目的探討廣泛門靜脈血栓形成（portal vein thrombosis，PVT）的診治經驗。 方法回顧性分析筆者所在醫院2004年1月至2012年12月期間收治的7例廣泛PVT患者的臨床資料。 結果按Yerdel’s分級7例患者屬Ⅲ～Ⅳ級；男4例，女3例；年齡28～54歲，中位年齡45歲；起病至就診時間4～10 d，平均6.9 d。表現為上腹痛3例，全腹痛、腹脹4例，血便2例，休克1例，腰背痛1例，惡心、嘔吐3例。查體：有腹膜炎體征3例，左下腹壓痛1例，腹水征陽性3例，腸鳴音消失2例，減弱1例。2例行D-二聚體檢查均升高。所有患者超聲檢查均提示門靜脈血栓形成、累及腸系膜上靜脈。給予抗凝、祛聚、溶栓等基礎治療；1例經腸系膜上動脈導管溶栓，2例手術切除壞死腸管，其中1例同時行脾切除術。1例術后發生腸瘺，經保守治療治愈；3例患者發生門靜脈高壓性胃腸病，口服普萘洛爾治療。 結論早期行血漿D-二聚體及影像學檢查，盡早行抗凝治療，無禁忌時行溶栓或介入治療以及實時手術治療，PVT患者可有較好的預后。
目的總結糖尿病并細菌性肝膿腫(DPHA)的臨床特點和診治經驗。方法回顧性分析我院2002年3月至2010年12月期間出院的DPHA與無DPHA(NDPHA)患者的臨床資料。結果細菌性肝膿腫患者共22例，其中DPHA患者11例。DPHA組人口學特征、臨床表現、白細胞計數與NDPHA組比較差異均無統計學意義(Pgt;0.05); DPHA組血白蛋白低于NDPHA(P=0.006)，而ALT高于NDPHA(P=0.006)。DPHA組病灶個數多于NDPHA組(P=0.032)，且病灶直徑也大于NDPHA組(P=0.006)。膿培養: 2組大腸桿菌均為3例; DPHA組克雷伯桿菌4例，而NDPHA組無克雷伯桿菌。DPHA組發生切口感染7例、腹腔感染2例，NDPHA組發生切口感染3例。 DPHA組抗生素使用時間、住院時間及住院費用均高于NDPHA組(Plt;0.05)。2組均分別治愈6例、好轉5例，2組均無死亡患者。結論DPHA有其特殊的臨床特征，并發癥多，住院費用高，但預后與NDPHA差別不大。
ObjectiveTo introduce and interpret ABCD classification system for subaxial cervical spine injury. MethodsThe literature related to subaxial cervical spine injury classification system was extensively reviewed, analyzed, and summarized so as to introduce the ABCD classification system. ResultsThe ABCD classification system for subaxial cervical spine injury consists of 3 parts. The first part of the proposed classification is an anatomical descri ption of the injury; it del ivers the information whether injury is bony, ligamentous, or a combined one. The second part is the classification of nerve function, spinal stenosis, and spinal instabil ity. The last part is optional and denotes radiological examination which is used to define injury type. Several letters have been used for simplicity to del iver the largest amount of information. And a treatment algorithm based on the proposed classification is suggested. ConclusionThe ABCD classification system is proposed for simplification. However further evaluation of this classification is needed.
