血管夹钢丝串连器的设计与使用

外科血管夹在手术使用过程中常存在易丢失，难以拿取的问一题，影响医生手术、消毒供应中心清洗及包装，影响医院感染的质量控制。我们在工作过程中总结经验，自发研制血管夹串联器，将血管夹串联在一起，成串的血管夹不易丢失，手术中医生护士易取用，方便消毒供应中心工作人员刷洗。     

Detectability of Hygroscopic Clips Used in Breast Cancer Surgery

Sonographically detectable clips were introduced over the last decade. We retrospectively studied the rate and duration of sonographically detectable clip detectability in patients with breast cancer who had sonographically detectable clips inserted over a 2‐year period. Nine of 26 patients had neoadjuvant chemotherapy, with all clips remaining detectable 140 to 187 days after insertion. Six of the 9 had intraoperative sonographic localization, with 1 reoperation (17%). Eleven additional patients with nonpalpable tumors and sonographically detectable clips had intraoperative sonographic localization with 1 reoperation (9%). In 1 patient, a sonographically detectable clip enabled intraoperative identification of a suspicious lymph node. There were no complications or clip migration. Sonographically detectable clips are helpful in breast cancer surgery with and without neoadjuvant chemotherapy, remaining detectable for many months and often averting preoperative localization and scheduling difficulties.     

Incidental detection of asymptomatic migration of Hem‐o‐lok clip into the bladder after laparoscopic radical prostatectomy

Hem‐o‐lok clips have been widely used in laparoscopic or robot‐assisted surgery. We report a case of an incidentally discovered Hem‐o‐lok migration into the bladder after laparoscopic radical prostatectomy. The patient was a 75‐year‐old man with localized prostate cancer who underwent laparoscopic radical prostatectomy in July 2009. At 3 postoperative years, follow‐up ultrasonography revealed a small round mass in the bladder. No lower urinary tract symptoms were reported, and urinalysis results had never indicated hematuria or pyuria. Cystoscopy revealed a Hem‐o‐lok clip in the bladder, near the vesicourethral anastomotic site. We could not remove it with forceps in the outpatient clinic, so we performed the procedure again under general anesthesia and successfully removed the Hem‐o‐lok clip. To our knowledge, this is the first report of an asymptomatic Hem‐o‐lok migration into the bladder.     

金属钛夹在急性非静脉曲张上消化道出血中的应用价值

目的：探讨金属钛夹在急性上消化道出血中的应用。方法：将我院收治的64例纳入研究的急性上消化道出血患者分为钛夹治疗组及药物治疗组进行治疗。结果：与钛夹治疗组相比,药物治疗组有效率明显下降而再出血率明显升高（P〈0.05）,且住院时间较长。结论：金属钛夹治疗急性非门脉性上消化道出血安全有效。     

免钛夹腹腔镜胆囊切除术

目的：探讨腹腔镜胆囊切除术(LC)中免钛夹的应用方法及价值。方法：将外科针持打结技术“移植”于LC。用丝线在腹腔内结扎胆囊管和胆囊动脉。结果：全组35例均结扎成功．无出血、胆漏等并发症。结论：LC中使用免钛夹安全、适用、省费用，可避免钛夹对机体的影响且可减少并发症的发生。     

金属钛夹在消化道息肉高频电凝电切术的应用评价

目的 探讨金属钛夹在消化道息肉高频电凝电切术中的应用价值与安全性评价.方法 2009年6月至2011年6月对253例直径大于0.5 cm的消化道息肉患者进行金属钛夹联合高频电凝电切术治疗.对于山田Ⅲ型、Ⅳ型息肉先用钛夹钳夹蒂根部后进行高频电凝电切术,对于山田Ⅰ型、Ⅱ型息肉先进行黏膜下注射,息肉隆起后行高频电凝电切术,再用钛夹夹闭创面.结果 253例共312枚息肉,切除307枚,使用钛夹344枚,成功率98.4％.所有病例术中、术后未见出血及穿孔等并发症.结论 对消化道息肉应用金属钛夹联合高频电凝电切术是一种操作简便、安全性高、疗效好的治疗方法,可以有效防止出血、穿孔等并发症的发生.     

