目的：探讨彩色多普勒超声在心脏手术中的应用价值。方法：在14例心脏病手术中，于心脏修复完成后经心外膜超声检查。结果：一例先天性心脏病室间隔缺损修补片周少量残余漏；一例风湿性心脏病二尖瓣、主动脉瓣置换术后，主动脉瓣下少量返流；因不构成血流动力学的改变，未行二次修复。结论：可即时、准确地为外科医生提供相关信息，评价手术效果。
Objective To observe the drug distributional characteristics after regional arterial perfusion chemotherapy (RAC) during gastric cancer radical resection, postoperative histopathological change and clinical toxic and adverse reactions. Methods According to the indications of RAC, 60 patients admitted in this department from September 2007 to November 2008 were included and divided into treated group and control group randomly. Treated group underwent the treatment of RAC with the 100 ml perfusion fluid including 5-FU (1 000 mg/m2), MMC (10 mg/m2) and 2 ml methylene blue injection by which the control group were not treated. Then the methylene blue distributional characteristics during operation, postoperative histopathological changes of tumors and clinical toxic and adverse reactions were observed. Results In the treated group, after RAC with injection contained methylene blue by primary supply arterial, the tumor region colored immediately and then dropped slowly, but it presented blue during whole operation. After operation, light microscope examination revealed a mild change of karyopyknosis, nuclear swelling, coagulation of cytoplasm in cancer cells, mild hydropsia of intercellular substance, invasion of inflammatory cells and mild vasculitis in some cases. Transmission electron microscope showed that nuclear swelling or coagulation, nuclear heterochromatin agglutination, nuclear-week gap expansion, mitochondrial swelling, endoplasmic reticulum expansion, and Golgi complex expansion. AST of treated group increased apparently on the first day (Plt;0.01), and recovered normal on the third day (Pgt;0.05). There was no significant difference between the two groups in renal function, ALT, ALP, GGT, LDH of liver function, medullary restraining, ECG by bed or reaction of gastrointestinal tract (Pgt;0.05). And stomal leak was not found in two groups. Conclusions The RAC during radical resection of gastric cancer enables gastric tumor to expose to therapeutics during whole operation and depresses the activity of cancer cells. Its clinical toxicity is little, so it can be used as an important supplementary means to prevent intraoperational extension and postoperative recurrence.
Twenty six cases with carotid body tumours (27 tumors) were operaterated on from November,1988 to October, 1997. Eleven of the 26 cases were misdiagnosed in other hospital. Twenty six cases experienced B-mode ultrasonic scanning and 18 carotid arteriography. Seventeen cases underwent general hypothermic anesthesia (30℃-32℃) and 9 general carotid-internal carotid shunt. Eight cases (9 tumors) experienced simple excision of tumor, 3 resection of the tumor with external carotid, 11 excision of the tumor with internal, external and general carotid and carotid-reconstructing. Two cases underwent anestomosis of general carotid with internal carotid and 2 ligation of the internal carotid. All patients showed good results but one complicated with hemiplegia. The authors consider that misdiagnosis can be avoided with careful physical examination, Bmode ultrasonic scanning and arteriography, and hypothermic general anesthesia and intraoperative general carotid internal carotid shunt were important measures for the protection of brain.
Objective To investigate the application value of intraoperative CT navigation in posterior thoracic pedicle screw placement for scoliosis patients. Methods Between October 2009 and December 2011, 46 patients with scoliosis were treated with thoracic pedicle screw placement under intraoperative CT navigation in 21 cases (group A) or under C-arm fluoroscopy in 25 cases (group B). There was no significant difference in age, gender, type of scoliosis, involved segment, and Cobb angle of main thoracic curve between 2 groups (P gt; 0.05). A total of 273 thoracic pedicle screws were placed in group A and 308 screws in group B. The pedicle screw position evaluated and classified by intraoperative CT images according to the Modi et al. method; and the accurate rate, the safe rate, and the potential risk rate of pedicle screws were calculated on the upper thoracic spine (T1-4), the middle thoracic spine (T5-8), the lower thoracic spine (T9-12), and the entire thoracic spine (T1-12). The accuracy and security of thoracic pedicle screw placement were compared between 2 groups. Results On the entire thoracic spine, the accurate rate of group A (93.4%) was significantly higher than that of group B (83.8%), the safe rate of group A (98.9%) was significantly higher than that of group B (92.5%), showing significant differences between 2 groups (P lt; 0.05). However, the potential risk rate of group B (7.5%) was significantly higher than that of group A (1.1%) (P lt; 0.05). On the upper, the middle, and the lower thoracic spines, there was no significant difference in the accurate rate, the safe rate, and the potential risk rate of pedicle screws between 2 groups (P gt; 0.05). According to CT evaluation results, the potential risk pedicle screws were revised or removed during operation. The patients of 2 groups had no neurological deficits through physical examination of nervous system at 3 days after operation. Conclusion Intraoperative CT navigation can improve the accuracy and security of posterior thoracic pedicle screw placement and it can ensure the safety of operation by finding and promptly removing or revising the potential risk pedicle screws.
