Indications for the use of temporary arterial occlusion during aneurysm repair: an institutional experience

This study was undertaken to determine variables that could predict, in the preoperative period, the likelihood for the need for intraoperative temporary arterial occlusion using clips (temporary clipping) when surgically repairing intracranial aneurysms. Data collected prospectively between October 1989 and March 2010 of 1129 unruptured intracranial aneurysms in 934 patients who were managed surgically was examined retrospectively. Temporary clipping was used in 400 patients (35.4%). Regression analysis of putative predictive variables revealed that aneurysms of a larger size, irregular fundus shape or midline location were more likely to be treated with temporary clipping.Basilar caput aneurysms larger than 10 mm were always managed with temporary clipping. There was no combination of factors studied that consistently predicted that temporary clipping would not be needed. Therefore, the potential need for temporary clipping must be considered for every patient with an aneurysm.     

我国肝癌诊断与治疗是否已到达外科4.0

探讨我国外科医师诊断与治疗原发性肝细胞癌(以下简称肝癌)是否已到达外科4.0。外科4.0是Hooshair A于2018年提出,主要是描述基于不同时期科学发现和应用推动外科发展的4个阶段:外科1.0(18―20世纪,外科科学期);外科2.0(1950―1980年,超大型手术和器官移植期);外科3.0(1980年至21世纪初,微创外科普及期)和外科4.0(21世纪初至今,数字外科期)。在医疗卫生领域中,数字科学的应用带来翻天覆地的改变。外科4.0主要是由大数据、人工智能、自动化、现代机器人和5G通讯五大科学推动,目前在外科领域初探成功,但在肝癌的诊断与治疗领域中,尚有很大发展空间。     

Fenestrated ASD Closure in a Child with Idiopathic Pulmonary Hypertension and Exercise Desaturation

Pulmonary arterial hypertension is a progressive disorder that may result in right heart failure and death. Atrial level shunts in the presence of pulmonary hypertension may allow right‐to‐left mixing with maintenance of cardiac output and improved survival. However, excessive mixing at the atrial level can cause undue systemic desaturation, increased fatigue and decreased exercise tolerance even in the presence of adequate cardiac output. A 5½‐year‐old was diagnosed with pulmonary hypertension, a large atrial septal defect and right‐to‐left shunting. Medical therapy over an 18‐month period was successful in decreasing pulmonary artery pressure and pulmonary vascular resistance. However, because of the size and position of the intracardiac defect, symptoms of fatigue, and severe systemic desaturation with only minor activities persisted. Fenestrated surgical closure of the defect was thus undertaken to decrease the degree of atrial mixing, but still allow atrial decompression if necessary. Subsequent hemodynamic evaluation has demonstrated continued improvement, and all previous symptoms have resolved. Repeated echocardiography has confirmed patency of the atrial fenestration with left‐to‐right atrial flow.     

Treatment of tophaceous gout: When medication is not enough

ObjectivesTo review the literature concerning surgical intervention of tophaeceous gout and propose clinical circumstances for when it may be considered.IntroductionTophi develop in approximately 12–35% of patients with gout. Tophaceous disease is usually preventable given the availability of effective urate lowering therapies (ULT) including allopurinol, febuxostat, probenecid, lesinurad, and pegloticase. Despite medical therapy, there remains a subset of patients who develop significant complications of tophi including infection, ulceration, and entrapment neuropathy. Tophi in close proximity to joints can cause joint instability, severely limited range of motion, and significant functional impairment. For the rare circumstance when a tophus is causing an urgent complication or if a patient has a contraindication to all available ULTs, surgery may be an appropriate option. This review summarizes the published experience with surgical interventions for tophaceous gout and offers recommendations for its consideration.MethodsUsing Medline and Google Scholar, all available series of surgery for tophaceous gout were reviewed.ResultsOverall, 7 published surgical series were identified. In all, 6 of these 7 series were published between 2002 and 2014. The reported outcomes of surgical interventions for tophaceous gout were generally positive without major post-surgical complications.ConclusionAlthough medical therapy with ULTs should be the first-line approach to tophaceous gout, surgery should be considered for the rare patient with impending or severe, debilitating complications including infections, entrapment neuropathy or those at risk for permanent joint destruction. In these selected clinical circumstances, surgical intervention for tophaceous gout may be appropriate.     

手术治疗159例肛瘘患者疗效观察

目的:探讨肛瘘切开手术半深缝合术的治疗效果。方法:将159例肛瘘单发患者随机分成3组,治疗组54例切开行半深缝合术治疗;对照1组48例行切开术,对照2组57例行切除1期缝合术;对治疗的时间和费用、瘢痕的宽度以及术后的并发症各方面综合比较分析。结果:三组全部治愈。各组间差异显著。结论:切开半深缝合治疗肛瘘时治愈的时间短且费用少,具有瘢痕小和并发症相对少的优势,术后无明显痛苦,处理也很简单,在肛瘘的治疗中是首选方案。     

肛裂后位切扩术与侧位切扩术疗效比较

目的探讨肛裂后位切扩术与侧位切扩术术式的临床选择,寻求肛裂的最佳手术方法。方法将120例肛裂患者随机分成Ⅰ组和Ⅱ组,Ⅰ组用肛裂后位切扩术治疗,Ⅱ组用肛裂侧位切扩术治疗,对两组患者的术后疗效、愈合时间、术后并发症等进行观察分析。结果后位切扩术组肛裂痊愈率为89.9%,显效率6.8%,有效率3.3%,总有效率100%;侧位切扩术痊愈率为77.1%,显效率1.6%,有效率11.5%,无效率9.8%,总有效率为90.2%。结论对于Ⅱ-Ⅲ期肛裂,尤其是合并皮下瘘管、肛乳头肥大等情况下首选后位切扩术;而侧位切扩术由于对肛管损伤小,痊愈时间短,故对于Ⅰ期肛裂患者可首选用侧位切扩术。在临床的选择应用上,应根据患者的具体情况,个体化制定手术方案,尽量减少手术创伤所带来的并发症。     

乳腺导管瘘40例外科治疗体会

目的:探讨手术切除瘘管治疗乳腺导管瘘的效果。方法:2002年1月～2008年1月,我院对40例乳腺导管瘘进行手术治疗。瘘管连同周围部分腺体切除35例,3例行瘘管所在象限腺体切除,2例行半乳切除。34例一期缝合,6例敞开换药。结果:40例随访3个月～6年,平均3年,一期缝合的34例中有5例复发,经敞开换药后治愈,余35例均一次性治愈。结论:瘘管切除术是治疗乳腺导管瘘的基本手术原则,在减少复发的前提下,为保持乳房外形的美观及缩短住院时间,尽量予以一期缝合。