腰椎间盘术后椎间盘炎7例临床分析

目的探讨腰椎间盘术后椎间盘炎的发病原因与临床特征，总结腰椎间盘术后椎间盘炎的早期诊断与及时治疗。方法回顾我院1995—2004年发生椎间盘炎的7例患者临床资料。结果6例椎间盘炎经保守治疗获得治愈，1例因症状重，保守治疗1周无好转而经吸切置管冲洗引流而恢复。结论椎间盘术后椎间盘炎早期诊断，治疗及时，效果良好。     

腰椎间盘术后椎间盘炎2例

腰椎间盘手术已广泛开展 ,加之各种介入性操作的应用 ,使术后椎间盘炎的发生率有上升趋势 ,本院近 10年来在 70 0余例腰椎间盘手术中有 2例术后发生椎间盘炎。例 1,王某 ,女 ,年龄 3 8岁。术后 1周突发腰痛 ,阵发性抽搐样发作 ,一般止痛剂不能控制 ,血沉 60ｍｍ/ｈ ,ＣＴ示 :髓核残留。应用抗生素 3周无效 ,手术刮出肉芽 ,培养阴性。次日症状明显缓解 ,住院 2个月出院 ,随访优。例 2 ,路某 ,女 ,68岁。术后原症状消失 ,第 13ｄ突然出现腰部阵发性痉挛性剧痛。体温正常 ,切口无红肿 ,一期愈合。次日查血沉、ＣＲＰ、血常规均正常。立即大剂量…     

腰椎间盘术后椎间盘炎的诊断与治疗

目的：介绍腰椎间盘术后椎间盘炎的临床特点,讨论治疗方法。方法：对１３例术后椎间盘炎临床资料回顾,分析常见诊治失误原因。依靠临床体征、血沉、Ｃ—反应蛋白、Ｘ线、ＣＴ或ＭＲＩ建立早期诊断。非手术治疗治愈１０例,手术治疗治愈３例。结果：术后１１例随访６～３６个月。９例恢复原工作,４例遗有慢性腰痛或腰椎活动受限,２例不能胜任体力劳动。结论：早期诊断应重视术后再发剧烈腰痛的特殊体征。血沉、Ｃ—反应蛋白是提示感染或观察疗效的指标。Ｘ线、ＣＴ、ＭＲＩ有诊断价值。多数患者经严格卧床,大剂量广谱抗生素治疗效果满意。保守无效,炎症扩散出现相应临床症状者,应行病灶清除术。     

椎间盘镜下清创灌洗治疗腰椎间盘术后椎间盘炎7例观察

腰椎间盘术后并发椎间盘炎是脊柱外科一种严重的并发症，早期容易误诊漏诊，从而延误治疗，给患者带来极大痛苦，后期出现腰部僵硬，遗留慢性疼痛。本院自2000～2006年，共收治7例腰椎间盘术后椎间盘炎，采用椎间盘镜下清创灌洗引流，全部治愈。     

术后椎间盘炎的诊断与治疗

目的　研究术后椎间盘炎的诊断、治疗方法。方法　回顾分析 9例术后腰椎间盘炎的临床表现、实验室检查及影像学表现 ,比较单纯静脉抗感染治疗和早期PLD +静脉抗感染的疗效差异。结果　术后发病时间平均为 7.6± 5 .6天 ;主要临床表现为腰背部剧烈疼痛 ,血沉增快平均为 ( 5 8.6± 18.0 )mm/h ,C反应蛋白增高平均为 ( 68.2± 2 0 .3 ) μg/ml;影像学主要表现为椎间盘水肿 ,椎间隙变窄和邻近椎体破坏。 9例均临床治愈。PLD可迅速缓解腰背痛和缩短住院时间平均达 3 2天。结论　术后再发剧烈腰背痛应考虑椎间盘炎可能 ;C反应蛋白增高、血沉增快和MRI表现是早期诊断椎间盘炎的重要指征 ;PLD可较快缓解临床症状和缩短病程     

