前列腺解剖位置观察及经直肠局部药物注射治疗慢性前列腺炎的临床分析

目的观察前列腺解剖位置,并探究经直肠局部药物注射治疗慢性前列腺炎的效果。方法选取15侧男性盆腔标本,对解剖结构及相关数据进行观察与测量,并选取2018年4月至2019年4月本院收治的94例慢性前列腺炎患者为研究对象,按照电脑随机法分为对照组与研究组,各47例。对照组予以静脉药物注射治疗,研究组予以直肠局部药物注射治疗,比较两组治疗效果,包括总有效率、症状评分、生活质量等。结果治疗后,直肠前壁距离前列腺后壁为(5.67±0.65)mm、可进针范围及深度分别为(15.23±1.29)mm、(5.63±0.87)mm,其中,可进针位置距离肛门皮肤35~47 mm。研究组总有效率为93.62%,高于对照组的74.47%,差异有统计学意义(P<0.05);研究组NIH-CPSI评分低于对照组,生活质量总评分明显高于对照组,差异均有统计学意义(P<0.05)。结论结合慢性前列腺炎结构特点,予以直肠局部药物注射治疗,疗效显著,且有助于改善症状体征,提高患者生活质量,值得临床推广。     

超声引导下平面外法桡动脉成功置管和并发症的相关因素

目的 寻找超声引导下平面外技术桡动脉置管成功及并发症可能的相关因素。方法 采用多因素Logistic回归分析方法,分析131例使用动态针尖定位法(DNTP) 或角度距离法(AD)行超声引导下平面外技术桡动脉置管的择期手术患者的临床资料,确定一次成功、总体成功、动脉后壁穿透和局部血肿的相关因素。结果 桡动脉前壁深度≥3 mm是穿透后壁(OR=0.314,95%CI:0.143~0.691,P=0.004)和局部血肿(OR=0.250,95%CI:0.107~0.585,P=0.001)的相关因素。使用DNTP方法是穿透后壁(OR=0.303,95%CI:0.138~0.667,P=0.003)的相关因素。结论 超声引导下平面外法动脉穿刺置管时,在桡动脉前壁深度≥3 mm的部位穿刺可以减少穿透后壁和局部血肿的发生率。与AD法相比,DNTP法可减少穿透后壁发生率。     

The Anatomic Study on Replacement of Artificial Atlanto-odontoid Joint through Transoral Approach

In order to provide anatomical basis for transoral approach(TOA) in dealing with the ventro lesions of craniocervical junction,and the design and application of artificial atlanto-odontoid joint,microsurgical dissecting was performed on 8 fresh craniocervical specimens layer by layer through transoropharyngeal approach.The stratification of posterior pharyngeal wall,course of ver-tebral artery,adjacent relationship of atlas and axis and correlative anatomical parameters of replacement of artificial atlanto-odontoid joint were observed.Besides,32 sets of atlantoaxial joint in adults' fresh bony specimens were measured with a digital caliper and a goniometer,including the width of bony window of anterior arch of atlas,the width of bony window of axis vertebra,the distance between superior and inferior two atlas screw inserting points,the distance between two axis screw inserting points etc.It was found that the width of atlas and axis which could be exposed were 40.2±3.5 mm and 39.3±3.7 mm respectively.The width and height of posterior pharyngeal wall which could be exposed were 40.1±5.2 mm and 50.2±4.6 mm respectively.The distance between superior and inferior two atlas screw inserting points was 28.0±2.9 mm and 24.0±3.5 mm respectively,and the distance of bilateral axis screw inserting points was 18.0±1.2 mm.The operative exposure position through TOA ranged from inferior part of the clivus to the superior part of the C3 vertebral body.Posterior pharyngeal wall consisted of 5 layers and two interspaces:mucosa,submucosa,superficial muscular layer,anterior fascia of vertebrae,anterior muscular layer of vertebrae and posterior interspace of pharynx,anterior interspace of vertebrae.This study revealed that it had the advantages of short operative distance,good exposure and sufficient decompression in dealing with the ventro lesions from the upper cervical to the lower clivus through the TOA.The replacement of artificial atlanto-odontoid joint is suitable and feasible.The design of artificial atlanto-odontoid joint should be based on the above data.     

