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蝶鞍区占位切除术后两种油纱填塞法止血效果比较

【摘要】　目的　寻找预防蝶鞍区占位切除术后出血最佳油纱填塞方式，以减少鼻腔出血、分泌物及降低患者疼痛程度。　方法　将2009年5－8月、2011年2－5月共80例经蝶窦入路鞍区占位切除术患者分为试验组、对照组各40例，试验组采用指套内塞油纱填塞鼻腔，对照组直接用油纱填塞鼻腔，并对两种方式的效果进行比较分析。　结果　指套内油纱填塞法虽在止血方面，与对照组油纱直接法相比差异无统计学意义，但清洁度和疼痛程度方面均优于直接用油纱填塞法。　结论　指套内塞油纱填塞法更有利于经蝶窦入路鞍区占位切除术患者。

纳吸棉在慢性中耳炎术后填塞中的临床观察

目的探讨纳吸棉在慢性中耳炎术后填塞中的效果，为临床耳科手术填塞物的选择提供依据。 方法将 2012年 4月－2013年 1月住院接受同一医疗组医生手术治疗的 200 例慢性中耳炎患者，根据入院时间分为对照组和试验组，对照组采用碘仿纱条材料填塞术耳腔，试验组采用纳吸棉材料填塞术耳腔，观察两组患者术后 48 h内术耳疼痛、渗血量，首次抽取填塞物时术腔出血及疼痛情况。 结果试验组患者术后 48 h 内术耳疼痛、首次抽取填塞物时的疼痛及出血情况均低于对照组，两组比较差异均有统计学意义（P＜0.05）；两组患者术后 48 h内术耳渗血情况差异无统计学意义（P＞0.05）。 结论慢性中耳炎术后应用纳吸棉填塞术腔能提高患者舒适度，减少抽取填塞物时对术耳的损伤，促进术耳康复。

鼻内镜电凝止血术替代后鼻孔填塞术的研究

目的研究顽固性鼻出血的出血部位规律和鼻内镜电凝止血术替代后鼻孔填塞术的疗效。 方法回顾性分析2011年1月－2012年12月因顽固性鼻出血接受鼻内镜电凝止血术的患者120例，其中入院前行后鼻孔填塞者31例。总结其出血部位规律，探讨鼻内镜电凝止血术替代后鼻孔填塞术的有效性。 结果120例患者中，出血部位位于嗅裂52例（43.3%），下鼻甲-下鼻道37例（30.8%），鼻中隔20例（16.7%），中鼻道7例（5.8%），鼻咽部4例（3.3%）；行1次手术者113例（94.2%），2次手术者6例（5.0%），3次手术并转院者1例（0.8%），治愈率99.2%。在入院前行后鼻孔填塞的31例患者中，出血部位位于下鼻甲-下鼻道15例（48.4%），嗅裂11例（35.5%），鼻中隔5例（16.1%）；行1次手术者27例（87.1%），2次手术者4例（12.9%）。 结论顽固性鼻出血最常见的出血部位为嗅裂、下鼻甲-下鼻道、鼻中隔，并非为传统理论所认为的蝶腭动脉和鼻-鼻咽静脉丛。用鼻内镜电凝止血术替代后鼻孔填塞术治疗顽固性鼻出血是有效的。

应用重症超声目标导向的心脏超声生命支持评估流程成功抢救食管癌术后乳糜性心包填塞一例

Prospective clinical study of modified LIFT combined with acellular anal fistula repair matrix packing in the treatment of high anal fistula

