泪小管断裂显微吻合28例分析

从1991年10月起,我们对28例(28只眼)新鲜泪小管断裂患者用硬膜外麻醉管(以下简称义管)作支撑物行一期显微吻合术,效果满意,报道如下。应用解剖选用学生用经福尔马林固定的尸体头8个,解剖观测泪炎位置、大小,泪小管走行、长度和管经以及汇合于泪囊的位置。泪点的直径0.18～0.31 mm,位于内眦后缘之内侧,泪乳头的尖端。上泪点在内眦外侧5.0     

粘弹剂在泪小管断裂吻合手术中的应用

目的 探讨粘弹剂在辅助寻找下泪小管断端的有效性.方法 首先在显微镜下或上泪小点注水辅助寻找下泪小管断端的鼻侧端,不能奏效的病例改用粘弹剂寻找其鼻侧断端.结果 29例下泪小管断裂患者中15例单纯在显微镜下或上泪小点注水辅助找到泪小管断端并吻合,不能奏效的14例中,12例在粘弹剂的辅助下找到泪小管断端并吻合.结论 采用粘弹剂辅助寻找下泪小管断端,较以往方法更容易找到,提高了下泪小管手术吻合的成功率,节省了手术时间.     

显微镜下行硅胶管双路植入治疗泪小管断裂

目的 探讨外伤性泪小管断裂吻合术中使用硅胶管作支撑物行双路全泪道留置的治疗效果.方法回顾性分析25例外伤引起下泪小管断裂患者,在显微镜下寻找断端,用两端带有金属探针的硅胶管分别从上、下泪点进入,行双路法植入于泪道,3个月后从鼻腔拔出硅胶管,随访并进行疗效分析.结果 25例均一次性吻合成功,术后随访3～12个月,治愈24例,好转1例,无并发症发生.结论 在显微镜下寻找泪小管断端,以硅胶管作为泪小管支撑物,行双路全泪道留置管治疗外伤性泪小管断裂方法简便、效果好.     

显微镜下泪小管吻合术

显微镜下泪小管吻合术徐法松，赵嘉宝，邱昆辉靠近内眦部的眼睑裂伤常伴有泪小管断离，若未妥当处理，势必造成永久性溢泪，近年来由于显微外科的发展，对泪小管断离的修复，重建泪道，恢复其功能已被重视。我们应用手术显微镜，以细硬膜外麻醉导管做支撑物对１２例泪小管...     

两种显微技术治疗泪小管断裂的疗效观察

目的 评价应川两种显微技术治疗上、下泪小管断裂的手术方法对预后的影响。方法 应用显微外科技术，在手术显微镜下找出泪小管的断端，按手术方式不同分为两组，即施行直接探查插管吻合组（56眼）和泪囊切开逆行插管吻合组（31眼）。结果 直接探奁插管吻合术56眼，治愈46例，好转7眼，失败3眼，治愈率82．14％；泪囊切开逆行插管吻合术31眼，治愈26眼，好转4眼，失败1眼，治愈率83．87％。结论 应用显微外科技术可明显提高治疗泪小管断裂的临床效果。     

改良的泪小管断裂吻合术

眼睑裂伤常伴有泪小管断裂，若不修复．可导致终身溢泪，给工作和生活带来诸多不便。泪小管吻合术是治疗泪小管断裂的唯一方法．良好的断端吻合和适宜支撑物应用是获得成功基础。因此，泪小管断裂后应尽量行泪小管吻合术。本院自1997年10月至2004年10月，在显微镜下行泪小管吻合术63例，疗效满意。现报告如下。     

显微吻合泪小管断裂27例临床体会

<正>外伤性泪小管断裂是眼科常见急诊,且常与眼睑、面部创伤同时存在。手术吻合断裂的泪小管是唯一的治疗方法。如果处理不当将造成终生溢泪的后遗症,给伤病员带来长期的痛苦,影响工作和生活质量。本院从2003年1月至2008年11月共收治下泪小管断裂27例27眼,以硅胶管为支撑物行泪小管断裂端端吻合术,取得较好的疗效。现将手术体会报告如下。     

泪小管断裂显微吻合术中支架的改良

目的 探讨外伤性泪小管断裂吻合术中支架放置的新方法，提高泪小管吻合术的成功率。方法 在手术显微镜下，利用硬膜外麻醉导管行30例泪小管断裂吻合术，其中改良组15例将导管从泪小点穿出皮肤固定的做法改为将导管潜行放置并固定于泪小管内，3个月后从鼻腔拔除支架。结果 改良组中14例吻合成功，由于导管不从泪小点穿出，术中和术后未发生泪小点损伤等并发症。对照组则有8例出现吻合口阻塞、泪小点损伤等并发症。结论 应用显微外科技术进行改良的潜行支架放置法，可进一步提高泪小管吻合术的成功率。     