尼龙绳联合钛夹荷包缝合在内镜胃壁全层切除术中的应用

目的探讨尼龙绳联合钛夹荷包缝合在内镜下行胃壁全层切除术(EFTR)中的应用价值。方法回顾分析该院15例胃黏膜下固有肌层肿瘤的住院患者采用尼龙绳联合金属钛夹行荷包缝合修补"主动穿孔"的方法行EFTR术的临床资料。结果 15例患者均经内镜手术将肿瘤完整切除,采用尼龙绳联合金属钛夹行荷包缝合修补EFTR术后的"主动穿孔",15例患者均成功修补。平均所用钛夹(5.0±1.0)枚。随访6个月,手术创面愈合,未见肿瘤复发。结论应用尼龙绳联合钛夹荷包缝合行EFTR术是安全、微创及快速康复的一种治疗方法。     

金属钛夹在结肠息肉高频电切除术中的应用

目的探讨金属钛夹在结肠息肉高频电切除术中的使用治疗效果。方法本院收冶的140例结肠息肉患者随机分为无钛夹组80例和钛夹组60例。钛夹组应用钛夹结合电凝电切术切除结肠息肉,无钛夹组仅应用电凝电切术。观察2组患者的术中、术后出血等并发症发生情况。结果2组患者手术过程均顺利,平均手术时间12min,无肽夹组术后发生结肠穿孔1例、迟发性出血4例;肽夹组无术后穿孔及迟发性出血发生。结论在内镜下电切结肠息肉的治疗中,金属钛夹可以起到迅速止血和预防再出血、穿孔等并发症的作用。     

Remote sonographic interpretation: Comparison of standardized video clips to still images

OBJECTIVE.: The aim of our study was to evaluate the role of standardized video clips compared with still images in the diagnostic accuracy of remote sonographic interpretation. METHODS.: We compared the remote interpretation of sonographic examinations acquired with a standardized video clip approach to examinations performed with still images alone in 60 patients with various hepatic and extrahepatic pathologies. RESULTS.: The use of video clips improved the diagnostic accuracy of sonographic studies interpreted remotely compared with the use of still images (p < 0.0001). The sensitivity, specificity, and positive and negative predictive values increased from 47.3% to 68.3%, 81.8% to 87.8%, 71.5% to 81%, and 63.8% to 74.5%, respectively. CONCLUSIONS.: Standardized video clips are easy to obtain, less operator-dependent than still images, and can be transferred to remote sites without loss of important data. We recommend this method in remote interpretation (teleradiology and distant consultation) of sonographic examinations. ? 2012 Wiley Periodicals, Inc. J Clin Ultrasound 40:495-501, 2012.     

Increased uterine and ovarian vascular resistance following filshie clip sterilization: Preliminary findings obtained with color Doppler ultrasonography

The effect of Filshie clip sterilization on uterine and ovarian circulation was studied with color Doppler ultrasonography in 16 women before and twice after the operation. As a whole, the vascular resistance was slightly raised in the largest uterine artery and in the fundal parts of the uterine arteries; likewise in the ovarian arteries 2 days after sterilization. The resistance in the uterine arteries approached the pre-sterilization level at 3 months after the operation, although these changes were not statistically significant. Two women had pelvic pain in the first days after the procedure, and they were compared with the symptom-free patients. Two days after sterilization, the patients with pain had significantly higher vascular resistance in all parts of the uterine arteries as compared to the symptom-free patients. After 3 months the difference had decreased in the largest uterine arteries and in the middle parts of the uterine arteries, but in the fundal parts the resistance was still higher than before sterilization. Vascular resistance in the ovarian arteries was increased in both groups, although the elevation was more pronounced in patients with pain. These preliminary findings imply that sterilization may cause an increase in the local vascular resistance, which is measurable by color Doppler sonography. © 1995 John Wiley & Sons, Inc.     

Novel endoscopic multi-firing-clip applicator for endoscopic closure of large colonic perforations

Background: Existing endoclip closure devices have difficulty in closing large colonic perforation. We developed a novel endoscopic multi-firing-clip applicator (EMFCA) system to address these limitations, and report on its initial evaluation.