腰椎间盘术后椎间盘炎与早期活动的相关性(附16例报告)

目的探讨腰椎间盘术后椎间盘炎与早期活动的相关性。方法对我院自1986年1月至2006年12月行腰椎间盘髓核摘除术1 223例患者的临床资料进行回顾性分析。结果术后2周以内下地活动椎间盘炎的发生率为2.0%,2周以后下地活动椎间盘炎发生率为0.2%,差异有统计学意义(P<0.01);保守治疗10例,3~7月(平均5.6月)治愈。手术治疗6例,术后症状迅速缓解。结论椎间盘炎与术后早期活动明显相关,建议椎间盘术后卧床时间大于2周。一经确诊,宜早期行病灶清除术,可迅速缓解症状,减轻痛苦,缩短病程,并可避免免疫治疗的并发症。     

术后椎间盘炎

术后椎间盘炎浙江省中医院（３１０００６）童培建，严亚成腰椎间盘突出症行髓核摘除术后发生椎间盘炎并不少见，发生率各家报道不一，本组５例占同期手术病人的１．９％。它以剧烈腰痛给患者带来痛苦。临床资料本组５例，男３例，女２例；年龄最大５３岁，最小２９岁；术...     

肝内胆管结石外科治疗选择(附407例分析)

目的 探讨肝内胆管结石术式选择原则。方法 回顾性分析407例肝内胆管结石病人，根据结石分布类型和伴随的病理变化以解除梗阻、去除病灶、通畅引流为基本要求，采取术中胆道镜和术中B超相结合取石160例，无这两项辅助手段取石207例；肝切除去除病灶144例；胆管空肠Roux-en-Y吻合内引流92例；T管引流86例；肝切除 胆肠Roux-en-Y内引流62例；肝切除 T管引流82例。结果 术中胆道镜 术中B超取石组残石率4．3％，无辅助手段取石组残石率40％。随访1～10年，肝切除 内引流和单纯内引流组优良率分别为93．5％和80．43％，肝切除 T管引流组和单纯T管引流组优良率分别为95％和82．56％，统计学上有显著性差异，肝切组无论是否作胆肠内引流，优良率均无显著性差异。结论 肝内胆管结石手术应根据结石分布类型和伴随的病理变化以解除梗阻、去除病灶、通畅引流为基本要求，个体化地选择术式，术中应把时间和精力放在解除梗阻、去除病灶上，胆肠内引流只作为补助性治疗措施。     

肝胆管结石术后并发症的防治(附180例分析)

目的探讨肝胆管结石手术后并发症及其影响因素，合理选择肝胆管结石的术式，预防或减少肝胆管结石的术后并发症。方法对180例肝胆管结石手术术后并发症进行回顾性分析。结果本组肝胆管结石术后1～30d内79例(43．9％)发生术后并发症，发生率较高的术后并发症有残余结石(21．7％)、切口感染(11．1％)、胸水(10．0％)；在不同的术式中，单纯T管外引流术后并发症率为50．0％，胆肠内引流术为46．9％，肝叶段切除 T管外引流术为31．0％，肝叶段切除 胆肠内引流术为60．0％，肝叶段切除术后并发症率较低且易于处理；全组手术死亡率1．7％。结论肝胆管结石手术并发症多，发生率高，结石部位和手术术式是影响术后并发症的主要因素，肝区段切除术既能达到治愈肝胆管结石及由其引起的肝胆病理改变的目的，又能获得较低的术后并发症率；对常见的术后并发症提出预防措施，探讨手术技巧的改进。     

度洛西汀在术后镇痛中的应用

度洛西汀是一种5-羟色胺和去甲肾上腺素再摄取抑制药,近年有学者探索其用于术后镇痛。但由于度洛西汀的药理特性,可能引起术中高血压、出血增加、影响围术期药物代谢等,其用法相对保守。本文对现有研究中度洛西汀用于手术患者的作用机制、用药方案、不良反应等进行阐述,综合分析现有研究结果,以期为该药物的安全、高效应用提供参考。     

