探讨如何提高经尿道膀胱肿瘤电切术的疗效和安全性以及并发症的防治措施

目的探讨经尿道膀胱肿瘤电切术的手术疗效和安全性以及并发症的防治。方法尿道膀胱肿瘤电切术(TURBT)33例,观察疗效及并发症。术后常规灌注1年,每3个月膀胱镜检查1次,必要时活检确定有无复发。结果肿瘤切除率100%,手术时间15～45min,术中2例(8%)发生闭孔神经反射,未出现膀胱穿孔,随访2年,6例原位复发,1例2年内死亡。结论 TURBT具有操作简单、时间短、损伤少、并发症低的特点,如何提高手术疗效和安全性、降低并发症是每个外科医生追求的高度。     

The relationship between compliance with lens replacement and contact lens-related problems in silicone hydrogel wearers

Purpose

To evaluate the relationship between compliance with replacement frequency (RF) and contact lens (CL)-related problems in silicone hydrogel (SiHy) wearers.

Methods

501 SiHy wearers from seven optometry offices completed surveys regarding their lens wear and any CL related problems which they may have experienced in the preceding 12 months. File review was subsequently conducted at their optometry offices to confirm the information provided.

Results

49% of respondents were wearing 2-week replacement (2WR) and 51% 1-month replacement (1MR) SiHy lenses. 67% wore their lenses for longer than the manufacturers’ recommended RF (MRRF) and 60% for longer than their optometrist's recommended RF (ORRF). The mean RF was 2.6× the MRRF for 2WR and 1.5× for 1MR wearers (p < 0.001) with median values of 31 and 37 days, respectively. Twenty-three percent reported signs or symptoms consistent with potential complications relating to CL wear. This rate was significantly higher for wearers who were non-compliant with the ORRF than compliant wearers (26% versus 18%, p = 0.028). It was also higher for those multipurpose solution users who reported never/almost never rubbing and rinsing their lenses when compared with those who did this every night (29% versus 17%, p = 0.007).

Conclusions

Two thirds of the SiHy wearers did not comply with the MRRF and 2WR wearers stretched the replacement interval of their lenses to a greater degree than 1MR wearers. Failing to replace lenses when recommended and failing to rub and rinse lenses were associated with a higher rate of patient-reported CL problems.     

Assessment of a practitioner’s perception of scleral contact lens complications

PurposeThe purpose of this survey was to better understand scleral lens (SL) practitioners’ fitting preferences and minor SL complications and their subsequent treatments.MethodPractitioners who attended the 2017 Global Specialty Lens Symposium were asked to complete an electronic questionnaire that was created by the investigators, a survey that asked practitioners about their SL fitting experience and preferences, their patients’ experience with poor SL wetting, SL fogging, ocular symptoms (redness, pain/discomfort, dryness), and blurred central and side vision, and how the practitioners treated these conditions.ResultsThis study analyzed data from 164 SL practitioners. The practitioners had been in practice for 16.3 ± 13.4 years, had been fitting SL for 5.5 ± 5.0 years, and fit 7.4 ± 7.1 SL/month. Practitioners preferred a SL with a final central corneal clearance of ∼200 μm and an overall diameter between 15.1 mm to 16.5 mm. Poor SL wetting (90.8% of practitioners documented condition), SL fogging (84.8%), blurred central vision (40.2%), ocular redness (34.8%), ocular dryness (24.4%), ocular pain/discomfort (20.7%), and blurred side vision (12.8%) were encountered by the practitioners. Practitioners preferred treating poor wetting and fogging with lens removal, cleaning, and reapplication, blurred central vision with a lens power change, blurred side (peripheral) vision, ocular redness, and ocular pain with a lens parameter change, and dryness with artificial tears.ConclusionsMost SL practitioners preferred a SL central corneal clearance of ∼200 μm, and they occasionally encountered SL-related complications in their practice, which they treated similarly to corneal gas permeable CLs.     

颈内静脉穿刺置管术术前彩色多普勒超声定位和术后超声监测的研究

目的:评估彩色多普勒超声监测颈内静脉置管术的临床价值。方法:应用彩色多普勒超声实时监测120例患者的置管过程,对临床"盲穿"不成功的25例患者及"盲穿"后出现并发症的30例患者进行超声检查分析。结果:120例经实时超声监测的患者均取得成功,没有出现严重的并发症;临床盲穿不成功的原因有误穿颈总动脉、颈内静脉瓣膜过长、误穿颈外静脉、穿入颈内静脉或锁骨下静脉的对侧壁致使导丝不能下移;"盲穿"后出现的并发症主要为血肿、导管堵塞、胸锁乳突肌肿胀、静脉血栓形成、胸腔积血、误穿动脉、假性动脉瘤形成、导管周围纤维鞘膜形成等。结论:超声定位有助于顺利完成颈内静脉穿刺置管,并且对颈内静脉穿刺的各种并发症能够作出准确的诊断。     

