关节镜下丝线内固定治疗前交叉韧带胫骨棘止点撕脱骨折

目的探讨关节镜下丝线固定治疗前交叉韧带（ACL）胫骨止点撕脱骨折的临床效果：方法收集2003年6月-2005年12月间通过关节镜下丝线固定技术治疗13例前交叉韧带（ACE）胫骨止点撕脱骨折患者。按Meyer和Mckeever分型：Ⅱ型3例,Ⅲ型10例：术前临床体征包括：Lachman试验阳性13例．前抽屉试验阳性11例,轴移试验阳性10例。术前术后采用Lysholm膝关节评分法评估。术后采用康复治疗：结果本组随访3～26个月,平均11．8月。13例患者术前评分为（47±13）分,随访时评分为（91±5）分（P〈0．01）。所有患者感觉膝部稳定,2例剧烈活动后术膝胀痛,1例膝关节屈曲受限20°,其余关节功能正常：结论丝线内固定可用于治疗前交叉韧带胫骨棘止点撕脱骨折,固定牢靠,术后可早期开展功能锻炼,     

Clinical presentation of coeliac disease in adult gastroenterological practice

Clinical features, complications and results of investigations are analysed in 50 patients diagnosed by jejunal biopsy as having coeliac disease at the Adult Gastroenterology Unit, Royal Victoria Hospital, Belfast, between 1969 and 1983. Only one patient was entirely asymptomatic, but 22% had no disturbance of bowel habit, and 50% had not lost weight. There were relatively few physical abnormalities on clinical examination. Screening tests using standard haematological and biochemical methods were positive only in between 8% and 52% of patients. More specific tests for malabsorption were positive in between 54% and 84% of patients. Jejunal biopsy remains the definitive procedure to identify patients with coeliac disease.     

Primary malignant lymphoma of the gastro-intestinal tract: a clinicopathological study of 24 cases.

Twenty-four cases of primary lymphoma of the gastro-intestinal tract were diagnosed during the period 1970 to 1991. There was a preponderance of males and the male to female ratio being 1.4:1. Age ranged from 9-70 years, mean 32.2 years. Small intestine was involved in 50% cases, large bowel in 9 cases (37.5%) and stomach in 3 cases (12.5%). There were 5 cases (20.8%) of Hodgkin's disease and 19 cases (79.2%) were of non-Hodgkin's lymphoma. All cases of gastric lymphoma complained of epigastric pain, weight loss and vomiting. In lymphoma of small intestine, 8 patients complained of pain associated with vomiting and 6 patients complained of distension of abdomen. In large bowel lymphoma, pain in right iliac fossa was complained by 4 patients and bleeding per rectum by 3 patients. Out of all the 24 cases, changes in bowel habit were noted in 15 patients and occult blood was positive in 13 cases. Palpable abdominal mass was noted in 14 patients. Histomorphologically, all the 3 cases in the stomach were of lymphocytic lymphoma diffuse type. Out of 19 non-Hodgkin's lymphoma, 15 were of lymphocytic lymphoma and 4 were of histiocytic lymphoma.     

The role of capsule endoscopy combined with double-balloon enteroscopy in diagnosis of small bowel diseases

Background The diagnosis of small bowel diseases remains relatively inefficient using traditional imaging techniques. Capsule endoscopy （CE） and double-balloon enteroscopy （DBE） are two novel methods of enteroscopy for examining the entire small bowel. The aim of this study was to evaluate the detection rate and diagnostic accuracy of CE and DBE in patients with suspected small bowel diseases and to investigate the clinical significance of combined use of these two novel modalities. Methods Two hundred and eighteen patients were evaluated for suspected small bowel disease, including 116 with obscure gastrointestinal bleeding and 102 with obscure abdominal pain or chronic diarrhea. One hundred and sixty-five out of these patients underwent CE first and 53 patients underwent DBE （under anesthesia with propofol） first. DBE was recommended after negative or equivocal evaluation on CE and vise versa. Introduction of the endoscope during DBE was either orally or anally and the patients were referred for a second procedure using the opposite route several days later when no abnormalities were found on the first procedure. The detection rates, diagnostic accuracy, tolerance and frequency of adverse events of these two modalities were then analyzed. Results Failure of the procedure was seen in one patient with CE and in two patients with DBE. Sixty-four DBE procedures were carded out in 51 patients; by the oral route in 34 cases, the anal route in 4 and both routes in 13 cases. The overall detection rate of small bowel diseases using CE （72.0%, 118/164） was superior to that with DBE （41.2%, 21/51）; X2=16.1218, P〈0.0001. The diagnostic rate （51.8%, 85/164） was also higher than that with the latter procedure （39.2%, 20/51）, but was not significantly different （X^2=2.4771, P〉0.05）. Furthermore, the detection rate of small bowel diseases in patients with obscure gastrointestinal bleeding using CE （88.0%, 88/100） was superior to that of DBE （60.0%, 9/15）; X2=7.7457, P=0.0054. Lesions were detected by DBE in 1 out of 4 patients in whom CE had a negative result. Suspected findings by CE were confirmed by DBE combined with biopsy in 12 out of 15 patients. On the other hand, small bowel lesions were identified by CE in all 3 patients after negative evaluations by DBE. There were no severe complications during or after either of the two procedures. Conclusions The detection rate of small bowel diseases by CE is very high. CE should be selected for the initial diagnosis in patients with suspected small bowel diseases, especially in patients with obscure gastrointestinal bleeding. DBE appears to be inferior to CE in the diagnosis of small bowel diseases. However, it was shown that abnormalities could still be identified by DBE in patients with normal images or used to confirm suspected findings from CE. DBE can also serve as a good complementary approach after an initial diagnostic imaging using CE.     

