肱骨远端关节内骨折的手术治疗疗效评价

对肱骨远端关节内骨折病例群体施以手术治疗,并对其效果展开探究。方法:择取60例病例,均系肱骨远端关节内骨折病患,时间区间:2017年4月到2019年12月。遵循收治顺序完善分组:保守组所纳30例病例行保守治疗,手术组所纳30例病例所行方案为手术治疗,术式为:肱骨远端关节内骨折切开复位及钢板内固定术治疗,借助Burri and Lob标准,以两组患者的手术治疗疗效和并发症发生率为观察指标,进行探究和评价。结果:手术组治疗效果综合评估总优良率为83.33%,同比于对照组数据50.00%,差异P<0.05;手术组并发生率数值为20.00%,相较于保守组所测得数据50.00%更低(P<0.05)。结论:针对肱骨远端关节内骨折病例群体,积极施以针对性手术固定方案,可促使其临床疗效优化,更好控制并发症率,意义突出。

分析探讨小脑血管畸形的临床特点及手术治疗方法与疗效

目的对小脑血管畸形的临床特点及手术治疗方法与临床疗效进行分析探讨。方法选取2012年9月至2014年3月在我院确诊为小脑血管畸形的患者100例作为研究对象,按照随机数字表法将患者分为对照组50例和观察组50例,对照组采用血管内栓塞治疗,观察组采用手术治疗,比较两组的临床疗效。结果观察组治疗后的总有效率(88.00%)明显好于对照组治疗后的总有效率(62.00%),观察组治疗后的不良反应等发生率(20.00%)明显低于对照组治疗后的不良反应的发生率(48.00%),两组比较具有统计学意义(P<0.05)。结论小脑血管畸形有不同的临床表现,采用手术治疗的疗效好于采用血管内栓塞治疗,患者的不良反应的发生率较低,值得在临床中推广应用。

仙方活命饮配合手术治疗马蹄形肛周脓肿

目的探讨仙方活命饮配合手术治疗马蹄形肛周脓肿的疗效。方法将我院收治的106例马蹄形肛周脓肿患者随机分为2组,对照组53例采用单纯手术治疗,试验组53例在对照组基础上给予仙方活命饮。比较2组治疗总有效率、创面愈合时间及住院时间。结果试验组临床总有效率为96.2%,高于对照组的81.1%,有统计学差异(P<0.05);试验组创面修复及住院时间显著低于对照组,有统计学差异(P<0.05)。结论仙方活命饮配合手术治疗马蹄形肛周脓肿效果显著,具有较高的临床有效率,同时创面恢复快、住院时间短,进而提高患者生活质量,值得临床选择。

老年股骨转子间骨折PFNA固定与半髋置换手术治疗对比

目的：探究老年股骨转子间骨折PFAN固定与半髋置换手术治疗的临床疗效。方法：选取我院2013年8月～2015年8月收治的100例老年股骨转子间骨折患者作为研究对象，通过随机分组的方法将其分为对照组与观察组，对照组患者（50例）采用PFAN固定进行治疗，观察组患者（50例）采用半髋置换手术进行治疗，对比2组患者的治疗效果。结果：观察组患者的手术时间、术后卧床时间、治疗的总有效率、并发症的发生率与对照组患者相比较，存在较大的差异，P＜0．05，差异具有统计学意义。结论：对老年股骨转子间骨折患者实施半髋置换手术进行治疗，治疗效果十分显著，有效改善患者的临床症状，缓解患者的髋部疼痛，促进患者受损组织功能的恢复，缩短患者恢复的时间，改善患者的活动能力，从而提高患者的生活质量，值得临床进一步应用以及推广。

手术治疗腰椎间盘突出症78例临床分析

回顾并总结腰椎间盘突出症手术治疗的方法及疗效。方法对我院近年78例通过手术治疗腰椎间盘突出症的患者的临床资料进行回顾性分析。其中57例行单侧椎板扩大开窗髓核摘除术，18例行单侧半椎板切除减压髓核摘除术，3例行全椎板切除减压髓核摘除术，同时探查并松解侧隐窝。结果随访4个月-8a，术后优良率82．3％结论根据具体情况选择相应手术方式。

