目的:探讨开颅夹闭和血管内栓塞治疗颅内动脉瘤的效果比较及并发症。方法:从2003～2008年近五年来我院收治的颅内动脉瘤54例,其中开颅夹闭24例(Hunt Hess分级Ⅰ～Ⅱ级20例,Ⅲ级2例,Ⅳ级2例),共26个动脉瘤。血管内栓塞30例(HuntHess分级Ⅰ～Ⅱ级23例,Ⅲ级5例,Ⅳ级2例),共31个动脉瘤。临床结果按GOS进行评价。结果:两组的良好率、并发症及死亡率无显著差别(Pgt;0.05)。随访平均12月,Ⅰ～Ⅱ级动脉瘤患者治疗良好率为100.0％(43/43),并发症发生率为4.7％(2/43),Ⅲ～Ⅳ级者分别为18.2％(2/11)和90.9％(10/11),两者相差显著(Plt;0.05)。结论:开颅夹闭和血管内栓塞治疗颅内动脉瘤,二者疗效相仿,各有优缺点。动脉瘤患者病情级别越高,治疗效果越差。
摘要:目的:探讨接受超声引导下经直肠前列腺穿刺活检术(transretal prostatic biopsy,TPB)检查的临床护理相关问题,为前列腺穿刺活检临床护理提供参考。方法:通过心理疏导接解除者术前对TPB的恐惧心理,明确TPB是比较安全、可靠的、不可替代的检查方法,了解手术过程、护理方法和一般并发症,提高TPB的检查效果及护理质量。结果:71例患者进行TPB检查,全部患者均能主动配合检查操作,检查术中并发迷走神经心血管反射1例,术后并发血尿4例,短期内疼痛5例,均早期发现,给与相应的护理与治疗后治愈。结论:TPB是前列腺占位性病变患者有效的定性有创性检查方法,对行TPB检察患者患者应采取针对性的护理措施,提高护理质量及检查安全性。 Abstract: Objective: To investigate correlative nursing measure of patients with transretal prostatic biopsy (TPB) guided by ultrasound, provide reference for clinical nursing of TPB. Methods: We dismissed patient’s fear by psychological nursing, and explained that TPB was a safe, reliable and nosubstitutive checking, and help them understand procedure of operation, nursing measure and common complication, so as to improve effect of checking and quality of care. Results: Seventyone patients received checking with TPB, all patients could initiativiy go with checking, one patient took place pneumogastric nerve reflect, 4 patients take place hematuria postoperation, 5 patients feel soreness in shortterm. All complications were found in morning, and were cure by nursing and treatment. Conclusion: TPB is valid checking method to occupy lesion of prostate for qualitation. Because TPB is a traumatic operation, homologous nursing measure must be take to improve safety of TPB and quality of care.
目的:探讨微创经皮肾通道碎石(Minimally Invasive Percutaneous Nephrolithotomy, mPCNL)与改良经皮肾通道碎石治疗复杂上尿路结石的临床疗效。方法:回顾性分析2003年10月至2009年2月经皮肾镜碎石术治疗上尿路结石430例,据术中建立的碎石通道将其分为mPCNL组(220例)和改良经皮肾通道组(210例),分析其术中出血量、手术时间、结石清除率、术后感染率、胸腹腔积液等指标。结果: mPCNL组和改良通道PCNL组均于术后24h复查血红蛋白分别下降(28±6) g/L,(30±5) g/L。其中术中或者术后输血者各为12例和11例,两组各有一例因术后大出血而行超选择动脉栓塞治愈。mPCNL组手术时间90~180 min平均为120 min。改良通道PCNL组手术时间50~150 min平均为90 min。结石清除率mPCNL组84.5%而改良通道PCNL组达到94.8%,两组残余结石均经二期、三期取石或者体外碎石排出。其mPCNL组与改良通道PCNL组损伤胸腹膜者各有3例。术后发生尿路感染分别有28例和25例,经选用敏感抗生素治疗3~5天体温降至正常。结论:采用改良经皮肾通道治疗复杂性上尿路结石能明显缩短手术时间,提高结石取净率并不增加出血、感染、胸腹腔损伤等并发症。
Objective To observe the factors influencing for results of laser treatment of zone one retinopathy of premature（ROP）. Methods The clinical data of 35 patients（69 eyes）with ROP in zone one who diagnosed by examination of indirect ophthalmoscopy were retrospectively analyzed. The eyes were divided into anterior zone one（49 eyes ）and posterior zone one（20 eyes）. The 69 eyes, aggressive posterior ROP（AP-ROP）in 12 eyes, anterior zone one in four eyes and posterior zone one in eight eyes. The laser photocoagulation of diode indirect ophthalmoscopy with +20 D lens and sclera compressor were used to entire avascular retina. Followup ranged from two to 48 months with the mean of (10.85plusmn;11.35 )months. Take the cristae fadeaway and stable condition as cure; retinopathy proceed to the stage 4 and 5 ROP as retinopathy progress. Results Forty-two out of 69 eyes (60.87%) were cured and retinopathy progress in 27 eyes (39.13%). Thirty-four out of 49 eyes (69.38%) with anterior zone one were cured and retinopathy progress in 15 eyes (30.61%); eight out of 20 eyes (40.00%) with posterior zone one were cured and retinopathy progress in 12 eyes (60.00%). The difference of progress rate between anterior and posterior zone one was statistically significant（chi;2=5.15, P＜0.05).Conclusions Laser photocoagulation is effective for treatment of zone one ROP, the prognosis of anterior zone one is better than posterior zone one; retinopathy progress after photocoagulation was associated with extent of fibrovascular organization.