目的:探討雙豬尾型輸尿管內支架(Double pigtail stent,DPS)作為泌尿外科上尿路疾病手術輔助治療的適應癥、并發癥及并發癥的治療。方法:總結我院2004年6月至2008年12月共122例施行輸尿管內支架放置術患者的適應癥、并發癥及并發癥的治療結果。結果:24例患者(19.6%)在置管期間出現1個或以上并發癥。主要并發癥包括肉眼血尿(9例)、疼痛(16例)、膀胱刺激征(12例)、高熱(1例)。大部分并發癥是輕微和可以耐受的,并迅速得到了適當的處理。2例須拔除內支架,其中劇烈疼痛1例、高熱1例。結論:DPS用于上尿路疾病手術輔助治療是安全和有效的,DPS引起的并發癥大部分易于處理。
Objective To discuss the key issues in the diagnosis and treatment of degenerative disc disease and thetherapeutic effect of transforaminal lumbar interbody fusion on it. Methods From September 2004 to August 2006, 15 cases of degenerative disc disease were treated by transforaminal lumbar interbody fusion, including 8 males and 7 females with the age of 33-46 years. All cases were single-level degenerative disc diseases, including 1 case of L3,4, 8 cases of L4,5 and 6 cases of L5, S1. The course of the disease was 2 -10 years. Preoperatively, the score of visual analogue scale (VAS) was 8.9 ± 1.8 and the score of Oswestry disabil ity index (ODI) was 51.4 ± 8.3. All patients had received normal conventional treatment for at least 3 months and had no therapeutic effect before operation. Results The operation time was 120-180 minutes (150 minutes on average) and the intra-operative blood loss was 200-500 mL (360 mL on average). There was no severe compl ication, except that the muscle tone of anterior tibia in one case decreased to the third level, which recovered to the 5- level 3 months after operation. A total of 15 cases were followed up for 12-24 months (18 months on average). All patients got interbody bony fusion 12 months after operation with the fusion rate of 100%. Postoperatively, the score of VAS was 2.8 ± 1.6 and the score of ODI was 19.1 ± 3.2, indicating there were significant difference in comparison with postoperative ones (P lt; 0.05). The improvement rates of postoperative VAS and ODI were 61.8% ± 7.3% and 64.3% ± 5.5%, respectively. For the therapeutic effect, 6 cases were regardedas excellent, 8 good, 1 fair, and the choiceness rate was 93.3%. All patients resumed their jobs and normal l ives. Conclusion Transforaminal lumbar interbody fusion is effective for the treatment of lumbar degenerative disc disease, but the indications for operation must be strictly defined.
ObjectiveTo investigate the association between colorectal adenoma (CRA) and colorectal cancer (CRC), and to analyze the main pathogenesis of CRA, in order to identify and control the key factors of CRA and reduce the incidence of CRC. MethodThe studies on the mechanism of CRA in recent years were searched and summarized, focusing on the interaction of inflammation, genetic and epigenetic changes, gut microbiota and lipid metabolism, and their effects on the development of CRA. ResultsInflammation, genetic and epigenetic changes, intestinal flora and lipid metabolism play an important roles in the occurrence and development of CRA. These factors had a significant impact on the formation and progress of CRA at different stages through complex interaction, and had potential application value in preventing CRC. ConclusionsMany factors participate in the occurrence and development of CRA and plays an important role, which provide reference for future research and clinical intervention.
