5例胸腰段脊柱前路手术并发症分析

目的：分析胸腰段脊柱前路手术入路并发症，以提高胸腰段脊柱前路手术的水平，方法：对近4年来我科53例胸腰段脊柱前路手术出现的5例并发症进行回顾性分析，探讨并发症发生的原因。结果；本组病例1例发生腹膜后乳糜液漏，1例切口疝，1例气胸，2例深静脉血栓栓塞，经过积极治疗，全部治愈。结论：胸腰段脊柱前路手术并发症的发生大多数和术者对该段解剖知识，手术操作，认识程度和经验有关，可以避免或及早发现。     

Specific selection of osteosynthetic material in the treatment of thoracic or lumbar spinal injuries by the posterior approach

Summary The authors report 165 cases of thoraco-lumbar lesions with neurological dysfunction. All the patient were operated. They analyze the neurological and mechanical results and indicate the use of different osteosynthesis apparatus according to the type and level of lesions.Harrington's rods seem to give more precise repositioning while Roy Camille's plates give more stability. When the posterior wall of the spinal canal is intact, Kempf's compression rods can be used.Thoraxic spine injuries seem to be an indication for Harrington's rods, while lumbar injuries seem to call for Camille's plates.     

Counterfactual (‘if only’) thinking in women with chronic widespread pain

The study explored the counterfactual thinking that women with chronic and widespread pain showed in response to what they themselves considered to be particularly stressful situations. Counterfactual thinking in 125 women sick‐listed due to chronic and widespread pain was investigated in terms of structure, function and control focus. The women were asked, for each of three types of problems that they indicated in a questionnaire to affect them most strongly, to describe a typical occurrence of it and to complete a counterfactual sentence in connection with it of the type ‘If only . . .’. The majority of counterfactuals pertained to predominantly somatic problems (e.g. musculo‐skeletal problems, pain and fatigue) classified as being affective rather than preparative and self‐focused rather than external, whereas in counterfactuals relating to predominantly psychological/psychosocial problems a preparative function and an external focus were more prominent. The numbers of problems listed and the numbers of situations responded to counterfactually were positively correlated. The counterfactuals, although often related to somatic problems, generally concerned psychological or psychosocial matters such as finances and paid or unpaid work. A contextual approach to elucidating counterfactual thinking based on subjects' own experiences is seen as providing valuable insight into what bothers them most. Copyright © 2006 John Wiley & Sons, Ltd.     

Traumatic Injury of the Superior Mesenteric Vein: Ligate,Repair or Shunt?

Abstract We report a case of SMV injury in a critically ill patient. The patient was a 19-year-old woman involved in a motor vehicle collision. Her injuries included grade II splenic and renal lacerations, devascularized and lacerated right and transverse colon, a transected transverse mesocolon, a massive shear injury of her abdominal wall, and two partial SMV transections. At initial damage control laparotomy, the SMV was ligated, the devascularized bowel resected and a temporary abdominal closure applied. At re-operation, a mesocaval shunt using saphenous vein was employed. The shunt failed and the patient required a saphenous vein jump graft. Although visceral vascular injuries are rare, ligation of the SMV in a damage control situation is acceptable. This case study is the first to discuss appropriate treatment when interruption to a patient's collateral visceral venous drainage limits the surgeon’s ability to ligate. In these situations, bypass shunts may be successful.     

多层螺旋CT扫描图像数据对经蝶窦入路穿刺三叉神经节及其分支的可行性研究

目的 探讨经蝶窦入路穿刺三叉神经节及其分支的可行性,分析两者的毗邻关系及相关限制因素.方法 对110例成年中国人头部薄层CT轴位原始资料进行多平面重组,观察圆孔、卵圆孔、翼腭窝（管）、Meckel腔与蝶窦外侧壁的关系,测量蝶窦外侧壁至诸结构的骨壁厚度.结果 ①圆孔紧靠蝶窦外侧壁的前外下方,骨壁厚度＜2 mm者84例（76%）;②重组图像可显示翼腭管全程,翼腭窝与蝶窦前下外侧壁之间的骨壁厚度＜2 mm者77例（70%）;③卵圆孔距离蝶窦外侧壁距离＞5 mm 98例（89%）;④由蝶窦腔内经颈内动脉管前方入路,斜向后下外方可及Meckel腔,骨壁厚度1～5 mm,颈动脉管为重要骨性标志.结论 经蝶窦内可分别穿刺或开放圆孔、翼腭窝和Meckel腔,而经蝶窦内穿刺卵圆孔基本不可行;经蝶窦入路至三叉神经节及其分支的可及性与蝶窦气腔的位置和扩展程度有关.     