Objective To explore the intraoperative imaging to monitor the prosthetic fixation for the total hip arthroplasty (THA) and to increasethe accuracy of the primary THA prosthetic fixation. Methods From April 2000 to August 2005, 69 patients (75 hips) underwent THA monitored by the imaging (the imaged THA group, Group I), and 72 patients (78 hips) underwent THA with the standard method (the standard THA group, Group S). There were 32 males and 37 females in Group S. The mean ages of the patients in Group I and Group S were 62.3 years and 60.5 years respectively, ranging 46-75 years in Group I and 43-75 years in Group S. Preoperative diagnoses were femoral neck fracture (Garden Ⅲ,Ⅳ) in 23 patients (23 hips) in Group I and 25 patients (25 hips) in Group S, acetabular dysplasia (Campbell Ⅰ, Ⅱ) in 9 patients (10 hips) in Group I and 11 patients (13 hips) in Grouop S, osteoarthritis in 16 patients (17 hips)in Group I and 15 patients (15 hips) in Group S, femoral head osteonecrosis (Ficat Ⅲ,Ⅳ) 15 patients (16 hips) in Group I and 17 patients (17 hips) in Group S, and rheumatoid arthritis in 6 patients (9 hips) in Group I and 4 patients (8 hips) in Group S. There were 21 hips of cement prostheses in Group I and 22 hips in Group S, 12 hips of cementless prostheses in Group I and 11 hips in Group S, 42 hips of cement and cementless prostheses in Group I and 45 hips in Group S. Group I used the standard THA and the intraoperative X-ray monitoring the prosthetic fixation in the numerical measure of abduction angle, anteversion angle, femoralneck length, and femoral offset distance. The items compared betweem Group I and Group S included incisional length, intraoperative bleeding, transfusion, operative time, frequency of X-ray imaging, infection, postoperative functional recovery, and prostheric position of postoperative X-ray imaging. Results The follow-up on 62 patients in Group I and 64 patients in Group S for 6-64 months averaged 42 months revealed that there were statistically significant differences in incisional length, intraoperative bleeding, transfusion, operative time, frequency of X-ray imaging, postoperative functional recovery, prosthetic position of postoperative X-ray imaging, and the Harris score between Group I and Group S one year after operation. The results of Group I were significatly better than those of Group S. Conclusion The intraoperative X-ray imaging can increase the accuracy of the THA prosthetic fixation and reduce the incidence of THA maloperation by The X-ray imaging can also be used in county hospitals if Carm fluoroscopy can be provided.
目的 探讨躯体感觉诱发电位（SEP）在颈脊髓损伤术前、术中监测的意义。 方法 纳入2010年1月－2012年4月治疗的241例颈脊髓损伤患者，术前按美国脊柱脊髓损伤协会（ASIA）评分并分级，确定损伤平面。术前与术中SEP监测，分析不同损伤分级以及不同损伤平面术前的波幅及潜伏期的差异，术中SEP监测以波幅下降＞50%和或潜伏期延长＞10%为预警标准。 结果 各损伤分级组术前SEP监测：A级组SEP波消失，呈一直线，而B、C、D、E级组均测出SEP波形，根据是否可测出SEP波形，可将A级与B、C、D、E及组区别。B、C、D级组之间波幅和潜伏期均无统计学意义（P＞0.05）。E级组较B、C、D级组波幅增高、潜伏期缩短，差异有统计学意义（P＜0.05）；不完全性颈脊髓损伤组内不同损伤平面组之间波幅和潜伏期差异均无统计学意义（P＞0.05）。术中SEP对脊髓功能损伤监测的灵敏度83.3%、特异度98.7%。其中术中：SEP阳性8例，真阳性5例，4例术者处理后波幅及潜伏期回复至正常范围，术后无新的神经功能损伤，另1例术者采取各种处理后波幅及潜伏期无恢复，术后神经功能损伤较术前加重；假阳性3例，1例麻醉师给予升高血压后波形恢复至正常，另2例经麻醉师调整麻醉深度后波形恢复正常，此3例术后无新的神经功能损伤。SEP阴性233例，真阴性232例，术后无新的神经功能损伤；假阴性1例，患者术中、术后波形未见异常，术后运动功能损伤程度较术前加重。 结论 ① SEP能准确评估完全性和不完性颈脊髓损伤，但对不完全性颈脊髓损伤的损伤程度不能作出准确评估、也不能区分颈脊髓损伤的损伤平面；② 术中SEP监测能较好地反映颈脊髓功能完整性，对减少颈脊髓损伤术中发生医源性颈脊髓损伤风险具有重要意义。
目的 分析颅内动脉瘤弹簧圈栓塞治疗术中出血的原因和防治对策。 方法 回顾性分析2003年3月－2012年8月358例颅内动脉瘤采用弹簧圈栓塞治疗患者，7例弹簧圈栓塞过程中出血，并继续栓塞止血。2例为弹簧圈栓塞中造影仅见血流明显变慢，术后CT证实的出血。术后对症治疗6例，开颅引流减压3例。 结果 9例术中破裂者中8例致密栓塞，1例部分栓塞。5例恢复好，1例一过性动眼神经麻痹，3例死于颅内高压 结论 术中出血与手中操作、动脉瘤形态和患者血管条件、血压变化有关，继续填塞及合理术中与后续治疗可以挽救大部分患者生命。
目的 分析总结经导管主动脉瓣置入的术中护理要点，以指导临床术中护理。 方法 回顾性分析2012年4月－5月新开展经股动脉逆行法经导管主动脉瓣置入术3例患者的临床资料。术前备齐手术用物及急救药品、术中协助患者正确体位，准确使用临时起搏器、除颤仪、认真做好病情及并发症观察和护理，总结术中临床护理方法。 结果 经导管主动脉瓣置入手术顺利成功，术中护理效果满意，无因物品或药品准备不齐及护理不当而影响手术进程、造成患者意外损伤及并发症发生。 结论 经导管主动脉瓣置入术，术前备齐相应的导管导丝，术中操作规范细致、及时、准确传递用物、认真进行临床观察和护理，手术顺利、成功无不良事件发生及并发症发生。