目的 提高對幼年性息肉致小腸套疊的診治水平。方法 按檢索策略，檢索PubMed、中國生物醫學文獻數據庫（CBM）、中文科技期刊全文數據庫（CSJD）、中國期刊全文數據庫（CJFD）及CNKI數字圖書館的相關文獻，并結合筆者所在醫院于2011年收治的1例幼年性息肉致小腸套疊病例資料，對該病進行一系統的描述。結果 共檢出相關文獻65篇，按納入及排除標準，最后納入6篇文獻。共7例患者，臨床表現為腹痛、嘔吐5例，便血2例，貧血3例；經超聲檢查診斷4例；全組均行小腸切除腸吻合術，其中1例為腹腔鏡輔助手術；有1例患者共實施了3次手術，最后死于惡液質，其余患者恢復較好。結論 幼年性息肉致小腸套疊為臨床罕見疾病，超聲檢查仍為首選診斷方法；提高醫師對該病的認識，術中徹底探查腸道，必要時術中行快速冰凍切片病理學檢查，有望減少息肉遺留，改善患者的預后。
Objective To explore the value of pathologic diagnosis for pancreatic head mass by using recise Tru-cut biopsy under intraoperative ultrasound guided. Methods Twenty-eight patients with solid pancreatic masses in People’s Hospital of Suqian，Affiliated Hospital Xuzhou Medical College from August 2010 to August 2011 were performed precise Tru-cut biopsy under intraoperative ultrasound guided. In all patients of 28 cases, male 20 cases and female 8 cases, the male-to-female ratio was 5∶2. The patients’ age was 34-78 years old（mean age： 64 years old）. Twenty-eight patients were divided into three groups based upon the greatest dimension of the masses as follows：equal or less than 1.5 cm （group S, 5 cases）, 1.5-3.0cm （group M, 7 cases）, and greater than 3.0cm （group L, 16 cases）. Three needlepasses in each mass were performed. The results of postoperative pathologic findings were compared with specimens in paraffin sections. Results In all cases of 28, the diagnostic coincidence rate was 100%, there were no false positive finding and false negative. The coincidence ratio for pathological diagnosis of tissues with only 1 strip sample （1/3）, only 2 strip samples （2/3）, and with 3 strip samples （3/3） were 3/5, 2/5, and 0/0, respectivly in S group, 0/0, 5/7, and 2/7, respectivly in M group, and 0/0, 4/16, and 12/16, respectivly in L group. The false negative rate of single strip sample in S group and M group was higher than that in L group （χ2=9.833，P=0.002）. There was false negative finding with master single test in small focus of infection. Conclusion Precise Tru-cut biopsy under intraoperative ultrasound guided is a safe and highly accurate method for pathological diagnosis of patients with solid pancreatic lesions, especially in small lesions，it is worthy of clinical application..
Objective To evaluate the limbs shortening and re-lengthening in the treatment of tibial infectious bone defect and chronic osteomyelitis. Methods Between January 2011 and April 2016, 19 cases of tibial infectious bone defect and chronic osteomyelitis were treated with the limbs shortening and re-lengthening technique. There were 13 males and 6 females, aged from 22 to 62 years (mean, 44 years). The causes of injury included traffic accident injury in 16 cases, crush injury in 1 case, and falling from height in 2 cases. One patient was infected after plate internal fixation of closed tibial fracture and 18 patients after external fixation of open tibial fractures (Gustilo type IIIB). The mean previous operation times was 3 times (range, 2-5 times). The time from injury to bone transport operation was 3-11 months (mean, 6.5 months). The bone defect length was 2.0-5.5 cm (mean, 4.3 cm) after debridement. After tibial shortening, limb peripheral blood supply should be checked after release of the tourniquet. Seven wounds were closed directly, 5 were repaired with adjacent skin flap, 5 were repaired with sural neurovascular flap, 1 was repaired with medial head of gastrocnemius muscle flap, and 1 underwent skin grafting. Single arm external fixator or ring type external fixator were used, and completely sawed off between 2 sets of external fixation screws at proximal and distal metaphysis of the tibia. Limb lengthening was performed after 1 week with the speed of 1 mm/d. Results All patients were followed up 10-36 months with an average of 14 months. Two cases delayed healing of the wound after operation, and the other wounds healed primarily. Natural healing of the opposite end of the bone were found in 18 cases, and 1 case had nonunion in the opposite end of the bone because of incomplete removal of lesion bone. There were 5 cases of slow growth of the callus, and healed smoothly by " accordion” technology and injecting red bone marrow in 4 cases, and by bone grafting and internal fixation in 1 case. The time of bone lengthening was 1-3 months, the prolongation index was 1.6-2.7 cm/month (2.20 cm/month). The bone healing time was 7-13 months (mean, 11.1 months). According to tibial stem diagnostic criteria Johner-Wruhs score, 9 cases were excellent, 8 cases were good, 2 cases were fair, with an excellent and good rate of 89.5%. Conclusion Limbs shortening and re-lengthening is an effective method for the treatment of tibial infectious bone defect and chronic osteomyelitis, with the advantages of improving the immediate alignment of the osteotomy ends, significantly shortening the bone healing time of opposite ends of bone.
Objective To explore the safety and feasibility of using modified Glisson pedicle transection methodin the precise hepatectomy of hepatocellular carcinoma （HCC）. Methods Sixty patients with HCC， which confirmed by postoperational pathology were admitted in the study. During the surgery of experimental group （Glisson group）， the segment pedicle were transected firstly using modified Glisson pedicle transection method. Then， the liver parenchyma was split follow the hepatic vein guided by intraoperative ultrasound. During the surgery of contrast group （Prigle group），the liver parenchyma was split using ultracision harmonic scalpel under intermittent pringle clamping of hilar. Results There were no significant difference in the amount of intraoperative bleeding， blood transfusion， as well as duration of surgery， serum alanine aminotransferase， total bilirubin， and length of hospital stay between the two groups （P＞0.05）. However， the incidence of postoperative complication was lower in Glisson group （23.3% vs. 50.0%， P＜0.05）. In addition， the length of tumor margin was more favorable in Glisson group 〔（2.3±0.7） cm vs. （1.5±0.6） cm， P＜0.05〕. The recurrence rate of Glisson group was lower than that Prigle group， but was not different significantly （P＞0.05）. Conclusions The modified Glisson pedicle transection method has the same safety as traditional method in the precise hepatectomy of HCC. And it has the advantages in lower postoperative complication and more favorable tumor margin， which may reduce the recurrence rate theoretically.