自制套管探针在泪小管吻合中的应用及护理

<正> 泪小管断裂在眼外伤中比较常见,及时手术恢复泪道通畅,可避免终身流泪。我们用自制套管探针对61例泪小管断裂行泪小管显微吻合术,创伤小,手术简便易行,经过我们的精心治疗和护理,效果满意。 1 资料与方法 1.1 一般资料:61例下泪小管断裂中,合并上泪小管断裂5例,均为单眼。右眼27例,左眼34例,男53例,女8例;年龄最小10岁,最大65岁,平均36.5岁;受伤时间40min～4天。材料:①自制套管泪道探针一支:取12号腰穿针,将尖端磨平即成。②小号硬脊膜外麻醉管一根(简称腰麻管)。③导尿管一根。     

两种内固定方法治疗桡骨远端骨折的疗效比较研究

目的 对比斜T型锁定加压接骨板系统(locking compression plate,LCP)及AO普通T型板钉系统治疗桡骨远端骨折的疗效.方法 对1999年3月至2009年12月我科收治的313例桡骨远端骨折患者中获得完整随访资料的72例(73侧),采用Sarmiento改良的Gartland-Werley评分系统(GW评分)进行术后功能评分,并比较LCP(LCP组)及AO普通T型板钉系统(普通组)内固定术后两组腕关节的功能.结果 术后随访时间为3个月至6年,平均25.4个月.X线片显示骨折全部愈合.GW评分LCP组平均1.98分,普通组平均1.43分,两组差异无统计学意义(P>0.05);两组在患者满意度上差异也无统计学意义(P>0.05).结论 对于绝大部分复位失败的桡骨远端A型骨折、移位明显的B型骨折及C型骨折,应用AO普通T型板钉固定就可满足手术需要,而对于骨质疏松严重的粉碎性C型骨折,LCP的内固定效果更为可靠.     

Comparison of the risk of breakage of two kinds of sacroiliac screws in the treatment of bilateral sacral fractures

Purpose

This study aimed at comparing the risk of breakage of lengthened sacroiliac screw and ordinary sacroiliac screw for the treatment of bilateral vertical sacral fractures to provide reference for clinical application.

Methods

A finite element model of type C pelvic ring injury (bilateral type Denis II fracture of sacrum) was produced. The bilateral sacral fractures were fixed with lengthened sacroiliac screw and ordinary sacroiliac screw in seven types of models, respectively. The maximal Von Mises stresses and stress distribution of the two kinds of screws in the case of standing on both feet were measured and compared.

Results

(1) Whether in lengthened sacroiliac screw or ordinary sacroiliac screw, the maximal Von Mises stress of screw fixation only in S1 segment is the largest, and the maximal Von Mises stress of screw fixation only in S2 segment is minor, and the maximal Von Mises stress of screw fixation in S1 and S2 segments, respectively, is the least. (2) When S1 and S2 were both fixed with ordinary screws, the maximal Von Mises stress of screw in S1 segment is larger than that of S2. When S1 and S2 were both fixed with lengthened screws, the maximal Von Mises stress of screw in S1 segment is similar to that of S2. (3) The maximal Von Mises stresses of bilateral symmetrical screws are similar. (4) When only S1 was fixed, the maximal Von Mises stress of lengthened screw is less than that of ordinary screw. When only S2 was fixed, the maximal Von Mises stress of lengthened screw is larger than that of ordinary screw. When S1 and S2 were both fixed, the maximal Von Mises stress of lengthened screw is slightly less than that of ordinary screw. (5) Whether in lengthened screw or ordinary screw, the stress concentrations all exhibited at the regions of screws corresponding to the sacral fracture regions and the part between sacral bilateral fracture lines. Compared with ordinary screw, the stress distribution in lengthened screw is more homogeneous. Whether in lengthened screw or ordinary screw, the stress distribution of only one sacral segment fixation is more concentrated than that of two sacral segments’ fixation. When S1 and S2 were both fixed, the stress distribution of upper screw is more concentrated and that of lower screw is more homogeneous.

Conclusion

In a finite elements simulated type C pelvic ring disruption (bilateral type Denis II sacral fracture), the breakage risk of screws fixed in double-segment bilaterally symmetrically is low, and the breakage risk of screws fixed in S2 segment is lower than that of S1 segment. The bilaterally symmetrical screw fixation in double-segment is strongly recommended to reduce the breakage risk of screws. In addition, the breakage risk of lengthened screws is lower than that of ordinary screws except when screws are fixed in only S2 segment, which merits attention.     

