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        west china medical publishers
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        find Keyword "食管穿孔" 3 results
        • Prognostic evaluation of benign esophageal perforation with perforation severity score and Charlson comorbidity index score

          ObjectiveTo evaluate the prognosis of benign esophageal perforation by Pittsburgh scoring system (perforation severity scores, PSS) combined with co-disease index (Charlson comorbidity index, CCI).MethodsThirty patients with benign esophageal perforation from August 2016 to August 2018 in our hospital diagnosed by imaging or endoscopy were selected, including 14 males and 16 females, aged 68.660±10.072 years. After treatment, we retrospectively analyzed whether there was any complication in the course of treatment, the healing of esophageal perforation at discharge and the follow-up after discharge. And the patients were divided into a stable group (20 patients with no complication, clear healing of esophageal perforation at discharge or death during follow-up) and an unstable condition group (10 patients with complications, esophageal perforation at discharge or death during follow-up). Complete clinical data of all the patients were obtained and were able to be calculated by the scores of PSS and CCI scoring system. The difference of PSS and CCI scores between the two groups was compared, and the clinical value of PSS combined with CCI score in the prognosis of benign esophageal perforation was analyzed.ResultsIn the stable group, the PSS was 2.750±1.372 (95%CI 2.110 to 3.390), CCI score was 2.080±1.055 (95%CI 1.650 to 2.500) with a statistical difference between the two systems (P=0.000). In the unstable group, PSS was 7.300 ±1.829 (95%CI 7.300 to 8.120), CCI was 4.640±1.287 (95%CI 4.220 to 5.060) with a statistical difference between the two systems (P<0.05). The area under the receiver operating characteristic curve of PSS and CCI scores in the prognostic evaluation of benign esophageal perforation was 0.982 and 0.870 respectively, which was statistically significant (P<0.05).ConclusionEsophageal perforation is a dangerous condition. It is of great practical value to evaluate the condition of esophageal perforation by PSS and CCI scores.

          Release date:2019-06-18 10:20 Export PDF Favorites Scan
        • 外科途徑治療經保守處理無效的食管異物

          目的 探討保守治療無效的食管異物經外科治療的手術途徑和方法,以減少手術對患者的損傷和術后并發癥的發生、促進患者快速康復。 方法 回顧性分析 2011 年 6 月至 2016 年 8 月我院食管異物經保守治療無效需外科手術治療 37 例患者的臨床資料,其中男 21 例、女 16 例,年齡 17~62(42.00±9.75)歲。8 例經頸部切口手術治療,27 例經胸部切口取出異物,2 例經胸腔鏡取出異物。 結果 隨訪 3~18(7.95±3.41)個月,4 例術后發生消化瘺患者在術后 2~5 個月能正常進食,其余患者均在術后 1 個月能正常進軟質飲食,術后 1.5 個月正常飲食。2 例手術患者因術后縱隔感染、胸腔感染致膿毒血癥,多器官功能衰竭死亡。 結論 食管異物的外科手術根據其嵌頓的位置不同、穿孔與否、手術路徑及方法亦有所不同,采取適宜的手術途徑和方法可以提高手術的準確性,減少手術對食管的損傷和術后并發癥,減輕患者的痛苦,從而提高患者術后生存質量。

          Release date:2018-06-01 07:11 Export PDF Favorites Scan
        • 繼發性縱隔膿腫的診斷與治療

          目的 探討多種原因導致的繼發性縱隔膿腫的診斷和綜合治療方法。 方法 回顧性分析1988年12月至2007年11月中國醫科大學附屬第一醫院收治的23例繼發性縱隔膿腫的臨床資料,男18例,女5例;年齡13個月~76歲,平均年齡40.9歲。致病原因:食管穿孔或破裂14例(外傷致食管破裂7例、醫源性食管破裂6例、自發性食管破裂1例),咽部膿腫5例,口底蜂窩組織炎2例,氣管斷裂2例。采取以外科手術治療為主,輔以抗感染和營養支持治療。行食管破裂修補術10例次,空腸或胃造瘺術6例次,膿胸纖維板剝脫術4例次,經頸部切口上縱隔引流術15例次,胸腔閉式引流術7例次,肺葉部分切除術2例次,心包引流術1例次,牙周和頜下切開引流術1例次。 結果 住院死亡5例,病死率21.7%(5/23),死于中毒性休克4例,靜脈大出血1例。出院時完全治愈或病情穩定18例。隨訪16例,隨訪時間6~18個月,隨訪期間生存患者生活質量提高,死于腦血管意外1例;失訪2例。 結論 繼發性縱隔膿腫病情發展迅速,且病死率高,應早期診斷,充分的外科引流、合理使用抗生素和營養支持是治療的關鍵。

          Release date:2016-08-30 05:57 Export PDF Favorites Scan
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