Survey on arteriovenous fistula in maintenance hemodialysis patients with type 2 diabetic nephropathy

This paper summed up the characteristics of native arteriovenous fistulas (AVFs) in maintenance hemodialysis patients with type 2 diabetic nephropathy (DN) in Chinese hemodialysis centers. A survey was conducted on AVF in maintenance hemodialysis patients with type 2 DN. A total of 224 cases of maintenance hemodialysis patients were included in this study, among which, 65 cases in DN group, 33 cases in diabetes mellitus (DM) group and 126 cases in non-diabetic control (C) group. Hemoglobin, albumin, blood urea nitrogen, parathyroid hormone and calcium-phosphate product of the three groups of patients were not significantly different. Glycated hemoglobin A1c of DN group and DM group was not significant different. AVF life of (28.7 ± 10.0) months in DN group was significantly shorter than that of (36.5 ± 19.4) months in C group (statistic probability P <0.01), and AVF life of (32.5 ± 10.1) months in DM group (P <0.05) was also shorter than that in C group, while there was no significant difference in AVF life between DN group and DM group. Proportion of upper arm fistula in DN patients (11/65) was significantly higher than that in C group (6/123, P < 0.01). Life of AVF in patients with DN was relatively short, with more times of angioplasty and greater possibility of selecting upper arm internal fistula.     

先天性冠状动脉左右心室瘘的外科治疗

本文报告4例少见的先天性冠状动脉左或右室瘘。1例为左冠状动脉前降枝右室瘘,行双结扎贯穿缝合;1例为右冠状动脉后降枝瘘入左室;2例为右冠状动脉后降枝瘘入右室;后3例在体外循环（CPB）下,切开瘤样扩张之冠状动脉（其中1例并切开右室）关闭瘘口。4例随诊平均7.8年均获满意疗效。文中重点讨论了诊断、手术适应证及手术方法的选择。     

经鼻腔、蝶窦至海绵窦手术入路的解剖学基础

1987年,M.Loyo 首次报道经鼻腔、蝶窦而入海绵窦,处理海绵窦内血管疾患的新手术入路.本文作者用30个(60侧)尸头及51个干颅骨(102侧)做了蝶窦的外科解剖观察,除为经蝶窦而达垂体的手术入路提供了数据外,本文侧重论证经蝶窦而达海绵窦手术入路的解剖基础及优点。     

贲门癌切除食道胃吻合口瘘15例的治疗

本文对胃近端大部切除术后并发吻合口瘘的病因及治疗进行了讨论,提出了充分有效的引流,广谱抗菌素的合理应用,全身支持、维持营养及水电解质的平衡等治疗措拖。保证了患者的康复,无1例死亡。     

国内直肠癌术后吻合口瘘危险因素的Meta分析

目的 探讨国内直肠癌术后吻合口瘘的危险因素.方法 运用 Meta分析方法对我国1999年1月至2009年1月公开发表的有关国内直肠癌术后吻合口瘘危险因素的19篇文献资料进行综合分析.结果 年龄≥60岁的直肠癌患者吻合口瘘的发生率高于<60岁者,合并OR值为0.50(95% CI:0.33～0.76,P<0.01);男性直肠癌患者吻合口瘘的发生率高于女性,合并OR值为2.17(95% CI:1.38～3.42,P<0.01);肿瘤下缘距肛缘距离≤7cm的直肠癌患者吻合口瘘的发生率高于距离>7cm者,合并OR值为1.79(95% CI:1.37～2.35,P<0.01);术前接受新辅助放疗的直肠癌患者吻合口瘘的发生率高于未进行新辅助放疗者,合并OR值为3.66(95% CI:2.19～6.09,P<0.01);吻合器吻合的直肠癌患者吻合口瘘发生率低于手工吻合者,但不具有统计学意义(P>0.05),合并OR值为0.70(95% CI:0.47～1.05);术前患有糖尿病的直肠癌患者吻合口瘘发生率低于无糖尿病者,合并OR值为3.16(95% CI:2.27～4.39,P<0.01);Dukes分期A、B期的直肠癌患者吻合口瘘发生率低于C、D期患者,合并OR值为0.61(95% CI:0.45～0.83,P<0.01);恶性度低的直肠癌患者吻合口瘘发生率低于恶性度高者,合并OR值为2.15(95% CI:1.47～3.15,P<0.01);预防性造瘘的直肠癌患者吻合口瘘发生率低于未进行造瘘者,但不具有统计学意义(P>0.05),合并OR值为0.39(95% CI:0.14～1.05);急诊手术的直肠癌患者吻合口瘘发生率高于择期手术者,合并OR值为0.27(95% CI:0.13～0.56,P<0.01).结论 年龄≥60岁、男性、糖尿病、术前新辅助放疗、肿瘤下缘距肛缘距离<7cm、Dukes分期C、D期、肿瘤恶性程度高及急诊手术是直肠癌术后吻合口瘘发生的危险因素.     

腹部闭合性损伤并胰腺损伤的诊治

本院251倒闭合性腹部损伤中,合并胰腺损伤的15例,其术前确诊困难,术中发现其中陕头损伤3例,体部损伤6例,尾部损伤5例,挫伤1例。行胰床引流1例,修补8例,胰尾切除6例。作者认为上腹部挤压伤者,术中应常规探查胰腺。尤其术前腹穿抽出淡红色血性液者,应考虑胰腺损伤的可能。手术方式依损伤的程度作胰床引流、修补及胰腺部分切除,对于胰头部的损伤主张修补加十二指肠及胆总管减压,为预防胰瘘,术中应力争结扎主胰管。