腰椎间盘突出症并椎管狭窄症的手术治疗探讨

目的探讨腰椎间盘突出症并椎管狭窄症的手术治疗效果。方法 35例腰椎间盘突出症并椎管狭窄患者采取手术治疗措施。结果患者手术情况均较为顺利,随访1年,治愈21例,显效11例,有效3例。患者在预后过程中没有出现严重的并发症情况,治疗效果较为理想。结论手术治疗腰椎间盘突出症并椎管狭窄,可以获得较为理想的临床治疗效果,值得进一步推广。

混合痔手术治疗74例临床分析

为探讨混合痔的有效治疗方法,对采用手术治疗的混合痔,进行回顾性分析,均一次性治愈,疗程1 8-24d,无肛门失禁的狭窄。结果表明,混合痔的内容为主要分界清楚的先扎内痔后肃离切切除外痔的我,外痔隐患)为主的,先切除外痔,并内痔结扎,严重的先行后肛管切扩后处理痔,疗效肯定,术后伤口外,使伤口愈合时间明显缩短。

不同治疗方法对急性单纯性阑尾炎患者的影响

目的探讨不同治疗方法对急性单纯性阑尾炎患者的影响。方法回顾分析2009年1月—2013年2月在我院治疗137例急性单纯性阑尾炎患者的临床资料,按照治疗方式的不同分为保守治疗组64例,手术治疗组73例。比较两种治疗方法的临床效果。结果保守治疗组治愈率为70.31%,手术治疗组治愈率为100.00%,2组治愈率比较差异有统计学意义(P<0.01);随访1年,保守治疗组复发病例多于手术治疗组(P<0.01)。结论急性单纯性阑尾炎患者的治疗方法应依据患者的具体情况及经济条件进行合理的选择。

经腹膜后精索内静脉结扎治疗精索静脉曲张87例临床分析

目的探讨经腹膜后精索内静脉结扎治疗精索静脉曲张的疗效方法回顾性分析我院近年收治的接受经腹膜后精索内静脉结扎术治疗精索静脉曲张的87例患者的临床资料。结果术前检查65例（75％）的患者精液异常，其中46例（70．8％）患者术后生精功能改善，症状消失，精子质量提高。结论精索静脉曲张影响精子质量，可导致不育，经腹膜后精索内静脉结扎术对该病疗效确切，且复发率低。

Long-term outcome and efficacy of endoscopic hemorrhoid ligation for symptomatic internal hemorrhoids

AIM:To assess the long-term outcome of endoscopic hemorrhoid ligation (EHL) for the treatment of symptomatic internal hemorrhoids.METHODS:A total of 759 consecutive patients (415 males and 344 females) were enrolled.Clinical presentations were rectal bleeding (593 patients) and mucosal prolapse (166 patients).All patients received EHL at outpatient clinics.Hemorrhoid severity was classified by Goligher's grading.The mean follow-up period was 55.4 mo (range,45-92 mo).RESULTS:The number of band ligations averaged 2.35 in the first session for bleeding and 2.69 for prolapsed patients.Bleeding was controlled in 587 (98.0%) patients,while prolapse was reduced in 137 (82.5%) patients.After treatment,93 patients experienced anal pain and 48 patients had mild bleeding.Patient subjective satisfaction was 93.6%.Repeat treatment or surgery was performed if symptoms were not relieved in the first session.In the bleeding group,the recurrence rate was 3.7% (22 patients) at 1 year,and 6.6%and 13.0% at 2 and 5 years.In the prolapsed group,the recurrence rate was 3.0%,9.6% and 16.9% at 1,2 and 5 years,respectively.CONCLUSION:EHL is an easy and well-tolerated procedure for the treatment of symptomatic internal hemorrhoids,with good long-term results.

