目的 探讨食管癌术后酒精戒断综合征的原因及有效预防治疗措施。 方法 2000年1月－2011年10月共行食管癌手术935例，术后发生酒精戒断综合征16例，患者均为男性，年龄41～67岁，平均54岁。饮酒史16～47年，平均27.8年；每日饮白酒量为250～1 000 g，酒精含量162～590 g，平均321.5 g。所有患者均符合中国精神疾病分类与诊断标准第3版（CCMD-3）酒精戒断综合征诊断标准。在食管癌常规术后治疗的基础上，根据患者谵妄、烦躁、精神失常、昏迷等不同情况应用维生素B族、纳络酮、氟哌啶醇、氯丙嗪、安定、促进脑细胞代谢及补充能量等综合治疗，必要时予以镇静后气管插管呼吸机辅助呼吸。 结果 患者经治疗后戒断症状均完全消失，治疗时间2～10 d，平均5.3 d。13例获随访，随访时间4～18个月，均完全戒酒，其中1例术后8个月死于急性心肌梗死；余12例均恢复良好，且未出现酒精戒断症状。 结论 经合理有效的围手术期处理，食管癌术后酒精戒断综合征发生率可明显降低，详细询问病史，术前术后积极预防并及时给予有效的治疗是治愈的关键。
Objective To summarize the treatment and outcomes of patients with multiple injuries combined with thoracic trauma following the Wenchuan earthquake. Methods The wounded patients admitted from 12th to 31st May with multiple injuries combined with thoracic trauma after the earthquake were retrospectively analyzed. This includes baseline information, treatments, outcomes and deaths. Results Liver repair, spleen abscission, decompression and removed of intracranial hematoma ranked the first three of the main reasons for the emergency surgery death of multiple injuries. Heart-lung machine support, trachea cannula and closed drainage of thoracic cavity ranked the first three of the main reasons for the death of thoracic trauma. Moreover, ARDS, fracture of sternum and flail chest ranked the first three of the main reasons for the death of other multiple injuries. All the casualties had the worst situation with high ISS scores. The main death reasons were cerebral wound, peritoneum viscera injuries and the four limbs and pelvis injuries. Besides, the severe thoracic trauma accelerated their death. Conclusion Main death reasons for the inpatients with multiple injuries combined with thoracic trauma are hemorrhagic shock and severe cerebral wound. The thoracic trauma degree will increase the risk of their death. The more the injury positions, the higher ISS scores, and the more serious thoracic trauma, the higher mortality rate. Rapid examination and diagnosis, rapied triage and distribution of thoracic trauma can help to create more chances for the further treatment and increase the success rate of rescue.
目的探索单操作孔电视胸腔镜手术治疗胸部良性疾病的有效性和安全性。 方法回顾性分析2008年3月至2013年4月德阳市人民医院单操作孔电视胸腔镜手术治疗胸部良性疾病186例患者的临床资料，其中男101例、女85例，年龄15～65（30.1±5.3）岁。 结果全组患者无围手术期死亡。手术时间18～88（47.2±7.6）min，术中出血量5.0～110.0（49.8±9.4）ml，患者术后住院时间7～16（9.2±2.1）d。2例因致密粘连转为辅助小切口手术。自发性气胸肺大泡切除术后当日及术后1～2 d出现持续肺漏气3例，1例肺漏气持续9 d，1例肺漏气持续10 d，1例肺漏气持续11 d，均经保守治疗治愈。切口脂肪液化4例，换药后治愈。术后肺部感染3例，经加强抗感染后治愈。随访3～24（6.8±3.2）个月，失访18例，总体随访率90.3%（168/186）。随访期间气胸复发4例，气胸压缩肺组织10%～20%，观察5～8 d自行吸收，未再次手术；肺及纵隔良性病变无复发；结核患者术后抗痨治疗12～18个月治愈。 结论单操作孔电视胸腔镜手术治疗胸部良性疾病创伤小，切口美观，患者恢复快，手术安全，对适应证患者可作为手术方式。