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THE PREVENTION OF SUBPHRENIC INFECTION AFTRE HEPATECTOMY

One hundred and five hepatic resection were performed from 1984 to 1994. Six of these patients complicated with subphrenic infection after hepatectomy, of whom two patients died of liver failure. Subphrenic dropsy occureeed in nine cases. Subphrenic infection is easy to occur in: right or extend lobectomy, massive blood loss at operation, and in postoperative bleeding which subjects to laparotomy for lemostasis. Seecure hemostasis, avoidence of hepatic tissue devitalization during operation and effective subphenic drainage aree essential to reduce the incidencee of subphrenic infection, and routine bacterial culture of subphrenic drainage fluid will help to select propre antibiotic.

老年重癥急性膽管炎59例報告

Vacuum Sealing Drainage for Patients with Wound Infection after Cardiac Surgery

Objective　To evaluate outcomes of vacuum sealing drainage（VSD）for the treatment of wound infection　after cardiac surgery.?Methods?We retrospectively analyzed clinical data of 70 patients（with valvular heart disease，congenital heart disease or coronary heart disease）who underwent cardiac surgery via mid-sternotomy and had postoperative wound infection from Jan. 2008 to Jan. 2012 in General Military Hospital of Guangzhou Command. According to different treatment strategy for wound infection, all the patients with wound infection （incision longer than 5 cm） were randomly divided into VSD group （n=35） and control group（n=35） by random number table，while VSD treatment was used for patients in VSD group and routine treatment was used for patients in control group. Treatment outcome，duration of wound infection, duration of antibiotic treatment and treatment cost were compared between the two groups.?Results?There was no in-hospital death in both groups. Wound exudate significantly decreased and fresh granulation tissue grew well in the wound in most VSD group patients after VSD treatment. The cure rate of VSD group was significantly higher than that of control group （94.3% vs. 60.0%，P＜0.05）. Duration of wound infection （12.9±3.4 d vs. 14.8±4.1 d；t=-2.094，P=0.040）and duration of antibiotic treatment （7.0±1.5 d vs. 8.3±1.9 d；t=-2.920，P=0.005） of VSD group were　significantly shorter than those of control group. There was no statistical difference in treatment cost between the two groups. Fifteen patients in VSD group were followed up （42.9%） for 3 months with good wound healing, and 20 patients in VSD group were lost in follow-up.?Conclusion?VSD is effective for the treatment of wound infection after cardiac surgery with shortened treatment duration and similar treatment cost compared with routine treatment.

Comparison of Laryngeal Tube Suction II and LMAProseal for Airway Management in Elective Surgery: Asystematic Review

摘要:目的:評價II代引流型喉管(LTS II)和Proseal喉罩(PLMA)在擇期手術中應用效果。方法:檢索了Cochrane圖書館(2009年第3期)、Pubmed(1950～2009)、EMBase(1989～2009)、CNKI(1979～2009)、VIP(1989～2009)、CBM(1978～2009)中相關II代引流型喉管(LTS II)和Proseal喉罩在擇期手術中應用的隨機對照試驗(RCT),同時篩檢納入文獻的參考文獻。由2名研究者對文獻質量進行嚴格評價和資料提取,根據指標相應異質性進行描述性分析或Meta分析(RevMan 5.0)。結果:共納入3個RCT,共244例研究對象,文獻質量均為B級。3個RCT的結果顯示與PLMA相比,LTS II具有相似的首次置入成功率(P=0.45)、術畢即刻上呼吸道損傷發生率(P=1.00)、術后24 h咽痛發生率(P=0.81)、術后24 h吞咽困難發生率(P=0.12)。2個RCT的結果顯示兩組引流管置入均較容易。1個RCT的結果顯示兩組的操作者主觀評價相近(OR=1.86,95%CI 0.39～ 8.99)。氣道封閉效果由于采用方法學差異性較大,指標也不盡相同,尚不能得出準確結果。結論:LTS II在擇期手術中用于氣道管理具有較好的前景。但是現時仍不宜用于需在擇期術中進行控制通氣的病人。關于氣道封閉效果,尚需采用更合理規范的指標、更高質量的研究設計進一步研究。Abstract: Objective: To assess the efficacy of laryngeal tube suction II (LTS II) and LMAProseal (PLMA) for airway management in elective surgery. Methods:We searched Cochrane Library (2009),Pubmed (19502009)、EMBase (19892009),CNKI (19792009),VIP (19892009),CBM (19782009). The quality of the trials was assessed by two reviewers independently. RevMan 5.0 software provided by the Cochrane Collaboration was used for statistical analysis. Results:Three studies involving 244 participants were included. Same rates of fist successful attempt (P=0.45),upper airway trauma (P=1.00),sore throat (P=0.81) and dysphagia (P=0.12) were observed in LTS II and PLMA in all studies. Two studies indicated that the insertion of gastric tube was easy in both groups. The similarity of subjective maneuverability in two groups was reported in one study (OR=1.86, 95%CI 0.39 to 8.99). The correct result of effectiveness of airway seal could not be made because of various methods and measurements. Conclusion:LTS II have a good perspective in the airway management. Otherwise, it is not safe for patient required control ventilation because of lack of evidence on the effectiveness of airway seal. More RCTs of high quality need to be undertaken in the future.

