目的:探讨双猪尾型输尿管内支架(Double pigtail stent,DPS)作为泌尿外科上尿路疾病手术辅助治疗的适应症、并发症及并发症的治疗。方法:总结我院2004年6月至2008年12月共122例施行输尿管内支架放置术患者的适应症、并发症及并发症的治疗结果。结果:24例患者(19.6%)在置管期间出现1个或以上并发症。主要并发症包括肉眼血尿(9例)、疼痛(16例)、膀胱刺激征(12例)、高热(1例)。大部分并发症是轻微和可以耐受的,并迅速得到了适当的处理。2例须拔除内支架,其中剧烈疼痛1例、高热1例。结论:DPS用于上尿路疾病手术辅助治疗是安全和有效的,DPS引起的并发症大部分易于处理。
膈神经是维持呼吸功能的主要神经, 由颈3 ～5 神经组成, 在维持正常通气功能中占有重要的地位。膈肌位于胸腔和腹腔之间, 为向上膨隆呈穹窿形的扁薄阔肌, 是主要的呼吸肌, 在呼吸运动中起着非常重要的作用。膈肌起搏即通过电刺激膈神经或膈肌使膈肌收缩, 维持患有膈肌功能障碍患者的自然负压呼吸。自发现电刺激能引起膈肌收缩至今已有200 多年历史, 该技术应用于临床也已有60 余年历史[1] 。
Objective To discuss the key issues in the diagnosis and treatment of degenerative disc disease and thetherapeutic effect of transforaminal lumbar interbody fusion on it. Methods From September 2004 to August 2006, 15 cases of degenerative disc disease were treated by transforaminal lumbar interbody fusion, including 8 males and 7 females with the age of 33-46 years. All cases were single-level degenerative disc diseases, including 1 case of L3,4, 8 cases of L4,5 and 6 cases of L5, S1. The course of the disease was 2 -10 years. Preoperatively, the score of visual analogue scale (VAS) was 8.9 ± 1.8 and the score of Oswestry disabil ity index (ODI) was 51.4 ± 8.3. All patients had received normal conventional treatment for at least 3 months and had no therapeutic effect before operation. Results The operation time was 120-180 minutes (150 minutes on average) and the intra-operative blood loss was 200-500 mL (360 mL on average). There was no severe compl ication, except that the muscle tone of anterior tibia in one case decreased to the third level, which recovered to the 5- level 3 months after operation. A total of 15 cases were followed up for 12-24 months (18 months on average). All patients got interbody bony fusion 12 months after operation with the fusion rate of 100%. Postoperatively, the score of VAS was 2.8 ± 1.6 and the score of ODI was 19.1 ± 3.2, indicating there were significant difference in comparison with postoperative ones (P lt; 0.05). The improvement rates of postoperative VAS and ODI were 61.8% ± 7.3% and 64.3% ± 5.5%, respectively. For the therapeutic effect, 6 cases were regardedas excellent, 8 good, 1 fair, and the choiceness rate was 93.3%. All patients resumed their jobs and normal l ives. Conclusion Transforaminal lumbar interbody fusion is effective for the treatment of lumbar degenerative disc disease, but the indications for operation must be strictly defined.
Obstractive To observe the clinical effects and safety of endobronchial electrocautery treatment for tracheobronchial obstructive lesions in inoperable tracheobronchial squamous cell carcinoma.Methods Ninety-five patients with advanced and inoperable tracheobronchial squamous cell carcinoma were included. Thirty-four patients with central airway obstruction were treated with endobronchial electrocautery plus chemotherapy ( group A) and 61 patients without central airway obstruction were treated with chemotherapy alone ( group B) . The chemotherapy consisted of cisplatin or carboplatin, plus another thirdgeneration chemotherapy agent. Results In groug A, there were mean improvements in FEV1 of 41. 1% and in peak expiratory flow( PEF) of 65. 6% . There was no significant difference in the survival rates of the patients with and without central airway obstruction. Median survival time of group A was 11. 3 months and those of group B was 11. 6 months. 3, 6, and 12-month survival rates in group A were 87% , 68% and 39% respectively, and those in group B were 93% , 76% , and 45% respectively. Conclusion Endobronchial electrocautery is an effective and safe approach for inoperable tracheobronchial obstructive malignancies with few complications.
