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誤診為急性心肌炎的心肌梗死一例

Application of Preperitoneal Tension-Ｆree Repair in Inguinal Hernia by Easy Prosthesis D-10

Objective To evaluate the clinical effect of Easy Prosthesis D-10 on open preperitoneal groin tension-free hernioplasty. Methods The operative time, operation-correlated complications, hospital stay and recent follow-up findings of 63 patients underwent preperitoneal groin tension-free hernioplasty were analyzed from October 2006 to April 2008. Results No case died in perioperative period. The average operative time was (47.6±10.5) minutes. None of incision infection and scrotal hydrocele occurred. The average hospital stay was (7.7±2.1) days. During follow-up period of 6 to 24 months, no recurrence, chronic pain and foreign body sensation were found. Conclusion The open preperioneal groin tension-free hernioplasty by Easy Prosthesis D-10 is safe and reliable, especially for the inguinal hernia with large hernia ring or defect of transversalis fascia and recurrent hernia.

腹腔鏡與開腹手術治療腹膜后位闌尾炎的臨床療效比較

目的 比較腹腔鏡闌尾切除術（laparoscopic appendectomy，LA）與開腹闌尾切除術（open appendectomy，OA）在腹膜后位闌尾炎治療中的臨床效果。 方法 回顧性分析 2012 年 1 月至 2016 年 12 月期間于筆者所在醫院科室接受 LA 或 OA 的 147 例腹膜后位闌尾炎患者的臨床資料，比較 LA 和 OA 的臨床療效。 結果 所有病例均未死亡、臨床治愈。2 組患者的手術時間和住院費用比較差異均無統計學意義（P>0.05），但 LA 組的腸功能恢復時間、止痛藥物使用率、術后感染率及住院時間均低于（短于）OA 組，差異均有統計學意義（P<0.05）。 結論 對于無腹腔鏡手術禁忌的腹膜后位闌尾炎患者，LA 較 OA 具有術后疼痛輕、恢復快、并發癥少及住院時間短的優點。

Diagnosis and Surgical Treatment of Pulmonary Tuberculosis Complicated by Aspergillus Infection

Objective To investigate diagnosis and treatment strategies of patients with pulmonary tuberculosis （TB） complicated by Aspergillus infection. Methods Clinical data of 38 patients with pulmonary TB complicated by Aspergillus infection who underwent surgical treatment from January 2008 to December 2010 in Chengdu Infectious Disease Hospital were retrospectively analyzed. There were 23 male patients and 15 female patients with their average age of 37.8 （23-59） years. Preoperatively，all the patients received regular anti-TB treatment for more than 2 weeks，and patients with definite Aspergillus infection received anti-Aspergillus therapy for more than 3 days with consultation of infectious disease physicians. After above treatment，26 patients underwent lobectomy，1 patient underwent right pneumonectomy，and 11 patients underwent left pneumonectomy. All the patients were followed up at the outpatient department after discharge. They were evaluated every 2 weeks in the first 3 months，every 1 month after 3 months，and every 6 months after 1 year. During follow-up，they received acid-fast bacillus smear and sputum culture to check Aspergillus，as well as CT chest scan. Results All the patients successfully received surgical resection of the pulmonary lesion without perioperative death or severe complication. Postoperative pathology examination confirmed pulmonary TB with Aspergillosis infection in all the 38 patients，whose basic diseases included TB cavity in 17 patients，TB-destroyed lung in 12 patients，and post-TB bronchiectasis in 9 patients. All the patients were followed up after discharge for 1.5-4.5 years. During follow-up，they received regular anti-TB therapy for adequate duration in addition to antifungal medications such as voriconazole. None of the 38 patients had recurrence of Aspergillus infection or pulmonary TB. One patient had hemoptysis which was controlled after proper treatment during follow-up. Conclusion Missed diagnosis rate of pulmonary TB complicated by Aspergillus infection is high. Surgical resection of the pulmonary lesion and postoperative medication treatment are the most effective treatment strategies for patients with pulmonary TB complicated by Aspergillus infection.

