纵隔炎

摘要： 目的探讨纤维素性纵隔炎的CT、MRI影像特点,探讨影像学检查在纤维素性纵隔炎临床诊疗中的作用,提高影像科医师对纤维素性纵隔炎疾病的认识,减少漏诊和误诊。方法选取48例纤维素性纵隔炎CT、MRI增强表现,包括病灶分布、密度及强化特点,对气管和支气管、动静脉血管的累及情况进行分析观察。结果48例纤维素性纵隔炎中,男性17例,占35.4%,女性31例,占64.6%,男女间发生率差异无统计学意义(P>0.05)。在所有患者中,合并肺动脉狭窄45例,占93.8%,合并肺静脉狭窄35例,占72.9%,合并支气管狭窄33例,占68.8%,12例患者进行了MRI检查,均可见纵隔内明显延迟强化病灶。结论纤维素性纵隔炎属于临床少见病,部分患者可能合并肺动静脉及支气管的狭窄,导致较重的临床症状,个别患者预后较差。CTPA检查能够较快、较准确地诊断纤维素性纵隔炎,并评估其病变范围及合并症,对临床早期诊断治疗具有重要价值。MRI增强检查可以辅助诊断纵隔炎性疾病,并可较准确地评估患者右心功能状态。

摘要： 咽部脓肿是耳鼻喉科的常见病,包括扁桃体周围脓肿、咽后脓肿和咽旁脓肿,如处理不当,感染易向邻近间隙和组织扩散,引起气道梗阻、颈部坏死性筋膜炎、下行性纵隔炎、败血症等并发症,是耳鼻喉头颈外科的危急重症之一。基层医务人员对该类疾病认识不足,识别和处理缺乏经验,如果处理不当易延误病情,引起严重后果。本文回顾性报道2例咽部脓肿病例,分析其临床特点及治疗经过,以期提高基层医务人员对该病的认识及诊治水平。

摘要： Objective To summarize the experience of applying cervical double parallel incision combined with mediastinoscope or thoracoscope in the treatment of cervical necrotizing fasciitis (CNF)accompanied with descending necrotizing mediastinitis (DNM),so as to provide a reference for clinical practice.Methods The clinical data of six patients with CNF accompanied with DNM who were admitted to the Department of Stomatology and the Department of Otolaryngology Head and Neck Surgery,The First People's Hospital of Changzhou from September 2014 to September 2018 were retrospectively analyzed.All of the six patients were confirmed by CT of neck and chest,among whom there were two males and four females aged from 48 to 73.Three patients were treated with cervical double parallel incision combined with mediastinoscope to be combined with cervical and thoracic drainage under general anesthesia while the other three with cervical double parallel incision combined with thoracoscope to be combined cervical and thoracic drainage under general anesthesia.The CT of neck and chest as well as infectious indicators including hematology,C-reactive protein (CRP) and procalcitonin (PCT) were reexamined during the postoperative period.Results The cervical and thoracic combined drainage was unobstructed in all of the six patients,no secondary surgery was performed,and the infectious indicators gradually decreased.All patients had off-bed activities on the first day after the operation,were all cured and discharged after an average of 21 days (16 to 36 days) in hospital and followed up for an average of 18 months (4 to 30 months)after the operation.None of them experienced infection relapse,and they were all satisfied with the appearance of the cervical incision.Conclusions Cervical double parallel incision combined with mediastinoscope or thoracoscope for the treatment of CNF accompanied with DNM has the advantages of complete drainage,small trauma,excellent efficacy and aesthetic operative area,thus being deserved to be clinically popularized.%目的 总结颈部双平行切口联合纵隔镜或胸腔镜治疗颈部坏死性筋膜炎(cervical necrotizing fasciitis,CNF)伴下行性坏死性纵隔炎(descending necrotizing mediastinitis,DNM)的治疗经验,以期为临床提供参考.方法 回顾性分析2014年9月至2018年9月常州市第一人民医院口腔科和耳鼻咽喉头颈外科收治的6例CNF伴DNM患者的临床资料,其中男性2例,女性4例,年龄48～73岁,均由颈胸部CT检查确诊.3例患者在全身麻醉下行颈部双平行切口联合纵隔镜下颈胸联合引流,另3例在全身麻醉下行颈部双平行切口联合胸腔镜下颈胸联合引流,术后复查颈胸部CT和血常规、C反应蛋白、降钙素原等感染性指标.结果 6例患者颈胸联合引流通畅,未行二次手术,感染性指标逐渐下降;术后第1天可下床活动,平均住院21 d(16～36 d)后均痊愈出院,术后平均随访18个月(4～30个月),感染未复发,患者对颈部切口外观满意.结论 颈部双平行切口联合纵隔镜或胸腔镜治疗CNF伴DNM,引流彻底,创伤小,效果佳,术区美观,值得临床推广.

