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Clinical Observation on Continuous Drainage of Abdominal Cavity in the Treatment of Thirty-eight Patients with Refractory Ascites

目的:觀察持續腹腔引流治療頑固性腹水的療效。方法:將頑固性腹水患者74例分為兩組,治療組38例,采用腹腔置管,持續腹腔引流腹水,3000mL/天;對照組36例,以常規補充白蛋白、限鈉、限水、利尿治療為主,比較兩組的療效。觀察治療組治療前后患者尿量、腹圍和體重變化,并比較治療組與對照組在肝、腎功能及電解質的變化及總體療效。結果:治療組療效優于對照組(Plt;0.05),與治療前比較,治療組治療后尿量、腹圍、體重有明顯改變(Plt;0.01), 肝、腎功能及電解質與對照組比較無明顯變化(Pgt;0.05)。結論:持續腹腔引流治療頑固性腹水經濟適用,不良反應少,患者依從性好。

Effect of intravenous tranexamic acid on postoperative drainage and elbow joint function after traumatic elbow stiffness release

Objective To explore the effect of intravenous tranexamic acid on postoperative drainage and elbow joint function after traumatic elbow stiffness release. Methods The clinical data of 44 patients with elbow joint stiffness who were treated with release surgery between March 2022 and December 2023 and met the selection criteria were retrospectively analyzed. Among them, 20 patients were given intravenous infusion of 100 mL (1 g/100 mL, once a day) of tranexamic acid solution for 3 consecutive days after surgery (group A), and 24 patients were not treated with tranexamic acid after surgery (group B). There was no significant difference in baseline data such as gender, age, side, body mass index, initial injury, and preoperative hemoglobin, visual analogue scale (VAS) score, and Mayo elbow function score (MEPS), elbow flexion and extension activity between the two groups (P>0.05). The drainage volume at 1 day and 3 days after operation, total drainage volume, drainage tube indwelling time, postoperative hospital stay, VAS score before operation and at 1, 2, and 3 days after operation, MEPS score before operation, at 3 months after operation, and at last follow-up, and elbow flexion and extension activity before operation and at last follow-up were recorded and compared between the two groups. Results Both groups of patients successfully completed the operation, and there was no significant difference in operation time (P>0.05). The drainage volume at 1 day and 3 days after operation, total drainage volume, drainage tube indwelling time, and postoperative hospital stay in group A were significantly less than those in group B (P<0.05). Both groups of patients were followed up 6-12 months, with an average of 8.6 months. No complications such as wound infection, elbow joint varus and varus instability or dislocation, and pulmonary embolism or other thromboembolic events occurred in either group. The VAS scores of both groups were significantly higher at 1 day and 2 days after operation than before operation (P<0.05); the VAS score of group A was significantly lower than that of group B (P<0.05). The VAS scores of both groups decreased to the preoperative level at 3 months after operation, and there was no significant difference between the two groups (P>0.05). At 3 months after operation and at last follow-up, the MEPS scores of both groups significantly improved when compared with those before operation (P<0.05); there was no significant difference between the two groups (P>0.05). At last follow-up, the postoperative elbow flexion and extension activity of the two groups significantly increased when compared with that before operation (P<0.05); there was no significant difference in change of elbow flexion and extension activity between the two groups (P>0.05). ConclusionIntravenous tranexamic acid for 3 consecutive days after release of traumatic elbow stiffness can significantly reduce postoperative drainage volume, shorten drainage tube indwelling time and hospital stay, and relieve early postoperative pain, but it has no effect on the risk of thrombotic and embolic events and postoperative elbow function.