术后认知功能障碍发病机制的新进展

背景 术后认知功能障碍(postoperative cognitive dysfunction,POCD)是麻醉手术后出现的认知功能减退,经常发生在老年人群中,可影响生存质量,给社会带来沉重的负担.目的 探讨POCD发病机制的最新进展,以便降低其发病率.内容 综述POCD的定义并讨论其发病机制和危险因素.趋向 尽管POCD被普遍认为是多因素致病的结果,其主要发病机制仍不明确.老年人口的增加促使更多的研究关注POCD,以探索其潜在的发病机制,为防治其发生提供新思路.     

Treatment strategies for the surgical complications of thoracic spinal stenosis: a retrospective analysis of two hundred and eighty three cases

Purpose

Our aim was to investigate the causes of and treatment strategies for surgical complications of thoracic spinal stenosis.

Methods

Between May 1990 and May 2010, 283 patients with thoracic spinal stenosis were treated in our department. Three physicians were assigned to patient follow-up. Patient medical records and radiographs were reviewed. Complications were categorised as perioperative, mid- to long-term and donor-site.

Results

Follow-up was completed for 254 patients; 249 patients survived. Follow-up time ranged from one to 19 years, with a mean of six years and two months. There were 107 cases with complications an incidence rate of 42.1 %. Eleven cases were pulmonary infection, seven transient nerve-root injury, three pulmonary injury and one vertebral canal haematoma, all of which resolved. Thirteen cases of spinal cord injury postoperatively were treated using dehydration and corticosteroid therapy; eight recovered to the preoperation level, and five deteriorated. Eleven cases resulted in dural injury, and four led to cerebrospinal fluid leakage. There were five cases of wound-fat liquefaction and one of wound infection. Seven cases with deep venous thrombosis of the lower limb resolved by elevating the affected limb and administration of low-molecular-weight dextran. Seven cases of delayed wound healing recovered following change of dressings and antibiotic administration. Four cases of delayed bone-graft fusion recovered by extending the external fixation time. One case of bone-graft absorption was treated by iliac bone grafting and bracing. Two cases of internal fixation breakage were treated by removing the internal fixation.

Conclusions

Thoracic spinal stenosis surgery may result in various complications but has a good prognosis with proper treatment. The key points in reducing complications are the surgeon’s familiarity with operative imperatives and the appropriate surgical approach.     

前列腺增生经尿道电切术后出血的原因与处理(附55例报告)

目的：探讨经尿道前列腺电切术(TURP)治疗前列腺增生(BPH)术后出血的原因与处理方法。方法：对55例BPH患者TURP术后出血的原因进行分析,然后进行针对性的止血处理。结果：出血的原因主要有患者高龄、高危等和在治疗中处理失当等两个方面。38例经一般治疗后出血缓解;17例于电切镜下冲洗血凝块并电凝止血后好转,其中2例复发出血均为一般治疗好转后再发出血的患者。结论：全面的术前分析．准确的术中及术后处理,是减少BPH TURP术后出血的关键。     

Postoperative discitis following single-level lumbar discectomy: Our experience of 17 cases

Background:

The established protocols of treatment of postoperative lumbar discitis have not been validated till date. We report a retrospective analysis of a series of patients with discitis following single level lumbar discectomy. We analyzed the outcome of conservative treatment of postoperative discitis with the objective to define when and what surgery was required when the conservative treatment failed.

Materials and Methods:

A total of 17 cases of postoperative discitis treated from 2002 to 2009 were followed up and evaluated clinically, radiologically and by laboratory investigations. All the patients were treated initially conservatively with rest and antibiotic therapy after diagnosis and those who did not respond to conservative treatment of at least 4 weeks were treated surgically. The cases were followed up with serial C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), X-ray, computed tomography (CT) scan and magnetic resonance imaging (MRI) for at least 1 year.

