New procedure for purse-string suture in thoracoscopic esophagectomy with intrathoracic anastomosis

Background In endoscopic surgery, one of the greatest problems is the difficulty with the reconstructive procedure. This problem frequently makes operating times longer. The authors have performed thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis for reconstruction using a circular stapler for the esophageal cancer. Although the circular stapler is a useful device for gastrointestinal anastomosis, it was difficult to place a purse-string suture and to fixate the anvil into the proximal esophagus endoscopically.Methods The authors devised a new procedure for the placement of the purse-string suture by using an Endo-Stitch device along with a new method to incise the esophageal wall and thereby facilitate fixation of the anvil.Results The authors attempted this procedure for five patients. The anastomoses were performed successfully.Conclusions The new procedure can make endoscopic intrathoracic anastomosis feasible and safe. In addition, this procedure can be applied widely to other endoscopic reconstructions.     

内口荷包缝合瘘管搔刮置管引流治疗复杂性肛瘘临床观察

目的评价内口荷包缝合、瘘管搔刮置管引流治疗复杂性肛瘘的疗效及可行性。方法将70例复杂性肛瘘患者随机分为两组,各35例。观察组采用内口荷包缝合、瘘管搔刮置管引流术;对照组采用挂线或切开等传统治疗方法。观察两组的疗效及可行性。结果 70例均获随访,两组患者治疗效果接近（P〉0.05）。观察组愈合时间为（14.46±3.58）d,短于对照组的（17.26±3.63）d（P〈0.01）。观察组术后肛门疼痛和肛门变形少于对照组（P〈0.05）,两组肛门狭窄情况对比差异无统计学意义。结论与传统术式相比,采用内口荷包缝合、瘘管搔刮置管引流治疗复杂性肛瘘具有微创、痛苦小、恢复快、并发症少等特点。     

阑尾切除残端荷包包埋与单纯结扎的效果分析

目的比较阑尾切除残端荷包包埋与单纯结扎的临床疗效。方法选择2010年1月～2012年1月在本院进行手术治疗的168例阑尾炎患者做为观察对象,随机将168例患者分成两组,观察组与对照组,每组84例,观察组患者的阑尾切除残端采用荷包包埋方法进行处理,对照组的阑尾切除残端采用单纯结扎的方法进行处理,比较两组患者手术中阑尾残端的处理时间及术后肛门排气时间、白细胞计数、体温恢复时间、住院天数及术后并发症发生率。结果观察组的阑尾残端处理时间为（5．4±1．5）min,对照组的阑尾残端处理时间为（1．6±0．9）min,观察组的时间明显比对照组长,差异有统计学意义（P〈0．01）;观察组的术后肛门排气时间为（1．7±0．8）d,白细胞为（5．7±1．4）×10^9g/L,体温恢复时间为（2．1±O．3）d,住院天数为（6．2±1．7）d,对照组的术后排气时间为（1．9±0．7）d,白细胞为（5．6±1．1）×10^9g/L,体温恢复时间为（1．9~0．1）d,住院天数为（6．1±1．9）d,两组比较,差异无统计学意义（P〉0．05）：观察组的并发症发生率为2-38％,对照组并发症发生率为4．76％,观察组的并发症发生率略低于对照组,差异有统计学意义（P〈0．01）。结论荷包包埋法处理阑尾切除残端的处理时间长,术后并发症略低,单纯结扎处理时间短,但技术要求高,且术后并发症较高,在临床实践中,术者可根据具体情况进行选择。     

招风耳伴耳垂前倾的改良矫正方法

目的探讨招风耳伴耳垂前倾的的一种改良手术治疗方法。方法对于招风耳耳廓部分应用Stenstrom技术和Mustarde褥式缝合法进行招风耳上半部分软骨矫正,对于耳垂前倾采用耳垂背面改良荷包缝合矫正。结果本组患者6例,均获得外形良好,自然逼真的耳廓形态。结论此方法,手术操作简单易行,效果良好。     

Comparison of a modified anoscope and the purse-string anoscope in stapled haemorrhoidopexy

AIM: To compare the results of the anoscope of the PPH kit and a modified anoscope during stapled haemorrhoidopexy.METHODS: The hospital records of 37 patients who underwent stapled haemorrhoidopexy between 2001 and 2006 were reviewed. The purse-string suture anoscope in the PPH kit was used on 15 patients (Group 1),and the modified anoscope was used on 22 patients(Group 2). Demographic characteristics of the patients,operation time, surgeon's performance, analgesic requirement, and complications were compared.RESULTS: Operation time was significantly longer in Group 1 (42.0±8.4 min vs 27.7±8.0 min, P = 0.039).The surgeons reported their operative performance as significantly better in Group 2 (the results of the assessments were poor in ten, medium in four and good in one in Group 1, while good in all patients in Group 2, P < 0.001). The need for haemostatic sutures was significantly higher in Group 1 (six cases) and was needed in two cases in Group 2 ( P = 0.034).CONCLUSION: Operation time decreased and the surgeon's satisfaction increased with use of the modified anoscope, and fewer haemostatic sutures were required if the surgeon waited longer before and after firing the stapler.     

