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Clinical Application of Damage Control Surgery in Treatment for Hepatic Rupture

目的　探讨损伤控制外科（DCS）理念在肝脏破裂救治中的作用。方法　收集2009年1月至2012年5月期间我院急诊外科收治的62例外伤致肝脏破裂患者的临床资料，比较DCS理念指导前（传统组）与DCS理念指导后（DCS组）急诊肝脏破裂救治的疗效。结果　DCS组的保守治疗率明显高于传统组 〔26.47% （9/34）比7.14% （2/28），P＜0.05〕，2组间保守治疗成功率比较差异无统计学意义〔100% （9/9）比100% （2/2），P＞0.05〕；DCS组的死亡率及术后并发症发生率较传统组明显降低〔死亡率：4.00% （1/25）比19.23% （5/26），P＜0.05；并发症发生率：32.00% （8/25）比61.54% （16/26），P＜0.05〕；2组手术患者住院时间、出血量、输血量、手术时间及住院费用比较差异均无统计学意义（P＞0.05）。结论　DCS理念指导下制定出的新的抢救措施，能够明显降低肝脏破裂的死亡率及术后并发症的发生率。

先天性鼻泪管阻塞患儿的保守治疗分析

目的　总结4月龄以内的先天性鼻泪管阻塞患儿采取保守治疗的治愈率。 方法　选择2009年4月－2010年1月明确诊断的先天性鼻泪管阻塞患儿55例，所有患儿均采用每天6次泪囊区按摩及每天6次抗生素眼液点眼的保守治疗，疗程持续4周。 结果　4例患儿因为严重的泪囊炎在保守治疗结束前进行了泪道探通，2例患儿因为严重的眼睑湿疹在保守治疗结束前进行了泪道探通，以上均归为未治愈者。37例患儿（67.27%）通过保守治疗治愈。 结论　对于4月龄以内的先天性鼻泪管阻塞患儿，建议首先采用保守治疗。

Research progress of resorption of lumbar disc herniation

ObjectiveTo summarize the research progress of resorption of lumbar disc herniation (RLDH). Methods The literature on RLDH at home and abroad in recent years was reviewed to summarize its influencing factors, pathogenesis, imaging findings, and predictive effect, as well as its influence on the treatment selection of lumbar disc herniation (LDH). ResultsThe main mechanism of RLDH is the combined effect of inflammatory response and neovascularization. Age, smoking, body mass index, and clinical manifestations are the influencing factors. Studies have shown that the annular enhancement around the nucleus pulposus on enhanced MRI images is the characteristic imaging manifestation of RLDH, which is a predictor of whether RLDH occurs. In the treatment of LDH, cyclooxygenase 2 inhibitors may have a negative impact on RLDH. ConclusionThe occurrence of RLDH suggests that strict conservative treatment is the first choice for LDH treatment, but surgery is still an important treatment method when the patient’s symptoms and imaging symptoms don’t significantly improved after conservative treatment.

米非司酮治疗异位妊娠的临床应用

摘要:目的: 探讨异位妊娠患者口服米非司酮的临床效果。 方法 :选择自愿要求保守治疗异位妊娠的患者,血HCG〈2 000 mIU/mL,附件包块≤4 c m,盆腔积液少,自觉症状轻,共80人,其中住院观察治疗共26人,门诊观察治疗54,采用电话咨询或来院随访的方法。 结果 :治疗有效70人,转开腹手术6人,4人未能进行服药后的随访。 结论 :选择好适用症明确的异位妊娠患者,口服米非司酮疗效显著、患者反应轻、痛苦小、经济适用、易接受、安全方便,尤其适合基层医院使用。

腹腔镜下改良保守手术治疗输卵管妊娠的临床疗效

【摘要】目的 探讨腹腔镜下行保守手术治疗输卵管妊娠的理想方法。方法 2008年9月-2009年10月腹腔镜下对68例输卵管妊娠患者行改良保守性手术,术中采用输卵管系膜血管结扎及垂体后叶素注射止血,从输卵管破口或开窗口负压吸胚,并行妊娠黄体剔除,术后口服米非司酮直至血绒毛膜促性腺激素(βHCG)降至阴性水平。结果 68例流产型、破裂型、陈旧型、未破损型全部成功完成保守手术(包括内出血超过1 000 mL者5例)。发生持续性宫外孕1例,术后3 d加用甲氨喋呤 75 mg,单次静推后治愈;术后第3天血βHCG平均下降率为92%,无手术并发症。术后随访36例,术后1~3个月行宫腔镜下输卵管通液通畅。结论 腹腔镜下保守术式的改进治疗输卵管妊娠安全可行,只要注意手术方法,加强术后监测, 可获得良好效果。

