简易支撑架联合一针缝合法在直肠癌末端回肠造口中的应用

目的：探讨低位直肠癌病人保肛根治手术中,应用简易支撑架联合一针缝合行末端回肠双腔造口的可行性及效果。方法：回顾性分析2019年12月至2021年5月我院普外科有术后吻合口漏高危因素的直肠癌病人。病人行腹腔镜辅助低位直肠癌根治术和末端回肠双腔造口术。分为简易支撑架联合一针缝合造口组35例,传统缝合造口组35例。术前、术后资料行统计学分析。结果：两组病人一般资料及术后造口相关并发症发生率差异无统计学意义(P>0.05)。所有病人住院期间均未出现严重并发症。所有病人末端回肠造口均成功还纳。简易支撑架联合一针缝合造口组病人一期造口时间[(13.77±2.02) min比(22.66±3.64)min(P<0.001)];二期造口还纳时间[(88.14±28.03) min比(103.29±30.96) min(P=0.04)]和术后总住院时间[(14.54±2.32) d比(17.34±4.57) d(P=0.002)];以及一期手术住院费用[(42 057.98±4 938.69)元比(44 728.46±5 223.62)元,(P=0.03)]和二期造口还纳手术出血量[(17....     

改良“瞄准器”状缝合术在回肠预防性造口还纳术中的应用

目的 探讨改良“瞄准器”状缝合术处理回肠造口还纳术后腹壁切口的应用效果。方法 回顾性分析2019年2月至2022年2月间笔者团队收治的58例回肠造口还纳术患者病例资料,根据造口还纳术后腹壁切口缝合方式的不同,将研究对象分为观察组（26例）及对照组（32例）,观察组采用改良“瞄准器”状缝合术,对照组采用传统一期缝合术。比较两组患者的手术时间、术中出血量、术后进食时间、拆线时间、术后住院时间、切口感染率及术后切口疼痛评分。结果 观察组术后进食时间、拆线时间、术后住院时间、术后第一天疼痛评分及切口感染率明显低于对照组（均P < 0.05）。两组手术时间、术中出血量差异比较未见统计学意义（均P > 0.05）。结论 与传统一期缝合术相比,改良“瞄准器”状缝合术处理腹壁切口可明显降低回肠造口术后切口感染率及术后第一天疼痛感,缩短术后进食时间、拆线时间及术后住院时间。     

腹腔镜辅助技术在结肠造口还纳术中的临床应用

目的探讨腹腔镜辅助技术进行结肠造口还纳的可行性及临床疗效。方法选择中山市人民医院2009年3月至2015年3月结肠造口还纳术患者50例,随机分为两组。其中25例开展腹腔镜辅助结肠造口还纳术(试验组),25例行传统开腹结肠造口还纳术(对照组)。记录两组患者的手术情况(平均手术时间、术中出血量)、术后恢复情况(术后疼痛评分、肠道功能恢复时间、住院时间)、术后并发症的发生情况。术后随访1年,评价两组患者的长期生存情况。结果 50例患者均手术顺利,无术中并发症、术后出血及腹腔感染的发生。试验组5例中转开腹,平均手术时间、术中出血量略高于对照组,但差异无统计学意义(t=0.625、0.729,P=0.671、0.823);胃肠道功能恢复时间为(3.5±0.5)d,平均住院时间为(7.0±0.5)d,显著短于对照组的(4.7±1.5)d、(10.5±1.5)d(t'=3.795、7.911,均P0.01)。试验组患者术后疼痛评分明显低于对照组(U=3.502,P0.01)。术后中位随访10个月,肿瘤复发5例,42例生存,7例吻合口狭窄并重新吻合,两组吻合口瘘及狭窄发生率差异无统计学意义(χ~2=0.166,P=0.684)。结论腹腔镜辅助技术在结肠造口还纳术中应用安全可靠,能明显缩短住院时间及胃肠道功能恢复时间,临床疗效良好。     

皮下引流持续冲洗负压吸引术在肠造口还纳术后预防切口感染的前瞻性研究

目的探讨皮下引流持续冲洗负压吸引术在结直肠癌手术并肠造口患者行还纳术后预防切口感染的应用价值。 方法前瞻性选择2017年2月至2018年12月佛山市第一人民医院收治的100例肠造口患者,按照随机数字表法分成两组,在肠造口还纳术中关闭切口时采用不同措施,每组50例,试验组采用皮下引流持续冲洗负压吸引装置,对照组采用传统关闭切口方法。比较两组患者的围手术期资料以及术后切口感染率。 结果两组患者均采取开腹手术,无一例围手术期死亡。两组造口类型、初次造口时机、造口时间、手术时间、术中出血量比较,差异均无统计学意义。试验组患者术后住院时间为（7.0±5.7）d,术后切口感染率为2.0%（1/50）,显著低于对照组的（9.5±5.6）d、16.0%（8/50）,差异有统计学意义（t=-2.193,P=0.031;χ²=4.396,P=0.036）。 结论皮下引流持续冲洗负压吸引术能有效降低结直肠癌肠造口还纳术患者的切口感染发生率,缩短住院时间,临床应用价值较高。     

