膈神经是维持呼吸功能的主要神经, 由颈3 ～5 神经组成, 在维持正常通气功能中占有重要的地位。膈肌位于胸腔和腹腔之间, 为向上膨隆呈穹窿形的扁薄阔肌, 是主要的呼吸肌, 在呼吸运动中起着非常重要的作用。膈肌起搏即通过电刺激膈神经或膈肌使膈肌收缩, 维持患有膈肌功能障碍患者的自然负压呼吸。自发现电刺激能引起膈肌收缩至今已有200 多年历史, 该技术应用于临床也已有60 余年历史[1] 。
目的:探讨双猪尾型输尿管内支架(Double pigtail stent,DPS)作为泌尿外科上尿路疾病手术辅助治疗的适应症、并发症及并发症的治疗。方法:总结我院2004年6月至2008年12月共122例施行输尿管内支架放置术患者的适应症、并发症及并发症的治疗结果。结果:24例患者(19.6%)在置管期间出现1个或以上并发症。主要并发症包括肉眼血尿(9例)、疼痛(16例)、膀胱刺激征(12例)、高热(1例)。大部分并发症是轻微和可以耐受的,并迅速得到了适当的处理。2例须拔除内支架,其中剧烈疼痛1例、高热1例。结论:DPS用于上尿路疾病手术辅助治疗是安全和有效的,DPS引起的并发症大部分易于处理。
Abstract： Objective To introduce the early experience of using vacuum-assisted closure （VAC） in the treatment of wound dehiscence after thoracic and cardiovascular surgery. Methods This report retrospective1y analyzed the clinical data of 12 patients who underwent VAC in the treatment of wound dehiscence after thoracic and cardiovascular surgery in the Affiliated Hospital of the Logistics University of CAPF between October 2010 and October 2011. There were 7 male patients and 5 female patients with their mean age of 64.3 years （ranging from 39 to 80 years）. All patients underwent operation via median sternotomy or lateral thoracic incision. All the wound dehiscence was deep to sternum or rib. After debridement of necrotic tissue, the wound surfaces were covered with VAC sponges, and intermittent negative pressure therapy was used. The VAC sponges were changed every 7-10 days. Results All the patients underwent an average of 2 times to change the VAC sponges during VAC treatment. After VAC treatment, the edema around the surgical wounds gradually disappeared, and the granulation tissue was refreshed. The overall conditions of all the patients were improved. The patients could leave their bed, walk in the ward, and look after themselves. Antibiotic treatment was no longer used. The residents checked up the negative pressure system every day to see whether it worked well. The patients were no longer afraid of changing dressing and pain every day. All the patients were healed, discharged from the hospital and followed up at outpatient department for a mean time of 7 months. Their wounds all healed well during follow-up. Conclusion VACsystem is easy to use. It can facilitate the healing of wound dehiscence quickly, decrease the inflammatory reaction of local wound and the body, and shorten the rehabilitation time. It’s also helpful to reduce the residents’ work load. It is recommended in the treatment of wound dehiscence after thoracic and cardiovascular surgery.
Objective To discuss the key issues in the diagnosis and treatment of degenerative disc disease and thetherapeutic effect of transforaminal lumbar interbody fusion on it. Methods From September 2004 to August 2006, 15 cases of degenerative disc disease were treated by transforaminal lumbar interbody fusion, including 8 males and 7 females with the age of 33-46 years. All cases were single-level degenerative disc diseases, including 1 case of L3,4, 8 cases of L4,5 and 6 cases of L5, S1. The course of the disease was 2 -10 years. Preoperatively, the score of visual analogue scale (VAS) was 8.9 ± 1.8 and the score of Oswestry disabil ity index (ODI) was 51.4 ± 8.3. All patients had received normal conventional treatment for at least 3 months and had no therapeutic effect before operation. Results The operation time was 120-180 minutes (150 minutes on average) and the intra-operative blood loss was 200-500 mL (360 mL on average). There was no severe compl ication, except that the muscle tone of anterior tibia in one case decreased to the third level, which recovered to the 5- level 3 months after operation. A total of 15 cases were followed up for 12-24 months (18 months on average). All patients got interbody bony fusion 12 months after operation with the fusion rate of 100%. Postoperatively, the score of VAS was 2.8 ± 1.6 and the score of ODI was 19.1 ± 3.2, indicating there were significant difference in comparison with postoperative ones (P lt; 0.05). The improvement rates of postoperative VAS and ODI were 61.8% ± 7.3% and 64.3% ± 5.5%, respectively. For the therapeutic effect, 6 cases were regardedas excellent, 8 good, 1 fair, and the choiceness rate was 93.3%. All patients resumed their jobs and normal l ives. Conclusion Transforaminal lumbar interbody fusion is effective for the treatment of lumbar degenerative disc disease, but the indications for operation must be strictly defined.
