目的 推荐在胃底贲门癌和直肠上段癌切除的病例，如果无条件使用胃肠吻合器，在胃肠道重建吻合时应用三翼钳。方法 我科自1990年7月至1998年11月在胃底贲门癌和直肠上段癌切除术中，应用三翼钳进行胃肠道重建吻合共40例。其中全胃切除12例，近侧胃切除7例，直肠上段及部分乙状结肠切除21例。重建术式有： 食管空肠Roux-Y吻合5例，食管空肠袢式吻合2例，食管十二指肠吻合3例，横结肠间置代胃2例，食管胃吻合7例，乙状结肠、直肠盆内吻合21例。结果 全部手术除1例术后死于呼吸衰竭外均恢复顺利出院，无1例发生吻合口瘘。术后病理证实仅1例远侧直肠端可见癌细胞浸润，其它均证实两断端已切干净。随访半年内发生吻合口狭窄4例。结论 对胃底贲门癌或直肠上段癌切除的病例应用三翼钳技术有如下优点： ①食管或直肠切除长度符合肿瘤切除标准； ②吻合时两端对合整齐，且无张力； ③吻合端不出血，视野清晰； ④吻合操作时从容稳定； ⑤全层吻合确实，可靠； ⑥结肠吻合时可避免粪便污染。
目的 探讨延髓肿瘤的治疗策略，以达到最佳预后。 方法 回顾分析2007年1月－2010年12月19例延髓肿瘤患者的临床资料，其中18例经外科手术治疗和病理证实，1例通过影像学确诊。 结果 12例血管网状细胞瘤中，11例手术全切，1例手术次全切；2例室管膜瘤均手术全切；2例海绵状血管瘤分别手术全切及伽马刀治疗；3例胶质瘤均手术部分切除。18例手术治疗患者术后神经功能障碍明显好转者13例，无明显变化者3例，2例因术后严重并发症死亡；1例伽马刀治疗患者症状好转。术后随访6～48个月，平均24个月。11例恢复工作，4例生活可自理，2例因肿瘤复发死亡。结论 术前通过MRI检查、术中神经电生理监测及熟练的显微外科技术是外科治疗优势，伽马刀治疗延髓较小肿瘤有着损伤小的优点，因此制定合理的治疗策略有利于提高患者生存质量。
目的 提高腹部锐器伤的诊断和治疗水平。方法 总结分析我院普外科1990年1月至1999年6月所收治的200例腹部锐器伤患者的资料。结果 男女比例7∶1，小于45岁者占75%，就诊平均时间3.8小时，95%为斗殴刀刺伤。单纯腹壁贯通伤占20%，单个脏器损伤占34%，多个脏器损伤占46%，休克发生率为26%。保守治疗20例，均为单纯腹壁贯通伤，手术治疗180例，总死亡率为2%。结论 腹部锐器伤的诊断虽然较为直观，但在6种特殊情况下容易延误诊断： ①腹内脏器损伤后的延时表现； ②经胸穿透膈肌导致腹内脏器损伤； ③经剑突下方刺伤并穿透膈肌导致心脏损伤； ④在受伤现场及来院途中的大量外出血导致休克； ⑤腹膜后血肿的诊断； ⑥直肠腹膜外损伤导致盆底腹膜贯通及腹内脏器损伤。在治疗方面，笔者强调了手术探查时的6项要点，并对各类脏器损伤的处理要点提出建议。
ObjectiveTo analyse the microsurgical treatment and facial nerve preservation of giant acoustic neuromas. MethodsUnder the conditions of facial nerve monitoring, 400 patients with giant acoustic neuromas underwent microsurgical removal via suboccipital retrosigmoid approach between January 2005 and January 2013. There were 186 males and 214 females, with the age ranged from 15 to 74 years (mean, 41.6 years). The disease duration was 2-13 years (mean, 2.4 years). The lesions were located at the left cerebellopontine angle region (CPA) in 191 cases, right CPA in 200 cases, bilateral CPA in 9 cases. The clinical manifestations included unilateral hearing loss and tinnitus as first symptoms in 389 cases, facial numbness in 373 cases, unilateral facial paralysis in 370 cases, headache in 269 cases, lower cranial nerve symptoms with drinking cough and dysphagia in 317 cases, and unstable gait in 342 cases. Preoperative skull base thin layer CT showed varying degrees of horn-like expansion in ipsilateral internal auditory canal opening. MRI showed cysts in 78 cases and solid masses in 322 cases; with hydrocephalus in 269 cases. Postoperative cranial MRI or CT was taken to observe the extent of tumor resection. The preservation of facial nerves in anatomy was assessed by intraoperative microscope video and electrophysiological monitoring; the facial nerves function was assessed according to House-Brackmann (HB) classification on the first day after operation; and the rehabilitation of facial nerve function was also assessed at discharge and at 1 year postoperatively by using HB grade. ResultsTotal tumor removal was achieved in 372 cases (93.00%), and subtotal removal in 28 cases (7.00%). One case died of delayed brainstem ischemia at 14 days after operation, and 1 case died of lung infection at 20 days after operation; 398 cases were followed up 6 months to 8 years (mean, 3.5 years). Recurrence occurred in 1 case because