老年人自发性气胸的诊治体会

自发性气胸是呼吸系统常见急症之一,老年患者有着不同于青少年自发性气胸的特点,本研究总结了民航总医院胸外科2003年10月至2008年12月间收治的37例年龄60岁以上自发性气胸患者的临床资料,报道如下。     

老年人自发性气胸60例临床分析

老年人自发性气胸６０例临床分析江苏省溧阳市人民医院（２１３３００）曹小琳我院自１９８７～１９９２年，共收治自发性气胸１６４例，其中老年人自发性气胸６０例，与同期青年人自发性气胸５６例，进行对比分析如下。１临床资料１．１一般资料老年组６０例，男４８例，...     

老年人自发性气胸48例临床分析

目的探讨老年人自发性气胸的临床特点。方法对我院2001年1月至2008年11月收治的老年人自发性气胸48例临床资料进行回顾性分析，并和同期住院的青壮年气胸40例进行对照分析。结果（1）病因：老年组中慢性阻塞性肺病34例（70．8％）、肺结核9例（18．8％）、特发性气胸5例（10．4％），而对照组分别为10例（25％）、11例（27．5％）、17例（42．5％），老年组继发性气胸占89．6％（43／48），明显高于对照组，差异有显著性。（2）临床表现：老年组表现为胸闷气急45例（93．7％）、胸痛25例（52％），而对照组分别为27例（67．5％）、35例（87．5％），两组相比差异有显著性。（3）气胸类型及治疗：老年组交通性、张力性气胸多见、治疗常需胸腔闭式引流，而对照组以闭合性气胸多见，老年组平均肺复张时间为16．2天，远高于对照组的10．4天，差异有显著性。结论老年人以继发性气胸多见，临床表现不典型，误诊率高，须认真检查，及时进行有效的治疗。     

基层医院诊治自发性气胸的体会

自发性气胸为内科急症之一。特别是张力性气胸 ,处理不当 ,可危及病人生命。我院自 1995年 2月～2 0 0 0年 10月共收治自发性气胸 10例 ,总结如下。1　临床资料10例均经胸部 X线确诊为自发性气胸 ,男性 9例 ,女性 1例 ,年龄 17～ 76岁 ,发病诱因 :均有咳嗽及剧烈运动史。气胸类型 :闭合性 4例 ,交通性 4例 ,张力性 2例 ,左侧气胸 6例 ,右侧气胸 3例 ,双侧气胸 1例 ;肺压缩达 30 %以下 3例 ,30～ 75 % 4例 ,75 %以上 3例 ;初次发作 9例 ,复发 1例。基础疾病 :原发性 3例 ,肺结核 2例 ,慢支 5例 ,其中 1例合并肺心。治疗及转归 :本组病例全部…     

肺癌合并自发性气胸的诊治体会

目的探讨肺癌合并自发性气胸的相关治疗方法。方法分析37例肺癌合并自发性气胸的病人的相关资料。结果经胸腔闭式引流及胸腔注药22例1周内愈合,14例2周内愈合,1例感染死亡。结论采取合适的治疗方式可以提高肺癌合并自发性气胸的治疗效果,减少并发症。     

自发性气胸92例治疗体会

自发性气胸为临床急症之一,严重者可危及生命,需及时诊断、正确处理。我院自1995～2005年共收治92例,应用“胸腔穿刺引流” 吸氧治疗自发性气胸患者,取得了良好的临床效果,现将治疗体会总结如下。1临床资料本组92例,男75例,女17例,平均年龄(65.39±8.56)岁。气胸部位:右侧51例,     

老年人自发性气胸的临床表现及治疗体会

老年人气胸由于寿命的延长，慢支、肺气肿患增多而相应增多。笔对1988年8月～1995年4月我院收治老年(60～78岁)自发性气胸40例与同期青年(19～33岁)自发性气胸40例作对比，结果如下。     

AECOPD合并自发性气胸24例的临床诊治体会

目的提高医护人员对COPD急性发作合并自发性气胸的诊断水平。方法回顾我科2004年1月～2008年6月,共收治慢性阻塞性肺疾病急性发作期(AECOPD)合并自发性气胸24例,分析延误诊断的原因。结果20例治愈出院,2例因心肺功能衰竭死亡,3例因病情加重家属放弃治疗。结论AECOPD合并自发性气胸临床表现不典型,易误诊,对AECOPD患者应加强气胸认识,做常规胸部X线检查,以降低其误诊率。     