Results:

The mean followup was 40.38 months (range 12-86 months). Four cases failed to respond to conservative therapy and were treated surgically. In three of these four cases, open debridement, transpedicular fixation and posterolateral fusion was performed, and in the fourth case percutaneous transpedicular fixation was done. In the former group, one case was diagnosed to be tubercular, in another case Staphylococcus aureus was cultured where as the third case culture was sterile. All operated patients showed evidence of interbody fusion at 1 year followup.

Conclusions:

Early detection and aggressive treatment are paramount in managing postoperative discitis and the majority do well with conservative treatment. Surgical management in the form of transpedicular fixation and debridement, when required, gives excellent results.     

Atrial fibrillation after surgery of the lung: clinical analysis of risk factors

Objective: The aim of this study was to determine which of the clinical parameters are the most valuable in predicting postoperative atrial fibrillation after lung surgery. Materials and methods: Retrospective analysis was carried out on 298 patients after pulmonary resection necessitated mainly by lung cancer. The following parameters were investigated: age and sex, disturbances of cardiac rhythm, history of ischemic heart disease, diabetes and atherosclerosis, NYHA classification and type of surgical procedure. In addition, the duration of surgery, variations in oxygen saturation, changes in systemic blood pressure and heart-rate were noted intraoperatively. Statistical analysis was performed using Fisher's exact test. Results and conclusions: Atrial fibrillation occurred in 25 cases (8.4%) and more frequently after pneumonectomy (24%). Other factors contributing to atrial fibrillation after lung surgery were: history of ischemic heart disease, congestive heart failure, intraoperative cardiac arrest and the need for rethoracotomy.     

经口寰枢椎手术后肺部并发症的相关因素分析

目的 探讨经口寰枢椎手术后肺部并发症(PPCs)的相关因素,为临床防治提供参考依据.方法 收集104例行经口寰枢椎术患者的临床资料,评价术后肺部并发症情况,分为PPCs组与非PPCs组,比较两组患者围术期观察项目的 差异性,并进行logistic回归多因素分析.结果 本组104例患者中23例出现PPCs,发生率22.1%.PPCs组与非PPCs组比较结果显示,气管导管留置时间、术中输液量、手术时间、气管切开、脊髓损伤程度(Frankle分级)、吸烟史、低蛋白血症(血清清蛋白＜35g/L)、低钠血症(血清钠＜135 mmol/L)及术前低体质量指数(BMI＜18.5)等9个因素差异有统计学意义;多因素分析结果显示,血清清蛋白＜35 g/L、气管切开、脊髓损伤程度(Frankle分级)、气管导管留置时间＞4 d、手术时间＞6 h等5个因素与PPCs有关.结论 血清清蛋白＜35 g/L、气管切开、脊髓损伤程度(Frankle分级)、气管导管留置时间＞4 d、手术时间＞6 h为PPCs的独立危险因素.     

几种有创方法用于胸外科术后呼吸道清洁的比较分析

目的 探讨几种有创方法用于术后进行呼吸道清洁的指征并比较其治疗效果.方法 回顾性分析2002年1月至2006年12月曾接受纤维支气管镜(简称纤支镜)吸痰、环甲膜穿刺置管、气管插管或气管切开的112例患者的临床资料.其中男性95例,女性17例;年龄14～81岁,平均年龄(65.2±11.1)岁.观察PaO2SpO2和肺不张的改善情况,并比较不同有创方式进行呼吸道清洁的治疗效果.结果 纤支镜吸痰组有效率40.0%(24/60),其中36例患者还需多次纤支镜吸痰或进一步的有创方式吸痰.气管插管组有效率31.2%(15/48),有11例患者还需环甲膜穿刺、22例患者需气管切开吸痰.气管插管组和纤支镜吸痰组的术后介入时间和疗效持续时间低于经环甲膜穿刺和气管切开组.结论 全面分析患者的病情有助于合理选择有效的有创呼吸道清洁方式.经气管插管和纤支镜吸痰在短期缓解患者症状方面有一定的作用,可作为胸外科术后有创方式吸痰的首选.