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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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[Postoperative lung complications: special problems exemplified by esophageal surgery]. [术后肺部并发症:以食管手术为例的特殊问题]。
H Bartels, J R Siewert

Pulmonary problems in esophageal surgery can result from the resection itself (intraoperative pulmonary trauma), the reconstruction procedure (intrathoracic organ interposition) and aspiration due to postoperative impairment of swallowing. Therapeutic strategies include postoperative ventilation, deflation of the interponate and a special dietary plan. Our rate of 5.2% postoperative pulmonary complications underlines the efficiency of our treatment modalities.

食管手术中的肺部问题可由切除本身(术中肺损伤)、重建过程(胸腔内器官介入)和术后吞咽障碍引起的误吸引起。治疗策略包括术后通气、内部通气和特殊饮食计划。术后肺部并发症发生率为5.2%,这表明了我们治疗方式的有效性。
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引用次数: 0
[Non-occlusive ischemic enteropathy--diagnosis, differential diagnosis and therapy]. 【非闭塞性缺血性肠病——诊断、鉴别诊断和治疗】。
H P Bruch, W Habscheid, G Schindler, T Schiedeck

Reduced cardiac output is the pathogenetic principle of non-occlusive disease. Prerequisites for early diagnosis include anamnesis, clinical and laboratory findings, sonography, mesentericography, contrast enema, and coloscopy. Conservative treatment with vasoactive drugs is promising in early stages. As the abdominal symptoms develop latently, laparotomy is indicated in most cases in order to identify necrosis or perforation and to allow surgery according to the intraoperative findings. Despite indisputable progress made during the past years, the death rate in our patients (n = 42) is still 43%. Only early diagnosis and consequential therapy can achieve better results.

心输出量减少是非闭塞性疾病的发病原理。早期诊断的先决条件包括记忆、临床和实验室检查、超声、肠系膜造影、造影剂灌肠和结肠镜检查。血管活性药物的保守治疗在早期阶段是有希望的。由于腹部症状发展缓慢,大多数病例需要开腹探查,以确定坏死或穿孔,并根据术中发现进行手术。尽管在过去几年中取得了无可争议的进展,但我们的患者(n = 42)的死亡率仍为43%。只有早期诊断和相应的治疗才能取得更好的效果。
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引用次数: 0
[Celiac artery compression syndrome]. [腹腔动脉压迫综合征]。
T Riemenschneider, P Huppert

External compression and kinking of the celiac axis is caused by the enlarged and fibrous median arcuate ligament of the diaphragm. The pathogenetic cause may be a functional ischemia or an irritation of the squeezed celiac ganglion. This painful syndrome is an unusual condition, which occurs at a maximum age of about 40 years and mostly in women. The diagnosis is established by exclusion of all other abdominal sources of pain and lateral aortography. The therapy can often be limited to longitudinal incision of the ligament; reconstructive procedures of the coeliac artery are sometimes necessary.

腹腔轴的外部压迫和扭结是由横膈膜的扩张和纤维状正中弓状韧带引起的。病因可能是功能性缺血或对腹腔神经节的刺激。这种痛苦的综合征是一种不寻常的情况,最多发生在40岁左右,主要发生在女性身上。诊断是通过排除所有其他腹部疼痛来源和外侧主动脉造影。治疗通常局限于韧带的纵向切口;腹腔动脉重建手术有时是必要的。
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引用次数: 0
[Imaging procedures in abdominal tumors]. [腹部肿瘤的成像程序]。
R Felix, R Langer

The value of imaging modalities in abdominal malignancies is discussed. Ultrasound is the first method to perform in hepatic tumors--HCC and liver metastases--, followed by CT and/or MRI. CT and ERCP are the diagnostic procedures of choice in pancreatic cancer. MRI is inferior to bolus-enhanced CT. CT and MRI are still equal in colorectal cancers for differentiating between scar and local recurrence after abdominal-perineal amputation.

讨论了腹部恶性肿瘤影像学诊断的价值。超声是肝肿瘤(HCC和肝转移)的首选检查方法,其次是CT和/或MRI。CT和ERCP是胰腺癌诊断的首选方法。MRI不如增强CT。CT和MRI在大肠癌中鉴别腹部会阴截肢术后瘢痕和局部复发的效果仍然相同。
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引用次数: 0
[Side effects of adhesion prevention by fibrinolytic drugs--in vitro studies of resorbable suture material and fibrin glue]. 【纤维蛋白溶解药物预防粘连的副作用——可吸收缝合材料和纤维蛋白胶的体外研究】。
P Wendt

Surgical threads of a variety of resorbable suture materials (Cat plain and Chrom Cat, Serag Wiessner, Polyglactin 910 and Polydioxanon, Ethicon and polyglycolic acid, Dexon) were incubated up to 7 days at 37 degrees C in Varidase-containing media (Lederle Cyanamid, 1000 IU/ml in 0.9% NaCl or citrated human plasma). Thereafter the knot-breaking strength remained within 90.0 and 108.2% of the respective control threads (incubation in Varidase-free media, n = 7, n.s.). The dose-dependent lysis of fibrin glue by Varidase is effectively inhibited by small amounts of aprotinin (15 KIU/ml as compared with 1000-3000 KIU/ml in routine application). The inhibitor is bound to the matrix and not readily eluted.