小切口重建钢板治疗锁骨中段骨折的比较研究

目的比较小切口与传统切口重建钢板治疗锁骨中段骨折的临床效果。方法 2007年3月～2009年5月,采用小切口(0.5～3.5cm)重建钢板治疗15例锁骨中段骨折,与前期2005年8月～2007年3月采用传统切口重建钢板治疗的20例进行比较。手术由同一术者完成,记录每个病例的手术切口长度、手术时间、出血量、术后24h疼痛评分、骨折愈合时间、术后3个月功能、并发症及病人对切口的满意率,并进行统计分析。结果所有病例均获随访6～18个月,平均13个月。小切口手术在切口长度[(3.5±0.5)cmvs(7.3±1.1)cm,t=-12.540,P=0.000],出血量[(55.0±10.2)mlvs(95.0±15.7)ml,t=-8.578,P=0.000],术后24h疼痛评分[(29.0±9.3)分vs(46.0±9.4)分,t=-5.318,P=0.000],骨折愈合时间[(9.1±1.1)周vs(10.8±1.3)周,t=-4.007,P=0.000]及病人对切口的满意率[80%(12/15)vs25%(5/20),χ2=10.380,P=0.001]方面均明显优于传统切口手术,而手术时间、并发症和术后3个月肩关节功能差异无显著性(P0.05)。结论小切口重建钢板治疗锁骨骨折能减小创伤、减少出血、加快骨折愈合,且外形美观,是一种治疗锁骨中段骨折较好的方法,但此种术式对医师的技术要求较高。     

目标性后腹腔镜与常规后腹腔镜肾上腺切除术的比较

目的 目标性后腹腔镜与常规后腹腔镜肾上腺切除术的临床效果。方法 回顾性分析我院2015年7月～2022年12月手术治疗135例肾上腺良性肿瘤的临床资料，其中目标性后腹腔肾上腺切除术65例(目标组),常规后腹腔镜肾上腺切除术70例(常规组),比较2组手术时间、术中出血量、切口长度、术后引流量、术后引流时间、术后住院时间、术后疼痛语言等级评定量表(Verbal Rating Scale, VRS)。结果 2组手术均顺利完成，无中转开放手术。目标组术中出血量[(29.4±16.6)ml vs.(40.1±17.4)ml,t=-3.653,P=0.000]、手术切口长度[(2.7±1.0)cm vs.(3.5±0.6)cm,t=-5.323,P=0.000]、术后引流量[(34.2±18.4)ml vs.(42.1±18.7)ml,t=-2.494,P=0.014]、术后疼痛VRS评分[(1.9±0.7)分vs.(2.2±0.7)分，t=-2.748,P=0.006]和术后住院时间[(4.5±0.9)d vs.(5.0±1.1)d,t=-3.257,P=0.001]显著优于常规组，手术时间明显...     

经脐单孔单通道与单孔双通道腹腔镜手术治疗青少年精索静脉曲张的对比研究

目的:对比经脐单孔单通道与单孔双通道腹腔镜手术治疗青少年精索静脉曲张的疗效。方法:将80例精索静脉曲张患儿随机分成两组(单通道组及双通道组各40例)。对比两组的手术时间、术后住院时间、切口疼痛评分、术后并发症、腹壁美容满意度评分。结果:两组手术均获成功。虽然双通道组术后切口疼痛视觉模拟评分(VAS)高[(3.6±1.1)分vs(4.8±1.4)分,t=-4.986,P0.01],但两组的手术时间[(31.2±4.6)min vs(29.8±4.2)min,t=1.383,P=0.171]、术后住院时间[(1.82±0.8)d vs(1.95±0.7)d,t=-0.784,P=0.436]、术后并发症(0 vs 0)和腹壁美容满意度[(4.8±0.5)分vs(4.6±0.6)分,t=1.253,P=0.214]均无明显差异。术后6个月两组均无复发,无脐疝、鞘膜积液及睾丸萎缩等并发症,腹壁无可见手术瘢痕。结论:在严格掌握手术适应证的前提下,经脐单孔单通道与单孔双通道腹腔镜治疗精索静脉曲张疗效相当,腹壁不留瘢痕,双通道腹腔镜手术无需特殊器械,更值得临床推广。     

