球海绵体肌瓣在女性复杂性膀胱阴道瘘修补术中的应用

目的探讨球海绵体肌瓣修补女性复杂性膀胱阴道瘘的应用价值。方法女性复杂膀胱阴道瘘患者11例,均有瘘修补失败史,均经膀胱镜检查确诊,瘘口直径3.0～5.0 cm。经腹会阴途径修补,瘘口周围瘢痕组织经腹彻底切除。会阴部切口,自阴道前壁和尿道后壁之间分离至瘘口,用可吸收线缝合阴道侧瘘口。沿大小阴唇之间纵行切开,游离球海绵体肌,避免损伤会阴外动脉血供。经小阴唇底部打一隧道,将球海绵体肌瓣通过隧道,阴蒂端经膀胱瘘口缝合于子宫前壁下端,缝合膀胱裂口。结果11例患者术后均无阴道漏尿及尿失禁。随访6个月～5年,患者均无尿道狭窄,10例已婚者性生活正常。结论球海绵体肌瓣移位术操作简单,成功率高,尤其适用于修补女性复杂膀胱阴道瘘。     

糖尿病性阴茎勃起功能障碍大鼠模型球海绵体肌和坐骨耻骨肌重量及显微结构的研究

ＳＤ大鼠注射链脲佐菌素制造糖尿病（ＤＭ）动物模型后,注射阿朴吗啡观察６周、８周及１２周大鼠队茎勃起情况,筛选ＭＤ性阴茎勃起功能障碍（ＥＤ）大鼠模型,研究其海绵体肌及坐骨耻骨肌重量及显微结构的改变,并测定其血清睾酮浓度,以探讨ＤＭ性ＥＤ的发病机理。结果：ＤＭ性ＥＤ大鼠模型球海绵体肌和坐骨耻骨肌重量及血清睾酮浓度显著降低;显策结构发生明显病理性改变,且上述变化与ＤＭ病程密切相关。揭示ＤＭ严重影响阴茎勃     

球海绵体肌瓣法矫治阴道松弛症探讨

目的:为寻找一种实用有效的治疗产后阴道松弛症的手术方法和临床效果。方法:采用自体阴道分离出撕裂的球海绵体,形成肌瓣。将肌瓣折叠缝合,纵形缝合阴道黏膜,使形成隆突,保留阴道黏膜,加固阴道后壁紧缩阴道腔的手术治疗方法。结果:本组30例患者创口均I期愈合,术后随访6个月至2年,性生活质量均有明显提高,效果较满意。结论:用自体阴道球海绵体肌瓣重叠法治疗阴道松弛症,能明显提高患者性生活质量,效果确切,方法简单,是一种治疗产后阴道松弛症简单有效的方法。     

带蒂球海绵体肌瓣间置修补尿道直肠瘘

1996年1月至2004年4月我们采用球海绵体肌瓣间置修补男性尿道直肠瘘患者16例，结果满意。现报告如下。     

皱眉肌及降眉肌的临床解剖学研究

目的 为鼻额部除皱提供解剖学依据。方法 对14例成人男性尸体头部标本,进行了大体及显微解剖。结果 皱眉肌分为横向型、斜向型、斜向分束型,以斜向型为主。该肌起点恒,止点变化大,轮廓清楚,降眉肌起于鼻骨与鼻外侧软骨连接处以上,止于两眉内侧的水平线。结论 通过观察弄清了鼻额部深层的皱眉肌和降眉肌的形态及其与血管神经的关系。     

阴道旁修补术联合球海绵体肌缝合治疗重度阴道松弛症

目的 探讨重度阴道松弛症的修复方法 及临床效果.方法 对48例重度阴道松弛症患者经阴道旁筋膜修补及球海绵体肌缝合,并随访术后性生活满意度、会阴外观、不自主排尿及阴道分泌物的改善效果.结果 术后随访43例,性满意度改善者40例,有效率为93%.14例对自身会阴外观不满意者术后均有明显改善;不自主排尿、阴道分泌物增多等症状有效缓解.结论 阴道旁修补术联合球海绵体肌缝合治疗重度阴道松弛症,手术安全,疗效可靠.     