两种治疗肝外胆管结石的微创手术方案对比

目的:比较腹腔镜下放置双猪尾胆管支架胆管一期缝合与T管引流治疗肝外胆管结石的疗效。方法:选取2014年1月至2015年1月收治的80例肝外胆管结石患者作为研究对象,采用随机数字表法分为两组,观察组(n=40)于腹腔镜下放置双猪尾胆管支架行胆管一期缝合术,对照组(n=40)行腹腔镜胆管探查T管引流术。对比两组患者手术情况、并发症发生率、机体应激反应及生活质量。结果:两组并发症总发生率(7.5%vs.10.0%)差异无统计学意义(P0.05)。观察组胆汁引流量、输液量、排气时间、住院时间、总费用均显著低于对照组;术后3 d观察组血清血管紧张素Ⅱ、总抗氧化能力、皮质醇、超氧化物歧化酶水平均低于对照组,观察组患者术后生活质量各项评分均优于对照组患者,差异有统计学意义(P0.05)。结论:腹腔镜下放置双猪尾胆管支架行胆管一期缝合与T管引流术治疗肝外胆管结石术后并发症发生率均较低,具有较佳的安全性,采用腹腔镜下放置双猪尾胆管支架胆管一期缝合术治疗肝外胆管结石术后机体应激反应小、康复快、住院时间短、住院费用低、生活质量较高,可优先考虑将其作为治疗肝外胆管结石的手术方案。     

跟骨骨折两种内固定手术疗效比较

目的对比分析可塑钛板及空心钉内固定治疗跟骨骨折的临床疗效。方法对40例(52足)跟骨骨折根据自愿原则分别进入可塑钛板内固定组及空心钉内固定组进行手术治疗,各20例(26足),对比分析两组患者手术时间、术中出血量、骨折愈合时间及术后足踝功能。结果 40例均获得随访6-18个月,平均(10.42±1.33)个月。空心钉内固定组与可塑钛板内固定组比较,手术时间较短、出血量较多,差异有统计学意义(P<0.05);骨折愈合时间、Bohler角、Gissane角、踝关节活动范围两组差异无统计学意义(P>0.05);两组并发症发生率差异无统计学意义(P>0.05)。结论空心钉内固定治疗跟骨骨折能有效防止关节面复位后再塌陷及骨折移位,手术方式简单、创伤小,具有较大的微创手术优势。     

两种腹腔镜下疝修补术治疗腹股沟疝的疗效比较

目的探讨两种腹腔镜下疝修补术治疗腹股沟疝的临床效果。方法选择本院2008年5月至2011年3月行腹腔镜腹股沟疝修补术的患者85例,将患者随机分为两组:经腹腹膜前疝修补术(TAPP)组(53例)和腹腔镜全腹膜外疝修补术(TEP)组(32例)。观察两组患者手术情况及住院时间、术后恢复情况及并发症发生情况等指标。结果两组手术均获成功,无中转开放。TAPP组与TEP组患者在手术时间、术中出血量、平均住院时间、术后住院时间方面无明显差异(P>0.05),在手术费用上TAPP组高于TEP组,具有统计学差异(P<0.05)。TAPP组与TEP组患者在术后1～5天最高体温、肛门排气时间、镇痛药使用率方面无明显差异(P>0.05)。TAPP组1例患者术后出现暂时的腹股沟区神经感觉异常,1例患者出现肠梗阻,经保守治疗后缓解。TEP组1例患者出现腹壁皮下血清肿。TAPP组并发症发生率为3.8%(2/53),TEP组并发症发生率为3.1%(1/32),两组患者在并发症发生率方面无统计学差异(P>0.05)。全部患者术后均获得全程随访,两组患者均无复发。结论TAPP与TEP均是治疗腹疝安全、有效的手术方式,值得临床推广应用。     

开放与通道下二种不同手术方式对腰椎管狭窄的治疗效果比较

目的：比较开放与通道下二种不同手术方式对腰椎管狭窄患者的治疗效果。方法：选择我院于2021年1月—2022年6月收治的腰椎管狭窄患者95例,依据手术方法分为开放组46例与通道组49例。开放组采用传统椎板切除减压内固定术,通道组采用固定通道技术治疗。两组患者均完成6个月随访。比较两组手术指标,术后并发症情况;术前和术后3 d患者疼痛介质和应激反应指标变化;术前、术后1个月和术后6个月腰痛和腿痛及腰椎功能变化。结果：通道组腰椎管狭窄患者术中出血量少于开放组,手术时间长于开放组,住院时间短于开放组（P <0.05）。通道组腰椎管狭窄患者术后并发症发生率小于开放组（P <0.05）。两组术后3 d腰椎管狭窄患者皮质醇（Cor）和去甲肾上腺素（NE）水平高于术前（P <0.05）;而通道组术后3 d Cor和NE水平低于开放组（P <0.05）。两组术后3 d神经肽Y(NPY)和P物质（SP）水平高于术前,而β-内啡肽（β-EP）水平低于术前（P <0.05）;而通道组术后3 d NPY和SP水平低于开放组,而β-EP水平高于开放组（P <0.05）。两组术后...     

