目的:探讨新生儿高未结合胆红素血症病因构成、发生规律及防治。方法:对340例新生儿高未结合胆红素血症进行病因综合分析。结果:(1)病因以感染因素占首位,其次是溶血因素及围产因素;(2)病因与发病时间的关系:溶血因素及围产因素均发生在日龄lt;3 d内,发病日龄gt;3 d以感染因素为主,还有母乳性黄疸。结论:早期新生儿高未结合胆红素血症以溶血因素及围产因素为主,中晚期新生儿高未结合胆红素血症则以感染因素为主。故加强围生期保健,加强预防及抗感染,减少孕期及产时并发症的发生可有效减少新生儿黄疸的发生。
In order to verify the effectiveness of neural stump buried into the muscle in the prevention and treatment of neuroma, 17 cases were reported, in which 8 cases having 19 painful neuromas and 9 cases having 13 amputated meural stumps, buried into muscle. They wese followed up for 6 months to 40 months, It was shown that good and excellent results were obtained and no evidence of neuroma was observed in all cases except in one which had painful neuroma occurred from the failure of embedment of the neural stump into the muscle. The conclusion was that the neural stump buried into muscle was an effective method for the prevention and treatment of neuroma.
Abstract: Esophageal carcinoma is one of the most common malignant tumours in China, surgery is one of the traditional therapy with a high complications rate. Among them, the anastomotic fistula was significant. At present, with the development of surgical technique, the incidence of anastomotic fistula become lower day by day, postoperative pulmonary complications of esophageal carcinoma has taken place of anastomotic fistula and become the main complications. The causes of pulmonary complication including pulmonary embolism, infection and acute lung injury have been revealed by recent researches. This article reviews the pathogenesis， prophylaxis and therapeutics of postoperative pulmonary complications of esophageal carcinoma.
Acute lung injury is one of the common and serious complications of acute aortic dissection, and it greatly affects the recovery of patients. Old age, overweight, hypoxemia, smoking history, hypotension, extensive involvement of dissection and pleural effusion are possible risk factors for the acute lung injury before operation. In addition, deep hypothermia circulatory arrest and blood product infusion can further aggravate the acute lung injury during operation. In this paper, researches on risk factors, prediction model, prevention and treatment of acute aortic dissection with acute lung injury were reviewed, in order to provide assistance for clinical diagnosis and treatment.
Objective To evaluate the characteristics and reasons of complications in the patients with thoracoscopic esophagectomy. Methods We retrospectively analyzed the clinical data of 165 patients with thoracoscopic esophagectomy in our hospital from January 2013 through January 2015. There were 102 males and 63 females at average age of 67.9±8.3 years. Results The operation time was 275.3±50.2 min. The intraoperative blood loss was 230.0±110.5 ml. The number of lymph node dissection was 18.1±6.5. The volume of drainage in thoracic cavity was 750±550 ml on the third day after operation. Thoracoscopic esophagectomy surgeries were successful except that 13 patients (7.8%) converted to open operation including 6 patients (4.2%) with severe pleural adhesion, 2 patients (1.2%) with hemorrhage, 2 patients (1.2%) with arrhythmia, and 3 patients (1.8%) with abnormal oxygenation. There were 17 patients (10.8%) were with intraoperative complications including 2 patients (1.2%) with arrhythmia, 3 patients (1.8%) with abnormal oxygenation, 7 patients (4.2%) with hemorrhage caused by vascular injury, 4 patients (2.4%) with thoracic duct injury, 1 patient (0.6%) with recurrent laryngeal nerve injury. Moreover, 46 patients (27.8%) experienced postoperative complications including 23 patients (13.9%) with pulmonary infection, 6 patients (3.6%) with hoarseness, 4 patients (2.4%) with anastomotic leakage, 3 patients (1.8%) with incision infection, 2 patients (1.2%) with tracheoesophageal fistula, and 2 patients (1.2%) with pneumothorax. Unexpectedly, five patients underwent re-operation due to chylothorax (n=3, 1.8%) and hemorrhage (n=2, 1.2%). One patient (0.06%) died of acute pulmonary embolism. Conclusion Serious adhesion in abdominal cavity, abnormal of lung and heart. And bleeding are the main reasons caused transferring open thoracic surgery operation in patients with thoracoscopic esophagectomy. Lung infection, hoarseness, and anastomotic leakage of neck are the most common postoperative complications. And acute pulmonary embolism is the main cause of postoperative death. Proper precautions to decrease the morbidity of complication are necessary.
胆道并发症发生率的高低往往代表了一个肝移植中心的整体技术水平。欧美成熟的肝移植中心胆道并发症发生率为7%~10%，1年生存率达到90%。来自中国肝移植登记注册网（CTLR）的资料： 香港玛丽医院2006年统计了香港公民在大陆进行肝移植的148例患者，在长期随访中发现，有48%的受体发生了胆道并发症，1年生存率只有59%； 说明目前肝移植胆道并发症的防治仍然是亟待解决的难题。究其原因，还是对胆管微循环保护的研究不够深入和并发症发生的防治体系不够完善，笔者就此谈几点体会。1胆管微循环保护的理论人体肝脏胆管及血管铸型模型的研究显示，胆管为动脉单一供血，肝固有动脉和胃十二指肠动脉终末支分出3点、9点动脉滋养肝外胆管，并构成肝门部胆管周围血管丛(peribiliary vascular plexus,PVP)，胆管的动脉系统与门静脉之间无明显的交通血管，门静脉在胆管的血液供应中作用有限 (图1)。在动脉损伤时胆管很难从别的途径获得充分的血液供应，从而造成胆管的缺血性损伤。碳素墨汁灌注透明法显示，肝门部每个肝叶胆管及其分叉部均有肝固有动脉的较大分支支配，肝动脉的分支与胆管壁微血管之间呈垂直的连接方式。胆管厚切片透明后可清楚地显示出PVP的平面结构: 外层微血管直径较粗，内层微血管象链条一样排列，中层微血管连接在内、外层之间[３](图2)。动脉血流从外层较粗大血管流入位于胆管黏膜下的内层微血管，它是胆管动脉的终末分支,由内层微血管滋养的胆管上皮细胞层是胆管最易受损的部位(Achilles heel)。所以，肝移植中胆管动脉灌洗非常重要，应尽可能选用能够进入胆管黏膜内层血管网的低黏滞度灌注液。笔者研究证实了HCA液结合UW液灌注快速获取无心跳供体（NHBD）的肝脏，其保存效果优于单用UW液、Celsior液或HTK液，采用价廉低黏滞度HCA液联合UW液灌注，既能防止胆管PVP微血栓形成，又能充分发挥UW液对肝细胞和胆管细胞的保护作用.............................
In post-coronavirus disease 2019 era, people’s style of work and life have undergone major changes. The sedentary style of work and life, such as long-time office work, online meetings, home eating, online social interactions, and reduced range of activities, affect people’s physical and mental health. Neck and shoulder pain is one of the common symptoms. By combining the clinical practice experience of orthopedic medical experts in West China Hospital of Sichuan University, and reviewing a large number of literatures, this article summarized the definition, incidence, hazards, causes, evaluation and prevention of neck and shoulder pain in post-coronavirus disease 2019 era. It aimed to provide experience for the prevention and treatment of neck and shoulder pain in post-coronavirus disease 2019 era.