普外科临床治疗中急性阑尾炎临床诊治效果观察

探讨急性阑尾炎患者的治疗方案以及治疗效果。方法 筛选2019年2月到2023年5月就诊的30位患者,随机分为两组,观察组腹腔镜手术治疗,对照组常规手术干预,通过对比SF-36等数据确定治疗效果。结果 观察组SF-36各项指标明显优于对照组,P<0.05,具有统计学意义。对比两组患者手术时间,P<0.05,具有统计学意义。结论 外科手术治疗,对于急性阑尾炎患者,通过腹腔镜能够明显减少患者的手术创伤,而且临床治疗优势明显,临床应用价值较高。

乳腺慢性化脓性炎症142例外科临床治疗观察

目的探讨针对乳腺慢性化脓性炎症患者,对其进行手术治疗的具体方式以及完成治疗后患者获得的临床效果表现。方法选取2010年12月～2012年12月山西省晋城市泽州县人民医院乳腺慢性化脓性炎症患者142例,根据患者病情及手术治疗方式将所有患者分成观察组（n=50）、对照1组（n=50）、对照2组（n=42）。观察组患者主要选择乳房区段切除术进行治疗,对照1组患者主要选择乳腺脓肿切开引流术进行治疗,对照2组患者主要选择肿块切除术进行治疗。对比3组患者完成手术后,分别获得的临床效果。结果观察组患者手术时间为21～61min,手术过程中出血量为12～31mL;对照1组患者手术的时间为6～16min,手术过程中的出血量为11～21mL;对照2组患者手术的时间为16～31min,手术过程中的出血量为5～16mL。结论针对乳腺慢性化脓性炎症患者,在选择方法对其进行治疗的过程中,应该观察患者肿块的特点表现,选择合理的手术方法对患者进行治疗,最终能够发挥最优的治疗效果,使患者在短时间内病情康复。

宠物犬猫角膜损伤的临床外科治疗

犬猫角膜损伤的临床表现随受伤的深度、大小和污染程度不同而不同。依角膜的损伤程度可分为 :表层的损伤、深层的损伤和全层的损伤。应根据具体情况实施相应的手术方案 。

普外科临床治疗中急性阑尾炎临床诊治的分析

本文旨在对于普外科临床对阑尾炎临床诊疗情况,进行分析,以期能够对于当前治疗方式进一步科学优化。方法:随机选取2021年4月-10月来我院接受治疗的阑尾炎患者60例作为研究对象,并将其随机分为两组,即对照组和观察组,每组各30例,其中对照组采用传统药物保守治疗方式,而观察组则采取手术治疗。结果:经实际治疗发现,两组治疗患者中,其中观察组中治疗有效率约为96%,并且大大获得了患者的认可;对照组中治疗有效率约为83%,两组数据差异具有统计学意义。结论:普外科临床治疗过程中,采用手术治疗方式,相对而言能够取得更为理想的治疗效果,对于提升患者质量能够起到积极的促进作用。

肛周克罗恩病的外科治疗

与一般的肛周疾病治疗不同,肛周克罗恩病治疗的总原则是要在内科治疗控制炎症的基础上行外科治疗,故重点讨论克罗恩病的各种肛周病变的外科治疗方法。

腹腔镜全子宫切除术联合FTS-CNP模式对患者营养及PCT、IL-6、CRP的影响

目的研究腹腔镜全子宫切除术联合加速康复外科临床治疗路径(FTS-CNP)模式对患者营养及降钙原素(PCT)、白介素6(IL-6)、C反应蛋白(CRP)的影响。方法选取2017年10月至2019年10月太仓市第一人民医院妇科收治的76例需行子宫切除术的患者,按照住院号单双数将其分为对照组和研究组,各38例。对照组进行传统开腹手术,研究组进行腹腔镜全子宫切除术。2组均实施FTS-CNP模式进行手术护理,持续至术后5 d。以患者术前、术后1、3、5 d PCT、IL-6、CRP、全血白细胞计数(WBC)以及营养指标(白蛋白、前白蛋白)作为观察指标,并记录患者术后并发症发生率。结果研究组手术时间、术后排气时间、下地活动时间均显著短于对照组,手术出血量均显著低于对照组(P<0.05);与术前比,术后1~5 d 2组血清IL-6、CRP、WBC、PCT水平呈先升高后降低趋势,且研究组始终显著低于对照组(P<0.05);与术前比,术后1~5 d 2组血清白蛋白、前白蛋白水平呈先降低后升高趋势,且研究组始终显著高于对照组(P<0.05);研究组术后并发症发生率(2.63%)显著低于对照组(15.78%)(P<0.05)。结论腹腔镜全子宫切除术联合FTS-CNP模式可减轻子宫疾病患者炎症反应,维持良好的营养状态,促进术后康复,并降低并发症发生率。