COPD合并自发性气胸42例诊治分析

自发性气胸(简称气胸)在临床上不难诊断,但慢性阻塞性肺病(慢阻肺COPD)患者并发气胸时,由于其肺部基础疾病表现明显,往往掩盖了气胸的症状和体征,是稳定期COPD急性加重的一个常见诱因,易误诊,且死亡率高。本文收集了我科2002～2005年32例COPD并发气胸的临床诊治报告如下。1临床资料本组32例中,男28例,女4例。年龄38～81岁,平均64.5岁。32例均有慢性支气管炎史,全部病例均符合COPD诊断标准[2],其中6例有肺结核病史,其诱因肺部感染18例,剧咳5例,用力或活动过猛3例,无明显诱因者6例。32例气胸中左侧13例,右侧18例,双侧1例。肺压缩<30%者…     

老年人自发性气胸79例临床分析

目的探讨老年人自发性气胸的临床特点、治疗及预后。方法对我院2000年1月—2009年12月间收治的79例老年人自发性气胸患者临床资料进行回顾性分析。结果老年人自发性气胸大多有肺部基础疾病,临床表现缺乏特异性,本组误诊为慢性阻塞性肺病急性发作4例、左心力衰竭2例、支气管哮喘1例。气胸类型为张力性气胸47例,闭合性气胸11例,交通性气胸21例。采用以肋间闭式引流为主的治疗措施,效果较好。结论老年人自发性气胸大多有肺部基础疾病,容易误诊,气胸的类型以张力性气胸多见,治疗多需排气减压术,及早的排气减压可望缓解症状,缩短肺复张时间,减少患者住院天数,降低病死率,提高老年人生活质量。     

胃窦血管扩张症致反复消化道出血一例

胃窦血管扩张症占非静脉曲张性消化道出血的4%,原因不明,多数患者无临床症状,消化道出血多为隐匿性出血,少见于急性出血,消化道大出血者罕见。本文报道一例内镜表现不典型的胃窦血管扩张症伴反复消化道出血病例的诊治经过。     

Acute calculous cholecystitis caused by Candida lusitaniae: an unusual causative organism in a patient without underlying malignancy

Candidiasis of the gallbladder is an uncommon cause of acute cholecystitis. Candidal cholecystitis is seen especially in patients with malignancies. In the present case, we report that acute calculous cholecystitis was caused by Candida lusitaniae in a 33-year-old patient without underlying malignancy. According to our review of the literature, this is the first report of acute cholecystitis caused by C. lusitaniae.     

Gastrointestinal bleeding caused by extrahepatic arterioportal fistula associated with portal vein thrombosis

An extrahepatic arterioportal fistula (APF) involving the gastroduodenal artery and superior mesenteric vein is rare and mostly results from iatrogenic injuries. The clinical symptoms associated with APFs may include abdominal pain, gastrointestinal bleeding, ascites, nausea, vomiting, diarrhea, or even congestive heart failure. We present the case of a 70-year-old man who presented with chronic abdominal pain and gastrointestinal bleeding secondary to APF and portal vein thrombosis. The endovascular embolization of APF was accomplished successfully, and symptoms of portal hypertension resolved immediately after intervention. Unfortunately, the patient did not respond well to anticoagulation therapy with warfarin. Therefore, the patient underwent implantation of a transjugular intrahepatic portosystemic shunt, and the complications of portal hypertension resolved. In conclusion, the embolization of APF is technically feasible and effective and can be considered the first-choice therapy in selected patients.     

Acute cholecystitis caused by Clonorchis sinensis

We are reporting a case of a 43-year-old Chinese male from Hong Kong, who came to see a doctor complaining of acute onset of severe upper abdominal pain. A diagnosis of acute cholecystitis was made and an emergency cholecystectomy was carried out. On opening the common bile duct, lancet-shaped worms were seen emerging from it. About 45 adult worms were collected and sent to the Department of Parasitology University of Malaya for identification. The worms were identified as Clonorchis sinensis. After the operation the patient was treated with praziquantel and he had an uneventful recovery.     