长收肌瓣在修复复杂尿瘘中的应用

1995年我们报告了长收肌瓣修复外伤性尿道直肠瘘、直肠会阴瘘的手术方法[1] ,至今手术 6例 ,均获成功 ,报告如下。1.临床资料 :本组 6例均为男性 ,年龄 2 5～ 45岁。 4例车祸致伤者 ,1例尿道直肠瘘、直肠会阴瘘 ,1例尿道直肠瘘并尿道会阴瘘 ,2例尿道直肠瘘 ;另 2例 ,1例从高处坠落被树杈刺伤肛门、直肠、尿道和膀胱 ,形成尿道、膀胱直肠瘘 ;1例直肠癌根治误伤尿道形成骶前分支状瘘。入院前手术修复次数为 2～ 4次。6例中 ,5例合并尿道狭窄 ,2例入院时带膀胱造瘘管 ,乙状结肠腹壁造口。 4例从肛门或会阴部瘘口排尿。2 .手术方法 :截石位 ,会…     

海绵体-肛门反射:肛门括约肌对海绵体肌肉受刺激的反应

目的:证明性交时海绵体肌肉收缩影响肛门括约肌反射性收缩这个假设。方法:研究了17名健康志愿者(10男,7女,平均年龄38.3±11.6岁)的坐骨海绵体肌和球海绵体肌受刺激后肛门内、外括约肌的肌电反应。测试分别在肛门括约肌和两个海绵体肌单独麻醉后和用盐水代替利多卡因(麻醉剂)后进行。结果:坐骨海绵体肌和球海绵体肌分别受刺激后,内外肛门括约肌的肌电反应灵敏度都增加。肛门括约肌对麻醉的海绵体肌肉受刺激后无反应,同时麻醉的肛门括约肌也对海绵体肌肉所受刺激无反应。用盐水代替麻醉剂不影响肛门括约肌对海绵体肌受刺激的反应。结论:本研究结果表明海绵体肌收缩引起肛门括约肌收缩,这可能是一个由"海绵体-肛门反射"调节的反射过程。肛门括约肌收缩可能在性交中起关闭肛管以防止排气排便的作用。     

皱眉肌与降眉肌的临床解剖学研究

目的　为鼻额部除皱提供解剖学依据。方法　对 14例成人男性尸体头部标本 ,进行了大体及显微解剖。结果　皱眉肌分为横向型、斜向型、斜向分束型 ,以斜向型为主。该肌起点恒定 ,止点变化大 ,轮廓清楚 ,降眉肌起于鼻骨与鼻外侧软骨连接处以上 ,止于两眉内侧的水平线。结论　通过观察弄清了鼻额部深层的皱眉肌和降眉肌的形态及其与血管神经的关系。     

Surgical anatomy of totally trans-oral video-assisted thyroidectomy

Objective To define the anatomical approach,anatomical planes related vessels and nerves to create a safe and reproducible combined sublingual and bivestibular access for transoral video-assisted thyroidectomy. Methods From November 2009 to May 2011     

Surgical anatomy for hemifacial spasm

Classically in the cerebello-pontine angle the facial (CN VII) and vestibular-cochlear (CN VIII) nerves should run parallel with the anterior inferior cerebellar artery, whereas the lower nerves (CN IX-XI) continue with the posterior-inferior-cerebellar artery (PICA). In fact, this is not always true, particularly when dealing with hemispasm surgery where the relationships between CN VII, CN VIII and PICA are often different and closer. Knowledge of anatomical bases in surgical situation will help neurosurgeons to appreciate anatomical nuances, that are important to increase effectiveness and safety of hemifacial spasm surgery.     

Surgical anatomy of the sciatic nerve: A meta‐analysis

The sciatic nerve has varying anatomy with respect to the piriformis muscle. Understanding this variant anatomy is vital to avoiding iatrogenic nerve injuries. A comprehensive electronic database search was performed to identify articles reporting the prevalence of anatomical variations or morphometric data of the sciatic nerve. The data found was extracted and pooled into a meta‐analysis. A total of 45 studies (n = 7068 lower limbs) were included in the meta‐analysis on the sciatic nerve variations with respect to the piriformis muscle. The normal Type A variation, where the sciatic nerve exits the pelvis as a single entity below the piriformis muscle, was most common with a pooled prevalence of 85.2% (95%CI: 78.4–87.0). This was followed by Type B with a pooled prevalence of 9.8% (95%CI: 6.5–13.2), where the sciatic nerve bifurcated in the pelvis with the exiting common peroneal nerve piercing, and the tibial nerve coursing below the piriformis muscle. In morphometric analysis, we found that the pooled mean width of the sciatic nerve at the lower margin of the piriformis muscle was 15.55 mm. The pooled mean distance of sciatic nerve bifurcation from the popliteal fossa was 65.43 mm. The sciatic nerve deviates from its normal course of pelvic exit in almost 15% of cases. As such we recommend that a thorough assessment of sciatic nerve variants needs to be considered when performing procedures in the pelvic and gluteal regions in order to reduce the risk of iatrogenic injury. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1820–1827, 2016.     