Effects of Wy14643 on hepatic ischemia reperfusion injury in rats

AIM: To investigate the effects and possible mechanisms of Wy14643 on hepatic ischemia-reperfusion (I/R) injury in rats.METHODS: Thirty male Sprague-Dawley rats weighing 220-280 g were randomly divided into five experimental groups: sham group (G1, n = 6): a sham operation was performed (except for liver I/R); I/R-untreated group (G2, n = 6): rats underwent liver ischemia for 90 min followed by reperfusion for 4 h; and I/R + Wy14643 groups (G3, G4, G5; n = 6): after the same surgical procedure as in group 2, animals were pretreated with Wy14643 at the dose of 1, 5 and 10 mg/kg 1 h before ischemia, respectively. Hepatic ischemia-reperfusion (I/R) was induced by clamping blood supply to the left lateral and median lobes of the liver for 90 min, and atraumatic clamp was removed for 4 h reperfusion. Blood samples and liver tissues were obtained at the end of reperfusion to assess serum and hepatic tissue homogenate aminotransferase (ALT), aspartate aminotransferase (AST), myeloperoxidase (MPO), serum interleukin-1β (IL-1β) and tumor necrosis factor alpha (TNF-α), as well as activity of superoxide dismutase (SOD) and content of malondialdehyde (MDA) in the hepatic tissue homogenate. RESULTS: Hepatic I/R induced a significant increase in the serum levels of ALT, AST, TNF-α, IL-1β and MPO, as well as the levels of ALT, AST and MDA in the liver tissue homogenate, which were reduced bypretreatment with Wy14643 at the dose of 1, 5 and 10 mg/kg, respectively. The activity of SOD in the liver tissue homogenate was decreased after hepatic I/R, which was enhanced by Wy14643 pretreatment. In addition, serum and liver tissue homogenate ALT and AST in the Wy14643 10 mg/kg group were lower than in the Wy14643 1 mg/kg and 5 mg/kg groups, respectively.CONCLUSION: Wy14643 pretreatment exerts significant protection against hepatic I/R injury in rats. The protective effects are possibly associated with enhancement of anti-oxidant and inhibition inflammation response.

Recurrent inflammatory fibroid polyp of cardia:A case report

Inflammatory fibroid polyp is one of the chronic inflammatory diseases in the digestive tract, which often mimics the submucosal tumor. Precise diagnosis is possible after removal of the detected lesion. Endoscopic removal is recommended as a safe and efficient method of the treatment. In this report the authors present a case of inflammatory fibroid polyp located in the cardia, which has been removed endoscopically. Twelve months later, recurrence of the lesion was noted and the patient was referred to surgical resection.

Percutaneous nephrolithotomy in pediatric age group:Assessment of effectiveness and complications

Management of kidney stone disease in pediatric population is a challenging condition in urology practice. While the incidence of kidney stone is increasing in those group, technological innovations have conrtibuted to the development of minimally invasive treatment of urinary stone disease such as mini-percutenous nephrolitotomy(mini-PCNL), micro-PCNL, ultra mini-PCNL. In this review we tried to evaluate the effect of new teratment techniques on pediatric kidney stones.

Clinicopathologic features of surgically resected primary gastric lymphoma

AIM:To analyze the clinicopathologic characteristics of surgically resected gastric lymphoma patients. METHODS:We retrospectively analyzed 57 surgically resected gastric lymphoma patients,dividing them into 2 subgroups:Low grade MALToma (the LG group),High grade MALToma and Diffuse large B cell lymphoma (the HG group). RESULTS:The numbers of patients were:20 in the LG group, 37 in the HG group.The diagnostic rate of gastroscopy was 34.8% at primary diagnosis and 50% including differential diagnoses.The positive rates of Hpyloriwere similar between the 2 groups (68% vs77%).Multiple lesions were found in 19.3%.The proportion of mucosal and submucosal lesions was 80.0%(16/20) in the LG group,and 24.3%(9/37) in the HG group (P<0.001).Lymph node invasion rates were 10.5%(2/19) in the LG group and 44.1%(15/34) in the HG group (P=0.031).The numbers of recurred patients were none in the LG group,and 8 in the HG group.By univariant analysis,group (P=0.024) and TNM stage (stage Ⅰ,Ⅱ vs stages Ⅲ,Ⅳ,P=0.002) were found to be the significant risk factors.There was a tendency of higher recurrence rate in the subtotal gastrectomy group than in the total gastrectomy group (P=0.50). CONCLUSION:The HG groups had a more advanced stage and a higher recurrence rate than the LG group.Although there was no difference between subtotal and total gastrectomies,more careful assessments of multiplicities and radical resections with lymph node dissections seem to be needed because of multiplicity and LN invasion even in LG group.

