睾丸鞘膜瓣在尿道修复中的应用

目的探讨睾丸鞘膜瓣覆盖技术在尿道畸形和尿道瘘修复中的效果。方法2002年起对38例尿道下裂手术和术后尿道瘘,采用睾丸鞘膜下组织蒂鞘膜瓣覆盖修复。结果术后随访半年至1年,除1例尿道上裂术后瘘修复后再次发生尿道瘘外,其余均获成功,未再出现尿道瘘或尿道狭窄,阴茎外观满意,勃起正常。结论采用该方法可有效防止尿瘘再发生,提高手术成功率且易于获取,对睾丸无不良影响。     

Post-biopsy arteriovenous fistulas of the native kidneys diagnosed by Doppler US

Two patients with arteriovenous fistulas of the native kidney occurring after needle biopsy were evaluated using duplex and color Doppler ultrasonography. The first patient had a fistula with associated pseudoaneurysm: color Doppler showed the lesion as a small rounded area with whirling flow; spectral analysis allowed recognition of both the afferent artery with low impedance flow and the draining vein with pulsatile, arterialized flow. The second patient had a normal color Doppler study; however, spectral analysis demonstrated signals with low vascular impedance from an intra-parenchymal artery at the lower pole, and a jet of turbulent flow. Following disappearance of clinical findings, such Doppler abnormalities were no longer detectable. When a iatrogenic arteriovenous fistula is considered on clinical grounds, both color and Doppler spectral analysis of waveforms from intra-parenchymal vessels should be performed. Possibly, further advances in color Doppler technology will permit the use of this examination as the first imaging procedure in these clinical situations.Correspondence to: L. E. Derchi     

Strecker stent in stenotic hemodialysis Brescia-Cimino arteriovenous fistulas

Flexible tantalum stents (Strecker) were used as an adjunct to percutaneous transluminal angioplasty (PTA) in the treatment of stenotic arterial or venous limbs of Brescia-Cimino hemodialysis fistulas. The diagnostic procedure was performed using retrograde fistulography. After PTA with unsatisfactory results, stents were placed in 5 patients with significant residual stenoses and poor fistula function. Within the mean follow-up period of 6.4 months (range 3–10 months) all fistulas were functioning. We conclude that Strecker stent is useful in the treatment of stenotic hemodialysis arteriovenous fistulas as an adjunct to PTA.     

硬脊膜动静脉瘘(附1例临床分析)

目的探讨硬脊膜动静脉瘘(SDAVF)的病因、发病机制、临床表现、诊断及治疗。方法回顾性分析了1例患者的相关临床资料。结果本例患者以双下肢渐进性麻木、无力1年余,加重伴大小便障碍9个月为主要临床表现,脊髓MRI显示T9~L1髓内以长T2长T1为主之异常信号,超选择DSA造影可见位于入LT12椎管处一硬脊膜动静脉之瘘口,成功地进行了经单侧椎板开窗夹闭瘘口术。结论SDAVF为一具有直接的动静脉交通性病变,常伴有小型畸形团,多发生于中年男性,误诊率高,主要表现为渐进性的肢体麻木、无力及大小便障碍,MRI有助于诊断,但仍须DSA确诊。阻断连接瘘口与冠状静脉丛的引流静脉是治疗SDAVF的有效方法,显微外科手术效果可靠、复发率低,尽早地确诊和治疗是取得良好疗效的根本前提。     

The association between caudal block and urethroplasty complications of distal tubularized incised plate repair: experience from a South China National Children’s Medical Center

BackgroundThe effect of caudal block (CB) on the incidence of urethroplasty complications in hypospadias repair remains controversial. The evidence is conflicting, and some confounding bias issues need to be addressed. We sought to study a more homogenous group of distal hypospadias patients undergoing primary tubularized incised plate (TIP) repair by a senior pediatric urology surgeon in the past 2 years to examine the relationship between urethroplasty complications and the use of CB.MethodsWe reviewed our database to identify consecutive patients who had undergone hypospadias repairs by a senior director surgeon at our Center between January 2018 and November 2020. To be eligible to participate in the study, patients had to meet the following inclusion criteria: (I) have distal hypospadias; (II) have undergone a primary TIP repair; and (III) have attended follow-up appointments for a minimum period of 6 months. The primary outcome was the development of urethroplasty complications during the follow-up period. The principal variable of interest was whether or not CB was used perioperatively. The patients were categorized into a CB group (general anesthesia combined with CB) or a control group (general anesthesia only). Other potential risk factors were analyzed, including patient age at operation, patient weight, glans width, and the length of the urethral plate defect.ResultsThirty (12.2%) of the distal patients developed postoperative surgical complications. The postoperative surgical complication rates were similar between the different anesthesia groups. Weight, the length of the urethral plate length, and glans width did not contribute to the risk. Age was the only independent risk factor for postoperative surgical complications, and the complication rates increased in older patients.ConclusionsOur data from consecutive TIP repairs in distal hypospadias patients indicated no association between the use of CB anesthesia and the postoperative urethroplasty complication rate. Patients who were older in age when they underwent surgery had a higher risk of complications.     

Epidemiologic study of vesicovaginal fistulas in ethiopia

Three hundred and nine patients (a 110 random sample) treated at the Addis Ababa Fistula Hospital during the years 1983 to 1988 were studied for biosocial factors, obstetric history, previous attempts at repair, the condition of the patient and the extent of injury to the genitourinary tract, as well as treatment and results. Sixty-five percent of patients were under 25 years. The cause of the fistula was obstructed labor in 97.4%; in 62.7% it was the patient's first labor; the outcome for the baby was a stillbirth in 92.7%. The fistula was complicated in 69.4%; a Martius graft was used in 73.6%; 88% were cured; 5.8% of repairs failed and in 6.2% the patient had stress incontinence. Obstetric fistulas in Ethiopia result from obstructed labor, mostly in a first pregnancy in young women, and it is rare for the baby to survive. Prevention will involve improved education, communication, transport and health care measures. With good preoperative and postoperative care and attention to surgical detail many of these women can be cured.     