Experience with gemcitabine and cisplatin in the therapy of inoperable and metastatic cholangiocarcinoma

AIM： To study the activity of gemcitabine and cisplatin in a cohort of patients with inoperable or metastatic cholangiocarcinoma.METHODS： Chemotherapy-naive patients with pathologically proven cholangiocarcinoma, receiving treatment that consisted of gemcitabine at 1250 mg/m^2 in a 30-rain infusion on d 1 and 8, and cisplatin at 75 mg/m^2 at every 21-d cycle, were retrospectively analyzed.RESULTS： From .lune 2003 to December 2005, 42 patients were evaluated. Twelve patients （28%） had unresectable disease and 30 （72%） had metastatic disease. There were 28 males and 14 females with a median age of 51 years （range 33-67） and median ECOG PS of 1 （range 0-2）. A total of 171 cycles were given with a median number of cycles of 4 （range 1-6）. There were 0 CR, 9 PR, 11 SD and 13 PD （response rate 21%）. Grade 3-4 hematologic toxicities were： anemia in 33%, neutropenia in 22% and thrombocytopenia in 5%. Non-hematologic toxicity was generally mild. No cases of febrile neutropenia or treatment-related death were noted. The median survival was 10.8 mo （range 8.4-13 mo） and progression free survival was 8.5 mo. One-year survival rate was 40%.CONCLUSION： Our results indicate that the combination of gemcitabine and cisplatin had consistent efficacy in patients with unresectable or metastatic cholangiocarcinoma.

Efficacy of Surgical Therapy for Carotid Body Tumors

Objective To evaluate the efficacy of surgical therapy for carotid body tumors. Methods A retrospective analysis was conducted, covering the diagnosis, surgical procedure, postoperative complications, and prognosis of 120 cases of carotid body tumors in Peking Union Medical College Hospital from 1949 to May, 2011. Results Surgical excision was successfully performed in 111 cases with 117 tumors. In all those cases, 50 underwent simple tumor resection, 42 underwent resection of tumors and ligation of the external carotid arteries, 7 underwent co-resection of tumors and common carotid arteries, internal carotid arteries, as well as external arteries without vascular reconstruction, and the other 12 cases experienced tumor resection and vascular reconstruction as internal carotid arteries were involved. After operation, 3 cases developed cerebral infarction, 30 cases showed cranial nerve palsy, including 15 cases of hypoglossal nerve damage, 10 cases of vagus paralysis, and 5 cases of Horner's syndrome. Conclusion It is essential to make a proper surgical strategy, which can reduce postoperative com- plications.

ANALYSIS OF EFFECT AND COMPLICATION ON SURGICAL TREATMENT OF CAROTID BODY TUMORS IN 46 CASES

Objective.To describe the effects of surgical treatment a nd complications in46patients with carotid body tumor.Method.Retrospe ctive study on surgical treatment and complications was carried out in46case s of CBT which were surgically treated with different kind of procedures.Resul t.All procedures performed successfully except that the CBT was not excised in 4cases.No operative mortality was observed.There were2postoperative hemiple gia,4hypoglossal nerve impairment ,2glossopharyngeal nerve impairment ,1va gus nerve impairment ,and1accessory nerve impairment.One patient presented p ostoperative cranial nerve impairment in glossopharyngeal,vagus and hypoglossa l nerves.Two patients developed local recurrence during the long-term follow-up.Conclusion.Complete surgical excision was possible in each patient if th e diagnosis had been cor-rectly made through selective preoperative angiography ,vessel ultrasound Doppler and other examinations.Reasonable surgical procedur e and Matas training were necessary to the successful surgical treatment and t hus decrease the complicative incidence rate of carotid chemodectomas.