ObjectiveTo observe the effect of modified ligation of intersphincteric fistula tract (LIFT) combined with acellular anal fistula repair matrix packing in the treatment of high anal fistula, and to evaluate its clinical efficacy and safety.MethodsAll 86 patients who met the diagnostic criteria of high anal fistula in Beijing Anorectal Hospital from October 2018 to August 2019 were selected and randomly divided into observation group and control group. The observation group was treated with modified LIFT combined with acellular anal fistula repair matrix tamponade, while the control group was treated with traditional low incision and high thread drawing surgery. The curative effect, wound healing time, postoperative pain score, intraoperative blood loss, postoperative complications, hospitalization time, patient satisfaction and recurrence at 6 months after operation were compared between the two groups.ResultsThe effective rate of the observation group was 92.9% (39/42), and that of the control group was 86.4% (38/44), there was no significant difference between the two groups (Z=−1.251, P=0.211). The healing time of the observation group and the control group were (24.8±8.5) days and (32.1±10.9) days, respectively, the difference was statistically significant (t=3.472, P<0.001). Compared with the control group, the observation group had less intraoperative blood loss, less postoperative pain and shorter hospital stay (P<0.05). There was no anal incontinence after operation in the two groups, and the incidence of postoperative complications such as bloody stool, anal border edema and urinary retention were lower in the observation group (11.9%) compared with the control group (31.8%), with a statistically significant difference (P<0.05). The treatment satisfaction of the observation group was 90.5%, and that of the control group was 81.8%. There was no significant difference between the two groups (Z=−1.284, P>0.05).ConclusionModified LIFT combined with acellular anal fistula repair matrix in the treatment of high anal fistula has the advantages of small trauma, quick recovery and low incidence of complications.

黄斑裂孔内界膜填塞手术后继发脉络膜新生血管1例

Comparison of inverted internal limiting membrane flap and internal limiting membrane multilayer tamponade techniques in the treatment of highly myopic macular hole-associated retinal detachment

ObjectiveTo compare the efficacy of internal limiting membrane (ILM) flip coverage with ILM multilayer tamponade in the treatment of highly myopic macular hole-associated retinal detachment (MHRD). MethodsA retrospective clinical study. From November 2019 to June 2022, 53 cases and 53 eyes of MHRD patients who were examined and diagnosed at the Eye Centre of Renmin Hospital of Wuhan University were included in the study. Among them, 21 cases and 21 eyes were male and 32 cases and 32 eyes were female. The age was (55.28±11.40) years. The patients were categorized into two groups: the ILM coverage group (from November 2019 to September 2020) and the ILM multilayer tamponade group (from October 2020 to June 2022) based on their surgical procedures. The ILM coverage group comprised of 11 cases involving 11 eyes, while the ILM multilayer tamponade group comprised of 42 cases involving 42 eyes. Best-corrected visual acuity (BCVA) and optical coherence tomography were conducted. BCVA was measured using standardized international visual acuity charts and transformed to logarithmic minimum angle of resolution (logMAR) visual acuity for statistical analysis. The affected eyes were all treated with standard transciliary flattening three-channel 23-gauge vitrectomy. The inverted ILM flap technique was combined with flap coverage in the inverted group, while the ILM multilayer tamponade group used circular ILM stripping to preserve the ILM in the macular area and ILM flap around the macular hole with multilayer ILM tamponade. Postoperative follow-up was carried out for a minimum of 6 months. Relevant examinations were conducted during the follow-up using the same equipment and methods as those used before surgery. The BCVA, as well as the closure of macular hole, resurfacing of the retina, and development of macular hyperplasia, were observed. ResultsIn the ILM-covered group, the macular hole was closed in 7 out of 11 eyes after 1 week of surgery. At 1 month after surgery, the macular hole was closed in all treated eyes. At 6 months after surgery, the macular hole was closed in 9 eyes, while 2 eyes were reopened. In 42 eyes from the ILM-multilayer tamponade group, the macular hole closed after surgery in 41 eyes. At 6 months postoperatively, best corrected visual acuity (BCVA) of eyes in ILM-covered and ILM-multilayer tamponade groups was 0.91±0.29 and 1.05±0.39, respectively, with no statistically significant difference between the two groups (t=1.140, P=0.260). The BCVA of the eyes in both groups showed a significant improvement compared to the preoperative period with a statistically significant difference (t=8.490, 13.840; P＜0.000 1); 6 months after surgery, 10 out of 11 eyes in the ILM coverage group had a restored retina with no detectable macular hyperplasia; 42 eyes in the ILM multilayer tamponade group had a restored retina, but 19 of these eyes had detectable macular hyperplasia. ConclusionsEither ILM flap coverage or ILM multilayer tamponade contributes to high myopic MHRD closure and improved visual acuity. Compared to ILM flap coverage, ILM multilayer tamponade results in higher and earlier rates of macular hole closure and lower rates of macular hole reopening. However, ILM multilayer tamponade may lead to a higher proportion of macular hyperplasia formation without affecting visual acuity recovery at 6 months after surgery.