常规器械经脐单孔与三孔腹腔镜胆囊切除术的对比观察

目的对比应用常规器械经脐单孔与三孔法腹腔镜胆囊切除术治疗结石性胆囊炎的疗效,评价经脐单孔腹腔镜胆囊切除术的安全性、可行性及优缺点。方法将88例结石性胆囊炎患者随机分成两组,每组各44例。单孔组应用常规器械行经脐单孔腹腔镜胆囊切除术;三孔组行三孔法腹腔镜胆囊切除术。将两组手术时间、术中出血量、胆囊破损例数、并发症、切口疼痛评分、术后住院时间、住院费用以及腹壁美容度评分等指标进行对比研究。结果两组手术均成功完成。两组术中出血量、胆囊破损例数、术后住院时间、住院费用和并发症率等指标差异无统计学意义(P0.05)。与三孔组相比,单孔组手术时间明显延长[(86.29±8.23)min vs.(36.71±6.65)min,t=27.42,P0.001],但术后切口疼痛VAS评分低[(3.29±0.91)分vs.(5.29±1.12)分,t=-2.33,P=0.038],术后2个月腹壁美容满意度评分高[(4.86±0.67)分vs.(3.29±0.85)分,t=3.175,P=0.008]。结论应用常规器械经脐单孔腹腔镜胆囊切除术不仅在治疗效果和安全性方面与三孔腹腔镜胆囊切除术相当,而且还具有术后切口疼痛轻和切口瘢痕隐蔽等优点。但单孔腹腔镜胆囊切除术手术时间明显延长,手术操作困难。     

改良三角吻合技术的完全腹腔镜乙状结肠癌根治术

目的比较改良三角吻合技术的完全腹腔镜下乙状结肠癌根治术与腹腔镜辅助小切口结肠重建手术的近期效果。方法回顾性分析我院2014年8月～2018年8月60例乙状结肠癌患者资料,均行腹腔镜乙状结肠癌根治术,完全腹腔镜下改良三角吻合技术和腹腔镜辅助小切口重建各30例。比较2组手术时间、重建时间、术中出血量、清扫淋巴结数目、肛门排气时间、进食流质时间、术后住院时间以及切口感染、肺部感染、吻合口出血和吻合口漏等并发症发生率。结果与腹腔镜辅助小切口组比较,完全腹腔镜组重建时间短[(31. 9±11. 3) min vs.(42. 9±8. 3) min,t=-4. 295,P=0. 000],肛门排气早[(2. 9±1. 1) d vs.(3. 6±1. 2) d,t=-2. 423,P=0. 019]。2组手术时间、术中出血量、清扫淋巴结数目、进食流质时间、术后住院时间差异无统计学意义(P 0. 05)。2组术后并发症总发生率分别为10. 0%(3/30)、16. 7%(5/30),差异无统计学意义(P 0. 05)。术后随访6～40个月,(14. 4±8. 3)月,均无局部复发及远处转移,腹壁穿刺孔无肿瘤种植,吻合口无狭窄。结论完全腹腔镜下改良三角吻合技术安全可行,而且创伤小,手术时间短,术后恢复快,近期手术效果令人满意。     

经脐入路和传统腹腔镜经腹腹膜前腹股沟疝修补术的比较

目的 比较经脐入路腹腔镜和传统腹腔镜经腹腹膜前腹股沟疝修补术(transabdominal preperitoneal prosthesis, TAPP)的临床效果。方法 对2020年1月～2021年6月我科64例腹股沟疝进行回顾性分析，由患者选择手术方式，行经脐TAPP和传统TAPP各32例。比较2组手术时间、术中出血量、术后24 h切口疼痛评分、术后住院时间、住院费用、术后并发症发生率、切口满意度评分及复发情况。结果 经脐组手术时间显著长于传统组[(94.3±10.7) min vs.(60.4±4.4) min,t=16.593,P=0.000],但术后切口疼痛评分低[(1.3±0.5)分vs.(3.1±0.7)分，t=-12.647,P=0.000],术后住院时间短[(1.7±0.7) d vs.(4.3±1.0) d,t=-12.149,P=0.000],住院费用低[(16.0±0.6)千元vs.(18.5±0.7)千元，t=-15.594,P=0.000],切口满意度评分高[(12.8±1.1)分vs.(8.6±1.5)分，t=12.635,P=0.000]。2组术中出血量...     