Long-term efficacy of infliximab maintenance therapy for perianal Crohn’s disease

AIM:To assess the long-term efficacy of seton drainage with infliximab maintenance therapy in treatment of stricture for perianal Crohn’s disease(CD). METHODS:Sixty-two patients with perianal CD who required surgical treatment with or without infliximab between September 2000 and April 2010 were identified from our clinic’s database.The activities of the perianal lesions were evaluated using the modified perianal CD activity index(mPDAI)score.The primary endpoint was a clinical response at 12-15 wk after surgery as a shortterm efficacy.Secondary endpoints were recurrence as reflected in the mPDAI score,defined as increased points in every major element.The clinical responses were classified as completely healed(mPDAI=0),partially improved(mPDAI score decreased more than 4 points),and failure or recurrence(mPDAI score increased or decreased less than 3 points). RESULTS:There were 43 males and 19 females,of whom 26 were consecutively treated with infliximab after surgery as maintenance therapy.Complete healing was not seen.Failure was seen in 10/36(27.8%) patients without infliximab and 4/26(15.4%)patients with infliximab(P=0.25).Partial improvement was seen in 26/36(72.2%)patients without infliximab and 22/26(88.5%)patients with infliximab(P=0.25). Short-term improvement was achieved in 48/62(77.4%) patients.Although the mPDAI score improved significantly with surgery regardless of infliximab,it decreased more from baseline in patients with infliximab(50.0%) than in those without infliximab(28.6%),(P=0.003). In the long-term,recurrence rates were low regardless of infliximab in patients without anorectal stricture.In patients with anorectal stricture,cumulative recurrence incidences increased gradually and exceeded 40%at 5 years regardless of infliximab.No efficacy of infliximab treatment was found(P=0.97).Although the cumulative rate of ostomy creation was also low in patients without stricture and high in patients with stricture,no protective efficacy was found with infliximab treatment(P =0.6 without stricture,P=0.22 with stricture). CONCLUSION:Infliximab treatment was demonstrated to have short-term efficacy for perianal lesions.Longterm benefit with infliximab was not proven,at least in patients with anorectal stricture.

Iatrogenic bile duct injuries:Etiology,diagnosis and management

Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Roux- en-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is end- to-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.

Therapeutic effectiveness of pediatric renal transplantation in 63 cases

Objective： To explore the characteristic of operation, intra-operation treatment and the application of immunosuppressant in pediatric renal transplantation in order to improve therapeutic effectiveness. Methods： From March 1986 to October 2006, the clinical data of 63 children who underwent renal transplantation in our hospital were retrospectively analyzed. Results： The 1-, 3-, 5-, 10-year graft survival rates were 98.4%, 90.5%, 88.9% and 68.3%, respectively. And the corresponding patient survival rates were 100%, 95.2%, 92.1%, 71.4%. The body weight increased 4 to 12 kg and the body height grew up 2 to 6 cm during the first year post-transplantation. The main complications in the first year post-transplantation were hypertension （26/63, 41.3%）, crinosity （14/63, 22.2%）, drug-induced hepatic injury（11/63, 17.5%）, gingival hyperplasia （10/63, 15.8%）, pulmonary infection（9/63, 14.3%）, bone marrow suppression（5/63, 7.9%）, herpes （4/63, 6.3%） and diabetes （3/63, 4.8%）. Conclusion： Renal transplantation is a preferred method for the treatment of children in end-stage renal disease （ESRD）. Good tissue matching, proper operative time and pattern, peri-operactive care were essential to success, as well as appropriate immuno-suppressant strategy and good compliance.

Role of surgical intervention in managing gastrointestinal metastases from lung cancer