Gastro-Gastric Fistulas and Marginal Ulcers in Gastric Bypass Procedures for Weight Reduction

Background: Gastro-gastric fistulas and marginal ulcers are frequent and serious complications of gastric compartmentalization procedures for obesity. Methods: The authors analyzed 810 patients after 911 operations for gastro-gastric fistulas and marginal ulcers over an 8-year period. All patients underwent a form of gastric bypass, in which a pouch is constructed along the lesser curvature of the stomach. The outlet of the pouch was restricted with a prosthetic band. In the first 189 patients (Group I), the pouch and stomach were stapled in continuity or partially divided. In the next 222 patients (Group II), segments were stapled and separated by transection. In the remaining 492 cases (Group III), in addition to transection of the stomach, a limb of jejunum was interposed between the pouch and excluded stomach. Stapled anastomoses were done in Group I and II patients and a portion of Group III patients. The remaining patients underwent hand-sewn anastomosis. Results: Gastro-gastric fistulas occurred in 49% of the patients in Group I, 2.6% of those in Group II, and 0% of those in Group III. In stapled anastomosis, the incidence of marginal ulceration in Groups I, II, and III were 8.5%, 5.4%, and 5.1%, respectively. In a subset of Group III patients, in whom a two-layer, hand-sewn anastomosis was done, the incidence was 1.6% when the outer layer was not absorbable and 0% when both layers were absorbable. Conclusions: Gastro-gastric fistulas and marginal ulcerations are likely the result of breakdown of the mucosa resulting from migrating staples and other foreign material. Lack of integrity of the gastric lining facilitates the action of the gastric digestive process. Transection of gastric segments with interposition of jejunum prevents gastro-gastric fistula formation. An intact serosa appears to block the digestion of bowel wall by gastric enzymes. Our early data suggest that the use of absorbable sutures at the gastrojejunostomy significantly decreases the incidence of marginal ulceration.     

胃癌术后腹腔淋巴瘘的相关因素分析

目的:探讨胃癌术后腹腔淋巴瘘的相关因素.方法:回顾分析26例胃癌术后腹腔淋巴瘘(LF)与肿瘤分期、肿瘤部位、术式、淋巴结转移、早期肠内营养(EN)及肝硬化间关系.结果:术后LF发生率为7.60%,早期肠内营养组高于非肠内营养组(14.29%比3.70%,P＜0.01);pTNMⅡ、Ⅲ期高于Ⅰ、Ⅳ期,Ⅲ期高于Ⅱ期(11.95%比7.94%,P＜0.05);D2以上术高于D2术(11.05%比4.23%,P＜0.01);胃中、上部癌高于下部癌(11.80%比3.05%,P＜0.01);淋巴结转移组高于未转移组(9.59%比4.07%,P＜0.05);是否合并肝硬化两组无显著差异(8.09%比6.54%,P＞0.05).结论:D2及D2以上术式、pTNMⅡ、Ⅲ期、中上部癌、淋巴结转移、术后早期EN是胃癌术后LF的危险因素.     

大鼠双侧卵巢腹腔及皮下移植的形态与功能研究

目的明确大鼠卵巢自体异位移植后的生存、生长及功能恢复情况。方法将性成熟的SD大鼠随机分为三组,A组为正常对照组,B组为去势对照组,C组为移植组。移植组将大鼠双侧卵巢自体移植于腹腔子宫角系膜处及颈部皮下,分别于移植后2、4、7、14、28、56d取移植的卵巢及部分子宫进行组织学研究,并取腹主动脉血测定血清雌激素、孕激素水平。结果移植卵巢依据苏木素-伊红(HE)染色后的组织学观察可分为三个阶段,移植后第2￣7天移植物内可见各期卵泡,数量少,多为原始卵泡及初级卵泡,有出血及炎细胞浸润,坏死区约占50%。第14天,移植物内可见不同阶段的发育卵泡,并可见间质腺及黄体,坏死区减少。第28天以后,移植物内可见大量不同阶段的发育卵泡,并可见间质腺及黄体,坏死区消失。移植组的子宫发育情况接近正常对照组,明显优于去势组。移植组平均第9天阴道涂片显示较规律的动情周期。血清学研究显示移植卵巢具有与正常卵巢接近的分泌雌激素、孕激素的功能。结论大鼠卵巢自体移植后能在异位存活,并可发育成具有内分泌功能的腺体,为卵巢组织移植治疗临床卵巢内分泌功能不足的可行性提供了实验依据。     

The effects of lavender aromatherapy on pain following needle insertion into a fistula in hemodialysis patients

ObjectiveThis study sought to determine the effects of lavender aromatherapy on pain following needle insertion into a fistula in patients undergoing hemodialysis.MethodThis is a randomized controlled clinical trial in which 92 patients undergoing hemodialysis with arteriovenous fistulas were randomly divided into two groups. The experimental-group patients inhaled lavender essence with a concentration of 10% for 5 min during 3 hemodialysis sessions, while the control-group patients received aromatherapy free of lavender essence.ResultsThe mean VAS pain intensity score in the experimental and control groups before the intervention was 3.78 ± 0.24 and 4.16 ± 0.32, respectively (p = 0.35). The mean VAS pain intensity score in the experimental and control groups after three aromatherapy sessions was 2.36 ± 0.25 and 3.43 ± 0.31, respectively (p = 0.009).ConclusionLavender aromatherapy may be an effective technique to reduce pain following needle insertion into a fistula in hemodialysis patients.