随着人口老龄化速度越来越快,骨质疏松合并退变性脊柱侧凸越来越成为老年人的一种常见疾病,对于此类疾病,保守治疗和手术治疗效果不尽相同。但是由于患者往往年龄偏大,因此在选择治疗方案时要格外慎重,同时围手术期的管理也尤为重要。...随着人口老龄化速度越来越快,骨质疏松合并退变性脊柱侧凸越来越成为老年人的一种常见疾病,对于此类疾病,保守治疗和手术治疗效果不尽相同。但是由于患者往往年龄偏大,因此在选择治疗方案时要格外慎重,同时围手术期的管理也尤为重要。但需要明确的是,不管是行保守治疗或是手术治疗,患者都应进行严格的抗骨质疏松治疗。With the aging of the population, osteoporosis combined with degenerative scoliosis has become a common disease in the elderly, and the effect of conservative treatment and surgical treatment for this disease is not the same. However, because patients tend to be older, careful treatment should be chosen, and perioperative management is particularly important. However, it should be made clear that patients should be treated with strict anti-osteoporosis therapy, regardless of whether they are treated conservatively or surgically.展开更多
腰椎椎体间融合术是常用的一种治疗腰椎间盘突出、腰椎椎管狭窄等疾病的手术。该术式在临床上应用广泛,但术后大多数患者都会出现不同程度的肠道功能障碍,尤其在腰椎后路融合术更常见,如:术后腹胀、便秘等症状,目前关于该并发症尚未有...腰椎椎体间融合术是常用的一种治疗腰椎间盘突出、腰椎椎管狭窄等疾病的手术。该术式在临床上应用广泛,但术后大多数患者都会出现不同程度的肠道功能障碍,尤其在腰椎后路融合术更常见,如:术后腹胀、便秘等症状,目前关于该并发症尚未有一种最佳的治疗方式。故本文对腰椎融合术后肠道功能障碍的治疗进展进行综述,并进一步研究以优化治疗,避免高死亡率并发症的发生。Lumbar interbody fusion is a commonly used procedure to treat lumbar disc herniation, lumbar spinal stenosis and other diseases. This procedure is widely used in clinic, but most patients will have different degrees of intestinal dysfunction after surgery, especially more common in lumbar posterior fusion, such as: postoperative abdominal distension, constipation and other symptoms, and there is not yet an optimal treatment regarding this complication. Therefore, this paper reviews the progress of treatment of intestinal dysfunction after lumbar spine fusion, and further studies are conducted to optimize the treatment and avoid the occurrence of high mortality complications.展开更多
1病例资料
患者男性，42岁，因间断左上腹疼痛2个月余入院。既往乙型肝炎病史10年余；病程中无发热等表现。查体：腹部平坦，未触及腹部肿物，左上腹压痛阳性，无反跳痛及肌紧张，腹部叩诊呈鼓音，移动性浊音阴性，肠鸣音约5次／min。...1病例资料
患者男性，42岁，因间断左上腹疼痛2个月余入院。既往乙型肝炎病史10年余；病程中无发热等表现。查体：腹部平坦，未触及腹部肿物，左上腹压痛阳性，无反跳痛及肌紧张，腹部叩诊呈鼓音，移动性浊音阴性，肠鸣音约5次／min。实验室检查未见明显异常；腹部彩超检查提示左上腹可见一大小约11．5 cm ×8．5 cm团块，回声不均匀；腹部CT平扫＋三期增强提示脾脏体积增大，可见团块状低密度影，大小约11．7 cm ×8．5 cm，增强扫描肿物边缘实性部分呈不均匀强化，静脉期及平衡期强化程度减低，肿物性质考虑为恶性（图1 a～d）。临床诊断为脾脏占位性病变，患者行脾切除术，术中探查发现脾脏上极可见一大小约11．5 cm ×8．5 cm褐色肿物，质软、边界清楚（图1 e～g）。术后病理回报：脾脏多形性未分化肉瘤，伴坏死，体积95 cm ×9 cm ×8 cm，局部侵及并突破脾脏被膜，脉管、神经及血管切缘未见肿瘤浸润，免疫组化提示CD68阳性， Desmin阴性，Ki－67阳性率70％，肌酸激酸（CK）阴性，抗平滑肌抗体（SMA）阴性，波形蛋白（Vimentin）阳性，S－100阴性。展开更多
文摘随着人口老龄化速度越来越快,骨质疏松合并退变性脊柱侧凸越来越成为老年人的一种常见疾病,对于此类疾病,保守治疗和手术治疗效果不尽相同。但是由于患者往往年龄偏大,因此在选择治疗方案时要格外慎重,同时围手术期的管理也尤为重要。但需要明确的是,不管是行保守治疗或是手术治疗,患者都应进行严格的抗骨质疏松治疗。With the aging of the population, osteoporosis combined with degenerative scoliosis has become a common disease in the elderly, and the effect of conservative treatment and surgical treatment for this disease is not the same. However, because patients tend to be older, careful treatment should be chosen, and perioperative management is particularly important. However, it should be made clear that patients should be treated with strict anti-osteoporosis therapy, regardless of whether they are treated conservatively or surgically.