B超对先天性肛门闭锁的诊断价值

目的应用B超对先天性肛门闭锁进行定位诊断.方法肛区直肠部位作矢状切面探查.合并会阴瘘和舟状窝瘘患儿经瘘管插管向直肠内注水,再观察直肠盲端与皮肤之间的距离.结果B超检查24例患儿直肠盲端距肛区皮肤距离,误差≤0.5 cm20例,＞0.5 cm4例,超声诊断符合率83%.结论B超能准确诊断先天性肛门闭锁,并能测量直肠盲端与皮肤间的距离,为手术方式的选择提供可靠依据.     

SURGERY FOR COMPLETE RECTAL PROLAPSE: A SIMPLIFIED APPROACH

Complete prolapse of rectum (procedentia) is said to occur when the full circumference of the rectal wall is everted through the anus. Numerous techniques have been developed in order to treat procedentia, an uncommon pathology that is managed occasionally by the general surgeon. A simple, safe and effective procedure is recommended for surgeons who treat procedentia recti once in a while. We describe a simple rectopexy procedure which has been used effectively in 38 patients in the last 10 years. In this prospective study we evaluated the results which are comparable to other standard operative techniques in terms of morbidity, anatomic correction and bowel function. This technique is based on sound scientific principles in the aetiopathogenesis of rectal prolapse. This procedure obliterates the abnormally deep cul de sac of rectovesical pouch and supports the anterior rectal wall by suturing it to the bladder base to prevent initiation of sliding herniation of anterior rectal wall, which causes procedentia recti. Posterior dissection fibrosis fixes the posterior rectal wall to the sacrum after healing and restores the normal posterior curve of rectal canal and corrects the pathogenic straightening of rectum which promotes prolapse. Minimal mobilization of rectum is done and lateral ligaments are not dissected hence all attendant complications e.g. impotence, urinary incontinence, constipation etc are avoided. Simplicity, effectiveness, safety and non requirement of prosthetic material makes it an ideal operation suitable for a general surgeon working in the periphery.KEY WORDS: Procedentia, Rectopexy     

内耳门及周围结构的显微解剖及神经内镜解剖研究

OBJECTIVE: To observe the morphology of the internal auditory meatus in relation with its surrounding structures in Chinese people, for the purpose of providing microanatomical reference for surgeries adopting retro-sigmoid approach. METHODS: The retro-sigmoid surgical approach was simulated on 5 fresh specimens of human head, in which the internal auditory meatus and its surrounding structures were observed through a neuroendoscope and a surgical microscope. The distances from the posterior inferior edge of the internal auditory meatus to the central point of the posterior edge of the sigmoid sinus and to the posterior edge of the posterior semicircular canal were measured. RESULTS: The internal auditory meatus was located at the center of the medial surface of the petrous bone, and the cranial nerve VII ran through its anterior-superior part while the cranial nerve VIII through its posterior-inferior part. After forming an arterial loop at the internal auditory meatus, the anterior-inferior cerebellar artery branched into 1 to 3 internal auditory arteries. The distance from the posterior-inferior edge of the internal auditory meatus to the central point of the posterior edge of the sigmoid sinus was 32.15+/-1.76 mm on the left side, and 33.34+/-1.57 mm on the right, and the distance to the posterior edge of the posterior semicircular canal was 12.51+/-2.15 mm on the left side, and 13.26+/-2.44 mm on the right. CONCLUSION: Thorough knowledge of the microanatomy of the internal auditory meatus and its surrounding structures is of crucial importance to preserve the functions of the cranial nerves VII and VIII in the surgical removal of acoustic neuroma.     

小针刀治疗神经根型颈椎病后侧入路的研究

为探讨小针刀治疗神经根型颈椎病的手术入路和安全性,对20具成年尸体,用人体测量仪测量后正中线旁开15mm,小针刀水平进入到椎间关节囊后壁的距离(AB),进针点到颈前缘的水平距离(AC),求Y=AB/AC,解剖测量椎间关节囊内侧缘间距、外侧缘间距,测量数据说明小针刀治疗神经根型颈椎病是安全有效的。     

