选择性保脾治疗脾外伤的体会

目的总结脾外伤患者行保脾治疗的经验。方法回顾性分析197例脾损伤治疗的临床资料。结果 197例选择性非手术治疗87例,选择性手术保脾治疗110例,其中粘合胶加大网膜填压修补28例,脾动脉结扎脾修补24例,脾部份切除26例,脾切除自体脾片移植22例,腹腔镜脾修补10例。手术治疗发生并发症17例,其中粘连性肠梗阻4例,脾热10例,胰漏2例,脑梗塞1例。全部治愈出院。结论外伤性脾破裂保脾治疗,较好的保持了脾脏功能,值得推广。     

电视腹腔镜下行脾损伤的保脾治疗30例分析

目的　应用电视腹腔镜行脾损伤的保脾治疗。方法　在电视腹腔镜下行外伤脾凝固止血 +脾窝橡皮管引流。结果　本组 30例病人术后无一例发生再出血 ,平均住院 4～ 5天 ,术后随访病人情况良好。结论　应用电视腹腔镜行脾损伤保脾治疗是一种新的保脾治疗方法 ,它不仅可以明确诊断 ,判断脾脏损伤的程度 ,对于腹腔内出血量较少或较慢、损伤程度轻的脾损伤在腹腔镜下行止血术是安全可行的 ,它避免了不必要的开腹手术给病人带来的痛苦 ,同时它具有损伤小、恢复快、住院时间短的优点。     

保留脾脏胰腺体尾切除术的临床应用研究

目的 探讨保留脾脏胰腺远端切除术的手术适应证及临床意义.方法 回顾性分析75例因胰腺体尾部占位病变而施行保留脾脏胰腺远端切除术病人的临床诊疗资料.结果 本组75例均成功行保留脾脏胰腺体尾切除术,其中浆液性囊腺瘤18例、黏液性囊腺瘤15例,胰腺实性假乳头状瘤11例,慢性胰腺炎9例,导管内乳头状黏液性肿瘤8例(其中2例有恶...     

脾损伤的保脾手术72例

脾脏对感染和肿瘤的免疫作用日益受到重视 ,因此主张最大限度地保留脾组织或保留脾脏以期保留脾脏的功能。我院 1990至 2 0 0 0年共手术治疗脾损伤 72例 ,其中行保脾手术 41例 ,效果满意 ,现报告如下。1　资料和方法1 1　一般资料　 41例中男 37例 ,女 4例。年龄 9～ 5 4岁 ,平均年龄 36岁。闭合性腹部损伤 40例 ,9例合并腹腔外其它损伤。交通事故伤 32例 ,坠落伤 4例 ,殴伤 4例 ,1例胃大部切除术拉钩导致医源性脾损伤。受伤后距入院时间为 1～15ｈ ,入院时均有不同程度的休克表现。 35例术前经诊断性腹腔穿刺、Ｂ超或ＣＴ确诊 ,5例在剖腹探…     

Statewide variation in the treatment of patients hospitalized with spleen injury

HYPOTHESIS: Surgeons' treatment decisions for patients with spleen injuries in Washington State from January 1, 1990, through December 31, 1994, were different in rural compared with urban communities. DESIGN AND SETTINGS: Retrospective cohort analyses using the Death and Illness History Database for the state of Washington, which provides a cross-linked record of an individual's sequential hospitalizations. Counties were defined as metropolitan, urban, or rural on the basis of population density. PATIENTS: A total of 1905 patients (1927 hospitalizations) with an International Classification of Diseases, Ninth Revision, Clinical Modification, discharge diagnosis code of 865. MAIN OUTCOME MEASURES: Physician management decisions (perform a celiotomy or repair the spleen) were stratified by geographic region. RESULTS: Throughout the state, there was substantial variability in the treatment of spleen-injured patients. Factors associated with higher odds of splenectomy included older age, overall severity of injury, treatment in rural hospitals, and treatment in the earlier years of study. While the frequency of splenic salvage increased over time, hospital length of stay, rehospitalization, and 30-day mortality did not increase. CONCLUSIONS: Injury to the spleen is a common problem for which management decisions vary by geographic region, indicating that a single management protocol does not universally apply. To evaluate appropriateness of care by process measures, such as splenic injury management, will require that decision makers grant some latitude in management variability based on factors such as practice setting.     

