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Langenbecks Archiv fur Chirurgie. Supplement II, Verhandlungen der Deutschen Gesellschaft fur Chirurgie. Deutsche Gesellschaft fur Chirurgie. Kongress最新文献

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[Reconstructive procedures in chronic occlusive processes of the intestinal arteries]. [慢性肠动脉闭塞的重建手术]。
R J van Dongen

Three approaches are considered: the left thoracoabdominal approach, the right-sided retro- or supracolic route and the transabdominal access. Aorto-common hepatic venous bypass grafting is the preferred procedure in singular occlusions of the celiac axis. Reimplantation and aorto-mesenteric venous bypass are the treatments of choice in singular occlusions of the mesenteric artery. Occlusions of both upper intestinal arteries can be treated with a venous bridge bypass graft or by transaortic end-arterectomy. Operative mortality is low (0.9%). Remaining occlusion and recurrent symptoms occurred in 12 of 92 patients.

我们考虑了三种入路:左胸腹入路、右背或背上入路和经腹入路。主动脉-肝总静脉旁路移植术是腹腔轴单发闭塞的首选方法。再植入术和主动脉-肠系膜静脉旁路术是单纯性肠系膜动脉闭塞的首选治疗方法。两个上肠动脉的闭塞可以通过静脉桥搭桥或经主动脉动脉末端切除术来治疗。手术死亡率低(0.9%)。92例患者中有12例出现残留闭塞和复发症状。
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引用次数: 0
[Sequelae and evaluation after distal radius fractures]. [桡骨远端骨折后的后遗症及评价]。
J Probst

The sequela of fractures of the distal radius show the same variety as the fracture models themselves, depending on conservative or operative repositioning. The most frequent disadvantages are deviation of the bone axis, depression of the basis of the radius, steps in the cartilage plain and rough deformity. Most important are the arthrotic changes in the joint, such as entrapment and compression neuropathies. The sequela of fractures in children, adults and the aged differ. The purpose of the expert appraisal is not only to assess the damages after fracture but also to give new proposals for further therapy.

桡骨远端骨折的后遗症表现出与骨折模型本身相同的多样性,取决于保守或手术复位。最常见的缺点是骨轴偏离,桡骨基底凹陷,软骨平顺和粗糙畸形。最重要的是关节的改变,如压迫和压迫神经病变。儿童、成人和老年人骨折的后遗症不同。专家鉴定的目的不仅是评估骨折后的损伤,而且为进一步的治疗提出新的建议。
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引用次数: 0
[Fresh fractures! Classification, management, results and problems: the wrist joint]. (新鲜骨折!分类、处理、结果及问题[j]。
P Brüser

Carpal bone fractures are rare, with an incidence of 13% compared to that of fractures and luxations of the hand bones. Generally they are intraarticular fractures. Fracture of the scaphoid bone occurs most frequently, with an incidence of 75%. The greater number of fractures is found in the middle-third of the wrist bordering on the os lunatum. They are usually treated conservatively by splinting with a cast. Surgery is indicated only when the fracture is open, instable, dislocated or combined with carpal instabilities.

腕骨骨折是罕见的,与手部骨折和脱位的发生率相比,腕骨骨折的发生率为13%。通常是关节内骨折。舟状骨骨折是最常见的,发生率为75%。较多的骨折位于腕关节中三分之一处,毗邻月骨。通常用夹板和石膏保守治疗。只有当骨折开放性、不稳定、脱位或伴有腕关节不稳定时才需要手术。
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引用次数: 0
[Treatment of phalangeal fractures]. 指骨骨折的治疗。
K Wilhelm, T Kreusser

Due to anatomical reasons the therapy of phalangeal fractures is a domain of conservative treatment in contrary to metacarpal fractures. Special attention must be focused on defective position in axis and rotation of the fractured phalanx. We use the Iselin splint. The indication for operation depends on the patients compliance, the type of fracture and its localisation. Indications for operation in our opinion are open fractures, dislocated, non reponible fractures, fractures involving the joint, condylar fractures. Conservative treatment gains the more importance the more the fracture is localized at the end of the phalanx.

