门脉高压症治疗观点之辩

对立统一规律是辩证法的实质,在唯物辩证法的理论体系中占有核心地位。门脉高压症的外科治疗有分流术与断流术两种不同的手术方法,这两种方法从治疗机制上看是矛盾的,用对立统一观来认识这两种手术的联系并揭示门脉高压外科治疗发展的哲学依据。     

Serial Neuropsychological Assessment and Evidence of Shunt Malfunction in Spina Bifida: A Longitudinal Case Study

Myelomeningocele is often accompanied by hydrocephalus (MMH), making it a potentially unstable neurological condition requiring shunt placement and possible revisions. Serial neuropsychological assessment is an important tool in monitoring children with MMH, as cognitive changes can indicate shunt malfunction and hydrocephalus. We present the case of a girl with MMH who had five neuropsychological assessments (ages 5, 7, 11, 12, and 14). Despite a lack of overt neurological symptoms or report of behavioral decline, testing at age 11 revealed decline in multiple neurobehavioral domains, and imaging at that time showed increased hydrocephalus, requiring shunt revision. Subsequent neuropsychological assessment conducted after a 2-year period of medical stability showed improvement and/or a return to baseline levels in some skill areas (i.e., working memory, verbal memory, visuomotor integration, and sustained attention), yet more lasting impairments in others (i.e., Verbal IQ, processing speed, organization, and response inhibition). These lasting cognitive deficits potentially impact independent completion of complex medical self-care tasks. This pattern of recovery highlights vulnerability of brain systems supporting executive functions in children with hydrocephalus and shunt failure.     

再论门静脉高压症的治疗观

门静脉高压症的治疗主要是断流术和分流术,就此笔者于１７年前在本刊发表过文章进行论述。１７年后,此病的治疗观出现以下进展和变化：１,对立和统一：这两种手术联合施行可产生优势互补,代偿充分者更适合做分流术,否则以断流术为宜,这是观念上的突破;２,有创和微创：微创概念和技术的出现,使治疗手段多样化和观念更新,医生有了更多的选择;３,治标和治本：肝移植的临床一改门静脉高压的治标手段而向治本手段发展。     

门静脉高压症的外科治疗观

门静脉高压症的外科治疗主要有门体静脉断流术和门体静脉分流术,这两种手术方式反映了唯物辩证法的对立统一规律。辩证唯物主义认为,人的认识过程是实践、认识、再实践、再认识,循环往复以至无穷的发展过程。随着实践的深入,医疗技术的进步,医疗设备的更新,近来兴起了分流加断流联合手术、TIPSS及肝移植术治疗门脉高压症。     

癫痫诊治中医患同盟建立的实践与策略

通过对肝硬化者行超声检测,预测食管静脉出血,结果显示,出血组门静脉及胃左静脉管径均增粗,但胃左静脉更明显,门静脉血流速减慢而胃左静脉增快;出血组胃左静脉均呈离肝血流,其分流指数明显增大。胃左静脉的管径及血流速与门静脉比较具有显著的变化,其分流指数和血流方向在预测出血方面具有更大的价值。