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Clinical Analysis of 156 Old Patients with Severe Acute Cholangitis Treated by PTCD under Ultrasonic Guidance

目的 总结超声引导下经皮经肝穿刺胆管引流术(PTCD)的优、缺点,为临床治疗重症急性胆管炎（SAC）提供参考。方法 回顾性分析我院1994年8月至2008年7月期间对156例老年SAC患者行在超声引导下的PTCD治疗的临床资料。结果 156例行PTCD均获成功,1次穿刺成功140例，其成功率达89.7%（140/156）; 16例首次穿刺失败后再次穿刺均成功。无一例发生腹腔出血、胆汁性腹膜炎等并发症。本组引流效果较好,中毒危象缓解，黄疸减退，肝功能改善。结论 PTCD较外科手术创伤小、操作简单、快速,具有微创的特点,对老年、有严重合并症及复杂疾病不能耐受手术及麻醉的SAC患者，其作为紧急抢救措施切实可行,并为后期施行根治性手术争取了时间。

Analysis of the safety and feasibility of two closed thoracic drainage methods after video-assisted thoracoscopic lung volume reduction surgery

ObjectiveTo investigate the effects of closed thoracic drainage with single tube or double tubes after video-assisted thoracoscopic lung volume reduction surgery.MethodsRetrospective analysis was performed on 50 patients (39 males, 11 females) who underwent three-port thoracoscopic lung volume reduction surgery in our hospital from January 2013 to March 2019. Twenty-five patients with single indwelling tube after surgery were divided into the observation group and 25 patients with double indwelling tubes were divided into the control group.ResultsThere was no significant difference in pulmonary retension on day 3 after surgery, postoperative complications, the patency rate of drainage tube before extubation, retention time or postoperative hospital stay (P>0.05). Postoperative pain and total amount of nonsteroidal analgesics use in the observation group was less than those in the control group (P<0.05). ConclusionIt is safe and effective to perform closed thoracic drainage with single indwelling tube after video-assisted thoracoscopic lung volume reduction surgery, which can significantly reduce the incidence of related adverse drug reactions and facilitate rapid postoperative rehabilitation with a reduction of postoperative pain and the use of analgesic drugs.

纵隔、胸腔双引流在防治食管癌手术后并发症发生中的应用

目的探讨纵隔、胸腔双引流在防治食管癌手术后并发症发生中的临床意义。 方法回顾性分析2010年1月至2013年10月淮南市东方医院集团总院胸心外科174例食管癌手术治疗患者的临床资料，根据术后引流方式不同将其分为两组，纵隔、胸腔双引流组：96例，男59例、女37例，年龄（60.75±6.28）岁，术后行纵隔、胸腔双引流；对照组：78例，男46例、女32例，年龄（62.36±5.24）岁，术后常规单纯胸腔引流。比较两组术后胸腔引流管带管时间、胸腔残余积液发生率、肺部感染发生率和心脏并发症发生率等。 结果纵隔、胸腔双引流组患者术后吻合口瘘发生率与对照组差异无统计学意义（2.1% vs.2.6%，P>0.05）。纵隔、胸腔双引流组2例发生吻合口瘘，均经保守治疗治愈。对照组2例发生吻合口瘘，1例经二次手术治愈；1例术后出现发热，术后3周因心肺功能衰竭死亡。纵隔、胸腔双引流组术后胸腔引流管带管时间［（71.86±7.43）h vs.（123.12±10.05）h］、胸腔残余积液发生率、肺部并发症发生率（13.5% vs.26.9%）、心脏并发症发生率（16.7% vs.32.1%）均低于对照组（P<0.05）。随访156例，失访17例，随访时间3～12个月，无严重手术相关并发症发生。 结论纵隔、胸腔双引流在食管癌手术中不能降低吻合口瘘的发生率，但可以减少心肺并发症的发生，有利于患者术后恢复。

腹腔镜胆总管探查术后胆总管一期缝合与T管引流的疗效观察

目的比较腹腔镜胆总管探查术后胆总管一期缝合与T管引流对临床治疗胆总管结石患者的影响 方法将2012年4月至2015年12月期间笔者所在医院收治的胆总管结石拟行腹腔镜胆总管切开取石术的90例患者作为研究对象，按随机数字表法分为观察组和对照组，数字为偶数者为观察组，奇数者为对照组，每组45例。观察组进行胆总管一期缝合，对照组行T管引流，记录并比较2组患者的手术情况及术后恢复情况，并对2组术后并发症的发生情况进行比较。 结果观察组手术时间明显短于对照组，差异有统计学意义（P＜0.05），2组术中出血量比较差异无统计学意义（P＞0.05）；观察组患者术后肛门排气时间、下床活动时间、住院时间及恢复工作时间均明显短于对照组，差异有统计学意义（P＜0.05）；此外观察组住院费用亦明显少于对照组，差异有统计学意义（P＜0.05）；观察组患者术后并发症的发生率明显低于对照组，差异有统计学意义（P＜0.05）。 结论在严格掌握相关适应证的前提下，采用腹腔镜胆总管切开取石一期缝合临床效果显著，具有手术时间短、术后恢复快、安全性高的优势，值得在临床推广使用。