保脾术治疗外伤性脾破裂的体会

目的 探讨外伤性脾破裂手术保脾治疗方法的选择及其治疗效果.方法 对2000年10月至2007年10月对19例外伤性脾破裂采用手术保睥治疗的临床资料进行回顾性分析.19例中脾损伤Ⅲ级11例,Ⅳ级7例,Ⅴ级1例,其中6例伴有不同程度休克.结果 19例均痊愈出院.其中2例为非手术保脾治疗期间因活动性出血而中转行脾切除后脾组织...     

选择性保脾术治疗小儿外伤性脾破裂16例体会

目的 为了避免免疫功能下降和继发感染的发生．在小儿外伤性脾破裂时采用选择性保脾术治疗。方法 采用选择性保脾术治疗16例小儿外伤性睥破裂，Ⅰ度伤8例．Ⅱ度伤5例，Ⅲ度伤3例，其中1例合并有左膈肌破裂。结果 本组16例保脾术均获成功．术后恢复顺利，痊愈出院，随访结果，疗效满意。结论 在外伤性脾破裂行保脾术中必须遵循“抢救生命第一，保留脾脏第二”的原则。手术成功的关键在于适当掌握手术适应证和术式的选择。     

外伤性脾破裂的手辅助腹腔镜手术技巧

目的 探讨手辅助腹腔镜技术在外伤性脾破裂治疗中的手术技巧.方法 2002年1月至2006年10月采用手辅助腹腔镜脾切除术治疗42例外伤性脾破裂,其中18例合并其他脏器损伤.结果 42例均手术顺利,无中转开腹手术;手术时间32～105 min,平均62 min;24例单纯性脾破裂患者术后平均住院7天,18例有合并伤者平均住院12.8天;无严重手术并发症及手术死亡.结论 手辅助腹腔镜脾切除术在外伤性脾破裂治疗中具有创伤小、手术时间短、操作安全等优点,熟练的手术技巧是手术成功的保证.     

前尿道损伤早期处理的治疗体会

目的 探讨前尿道损伤早期处理方式的选择.方法 回顾性总结2001年9月至2011年6月我科47例尿道损伤患者的临床资料,分析术后并发症及排尿情况.结果 47例患者随访41例,随访时间1～84个月,术后2～6周拔除尿管;采用膀胱穿刺造瘘术3例,留置导尿8例,输尿管镜尿道置管术18例,腔镜下尿道会师术4例,尿道修补术或断端吻合术14例(术后会阴伤口感染2例,尿漏2例),术后31例排尿良好,尿道狭窄10例,失访6例.结论 前尿道不全断裂首选输尿管镜尿道置管术,不成功时行腔镜下尿道会师术,而对于前尿道断裂仍宜行尿道断端吻合术.     

保留脾脏的胰体尾癌切除14例分析

目的探讨保留脾脏的胰体尾切除在脾及脾动、静脉未受侵的胰腺癌中的应用。方法回顾性分析1996-2002年我院行保留脾脏的胰体尾切除的14例胰体尾癌病人的临床资料,统计术后并发症、症状改善情况及生存期。结果手术后出现并发症3例,全组病人术后症状消失或明显改善,中位生存时间为46个月。结论保留脾脏的胰体尾切除术损伤小,术后并发症少,病人生存期延长,适用于脾脏及脾动、静脉未受侵的胰体尾恶性肿瘤病人。     

大肠癌根治术中脾脏误伤的防范及处理

目的 探讨大肠癌根治术中脾脏损伤的防范及处理。方法 对大肠癌根治术中９例病人损伤脾脏的原因及处理进行分析。结果 本组大肠癌术中脾脏损伤发生率为０．８１％，主要原因有：（１）为使近端结肠无张力吻合或处置时，在未游离脾结肠韧带或该韧带有粘连或挛缩时，强力牵拉结肠，致脾包膜撕脱（６例）；（２）麻醉不满意，或暴不满意时，为达到良好显露，用拉钩强力牵扯致脾脏挫伤（２例）；（３）粗暴探查致脾包膜撕裂（１例）。     

严重颅脑损伤伴脾破裂的诊治体会

本院自1996年11月至2003年11月期间,收治18例严重颅脑损伤伴脾破裂患者,诊治体会报告如下.     

