目的 总结我院35岁以下青年人胃癌43例的诊治经验。方法 对43例患者临床特征、诊断及治疗进行回顾性分析。结果 手术40例，根治性切除14例，姑息性切除9例，胃空肠吻合6例，单纯探查11例，切除率57.50%。术后3个月内死亡5例，4～12个月内死亡18例，12～24个月内死亡8例，生存2年以上9例，5年以上3例。误诊26例，误诊率60.46%。结论 青年人胃癌发病率低，恶性程度高，病程短，转移早，早期诊断率低，误诊率高，治疗关键是提高早期诊断率。
目的 总结术后早期炎性肠梗阻的临床特点及诊治经验。方法 回顾性分析我院2004年1月至2010年12月期间收治的22例腹部手术后早期炎性肠梗阻患者的临床资料。结果 全组均行保守治疗，均治愈出院。肠梗阻解除时间平均6.5d。2例出院后再次出现慢性肠梗阻，经保守治疗好转。结论 术后早期炎性肠梗阻在腹腔严重感染性疾病术后多见，治疗以保守治疗为主，同时应动态观察腹部症状、体征变化，严防误诊、误治。
Objective To explore the methods of early diagnosis of arteriosclerosis obliterans of lower extremity (ASOLE). Methods The related literatures on ASOLE detection means adopted clinically were reviewed, and their advantages and disadvantages were compared.Results Asymptomatic ASOLE could be discovered by determination of ankle brachial index (ABI) and toe brachial index (TBI), which was a good index for arterial function assessment of lower extremity. Pulse wave velocity (PWV) was more vulnerable and less sensitive than ABI, and therefore more suitable for screening of a large sample. ASI was an index to assess arterial structure and function, and it had a good correlation with PWV. Flow-mediated dilation (FMD) was a measurement evaluating the function of endothelial cell; Pulse wave measurement was simple, sensitive, and its result was reliable. Color Doppler ultrasonography could localizate the lesion and determine the degree of stenosis at the same time. Multiple-slice CT angiography (MSCTA) was more accurate than color Doppler ultrasonography, but its inherent shortcomings, such as nephrotoxicity of contrast agent, was still need to be resolved. 3D-contrast enhancement magnetic resonance angiography (CEMRA) had little nephrotoxicity, but a combination of other imaging methods was necessary. Microcirculation detections required high consistency of the measurement environment, but they were simple, sensitive and noninvasive, and therefore could be used for screening of ASO. Conclusion Publicity and education of highrisk groups, and reasonable selection of all kinds of detection means, are helpful to improve the early diagnosis of ASOLE.
目的探讨术后早期肠梗阻的临床特点、诊断及治疗。方法对10例术后早期肠梗阻患者进行回顾性分析。结果10例均为机械性肠梗阻。保守治疗6例，其中治愈5例，死亡1例； 手术治疗4例，其中3例术中有绞窄性肠梗阻征象，均治愈。1例术中发现为广泛癌性粘连，行部分粘连松解术，术后第8天再发肠梗阻，保守治疗1天无效，患者自动出院。结论术后早期肠梗阻诊断并不困难； 保守治疗多数有效，故宜先行保守治疗； 可疑肠绞窄时应及时中转手术。
ObjectiveTo systematically review the incidence and influencing factors of early enteral nutritional feeding interruptions in critically ill patients. MethodsThe PubMed, Web of Science, Embase, Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect observational studies on the early enteral nutritional feeding interruptions in critically ill patients from inception to January 2, 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 17.0 software. ResultsA total of 12 studies including 1 121 patients were included. Meta-analysis showed that the incidence of early enteral nutritional feeding interruptions in critically ill patients was 75.0% (95%CI 64.0% to 84.0%). Influenced by feeding intolerance, airway management, tube problems, radiological examination, and endoscopy, surgery and so on, interruptions of early enteral nutritional feeding frequently occur in critically ill patients. ConclusionCurrent evidence shows that early enteral feeding interruptions in critically ill patients are affected by many factors, and the incidence is high. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
目的 探讨术后早期炎症性肠梗阻的诊断和治疗。方法 对我院1995年至1999年间收治的16例术后早期炎症性肠梗阻患者的临床资料进行回顾性分析。结果 15例患者经胃肠减压、抗生素、理疗、肾上腺皮质激素及中药等治疗治愈，平均治疗时间11天； 中转手术治疗1例，无1例肠坏死。结论 术后早期炎症性肠梗阻的特点有： ①多在手术后7天左右出现梗阻症状，多由腹腔内炎症所致广泛粘连引起； ②症状以腹胀为主，腹痛相对较轻，较少发生肠绞窄； ③治疗应首选非手术疗法。
Objective To evaluate the effect of early clinical interference strategies on preventing the conversion of acute pancreatitis to the severe form and aggravation of severe acute pancreatitis (SAP). Methods The patients with acute pancreatitis admitted to this hospital were divided into two therapeutic phases by different therapeutic methods from January 2001 to December 2008. Patients in the first phase (from January 2001 to December 2004) were treated by the routine management, and the second phase (from January 2005 to December 2008) by the routine management combined with early clinical interference strategies. Then, the ratio of conversion from acute pancreatitis to SAP and prognosis of SAP between two phases were compared. Results Compared with the first phase, the rate of aggravation of acute pancreatitis was significantly decreased in the second phase (4.48% vs. 21.18%), the average healing time of SAP, the incidences of systemic and local complications and the mortality of pancreatitis were reduced (P＜0.05). When early clinical interference strategies were performed, some adverse reaction and complications occurred in 35 cases, but without severe consequence. Conclusion Early clinical interference strategies may serve as a beneficial strategy on preventing the progression of mild acute pancreatitis to the severe form or halting the aggravation of acute pancreatitis.
目的:观察采用疏血通注射液联合ACEI/ARB治疗早期糖尿病肾病(DN)的疗效。方法:将78例2型DN患者随机分为对照组(ACEI/ARB)和治疗组(ACEI/ARB+疏血通注射液),疗程4周。比较两组治疗前和治疗后尿微量白蛋白(mAlb),Scr、BUN等指标的变化。结果:(1)治疗后治疗组和对照组尿白蛋白均显著下降(Plt;0.01,Plt;0.05),治疗组比对照组下降更为明显(Plt;0.05)。(2)治疗后两组血浆白蛋白均增加(Plt;0.01),治疗组与对照组治疗后比较无明显差异(Pgt;0.05)。(3)治疗后两组Scr、BUN、TC、TG和血钾均无明显变化。结论:联合应用疏血通注射液能有效减少早期DN患者的蛋白尿,改善肾功能。