Abstract： Objective To introduce the early experience of using vacuum-assisted closure （VAC） in the treatment of wound dehiscence after thoracic and cardiovascular surgery. Methods This report retrospective1y analyzed the clinical data of 12 patients who underwent VAC in the treatment of wound dehiscence after thoracic and cardiovascular surgery in the Affiliated Hospital of the Logistics University of CAPF between October 2010 and October 2011. There were 7 male patients and 5 female patients with their mean age of 64.3 years （ranging from 39 to 80 years）. All patients underwent operation via median sternotomy or lateral thoracic incision. All the wound dehiscence was deep to sternum or rib. After debridement of necrotic tissue, the wound surfaces were covered with VAC sponges, and intermittent negative pressure therapy was used. The VAC sponges were changed every 7-10 days. Results All the patients underwent an average of 2 times to change the VAC sponges during VAC treatment. After VAC treatment, the edema around the surgical wounds gradually disappeared, and the granulation tissue was refreshed. The overall conditions of all the patients were improved. The patients could leave their bed, walk in the ward, and look after themselves. Antibiotic treatment was no longer used. The residents checked up the negative pressure system every day to see whether it worked well. The patients were no longer afraid of changing dressing and pain every day. All the patients were healed, discharged from the hospital and followed up at outpatient department for a mean time of 7 months. Their wounds all healed well during follow-up. Conclusion VACsystem is easy to use. It can facilitate the healing of wound dehiscence quickly, decrease the inflammatory reaction of local wound and the body, and shorten the rehabilitation time. It’s also helpful to reduce the residents’ work load. It is recommended in the treatment of wound dehiscence after thoracic and cardiovascular surgery.
Objective To assess the performance of post-disaster reconstruction of Yushu earthquake at the first anniversary, so as to summarize the Yushu modes of post-disaster reconstruction and provide references for reconstruction work after extreme natural disasters at home and abroad. Methods All the materials seen during the first year after Yushu Earthquake were collected, such as all documents, information notifications and work reports issued by the Central Government and the Ministry of Health, and all the information from the website of News Office of the State Council, the Ministry of Health, Qinghai Provincial People’s Government, and Xinhuanet. The literatures about Yushu Earthquake were also searched from CNKI. All the data were retrospectively analyzed to describe the reconstruction tasks and summarize the effectiveness. Results?a) The reconstruction faced upon special difficulties, including short construction time, cold climate and hypoxia, poor transport, lack of construction resources, economic backwardness, weak logistics and higher cost of reconstruction; b) The performance was significant, e.g., the government completed an investment of 5.01 billion yuan. The goal of urban and rural housing construction was fully completed. Public and municipal infrastructure construction made an important breakthrough. The projects related to livelihood were rapidly implemented. The counterpart’s education at remote was basically completed. Conclusion?As the largest reconstruction in the highest altitude area after a magnitude 7.0 earthquake, Yushu’s reconstruction learns from the experience in Wenchuan, keeps the foothold of its own features and conditions, challenges the limits of high altitude with cold and hypoxia climate, forms a post-disaster reconstruction mode with Chinese characteristics, demonstrates the speed and quality of reconstruction, and provides the valuable experience for domestic and foreign counterparts.
ObjectiveTo investigate the association between colorectal adenoma (CRA) and colorectal cancer (CRC), and to analyze the main pathogenesis of CRA, in order to identify and control the key factors of CRA and reduce the incidence of CRC. MethodThe studies on the mechanism of CRA in recent years were searched and summarized, focusing on the interaction of inflammation, genetic and epigenetic changes, gut microbiota and lipid metabolism, and their effects on the development of CRA. ResultsInflammation, genetic and epigenetic changes, intestinal flora and lipid metabolism play an important roles in the occurrence and development of CRA. These factors had a significant impact on the formation and progress of CRA at different stages through complex interaction, and had potential application value in preventing CRC. ConclusionsMany factors participate in the occurrence and development of CRA and plays an important role, which provide reference for future research and clinical intervention.
Objective To enhance the understanding of pulmonary hemangiopericytoma. Methods With a case report and reviewing related literatures, the etiology, clinical manifestations, radiological features,pathological features, diagnosis, treatment and prognosis of pulmonary hemangiopericytoma were discussed.Results The etiology of this rare disease remains unknown. Clinical symptoms are rare and non-specific.Radiological features show a round, homogeneous, soft-tissue mass without calcification. Pathologic feature reveals a large number of capillary lumen, and some tumors can be dressed with pseudo capsule or show infiltration growth to the surrounding tissue. The diagnosis of pulmonary hemangiopericytoma is mainly based on the imaging findings, and pathological examination is needed for final diagnosis. The best choice of treatment is surgery, combined with chemotherapy and radiotherapy.Conclusions Pulmonary hemangiopericytoma is rare and often misdiagnosed as other pulmonary diseases. More attention should be paid to improve its therapeutic effect and prognosis.