Rupture of hepatocellular carcinoma during pregnancy： 3 case reports and review of the literature

Hepatocellular carcinoma (HCC) is one of themost common cancers in the world, but the occur-rence in pregnant women is rare, and rupture ofHCC during pregnancy is even rarer. It is suggest-ed that the paucity of hepatocellular carcinomaduring pregnancy is multifactorial[1]. HCC is lesscommon in females, particularly those of reproduc-tive age, and infertility complicates cirrhosis,which is present in the majority of patients withHCC. Pregnant women with spontaneous ruptureof HCC usually …     

术后早期炎性肠梗阻42例诊治体会

目的：探讨术后早期炎性肠梗阻的临床特点及处理方法,方法：分析４２例术后早期炎性肠梗阻的临床特点及治疗结果。结果：４２例均经肠减压,应用生长抑素、肠外营养等支持疗法,平均治愈时间为１３．５d,无一例再手术,结论：术后早期炎性肠梗阻多发生在术后６－８d可表现为典型的肠梗阻体征,多由小肠无菌性炎症致广泛肠粘连引起,多数病例采用保守疗法可治愈。     

小儿贲门失弛缓症的手术治疗

①目的 探讨小儿贲门失弛缓症的手术方法和治疗效果。②方法 回顾性分析我院近10年收治的小儿贲门失弛缓症32例。全部行经腹改良Heller手术治疗,23例附加Nissen手术治疗。③结果 术后随访l～2年无复发者,生长发育正常。单纯行Heller手术者有2例在术后1个月左右出现轻度泛酸、嗳气等症状;23例附加Nissen手术者无胃食管反流症状。④结论 经腹改良Heller手术附加Nissen手术,操作简便,创伤相对较小,可大大减少胃食管反流的发生,是治疗小儿贲门失弛缓症的理想手术方法。     

结肠次全切除逆蠕动盲-直吻合术治疗慢传输型便秘的临床研究

目的评估结肠次全切除逆蠕动盲-直吻合术治疗慢传输型便秘的疗效。方法采用结肠次全切除逆蠕动盲-直吻合术治疗17例,其中特发性慢传输型便秘14例,慢传输型合并出口梗阻型便秘2例, 特发性巨结肠1例。评估患者术后排便情况、并发症、生活质量。结果术后1个月平均每天大便次数5 (3-7)次,半液体状大便;术后1年平均每天大便次数3(2-4)次,固体状大便;术后2年平均每天大便次数2 (1-4)次。术后所有患者均不需用止泻药;1例混合型便秘患者仍间断使用泻药外其余患者均未用泻药。17 例患者(100％)术后生活质量得到明显改善。术后2例出现粘连性小肠梗阻,其余患者未出现腹泻、腹痛、腹部不适等并发症。结论对部分慢传输型便秘及特发性巨结肠患者,结肠次全切除逆蠕动盲-直吻合术是一种安全、有效的术式。     

脾动脉结扎带蒂大网膜覆盖或填塞行保脾手术17例体会

目的探讨外伤性脾破裂保脾手术方式。方法对17例外伤性脾破裂采用脾动脉结扎带蒂大网膜填塞脾破裂口缝合修补治疗。结果手术保脾治疗17例,其中单纯修补缝合3例,脾修补缝合加大网膜填塞5例,脾部分切除加大网膜填塞修补9例,术后均未出现再出血等并发症,经1~3年随访,B超、CT扫描脾解剖形态未见异常。结论该手术方法操作简单,效果满意,是较理想的保脾手术方法。     