ONE STAGE CHOLECYSTO-JEJUNAL AND GASTRO-JEJUNAL LOOP DOUBLE ANASTOMOSIS

Sixteen cases unresectable carcinoma of the head of the pancreas complicated with jaundice were treated by one stage cholecysto-jejunal and gastro-jejunal loop double anastomosis, the same result of jaundice drainage and prevention of bile reflux were obtained when compared with simple cholecysto-jejunal loop anastomosis, on the other hand, the obstructive symptoms resulting from postoperative cancerous comppression of duodenum and pylorus were avoided as well. The operation is simple with less physiologic disturbance and the patient can lead better postoperative live.

持续封闭冲洗负压引流在深部窦道感染伤口中的应用

目的　总结持续封闭冲洗负压引流治疗术在后深部窦道伤口感染治疗中的效果。 方法　回顾性分析2010年10月－2011年10月收治的7例深部窦道伤口感染患者的临床资料，总结采用持续封闭冲洗负压引流进行伤口治疗的方法及疗效。 结果　7例患者经过3～5 d持续封闭冲洗负压引流治疗，拔管后2～3 d伤口闭合，上皮覆盖，伤口全部愈合。 结论　采用持续封闭冲洗负压引流治疗深部窦道伤口感染，方法简便，费用低廉，可有效促进伤口愈合。

The clinical value of preoperative biliary drainage in patients undergoing pancreaticoduodenectomy

ObjectiveTo investigate the clinical value of preoperative biliary drainage in patients with malignant obstructive jaundice and its influence on postoperative complications.MethodsThis study retrospectively analyzed patients from June 2006 to June 2018 at Department of Hepatobiliary Surgery of Gaozhou People’s Hospital, Guangdong Medical University, who had underwent pancreaticoduodenal surgery. In this study, bilirubin was divided into bilirubin normal group and bilirubin abnormal group according to the level of bilirubin, then the bilirubin abnormal group was divided into non-drainage group and drainage group. The main observation indexes were the incidence of complications and their severity.ResultsThere was no difference in intraoperative blood loss, operative time, and postoperative hospitalization among the three groups (P>0.05), but there was significant difference among the three groups on incidence of bile leakage, pulmonary infection, and the comprehensive complication index (CCI) value (P<0.05). The trend of clotting time, serum albumin, and hemoglobin in the bilirubin normal group, non-drainage group, and drainage group after operation were basically the same. The transaminase was recovered after operation in the bilirubin normal group and the drainage group, which were better than that of the non-drainage group within 7 days .ConclusionsThe preoperative biliary drainage in patients with malignant obstructive jaundice complicated with hyperbilirubinemia, cholangitis, and hepatic dysfunction do not significantly improve the incidence of complications, but could significantly improve the severity of the overall complication.

胸部物理疗法联合口咽通气管吸痰在支气管扩张症无创通气中的应用

目的 探讨胸部物理疗法联合口咽通气管吸痰对行无创正压通气的支气管扩张症患者的治疗效果及安全性。 方法 选取 2013 年 1 月—2015 年 8 月存在不同程度急性呼吸衰竭的急性加重期支气管扩张症患者 27 例，在给予抗菌药物治疗、对症治疗、营养支持的基础上行无创正压通气，护理上给予手法叩背、应用体外震动排痰机、体位引流等胸部物理疗法联合经口咽通气管吸痰。 结果 经综合治疗和护理后，患者最终显效 16 例，有效 9 例，无效 2 例，治疗有效率达 92.6%。 结论 对伴有呼吸衰竭的支气管扩张症急性加重期患者，在实施无创正压通气时，用胸部物理疗法配合口咽通气管吸痰能解决无创正压通气中患者无力咳痰的问题，保持呼吸道通畅，保障无创正压通气的顺利实施，改善患者预后。

妊娠期合并乳腺脓肿行引流术护理一例

THE EFFECTS OF DRAINAGE THROUGH ANUS ON ENDOTOXIN AND TUMOR NECROSIS FACTOR AFTER ONE STAGE RESECTION FOR LEFT OBSTRUCTING COLONIC CARCINOMAS

目的 确定不同的经肛引流方式对左半结肠癌患者一期术后外周血浆内毒素(ET)及肿瘤坏死因子(TNF)水平的影响。 方法左半结肠癌伴梗阻患者按术后经肛引流方法不同分为扩肛组(A)、经肛吻合口上单管引流组(B)及经肛吻合口上下双管引流组(C)3个组，观察各组患者一期术后ET及TNF的变化。 结果 术后A、B、C 3组ET及TNF水平均呈下降趋势，与术前比较差异有显著性意义(P＜0.01)。自术后第4天，C组患者ET及TNF水平开始显著低于B组(P＜0.05)。结论 左半结肠癌性梗阻患者一期手术行经肛引流能更有效地减少内毒素的吸收，降低TNF水平，而经肛双管引流法引流效果又优于经肛单管引流法。