Analysis of the Long-term Effect of Intraoperative Radiotherapy (IORT) for Non-Small Cell Lung Carcinoma (NSCLC)

OBJECTIVE To analyze the long-term effects of treatment with an op-eration + postoperative irradiation (A group) and an operation+intraoperative radiotherapy+postoperative irradiation (B group) in non-small cell lung cancer patients. METHODS Through a prospective randomized clinical trial, a total of 154 patients with non-small cell lung carcinoma were divided into two groups of 77 cases. Among the 154 cases, there were 134 squamous carcinomas, 17 adenocarcinomas and 3 adeno-squamous carcinomas. TNM staging: there were 17 in StageⅠ, 76 in Stage Ⅱ and 61 in Stage Ⅲ. A dosage of 15～25 Gy IORT, energy 9～16 MeV electrons, was delivered to the tumors. The doses given were 40～60 Gy postoperation. RESULTS The local control rates in A and B groups were 49.4% and 62.3% respectively (P<0.05). The survivals at 3, 5 and 7 years for group A were 40.3%, 27.3%, and 5.2% and for group B 44.2%, 28.6% and 6.5% (P>0.05). There were 16 deaths from radiotherapy complications, with 2 cases in group A and 14 in group B. CONCLUSION IORT+postoperative irradiation can enhance the local control rate of non-small cell lung cancer patients and reduce the recurrent rates, but it can not improve long-term survival.

SURGICAL TREATMENT OF SPINAL TUMOR(ANALYSIS OF 32 CASES)

With the advance of spinal surgery in the last decade,surgical treatment of spinal tumors has been no longer limited to simple laminectomy.The principles of surgical treatment of spinal tumors include:(1) anterior approach for the anterior lesion and posterior approach for the posterior lesion;(2) combined anterior and posterior approach for extensive lesions and(3) internal fixation for spinal stability.32 cases of spinal tumors were treated on the basis of the above guiding principles and 84%(27/32) showed excellent or good results.

SURGICAL TREATMENT AND PROGNOSIS OF BRONCHIAL CARCINOID TUMOR

In order to understand the effect of surgery in the treatment of the bronchial carcinoid tumor and the factors affecting prognosis, 18 cases of bronchial carcinoid tumor are presented, including 5 cases with Cushing's syndrome. There were lobectomy in 10, lung wedge resection in 3, excision of intraluminal tumor of bronchus in 3, exploratory thoracotomy in 2 cases. No operation death. Pathological examination revealed 14 cases were typical carcinoid tumor and 4 cases were atypical carcinoid tumor. By 2-13 years follow-up . 3 , 5 and 10 years survival rate were 82% , 78%and 70% respectively. Bronchial carcinoid tumor is often confused with small cell carcinoma of lung, the correct diagnosis can be obtained by light microscopic, electron microscopic and immunohistochemistry studies. Those patients accompanied with ectopic-ACTH secretion always have Cushing,s syndrome , resection of tumor can produce gho result. Proper operation method depends on the location of the tumor and patient's extent of cardiac and pulmonary reserve.Atypical carcinoid tumor had high malignancy and poor prognosis. The size of tumor, lymph node involvement and adjuvant therapy seem no definite effect on the patients' survival rate.

DIAGNOSIS AND SURGICAL TREATMENT OF BRONCHOGENIC CYSTS

Between 1974 and 1993, 22 patients with bronchogenic cysts were operated on in our hospital; there were 14 men and 8 women, ranging in age from 11 to 62 years. The cyst locations were mediastinal in 13 (59.1%) and intrapulmonary in 9 (40. 9%). There were symptoms (chest pain and recurrent bronchiolits) in 20 patients (91%). The preoperative complications included infection in the lung and in the cyst and dysphagia due to esophageal compression. Chest pain was the main symptom in mediastinal cyst and recurrent infection of lung in intrapulmonary cyst. Plain chest radiograms showed that a round shadow, occasional air-fluid levels, and peripheral calcification may be found in cysts. An operation is the best treatment for cysts. All cysts were completely excised. No postoperative cornphcations. late complications, or recurrence developed in our patients.