胰床持續對流灌洗加后上腰部引流治療急性壞死性胰腺炎20例分析

Continuous Lumbar Drainage for Subarachnoid Hemorrhage: A Systematic Review

ObjectiveTo assess the effectiveness and safety of continuous lumbar drainage of cerebrospinal fluid for subarachnoid hemorrhage (SAH). MethodsThe Cochrane Library (January 1992 to May 2013), Medline (January 1950 to May 2013), SinoMed (January 1979 to May 2013), CNKI (January 1979 to May 2013), and Wanfang Database (January 1979 to May 2013) were searched for randomized controlled trials (RCTs) on continuous lumbar drainage for SAH. The method of Cochrane systematic review was used to evaluate all the included RCTs. ResultsTwelve RCTs (857 patients) met the inclusion criteria, but the general methodological quality of trials was poor. Only two studies addressed the outcomes about SAH patients' death, vegetative state or disability and other adverse events at the end of the follow-up period (at least 3 months). Meta-analysis of fatality showed a better effect of lumbar continuous drainage of the cerebrospinal fluid for SAH than the control group with statistical significance [RR=0.27, 95%CI (0.12, 0.59), P=0.001]. Meta-analysis of complications also showed a better effect of lumbar continuous drainage of the cerebrospinal fluid for SAH than the control group with statistical significance (except re-bleeding) [cerebral vasospasm: RR=0.20, 95%CI (0.14, 0.30), P<0.000 01; hydrocephalus: RR=0.24, 95%CI (0.13, 0.41), P<0.000 01; cerebral infarction: RR=0.27, 95%CI (0.16, 0.45), P<0.000 01]. Only one trial reported the adverse events of lumbar continuous drainage of the cerebrospinal fluid including intracranial infection and intracranial hypotension reaction, while the others did not report the adverse events. ConclusionWith poor quality of the most included trials, insufficient evidence is obtained to support the conclusion that lumbar continuous drainage of the cerebrospinal fluid is safe and effective in the treatment of SAH. Further high-quality RCTs should be carried out to provide more reliable evidences.

Clinical Efficacy of Redirection Catheter Drainage outside the Anus in Treating Rectal Submucosal Abscess

目的　探討改道置管肛外引流術治療直腸黏膜下膿腫的臨床療效。 方法　2007年5月－2012年5月，將76例直腸黏膜下膿腫患者分為改道置管肛外引流術（治療組）和傳統切開引流術（對照組）治療，每組各38例，兩組患者在年齡、性別比、病程等方面具有可比性。觀察兩組患者治愈時間、治愈率、隨訪3個月的復發情況以及肛門直腸壓力測定，評價兩組患者臨床療效及肛門功能保護情況。 結果　治療組患者治愈時間為（21.3 ± 6.37）d，對照組為（29.5 ± 4.52）d，治療組時間明顯縮短（t=5.79，P＜0.01）；治療組治愈率97.3%，對照組為73.6%，差異有統計學差異（χ2=6.81，P＜0. 01）；兩組患者隨訪3個月的肛門功能比較，RRP治療組為3.48 ± 0.61，對照組3.22 ± 0.79，差異無統計學意義（t=?1.61，P＞0.05）；ARP治療組為19.05 ± 3.76，對照組為17.55 ± 3.31，差異無統計學意義（t=?1.85，P＞0.05）；ALCT治療組為36.74 ± 4.70，對照組為37.13 ± 3.90，差異無統計學意義（t=?0.39，P＞0.05）；AMCP治療組為24.03 ± 5.80，對照組為21.8 ± 4.91，差異無統計學意義（t=?1.61，P＞0.05）。 結論　改道置管肛外引流術治療直腸黏膜下膿腫可縮短療程，提高治愈率。

自制雙活瓣抗反流引流管在地震救援中的應用

Progress of acute obstructive suppurative pancreatic ductitis in diagnosis and treatment

Objective To investigate the etiology, pathogenesis, clinical manifestations, diagnosis and treatment of acute obstructive suppurative pancreatic ductitis (AOSPD). Method The literature reports on AOSPD at home and abroad were reviewed and analyzed comprehensively based on clinical experience. Results AOSPD was a rare clinically infectious disease of purulent pancreatic duct. Chronic pancreatitis and ampullary operations were the main pathogenesis factors. The clinical symptoms were non-specific, and the imaging manifestations were pancreatic duct dilatation and pancreatic duct calculi. The clinical diagnosis was mainly determined by epigastrium CT or endoscopic retrograde cholangiopancreatography, which was easy to be misdiagnosed and missed. Conclusion The clinical diagnosis of AOSPD is difficult, early pancreatic duct drainage is the key to the treatment, and attention should be paid to its diagnosis and treatment.