由于解剖学上的原因,与掌骨骨折相反,指骨骨折的治疗是保守治疗的一个领域。必须特别注意骨折指骨在轴线和旋转上的缺陷位置。我们使用Iselin夹板。手术指征取决于患者的顺应性、骨折类型和骨折部位。我们认为手术的适应症是开放性骨折、脱位骨折、非责任性骨折、关节骨折、髁突骨折。骨折越局限于指骨末端,保守治疗越重要。
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引用次数: 0
[Technique of thyroid gland operation: prevention of lesions of the superior laryngeal nerve]. 甲状腺手术技术:预防喉上神经病变。
B Lefèbre, R Steffen, T Steinmüller, P Neuhaus

The anatomical variant of the external branch of the superior laryngeal nerve is at risk during thyroid surgery. We recommend a careful dissection of the upper thyroid pole strictly avoiding even minor mass ligatures and all vascular structures have to be selectively identified. Of a consecutive series of 161 upper pole dissections the superior laryngeal nerve was found in 31% and no postoperative injury was detected by video stroboscopy.

在甲状腺手术中,喉上神经外支的解剖变异是有危险的。我们建议仔细解剖甲状腺上极,严格避免小肿块结扎,并选择性地识别所有血管结构。在连续161例上极解剖中,31%发现喉上神经,视频频闪检查未发现术后损伤。
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引用次数: 0
[Postoperative lung complications--introduction]. 【术后肺部并发症——介绍】。
A Encke

Intensive care patients suffer according to literature in 20-60% from pneumonia with a mortality up to 80%. The patient, operation and postoperative therapy influence its pathogenesis. Mechanical ventilation is a special risk factor. However, in this regard origin and sequelae may not be changed by mistake. Specifity of clinical and plain X-ray diagnosis is only 30-50%. Selective gastrointestinal decontamination, exactly monitored fluid balance, and physio-, and paintherapy seem to be valuable preventive measures.

根据文献,重症监护患者中有20-60%患有肺炎,死亡率高达80%。患者、手术和术后治疗影响其发病机制。机械通气是一种特殊的危险因素。然而,在这方面,起源和后遗症可能不会被错误地改变。临床及x线平片诊断的特异性仅为30-50%。选择性胃肠道净化,精确监测体液平衡,物理和疼痛治疗似乎是有价值的预防措施。
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引用次数: 0
[Surgical interventions in liver metastases]. [肝转移的手术干预]。
J Scheele, R Stangl, A Altendorf-Hofmann

Surgical treatment of hepatic metastases is predominantly aimed at "curative" resection. This can be achieved in about 20% of colorectal secondaries, and is associated with a 30-40% 5-year survival. One to three metastases in the absence of extrahepatic disease are regarded a clear indication to resection. Among patients with non-colorectal malignancies, occasional long term survival was reported in leiomyosarcoma, breast cancer, and renal cancer metastases, respectively. Endocrine tumors such as carcinoid, gastrinoma, or pheochromocytoma, are different because of their remarkable symptoms along with a protracted natural history. Quality of life may be considerably improved here by even non-radical debulking. The vast majority of patients, however, ist not suitable to undergo hepatic resection. Palliative therapeutic options involve hepatic artery ligation or embolization, cryo-surgery and percutaneous laser coagulation, and various types of regional chemotherapy. These methods may enable a temporary relief of symptoms, but no significant impact on survival time, and no true long term benefit has been proven. Prospective randomized trials against combined treatment as well as untreated patients are required for a more meaningful judgement and improved effectiveness.

