目的 探究小儿急性阑尾炎术后切口感染的影响因素及病原学分布特点,为临床诊疗提供参考.方法 选取2014年06月-2019年06月在我院行阑尾切除术并经病理证实为急性阑尾炎的763例患儿(0～14岁),回顾性分析导致患儿术后切口感染的相关影响因素及病原学分布特点.结果 763例急性阑尾炎患儿术后发生切口感染的共43例,感染率为5.64％;病程＞24 h、切口长度＞5 cm、手术时间＞60 min、术中出血量＞30 ml、留置腹腔引流、阑尾穿孔为小儿急性阑尾炎术后切口感染的独立影响因素(P＜0.05);感染切口分泌物分离培养出病原菌共54株,其中以大肠杆菌为主的革兰氏阴性菌41株,以金黄色葡萄球菌为主的革兰氏阳性菌13株.结论 小儿急性阑尾炎术后切口感染与病程长短、手术时间、切口长度、手术时间、术中出血量、是否留置腹腔引流、阑尾是否穿孔密切相关,且切口感染病原菌以革兰氏阴性菌为主,应针对性采取预防措施.

翼状胬肉切除术后发生巩膜坏死的病例时有报道[1-4],多是应用丝裂霉素C或联合羊膜移植者.我们在应用0.1%氟米龙滴眼液预防术后胬肉复发的过程中,发现巩膜溃疡1例,报告如下.

电视腹腔镜胰十二指肠切除术是一种技术难度较大的手术.目前国外已报告110多例[1],国内10余例[2-3 ].我们自开展腹腔镜下胰十二指肠切除术至今已成功进行13例.在手术技术上,从肿瘤的可切除判断到胰腺、胆道、胃肠的离断及周围淋巴结的清扫等都有许多值得探讨之处,而胰十二指肠切除术后消化道重建方法是手术成功的关键.

Objective To investigate physiological changes, anesthetic management and effect of fluid therapy on restoring blood volume in patients with massive hemorrhage during surgery Methods We retrospectively studied 538 adult patients with blood loss more than 40% of total blood volume during surgery General anesthesia(476 cases)and epidural anesthesia (62 cases) were performed BP ECG、SPO2、CVP、HCT、Urinaryvolume and blood gas analyse were monitored When massive hemorrhage occurred, blood volume was maintained by mainly infusing Gelofusine or hydroxyethyl starch, sodium lactate Ringer's solution and properly transfusing packed red blood cells or whole blood Results Average blood loss was(2552±1025)ml Sixty one patients and thirteen patients presented hypotension and shock respectively A hundred and six patients presented with low CVP The values of HCT,PH,BE and serum potassium after massive hemorrhage were lower than before surgery (P0 01 or P0 05) in58 patients whose blood loss were beyond 3000ml Conclusions General anesthesia is most appropriate for the patients with tendency of massive hemorrhage duting surgery Fluid and transfusion therapy can restore blood volume effectively in most patients, bust can not in few patients due to incontrollable bleeding and insufficient blood supply