Open Surgery Repair for Incision Hernia of Abdominal Wall

目的探討腹壁大切口疝和巨大切口疝治療經驗。方法對我院采用補片行開放式腹壁大切口疝和巨大切口疝修補術的51例患者臨床資料進行回顧性分析。結果采用肌前補片修補法3例，肌肉間補片修補法3例，肌后腹膜前補片修補法39例，腹腔內補片修補法6例。 手術時間109～195 min，平均135.2 min; 術中出血15～90 ml，平均35.6 ml；術中無血管和內臟損傷等并發癥。 術后3～7 d（平均4.9 d）下床活動; 住院時間7～19 d，平均9.7 d。 2例患者術后出現漿液腫，經穿刺抽吸、負壓吸引和腹帶加壓包扎后治愈。51例患者隨訪12～36個月（平均24.5個月），3例（5.9%）患者復發，后行開放式腹腔內補片修補手術，恢復良好，無再復發。所有病例無慢性疼痛。結論應用補片行開放式腹壁大切口疝和巨大切口疝修補術是一種安全、可靠的方法，復發率低。

外科手術治療慢性結核性膿胸的療效分析

目的　探討慢性結核性膿胸的治療方式。 方法 對成都市傳染病醫院2008年1月至2010年12月收治的184例慢性結核性膿胸進行分組治療：手術組89例，男52例、女37例，年齡14～66歲，在正規有效抗癆基礎上行膿胸清除＋纖維板（增厚的胸膜）剝脫術，術后繼續正規抗癆治療；對照組95例，男61例、女34例，年齡15～68歲，僅采用內科正規有效抗癆治療，比較兩組治療前后的病情變化。 結果 手術組患者經過手術治療后膿胸消除，胸廓的塌陷得到遏制，多數患者可以使塌陷胸廓得到改善，肺功能均有明顯改善，生活質量得到改善；而對照組患者治療前后癥狀無明顯改善（3例治療期間退出研究），反而自覺胸悶、胸痛、氣促等癥狀多有加重，胸廓塌陷更明顯，肺功能繼續惡化，生活質量變差。治療結束后兩組病例均進行門診隨訪1～3年，手術組失訪1例，對照組失訪2例，隨訪率98.3%；隨訪期間，手術組無膿胸復發，患者癥狀體征改善，無再住院，而對照組患者癥狀體征多有加重，再住院率40.2%。 結論 外科手術是治療慢性結核性膿胸的最佳方式。

Clinical Research on Assessment of Prognosis by Lactate Clearance in Severe Trauma

【摘要】　目的　評估乳酸清除率與重癥創傷患者預后的關系。　方法　回顧性分析2010年1－6月收住曲靖市第一人民醫院ICU科的37例重癥創傷患者的初始血乳酸值、第2次血乳酸值、乳酸清除率及患者的預后，將患者分為存活組和死亡組，比較兩組患者初始血乳酸值、乳酸清除率的差異。　結果　兩組患者年齡、性別、初始血乳酸值差異無統計學意義（Pgt;0.05）。存活組血乳酸清除率（48.26±21.57）%明顯高于死亡組（11.71±20.88）%，差異有統計學意義（Plt;0.001）；當乳酸清除率≥13%時，能較好地預測患者生存，其靈敏度為96%，特異度為80%。　結論　乳酸清除率可用于評估重癥創傷患者的預后。【Abstract】　Objective　To evaluate the correlation between prognosis and lactate clearance in severe trauma.　Methods　The clinical data of 37 patients with severe trauma admitted between January and June 2010 in the First People′s Hospital of Qujin were analyzed retrospectively. These data included initial blood lactate concentration, second blood lactate concentration, lactate clearance rate, and prognosis of the patients. The patients were divided into survivor group and non-survivor group, and the differences of initial blood lactate concentration and lactate clearance rate between them were compared.　Results　There were no differences in age, sex, and the initial blood lactate concentration (Pgt;0.05) between the two groups. Compared with non-survivors, the survivors had a significantly higher lactate clearance [(48.26±21.57)% vs. (11.71±20.88)%, Plt;0.001]. Patients with a lactate clearance higher than or equal to 13% had a sensitivity of 96%, specificity of 80%, for predicting survival.　Conclusion　Lactate clearance rate can be used to predict the prognosis of severe trauma.