Experience in PTCD Under Improved BMode Ultrasound Guidance

目的 總結分析普通B超監測引導PTCD方法改進后的優點及經驗。方法 用普通B型超聲診斷儀，腹部扇掃探頭和國產配套的專用PTCD套針及引流管，改進監測引導PTCD的方法，總結分析其方法的優越性。結果 95例梗阻性黃疸患者PTCD成功率為100%，引流效果良好，并發癥發生率為零。結論 用改進普通B超監測引導的方法進行PTCD，能克服在X線下進行PTCD的盲目性，對碘過敏者無禁忌，避免了長時間X線對人體的傷害。同時具有定位準確、費時少、成功率高、并發癥少、價格便宜、適宜在基層醫院推廣應用等優點。

負壓引流技術在臨床應用中的研究進展

【摘要】　負壓引流技術作為一種促進創面愈合的有效治療手段， 目前越來越多的應用于臨床各類難愈性創面的治療工作中。現就負壓引流技術的作用機制、適應證、禁忌證及療效影響因素等方面進行了綜述。

姑息性膽管引流術治療晚期高位膽管癌43例報告

胸部物理療法聯合口咽通氣管吸痰在支氣管擴張癥無創通氣中的應用

目的 探討胸部物理療法聯合口咽通氣管吸痰對行無創正壓通氣的支氣管擴張癥患者的治療效果及安全性。 方法 選取 2013 年 1 月—2015 年 8 月存在不同程度急性呼吸衰竭的急性加重期支氣管擴張癥患者 27 例，在給予抗菌藥物治療、對癥治療、營養支持的基礎上行無創正壓通氣，護理上給予手法叩背、應用體外震動排痰機、體位引流等胸部物理療法聯合經口咽通氣管吸痰。 結果 經綜合治療和護理后，患者最終顯效 16 例，有效 9 例，無效 2 例，治療有效率達 92.6%。 結論 對伴有呼吸衰竭的支氣管擴張癥急性加重期患者，在實施無創正壓通氣時，用胸部物理療法配合口咽通氣管吸痰能解決無創正壓通氣中患者無力咳痰的問題，保持呼吸道通暢，保障無創正壓通氣的順利實施，改善患者預后。

持續封閉沖洗負壓引流在深部竇道感染傷口中的應用

目的　總結持續封閉沖洗負壓引流治療術在后深部竇道傷口感染治療中的效果。 方法　回顧性分析2010年10月－2011年10月收治的7例深部竇道傷口感染患者的臨床資料，總結采用持續封閉沖洗負壓引流進行傷口治療的方法及療效。 結果　7例患者經過3～5 d持續封閉沖洗負壓引流治療，拔管后2～3 d傷口閉合，上皮覆蓋，傷口全部愈合。 結論　采用持續封閉沖洗負壓引流治療深部竇道傷口感染，方法簡便，費用低廉，可有效促進傷口愈合。

Application of Two Types of Chest Drainage in Patients after Lung Resection: A Case Controlled Study

ObjectiveTo compare and evaluate the application of two types of chest drainage in patients who had undergone the lung lobe resection. MethodWe retrospective analyzed the clinical data of 240 patients who underwent left lobe resection. The patients were divided into a single conventional drainage group with single chest drainage tube (normal group) and a single conventional drainage tube combined with drainage of disposable surgical negative pressure drainage ball (NPBD) (combination group). There were 140 patients including 86 males and 54 females at mean age of 48.76± 4.92 years in the normal group. There were 100 patients including 58 males and 42 females at mean age of 48.37± 4.56 years in the combination group. We compared the outcomes between the two groups. ResultThe postoperative pathological results revealed there were 12 patients with tuberculosis (TB), 87 patients with squamous carcinoma, and 41 patients with adenocarcinoma in the normal group; 5 patients with TB, 66 patients with squamous carcinoma, and 29 patients with adenocarcinoma in the combination group. There were statistical differences in postoperative hospital stay (11.35± 2.78 d vs. 9.33± 2.46 d), chest drainage tube indwelling time (6.75± 2.10 d vs. 8.28± 2.10 d), total volume of chest drainage (1 176.07± 384.62 ml vs. 926.50± 22.35 ml) with P values less than 0.001 between the normal group and the combination group. No statistical difference was found between the two groups in complications (P>0.05). ConclusionSingle conventional drainage tube combined with drainage of disposable surgical negative pressure drainage ball (NPBD) has more advantages than single conventional chest drainage tube drainage, and is worth to be applied popularly in clinic.