The effect of the selective NMDA receptor antagonist traxoprodil in the treatment of traumatic brain injury

Traumatic brain injury (TBI) remains a major public health problem, and there is a great medical need for a pharmacological treatment that could improve long-term outcome. The excitatory neurotransmitter, glutamate, has been implicated in processes leading to neurodegeneration. Traxoprodil (CP-101,606) is a novel and potent glutamate receptor antagonist that is highly selective for the NR2B subunit of the NMDA receptor; it has been shown to be neuroprotective in animal models of brain injury and ischemia. A randomized, double-blind, placebo-controlled study was therefore conducted to assess the efficacy and safety of a 72-h infusion of traxoprodil compared to placebo in subjects with computed tomography scan evidence of severe TBI (GCS 4-8). A total of 404 males and non-pregnant females, aged 16-70, were treated within 8 h of injury. At baseline, subjects were stratified by motor score severity. The results showed that a greater proportion of the traxoprodil-treated subjects had a favorable outcome on the dichotomized Glasgow Outcome Scale (dGOS) at 6 months (delta 5.5%, OR 1.3, p = 0.21, 95% CI:[0.85, 2.06]) and at last visit (delta 7.5%, OR 1.47, p = 0.07, 95% CI:[0.97, 2.25]). The mortality rate with traxoprodil treatment was 7% less than with placebo treatment (OR 1.45, p = 0.08, 95% CI:[0.96, 2.18]). Differences between treatment groups were more pronounced in the severest subset (delta 11.8% for the dGOS at last visit and delta 16.6% for mortality). Traxoprodil was well tolerated. Although these results are intriguing, no definitive claim of efficacy can be made for traxoprodil for the treatment of severe TBI.     

The mechanism of spleen injury in rabbits with acute renal failure

Immune function disorders are common during acute renal failure (ARF), but the mechanisms are unknown. As the spleen is the largest organ of the immune system, we aimed to observe if there are morphological changes in the spleen in rabbits with ARF. In addition, we tried to explore its mechanism from the perspective of oxygen free radicals, nitric oxide (NO), myeloperoxidase (MPO), and membrane pump activities. ARF animal models were established by either hypodermic injection of 1.3 mL/kg bw 1% HgCl? or intramuscular injection of 10 mL/kg bw 50% glycerin. Animals were divided into 12 h, 24 h, and 48 h treatment groups with six rabbits in each group. Compared with control animals, congestion was found in the spleen and splenic trabeculae were increased in the two ARF model groups at multiple time points. The malonaldehyde, NO, nitric oxide synthase, and MPO levels in the ARF models were increased compared with the control group at 24 h or 48 h, and the superoxide dismutase and adenosine triphosphatase activities were significantly lower than the levels in the control group at multiple time points. These indices of free radical damage were induced gradually with ARF development, and there were statistically significant differences at different time points. These data suggested that histological damage of spleen during ARF may lead to immune disorders, which might be related to free radical injury, NO excessive release, polymorphonuclear neutrophils (PMN) sequestration, and membrane pump dysfunction.     

SPR治疗脊髓损伤后下肢痉挛的临床观察

目的:探讨采用选择性脊神经后根切断术(SPR)治疗脊髓损伤后下肢痉挛的效果。方法:16例患者术前3d进行步态分析,术中对支配痉挛下肢的L2～S1的脊神经后根进行分束,电刺激仪测阈值,将阈值较低神经束切断。神经根切断比例结合肌张力、肌力、体重及肌群功能进行量化,均小于30%。结果:术后步态有明显改善(P<0.01)。16例平均随访3年,痉挛解除率90%,功能改善率80%。结论:选择性脊神经后根切断术能较有效地治疗脊髓损伤后下肢痉挛。     

超选择性肾动脉造影与栓塞在急诊肾外伤中的应用价值

目的评价超选择性动脉造影与栓塞在急诊肾外伤中的临床应用价值。方法本组25例,其中6例为2个以上腹腔脏器损伤,15例有创伤/失血性休克。所有病例均作了急诊选择性动脉造影,22例行超选择性栓塞治疗,栓塞物为明胶海绵。3例经导管局部灌注立止血。结果22例经栓塞/或灌注立止血后,出血即止,经输血、扩容后血压和血红蛋白回升。1例栓塞术后仍间歇性出现肉眼血尿,经再次栓塞后血尿消失。1例肾刀刺伤伴肾蒂血管损伤以及1例严重左肾挫裂伤并胰尾损伤栓塞术后血压不回升,行患侧肾脏和胰尾切除。20例肾脏创伤栓塞术后3个月作IVU及ECT检查显示患肾功能正常。结论急诊选择性动脉造影和栓塞治疗对各种原因所致肾外伤出血,有诊断明确、止血迅速、疗效肯定、并发症少的优点,值得推广。