大网膜包裹胰肠吻合口在胰十二指肠切除术中的应用体会

目的 探讨采用大网膜包裹胰肠吻合口方法预防胰十二指肠切除术后胰瘘的效果。方法 回顾性分析江门市中心医院肝胆胰脾外科自2018年1月至2020年12月78例行胰十二指肠切除术患者的临床资料,其中38例胰十二指肠切除联合大网膜包绕胰肠吻合口（包绕组）,40例仅行胰十二指肠切除术（未包绕组）,比较两组术前、术中、术后相关临床指标。结果 两组患者年龄、性别、术前白蛋白、术前总胆红素、胰腺质地、胰管直径和手术时间差异均无统计学意义（均P>0.05）。虽然术后两组的胰漏发生率差异无统计学意义,但包绕组术后胰漏分级均为A级胰漏,未见B、C级胰漏,而未包绕组A级胰漏2例,B级胰漏5例,C级胰漏1例,差异具有统计学意义（P=0.003）;术后包绕组出现2例胃排空延迟,而未包绕组出现1例胆漏,5例术后出血,3例胃排空延迟,除了1例术后腹腔出血需行介入治疗外,其余患者均予以保守治疗而治愈,两组差异无统计学意义（P=0.231）;术后住院时间（1.5±3.0天 vs. 17.4±6.8天,P<0.001）及住院费用（106442±16230 vs. 129831±35875元,P<0.001）包绕组较为包绕组明显减少（P<0.05）。结论 采用大网膜包绕胰肠吻合口方法可以减轻胰十二指肠切除术后胰瘘程度,促进术后胰漏愈合,未增加腹腔感染、腹腔脓肿、胃排空延迟等严重并发症发生,且可减少住院时间及住院费用,且方法简单、易操作。     

复位股骨大粗隆顶点骨折对PFNA治疗不稳定股骨粗隆间骨折预后的影响

目的评估应用股骨近端防旋髓内钉（PFNA）内固定治疗合并股骨大粗隆顶点局部骨折的不稳定股骨粗隆间骨折术中将股骨大粗隆顶点局部骨折复位对预后的影响。方法合并股骨大粗隆顶点局部骨折的不稳定股骨粗隆间骨折46例,股骨大粗隆顶点局部骨折复位固定26例（复位组）,未复位固定20例（未复位组）。比较2组手术时间、术中出血量、术后第2天血红蛋白及白蛋白水平、骨折愈合时间、术后并发症及末次随访时髋关节功能Harris评分。结果复位组较未复位组手术时间更长、术中出血量更多,差异有统计学意义（P〈0.05）;但复位组在术后并发症及末次随访时髋关节的功能恢复方面明显优于未复位组,差异有统计学意义（P〈0.05）;而2组在骨折愈合时间、术后第2天血红蛋白及白蛋白水平方面差异无统计学意义（P〉0.05）。结论复位固定移位的股骨大粗隆顶点骨折能够提高PFNA主钉进针定位的准确性,降低股骨大粗隆外侧壁继发性骨折的发生率,改善术后髋关节功能,减少术后隐性出血量。     

空心螺钉与锁定钢板内固定治疗移位肱骨大结节骨折的效果比较

目的比较空心螺钉内固定与锁定钢板内固定治疗移位肱骨大结节骨折的临床效果。方法回顾性分析2013年6～12月在本院进行治疗的移位肱骨大结节骨折患者43例的临床资料,其中21例患者采用空心螺钉内固定治为空心螺钉组,22例患者采用锁定钢板内固定治疗为钢板组。比较两组的临床疗效。结果两组的手术时间、术中出血量、术后骨折愈合时间比较,差异无统计学意义（P〉0.05）;术后3、6个月两组优良率比较,差异无统计学意义（P〉0.05）。结论空心螺钉内固定和锁定钢板内固定治疗移位肱骨大结节骨折均具有较好的临床疗效,在临床工作中应综合考虑,选择合适的手术方法。     

Sympathetic nerve tissue in milky spots of the human greater omentum

Omental milky spots (OMSs), small lymphoid structures positioned in the greater omentum, are involved in peritoneal immune homeostasis and the formation of omental metastases. Sympathetic nerve activity is known to regulate immune function in other lymphoid organs (e.g. spleen and lymph nodes) and to create a favourable microenvironment for various tumour types. However, it is still unknown whether OMSs receive sympathetic innervation. Therefore, the aim of this study was to establish whether OMSs of the adult human greater omentum receive sympathetic innervation. A total of 18 OMSs were isolated from five omenta, which were removed from 3% formaldehyde-perfused cadavers (with a median age of 84 years, ranging from 64 to 94). OMSs were embedded in paraffin, cut and stained with a general (PGP9.5) and sympathetic nerve marker (TH and DBH), and evaluated by bright field microscopy. A T-cell, B-cell, and macrophage staining was performed to confirm OMS identity. In 50% of the studied OMSs, sympathetic nerve fibres were observed at multiple levels of the same OMS. Nerve fibres were represented as dots or elongated structures and often observed in relation to small vessels and occasionally as individual structures residing between lymphoid cells. The current study shows that 50% of the investigated OMSs contain sympathetic nerve fibres. These findings may contribute to our understanding of neural regulation of peritoneal immune response and the involvement of OMSs in omental metastases.     