摘要： Objective To examine the impact of vacuum sealing drainage on clinical outcomes of patients with post-sternotomy mediastinitis after cardiac surgery. Methods A systematic search were performed in Cochrane Library, Pubmed, Embase, China Biology Medicine(CBM), WanFang, VIP database. The quality of articles was critically appraised and data were extracted by 2 reviewers independently. Meta-analysis were conducted for the eligible researches. Results Fourteen cohort studies were inclued finally. Patients treated with VSD had significantly lower in-hospital mortalityand lower re-infection compared to those treated without VSD. While there had no significant defferences in length of ICU stay(days) and in-hospital stay (days) between VSD group and control group. Conclusions VSD therapy was associated with lower re-infection and in-hospital mortality than other conventional methods in patients with post-sternotomy mediastinitis after cardiac surgery and those results should be further tested in future research and practice.%目的 评价负压封闭引流技术用于心脏疾病行胸骨切开术,术后并发纵隔炎患者的效果.方法 计算机检索Cochrane library、PubMed、Embase、维普、万方及中国生物医学文献数据库中关于心脏术后纵隔炎患者应用负压封闭引流的随机对照试验、类试验、病例对照及队列研究,同时筛选文献的参考文献.2名研究者进行文献质量评价和资料提取,对符合标准的文献行Meta分析.结果 共纳入14项队列研究,4项研究显示负压封闭引流不能降低患者IUC住院天数;6项研究提示负压封闭引流与常规治疗组患者在住院总天数方面无差异;4项研究提示负压封闭引流可有效降低患者再感染的发生率;6项研究提示负压封闭引流患者的院内病死率低于常规治疗组.结论 目前负压封闭引流在心脏疾病行胸骨切开术后纵隔炎患者中的应用效果尚可,有待设计更为严谨的队列研究或随机对照研究进一步检验.

摘要： 目的 探讨肺灌注(Q) SPECT显像及通气(V) SPECT显像在纤维素性纵隔炎(FM)中的价值.方法 回顾性分析2015年1月至2018年7月间于中日友好医院就诊并行肺V/Q SPECT显像的14例FM患者(男6例、女8例,平均年龄74岁)资料,观察其显像表现,并根据肺灌注及通气受损范围占全肺容积的百分比(％)将肺受损程度分为轻度(＜20％)、中度(20％～50％)和重度(＞50％).采用x2检验分析不同肺叶血流灌注受损的发生率.结果 肺Q SPECT显像示14例患者左肺上叶有和无受累者分别有14和0例,左肺下叶、右肺上叶、右肺中叶、右肺下叶受累者相应例数分别为11和3例、14和0例、13和1例、12和2例.不同肺叶血流灌注受损的发生率相当(x2=6.198,P=0.185);肺灌注受损范围为轻度者1例,中度7例,重度6例.肺V SPECT显像示不同肺叶通气功能受损的发生率相当(x2=1.587,P=0.811);肺通气受损范围为轻度者11例,中度2例,重度1例.肺Q SPECT显像与肺V SPECT显像检出的FM受损肺段及亚肺段分别有119和41处,差异有统计学意义(x2=28.42,P＜0.05),前者显示的受损范围较多,但两者显示的受损表现均呈肺段或亚段型分布.结论 FM患者肺V/Q SPECT显像显示的受损均呈节段性分布,且肺灌注受损多于肺通气受损.肺V/Q SPECT显像可用于评价FM患者的肺灌注及通气受损范围和程度.%Objective To investigate the value of pulmonary ventilation/perfusion (V/Q) SPECT imaging in fibrosing mediastinitis (FM).Methods From January 2015 to July 2018,14 FM patients (6 males,8 females,average age 74 years) who underwent V/Q SPECT imaging in China-Japan Friendship Hospital were retrospectively studied.The data of V/Q SPECT imaging were analyzed and the defect extent was classified as mild (＜20％),moderate (20％-50％) and severe (＞50％) according to the percentage of pulmonary perfusion and ventilation defect in total lung volume (％).x2 test was used to analyze the incidence rates of the impaired blood perfusion of each lung lobe.Results According to the results of Q SPECT imaging,all 14 patients had impaired blood perfusion in the superior lobe of left lung,and the number of patients with/without impaired blood perfusion in the inferior lobe of left lung,superior lobe of right lung,middle lobe of right lung,inferior lobe of right lung were 11/3,14/0,13/1,12/2,respectively.The incidence rates of impaired blood perfusion in different lobes were not significantly different (x2=6.198,P=0.185).The range of lung perfusion defect was mild in 1,moderate in 7 and severe in 6 patients.The incidence rates of impaired blood ventilation in different lobes were not significantly different (x2 =1.587,P=0.811).The range of lung ventilation defeat was mild in 11,moderate in 2 and severe in 1 patients.The defect extent of lung segments and subsegments in Q SPECT imaging and V SPECT imaging were 119 and 41,respectively (x2=28.42,P＜0.05).There was more defect in Q SPECT imaging,but both methods showed segmental or subsegmental distribution.Conclusions The defect of V/Q SPECT imaging in FM patients is segmental in distribution,and more is observed in Q SPECT imaging.Pulmonary V/Q SPECT imaging can evaluate the defect range and extent of pulmonary perfusion and ventilation in FM patients.