文摘腰椎椎体间融合术是常用的一种治疗腰椎间盘突出、腰椎椎管狭窄等疾病的手术。该术式在临床上应用广泛,但术后大多数患者都会出现不同程度的肠道功能障碍,尤其在腰椎后路融合术更常见,如:术后腹胀、便秘等症状,目前关于该并发症尚未有一种最佳的治疗方式。故本文对腰椎融合术后肠道功能障碍的治疗进展进行综述,并进一步研究以优化治疗,避免高死亡率并发症的发生。Lumbar interbody fusion is a commonly used procedure to treat lumbar disc herniation, lumbar spinal stenosis and other diseases. This procedure is widely used in clinic, but most patients will have different degrees of intestinal dysfunction after surgery, especially more common in lumbar posterior fusion, such as: postoperative abdominal distension, constipation and other symptoms, and there is not yet an optimal treatment regarding this complication. Therefore, this paper reviews the progress of treatment of intestinal dysfunction after lumbar spine fusion, and further studies are conducted to optimize the treatment and avoid the occurrence of high mortality complications.
基金the National Natural Science Foundation of China,No.81560348,81260269,81550042(to LZJ),No.81460330(to LXH)the Youth Elite of Science and technology of Inner Mongolia Autonomous Region Colleges and Universities “Young Science and Technology Talents Program”,No.NJYT-15-B05(to LXH)+3 种基金the Inner Mongolia Autonomous Region Science and Technology Plan Project(2016)(to LXH)the Natural Science Foundation of Inner Mongolia Autonomous Region,No.2016MS08131(to LXH)the Science and Technology Innovation Leading Project of Inner Mongolia Autonomous Region(2017)(to LXH)the Fund for Returnees from the Department of Human Resources and Social Security of Inner Mongolia Autonomous Region(to LXH)~~
文摘1病例资料
患者男性，42岁，因间断左上腹疼痛2个月余入院。既往乙型肝炎病史10年余；病程中无发热等表现。查体：腹部平坦，未触及腹部肿物，左上腹压痛阳性，无反跳痛及肌紧张，腹部叩诊呈鼓音，移动性浊音阴性，肠鸣音约5次／min。实验室检查未见明显异常；腹部彩超检查提示左上腹可见一大小约11．5 cm ×8．5 cm团块，回声不均匀；腹部CT平扫＋三期增强提示脾脏体积增大，可见团块状低密度影，大小约11．7 cm ×8．5 cm，增强扫描肿物边缘实性部分呈不均匀强化，静脉期及平衡期强化程度减低，肿物性质考虑为恶性（图1 a～d）。临床诊断为脾脏占位性病变，患者行脾切除术，术中探查发现脾脏上极可见一大小约11．5 cm ×8．5 cm褐色肿物，质软、边界清楚（图1 e～g）。术后病理回报：脾脏多形性未分化肉瘤，伴坏死，体积95 cm ×9 cm ×8 cm，局部侵及并突破脾脏被膜，脉管、神经及血管切缘未见肿瘤浸润，免疫组化提示CD68阳性， Desmin阴性，Ki－67阳性率70％，肌酸激酸（CK）阴性，抗平滑肌抗体（SMA）阴性，波形蛋白（Vimentin）阳性，S－100阴性。
