低位阴囊切口治疗腹股沟型隐睾

<正>隐睾在新生儿中发病率约为2%~4%,到1岁时发病率降至1%左右[1]。传统的治疗腹股沟型隐睾的方法是经腹股沟切口的睾丸下降固定术。1989年Bianchi等[2]提出了单纯的经阴囊切口的睾丸下降固定术,这种手术方式可缩短手术时间并减少手术切口,创伤较小且更美观。我院采用该术式对低     

改良Bianchi睾丸下降固定术治疗中低位隐睾的临床疗效

目的:探讨改良Bianchi(阴囊中缝切口)睾丸下降固定术与传统(腹股沟联合阴囊切口)睾丸下降固定术的优缺点。方法:2013年2月至2014年2月收治的所有82例中低位隐睾患儿中,随机对其中46例(53侧睾丸)行改良Bianchi睾丸下降固定术作为观察组;传统方法即经腹股沟联合阴囊切口治疗36例(40侧)作为对照组。比较2组手术时间、术后并发症等方面的差异。结果:观察组与对照组患儿的手术时间分别为(25±6)min和(35±4)min,两组比较差异有统计学意义(P0.01);经过1~2年的随访比较,均未出现睾丸萎缩情况;观察组患儿出现3例睾丸上缩情况,对照组出现2例术后睾丸上缩,发生率的差异没有统计学意义;术后均未出现腹股沟斜疝、鞘膜积液的并发症,但对照组患儿有1例出现腹股沟处切口血肿且所有患儿切口均较明显,而观察组术后手术切口几乎观察不到。结论:行改良Bianchi睾丸下降固定术治疗中低位隐睾效果满意,较传统手术在手术时间和切口美观等方面具有一定的优势,值得临床推广。     

腹腔镜及经阴囊小切口治疗小儿隐睾症的疗效观察

目的探讨小儿隐睾症的不同手术方式选择及疗效观察。方法 2013年9月至2014年7月在我科行睾丸下降固定术的患儿159例,其中睾丸位于阴囊上方或可推至阴囊内者采用经阴囊小切口行睾丸下降固定术,睾丸位于内环口或者无法触及睾丸且超声提示未见明显睾丸者采用腹腔镜睾丸下降固定术,摒弃经腹股沟切口睾丸下降固定术。结果 159例隐睾患儿,除其中15例睾丸萎缩切除外,其余均成功将睾丸降至阴囊内。术后随访患儿,睾丸发育正常,手术切口隐蔽,无明显疤痕,美容效果好。结论低位隐睾选择经阴囊小切口,高位隐睾选择腹腔镜下睾丸下降固定术,手术均能获得满意效果,且术后外观更美观,掌握好这两种手术的适应证和手术技巧,或可取代经典的经腹股沟切口睾丸下降固定术。     

不同类型小儿隐睾的微创治疗

目的探讨不同位置的隐睾,采用不同微创手术方式的效果及可行性。方法自2013年6月至2016年6月我院收治各类隐睾共56例。腹腔型隐睾9例采用腹腔镜手术。腹腔镜下游离患侧睾丸及精索,自腹股沟管将睾丸牵入阴囊,固定于阴囊底部肉膜囊内。阴囊高位型隐睾及滑动睾丸6例采用单纯经阴囊切口手术(Bianchi),直接于患侧阴囊底部皮肤皱褶内做顺皮纹切口,游离精索,将睾丸固定于肉膜囊内。腹股沟型隐睾41例,采用腹腔镜手术与Bianchi手术相结合的治疗方法,不将睾丸提入腹腔,不切断睾丸引带,腹腔内游离精索后,将睾丸下推至阴囊,然后转至阴囊部操作,采用Bianchi手术,将睾丸固定于阴囊底部肉膜囊内。结果全部病例均顺利完成手术,达到睾丸无张力固定于阴囊底部的效果。平均手术时间,腹腔型(65±8)min,腹股沟型(56±6)min,阴囊型(45±5)min。术后恢复顺利,无围手术期并发症出现。术后第3天出院。随访3~12个月,所有病例睾丸位置均位于阴囊底部,无睾丸萎缩或回缩病例,血供良好,发育正常。结论根据睾丸位置选取不同的微创手术方式,使隐睾手术全部达到微创化治疗,损伤小,恢复快,无明显切口瘢痕,精索游离充分,能够将睾丸固定于阴囊低位,效果满意。     

阴囊内睾丸固定术治疗隐睾19例

1986～1988年,我院采用阴囊内睾丸固定术治疗隐睾19例,其中右侧14例,左侧4例,双侧1例.外环型隐睾6个,腹股沟管型隐睾14个.年龄2～6岁.效果良好.手术方法:循斜疝修补术切口,显露睾丸及精索,切断睾丸引带并处理疝囊.充分松解精索,直到睾丸能无张力地降入阴囊.分离阴囊直达阴囊底部,由且手用     

隐睾固定术中改良阴囊切口的应用

正隐睾症是儿童泌尿生殖系统常见畸形之一,按照隐睾位置不同分为外环口型隐睾、腹股沟型隐睾及腹腔型隐睾[1]。手术是治疗隐睾最主要的方法。目前常用的术式有腹腔镜高位隐睾下降固定、开放隐睾下降固定等,不论哪种类型的隐睾,行睾丸下降后均需在阴囊做一切口将睾丸固定于阴囊内。目前临床常采用阴囊中部切口固定睾丸[1],该术式操作简便,固定效果好,应用广泛,然而术后易出现阴囊血肿、感染、切口裂开、睾丸脱出等情况以及切口外     