复方川脊片对兔颈椎病模型椎动脉基质金属蛋白酶-2的干预作用

目的:探讨基质金属蛋白酶-2(MMP-2)在椎动脉血管表达的意义及复方川脊片的干预效果。方法:40只兔随机分为正常组,模型组,颈复康组,复方川脊片组。硬化剂注射法造模,4周后,模型组,颈复康组及川脊片组分别以生理盐水、颈复康及川脊片混悬液灌胃。治疗4周后检测椎动脉血管搏动指数,全血黏度及血浆黏度,椎动脉血管MMP-2的表达。结果:与正常组相比模型组搏动指数提高,全血黏度及血浆黏度增加,MMP-2表达增多(P<0.05);与模型组相比,治疗组搏动指数降低,全血黏度及血浆黏度降低,MMP-2表达较少(P<0.05)。结论:部分的抑制MMP-2在椎动脉的表达可能是复方川脊片治疗颈椎病的机制之一。     

扩大经鼻蝶入路海绵窦的内镜解剖研究

目的通过对扩大经鼻蝶窦入路的内镜解剖学研究,为临床应用提供形态学基础.方法在10具动脉灌注染料的成人尸头上模拟扩大经鼻蝶窦手术入路,测量海绵窦内重要结构与鞍底的距离.结果扩大经鼻蝶手术入路可清晰显示鞍底的骨膜、硬脑膜外层、海绵窦内侧壁,及海绵窦内的颈内动脉及其分支血管、动眼神经、滑车神经、展神经及视神经等结构.结论内镜下行扩大经鼻蝶手术入路可清晰显露海绵窦及其内的解剖结构,适用于鞍内病变侵犯海绵窦的外科治疗.     

Elective laparoscopic-assisted colectomy for sigmoid diverticulitis.

OBJECTIVES: The aim of this study was to evaluate the safety and effectiveness of laparoscopic-assisted sigmoid colectomy for diverticulitis and to assess its postoperative advantages. METHODS: From 1999 to 2001, 5 patients were selectively operated on with a laparoscopic-assisted procedure for uncomplicated sigmoid diverticulitis. In the preceding period (September 1997 through December 1998), 4 patients underwent open procedures for the same pathology. The surgical indication with the same criteria was restrictive: at least 2 acute episodes had occurred that were treated with hospital admission and that were separated by an adequate period (2 months) of medical therapy. RESULTS: No conversions of laparoscopy to an open procedure were necessary. Age, sex, weight, morbidity, and mortality were similar between the 2 groups. Operative time was 180 minutes for laparoscopy and 120 minutes for laparotomy. Postoperative resumption of peristalsis was 24 hours versus 4 days, resumption of alimentation was on the second postoperative day versus the fifth postoperative day, and hospital stay was 7 days versus 12 days for laparoscopy and laparotomy, respectively. CONCLUSION: This study shows the feasibility and the advantages of elective laparoscopic-assisted colonic resection for uncomplicated sigmoid diverticulitis. The advantages of the laparoscopic approach are the lower need for analgesics and the more precocious ambulation, canalization, resumption of alimentation, and the shorter hospital stay.     

胸椎骨折合并胸外伤的外科治疗

目的　总结 17例胸椎骨折患者的特点与诊疗情况 ,为提高此类合并胸外伤患者的疗效提供有效的治疗方案。方法　分析了 17例胸椎骨折患者的临床特点、诊疗经过、近远期随访结果。结果　 14例 (82 .4 % )合并肋骨骨折 ,11例 (6 4 .7% )合并血气胸 ,10例 (5 8.8% )合并严重脊髓伤 ,3例 (30 % )远期脊髓伤为有用恢复。结论　胸椎骨折常合并肋骨骨折、血气胸、严重脊髓损伤 ,预后较差 ,为此应重视合并胸外伤的胸椎骨折的围手术期处理     

Greater curve approach for laparoscopic gastric bypass: total stapler gastrojejunostomy

BACKGROUND: Gastric bypass is an established bariatric procedure that has undergone multiple modifications to improve its effectiveness. The side-to-side stapled technique is well recognized, but closure of the gastrotomy/enterotomy by the stapler can potentially narrow the Roux limb. Because of this, many surgeons will hand suture the closure of the gastrotomy/enterotomy. To obviate this difficulty, we inserted the linear stapler from the stomach's greater curvature, using a double-stapled anastomosis that minimized the need for hand suturing. METHODS: We performed a retrospective analysis of 307 patients undergoing this technique for laparoscopic gastric bypass. The weight loss and 30-day morbidity and mortality were tabulated and compared with those in other published series. RESULTS: Of the 307 patients, none died postoperatively. The overall 30-day morbidity rate was 15%. Two leaks from the gastrojejunostomy and 2 from the jejunojejunostomy (1.2%) developed. The mean percentage of excess weight loss was 34% at 3 months, 52% at 6 months, 73% at 1 year, 71% at 2 years, and 69% at 3 years. CONCLUSION: The greater curve approach avoids Roux limb obstruction, minimizes the need for hand suturing, and uses standard trocar incisions. Our short-term follow-up results are similar to those of series of other techniques.