各种可吸收缝合材料的手术线(Cat plain和Chrom Cat, Serag Wiessner, Polyglactin 910和Polydioxanon, Ethicon和polyglycolic acid, Dexon)在含varidase的培养基(Lederle Cyanamid, 1000 IU/ml在0.9% NaCl或柠檬酸人血浆中)中在37℃下孵育7天。此后,结断强度保持在各自对照线的90.0和108.2%以内(在无varidase培养基中孵育,n = 7, n.s)。少量的抑肽蛋白(15 KIU/ml,而常规应用为1000-3000 KIU/ml)可有效抑制Varidase对纤维蛋白胶的剂量依赖性裂解。抑制剂与基质结合,不易洗脱。
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引用次数: 0
[Physiology and pathophysiology of intestinal circulation]. [肠循环的生理与病理生理]。
E D Schwilden

Splanchnic blood flow is regulated by cardiovascular factors, the autonomic nervous system, circulating vasoactive agents and local mechanical factors. Typical physiologic phenomena such as "autoregulation", "autoregulatory escape" and "countercurrent exchange" are discussed. Aspects of therapy especially for acute mesenteric infarction, are elucidated with reference to the circulating vasoactive agents, the effects of bowel distension on intestinal blood flow and reperfusion injuries.

内脏血流受心血管因素、自主神经系统、循环血管活性药物和局部机械因素的调节。讨论了“自调节”、“自调节逃逸”和“逆流交换”等典型生理现象。从循环血管活性药物、肠膨胀对肠血流和再灌注损伤的影响等方面阐述了急性肠系膜梗死的治疗方法。
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引用次数: 0
[Mixing results of prospective and retrospective studies by objective decision analysis: evaluating probability by healthy human minds?]. [通过客观决策分析混合前瞻性和回顾性研究的结果:用健康人的思维评估概率?]。
G Feifel

The major shortcomings of formal decision analysis derive from the complexity of the clinical problem, behavioral qualities of the investigator and the method itself. It seems difficult to translate study results into a probability estimate for the problem in an individual patient. Therefore, probability assessments from the medical literature, one's own clinical experience and data sources should be combined. Decision analysis is not itself clinical reality but provides a model for thinking explicitly about the problem.

正式决策分析的主要缺点源于临床问题的复杂性、研究者的行为素质和方法本身。似乎很难将研究结果转化为对个体患者问题的概率估计。因此,概率评估应结合医学文献、个人临床经验和数据来源。决策分析本身不是临床现实,但它提供了一个明确思考问题的模型。
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引用次数: 0
[Laparoscopic surgery of gallstones--report of treatment of 157 patients]. 腹腔镜手术治疗胆结石157例报告
J Perissat, D Collet, R Belliard, C Dost, M Sosso

From November 1988 to February 1990 157 patients with gallbladder stones haven been treated by a laparoscopic surgical procedure. They are 28 males and 129 females from 13 to 81 years old. 18 have had a cholecystostomy after intracorporeal lithotripsy (Lus Ultrasonic Olympus). They were placed on bue acids during 3 months. The average follow up time is 11 months. The mortality is zero and 2 mild complications occurred medically cured. 3 patients have a recurrent stone 6 months after surgery. 139 patients have had a cholecystectomy 89 after the same lithotripsy procedure seen above, 50 without prior lithotripsy. In 3 cases the laparoscopic procedure was abandoned, twice because of a sever bleeding, one for too compact surrounding adhesions. The mean follow up is 9 months. 123 were drained 1 day 16 had no drain. The mortality is zero. 2 patients without drainage developed a sub hepatic and douglas pouch abscess. They were cured by a lavage drainage laparoscopically made. 1 patient with drainages had a 7 days bile leak, which disappeared spontaneously. The 136 others have had a short stay in the hospital (2-4 days) a painless post operative time. They could go back to work and sport within 1 week. They have minimal scars and no danger of incisional herriae. The magnification of the optical system enables the dissection of the cystic duct and artery easier and safer than it is by mini laparotomy mostly in obese people. At the beginning of our experience only the patients with frequent biliary colics have been selected for the laparoscopic procedure. At that time 13 patients with subacute cholecystitis and 9 patients with stones in the commun bile duct have had a laparoscopic cholecystectomy associated with an endoscopic sphincterotomy in the last cases without complications.