Material and methods: The functionality and efficacy of the prototype EMFCA equipped with re-openable clamp and preloaded with four clips were assessed using standardized 1.5?cm incisions created in ex-vivo porcine colonic segments. Endoscopic closure of the lacerations with two, three and four clips (n?=?five for each group) was followed by measurement of the leakage pressure of the three groups. Finite element analysis (FEA) was performed to validate the clip behavior and reliability during deployment.

Results: All 15 perforations were sealed without leakage until fully distended. The leakage pressures of colonic lacerations sealed with two, three, and four clips were 26.1?±?2.8?mmHg, 37.3?±?7.3?mmHg and 42.3?±?7.4?mmHg, respectively. The mean operation time to deploy one clip was 25.4?±?5.2?seconds. On FEA, the deformation of the shape of the clip matched that of the intended design, with each clip sustaining a maximum stress of 648.5?MPa without any material failure during deployment.

Conclusions: These initial results confirm the efficacy of the EMFCA prototype system for endoscopic closure of colonic perforations.     

IT刀联合钛夹和透明帽治疗结直肠带蒂大息肉的效果研究

目的探讨内镜下应用IT刀联合钛夹和透明帽治疗结直肠带蒂大息肉的有效性和安全性。方法在透明帽辅助下,用钛夹夹闭大息肉蒂部阻断其血供,后用IT刀电切蒂部以切除息肉。通过回顾2014年1月-2015年12月在中国人民解放军第一七五医院消化内科运用此方法治疗结直肠带蒂大息肉(息肉直径≥2.0 cm)的45例临床资料,统计治疗操作时间、所用钛夹数量和并发症发生情况等,分析应用此方法切除大息肉的治疗效果。结果 45枚大息肉均一次切除,其中有3例患者创面出现少量渗血,其余术中无出血、穿孔;术后均无迟发性出血及穿孔并发症发生。平均使用钛夹2.7枚,操作时间3~12 min,平均(5.7±1.2)min。结论联合应用IT刀、钛夹、透明帽治疗结直肠带蒂大息肉安全、有效,操作较为便捷省时。     

The new reusable laparoscopic multi-fire clip-applier for titanium clips

Summary

This article presents a new clip-applier characterized by its reusable construction with interchangeable disposable clip storage magazines containing eight titanium clips. The advantage of this multi-fire clip-applier is evident in laparoscopy under the conditions of pneumoperitoneum because the clips are loaded intra-abdominally. Gas losses as seen during introductions through special trocars when changing the clips outside the abdomen are missing. The authors discuss the technical features of the instrument in detail.     

胃镜下金属钛夹治疗Dieulafoy病变出血的临床研究

目的探讨胃镜下金属钛夹治疗Dieulafoy病变出血的临床效果。方法 34例Dieulafoy病变出血患者随机分为两组,观察组采用胃镜下放置金属钛夹治疗,对照组采用硬化剂注射治疗,比较观两组患者的治疗效果。结果两组患者在早期止血率、远期止血率、转外科手术率以及住院时间方面差异均无显著性(P>0.05),观察组再出血率明显低于对照组,差异具有统计学意义(P<0.05)。结论胃镜下放置金属钛夹治疗Dieulafoy病变出血是一种积极有效地方法,对预防再出血具有较大的优势。     

金属夹钳夹联合高频电凝切除术治疗消化道息肉的疗效分析

目的:探讨金属夹钳夹联合高频电凝切除治疗消化道息肉的疗效。方法:在内镜下应用金属夹钳夹联合高频电凝切除术治疗179例消化道息肉患者。术后内镜随访,评价治疗的安全性及有效性。结果:共成功切除216枚消化道息肉,息肉直径0.8～3.0cm,平均直径2.1 cm;成功切除率100%;无患者发生术中出血,1例(0.5%)患者发生术中穿孔;5例(2.7%)患者术后2周内发生迟发出血,再次内镜下治疗均成功止血。术后病理结果显示,腺瘤性息肉是最多见病变,其中2例为息肉癌变。术后随访中6例患者息肉残蒂存留,再次予以内镜下切除。结论:内镜下应用金属夹联合高频电凝切除消化道息肉能显著降低术后出血的风险。     