股直肌内神经血管解剖研究和临床意义

目的：详细了解股直肌内神经血管解剖分布，评价该肌肉能否被分成两个功能单位，以提供新的功能性骨骼肌游离移植供区。方法：解剖经双侧股动脉内灌注改良氧化铅－明胶混合液的10具新鲜尸体及10具甲醛浸泡的尸体共40条成人股直肌。结果：40条股直肌肌肉内外血管分布呈现3种不同类型。12．5％的股直肌仅接受1支动脉供应；80％的肌肉由1支优势动脉和1－2支次要动脉供应；7．5％的肌肉含有2支大小接近的优势动脉。股直肌的神经支配来自股神经后束发出的神经支。该支在进入肌肉之前常分成2支，分别有动脉伴行构成神经血管束。结论：根据股直肌内神经血管供应类型以及肌肉内特有的肌腱组织，可将该肌分成2个功能单位，供节段性游离肌肉移植。     

双侧臀肌挛缩症的手术治疗

目的:探讨经股骨大转子弧形向上后方延长至条索状块切口手术治疗臀肌挛缩症的疗效。方法:78例双侧臀肌挛缩症患者,男42例,女36例;年龄5～20岁,平均12.6岁。患者步态异常,双膝并拢不能下蹲,翘腿试验阳性,均存在Ober征阳性。双侧同时手术,采用经股骨大转子弧形向上后方延长至条索状块切口,术中探查臀肌挛缩情况,紧贴大转子上缘切断挛缩束带,切除部分挛缩组织,术后放置引流皮片。结果:78例患者随访6～36个月,平均24.4个月。依据夏榕圻疗效评定标准,优58例,良16例,差4例。无坐骨神经损伤及感染者。结论:采用经股骨大转子弧形向上后方延长至条索状块切口,手术创伤小,术后功能好,是治疗臀肌挛症缩满意的手术方案。     

女性泌尿生殖道瘘诊治分析(附26例报告)

目的：探讨女性泌尿生殖道瘘的诊断与治疗。方法：回顾性分析26例女性泌尿生殖道瘘患者的治疗效果,比较单纯瘘道修补术和球海绵体肌瓣移植修补术的差别。结果：行单纯尿瘘修补术的治愈率为81．82％,而行球海绵体肌瓣修补术的治愈率为100％。结论：女性泌尿生殖道瘘的诊治和预防都很重要,球海绵体肌瓣移植修补术为治疗女性复杂尿瘘的理想术式。     

Surgical inclination and anatomy teaching at the University of Auckland

BACKGROUND: Medical graduate interest in surgery has declined and medical students are less capable in anatomy than they once were. Declining interest in surgery is because of factors, including growing number of women entering medical school. There has been less emphasis in teaching anatomy at various medical schools in recent years. The aim of this study is to quantify surgical inclination in Auckland medical students to assess whether gender differences exist in surgical inclination and determine confidence in anatomy knowledge and resources used by Auckland medical students. METHOD: Survey design was cross-sectional and included 25-point questionnaire using Likert scale response ranking and tick box replies. Two hundred and eighteen surveys were emailed to functioning addresses of fourth and fifth year students at University of Auckland, School of Medicine, New Zealand. RESULTS: Response rate was 71.6%. Twenty per cent of students were found to be surgically inclined (95% confidence interval, 0.15-0.26). The proportion of surgically inclined men was significantly higher than women (P < 0.05). Thirty-three per cent of all respondents (95% confidence interval, 0.26-0.41) felt their knowledge of anatomy was adequate to practice medicine safely. Textbooks and atlases were most commonly used to learn anatomy (P < 0.05). Radiology was the least commonly used method to learn anatomy (P < 0.05). Eighty-seven per cent (95% confidence interval, 0.81-0.92) of respondents agreed that revisiting dissection during surgical attachments would be helpful. CONCLUSION: Men are significantly more likely to be surgically inclined than women at the University of Auckland. A significantly greater proportion of students felt that their knowledge of gross anatomy was inadequate for safe medical practice. Students use traditional methods to learn anatomy more commonly than radiological methods. The majority of students surveyed would like to revisit cadaver dissection during clinical attachments in surgery.