Obstractive To observe the clinical effects and safety of endobronchial electrocautery treatment for tracheobronchial obstructive lesions in inoperable tracheobronchial squamous cell carcinoma.Methods Ninety-five patients with advanced and inoperable tracheobronchial squamous cell carcinoma were included. Thirty-four patients with central airway obstruction were treated with endobronchial electrocautery plus chemotherapy ( group A) and 61 patients without central airway obstruction were treated with chemotherapy alone ( group B) . The chemotherapy consisted of cisplatin or carboplatin, plus another thirdgeneration chemotherapy agent. Results In groug A, there were mean improvements in FEV1 of 41. 1% and in peak expiratory flow( PEF) of 65. 6% . There was no significant difference in the survival rates of the patients with and without central airway obstruction. Median survival time of group A was 11. 3 months and those of group B was 11. 6 months. 3, 6, and 12-month survival rates in group A were 87% , 68% and 39% respectively, and those in group B were 93% , 76% , and 45% respectively. Conclusion Endobronchial electrocautery is an effective and safe approach for inoperable tracheobronchial obstructive malignancies with few complications.
Objective To enhance the understanding of pulmonary hemangiopericytoma. Methods With a case report and reviewing related literatures, the etiology, clinical manifestations, radiological features,pathological features, diagnosis, treatment and prognosis of pulmonary hemangiopericytoma were discussed.Results The etiology of this rare disease remains unknown. Clinical symptoms are rare and non-specific.Radiological features show a round, homogeneous, soft-tissue mass without calcification. Pathologic feature reveals a large number of capillary lumen, and some tumors can be dressed with pseudo capsule or show infiltration growth to the surrounding tissue. The diagnosis of pulmonary hemangiopericytoma is mainly based on the imaging findings, and pathological examination is needed for final diagnosis. The best choice of treatment is surgery, combined with chemotherapy and radiotherapy.Conclusions Pulmonary hemangiopericytoma is rare and often misdiagnosed as other pulmonary diseases. More attention should be paid to improve its therapeutic effect and prognosis.
ObjectiveTo discuss the effectiveness of limited open reduction via sinus tarsi approach using medial distraction technique in the treatment of intra-articular calcaneus fractures by comparing with open reduction and internal fixation via extensile L-shaped incision. MethodsA retrospective analysis was made on the clinical data of 21 patients with intra-articular calcaneus fractures treated by sinus tarsi approach combined with medial distraction technique between April 2013 and November 2014 (minimally invasive group), and 32 patients treated by extensile L-shaped incision approach between June 2012 and September 2014 (extensile incision group). No significant difference was found in gender, age, injury pattern, fracture classification, time from injury to operation, preoperative B?hler angle, Gissane angle, calcaneal varus angle, the ankle and hind-foot score of American Orthopaedic Foot and Ankle Society (AOFAS), and visual analogue scale (VAS) score between 2 groups (P>0.05), which was comparable. The operation time, wound complications, and bone healing time were recorded. The postoperative function was also evaluated by AOFAS score and VAS score. The pre-and post-operative B?hler angle, Gissane angle, and calcaneal varus angle were measured on the X-ray films, and the corrective angle was calculated. ResultsSixteen patients were followed up 6-18 months (mean, 11.5 months) in the minimally invasive group, and 23 patients for 6-24 months (mean, 13.5 months) in the extensile incision group. Difference was not significant in operation time between 2 groups (t=0.929, P=0.796). No complication occurred in the minimally invasive group; partial skin flap necrosis occurred in 3 cases of the extensile incision group, was cured after dressing change. There was no loosening of implants or reduction loss in 2 groups at last follow-up. Subtalar joint stiffness occurred in 1 case of the minimally invasive group and 4 cases of the extensile incision group, and 1 patient had discomfort for the implants in the extensile incision group. The bone healing time was (9.9±0.8) weeks in the minimally invasive group, and was (10.1±0.7) weeks in the extensile incision group, showing no significant difference (t=0.613, P=0.845). B?hler angle, Gissane angle, calcaneal varus angle, AOFAS score, and VAS score were significantly improved at last follow-up when compared with preoperative values in 2 groups (P < 0.05), but there was no significant difference between 2 groups (P>0.05), and the corrective value of angle showed no significant difference between 2 groups (P>0.05). ConclusionLimited open reduction via sinus tarsi approach for intra-articular calcaneus fractures could reduce the incidence of wound complications effectively. Meanwhile, the medial distraction technique is helpful to correct the heel varus deformity.