尺骨鹰嘴骨折两种治疗方法的疗效比较

目的：比较尺骨鹰嘴钢板和张力带治疗尺骨鹰嘴骨折的疗效。方法：采用2种方法治疗尺骨鹰嘴骨折63例，张力带内固定组（A组）35例，男21例，女14例；年龄15-62岁，平均48．9岁。尺骨鹰嘴钢板内固定组（B组）28例，男20例，女8例；年龄25～67岁．平均50．6岁。按Delee，JC（1984）分类方法，A组1A型5例，1B型8例，2型14例，3型7例，4型1例；B组1A型3例，1B型5例，2型6例，3型11例，4型3例。比较两组固定方法的疗效。结果：63例患者均获随访，时间6～15个月，参照庞桂根疗效评价标准，B组：优20例，良7例，可1例，差0例；A组：优23例，良10例，可2例，差0例。两种治疗方法疗效差异无统计学意义。结论：尺骨鹰嘴钢板和张力带都是治疗尺骨鹰嘴骨折的有效方法，可根据具体情况选择使用。     

四种胆管造影法在腹腔镜胆囊切除术中预防胆管损伤作用的比较

目的 为了减少胆管损伤的发生，比较在腹腔镜胆囊切除术中四种胆管造影法对预防胆管损伤所起的作用。方法 分别用光亮胆管造影法(cold light cholangiography，CLCP)、美蓝胆管造影法(methylenum coeruleum cholangioguaphy，MCCP)、术中X线胆管造影法(intraoperative cholan—giography，IOCP)、术中逆行胰胆管造影法(intraoperative endoscopic retrogarde cholangiopancreatography，IERCP)进行比较。结果 四种胆管造影法均能在腹腔镜胆囊切除术(1aparoscopic cholecystectomy，LC)中提供胆管图像。前两种为直接图像，有助于术者术中进行解剖，效果以CLCP为佳。后两种为间接图像，对术中解剖无直接帮助。结论 CLCP能清楚、直接地显示胆管走向。在解剖不清的LC中，能有效帮助术者进行解剖，提高手术安全性，与其他3种方法相比，实用价值更高。     

Therapeutic effects of two anastomoses of lacrimal passage on canalicular laceration

Objective： To evaluate the therapeutic effects of two anastomoses （canaliculus-to-lacrimal sac anastomosis and end-to-end anastomosis） on nasolacrimal laceration for over 7 mm from the broken end to the dacryon.
Methods： A total of 71 patients （44 males and 27 females, aged 16-55 years, mean=34.32 years） with fresh canalicular laceration were treated in our hospital from March 2003 to April 2008. Under a microscope, 37 patients were treated with lacrimal sac anastomosis （the treatment group） and 34 with end-to-end anastomosis （the control group）, detaining silicone tubes till 3 months later.
Results： The cure rate of the treatment group （89.19%） was significantly higher than that of the control group （55.56%）. Class I cure rates were 70.27% in the treatment group and 47.06 % in the control group, and the difference between the two groups was significant （P〈0.05）. Postoperative inflammatory reactions had significant influences on the two kinds of anastomosing methods, but no significant difference was found between the two groups （P〉0.05）.
Conclusions： When the distance from the broken end to the dacryon is over 7 mm, especially when it is necessary to find the paranasal broken end of the lacrimal canaliculus with dacryocystotomy, canaliculus-to-lacrimal sac anastomosis is a better treatment method than end-to-end anastomosis for laceration of lacrimal canaliculus.     

Bile duct patterns in the hilar region of the liver in two cases of biliary atresia

Bile duct patterns in the hilar region of the liver were demonstrated in two autopsy cases of biliary atresia by three-dimensional graphic reconstructions. In one case, jaundice had completely disappeared after successful hepatic portojejunostomy. However, at the age of 4 months, this patient died of cardiac failure caused by endocardial cushion defect. The histological reconstruction of this case showed that there were large patent bile ducts, 150 microns to 400 microns in diameter, and plenty of bile ductules surrounding the large ducts to form networks. The other patient died of hepatic failure at the age of 9 months. In this case, only a few large ducts ended in bile lakes that did not connect with the portojejunostomy, and only a few ductules were found around the large ducts. These results indicate that the existence of networks of bile ductules and the patency of large bile ducts at the porta hepatis contribute to good postoperative bile excretion.