AIM:To investigate the clinicopathological characteristics of late-stage lung cancer patients with gastrointestinal(GI)-tract metastases,focusing on therapeutic options and outcomes.METHODS:Our institution(the National Taiwan University Hospital) diagnosed 8159 patients with lung cancer between 1987 and 2008,of which 21 developed symptomatic GI metastases.This study reviewed all of the patients' information,including survival data,pathological reports,and surgical notes.RESULTS:The most common histological type of lung cancer was adenocarcinoma,and 0.26% of patients with lung cancer developed GI metastases.The median duration from lung cancer diagnosis to GI metastases was three months(range,0-108 mo),and the average time from diagnosis of GI metastasis to death was 2.8 mo.Most patients with symptomatic gastric and/or duodenal metastases exhibited GI bleeding and were diagnosed by panendoscopy.In contrast,small bowel metastases typically presented as an acute abdomen and were not diagnosed until laparotomy.All patients with small bowel or colonic metastases underwent surgical intervention,and their perioperative mortality was 22%.Our data revealed a therapeutic effect in patients with solitary GI metastasis and a favorable palliative effect on survival when metastases were diagnosed preoperatively.In patients with multiple GI metastases,the presentation varied according to the locations of the metastases.CONCLUSION:Surgical treatment is worthwhile in a select group of patients with bowel perforation or obstruction.Physicians should be more alert to symptoms or signs indicating GI metastases.

COMPARISON THE EFFICIENCY OF DIFFERENT SURGICAL PROCEDURES FOR URINARY STRESS INCONTINENCE

Objective.To analyse the efficiency of two operations for treatment of unirary stress incontinence (USI). Methods. The clinical data of 95 USI cases or accompany USI treated by surgical procedures (Kelly operation 63 cases, Colposuspension 32 cases) was analysed retrospectively in our department. Results.The cure rates during three months after operation were 92.9% in Colposuspension group and 68.9% in Kelly operation group (P<0.05), and decreased to 73.7% and 57.5% one year after operation in Colposuspension group and Kelly operation group respectively (P>0.05). Abnormal senses rates of sexual intercouse was 3.7% in Cloposuspension and 7.3% in Kelly operation group. The length of retaining Folly catheter after Colposuspension was more than Kelly operation. [WT5”BX]Conclusion.[WT5”BZ]The cure rate during three months after Colposuspension is better than Kelly operation. But the cure rates during one year after surgery are the same in two groups.

SURGICAL TREATMENT OF GYNECOLOGIC MALIGNANCES IN PATIENTS 70 YEARS OF AGE AND OLDER

Objective.T o assess the viability of surgical procedures on gynecologic malignant patients o f70years age and older.Methods.Between September1,1983to June30,1 999,57gynecologic malignant patients aged70years and older were treated by surgical procedures.A retrospective study was perf ormed.All patients were analyzed for preexisting medical conditions,length of hospital stay,morbidi-ty,and mortality.Results.Thirty-four patients had a n extensive surgical procedure,while a local surgical procedure was done in23 patients.Forty-one patientshad one or more preexisting medical i llnesses.Minor surgical morbidity occurred in24patientsand majo r surgical morbidity occurred in6patients.There were no differen ces in the types of surgical procedures,mean hospital stay,preexisting medical illness and postoperative complications between the two groups of patients70 to75year older and over age75.The major postoperative complications all occ urred in the extensive surgical procedure group that were higher as compared wit h local operation and postoperative mean stay was also significant-ly length in former group.Conclusions.The extensive surgical procedure can be performed fo r elderly patients with gynecologic malignances.Careful preoperative evaluatio n,monitoring,and meticulous postoperative care are vital to the success.

SURGICAL TREATMENT OF SPONDYLOLISTHESIS WITH SOCON INSTRUMENTATION

To observe the clinical outcomes of using a new instrumentation SOCON system in the treatment of degenerative spondylolisthesis. Methods. Retrospective clinical and roentgenograph review of 21 patients who suffered from degenerative spondylolisthesis with spinal stenosis treated by decompression, posterolateral intertransverse arthrodesis, and with transpedicle instrumentation of SOCON system. Results.Nineteen of 21 patients were completely recovery from their preoperative symptoms, 17 of 18 cases with grade one slippage reduced to normal spine alignment, 2 cases of grade two slippage fully reduced, and one case of grade two spondylolisthesis got 70% reduction. Post operative satisfactory rate was 90.5%. Pain relief was 90.5%. Neither infection nor neurologic complication occurred in this series. Conclusion. Our short time followup and limited cases showed satisfactory preliminary result of surgical treatment of spondylolisthesis with SOCON instrumentation.