The clinical features of thoracic stomach cancer after surgical treatment for esophageal carcinoma

Objective:Postoperative recurrence of esophageal carcinoma was the main factor that affect the patients' survival and quality of life.This study mainly investigated the clinical features of thoracic stomach cancer (TSC) after surgical treatment for esophageal carcinoma.Methods:We retrospectively reviewed 51 cases of postoperative TSC in our hospital (Henan Province Tumor Hospital,Zhengzhou,China).Results:The 51 (10.97%) of all 465 cases that underwent endoscope after surgical treatment for esophageal carcinoma in our hospital were TSCs.There were 13 cases with complicating anastomotic recurrence.The locations of 46 cases (90.2%) were the same as the primary cancer.The 48 cases were squamous cell carcinomas and 3 cases were adenocarcinomas after esophagectomy for esophageal carcinoma.Endoscopic manifestations were puffiness-infiltrating type at 39.2% (20/51),massive type at 15.7% (8/51),ulcerative type at 7.8% (4/51) and ulcerative infiltrating type at 3.9% (2/51) and stenotic type etc.Conclusion:The incidence of TSC after surgical treatment for esophageal carcinoma is high.The main cause was that the local residual cancer invaded gastric wall.The gastroscopic features of TSC are different from those of gastric cancer.Regular review with endoscopy in postoperative esophageal carcinoma patients was a major way to diagnose TSC.

Surgical treatment of primary tracheobronchial malignant tumors

Objective： The aim of our study was to explore the clinical experience of surgical treatment for primary tracheobronchial malignant tumors. Methods： The clinicopathological data of 18 patients with primary tracheobronchial malignant tumors surgically treated from February 1994 to August 2007 were reviewed retrospectively. The surgical management included sleeve tracheal resection in 8 cases, lower trachea and carina resection with carina reconstruction in 4 cases, local enucleation of the tumor in 4 cases, left or right carino-pneumon-ection in 2 cases, and resection of the tracheal or bronchial tumor and reconstruction of the airway under cardiopulmonary bypass （CPB）in 6 cases. Results： Among the 18 cases, there were 7 adenoid cystic carcinomas, 9 squamous cell carcinomas, 1 lymphoepithelial-like carcinoma and 1 follicular non-Hodgkin tymphoma. All the cases recovered well except one who died of endotracheal bleeding and asphyxia at the 10th postoperative day. Conclusion： Surgical resection is the most effective treatment for primary tracheobronchial malignant tumors. The selection of operation modes should be individualized according to patients＇ condition. Both complete resection and safety should be taken into consideration simultaneously.

Extra-pulmonary tuberculosis infection in the dialysis patients with end stage renal diseases:case reports and literature review

The diagnosis of extra-pulmonary tuberculosis(TB) seems relatively difficult due to the absence of specific symptoms and signs in patients on peritoneal dialysis or hemodialysis.We report four cases of extra-pulmonary tuberculosis on dialysis,with two cases on peritoneal dialysis and two cases on hemodialysis.The presentations,therapy,and outcomes of TB infection in these patients were reviewed.Otherwise,the English literature published in the PubMed database associating extra-pulmonary tuberculosis on dialysis over the last three decades is reviewed.A total of 61 studies containing 70 cases were included.The most common primary disease was diabetic nephropathy(22.86%,16/70).The peritoneum(31.42%,22/70),bone(21.42%,15/70),and lymph node(20%,14/70) were the most frequently infected.Single organ infection was common(90%,63/70).Fever(58.57%,41/70),pain(35.71%,25/70),and enlarged lymph node(20%,14/70) were the most common symptoms.Biopsy(67.14%,47/70) and culture(40%,28/70) provided most reliable methods for clear diagnosis of tuberculosis.The combined treatment of isoniazid,rifampicin,pyrazinamide,and ethambutol(44.29%,31/70) was the most common therapy.The majority of patients improved(82.86%,58/70);however,12 cases got worse(17.14%),with 10 of them dying(14.29%).Physicians should be aware of the non-specific symptoms and location of infection,and consider tuberculosis in their differential diagnoses in dialysis patients presenting with symptoms such as fever,pain,and weight loss.

