Objective To evaluate the clinical effectiveness of endoscopic third ventriculostomy (ETV) and ventriculal peritoneum shunt (VPS) for hydrocephalus. Methods A fully recursive literature search was conducted in PubMed (1996 to June, 2011), EMBASE (1996 to June, 2011), Cochrane Central Register of Controlled Trials (Issue 3, 2011), CBM (1996 to June, 2011), CNKI and Wanfang Database (1996 to June, 2011) in any language. The randomized or non-randomized controlled trials of hydrocephalus treated by endoscopic third ventriculostomy and ventriculal peritoneum shunt were considered for inclusion. The analyzed outcome variables were overall complications and the survival rate of all time points. Data related to clinical outcomes were extracted by two reviewers independently. Statistical analyses were carried out by using RevMan 5.0 software. Results Nine published reports of eligible studies involving 1 187 participants met the inclusion criteria. Compared with VPS, ETV had no significant differences in short-term (1 or 2 years) survival rate (RR=1.02, 95%CI 0.90 to 1.16, P=0.74; RR=1.14, 95%CI 1.00 to 1.30, P=0.06), but there were significant differences between the two groups in overall complication rate (RR=0.70, 95%CI 0.57 to 0.89, P=0.001), postoperative 3-year survival rate (RR=1.23, 95%CI 1.07 to 1.41, P=0.004), and postoperative 5-year survival rate (RR=1.14, 95%CI 1.29 to 1.66, P=0.05). So the outcomes indicated ETV was superior in controlling the overall complication rate and prolonging the long-term survival rate. Conclusion Current evidence suggests that endoscopic third ventriculostomy is superior to ventriculal peritoneum shunt in reducing the overall complications and prolonging the long-term survival rate, but there is no significant difference in short-term survival rate between the two methods. The effectiveness of the two operational methods for hydrocephalus caused by all specific reasons still has to be further proved by more high-quality, multi-centered and double-blind RCTs.
目的 报告螺纹管在左半结肠梗阻造瘘术中的应用以及术后护理的体会。方法 对近年来收治的36例左半结肠癌性梗阻患者行急诊梗阻近端结肠螺纹管造瘘，并与同期施行的20例结肠造瘘一期外翻成形做比较。结果 结肠螺纹管单腔造瘘术操作简单，术后患者获得满意的减压效果，未发生切口感染。而一期外翻成形者有3例发生切口感染。结论 左半结肠梗阻术中行螺纹管造瘘是一种简单、经济、省时、低污染、减压效果好、护理方便的手术方法。
目的采用乙状结肠皮下预埋造瘘术以解决和提高晚期直肠癌术中无法切除但无明显肠梗阻或不全性肠梗阻患者的生活质量。方法常规行乙状结肠近端单口造瘘，将乙状结肠近端封闭后埋于皮下，再在距盲端15 cm处做乙状结肠近端与远端乙状结肠端-侧吻合。后期在患者出现明显肠梗阻后，将预埋皮下造瘘盲端打开即可。结果全组21例患者中未发生1例预埋处感染。后期打开预埋造瘘盲端时间为3～18个月。结论该方法可使患者生活质量明显提高，避免了二次开腹造瘘之痛苦和风险。
To evaluate the feasibility, safety and effectiveness of enteral nutrition (EN) via jejunostomy in the early postoperative period in patients with acute hemorrhagic necrotizing pancreatitis (AHNP), 38 patients were divided into the early group (start EN 3 or 4 days after operation) and the later group (start EN 7 days after operation). All patients received parenteral nutrition at first, then were transited to EN. The enteral nutrition liquid was transfused by continuous drip via jejunostomy in both groups. Levels of serum amylase, blood glucose, as well as the liver function were used as indices of tolerance. Symptoms and physical signs of abdominal pain as well as the level of serum albumin were used as the indices of effectieness. Patients tolerated the therapy well in both groups. Moreover, they enjoyed an earlier correction of hypoalbuminemia with more quickly improved serum albumin and no abdominal pain. Starting enteral nutrition in the early postoperative period is feasible, safe and efficacious for acute hemorrhagic necrotizing pancreatitis patients. It plays an important role in treating AHNP and improving curing rate.
Objective To investigate the clinical application of fistulation of artery and vein with self-blood vessel transplantation. Methods Seven patients with renal failure were given antebrachial fistulation of artery and veinwith great saphenous veins of themselves. The ortho- and pachy-great saphenous vein was chosed after it was cut. The great saphenous vein was passed bridge inside forearm in straight line or morpha-U. The method was anastomosis of the radial artery or brachial artery and cephalic vein, basilic vein or median cubital vein. Results The fistulations of artery and vein were successfuland all patients were in hemodialysis regularly. Conclusion The fistulation of artery andvein with selfblood vessel transplantation is a convenient, easy, cheap operation. It can coincide with the clinical demand and be used to make up the failureof fistulation or the fistulation that there is no blood vessel in the forearm.
OBJECTIVE To investigate the clinical application of artificial blood vessel graft for arteriovenous fistulization. METHODS From October 1995 to August 1998, 23 cases with renal failure received PTEF artificial vessels grafting for arteriovenous fistulization in the forearm. The PTFE artificial vessel was 6 mm in diameter, and 40 cm in length. Artificial vessel "U"-shaped loop was formed from elbow incision to wrist incision, and perfused by 20 ml heparin saline. The two ends of artificial vessel were end-to-side anastomosed with superficial cubital vein and cubital artery respectively. RESULTS All of arteriovenous fistulas were successfully formed, and could be performed hemodialysis periodically. The artificial vessels could be punctured repeatedly, and had sufficient volume of blood flow. It had no rejection, no formation of false aneurysm, and no ischemia in arm or exacerbated reflux to heart. CONCLUSION The artificial vessel grafting for arteriovenous fistulization is a safe and convenient technique in clinical practice, especially when there is no autogenous vessels for arteriovenous fistula.