Obstractive To observe the clinical effects and safety of endobronchial electrocautery treatment for tracheobronchial obstructive lesions in inoperable tracheobronchial squamous cell carcinoma.Methods Ninety-five patients with advanced and inoperable tracheobronchial squamous cell carcinoma were included. Thirty-four patients with central airway obstruction were treated with endobronchial electrocautery plus chemotherapy ( group A) and 61 patients without central airway obstruction were treated with chemotherapy alone ( group B) . The chemotherapy consisted of cisplatin or carboplatin, plus another thirdgeneration chemotherapy agent. Results In groug A, there were mean improvements in FEV1 of 41. 1% and in peak expiratory flow( PEF) of 65. 6% . There was no significant difference in the survival rates of the patients with and without central airway obstruction. Median survival time of group A was 11. 3 months and those of group B was 11. 6 months. 3, 6, and 12-month survival rates in group A were 87% , 68% and 39% respectively, and those in group B were 93% , 76% , and 45% respectively. Conclusion Endobronchial electrocautery is an effective and safe approach for inoperable tracheobronchial obstructive malignancies with few complications.
ObjectiveTo investigate the association between colorectal adenoma (CRA) and colorectal cancer (CRC), and to analyze the main pathogenesis of CRA, in order to identify and control the key factors of CRA and reduce the incidence of CRC. MethodThe studies on the mechanism of CRA in recent years were searched and summarized, focusing on the interaction of inflammation, genetic and epigenetic changes, gut microbiota and lipid metabolism, and their effects on the development of CRA. ResultsInflammation, genetic and epigenetic changes, intestinal flora and lipid metabolism play an important roles in the occurrence and development of CRA. These factors had a significant impact on the formation and progress of CRA at different stages through complex interaction, and had potential application value in preventing CRC. ConclusionsMany factors participate in the occurrence and development of CRA and plays an important role, which provide reference for future research and clinical intervention.
Objective To assess the performance of post-disaster reconstruction of Yushu earthquake at the first anniversary, so as to summarize the Yushu modes of post-disaster reconstruction and provide references for reconstruction work after extreme natural disasters at home and abroad. Methods All the materials seen during the first year after Yushu Earthquake were collected, such as all documents, information notifications and work reports issued by the Central Government and the Ministry of Health, and all the information from the website of News Office of the State Council, the Ministry of Health, Qinghai Provincial People’s Government, and Xinhuanet. The literatures about Yushu Earthquake were also searched from CNKI. All the data were retrospectively analyzed to describe the reconstruction tasks and summarize the effectiveness. Results?a) The reconstruction faced upon special difficulties, including short construction time, cold climate and hypoxia, poor transport, lack of construction resources, economic backwardness, weak logistics and higher cost of reconstruction; b) The performance was significant, e.g., the government completed an investment of 5.01 billion yuan. The goal of urban and rural housing construction was fully completed. Public and municipal infrastructure construction made an important breakthrough. The projects related to livelihood were rapidly implemented. The counterpart’s education at remote was basically completed. Conclusion?As the largest reconstruction in the highest altitude area after a magnitude 7.0 earthquake, Yushu’s reconstruction learns from the experience in Wenchuan, keeps the foothold of its own features and conditions, challenges the limits of high altitude with cold and hypoxia climate, forms a post-disaster reconstruction mode with Chinese characteristics, demonstrates the speed and quality of reconstruction, and provides the valuable experience for domestic and foreign counterparts.
Objective To enhance the understanding of pulmonary hemangiopericytoma. Methods With a case report and reviewing related literatures, the etiology, clinical manifestations, radiological features,pathological features, diagnosis, treatment and prognosis of pulmonary hemangiopericytoma were discussed.Results The etiology of this rare disease remains unknown. Clinical symptoms are rare and non-specific.Radiological features show a round, homogeneous, soft-tissue mass without calcification. Pathologic feature reveals a large number of capillary lumen, and some tumors can be dressed with pseudo capsule or show infiltration growth to the surrounding tissue. The diagnosis of pulmonary hemangiopericytoma is mainly based on the imaging findings, and pathological examination is needed for final diagnosis. The best choice of treatment is surgery, combined with chemotherapy and radiotherapy.Conclusions Pulmonary hemangiopericytoma is rare and often misdiagnosed as other pulmonary diseases. More attention should be paid to improve its therapeutic effect and prognosis.
