单纯性肾囊肿的个体化治疗方案探讨

目的根据肾囊肿的部位个体化选择治疗方案,以提高单纯性肾囊肿的外科治疗效果。方法回顾性分析398例单纯性肾囊肿患者的临床资料,分析患者全身情况、囊肿位置及囊肿大小等特点与成功治疗肾囊肿的相关性。结果接受经皮穿刺引流并反复注射无水乙醇或联合生物蛋白胶的患者225例,接受经腹腔镜肾囊肿去顶减压术联合生物蛋白胶治疗的患者158例,接受输尿管镜下内切开引流术者15例。其中有效率99.5%,治愈率94.0%,无其他脏器损伤、感染性休克、化学性肾盂肾炎等严重并发症。结论单纯性肾囊肿患者应根据肾囊肿部位、个体化选择治疗方法。     

改良后腹腔镜下单纯性肾囊肿去顶减压术治疗体会附41例报道

目的 探讨后腹腔镜下单纯性肾囊肿去顶减压术的治疗方法及疗效.方法 采用后腹腔镜下治疗单纯性肾囊肿患者41例.在全麻下行后腹膜腔途径,未行气囊扩张及未充分游离情况下根据影像结果腹腔镜找到并暴露肾囊肿,用电凝勾距离肾实质3 ～ 5mm切除囊壁.结果 41例手术均成功,无中转开放手术,无严重并发症发生.手术时间20～ 35 min,平均28min.术中出血量5～ 10mL,平均6 mL.术后1～2d拔除引流管,无出血及感染等并发症.术后住院4～8d,平均5.6d.术后随访3～24个月,平均13个月,无复发.结论 腹腔镜下肾囊肿去顶减压术具有多种优点,更加减少手术时间,减少术中术后出血,恢复快,是外科治疗肾囊肿的理想术式.     

腹膜后腹腔镜肾囊肿去顶减压术34例报告

目的:探讨经腹膜后腹腔镜肾囊肿去顶减压术的临床应用价值。方法:回顾分析34例患者行腹膜后腹腔镜肾囊肿去顶减压术的临床资料。结果:所有患者手术均获成功;平均手术时间53min,失血19ml。随访3个月至9年,原手术部位无囊肿复发。结论:腹膜后腹腔镜肾囊肿去顶减压术是治疗单纯性肾囊肿和多囊肾的最好方法,患者创伤小、康复快、住院时间短,且可早期下床活动。     

俯卧位背侧人路后腹腔镜肾囊肿去顶术的临床分析（附12例报告）

目的：探讨俯卧位经背侧人路后腹腔镜肾囊肿去顶术的方法和疗效。方法：回顾性分析俯卧位经背侧入路后腹腔镜肾囊肿去顶术治疗12例单纯性肾囊肿患者的临床资料。其中男7例,女5例,年龄为31～67岁,平均42．6岁。术前均行泌尿系B超、静脉尿路造影（IVu）和肾脏CT平扫及增强检查明确囊肿大小、数量及位置,证实与肾盂集合系统不相通。囊肿直径4．5～12．0cm,平均7．6cm。结果：12例患者均在后腹腔镜下顺利完成手术。手术时间30～105min,平均48．5min;术中出血量5～25ml,平均14．2ml;术后住院时间3～6天,平均4．8天。围手术期未出现并发症。随访12~20个月,平均15．3个月,未见囊肿复发。结论：俯卧位背侧入路后腹腔镜肾囊肿去顶术治疗单纯性肾囊肿安全可行。经背侧入路后腹腔镜手术的成功实施为临床手术路径的研究提供一种新的思路。     

后腹腔镜肾囊肿去顶减压术并带蒂脂肪瓣填塞在治疗单纯性肾囊肿中的应用价值

目的探讨经后腹腔镜肾囊肿去顶减压术并带蒂脂肪瓣填塞固定在治疗单纯性肾囊肿中的临床应用。方法回顾性分析本院2015年6月至2018年6月收治的42例大部分位于肾实质内的单纯性肾囊肿患者的临床资料,均实施后腹腔镜肾囊肿去顶减压术并带蒂脂肪瓣填塞残腔,观察手术时间、出血量、住院时间、复发率及并发症。结果42例患者均成功完成手术,术中无中转开放手术,平均手术时间36 min,平均出血量20 mL,平均住院时间4.6 d,无输血患者及并发症发生,术后病理报告均为单纯性肾囊肿。随访1.5~4.5年无囊肿复发。结论后腹腔镜肾囊肿去顶减压术并带蒂脂肪瓣填塞术后恢复快、复发率低,手术方式易于掌握,值得临床推广应用。     