腹股沟可触及睾丸的隐睾的微创治疗

目的探讨腹股沟可触及睾丸的隐睾的微创治疗方法。方法2007年8月～2008年3月对60例腹股沟区可触及睾丸的隐睾,根据睾丸位置高低,采取经阴囊或腹腔镜辅助下睾丸固定手术。结果经阴囊睾丸固定术24例,睾丸位于外环口与阴囊上极之间,23例固定于阴囊底,1例固定于阴囊上极。经阴囊转腹腔镜睾丸固定术2例,均为右侧,睾丸位于外环口与阴囊上极之间,经隐囊手术睾丸下降位置不满意,转为腹腔镜手术将睾丸固定于阴囊底。经腹腔镜睾丸固定术34例,其中睾丸位于腹股沟内16例（41.1%）,位于近外环口处18例（52.9%）,合并腹股沟斜疝8例（23.5%）,均在腹腔镜下行内环口结扎,术后睾丸固定于阴囊底部。60例B超随访3～6个月,平均4.3月,无睾丸萎缩及回缩,无腹股沟斜疝的发生。结论可触及睾丸的腹股沟隐睾如果能推到阴囊上极,则可选择经阴囊切口的睾丸固定术;如果不能将睾丸推到阴囊上极或经阴囊切口不能将睾丸固定到阴囊底时,可选择腹腔镜手术。2种手术方法睾丸固定位置满意,可作为临床医师的参考手术方式之一。     

三种手术方案治疗小儿隐睾的临床疗效及安全性

目的:探讨开放手术、腹腔镜高位隐睾固定术及腹腔镜高位结扎+经阴囊隐睾固定术治疗小儿隐睾的临床疗效与安全性。方法:回顾分析2012年1月至2018年6月收治的162例小儿隐睾的临床资料,共216侧,其中62侧行开放手术(A组),96侧行腹腔镜下高位隐睾固定术(B组),58侧行腹腔镜高位结扎+经阴囊隐睾固定术(C组);比较3组手术成功率、手术时间、住院时间、不良反应及并发症发生情况。结果:三组手术成功率差异无统计学意义(P0.05);B组手术时间长于A组、C组(P0.05);B、C组住院时间短于A组(P0.05);3组术后切口感染率差异无统计学意义(P0.05)。结论:腹腔镜高位隐睾固定术与腹腔镜高位结扎+经阴囊隐睾固定术治疗高位隐睾疗效确切,且能同期处理未闭鞘状突;其中腹股沟低位隐睾采用腹腔镜鞘状突结扎+经阴囊切口手术效果更佳;经腹股沟开放手术治疗睾丸缺如、睾丸发育不良仍具有一定的临床价值。     

经腹股沟与阴囊切口治疗睾丸鞘膜积液体会

目的 探讨睾丸鞘膜积液治疗方式.方法 对63例睾丸鞘膜积液病人行手术治疗,其中33例行经腹股沟切口治疗睾丸鞘膜积液;30例行经阴囊手术治疗睾丸鞘膜积液.结果 两组手术时间、出血量无明显差异,经腹股沟切口组术后复发、阴囊水肿、感染等方面优于经阴囊切口手术组,差异有统计学意义(P＜0.05).结论经腹股沟切口可替代传统的阴囊切口治疗睾丸鞘膜积液.     

单阴囊切口且不结扎鞘状突在可触及型隐睾治疗中的应用研究

目的:通过对可触及型隐睾采用单阴囊切口且离断不结扎鞘状突行睾丸下降固定的手术方法的应用,探讨此方法的可行性及近期效果观察。方法:通过一项回顾性研究,纳入从2015年1~12月间因隐睾入院手术的病例:可触及型隐睾109例(125侧)(A+B组);未触及型隐睾15例(C组)。前者采用单阴囊切口+近内环口高位离断鞘状突(未结扎)睾丸下降固定(A组,53例,61侧)或标准腹股沟阴囊双切口睾丸下降固定(B组,56例,64侧),后者腹腔镜探查(C组)。分析单阴囊切口睾丸固定术在可触及型隐睾中的治疗成功率、术后近远期并发症、斜疝或鞘膜积液的发生(复发),以及单、双切口(A、B组)治疗可触及型隐睾中相关参数的比较。结果:可触及型隐睾患儿中位年龄1.4(0.6~11.0)岁。A组:中位年龄1.5(0.6~7.0)岁。隐睾侧别:左24例,2例伴有鞘膜积液;右20例,1例伴有鞘膜积液,2例术中增加腹股沟切口;双侧9例,1例右侧术中增加腹股沟切口。治疗成功率为95.1%(58/61)。B组:中位年龄1.4(0.8~11)岁。隐睾侧别:左27例;右22例,3例伴有腹股沟斜疝;双侧7例,1例术后右侧睾丸回缩。两组中鞘状突未闭合率80.8%(101/125)。未触及型隐睾C组15例全部腹腔镜探查:2例睾丸先天缺如;6例睾丸发育不良且切除;3例在内环口呈"窥视",改普通双切口术;4例腹腔镜手术固定。切口愈合良好,无睾丸萎缩,无斜疝或鞘膜积液发生(复发)。结论:单阴囊切口且不结扎鞘状突治疗可触及型隐睾是一种安全的手术方法,且不结扎鞘状突未增加发生斜疝或鞘膜积液的风险。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.