输尿管镜气压弹道碎石术严重并发症的防治

目的探讨输尿管镜气压弹道碎石严重并发症与预防措施。方法总结分析输尿管镜气压弹道碎石治疗患者的资料,统计并发症的发生和处理情况。结果输尿管穿孔3例,输尿管口损伤2例,输尿管黏膜下假道形成3例,输尿管断裂1例,输尿管全层黏膜撕脱1例。结论输尿管镜下取石术并发症的发生与手术者的技术操作密切相关,正确熟练地操作可有效减少并发症。     

Development of a contact Lens risk survey

PurposeTo describe the development and report psychometric properties of the Contact Lens Risk Survey (CLRS) to identify patients at risk for soft contact lens-related complications.MethodsPsychometric properties of the CLRS, a web-based survey with branching logic, were determined using data from 5 multi-site fieldings (n = 1059), including re-fielding to sub groups. Responses from participants with and without an active red eye were used to identify risk factors of a red eye event and calculate an overall risk score. A 6th fielding of the CLRS (n = 171) was used to assess discriminate validity.ResultsParticipants needed 11−12 min to complete the survey with a negligible difference by age. Internal consistency was excellent (Cronbach’s α ≥ 0.70) for 3 of the 5 constructs identified by factor analysis. Twelve of the 17 survey items exhibited excellent within-subject repeatability (Kappa ≥ 0.61). Between-subject agreement, assessed in 18−25 year olds, was high for the majority of items, suggesting good generalizability across different populations of SCL wearers. The ability of the model using individual items of the CLRS to discriminate Controls and participants with a red eye was good with an area under the curve of 0.779.ConclusionThe CLRS tool is a repeatable and valid instrument to standardize documentation of demographic, behavior, and exposure factors which appear to drive the greatest risk of a contact lens related red eye event.     

两种不同径路茎突截短术治疗茎突综合征的临床疗效比较

目的探讨不同路径茎突截短术治疗茎突综合症的临床疗效。方法选取我院2006年7月至2009年8月收治的220例茎突综合症患者的临床资料,随机分为治疗组(200例)和对照组(20例),治疗组患者行经颈外径路茎突截短术,对照组患者行经口内径路茎突截短术,比较两组患者的临床疗效。比较两组患者的术后并发症。结果对照组患者术后并发症发生率明显高于治疗组,两组患者比较差异有统计学意义(P<0.05)。结论经颈外径路茎突截短术治疗茎突综合症,避免大神经和血管的损伤,降低术后并发挥的发生,疗效满意值得在临床推广。     

腹腔镜胆囊切除术并发症40例的临床分析

目的探讨腹腔镜胆囊切除术并发症的原因及处理措施。方法选取我院2006年6月至2010年3月腹腔镜胆囊切除术患者800例,对其术后并发症及其治疗措施进行分析总结。结果腹腔镜胆囊切除术800例中,并发症40例(4.0%)采取有效的护理治疗措施,均痊愈出院。结论术前进行严格检查,术中规范手术操作能够显著减少腹腔镜胆囊切除术的并发症;术后加强观察及护理是及早发现并发症的前提,并能提高工作效率和护理质量,使患者快速康复,减轻痛苦,防止腔镜胆囊切除术手术不良反应。     

胶囊内镜临床应用观察及影响因素分析

目的分析胶囊内镜（Capsule endoscopy,CE）在临床检查中的安全性有效性,总结并发症预防及解决办法。方法通过回顾性分析116例胶囊内镜检查临床资料。结果 116例患者中82例内镜检出阴性,21例小肠血管畸形,8例小肠间质瘤,2例克罗恩病,2例小肠钩虫病,1例放射性肠炎,阳性检出率为37.9%,检查过程中98例患者顺利完成胶囊内镜检查,12例存在幽门通过障碍,3例出现胶囊内镜设备电力不足,2例收集图像部分丢失,1例并发胶囊内镜梗阻,并发症发生率为15.5%。结论 CE在消化道疾病筛查、原因不明的消化道出血、炎症性肠病等消化系统疾病的诊断中具有重要意义。良好的临床沟通、对患者病情的预判、及早干预性治疗是顺利完成内镜检查,避免及减少并发症发生的关键。     

无痛胃肠镜检查并发症的原因分析及护理对策

目的:分析无痛胃肠镜检查并发症的原因及护理对策.方法:在我院检查无痛胃肠镜的患者中选取7269例,纳入时间为2017年1月-2018年12月,172例在检查后出现并发症,发生几率为2.4％,并发症类型包括严重胀气、一过性低血压、恶心呕吐等.回顾性分析患者一般资料,对其独立的危险因素展开研究.结果:发生组与未发生组,气道...