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Vitreous surgery for severe ocular trauma

Objective To summarize the visual outcome of patients with severe ocular trauma treated with vitreous surgery. Methods Clinical data of 188(191 eyes) with severe ocular trauma treated with vitreous surgery in a period from November 1996 to April 1998 were analysed retrospectively. Results The study included penetrating injury in 56 eyes, foreign bodies in the posterior segment in 70 eyes, blunt injury in 41 eyes , and globe rupture in 24 eyes. Main complications included endophthalmitis in 35 eyes, choroidal bleeding in 20 eyes, retinal detachment in 60 eyes, and vitreous hemorrhage in 97 eyes. Post-opera-tively, out of 188 eyes, except for 3 of patients too young to examine, visual acuity improved in 133(70.7%), including 85(45.2%) with visal acuity 0.02-1.0, 46(24.5%) remained unchanged; and 9(4.8%) had worse vision. Among 34 with no-light-perception, 12 had light-perception or over. Conclusion A majority of severe trauma eyes can be salvaged with considerable visual recovery after adequate and timely vitreous surgery. (Chin J Ocul Fundus Dis,1999,15:4-6)

Clinical Preliminary Observations on Laparoscopic Staging of Gastric Cancer

目的：探讨腹腔镜检查对胃癌分期的价值。方法: 2007 年1月至2007 年11 月收治的胃癌患者14 例胃癌患者在全麻下行腹腔镜检查。结果: 腹腔镜T分期与术后病理检查结果符合率为92.9％，术前临床T分期与术后病理检查结果符合率为64.3%。腹腔镜分期显著优于临床分期Plt;0.05。在14例术前临床分期均未发现腹膜转移的病例中，腹腔镜探查发现有腹膜转移（P1-P3）者4例，腹腔镜对腹膜转移的评估显著优于临床分期P lt;0.05。结论: 腹腔镜可作为常规检查手段的一种补充，能对进展期胃癌进行准确的诊断和分期，有助于手术决策制定及估计治疗结果与预后，避免不必要的剖腹探查。

远节指骨内生性软骨瘤临床分析

总结远节指骨内生性软骨瘤的临床特点及治疗方法。 方法 2000 年1 月－ 2008 年4 月，收治7 例远节指骨内生性软骨瘤患者。男2 例，女5 例；年龄5 ～ 35 岁。中指3 例，环指2 例，示、小指各1 例。其中4 例多发，合并其他掌、指骨内生性软骨瘤；3 例单发。术中取手指侧方入路，刮除肿瘤，其中2 例肿瘤横径gt; 1 cm 者移植冻干异体髂骨块修复肿瘤刮除后造成骨折和骨缺损。 结果 术后切口均Ⅰ期愈合。患者均获随访，随访时间6 ～ 24 个月。患指外形均满意，骨质均愈合，肿瘤无复发。除2 例植骨患指因固定时间较长，远指间关节屈伸受限外，余患指活动无明显影响。 结论 远节指骨内生性软骨瘤早期手术可获得良好效果。

高血压脑出血手术治疗78例临床分析

目的:观察高血压脑出血患者的外科治疗效果。方法:回顾性分析78例高血压脑出血患者的手术方法及术后随访结果。结果: 本组78例术后3个月随访中死亡9例(11.5%), ADLⅠ级13例(16.7%),Ⅱ级19例(244%),Ⅲ级25例(32.1%),Ⅳ级9例(11.5%),Ⅴ级3例(3.8%)。结论: 不同类型的高血压脑出血应及时采取外科手术治疗。

十二指肠损伤55例诊治体会

摘要:目的: 探讨十二指肠损伤的诊治方法。 方法 : 对我院1990～2006年收治的十二指肠损伤55例的临床资料作回顾性分析。 结果 :本组闭合性损伤45例,开放性损伤10例,行单纯缝合术40例,Rumeny吻合术2例,十二指肠憩室化5例。本组全部治愈。 结论 :十二指肠损伤的早期诊断和及时手术处理是非常重要的。十二指肠修补术、空肠十二指肠RouxenY吻合术是较实用的手术方法。合理运用十二指肠腔内减压,可防止肠瘘发生。

肾透明细胞癌支气管腔内转移一例

Curative effects of vitreoctomy and scleral buckling on retinal multiple-tear detachment associated with tracted anterior flap