Surgical device closure a new technique of ASD closure

Background Conventional approach of atrial septal defect (ASD) closure with cardio pulmonary bypass using mid sternotomy, minimally invasive or endoscopic technique is time tested. We decided to use custom made device with direct minimally invasive approach without cardio pulmonary bypass. Percutaneous transfemoral route using custom made device is a well established procedure performed by interventional cardiologist with occasional trauma and vessels. Method We performed the procedure in 3 patients of secundum ASD deemed adequate for device closure. We used a mini Right anterior thoracotomy approach using a double umbrella device which was implanted through direct Right Atrial puncture. Results In two patients we were successful in deploying the device. The proedure lasted 30 minutes with small infra Mammary scar and the post operative period was uneventful. In the third case where our attempt at surgical device closure failed the inferior margin was only one mm. The optimal size device kept slipping into the right atrium when the guide-wire was tugged after final deployment. The placement of an oversize device distorted the mitral valve, may causing regurgitation. Conclusion We think that this is a simple and safe technique of secundum ASD closure without cardio pulmonary bypass.     

渐进性关腹术：一种新的暂时性腹腔关闭术后早期确定性腹壁关闭技术

正损害控制性剖腹术提出已经近30年,随着负压封闭引流辅助的暂时性腹腔关闭(temporary abdominal closure,TAC)技术的发展和成熟,TAC显著改善了腹腔间隙综合征、严重腹部创伤和腹腔感染等患者的全身血液灌注和脏器功能,降低了病死率~([1-2])。虽然临床高度重视开放腹腔术后的早期腹部切口确定性关闭,但仍然有10%～25%的患者需要植皮形成计划性腹疝(planned ventral hernia,PVH)~([3]),这些患者需要在6～12个月后行确定性腹壁重建,常需应用腹壁分离技术~([4])或生物补片~([5])等人工材料,可能发生肠瘘、切口感染等并发症,     

Pericardial closure

Closure of the pericardium after operation for coronary bypass is recommended. It affords protection for the right ventricle and overlying bypass grafts if repeat sternotomy is necessary, and may decrease the incidence of tamponade. A mild compressive effect on the heart has been noted at the time of pericardial closure that does not appear to affect clinical outcome. Hemodynamic studies support this impression. The supracardiac portion of this layer is not closed, and permits use of internal mammary artery conduits. Pericardial closure is not feasible in all instances, however. The need for increased filling pressures, the anticipation of cardiac rather than mediastinal postoperative bleeding, and occasional interference with the course of internal mammary pedicles may preclude closure.     

Colostomy closure

One hundred and forty-seven colostomies were closed in 146 patients at Wellington Hospital between 1 January 1978 and 1 January 1987. The majority of stomata were formed in patients with colorectal cancer. At least one additional significant procedure was undertaken at the time of stoma closure in 10 patients. The overall complication rate was highest in those patients undergoing closure of a sigmoid end-colostomy (50%). Three complications resulted in death (2%). Twenty-four patients (16.3%) developed wound infections. Five patients developed 'leaks' (3.4%). The use of prophylactic antibiotics appeared to reduce the rate of infection significantly. The highest rates of wound infection and leakage occurred in patients in whom drains were used. Wound infections increased hospital stay. Thirty-one non-bowel or wound-related complications occurred in 25 patients.     

Use of dynamic wound closure system in conjunction with vacuum-assisted closure therapy in delayed closure of open abdomen

Aim

Definitive abdominal closure may not be possible for several days or weeks after laparotomy in damage-control surgery, abdominal compartment syndrome and intraabdominal sepsis, until the patient has stabilized. Vacuum-assisted closure (VAC therapy^®, KCI, San Antonio, TX, USA) and abdominal re-approximation anchor system (ABRA, Canica, Almonte, Ontario, Canada) are novel techniques in delayed closure of open abdomen. Our aim is to present the use of these strategies in the management of 7 patients with open abdomen.

Methods

Between August 2010 and December 2011, 7 patients with severe peritonitis were stabilized by laparotomy and treated with either ABRA system or ABRA system in conjunction with VAC dressing. VAC dressing applied to 4 patients initially and followed by ABRA. ABRA was applied alone to remaining 3 patients. Demographic data and patient characteristics, timing of VAC dressing and ABRA system were recorded. ICU and hospital stay and development of incisional hernia were also recorded. Stage of open abdomen, width of abdominal defect, extent to damage to fascia, and pressure sores were staged.

Results

The mean duration with VAC dressing before ABRA application was 18 days. The mean duration of ABRA application was 53 days. The average width of the abdominal defect was 18 cm. The average length of defect was 20.8 cm. Delayed primary abdominal closure was accomplished in 6 patients without further surgery. Incisional hernia with a small abdominal defect developed in 2 patients.

Conclusion

Abdominal re-approximation anchor system and VAC dressing can be used separately or in conjunction with each other for closure of delayed open abdomen successfully.     

Complications following colostomy closure --resection or extraperitoneal closure?]

At the Surgical Clinic of the University Erlangen-Nürnberg 213 colostomies in the period between 1961 and 1971 have been closed. In 88 patients an extraperitoneal procedure and in 125 patients a resection was performed. We recommend resection, because complications (first of all leakage) have been observed less often than in the extraperitoneal method.