牙线牵引金属夹缝合结直肠内镜黏膜下剥离术后创面的临床应用

目的探讨单钳道内镜下通过牙线牵引金属夹辅助缝合结直肠病变内镜黏膜下剥离术(ESD)后创面的优势、疗效及安全性。方法回顾性分析2018年6月-2020年9月该院通过单钳道内镜下使用牙线牵引辅助金属夹缝合ESD术后创面的患者17例。其中,回盲部2例、升结肠2例、横结肠3例、降结肠3例、乙状结肠3例、直肠4例。观察患者ESD术后创面大小、封闭创面时间、成功率、术后并发症发生情况和肠镜复查结果等。结果 ESD术后创面直径为3.0～6.5 cm,其中16例患者术后创面缝合获得满意效果,成功率为94.1%,1例因牙线过早被剪断使牵引失效导致仅缝合部分创面;创面缝合时间为5～16 min,所有病例均未发生迟发性出血和穿孔,术后3～24个月复查肠镜提示创面金属夹脱落,术后创面修复良好。结论牙线牵引金属夹缝合结直肠ESD术后创面操作简便,安全实用。     

Trackless surgery using focused ultrasound: Technique and case report

The introduction of laparoscopic cholecystectomy may have resulted in an increase of cystic duct leaks, which could be attributed to the use of endoclips. There are also reports of other complications associated with clips. Complications associated with clips can be avoided by using intracorporeal ligation. The time necessary to complete the ligation was measured from preparing the pedicle, to dividing the duct and artery in 170 cases. A 10 cm 2′0′ polyglactin tie was used to ligate the artery, proximally, and the cystic duct, both proximally and distally, and the structures were divided. We took 2-8 min (mean time = 4.03) from the end of preparation of the cystic pedicle to division of the structures using intracorporeal ligation. The cost of endoclips (ER 320-Ethicon) is approximately £152 per patient. The polyglactin ligature costs <£1. Ligation of the cystic duct and artery is safe and cost-effective. It does not add significantly to the operative time. Training should improve the skills necessary for secure intracorporeal knots, reducing the dependence on expensive disposable instruments.     

尼龙圈联合钛夹闭合术在内镜黏膜下剥离术中的价值

目的 评价尼龙圈联合钛夹在内镜黏膜下剥离术中闭合切口的有效性和安全性.方法 对内镜发现的胃黏膜下肿瘤(SMT)行EUS,对其中来源于固有肌层的SMT行内镜黏膜下剥离治疗.完整切除病变后,经内镜活检通道、直视下应用尼龙圈和钛夹缝合切口.观察术中尼龙圈联合钛夹缝合的成功率;术后内镜随访,检查尼龙圈联合钛夹缝合效果.结果 35例患者中病变位于胃底部24例,胃体部8例,胃窦部3例.3例发生穿孔,应用尼龙圈结合钛夹闭合术成功封闭,未转外科手术.35例完整缝合切口成功率100％,术后3个月均无发热腹痛等症状;平均随访5.3个月,创面均完整愈合.结论 内镜下应用尼龙圈联合钛夹缝合内镜黏膜下剥离术中的切口是一种安全、有效的方法.     

卡通式视频短片在经腹腔镜胆囊切除术围手术期患者健康教育中的运用

目的：探讨卡通式视频短片在经腹腔镜胆囊切除术围手术期患者中的应用效果。方法：制作经腹腔镜胆囊切除术围手术期护理健康教育卡通式视频短片。实验组选240例组织观看卡通式视频短片进行健康教育,对照组选240例进行常规健康教育。分别统计入院第1天、第2天、术前、出院前对围手术期健康知识的知晓率及两组患者出院前的满意度。结果：实验组患者在入院第1天、第2天、术前、出院前对围手术期健康知识的知晓率分别是95．8％、92．5％、98．7％、96．6％,对照组患者在入院第1天、第2天、术前、出院前对围手术期健康知识的知晓率分别是89．1％、77。9％、75％、83．7％;出院前实验组患者满意度是95％,对照组满意度是82．91％;实验组与对照组相比差异均有统计学意义（P〈0．05）,实验组较对照组知晓率、满意度均明显提高。结论：卡通式式视频短片可提高患者接受健康教育的兴趣,提高患者健康知识的知晓率,促进护患沟通,提高患者的满意度,值得在医院的护理工作中推广。