Long-term survival of surgical versus non-surgical treatment for esophageal squamous cell carcinoma in patients ≥70 years: A retrospective cohort study

ObjectiveTo compare the long-term survival of elderly patients with esophageal squamous cell carcinoma (ESCC) treated with surgical versus non-surgical treatment. MethodsA retrospective analysis was conducted on the clinical data of elderly patients aged ≥70 years with ESCC who underwent esophagectomy or radiotherapy/chemotherapy at Sichuan Cancer Hospital from January 2009 to September 2017. Patients were divided into a surgical group (S group) and a non-surgical group (NS group) according to the treatment method. The propensity score matching method was used to match the two groups of patients at a ratio of 1∶1, and the survival of the two groups before and after matching was analyzed. ResultsA total of 726 elderly patients with ESCC were included, including 552 males and 174 females, with 651 patients aged ≥70-80 years and 75 patients aged ≥80-90 years. There were 515 patients in the S group and 211 patients in the NS group. The median follow-up time was 60.8 months, and the median overall survival of the S group was 41.9 months [95%CI (35.2, 48.5)], while that of the NS group was only 24.0 months [95%CI (19.8, 28.3)]. The 1-, 3-, and 5-year overall survival rates of the S group were 84%, 54%, and 40%, respectively, while those of the NS group were 72%, 40%, and 30%, respectively [HR=0.689, 95%CI (0.559, 0.849), P<0.001]. After matching, 138 patients were included in each group, and there was no statistical difference in the overall survival between the two groups [HR=0.871, 95%CI (0.649, 1.167), P=0.352]. ConclusionCompared with conservative treatment, there is no significant difference in the long-term survival of elderly patients aged ≥70 years who undergo esophagectomy for ESCC. Neoadjuvant therapy combined with surgery is still an important choice to potentially improve the survival of elderly patients with ESCC.

Comparison of extended thymectomy and medicine for myasthenia gravis

Objective To assess the long-term results and relevant influencing factors of extended thymectomy and medicine-alone treatment of non-thymomatous myasthenia gravis (MG) patients. Methods We retrospectively analyzed the clinical data of 174 patients with non-thymomatous MG diagnosed and treated in our department from December 2009 to April 2017, including 81 males and 93 females, aged 13-88 (47.1±17.8) years. According to the different treatment methods, the patients were divided into two groups: an operation group (91 patients receiving extended thymectomy) and a medicine-alone group (83 patients receiving medical therapy alone). The efficacy was evaluated according to the Myasthenia Gravis Foundation of America (MGFA). Survival curves of the patients were plotted using the Kaplan-Meier method to evaluate the remission rate and survival rate. Cox regression analysis was used to assess the influencing factors of the outcomes. Results The patients were followed up for 3 to 94 (39.1±26.9) months. As a result, 29 patients (31.9%) achieved complete remission in the surgery group and 13 patients (15.7%) were completely relieved in the medicine-alone group (P=0.014). Further analysis showed that treatment pattern (P=0.018) and MG type (P=0.021) were the main factors related to the efficacy. Conclusion For patients with non-thymomatous MG, extended thymectomy is superior to the medicine-alone in terms of complete remission rate and the postoperative immunosuppression ratio.

内科成功保守治疗经口内镜食管肌切开术后并发双肺压缩约35%气胸患者一例

Non-surgical management of osteoporotic vertebra compression fractures

Osteoporotic vertebral compression fractures (OVCFs) are common in elderly patients with reduced bone density. Pain and loss of function after fractures have a serious impact on the patient's activities of daily living and quality of life. Management of patients with early OVCFs who choose non-surgical treatment is necessary to prevent complications, relieve pain, and improve functional status. This paper focuses on the development of OVCFs non-surgical management in many aspects, which may provide reference for the rapid recovery of OVCFs patients in the process of non-surgical management.

Clinical research progress of spinal epidural lipomatosis

ObjectiveTo review the clinical research progress of spinal epidural lipomatosis (SEL). Methods The clinical studies on SEL at home and abroad in recent years were extensively reviewed, and the pathogenesis, clinical and imaging manifestations, and treatment status of SEL were summarized and analyzed. ResultsSEL is a disease characterized by compression of the spinal cord and nerve roots due to abnormal accumulation of epidural adipose tissue in the spinal canal. Its prevalence and diagnosis rate are low and the pathogenesis is not fully understood. MRI is the most sensitive and specific diagnostic test for SEL. Surgical decompression and removal of excess adipose tissue are the only options for patients with acute SEL or those who have failed conservative management, and conservative management should be considered for other patients. ConclusionSEL is a rare disease and related research still needs to be improved. In the future, high-quality, multi-center and large-sample studies will be of great significance for evaluating the choice of treatment methods and effectiveness of SEL patients.