访期间，手术组无脓胸复发，患者症状体征改善，无再住院，而对照组患者症状体征多有加重，再住院率40.2%。 结论 外科手术是治疗慢性结核性脓胸的最佳方式。

Clinical Research on Assessment of Prognosis by Lactate Clearance in Severe Trauma

【摘要】　目的　评估乳酸清除率与重症创伤患者预后的关系。　方法　回顾性分析2010年1－6月收住曲靖市第一人民医院ICU科的37例重症创伤患者的初始血乳酸值、第2次血乳酸值、乳酸清除率及患者的预后，将患者分为存活组和死亡组，比较两组患者初始血乳酸值、乳酸清除率的差异。　结果　两组患者年龄、性别、初始血乳酸值差异无统计学意义（Pgt;0.05）。存活组血乳酸清除率（48.26±21.57）%明显高于死亡组（11.71±20.88）%，差异有统计学意义（Plt;0.001）；当乳酸清除率≥13%时，能较好地预测患者生存，其灵敏度为96%，特异度为80%。　结论　乳酸清除率可用于评估重症创伤患者的预后。【Abstract】　Objective　To evaluate the correlation between prognosis and lactate clearance in severe trauma.　Methods　The clinical data of 37 patients with severe trauma admitted between January and June 2010 in the First People′s Hospital of Qujin were analyzed retrospectively. These data included initial blood lactate concentration, second blood lactate concentration, lactate clearance rate, and prognosis of the patients. The patients were divided into survivor group and non-survivor group, and the differences of initial blood lactate concentration and lactate clearance rate between them were compared.　Results　There were no differences in age, sex, and the initial blood lactate concentration (Pgt;0.05) between the two groups. Compared with non-survivors, the survivors had a significantly higher lactate clearance [(48.26±21.57)% vs. (11.71±20.88)%, Plt;0.001]. Patients with a lactate clearance higher than or equal to 13% had a sensitivity of 96%, specificity of 80%, for predicting survival.　Conclusion　Lactate clearance rate can be used to predict the prognosis of severe trauma.

Open Surgery Repair for Incision Hernia of Abdominal Wall

目的探讨腹壁大切口疝和巨大切口疝治疗经验。方法对我院采用补片行开放式腹壁大切口疝和巨大切口疝修补术的51例患者临床资料进行回顾性分析。结果采用肌前补片修补法3例，肌肉间补片修补法3例，肌后腹膜前补片修补法39例，腹腔内补片修补法6例。 手术时间109～195 min，平均135.2 min; 术中出血15～90 ml，平均35.6 ml；术中无血管和内脏损伤等并发症。 术后3～7 d（平均4.9 d）下床活动; 住院时间7～19 d，平均9.7 d。 2例患者术后出现浆液肿，经穿刺抽吸、负压吸引和腹带加压包扎后治愈。51例患者随访12～36个月（平均24.5个月），3例（5.9%）患者复发，后行开放式腹腔内补片修补手术，恢复良好，无再复发。所有病例无慢性疼痛。结论应用补片行开放式腹壁大切口疝和巨大切口疝修补术是一种安全、可靠的方法，复发率低。