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甲状腺癌术后乳糜瘘的观察与护理

【摘要】　目的　总结甲状腺癌行颈廓清术并发乳糜瘘的治疗及护理方法。　方法　2008年8月-2009年10月，对8例甲状腺癌行颈廓清术发生乳糜瘘患者，采用局部加压包扎，引流管接负压器充分引流或手术缝扎乳糜管等治疗，并进行心理护理、营养指导、引流管监护、并发症的预防等专科护理和基础护理。　结果　4例患者经保守治疗、4例患者采用手术缝扎乳糜管，治愈出院。　结论　对甲状腺癌颈廓清术后并发乳糜瘘患者，采取适当的治疗方法及正确的护理措施，能促进患者尽快早日康复出院，缩短住院时间和减少经济负担。

复方利多卡因乳膏减轻血透内瘘穿刺疼痛效果的观察

【摘要】目的观察复方利多卡因乳膏在减轻血液透析内瘘血管穿刺疼痛中的效果。方法将52例首次使用内瘘穿刺的血透患者,随机分为对照组和复方利多卡因乳膏组。对照组以常规方法进行穿刺;复方利多卡因乳膏组在穿刺前以穿刺点为中心涂擦复方利多卡因乳膏,60 min后进行穿刺。结果复方利多卡因乳膏组内瘘穿刺疼痛程度与对照组比较,差异有统计学意义(Plt;005)。结论复方利多卡因乳膏涂擦可减轻内瘘穿刺时的疼痛。

Prevention Pancreatic Fistula after Whipple Operation by Casing Stump Ends of Pancreas and PancreaticojejunostomyReport of Cases

目的探讨如何降低胰十二指肠切除术后胰空肠吻合口漏的发生。方法采用胰管空肠吻合胰腺残端套入法行胰肠吻合，按胰、胆、胃顺序与空肠重建消化道。结果27例胰十二指肠切除术中，手术并发症7例（25.93%），其中应激性溃疡出血3例，胃排空延迟2例，腹腔及腹壁创口感染各1例，均经非手术治愈。全组无围手术期死亡，亦无一例发生胰瘘。结论胰瘘的发生同术式和操作技术密切相关，亦与吻合口部位血供和张力以及吻合口远端通畅与否有关。本术式增加了胰空肠吻合的严密性，对预防胰瘘的发生起到了积极的效果，且操作简便，易于掌握，效果可靠。

Clinical effect of anal fistula clip in treatment of anal fistula

ObjectiveTo analyze the effect of anal fistula clip (AFC) in the treatment of anal fistula, and to evaluate its safety. MethodsA historical cohort study method was conducted. Eighty-three patients with glandular transsphincteric anal fistula in the Xuzhou Central Hospital from September 2018 to May 2021 were collected, of which 42 patients underwent the AFC treatment (AFC group), 41 patients underwent the endorectal advancement flap (ERAF) treatment (ERAF group). The operation time, intraoperative blood loss, visual analogue scale (VAS) score of anus pain on postoperative day 1, 3, and 7, wound healing time, Wexner incontinence score of anal function on postoperative month 6, and clinical efficacy (healing and failure) were compared between the two groups. ResultsThe operation was successfully completed in both groups. The operation time and intraoperative blood loss in the AFC group were shorter or less than those in the ERAF group (P<0.05). No complications such as internal opening infection and bleeding occurred in the two groups. There were no statistical differences in the VAS score of postoperative anus pain at all time point between the two groups (P>0.05). The median follow-up time was 22 months. There was no statistical difference in the wound healing time between the two groups (P>0.05). The Wexner score of anal function in the AFC group was lower than that in the ERAF group (P<0.05), and there was no statistical difference between after operation and before operation (Z=–1.751, P=0.089) in the AFC group, while that in the ERAF group after operation was higher than before operation (Z=–1.859, P=0.014). The healing rate had no statistical difference between the AFC group and ERAF group (85.7% versus 77.5%, χ2=0.925, P=0.336). Conclusion From the results of this study, the AFC is safe and effective in treatment of anal fistula, with the advantages of relatively simple operation, less bleeding during operation, lighter postoperative pain, and good protection of anal function.