摘要： 本发明公开了一种带波形纵隔板的防滑索鞍结构，包括鞍座，鞍座的鞍槽底部设有至少一道与槽壁平行的波形纵隔板，槽壁内侧面为波形；槽壁内侧面、波形纵隔板组合形成等宽的波形槽，可将单根索股放置于槽内，并使索股沿波形分布，从而创造索股水平向包角，增加索股与鞍槽槽壁、波形纵隔板间的摩擦力，甚至可以在索股没有竖向包角的情况下保证主缆在鞍槽内不会滑动。因此，本发明防滑索鞍结构提供了一种有效的解决方案，能够大大提高索鞍防滑能力，从而拓展悬索桥的应用范围。

摘要： 本发明公开了一种基于深度学习网络的纵隔淋巴引流区的自动勾画方法，其适用于CT影像，自动勾画方法包括以下步骤：S1：采集CT图像数据和医生手工标注的纵隔淋巴引流区图像，并预处理CT图像数据和医生手工标注的纵隔淋巴引流区图像；S2：对预处理后的CT图像数据进行分组，得到训练集、验证集和测试集；S3：对训练集、验证集及测试集进行数据增强；步骤S4：构建深度学习分割模型；以及S5：将训练集中的CT图像数据和的医生手工标注纵隔淋巴引流区图像输入已经构建完的深度学习分割模型，训练迭代收敛后，保存纵隔淋巴引流区的分割模型，再进行纵隔淋巴引流区识别和预测，得到纵隔淋巴引流区的每个分区的概率图。网络可以更好的定位和分割小引流区。

摘要： 本发明提供没有副作用、能够使类风湿性关节炎的免疫异常正常化的类风湿性关节炎抑制剂、预防剂及治疗剂。本发明是作为有效成分含有来自于裸藻的物质的类风湿性关节炎抑制剂、预防剂或治疗剂。可以作为通过改善类风湿性关节炎的免疫异常来控制类风湿性关节炎的活动性的抗风湿药使用。另外，可以用于没有接受类风湿性关节炎的确诊的生物体用途。可以从类风湿性关节炎的确诊前到接受确诊后的任意的时间点，对生物体持续施用。来自于裸藻的物质是选自裸藻的藻体、来自于所述裸藻的裸藻淀粉、对该裸藻淀粉实施碱处理及中和处理而得的水溶性的非晶裸藻淀粉、以及实施以超高压使所述裸藻淀粉水溶液从细孔喷嘴中喷出后与被碰撞物碰撞的处理而得的乳液裸藻淀粉中的至少一种物质。

摘要： 本实用新型公开一种用于充气式纵隔腔镜下食管癌根治术的导气排烟纵隔拉钩，包括拉钩主体、拉钩头部、拉钩尾段和手柄，拉钩主体、拉钩头部和拉钩尾段的内部中空且相互连通形成烟气流通管路，在拉钩尾段的外侧端部设有烟气出口，在拉钩头部的弧形弯曲状外侧端的端头部位及内、外弧面上设有烟气进口。本新型利用纵隔腔内的正压，设计了烟气进口、烟气出口以及烟气流通管路，改变了烟气原来的浅表循环流程，实现了气流从浅表‑深部‑外部循环的转换，达到将手术过程中纵隔腔深部的烟气快速排出的目的，有助于提高充气式纵隔腔镜下食管癌根治手术过程中持械操作人员的视野清晰度，提升手术过程的精准性，缩短手术时间，进而保证手术的安全性与流畅性。