To compare the effectiveness of microdiscectomy and macrodiscectomy on the single-level lumbar disc protrusion (LDP). Methods Between November 2002 and October 2005, 241 patients with LDP underwent 2 surgical procedures: microdiscectomy (group A, 93 cases) and macrodiscectomy (group B, 148 cases). All patients had singlelevel LDP. In group A, there were 51 males and 42 females with an average age of 32.3 yeares (range, 18-47 years); there were 23cases of protrusion, 52 cases of prolapse, and 18 cases of sequestration with an average disease duration of 8.5 months (range, 1-18 months), including 8 cases at L2,3 level, 11 cases at L3,4 level, 35 cases at L4,5 level, and 39 cases at L5, S1 level. In group B, there were 81 males and 67 females with an average age of 31.8 years (range, 16-50 years); there were 37 cases of protrusion, 85 cases of prolapse, and 26 cases of sequestration with an average disease duration of 9.3 months (range, 1-20 months), including 9 cases at L2,3 level, 15 cases at L3,4 level, 63 cases at L4,5 level, and 61 cases at L5, S1 level. There was no significant difference in age, sex, segment level, type, or disease duration between 2 groups (P gt; 0.05). Results Immediate back and sciatic pain rel ief was achieved in 225 (93.4%) patients after operation. The satisfactory rates were 91.4% in group A and 87.8% in group B at 1 week after operation, showing no significant difference (P gt; 0.05). The length of incision, amount of bleeding, amount of drainage, and hospital ization time in group A were significantly fewer than those in group B (P lt; 0.05); while the operative time in group A was longer than that in group B, but showing no significant difference (P gt; 0.05). Dural laceration occurred in 4 cases of groupA and 5 cases of group B, superficial infections of incision occurred in 5 cases of group B and intervertebral space nfections occurred in 4 cases of group B, and epidural hematoma occurred in 1 case of group A. The perioperative compl ication rate (5.4%, 5/93) in group A was significantly lower (P lt; 0.05) than that in group B (9.5%, 14/148). LDP recurred in 4 cases (4.3%) of group A and in 9 cases (6.1%) of group B postoperatively, showing no significant difference (P gt; 0.05); of them, 11 cases received second operation and 2 cases were treated conservatively. All cases were followed up 36-77 months (mean, 51.4 months). There were significant differences in visual analog scale (VAS) and Oswestry disabil ity index (ODI) between 2 groups at the last follow-up and preoperation (P gt; 0.05), but there was significant difference in VAS at 1 week postoperatively between 2 groups (P lt; 0.05). VAS and ODI were obviously improved at 1 week and last follow-up when compared with preoperation (P lt; 0.05). There was no significant difference in the improvement rates of VAS and ODI between 2 groups at last follow-up (P gt; 0.05). According to cl inical evaluation of Modified Macnab criteria, the excellent and good rate was 90.3% in group A and 86.5% in group B at final follow-up (P gt; 0.05). Conclusion Both macrodiscectomy and microdiscectomy are effective for LDP, furthermore microdiscectomy is less invasive than macrodiscectomy. Microdiscectomy is recommended to treat single-level LDP.
Objective To establ ish sophisticated three-dimensional finite element model of reconstructing the whole pelvis and defects in pelvis caused by the resection of periacetabular tumor, and to research the stress distribution regularity ofthe pelvis reconstructed by the fibular transplantation through three different internal fixation techniques. Methods The CTdatasets including L3 to middle-femur, unilateral fibular and internal fixation system from 1 healthy 35-year-old male volunteer were collected to establ ish finite element models of reconstructing the pelvis after the resection of periacetabular tumors through 3 different internal fixation means, namely fibular with plates, pedicle-rods and sacral-il iac rods. Bilateral leg standing position was simulated, then vertical load of 500 N was imposed on the surface of L3, the stress distribution regularity of reconstructed pelvis, transplanted fibular and internal fixation system were evaluated. Results The finite element models of the pelvis reconstruction after resection of periacetabular tumors were establ ished. The stress concentration of transplanted fibular was extremely high in the vicinity of the host junction sites. For the three internal fixation systems, the connection between steel plate and screw or between titanium bar and screw inclined to have stress concentration; and when the titanium bar was adopted to reconstruct, the transplanted fibular and the healthy side of femoral neck had less stress concentration, while sacral-il iac rods had the most obvious stress concentration. Conclusion For the reconstruction pelvis, the three fibula transplantation and steel plate internal fixation are consistent with intact state of pelvis in terms of the stress distribution, which is a relatively good method for the treatment of bone defect after periacetabular tumor. The finite element model can be used as a tool for the pelvis biomechanics research.