老年腹股沟疝无张力修补术的临床应用

目的探讨无张力疝修补术在老年腹股沟疝修补术中的应用价值。方法总结分析5年中应用补片治疗110例老年腹股沟疝患者的治疗经验,其中合并心肺功能不全、高血压病、糖尿病、肝硬化腹水者为57%。结果本组110例切口一期愈合,无感染、无死亡,术后3~6d出院,随访10~48个月,随访率为93.4%,无一例复发。结论无张力疝修补术创伤小,手术时间短,符合腹股沟解剖生理,没有缝线张力,术后患者痛苦少,恢复快,复发率低,不限制体力活动。     

关节镜下空心针带无损伤缝线法修复撕裂半月板的疗效评价

目的评价关节镜下应用空心针带无损伤缝线治疗半月板损伤的近期疗效。方法2002年4月~2004年12月,关节镜下采用空心针带无损伤缝线缝合固定18例18侧半月板损伤。结果所有病例术后均无早期并发症发生。全部患者均获得随访,随访时间6~14个月,平均9.2个月。随访时所有患者膝关节稳定,无疼痛、绞锁等症状。结论空心针带无损伤缝线治疗半月板损伤近期疗效较好,是一种简便快捷、安全有效的半月板缝合方法。对于半月板损伤,如撕裂类型和部位适当,可选择空心针带无损伤缝线技术固定半月板。     

Marchac法治疗中重度乳房肥大的疗效

目的观察M archac巨乳缩小术治疗中重度乳房肥大的临床疗效。方法2001~2006年,应用M archac法对21例中重度乳房肥大患者施行巨乳缩小手术,平均每侧切除组织700 g。术后1年随访,通过对乳房整体外形、乳头感觉、瘢痕大小等方面的4级评分,进行疗效评价。结果21例患者中伤口一期愈合17例,二期愈合4例(脂肪液化4例,合并血肿1例),无感染及乳头和乳晕坏死病例。14例患者术后1年随访,外形评价“好”12例,“中”2例;部分患者保留乳头感觉;乳房下皱襞瘢痕均短于8.5 cm。结论M archac法治疗中度乳房肥大具有效果持久,外形好,瘢痕短等优点;对于重度肥大的乳房,通过控制术中腺体瓣的厚度及配合术后积极处理,也可取得满意的治疗效果。     

以泌尿系症状首诊的乙状结肠癌临床诊治分析

目的 探讨乙状结肠癌侵犯泌尿系统而以泌尿系症状为首诊症状病例的诊断与治疗.方法 根据患者泌尿系的不同症状分成两组:(1)以膀胱刺激症状为主的为A组,共16例,手术中证实为乙状结肠癌侵犯膀胱形成结肠膀胱瘘,进行乙状结肠癌根治性切除联合膀胱部分切除;(2)以血尿症状为主的为B组,共9例,手术中证实为乙状结肠癌侵犯左侧输尿管...     

全胃切除间置"O"形环状空肠代胃消化道重建术

目的探讨全胃切除消化道重建的理想术式。方法全胃切除术后利用游离的空肠在食管与十二指肠间建立１个“Ｏ”形环状空肠贮袋———“新胃”。结果３９例胃原发恶性肿瘤治疗后,３、５年无瘤生存率分别为６７．７％和５５．６％。生存至术后６个月以上者,均恢复了１日３餐的饮食习惯。术前和术后１年比较患者的体重,两者水平相当、增加和下降率分别为７１１％、１５８％和１３１％。全组无胸骨后疼痛及食物、消化液返流等症状,无倾倒综合征表现。在术后１年,“新胃”可代偿性扩大至原来的胃形状,且以“胃底”增大明显。结论间置“Ｏ”形环状空肠代胃消化道重建术是理想的、值得推广的全胃切除消化道重建术式。     

腔镜辅助手术治疗下肢原发性静脉曲张

目的:探讨腔镜技术在下肢原发性静脉曲张手术中应用的可行性和结果。方法:腔镜辅助手术治疗24例(32条患肢)下肢原发性静脉曲张病人。术后随访3～22个月;传统手术治疗20例(27条患肢)下肢原发性静脉曲张病人.术后随访5～24个月。结果:腔镜辅助手术治疗24例病人术后肢体症状和浅静脉曲张消失,16例合并有静脉性溃疡患者短期内溃疡愈合,随访3～22个月只有1(1/32)条患肢复发静脉曲张,其余病人未见静脉曲张复发及并发症;而传统手术治疗20例病人术后肢体症状和浅静脉曲张消失,10例合并有静脉性溃疡患者短期内溃疡愈合,随访5～24个月有3(3/27)条患肢复发静脉曲张,2(2/10)条患肢复发溃疡。结论:腔镜辅助手术治疗下肢原发性静脉曲张手术效果好,术后复发率低,患肢创伤小,病人满意度高,是治疗下肢原发性静脉曲张的有效方法。     