吻合靜脈加負壓引流治療全手掌皮膚脫套傷

目的 總結吻合靜脈加負壓引流治療全手掌皮膚脫套傷的治療方法和臨床效果。 方法 2005 年6 月－ 2007 年9 月，收治全手掌皮膚脫套傷7 例。男5 例，女2 例；年齡17 ～ 45 歲，平均30 歲。機器壓傷5 例，滾軸絞傷2 例。手掌、手背自腕橫紋逆行脫套至指蹼。受傷至手術時間為1 ～ 6 h，平均3 h。術中吻合皮下靜脈、重建靜脈回路，傷口內放置負壓引流進行原位修復。 結果 6 例脫套皮膚全部成活；1 例脫套皮膚遠端掌側部分壞死，行游離植皮后成活。7 例均獲隨訪，隨訪時間3 ～ 17 個月，平均12 個月。手部外形及色澤基本正常，出汗正常，手指屈、伸及感覺功能恢復良好。按中華醫學會手外科學會上肢部分功能評定試用標準：獲優3 例，良3 例，差1 例，優良率85.7%。 結論 吻合靜脈加負壓引流可以減輕皮膚水腫，提高脫套皮膚的成活率，是治療全手掌皮膚脫套傷的一種較好方法。

腹腔鏡膽總管探查術后膽總管一期縫合與T管引流的療效觀察

目的比較腹腔鏡膽總管探查術后膽總管一期縫合與T管引流對臨床治療膽總管結石患者的影響 方法將2012年4月至2015年12月期間筆者所在醫院收治的膽總管結石擬行腹腔鏡膽總管切開取石術的90例患者作為研究對象，按隨機數字表法分為觀察組和對照組，數字為偶數者為觀察組，奇數者為對照組，每組45例。觀察組進行膽總管一期縫合，對照組行T管引流，記錄并比較2組患者的手術情況及術后恢復情況，并對2組術后并發癥的發生情況進行比較。 結果觀察組手術時間明顯短于對照組，差異有統計學意義（P＜0.05），2組術中出血量比較差異無統計學意義（P＞0.05）；觀察組患者術后肛門排氣時間、下床活動時間、住院時間及恢復工作時間均明顯短于對照組，差異有統計學意義（P＜0.05）；此外觀察組住院費用亦明顯少于對照組，差異有統計學意義（P＜0.05）；觀察組患者術后并發癥的發生率明顯低于對照組，差異有統計學意義（P＜0.05）。 結論在嚴格掌握相關適應證的前提下，采用腹腔鏡膽總管切開取石一期縫合臨床效果顯著，具有手術時間短、術后恢復快、安全性高的優勢，值得在臨床推廣使用。

STUDY ON DIAGNOSIS AND TREATMENT OF KNIFE TRAUMA OF THE ABDOMEN

目的 探討腹部刀刺傷診治策略，提高治療水平。方法 回顧性總結分析147例腹部刀刺傷的診斷和治療。結果 剖腹手術139例，傷口清創縫合8例，治愈145例，死亡2例。結論 休克，大網膜及腹腔臟器外脫，腹痛伴腹膜炎體征，診斷性腹腔穿刺陽性均是手術指征。臀部刀刺傷要警惕損傷腹腔臟器。合并胸部傷或發生胸腹聯合傷時，除有心臟大血管損傷外，原則上應先剖腹，術前置胸腔引流觀察胸腔出血漏氣情況，改善呼吸。