Eosinophilic cholecystitis caused by Ascaris lumbricoides

Eosinophilic cholecystitis is caused by the accumulation of eosinophils in the gallbladder wall and diagnosis is usually made based on histopahologic studies. The purpose of this paper is to comment on a case report published in World 3 GaslToenterol 2007 .July; 13 （27）： 3760-3762, about eosinophilic cholecystitis along with pericarditis without histopathological studies, which are considered necessary for its diagnosis.     

《2016年世界急诊外科学会急性结石性胆囊炎指南》摘译

胆结石在人群中非常普遍,目前急性结石性胆囊炎(acute calcolous cholecystitis,ACC)的诊断与治疗存在较大争议,学术上争论的焦点主要在于手术时机的选择.对于手术与保守治疗的选择,特别是针对高手术风险的患者,这方面的问题仍缺乏广泛的论证.其他方面的争议还包括:胆道系统结石的诊断方法与其诊断的必要性、治疗方法的选择、手术方式、高手术风险患者(澄清胆囊造口术的角色与作用)的诊疗.由此,世界急诊外科学会决定召开会议,以探究相关争议并明确ACC的诊疗方案.     

Timing of cholecystectomy for acute calculous cholecystitis: a meta-analysis

OBJECTIVES: To compare early with delayed cholecystectomy for the treatment of acute lithiasic cholecystitis: a meta-analysis of prospective randomized trials. METHODS: Pertinent studies were selected from the Medline, Embase, Cancerlit, HealthSTAR and Cochrane Library Databases, references from published articles, and reviews. Twelve prospective randomized trials (9 addressing open cholecystectomy and 3 laparoscopic cholecystectomy) were selected. Conventional meta-analysis according to the DerSimonian and Laird method was used for the pooling of the results. The rate difference (RD) (95% CI) and the number needed to treat (NNT) were used as a measure of the therapeutic effect. RESULTS: Cumulative operative and perioperative mortality and morbidity were 0.9% and 17.8%, respectively, for open cholecystectomy and 0% and 13.1%, respectively, for laparoscopic cholecystectomy. The pooled RD for operative complications in early surgery was 1.37% (95% CI =-3.78% to 6.53%; p= 0.2) for open cholecystectomy and 3.11% (95% CI =-15.10% to 8.87%; p= 0.6) for laparoscopic cholecystectomy. In laparoscopic cholecystectomy the cumulative conversion rate to open cholecystectomy was 21.5%. The pooled RD for conversion rate in early laparoscopic cholecystectomy was -7.99% (95% CI =-18.46% to 2.47%; p= 0.1; NNT = 13). Total hospital stay (mean +/- SD) was significantly shorter in the early surgery group (9.6 +/- 2.5 days vs 17.8 +/- 5.8 days; p < 0.0001). More than 20% of patients referred to delayed surgery fail to respond to conservative management or suffer recurrent cholecystitis in the interval period. CONCLUSIONS: Early operation (open or laparoscopic) does not carry a higher risk of mortality and morbidity compared to delayed operation and should be the preferred surgical approach for patients with acute lithiasic cholecystitis.     

Gastrointestinal infections caused by cytomegalovirus

Cytomegalovirus (CMV) is an important human pathogen, causing a variety of syndromes ranging from asymptomatic infections to life-threatening end-organ disease. Infections of the gastrointestinal tract are an especially common form of disease caused by CMV and are usually manifest as luminal infections, such as esophagitis or colitis. Solid organ disease caused by CMV is also known to occur, with hepatitis being the most common syndrome. The large majority of cases of tissue-invasive disease caused by CMV have been reported to occur in immunocompromised hosts. Patients at highest risk for serious CMV-mediated disease are commonly HIV infected, recipients of transplants, or are receiving potent immunosuppressive medications. Intriguingly, several recent reports have discussed the previously underappreciated role of serious forms of CMV-mediated disease occurring in immunocompetent patients. This paper reviews several recent reports addressing important aspects related to the diagnosis, treatment, and management of CMV infections of the gastrointestinal tract.