Kocher-Langenbeck入路加大转子截骨治疗髋关节后脱位并髋臼后柱(壁)骨折

目的探讨应用Kocher-Langenbeck入路加大转子截骨手术治疗髋关节后脱位并髋臼后柱(壁)骨折的手术方法和疗效。方法收集14例采用Kocher-Langenbeck入路结合大转子截骨手术治疗的髋关节后脱位并髋臼后柱(壁)骨折病例,分析其手术方法、术中情况及术后恢复情况。结果平均手术时间为105 min,术中平均出血量为600 mL。术后解剖复位5例,良好复位8例,复位不满意1例。临床效果优7例,良4例,可3例。3例出现异位骨化,4例发生创伤性关节炎。髋臼后柱(壁)、大转子截骨断端均骨性愈合,无医源性坐骨神经损伤及股骨头缺血坏死。结论应用Kocher-Langenbeck入路加大转子截骨治疗髋关节后脱位并髋臼后柱(壁)骨折,术中显露情况良好,有利于骨折、脱位的复位及固定。     

Peripheral blood lymphocyte subsets (CD4+, CD8+ T cells), leptin level and weight loss after laparoscopic greater curvature plication in morbidly obese patients

Introduction

The aim of the study was to detect the effect of laparoscopic greater curvature plication (LGCP) on peripheral blood lymphocyte subsets (helper and cytotoxic T lymphocytes – CD4+ and CD8+ T cells respectively), leptin level and weight loss in morbidly obese patients.

Material and methods

Morbidly obese patients (n = 20, age range: 25–50 years, body mass index (BMI) range: 37–45 kg/m²) who underwent LGCP were enrolled in a prospective study to determine the percentages of their peripheral blood T cells (CD4+ and CD8+) before and 4 months postoperatively using flow cytometry. Also, the level of their leptin before and 4 months postoperatively was established using enzyme-linked immunosorbent assay (ELISA). The data are expressed as the percentage of total lymphocytes ± the standard error of the mean.

Results

A decrease in the BMI and loss of weight (31.20 ±1.2%) were confirmed 4 months postoperatively since BMI was 44.71 ±4.3 (range: 37–45) kg/m² preoperatively, and decreased to 31.80 ±1.1 (range: 24–33) kg/m² after surgery. The mean percentage of CD4+ and CD8+ T lymphocytes significantly decreased postoperatively (38.2 ±1.5 before and 29.3 ±2.6 after operation for CD4+, 17.3 ±1.8 preoperatively and 9.5 ±1.7 postoperatively for CD8+, p < 0.05). The mean leptin level was 43.01 ±22.01 preoperatively while postoperatively it was 24.8 ±11.1 (p < 0.05), so the leptin level substantially decreased compared to its preoperative values.

Conclusions

This study found that weight loss after LGCP in morbidly obese patients led to decreases in levels of leptin and circulating immune cells compared to their preoperative values.     

The hip abductors at MR imaging

Imaging of the hip abductors plays an increasing role for the evaluation of greater trochanteric pain in patients with and without total hip arthroplasty. This review article addresses the anatomy of the hip abductors and their intervening bursae. It highlights different possible imaging appearances such as tendinopathy or partial and full thickness tears of the gluteal tendons. Muscle atrophy or fatty degeneration of the gluteal muscles is an important reason for limping. Inflammatory diseases such as hydroxyapatite crystal deposition disease or spondylarthritis have to be considered. Knowledge of these different entities is important to achieve optimal treatment and outcomes.     

小切口加可吸收螺丝钉治疗肱骨节骨折

目的探讨小切口加可吸收螺丝钉治疗肱骨大结节骨折的临床疗效。方法回顾分析2002年10月至2005年11月41例应用可吸收钉治疗肱骨大结节骨折，术后评价：肩关节功能进行评价分析。结果41例患者经6月～14月随访，平均9个月，根据Neer关节功能评定标准，优36例，良3例，可2例，优良率95．12％。结论该方法具有固定可靠，创伤小，骨折愈合快，避免二次手术的优点。     

Idiopathic segmental infarction of the greater omentum successfully treated by laparoscopy: Report of case

(Received for publication on Feb. 12, 1999; accepted on Nov. 11, 1999)