【摘要】 目的 评价在鼻烟壶及腕部行动静脉造瘘术的疗效。 方法 将2007年6月-2009年6月收治的156例肾功能衰竭患者随机分成两组，分别在鼻烟壶及腕部行动静脉造瘘术，术后经彩色超声随访其吻合口通畅情况，临床观察瘘管使用时间及其并发症。 结果 术后随访2年，鼻烟壶处行动静脉造瘘术的患者，瘘管术后1年初级通畅率及累积次级通畅率分别为76.9%、92.1%；术后2年初级通畅率及累积次级通畅率分别为57.9%、78.9%。而腕部组瘘管1年初级通畅率及累积次级通畅率分别为64.1%、81.3%；术后2年初级通畅率及累积次级通畅率分别为56.0%、76.0%。两组在术后1年初级通畅率及累积次级通畅率差异有统计学意义（Plt;0.01），术后2年初级通畅率及累积次级通畅率差异无统计学意义（Pgt;0.05）。 结论 鼻烟壶处行动静脉造瘘术的瘘管在短期内通畅率较腕部高，长期并无显著性差异。【Abstract】 Objective To evaluate the effect of artificial arteriovenous fistula between tabatiere anatomique and wrist. Methods From June 2007 to June 2009, 156 cases of renal failure were randomly divided into two groups, and underwent artificial arteriovenous fistula on tabatiere anatomique or wrist, respectively. The patency of the anastomotic stoma was observed via B ultrasonography. Results The patients were followed up for two years postoperative. After the operation, the primary patency was 76.9% at the first year and 57.9% at the second year in tabatiere anatomique group; cumulative secondary patency was 92.1% at the first year and 78.9% at the second in tabatiere anatomique group; primary patency was 64.1% at the first year and 56.0% at the second in wrist group; cumulative secondary patency was 81.3% at the first year and 76.0% at the second year in wrist group. The primary patency and cumulative secondary patency were significantly different between tabatiere anatomique group and wrist group at the first year postoperatively (Plt;0.01) and not significant at the second year postoperatively (Pgt;0.05). Conclusion Prophase patency of tabatiere anatomique is higher than that of wrist. There was no significant difference between them in a long term.
目的:探讨内镜在梗阻性脑积水治疗中的临床应用价值。方法:将我院80例梗阻性脑积水患者随机分为治疗组及对照组,对照组患者采用分流术,治疗组患者采用神经内镜下三脑室底造瘘术。结果:治疗组均造瘘成功,无中转分流术。手术时间治疗组明显短于对照组,术后并发症例数也明显少于对照组,差异有统计学意义(Plt;0.05),术后症状缓解率差异无统计学意义(Pgt;005)。两组患者均获随访,时间6～12个月,症状均有锁缓解,复查CT或MRI见脑室均有不同程度缩小.结论:ETV治疗梗阻性脑积水符合当今神经外科微创原则,疗效确切,手术时间短、脑暴露少、对组织损伤小,手术费用降低,并发症少,值得推广。
Objective To explore the clinical value of early enteral nutrition in severe acute pancreatitis （SAP） by percutaneous endoscopic gastrostomy/jejunostomy （PEG/J）.Methods Treatment condition of nighty patients with SAP were retrospectively analysed.The 90 patients were collected peripheral venous blood respectively on 1， 12， and 18 d after admission to hospital.Forty-five of them were in PEG/J group， the others were in control group. Serum IL-6，TNF-α and endotoxin were detected by enzyme-linked immunosorbent assay （ELISA），CD4 /CD8 was determinated by indirect immunofluorescence staining method （FITC-labeled）.Results On 12 d and 18 d，the levels of serum IL-6， TNF-α， and endotoxin in PEG/J group were lower than those in control group （P＜0.01）.The CD4 /CD8 was significantly higher than that in control group （P＜0.01）.In control group， 2 cases complicated upper gastrointestinal haemorrhage，4 cases complicated pancreatic pseudocysts， and 2 cases complicated double infection， the temperature became normal after about 13.5 d.In PEG/J group， there were not upper gastrointestinal haemorrhage and double infection，but 2 cases also complicated pancreatic pseudocysts， the temperature became normal after about 10.5 d.Conclusion The clinical effectiveness of early enteral nutrition in SAP by PEG/J is satisfactory.
目的 探讨实施肠内营养的途径。方法 采用回顾性研究的方法，分析兰州大学第一医院2007年1月1日至2007年12月31日实施胆肠吻合术的15例患者的临床资料，包括复发性胆管结石4例，胆管癌3例，胆总管囊肿3例，壶腹癌（不能根治）5例； 平均年龄75.5岁； 在行胆肠Roux-en-Y吻合时，利用空肠盲襻实施空肠造瘘，术后第12 h开始肠内营养。统计肛门排气时间、住院时间及并发症。结果 15例患者平均肛门排气时间为54.6 h，平均住院时间为12 d，平均营养管拔除时间为20 d； 发生吻合口漏1例，肺部感染1例，切口感染1例，无一例因造瘘而发生机械性肠梗阻。结论 胆肠吻合利用空肠盲襻实施空肠造瘘肠内营养是肠内营养一种方便、可行的途径，它可以减少并发症的发生，缩短患者的住院时间，减轻患者的经济负担。与传统的方法比较，不会引起咽部不适及肺部感染，患者依从性好； 不会导致机械性肠梗阻，安全可行。