Objective To discuss the effectiveness of posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures using pedicle screw fixation. Methods Between May 2008 and July 2013, 52 patients of severe unstable thoracolumbar fractures were treated through posterior short-segment fixation including the fractured vertebra using pedicle screw fixation. There were 33 males and 19 females with an age of 21-56 years (mean, 37.9 years). The causes of thoracolumbar burst fractures included fall from height in 32 cases, traffic accidents in 16 cases, and others in 4 cases. The load sharing classification (LSC) score was 7-9 (mean, 7.85). The levels involved included T11 in 4 cases, T12 in 19 cases, L1 in 25 cases, and L2 in 4 cases. According to Frankel classification, there were 2 cases of grade A, 4 cases of grade B, 8 cases of grade C, 11 cases of grade D, and 27 cases of grade E. The rate of spinal canal occupying was 24.2%-76.7% (mean, 47.1%). The time from injury to operation was 3-5 days (mean, 3.6 days). The effectiveness was assessed by the changes of injured vertebral Cobb angle, anterior vertebral height, and the Frankel grading at pre- and post-operation. Results The operation time was 85-127 minutes (mean, 106.5 minutes). The intraoperative blood loss was 90-155 mL (mean, 137.6 mL). All the incision healed at first intension. Forty-seven patients were followed up 19-27 months (mean, 23.2 months), and no incision infection, screw loosening, or other internal fixation failures was found during follow-up. The injured vertebral Cobb angle and anterior vertebral height at immediate after operation or at last follow-up were significantly improved when compared with preoperative values (P<0.001). There was a loss of injured vertebral Cobb angle and anterior vertebral height at last follow-up, but no significant difference was found between at immediate after operation and at last follow-up (P>0.05). The Frankel grade improved by 0-2 grades at last follow-up, showing significant difference when compared with preoperative grades (Z=15.980, P=0.003). Conclusion Posterior short-segment fixation including the fractured vertebra for severe unstable thoracolumbar fractures (LSC≥7) using pedicle screw fixation can correct the kyphosis deformity, restore vertebral body height, and aviod the need of anterior reconstruction.
Objective To investigate the effectiveness of portable bracket of lower limb in the reconstruction of anterior cruciate l igament (ACL) by the long fibular muscle tendon under arthroscopy. Methods Between March 2008 and September 2010, 22 patients with ACL injury were treated. The limb position was maintained by portable bracket of lower limb and ACL was reconstructed with the long fibular muscle tendon under arthroscopy. There were 15 males and 7 females with an average age of 33.8 years (range, 19-64 years). The causes of ACL injury were traffic accident injury in 14 cases, sport trauma in 5 cases, and fall ing injury in 3 cases. The locations were the left knee in 10 cases and the right knee in12 cases, including 12 fresh injuries and 10 old injuries. Of 22 patients, 17 had positive anterior drawer test, 19 had positive pivot shift test, and 20 had positive Lachman test. According to International Knee Documentation Committee (IKDC) criteria, there were 6 abnormal and 16 severely abnormal. The subjective IKDC score was 57.64 ± 6.11. The Lysholm score was 55.45 ± 4.37. Results All incisions healed by first intention, and no complication was found. All patients were followed up 9-38 months (mean, 15 months). At last follow-up, the flexion of the knee ranged from 120 to 135° (mean, 127°). One patient had positive anterior drawer test, 1 patient had positive pivot shift test, and 2 patients had positive Lachman test. No ligament loosening and breakage occurred. According to the IKDC criteria, 10 patients rated as normal, 11 patients as nearly normal, and 1 patient as abnormal. The subjective IKDC score was 90.44 ± 6.11, showing significant difference when compared with preoperative one (t=4.653, P=0.021). The Lysholm score was 90.12 ± 5.78, showing significant difference when compared with preoperative one (t=4.231, P=0.028). Conclusion Portable bracket of lower limb in the reconstruction of ACL has the advantages of saving manpower and easy operation. The long fibular muscle tendon is enough long and b to reconstruct the ACL, which can increase the contact surface between the tendon and bone and is beneficial to tendon-bone heal ing.