Abstract： Objective To investigate the effect of intramyocardial injection of slow release microspheres of tannic acid （TA） on ventricular remodeling after acute myocardial infarction （AMI） in rats. Methods Slow release microspheres of TA were prepared and the release parameters in vitro were detected. AMI model in rats was induced. Eighty rats were enrolled and divided into 4 groups by random digital table：poly （lactic-co-glycolic acid） （PLGA） microspheres injection （PLGA group， n=24）， PLGA-TA microspheres injection （PLGA-TA group， n=24）， TA injection group （TA group， n=16） and normal saline injection group （NS group， n=16）. Heart function was evaluated by echocardiography after the injection. The structure of cardiac extracellular matrix （ECM） in the infarcted borderline area was evaluated at 4th week after the injection. Collagen content in the infarcted area was evaluated by hydroxyproline colorimetry assay at 2nd and 4th week after the injection. Results TA release was maintained at a constant rate from the microspheres for one month in vitro. Two weeks after the injection， left ventricular ejection fraction（LVEF）， left ventricular fraction shortening（LVFS）， left ventricular end-diastolic diameter（LVEDD） and left ventricular end-systolic diameter（LVESD） in PLGA-TA group and TA group were significantly better than those in the other two groups（P＜0.05）. Four weeks after the injection， LVEF， LVFS， LVEDD and LVESD in PLGA-TA group were significantly better than those in the other three groups （P＜0.05）. Four weeks after the injection， slow release microspheres of TA in the PLGA-TA group effectively improved the arrangement of ECM compared with TA group. Four weeks after the injection， collagen content in the infarcted area of PLGA-TA group was significantly higher than that in TA group（88.88±7.28 μg/mg dry weight vs. 72.43±9.02 μg/mg dry weight）， PLGA group（88.88±7.28 μg/mg drg weight vs. 71.97±6.06 μg/mg dry weight） and NS group（88.88±7.28 μg/mg dry weight vs. 68.86±7.55 μg/mg dry weight， F=7.162，P=0.003）， but there was no statistical difference in the collagen content of the infarcted area among TA group， PLGA group and NS group （P＞0.05） . Conclusion Intramyocardial injection of slow release microspheres of TA can maintain a constant release of TA for a comparatively long period， inhibit collagen matrix degradation， and effectively attenuate ventricular remodeling after AMI in rats.
Objective To compare the effectiveness of posterior axillary edge approach and arthroscopic assisted reduction in the treatment of Ideberg type Ⅰ and Ⅱ glenoid fracture of the scapula. Methods The clinical data of 26 patients with fresh Ideberg type Ⅰ and Ⅱ scapular fractures admitted between June 2021 and September 2024 who met the selection criteria were analyzed retrospectively. The patients were divided into two groups according to different treatment methods. Ten cases in the posterior axillary edge group were fixed by open reduction plate through the posterior axillary edge approach, and 16 cases in the arthroscopy group were treated with suture anchor fixation under arthroscopy. There was no significant difference in baseline data between the two groups (P>0.05), such as gender, age, surgical side, Ideberg type, cause of injury, time from injury to operation, rotator cuff injury, and superior labrum anterior posterior (SLAP) injury, etc. The operation time and fracture healing time were recorded and compared between the two groups, and the shoulder pain was evaluated by visual analogue scale (VAS) score at 1 week, 1 month, and 3 months after operation. At 3 and 6 months after operation, the range of motion of shoulder joint in anteflexion, abduction, external rotation, internal rotation, and backward extension was evaluated, the upper limb dysfunction was evaluated by the Disability Assessment Scale of Arm, Shoulder, and Hand (DASH), and the shoulder joint function was evaluated by the Constant-Murley score. The differences between 6 months and 3 months after operation (changes) were statistically analyzed. ResultsPatients in both groups were followed up 11-13 months, with an average of 12.5 months. The operation time and fracture healing time in the posterior axillary edge group were significantly shorter than those in the arthroscopy group (P<0.05). There was no complication such as wound infection, vascular and nerve injury, loss of reduction, bone nonunion, or glenohumeral instability in both groups. At 1 week after operation, the VAS score in the posterior axillary edge group was significantly higher than that in the arthroscopy group (P<0.05); there was no significant difference in the VAS score between the two groups at 1 and 3 months after operation (P>0.05). At 6 months after operation, the changes of shoulder joint in anteflexion, internal rotation range of motion and DASH scores in the posterior axillary edge group were significantly lower than those in the arthroscopy group (P<0.05), while the changes of abduction, external rotation, backward extension range of motion and Constant-Murley scores were not significantly different between the two groups (P>0.05). ConclusionFor Ideberg type Ⅰ and Ⅱ glenoid fracture of the scapula, the posterior axillary edge approach for internal fixation has a short operation time, fast fracture healing, and is beneficial for early functional recovery; arthroscopic assisted reduction has minimal trauma and can handle joint injuries simultaneously. Both surgical procedures are safe and effective, and individualized selection should be made based on soft tissue conditions and combined injuries.