一层间断缝合法在低位直肠癌保肛手术中的应用

目的探讨一层间断缝合法在低位直肠癌保肛手术中的应用价值。方法回顾分析66例低位直肠癌患者采用一层间断缝合法行保肛手术,对术后吻合口并发症、排便功能、局部复发等进行了随访。结果术后发生吻合口瘘1例,无吻合口狭窄,术后排便功能控制好,局部复发3例。结论一层间断缝合法具有操作简便,安全性高,费用低廉,术后并发症少,排便功能控制好等优点,在低位直肠癌保肛手术中仍占有重要地位。     

后腹腔镜手术治疗肾上腺嗜铬细胞瘤（附14例报道）

目的：探讨后腹腔镜手术治疗肾上腺嗜铬细胞瘤的安全性及可行性。方法：回顾性分析14例后腹腔镜肾上腺嗜铬细胞瘤切除术患者的临床资料。结果：13冽手术均成功,1例因粘连严重,术中出血改为开放手术。肿瘤直径1．0—8．Ocm,平均3．8cm。手术时间40—190min,平均100min。术中出血量40～160ml,平均70ml。术后住院5—9d,平均5．6d。术后病理检查证实均为肾上腺嗜铬细胞瘤。全部例随访3—20个月,平均10个月,临床症状消失,B超或CT检查未见肿瘤复发。结论：后腹腔镜肾上腺嗜铬细胞瘤切除术由于损伤小,手术时间短,出血少,术后恢复快,并发症少,疗效好,具有广泛的临床应用前景。     

腹腔镜根治性前列腺切除术中保留膀胱颈在术后控尿的效果观察

目的：探讨保留膀胱颈在术后控尿中的作用以及对切缘阳性率的影响。 方法：回顾性分析2006年7月-2010年5月期间对145例T1b～T2c局限性前列腺癌患者行腹腔镜根治性前列腺切除术资料,其中保留膀胱颈59例,不保留膀胱颈86例。使用国际尿控协会调查问卷,分别在术后1个月、3个月、6个月评估患者的控尿情况。 结果：在术后1个月、3个月、6个月,保留膀胱颈组的控尿率分别为42.4%、74.6%、86.4%,不保留膀胱颈组的控尿率分别为25.6%、58.1%、80.2%。在术后1个月和3个月两组的控尿率差异有统计学意义(P=0.034和P=0.042）,而在术后6个月两组间控尿率差异无统计学意义(P=0.331)。两组阳性切缘位于膀胱颈的各1例,两组切缘阳性率相近（P=0.954）。 结论：腹腔镜根治性前列腺切除术中保留膀胱颈对术后的早期控尿有着积极作用,而且不增加术后的切缘阳性率。     

Laparoscopic Suture Rectopexy: An Effective Treatment for Complete Rectal Prolapse

Background

The study was undertaken to validate the efficacy of laparoscopic suture rectopexy as the treatment modality of choice for complete prolapse of rectum.

Methods

Data was prospectively collected and analyzed on 36 patients who underwent laparoscopic suture rectopexy for full thickness rectal prolapse between May 2006 to May 2008. There were 10 male and 26 female patients in this study with a mean age of 43.5 years. The pre and postoperative course of each patient was followed up with attention paid to ano-rectal manometery pressures, first bowel movement, hospital stay, duration of surgery, faecal incontinence, constipation, recurrence and morbidity. Mean follow up period was 12 months (range 1–24 months).

Result

One patient had conversion from laparoscopic to open surgery. while another had recurrence of prolapse in the follow up period. Mean duration of surgery was 115 (range 100–150) minutes. Postoperatively, the mean time for the first bowel movement was 40 (range 24–64) hours. Mean hospital stay was five (range 4–7) days. There was no significant postoperative complication except for one port site infection and one pelvic collection. Of the 20 patients who had varying degree of incontinence preoperatively, 16 (80%) showed improvement after surgery. Constipation was present in 15 (41%) patients preoperatively. Nine of these 15 patients (60%) improved as regards constipation after surgery.

Conclusion

Laparoscopic suture rectopexy is both safe and effective operation for the management of complete prolapse rectum. The procedure carries minimal morbidity and helps improve the problems of incontinence and constipation.Key Words: Laparoscopic, Suture rectopexy, Rectal prolapse     

可控回结肠膀胱成形术(附4例报告)

本文报告了4例国内尚未开展的可控回结肠膀胱成形术,近期观察疗效满意。4例均为膀胱癌患者,术后3～4小时自行导尿1次,300ml～400ml,最大容量达500ml。膀胱内压:400ml时为15～19cmH_2O。术后无尿失禁,无代谢紊乱,不挂尿袋,生活方便。