腹腔镜与开放性肾囊肿去顶术的比较（附30例报告）

目的：比较开放性与腹腔镜肾囊肿去顶术的优越性,并探讨经腹腔与后腹腔腹腔镜肾囊肿去顶术的适应证及疗效。方法：采用经腹腔及后腹腔腹腔镜行肾囊肿去枯术30例,其中经腹腔路径9例,用膜后路径21例,并回顾性分析比较31例开放性肾囊肿去枯术,结果：腹腔镜手术用时25－110min,平均46min,其中经腹腔路矩平均40min,腹后路径平均需时50min,术后恢复快,无一例发生并发症,对比开放手术,腹腔镜手术的手术时间,术后并发症以及术后住院天数均明显减少,结论：腹腔镜肾囊肿去顶术治疗单纯性肾囊肿的疗效明显优于传统开放性手术,值得推广。     

后腹腔镜一期手术治疗34例双侧肾囊肿的疗效观察

目的探讨后腹腔镜一期手术治疗双侧单纯性肾囊肿的临床价值。方法对34例后腹腔镜一期行双侧肾囊肿去顶减压患者临床资料进行回顾分析。其中男1例,女13例,年龄17～65岁(34±0.53),囊肿直径5.32±1.31cm,左侧囊肿43个,右侧48个。结果经后腹膜入路34例患者双侧肾囊肿顺利去顶,平均每侧手术时间37.28±0.45min,平均每侧术中出血量7.18±0.53ml,2例随访3～6个月无复发,术中出现单侧腹膜损伤,未伤及腹腔脏器。平均住院天数7.47±0.32d,平均术后住院天数4.10±0.27d。结论后腹腔镜一期行双侧肾囊肿去顶术是一种安全、可行的治疗方式。     

经脐单孔腹腔镜治疗双侧肾囊肿(附10例报告)

目的:探讨经脐单孔腹腔镜治疗双侧单纯性肾囊肿的临床应用价值。方法:回顾性分析对本院自2010年2月～至2011年12月收治的10例双侧单纯性肾囊肿患者临床资料,所有均施行经脐单孔腹腔镜下双侧肾囊肿去顶减压术。其中男4例,女6例,年龄47～70岁,囊肿直径(7.70±1.54)cm。本组患者9例双侧囊肿位于肾脏腹(外)侧,仅1例单侧囊肿位于肾盂旁,均适合此手术方式。于脐部作一2～3cm切口建立自制单孔操作通道,切开结肠旁沟处的侧腹膜,游离并暴露囊肿。在距肾实质约5mm处用超声刀将大部分囊肿壁完整切除,撤出腹腔镜,保留操作通道,改变患者体位并以同样方式处理对侧囊肿。结果:9例顺利完成单孔腹腔镜手术,1例因囊肿位置特殊,术中分离较困难,在合适部位增加一5mm操作通道。手术时间平均(91.7±24.7)min,术中平均出血(38.9±25.8)ml,平均术后住院(3.5±1.7)d,术后平均留置引流管2.1d。术后随访3～12个月,脐部切口愈合良好,囊肿无复发,无脐疝等相关手术并发症产生。结论:采用自制经脐单孔多通道腹腔镜治疗双侧肾囊肿安全可行,手术时间缩短,术后恢复快,术后切口瘢痕隐蔽,具有良好的微创和美容效果,为双侧肾脏病变提供新的手术治疗方式。     