从1988年11月至1990年2月,157例胆囊结石患者采用腹腔镜手术治疗。其中男性28人,女性129人,年龄13 - 81岁。18例在体外碎石术后行胆囊造瘘术。他们服用了3个月的蓝酸。平均随访时间为11个月。死亡率为零,发生2例轻度并发症经医学治愈。3例术后6个月结石复发。139例患者行胆囊切除术,89例患者行上述碎石术,50例患者未行碎石术。3例放弃腹腔镜手术,2例因严重出血,1例因周围粘连过于紧密。平均随访时间为9个月。123例引流1 d, 16例无引流。死亡率为零。2例无引流,并发肝下及道格拉斯袋脓肿。经腹腔镜下灌洗引流治愈。1例引流患者胆漏7 d后自行消失。其余136人术后均在医院短暂住院(2-4天),术后无痛。他们可以在一周内恢复工作和运动。他们有最小的疤痕,没有切口疱疹的危险。光学系统的放大使得囊管和动脉的解剖比小型剖腹手术更容易,更安全,主要是在肥胖人群中。在我们的经验开始时,只有经常胆绞痛的患者才被选择进行腹腔镜手术。当时13例亚急性胆囊炎患者和9例胆总管结石患者行腹腔镜胆囊切除术并内镜下括约肌切开术,最后一例无并发症。
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引用次数: 0
[Surgical treatment of asymptomatic carotid stenosis]. [无症状颈动脉狭窄的外科治疗]。
G Hohlbach, E Muhl, M Pütz, D Kummer

A total of 274 patients (mean age 67.1 +/- 8.2 years) with asymptomatic stenosis of the internal carotid artery greater than 70% was treated by desobliteration and patchplasty; 332 reconstructions were performed either uni- or bilaterally. In this group only 29% revealed a one vessel disease. Lethality within 30 days was 1.5%; the incidence of complete stroke amounted to 0.9%. In a mean follow up period of 30.8 +/- 20.2 month to lethality rate was 4.4%; 7.8% developed a completed stroke and only 3.8% were related to the operated site. The 5-year-survivalrate was 88.9% and 93.2% of this cohort was neurological free of symptoms.

274例无症状性颈内动脉狭窄大于70%的患者(平均年龄67.1±8.2岁)采用去闭塞补片成形术治疗;332例进行了单侧或双侧重建。在这一组中,只有29%的人发现了单血管疾病。30天内死亡率为1.5%;全脑卒中发生率为0.9%。平均随访30.8±20.2个月,病死率为4.4%;7.8%的人发生了完全中风,只有3.8%的人与手术部位有关。5年生存率为88.9%,该队列中93.2%的患者神经系统无症状。
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引用次数: 0
[Surgery for asymptomatic carotid stenosis: a contribution to a controversial discussion]. [手术治疗无症状颈动脉狭窄:对有争议的讨论的贡献]。
W Hepp, C Pallua, E Becker, K Haar, S Heise

From 1 January 1982 to 30. June 1986, 436 operations on the internal carotid artery were performed: 164 were asymptomatic (37.6%). Morphologic indication was stenoses greater than 70% only. Supra-aortic multivessel disease played a major role. The operative mortality amounted to 0.6% (total 0.9%) and the perioperative mortality, 1.8%. The cumulative morbidity was 1.6% after the first and 1.8% after the second year, whereas the cumulative survival rate measured 89.8% after one and 80.4% after three years. Therefore surgery for asymptomatic carotid internal stenoses is justified under conditions of the restrictive indication. It also seems to be more favorable as regards early and late results.

1982年1月1日至30日。1986年6月,436例颈内动脉手术,其中164例无症状(37.6%)。形态学指征仅狭窄大于70%。主动脉上多血管疾病起主要作用。手术死亡率为0.6%(总死亡率0.9%),围手术期死亡率为1.8%。第一年后的累积发病率为1.6%,第二年后为1.8%,而一年后的累积生存率为89.8%,三年后为80.4%。因此,手术治疗无症状的颈动脉内狭窄是合理的条件下,限制性指征。在早期和晚期的结果方面,它似乎也更有利。
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Langenbecks Archiv fur Chirurgie. Supplement II, Verhandlungen der Deutschen Gesellschaft fur Chirurgie. Deutsche Gesellschaft fur Chirurgie. Kongress
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