SURGICAL TREATMENT OF LYMPHATIC FISTULA OF SCROTUM

Abstract In order to investigate the different methods of operation to treat lymphatic fistula of scrotum, subtotal scrotectomy, ligation of lymphatic vessel and anastomosis of inguinal lymph nodes with greater saphenous vein were performed. From 1980 to 1994, 15 patients were treated, among them, 2 patients had complicated with chyluria. The clinical results were satisfactory after a follow-up for six months to three years. It was considered thatthe anastomosis of inguinal lymph node with the greater saphenous vein was the most effective method, besides, the method was simple and safe, as well.

The Clinical Significance of Drained Versus Nondrained Pancreaticojejunostomy in Prevention of the Pancreatic Leakage after Pancreaticoduodenectomy

ObjectiveTo investigate the effect of drained versus nondrained pancreaticojejunostomy on prevention of the pancreatic leakage after pancreaticoduodenectomy. MethodsSeventysix patients underwent the standard pancreaticoduodenectomy including resection of the distal stomach,common bile duct, the head of pancreas and the duodenum.Pancreaticenteric reconstruction was accomplished via either pancreaticojejunostomy by endtoside anastomsis or pancreaticojejunostomy by ducttomucosa anastomsis.The stented external drainage of pancreatic duct was used in 45 of 76 patients. ResultsPancreatic leakage was identified in 1 patient in the drained group consisting of 45 patients,in 7 patients in the nondrained group consisting of 31 patients, the incidence of pancreatic leakage in the drained group (2.2%) was significantly less than in the nondrained group (22.6%,P＜0.05).ConclusionComparing the incidences of pancreatic leakage from both groups,the authors believe that the stented external drainage of pancreatic duct can significantly reduce the incidence of pancreatic leakage after pancreaticoduodenectomy.

食管、贲门癌切除器械吻合术519例

目的 总结食管、贲门癌切除后应用器械吻合防止吻合口瘘和狭窄的临床经验。方法 回顾性地分析519例食管、贲门癌患者应用吻合器治疗的结果。结果 发生并发症7例，包括吻合口瘘2例，吻合口出血2例，吻合口狭窄3例，无手术死亡和住院死亡。结论 器械吻合完整快捷，明显地减少了手术操作时间和吻合口并发症的发生，降低了手术死亡率。

巨型基底动脉动脉瘤表现为第三脑室占位一例

彩色多普勒超声在透析患者动静脉内瘘并发症中的应用

目的　探讨彩色多普勒超声在透析患者动静脉内瘘并发症中的应用价值。 方法　2009年1月－2012年4月应用彩色多普勒超声检测129例透析患者动静脉内瘘瘘口、桡动脉、头静脉的解剖及血流动力学状况。 结果　129例透析患者动静脉内瘘中103例动静脉内瘘通畅，12例血栓形成，7例狭窄，4例静脉瘤样扩张，2例血肿，1例局部感染。 结论　彩色多普勒超声是监测透析患者动静脉内瘘血管通路的无创、简便、快速、有效的检测方法，能明确诊断动静脉内瘘并发症，还能快速诊断其低血流量原因，从而为临床及时治疗提供科学依据。

食管瘘治疗新进展

食管瘘是指各种原因所致食管与邻近器官的异常交通，根据瘘口连通的部位可分为食管胃吻合口瘘、食管气管瘘、食管纵隔瘘、食管胸腔瘘、食管主动脉瘘等，其中食管主动脉瘘相对较少见。食管瘘发生后消化道分泌物甚至食物可经过瘘口进入气管、胸腔、纵隔等，常导致致命性感染，且感染较难控制，若食管瘘不能得到及时诊治，常导致多器官功能衰竭甚至死亡。因此食管瘘的治疗成为胸外科和消化内科医生研究的热点之一。近年随着内镜技术的不断发展，食管瘘的内镜治疗取得良好的效果。现就食管瘘治疗的方法、效果等作一综述。