Objective To evaluate the curative effects of vitreoctomy or simple scleral buckling on retinal multiple-tear detachment associated with tracted anterior flap. Methods The clinical data of 89 eyes in 89 patients with retinal multiple-tear detachment associated with tracted anterior flap diagnosed in Jan, 1999-Jan, 2002 were retrospectively analyzed. In the 89 patients, 41 had undergone vitreoctomy and 48 had undergone scleral buckling without vitrectomy. In the duration of 2- to 36-month follow-up with the mean of (11.02±7.90) months, visual acuity, retinal reattached rate and postoperative complication were examined and the results in the 2 groups were compared. Results In 41 eyes underwent vitreocotmy, successful reattachment was found in 38 (92.7% ); visual acuity increased in 33 (80.5%), didn′t change in 6 (14.6%), and decreased in 2 (4.9%); leakage of flocculent membrane in anterior chamber occured was found in 2 (4.9%), complicated cataract in 3 (7.3%),and severe proliferative vitreoretinopathy (PVR) in 3 (7.3%). In 48 eyes underwent scleral buckling, 41 (85.4%) had success reattachment; visual acuity increased in 36 (75.0%), didn′t change in 4 (8.3%), and decreased in 8 (16.7%); leakage of flocculent membrane in anterior chamber was found in 6 (12.5%), complicated cataract in 9 (18.8 %), and severe PVR in 8 (16.7%). Conclusion There isn′t any difference of the success rate of the surgery between vitrectomy and scleral buckling for retinal multiple-tear detachment associated with tracted anterior flap.The better visual acuity and less complications are found in the vitrectomy gro up than those in the scleral buckling group. (Chin J Ocul Fundus Dis，2004，20：209-211)

肺浆细胞瘤一例

一期手术纠治主肺动脉窗及伴发畸形

目的 总结一期手术纠治主-肺动脉窗及伴发畸形的临床经验,以提高手术疗效。 方法 我科共收治26例主-肺动脉窗患者，男14例，女12例；年龄1.4±1.6岁；体重7.8±3.8kg。其中单纯主-肺动脉窗8例，合并主动脉弓中断、右肺动脉异常起源于主动脉、法洛四联症、房间隔缺损、室间隔缺损、二尖瓣反流和气管狭窄等18例。25例患者一期手术经主动脉切口补片关闭瘘口纠治主-肺动脉窗，同时纠治伴发的畸形；1例放弃治疗。 结果 全组无手术死亡。2例伴主动脉弓中断、动脉导管未闭和右肺动脉起源于升主动脉的新生儿术后3d延迟关胸；1例术后出血，3h后再次开胸止血。术后随访22例，随访时间1个月～4年。所有患者无明显的主动脉瓣上狭窄和肺动脉分支狭窄，2例残留轻度二尖瓣反流，1例残留轻至中度二尖瓣反流。 结论 主-肺动脉窗患者早期易发生肺动脉高压，一经诊断应立即手术。手术方式首选修补主肺动脉窗及一期纠治伴发畸形。尽管主-肺动脉窗可合并各种心内外畸形，但早期手术纠治可获得较好的中长期疗效。

EXPERIMENTAL STUDY ON SURGICAL OPERATION AND HYPOPHOSPHATEMIA

Objective To investigate the relationship between surgical operation and hypophosphatemia, to observe the possible damage of hypophosphatemia and to assess the value of postoperative phosphate supplementation. Methods Sixty four male SD rats were randomly divided into 2 groups, Group Ⅰ, drinking a specially prepared solution to reduce their phosphate storage, Group Ⅱ, drinking water as a control. All received common bile duct ligation 3 weeks later. The serum biochemical data including phosphate level were obtained before and after operation. Then half of rats in each group were supplied with NaH2PO4 5-day survival rates were analyzed with statistic methods and their vital organs were observed under electron microscope. Results The phosphate level of each group was descended after operation. The group with phosphate shortage before operation (group Ⅰ) had a greatest fall of phosphate and average arterial pressure. The phosphate-supplied rats had a minor change of vital organs under electron microscope scan and higher 5-day survival rate compared to others in this group.Conclusion Abdominal surgery may induce postoperative hypophosphatemia, especially when the phosphate has been lacking before operation. Severe hypophosphatemia, superimposed on surgical trauma, enhances the damage to the body. Prompt supplement of phosphate will improve the prognosis of surgical operation.