摘要： 本实用新型公开了一种用于经剑突下前纵隔微创手术使用的胸骨拉钩装置，包括胸骨拉钩，还包括第三连接件以及设置于第三连接件内的牵引锁组，牵引锁组包括限位杆、第二旋钮以及连接限位杆与第二旋钮的牵引绳，并通过旋转第二旋钮使牵引绳拉动限位杆保持滑动，以使胸骨拉钩与第三连接件保持固定连接。该经剑突下前纵隔微创手术使用的胸骨拉钩装置通过设置床边夹持组件，使装置安装拆卸更加方便，通过竖杆、横杆和调节杆相配合，便于控制胸骨拉钩的位置，通过设置第三连接件配合牵引锁组，方便快速更换和固定胸骨拉钩，避免手术过程中胸骨拉钩滑脱，“T”字型胸骨拉钩表面圆钝，上抬胸骨时对周围组织损伤小，增加手术安全性。

摘要： 本实用新型属于医疗器械技术领域，涉及一种用于纵隔肿瘤手术的胸骨牵拉装置，包括：固定臂；齿条，有两个，分别固定连接在固定臂两端，相互平行，且齿部朝上；活动臂，中空结构，两端分别设置有从动直齿轮，与两个齿条的齿部啮合连接；多个挡钩，分别对称设置在活动臂与固定臂上的下部；驱动机构，设置在活动臂内部，用于驱动活动臂移动，从而调整活动臂与固定臂上挡钩之间的距离。本实用新型通过驱动机构改变了原有的传动比，使操作更加省力，同时固定臂、活动臂的另一端也增加了受力点，避免了端部因受力而变形，并在挡钩上加上缓冲结构，抵消了一部分作用力，保证了使用过程中不会出现变形，影响手术，操作省力，提高了手术的效率。

摘要： 本发明涉及一种治疗慢性纵隔炎的中药，由以下重量配比的药材制备而成：单根木15份、鬼灯笼12份、大独脚金14份、新疆一支蒿8份、宁油麻藤10份、慈菇12份、崖姜12份、凤眼草14份、南天仙子10份、刺芫荽12份、水底龙14份、骑马参12份、毒根斑鸠菊10份、棉籽12份、搬倒甑14份、白芍10份、茯苓12份、金樱子14份。临床试验证明，其能够安全有效治疗慢性纵隔炎。

摘要： 本发明涉及一种治疗慢性纵隔炎的中药，由以下重量配比的药材制备而成：蟛蜞菊16份、实葫芦15份、藤梨根15份、大榆蘑10份、大羽藓8份、绣线菊12份、禾叶毛兰12份、浮尸草6份、毛水苏10份、鸡肫草14份、六曲10份、掌羽凤尾蕨11份、草鞋青14份、翅茎蜂斗草8份、臭李子11份、穿耳菝葜12份、刺梨子12份、骆驼蓬10份、蛤蒌8份、秃疮花14份。临床实验证明，本发明能够安全有效治疗慢性纵隔炎。

摘要： 本发明涉及一种治疗慢性纵隔炎的中药，由以下重量配比的药材制备而成：蟛蜞菊16份、实葫芦15份、藤梨根15份、大榆蘑10份、大羽藓8份、绣线菊12份、禾叶毛兰12份、浮尸草6份、毛水苏10份、鸡肫草14份、六曲10份、掌羽凤尾蕨11份、草鞋青14份、翅茎蜂斗草8份、臭李子11份、穿耳菝葜12份、刺梨子12份、骆驼蓬10份、蛤蒌8份、秃疮花14份。临床实验证明，本发明能够安全有效治疗慢性纵隔炎。

摘要： 本发明涉及一种治疗慢性纵隔炎的中药，由以下重量配比的药材制备而成：单根木15份、白花灯笼12份、大独脚金14份、新疆一支蒿8份、宁油麻藤10份、慈菇12份、崖姜12份、凤眼草14份、南天仙子10份、刺芫荽12份、水底龙14份、骑马参12份、毒根斑鸠菊10份、棉籽12份、搬倒甑14份、白芍10份、茯苓12份、金樱子14份。临床试验证明，其能够安全有效治疗慢性纵隔炎。