腹腔镜技术治疗复发性肾囊肿的探讨

目的：观察应用腹腔镜技术再次治疗腹腔镜肾囊肿去顶术后复发性囊肿的可行性。方法：总结5例腹腔镜技术治疗腹腔镜。肾囊肿去顶术后囊肿复发的临床资料,其中3例经腹腔途径,2例经腹膜后途径。结果：5例患者手术均获得成功。手术时间50～100min,平均75min。出血60～180ml,无并发症发生,术后住院4～9天,术后随访6～14个月,未再复发。结论：对于复发性肾囊肿仍可采取腹腔镜技术进行手术处理。     

后腹腔镜下单纯性肾囊肿去顶减压术20例疗效观察

目的总结后腹腔镜下单纯性肾囊肿去顶减压术的疗效和体会。方法在全麻下对20例单纯性肾囊肿患者行后腹腔镜下肾囊肿去顶减压术。结果本组20例均成功完成手术,无中转开放手术。手术时间:42～76 min,平均(54±5.1)min。平均术中出血量40 mL,术后24～48 h拔除引流管,无尿漏、感染等并发症,术后住院4～7 d,平均5 d。随访4～24个月,恢复良好。结论实施后腹腔镜单纯性肾囊肿去顶减压术治愈率高,创伤小,效果良好。     

Treatment of cardiogenic shock with levosimendan in combination with beta-adrenergic antagonists

Levosimendan, a calcium sensitizer, was used in combinationwith ß-adrenergic antagonists in a man aged 56 yrwith cardiogenic shock, complicating acute myocardial infarction,who developed severe tachycardia after dobutamine administration.The patient's trachea was intubated, his lungs were ventilated,and he was started on dopamine 5 µg kg^–1 min^–1and dobutamine 5 µg kg^–1 min^–1, titrated toa mean arterial pressure 65 mm Hg. He progressively became tachycardiac(>120 beats min^–1) with a cardiac index (CI) of 1.4litre min^–1 m^–2 despite adequate preload. Levosimendan6 µg kg^–1 was administered intravenously over 10min followed by a continuous infusion of 0.2 µg kg^–1min^–1 for 24 h. Within 30 min, the patient's CI increasedto 2.2 litre min^–1 m^–2, but the heart rate (HR)also increased from 142 to 155 beats min^–1. Esmolol 1mg kg^–1 i.v. was administered with a consequent transientdecrease in HR to 110 beats min^–1 without adverse haemodynamiceffects; however, HR increased again shortly afterwards. Carvedilol3.125 mg orally twice a day was then administered, and the dosewas increased to 6.25 mg orally twice daily on the followingday. Subsequently, HR decreased over time and both catecholamineswere discontinued 14 h after starting levosimendan infusion.The trachea was extubated within 20 h and the patient was dischargedto the ward on day 4 after admission. In conclusion, levosimendanin combination with a ß-adrenergic antagonist mayhave beneficial effects in patients with cardiogenic shock whoexhibit tachycardia in response to inotropic agents.     

Randomized crossover comparison of ProSeal Laryngeal Mask Airway with Laryngeal Tube Sonda during anaesthesia with controlled ventilation

Background. The Laryngeal Tube Sonda^® (LTS) is a supraglotticairway which, like the ProSeal^® Laryngeal Mask Airway (PLMA),incorporates a drain tube. We compared the performances of LTSand PLMA during controlled ventilation anaesthesia. Methods. The devices were studied in 32 ventilated patientsby randomized crossover trial. Primary outcome was airway sealpressure. Secondary outcomes included insertion success andtime, manipulations required, ventilation quality, peak andplateau airway pressures, ability to pass a gastric tube andfibreoptic laryngeal view. Results. The PLMA produced a higher seal pressure (median values,PLMA 26 cm H₂O and LTS 24 cm H₂O, P<0.01). First-attemptinsertion succeeded with PLMA 28 times and LTS 22 times (P>0.05).The PLMA required fewer manipulations (P<0.05) in fewer patients(P<0.05) and took less time to insert (P<0.01). All PLMApatients and 22 LTS patients achieved optimal ventilation (P<0.01).Peak airway pressure was lower with the PLMA than with the LTS(P<0.01). The vocal cords were visible through the PLMA in32 patients and through the LTS in nine patients (P<0.001).The laryngeal view was superior through the PLMA (P<0.001). Conclusion. The difference in seal pressure between deviceswas clinically unimportant. However, the LTS had an unexpectedlyhigh failure rate. PLMA performance exceeded LTS performancein many clinically useful measures. The PLMA has greater clinicalutility than the LTS during controlled ventilation.      