of neurofibromatosis at 5 years after operation. The rate of anatomical preservation of the facial nerve during operation was 91.75% (367/400), and the functional preservation rate at the first day after operation was 62.75% (251/400). The HB grade of facial nerve function showed significant difference aomng 3 time points (at the first day, at discharge and at 1 year after operation) (χ2=23.432, P=0.000). Complications included postoperative intracranial infection in 11 cases (2.75%), cerebrospinal fluid leakage in 29 cases (7.25%), aggravated lower cranial nerve symptoms in 18 cases (4.50%), subcutaneous effusion in 13 cases (3.25%), second operation to remove hematoma in 9 cases (2.25%), postoperative circumoral herpes simplex virus infection in 25 cases (6.25%), and all complications were cured after symptomatic treatment. Postoperative hydrocephalus disappeared in 261 cases. ConclusionSurgical operation is the first choice in the treatment of giant acoustic neuromas. Under the auxiliary of neural electrophysiological monitoring, the microsurgery operation via suboccipital retrosigmoid approach for giant acoustic neuromas has extremely low mortality and high preservation rate of facial nerve function.
ObjectivesTo identify the clinical characteristics and prognosis for CRKP (Carbapenem-resistant Klebsiella pneumonia, CRKP) infection among ICU patients in the Second Affiliated Hospital of Anhui Medical University. MethodsWe conducted a retrospectively analysis in which 19 patients infected by CRKP with another 21 CSKP (Carbapenem-sensitive Klebsiella pneumoniae, CSKP) infected patients from January 2017 to April 2018. Risk factors for CRKP infection were assessed. ResultsThe lower respiratory tract is the most common site of CRKP infection in our department. CRKP infection was associated with several clinical symptoms, particularly a higher incidence of sepsis shock (χ2=8.338, P=0.004), more application of the combined medicine (χ2=26.3, P<0.001), prolonged hospital stays (χ2=–2.217, P=0.027) and more expenses on antibiotics (χ2=12.855, P=0.005), and the declined survival rates in 14 days (χ2=4.269, P=0.039) and 21 days (χ2 =5.647, P=0.017). The resistance rate of CRKP strains was high, however no resistance to tegafycline was found. The risk factors of CRKP infection included three generations of cephalosporin and/or hydrocarbonase antibiotics exposure (χ2 =6.388, P=0.041), exposure time of three generations of cephalosporin (U=–2.187, P=0.029), exposure time of hydrocarbonase antibiotics (U=–2.103, P=0.035), tracheal intubation (χ2=6.352, P=0.012), tracheotomy (χ2 =4.821, P=0.028), SOFA score (t=4.505, P<0.001) and Charlson comorbidity index (t=3.041, P=0.004). The SOFA score was the only factor independently associated with CRKP bacteremia (P=0.02). ConclusionsCRKP infections in ICU directly affect the course of disease, survival time and treatment expenses of patients. Therefore, monitoring bacterial resistance, rational use of antibiotics, and protection of the immune function are of great significance for prevention and treatment of CRKP infection.