肝转移的手术治疗主要是为了“治愈性”切除。约20%的结直肠癌继发病例可实现这一目标,并伴有30-40%的5年生存率。在没有肝外疾病的情况下,一到三个转移被认为是明确的切除指征。在非结直肠恶性肿瘤患者中,平滑肌肉瘤、乳腺癌和肾癌转移患者的长期生存率分别偶有报道。内分泌肿瘤,如类癌、胃泌素瘤或嗜铬细胞瘤,因其症状显著且自然病程长而不同。在这里,即使是非根治性的减瘤术也可以大大提高生活质量。然而,绝大多数患者不适合行肝切除术。姑息性治疗方案包括肝动脉结扎或栓塞,冷冻手术和经皮激光凝固,以及各种类型的局部化疗。这些方法可能暂时缓解症状,但对生存时间没有显著影响,也没有真正的长期益处。需要对联合治疗和未经治疗的患者进行前瞻性随机试验,以做出更有意义的判断和提高疗效。
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引用次数: 0
[Non-occlusive disease--ultrasound diagnosis and trend analysis as a treatment guideline]. 【非闭塞性疾病——超声诊断及趋势分析作为治疗指南】。
G Meiser, H W Waclawiczek, G Lexer, O Boeckl

16 patients with angiographically proved NOD underwent immediate abdominal sonography (age: 76 +/- 24 years). All patients suffered from "low cardiac output syndrome". The sonographic criteria were as follows: bowel wall edema [16], hyper-peristalsis [16], free peritoneal fluid [14], and signs of incomplete ileus [14]. 11 patients were successfully treated with conservative therapy on the basis of followup ultrasound observation and analysis. 5 patients underwent operation because of worsening ultrasound findings. These patients died from the underlying cardiac illness.

16例经血管造影证实为NOD的患者接受了立即腹部超声检查(年龄:76±24岁)。所有患者均出现“低心输出量综合征”。超声诊断标准为:肠壁水肿[16]、过度蠕动[16]、游离腹膜液[14]、不完全肠梗阻征象[14]。在随访超声观察分析的基础上,对11例患者进行保守治疗。5例患者因超声表现恶化而行手术。这些病人死于潜在的心脏病。
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引用次数: 0
[Kidney and bladder injuries: diagnosis and therapy]. 【肾膀胱损伤:诊断与治疗】。
H Huland

Classification of renal trauma is given. Perforated trauma requires operation, blund trauma is treated conservatively, at least in stage I and II. Severe hemorrhage is reason for surgical exploration and nephrectomy in stage III and IV renal trauma. Renal trauma is best diagnosed by sonography and CT-scan. Bladder trauma is best diagnosed by cystogram and classified to intraperitoneal leasons which require immediate operation and to extraperitoneal leasons which are treated conservatively.

给出了肾外伤的分类。穿孔创伤需要手术,钝挫伤至少在I期和II期保守治疗。严重出血是III期和IV期肾外伤手术探查和肾切除术的原因。肾外伤最好通过超声和ct扫描诊断。膀胱损伤可通过膀胱造影诊断,并可分为腹膜内病变和腹膜外病变,需立即手术治疗。
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引用次数: 0
[Accident mechanisms and classification in distal radius fracture]. [桡骨远端骨折的事故机制及分类]。
D Havemann, F W Busse

The form and severity of fracture of the distal radius as well as the concomitant injury of discoligamentary structures of the wrist depend on the position of the wrist at the moment of hitting the ground. The width of this angle influences the localization of the fracture. Pronation, supination and abduction determine the direction of force and the compression of the carpus and the different appearances of ligamentary injuries. The classifications of these fractures published by Frykman (1967) and M. E. Müller et al. (1989, AO-Group), incomplete, are useful for objective evaluation or documentation and may suggest indications for treatment when critically used.

桡骨远端骨折的形式和严重程度以及伴随的腕部韧带结构损伤取决于腕部着地瞬间的位置。这个角度的宽度影响着裂缝的定位。旋前、旋后和外展决定了力的方向和对腕骨的压迫以及韧带损伤的不同表现。Frykman(1967)和m.e. m ller等人(1989,o - group)发表的这些骨折分类虽然不完整,但对客观评估或文献记录有用,并且在严格使用时可能建议治疗指指。
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引用次数: 0
期刊
Langenbecks Archiv fur Chirurgie. Supplement II, Verhandlungen der Deutschen Gesellschaft fur Chirurgie. Deutsche Gesellschaft fur Chirurgie. Kongress
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