The effects of speed of injection on induction with propofol A comparison with etomidate

One hundred and eighty female patients received either propofol 2.5 mg/kg or etomidate 0.3 mg/kg injected over 20, 40 or 80 seconds for induction of anaesthesia after premedication with temazepam 20 mg. The mean induction times for both etomidate and propofol were significantly reduced with increasing speed of injection. The mean induction times for etomidate were significantly less than propofol at the slower rates of injection. At each speed of injection, the decrease in systolic, mean and diastolic arterial blood pressures with etomidate were less than with propofol. The decrease in systolic blood pressure was not significantly affected by injection speed for either drug. Apnoea occurred significantly more frequently with propofol than with etomidate at each speed of injection and the incidence of apnoea greater than 60 seconds with propofol was significantly higher when injected over 20 seconds than 80 seconds. The incidence of pain on injection was unaffected by injection speed for either drug. The incidence of myoclonus and (or) hypertonus was significantly higher following etomidate.     

Intubation with propofol augmented with intravenous lignocaine

Sixty patients of ASA grade 1 and aged 18 to 55 years were admitted to a double-blind study. Anaesthesia was induced with propofol 2.5 mg/kg after intravenous pretreatment with lignocaine 1.5 mg/kg or a similar volume of isotonic saline. The quality of subsequent tracheal intubation was graded and the pressor response to tracheal intubation assessed. There were no significant differences between treatment groups.     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Airway management of patients with tracheobronchial stents

The use of tracheobronchial stents for compromised large airwaysis increasing. We provide a case series highlighting some ofthe complications of airway management in patients with tracheobronchialstents in situ and propose an approach for dealing with thispotentially complicated situation.     

转子下截骨短缩全髋关节置换治疗髋关节发育不良

目的探讨股骨转子下截骨短缩人工髋关节置换治疗成人CroweIV型髋关节发育不良的临床疗效。方法CroweIV型髋关节发育不良患者18例24髋，均为女性，平均年龄46．8岁（38-55岁）。采用S-ROM或AML假体结合股骨转子下横断截骨短缩行人工关节置换术，按术前计划、股骨重叠情况及软组织和坐骨神经张力截除相应长度股骨。术前、术后行Harris评分及功能评价。结果全部病例随访9-72个月，平均29个月。Harris评分由术前41分增加到术后89分，优良率83．3％。髋旋转中心平均下降56mm，平均截骨短缩长度为31mm。截骨平均愈合时间为8个月。1髋术中、2髋术后并发股骨骨折，发生率12．5％，用加压钢板及钢丝固定，平均10个月后骨折愈合。术前Trendelenburg征均为阳性，术后15例阴性、3例阳性，转阴时间平均为13个月。单侧患者肢体不等长发生率为25％。无一例出现关节感染、假体松动、脱位、神经功能损伤等并发症。结论股骨转子下截骨短缩人工髋关节置换治疗髋关节发育不良高位脱位可避免坐骨神经损伤，单侧患者易形成肢体不等长，软组织平衡及肌力恢复需要一定时间，Trendelenburg征转阴时间长，易并发术中及术后股骨骨折，需用钢丝环扎预防。     

Spinal epidural abscess associated with moxibustion-related infection of the finger

OBJECTIVE: To describe a spinal epidural abscess that originated from cellulitis after moxibustion. METHODS: Case report. FINDINGS: A 78-year-old woman with diabetes mellitus was diagnosed with tetraplegia due to a cervical spinal epidural abscess extending to the thoracic spinal epidural space. The abscess was caused by osteomyelitis and cellulitis of the right third finger, which had been cauterized repeatedly with moxa. After surgical decompression and drainage of the spinal epidural abscess and comprehensive rehabilitation, motor strength and functional level improved. CONCLUSIONS: This case illustrates the risk of spinal epidural abscess in persons with diabetes mellitus who present with focal cellulitis and osteomyelitis.