Comparative study on treating complete dislocation of acromioclavicular joint with three different methods

Objective:To comparatively study complete dislo cation of acromioclavicular joint treated with three different methods. Methods:A total of 96 patients (81 males and 15 females, aged 16-59 years, mean=45 years) with complete dislocation of acromioclavicular join t were treated with Dewars operation (Group A, n=32), internal fixation with K irschner tension band wires (Group B, n=44), or internal fixation with Wolter pl ates (Group C, n=20), respectively, in this study. Eighty-five patients suffere d from acute dislocations and eleven from chronic dislocations. Results:The patients were followed up for 50 months on an aver age. According to Karlssons standard, in Group A, 26 patients were assessed as good, 5 as fair and 1 as poor. In Group B, 20 patients were assessed as good, 1 3 as fair and 11 as poor. In Group C, 15 patients were assessed as good, 4 as fa ir and 1 as poor. The good and fair rates were significantly different between G roup A and Group B, and between Group C and Group B, but no statistical differen ce was found between Group A and Group C. The operating time was ( 52.36 ± 7 .24 ) minutes, ( 67.43 ± 8.11 ) minutes and ( 69.73 ± 8.04 ) minutes in Groups A, B and C, respectively. And the hospitalizing fees were ( 2 400 ± 270) yuan, ( 2 100 ±190) yuan and ( 8 450 ±360) yuan in Groups A, B and C, respectively. Conclusions:Dewars operation is a good and safe method with shorter operating time and lower hospitalizing fee for treating complete disloca tion of acromioclavicular joint. The method is simple without the need of a seco nd operation to remove the implants and with few complications.

Clinical analysis of craniocerebral trauma complicated with thoracoabdominal injuries in 2165 cases

Objective: To explore the optimal treatment for craniocerebral trauma complicated with thoraco-abdominal injuries. Methods: A total of 2 165 cases of craniocerebral trauma complicated with thoraco-abdominal injuries admitted to our hospital between July 1993 and June 2003 were retrospectively studied. Among them, 382 cases sustained severe craniocerebral trauma (in which 167 were complicated with shock), 733 thoracic injuries, 645 abdominal injuries and 787 thoraco-abdominal injuries. On admittance, 294 cases had developed shock. With the prime goal of saving life, respiratory and circulatory systems and encephalothilipsis were especially treated and monitored. Priority in management was directed to severe or open injures rather than to moderate or closed injures. For cases with cerebral hernia due to intracranial hematoma and severe shock due to blood loss, cerebral hernia and shock were treated concurrently. Results: After treatment, 2024 ( 93.49%) cases survived and the other 141 ( 6.51%) died. Among patients who had severe craniocerebral injury with shock and those without, 78 ( 46.71%) and 53 ( 24.56%) died, respectively. For patients who had underwent craniocerebral and thoraco-abdominal operations concurrently and those who had not, the death rates were 58.49%- 65.96% and 28.57% respectively, indicating a significant difference (P< 0.05). Conclusions: Treatment for hematoma hernia, shock and disturbed respiration is the key in the management of multiple trauma of craniocerebral, thoracic or abdominal injuries, especially when two or three conditions occurred simultaneously. Unless it is necessary, operations at two different parts at the same time is not recommended. It is preferred to start two concurrent operations at different time.

Surgical management of transected injury to the pancreatic neck

Objective: To present a batch of data of transected pancreatic neck injuries and to sum up the experience in surgical interventions for the injuries.Methods: We analysed 13 patients with a transected injury to the pancreatic neck from Jan. 1995 to Dec. 2000. External drainage was performed in all patients. Pancreatoduodenectomy was conducted in 2 patients with a transected injury to the pancreatic neck associated with duodenal ruptures, and TPN was administered immediately after operation. Proximal closure of the transected margin and distal pancreaticojejunostomy was performed in 4 patients. Proximal closure of the transected margin and distal pancreaticojejunostomy plus splenectomy was performed in 7 patients associated with contusion of pancreatic body or tail plus spleen rupture. Results: 12 patients healed and one patient died of anesthetic accident during the course of restoration of the dislocation of his right hip joint. Complications occurred in 7 patients.Conclusions: The operation should be performed according to the degree of the injuries and associated duodenal injuries. Routine drainage and nutrient support should be recommended.