Evidence-based adoption of purse-string skin closure for stoma wounds

BackgroundOpinion is divided on the optimal technique of skin closure after stoma reversal as most conventional techniques compromise either on speed/neatness of wound apposition or on the incidence of surgical site infection (SSI). Evidence suggests that purse-string skin closure (PSSC) may achieve both objectives. This study aims to compare conventional primary closure (PC) with PSSC to determine the efficacious technique for stoma wound closure.MethodsPatients undergoing stoma reversal between April 2015 and September 2017 were prospectively studied. Patients were divided into two groups based on the technique of skin closure (PC or PSSC). The following parameters were assessed: SSI, hospital stay, additional outpatient visit, wound healing time and patient satisfaction based on a standardised questionnaire.ResultsForty one patients underwent stoma reversal (20 PSSC vs 21 PC). Wound infection, need for wound care, length of hospital stay, healing time and scar size were significantly less, whereas average patient wound satisfaction scores were significantly more in the PSSC group.ConclusionPurse-string skin closure (PSSC) proves efficacious and hence merits adoption as the technique of choice for closure of stoma wounds.     

Pancreatogastrostomy with an elastic purse-string suture around the gastric orifice after pancreatoduodenectomy

Postoperative pancreatic fistula (POPF) is a potentially fatal complication of pancreatoduodenectomy (PD). Fixation of the remnant pancreas to the gastric wall is considered essential to prevent anastomotic leakage in patients undergoing pancreatogastrostomy (PG) after PD. PG was performed with invagination of the pancreatic stump. To limit the number of sutures in the pancreas parenchyma to three or four, we placed an elastic purse string suture around the orifice of the posterior gastric wall in an attempt to fix the gastric wall to the remnant pancreas. We performed PG using this technique in 30 patients. According to the international POPF criteria, POPF developed in three (10%) patients; as grade A in one, and grade B in two. These results demonstrate the potential advantage of performing PG after PD, by using this invaginated technique with an elastic suture.     

三种荷包缝合技术在PPH痔疮治疗的临床效果

目的：比较三种不同的吻合器痔上粘膜环形切除钉合术（procedure for prolapse andhaemorrhoids,PPH）手术的荷包缝合法及效果。方法：采用单荷包单圈缝合法（A组）、双荷包双圈缝合法（B组）以及双半荷包单圈缝合法（C组）,对120例Ⅲ、Ⅳ度环状脱垂性内痔行PPH术,比较分析三组病例的手术时间、术中下腹部疼痛、切除直肠粘膜宽度、粘膜环完整性及均匀度、痔核回缩、吻合口部位、术中出血、痔核回缩度、术后肛门疼痛、术后出血及住院时间。结果：双半荷包单圈缝合后切除的直肠粘膜宽度cm、粘膜环完整性及均匀度、痔核回缩与双荷包双圈缝合法无显著性差异,优于单荷包单圈缝合法（P〈0.05）;双半荷包单圈缝合法及单荷包单圈缝合法手术时间较双荷包双圈缝合法时间缩短（P〈0.05）;术后肛门疼痛、术后出血及住院时间三组无显著性差异（P〉0.05）。结论：双半荷包单圈缝合法能保证PPH手术切除直肠粘膜宽度、粘膜环完整性及均匀度、痔核回缩明显,且不增加手术程序及手术时间、具有一定的临床推广价值。     

小切口重度巨乳缩小术的临床应用

目的探讨一种切口瘢痕较小的乳房缩小整形术在巨乳治疗中的应用。方法去除乳晕周围皮肤的表皮，切除乳房下方梯形区域内的皮肤和乳腺组织，再以荷包缝合形成新乳晕，手术后仅在乳房下半留有一条垂直短小瘢痕。结果以该术式共治疗9例，效果良好，外观较满意，乳头血运、感觉良好，切口较隐蔽，并能够切除乳腺所有象限的肿物。结论该方法对于重度巨乳和合并有肿瘤的县乳的手术整复有其显著优点，值得推广。