目的 探讨围手术期处理措施在胆管损伤（BDI）治疗中的作用。方法 分析我院1990年7月至2008年7月期间46例BDI患者的临床资料。结果 46例BDI患者术中发现32例，术后发现13例，1例外伤所致。2例BDI患者行二期胆管修复术后，死于漏胆引起的弥漫性腹膜炎及全身衰竭，1例十二指肠降部憩室手术胆胰管损伤死于并发症，2例胆肠吻合因反复胆管炎死于全身衰竭。结论 除手术措施外，围手术期处理措施对BDI预后有重要影响。应及时发现并处理BDI，术中胆管造影对诊断和治疗有指导意义，术后发现BDI并严重腹腔感染者，围手术期应选择恰当的非手术处理措施有效控制病情后决定手术时机。
摘要:目的:探讨老年人梗阻性大肠癌的围手术期处理。方法:回顾性分析2003年至2008年间71例60岁以上老年人梗阻性大肠癌的围手术期处理情况。 结果:术前发现并存病者43例,术中出现并发症19例,术后发生并发症37例得,除5例死亡外,均得到有效控制,死亡原因与并存疾病有关。结论:加强围手术期处理,积极治疗并存疾病,老年人梗阻性大肠癌的治疗同样能取得满意的效果。Abstract: Objective:To study the perioperative measures for the aged patients with Obstructive Colorectal Cancer. Methods: Seventyone cases above 60 years with Obstructive Colorectal Cancer were analysed retrospectively on their individual accompanied diseases and perioperative treatments, from 2003 to 2008.Results: Fortythree cases of them had suffered from other diseases. Midoperative complications occurred in 19 cases. Postoperative complications occurred in 37 cases. Except 5 cases of death, complications occurring in others cases were well controlled. The death causes mainly were correlated with accompanied chronic diseases. Conclusion: Strengthen care, active management of other chronic diseases are important significantly for senile patients with colorectal carcinoma to get satisfied outcome.
ObjectiveTo summarize the individualized selection of surgical treatment strategies and the key points of perioperative management for patients with heart valve disease complicated with severe chronic heart failure.MethodsThe clinical characteristics of 5 male patients with valvular heart disease complicated with severe chronic heart failure (CHF) were analyzed retrospectively from June 2017 to October 2018 in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, with an average age of 60.21 years.ResultsFive patients were given angiotensin receptor and neprilysin inhibitor (ARNI)-based anti-heart failure treatment after admission. The operation mode of these patients was decided to be valve replacement under cardiopulmonary bypass after individualized evaluation of patients’ improving symptoms. Three patients were treated with intra-aortic balloon pump (IABP) and continuous renal replacement therapy (CRRT) early after operation to assist patients in improving cardiac function. Five patients recovered oral anti-heart failure after awakening. All patients were discharged smoothly 2 weeks after operation.ConclusionIndividualized evaluation is needed for the choice of operation timing and mode, standardized preoperative treatment for heart failure, shortening the aortic blocking time during cardiopulmonary bypass, and early application of left ventricular adjuvant drugs or instruments are all important measures to help patients recover smoothly.
目的 了解单纯胆囊切除术患者围手术期抗菌药物的使用情况及合理性，促进临床合理用药。 方法 对昆明医学院第二附属医院2004年7～9月期间出院的661例单纯胆囊切除术患者应用抗菌药物的合理性进行回顾性分析。结果 胆囊切除患者抗菌药物应用共涉及9大类39个品种，使用率为100%。预防用药380例（57.49%），其中单用38例(10.00%)，平均用药6.55 d，平均住院时间10.79 d； 两联281例(73.95%)，平均用药6.49 d，平均住院时间12.30 d； 三联57例(15.00%)，平均用药6.52 d，平均住院时间11.75 d； 四联4例(1.05%)，平均用药6.75 d，平均住院时间9.00 d。感染治疗281例(42.51%)，其中单用10例(3.56%)，平均用药9.60 d，平均住院时间15.10 d； 两联206例(73.31%)，平均用药11.25 d，平均住院时间15.79 d； 三联56例(19.93%)，平均用药15.23 d，平均住院时间15.23 d； 四联9例(3.20%)，平均用药13.00 d，平均住院时间21.78 d。结论 单纯胆囊切除术患者抗菌药物使用存在一些不合理现象，应按围手术期给药方案进行。加强抗菌药物使用的管理和监督，不仅减少耐药菌株及不良反应的产生，而且对降低医药费用具有积极的意义。
Objective To investigate the surgicalmethod and perioperative treatment for senile lumbar disease accompanied by internal disease. Methods From June 2000 to December 2003,the complete neurological and physical examinations were performed on the patients before operation, as treatment of internal diseases could improve the patients’ conditions. Lumbar operations were performed on 125 patients, among whom 23 had simple lumbardisc herniation, 13 had lumbar spine stenosis, 81 had lumbar disc herniation with lumbar spine stenosis, and 8 had spondylolisthesis.The JOA score was 116±2.5. There were 3 patients undergoing fenerstration+discectomy, 16 undergoing semilaminectomy+discectomy,82 undergoing total-laminectomy+disectomy, 5 undergoing total-laminectomy+disectomy+pedicle fixation, 11 undergoing lamina decompression+nerve-root pathyway decompression, and 8 undergoing pedicle screw fixation+bone graft and fusion in spondylolisthesis. Results With an effective medical treatment, the internal disease produced little effect on the operation. Improved functions and bone fusions were observed after- operation. According to the JOA standards, the average alleviation rate was 87.9%. Conclusion Early neurological examination and proper treatment of internal diseases are the keys to the successful operation on the senile patients with lumbar disease. Radiological data are important in avoidance of mistaken diagnosis.