胫后动脉的解剖学测量

目的 测量胫后动脉的内径、外径及血管壁厚度,为临床介入治疗下肢尤其膝下动脉闭塞提供解剖学依据.方法 用体视显微镜分组测量30具标本,记录60侧胫后动脉的近端(内踝最高点上5 cm)、中点(内踝最高点)、远端穿踝管后(足底内、外侧动脉分支前)内外径及动脉壁厚度.按年龄分为3组:青年组(年龄30岁以下,n=16);中年组(年龄30～50 岁,n=26);老年组(年龄50岁以上,n=18),并进行性别、年龄、侧别的比较.采用PEMS3.0进行统计学分析.结果 胫后动脉中点的外径(2.74±0.51)mm,内径(1.29±0.47)mm,管壁厚度(0.62±0.18)mm,与近、远端比较,三组数据差异均有统计学意义.两侧的远、中、近三处胫后动脉的内、外径及管壁厚度值无显著差异;男性管壁厚度大于女性;50岁以上者的外径及管壁厚度大于中、青年组.结论 本研究提供了胫后动脉解剖学相关资料及数据比较、分析,其结果为临床对胫后动脉穿刺置管术的开展与应用提供了参考依据.     

Left atrial wall thickness: anatomic aspects relevant to catheter ablation of atrial fibrillation

Background  The success and complication rates of atrial fibrillation (AF) ablation may be related to regional differences in left atrial (LA) wall thickness. The purpose of this study was to investigate the transmural LA wall thickness in various regions.

Methods  We measured LA wall thickness in 36 human heart specimens using calipers at three planes including left pulmonary veins (PVs) vestibule plane, right PVs vestibule plane and the middle plane between the two. In each plane, eight points were selected, including superior, middle and inferior levels at anterior and posterior wall, roof and bottom.

Results  The anterior and posterior wall thickness displayed gradient from superior to inferior level (anterior wall: (2.73±1.01) mm, (2.08±0.91) mm and (1.54±0.69) mm; posterior wall: (1.74±0.68) mm, (1.48±0.39) mm and (1.27±0.42) mm). At the roof, LA wall thickness was thickest in middle plane ((2.01±1.02) mm) and was thinnest in left PVs vestibule plane ((1.29±0.41) mm). The posterior wall thickness in left PVs vestibule plane was thinner than in the other two planes (P <0.05–0.001), and was thinner in right PVs vestibule plane than in middle plane (P <0.01–0.001). Whereas in anterior wall, the wall thickness in left PVs vestibule plane was thicker than in middle and right PVs vestibule plane.

Conclusions  Significant variations exist for mean LA wall thickness at different regions which are often targeted during circumferential pulmonary venous ablation (CPVA). Appreciating these differences may have significant implications in catheter ablation of AF.

     

蝶窦的解剖及其在经单鼻孔蝶窦入路的应用

OBJECTIVE: To study the anatomy of the sphenoid sinus for safe pituitary adenoma resection via transsphenoidal approach through a single nostril. METHODS: Eight fresh adult cadavers and the magnetic resonance images (MRI) of the sphenoidal sinus of 5 adults were observed. In anteroposterior axes, the root of the nasal columella was defined as the point O, the inferior border of the sphenoidal sinus anterior wall as point B, the superior border of the spheniodal sinus anterior wall as point C, and the midpoint of the sellar floor as point D. Line OA ran through the point O in parallel with the maxillary alveolar process. Angle AOB', angle AOC' and angle AOD' were the supplementary angles of angle AOB, angle AOC and angle AOD respectively, and angle AOB', angle AOC', angle AOD', OB, and BC were measured. RESULTS: In the 8 fresh adult cadavers, angle AOB', angle AOC', angle AOD', OB, and BC were (43.2+/-4.3) degrees, (22.9+/-3.0) degrees, (35.4+/-4.1) degrees, 66.3+/-3.6 mm, and 20.9+/-1.5 mm, respectively, with 2 cases having ethmoid cell superior to the sphenoid bone; in the MRI of 50 adults, the measurements were (44.1+/-5.5) degrees, (25.7+/-6.4) degrees, (34.2+/-5.9) degrees, 68.7+/-4.9 mm, and 23.3+/-3.1 mm, respectively, with 15 cases having ethmoid cell superior to the sphenoid bone. Two independent-sample t test and Chi-square test revealed no significant differences in the measurements between the two groups (P>0.05). CONCLUSION: Preoperative MRI facilitates safe opening of the anterior wall of the spheniodal sinus and the sellar floor, and the best angle between the axis of the speculum and line OA was 39 degree.