口内双侧纵形小切口U形剥离法治疗小颏畸形

目的 探讨口内双侧纵形小切口U形剥离法隆颏术矫正小颏畸形的临床效果.方法 自2011年1月至2012年9月,应用口内双侧纵形小切口U形剥离法隆颏术治疗小颏畸形36例,均采用口内双侧纵形小切口入路,骨膜下U形分离腔隙,血管钳引导置入硅胶假体.结果 对所有患者随访3～15个月,术后恢复良好,无切口裂开、假体移位、假体位置不对称等并发症发生,颏部外形满意.结论 口内双侧纵形小切口U形剥离法隆颏术切口隐蔽,下唇肌肉无明显破坏,假体易于放入,双侧对称性良好,术后固定要求不高,该方法易于掌握,安全有效.     

Hemorrhoidectomy

A simple method of hemorrhoidectomy has been presented, which if properly performed, will be followed by few complications and should give prolonged relief in the usual case. The pre- and postoperative care has been simplified and less disturbance of the patient's general health results.     

“W”切口腋臭清除术的疗效及并发症防治

目的:探讨"W"切口腋臭清除术的疗效及并发症的防治。方法:采用腋下"W"切口、翻转皮瓣、剪除大汗腺后皮肤原位回植、打包固定的手术方法,观察术后疗效及并发症。结果:36例腋臭清除术患者术后疗效肯定,无异味残留,无皮肤坏死,其中4例患者单侧切口出现愈合不良。结论:"W"切口治疗腋臭,疗效满意,并发症少,外形美观,是治疗腋臭较为理想的手术方法。     

T型离断与疝囊剥离在腹腔镜经腹膜前斜疝修补手术的临床应用

目的对比分析T型离断与疝囊完全剥离技术两种处理方式在腹腔镜经腹腹膜前疝修补术（TAPP）临床应用中的安全性和有效性。 方法收集解放军联勤保障部队第904医院自2017年1月至2019年12月确诊并收治的单侧腹股沟斜疝的男性127例患者的临床资料,其中行T型离断的患者67例（T型离断组）,行疝囊完全剥离的患者60例（完全剥离组）;对2组患者的临床资料进行回顾性分析,比较2组患者的手术时间、疝囊处理时间、术中出血量、精索损伤、术后疼痛评分、术后血清肿和远期复发情况等。 结果T型离断组的手术时间、处理疝囊时间、术中出血量、术中精索血管和输精管损伤控制、术后血清肿的发生率均优于完全剥离组,差异有统计学意义（P<0.05）;2组术中腹壁下血管损伤、术后发生切口感染、尿潴留及阴囊积液比较,差异均无统计学意义（P>0.05）;2组术后早期疼痛评分、远期慢性疼痛发生率及术后复发率比较,差异均无统计学意义（P>0.05）。 结论T型离断技术在TAPP术中能显著缩短手术时间、减少术中出血、降低术中精索意外损伤从而降低手术难度,且在术后早期及远期并发症控制的效果均不劣于完全剥离疝囊组,是一种安全有效的手术方式。     

Stapled Hemorrhoidectomy versus Conventional Excision Hemorrhoidectomy for Acute Hemorrhoidal Crisis

We compared the safety and clinical outcomes of stapled hemorrhoidectomy and conventional excision hemorrhoidectomy in the treatment of acute hemorrhoidal crisis, and analyzed various factors associated with complications in stapled hemorrhoidectomy. Forty patients underwent stapled hemorrhoidectomy and forty underwent conventional excision hemorrhoidectomy. All had the operation under local anesthesia with conscious sedation within 24 h of admission. The length of surgery, hospital stay, disability, postoperative pain, and the use of analgesics were significantly less for patients in the stapled hemorrhoidectomy group. Stapled hemorrhoidectomy did not significantly increase the rate of complications. Five patients in the stapled group (12.5%) required further surgical intervention: three with thrombosed hemorrhoids and two with recurrent prolapse. No serious complications were reported in either group. Patient satisfaction was similar in the two groups. Increased age was identified as a factor that significantly elevated the risk of complications in the stapled group (OR, 1.06; 95% CI, 1.01–1.13). Anemia and time between the onset of prolapsed hemorrhoids and hospital admission were also risk factors for complications, although they were not significant. Stapled hemorrhoidectomy is a feasible treatment for selected patients with an acute hemorrhoidal crisis and has a similar complication rate to that of conventional excision hemorrhoidectomy. Stapled hemorrhoidectomy is superior in less-postoperative pain, shorter operation time, shorter hospital stay, and earlier return to normal activity. However, we suggest that older patients with anemia or a prolonged hemorrhoidal crisis are unsuitable for stapled hemorrhoidectomy. Presented at the 48th Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington, DC, May 19–23, 2007 (poster presentation).     

An update on incision for ilioinguinal lymph node dissection.

The wound morbidity after ilioinguinal lymph node dissections can be significantly reduced by precise planning of both the incision and the extent of flap elevation. Flap elevation extends no farther than the edges of the quadrilateral block of Anson, and exposure is best obtained with a bipedicle incision with broad-based pedicles. The broad bases ensure the greatest possibility for the sustentation of the flaps by the remaining microcirculation. All suction drains are placed far laterally, not through the base of any flaps, to avoid the high bacterial count on the skin of the groin, genitals, perineum, and anus. Closure is undertaken with a running suture, which allows for a seal that will facilitate suction. Suction continues until drainage is less than 25 mL/d.     

痔环切吻合器的临床应用

痔是肛垫病理性肥大、下移和肛周皮下血管丛血流淤滞形成的团块;若伴有出血、脱垂等症状时称为痔病[1]。痔病是一种常见病、多发病,据统计,其患病率高达48%[2]。自20世纪70年代以来,人们对痔病有了更深入的认识,概念有所更新,尤其是1993年意大利的外科医师Antonio首先用吻合器治疗痔病,为痔病的治疗开创了一个新纪元。我国从2000年引进痔环切吻合器(procedureforprolapseandhemorrhoids,PPH)技术以来,已治疗痔病1600例,我院应用PPH治疗135例病人,取得了很好的疗效,积累了宝贵的经验。PPH手术治疗痔病基础痔病的近代概念认为,痔是直肠下…     

A Prospective Randomized Comparison Between an Open Hemorrhoidectomy and a Semi-Closed (Semi-Open) Hemorrhoidectomy

A semi-closed hemorrhoidectomy is a popular surgical procedure among Japanese coloproctologists because it is thought that the risk of postoperative bleeding is reduced, and postoperative pain is milder after a semi-closed hemorrhoidectomy than after an open hemorrhoidectomy. However, no prospective randomized trial comparing an open and semi-closed hemorrhoidectomy has yet been published. We conducted a prospective randomized trial comparing both clinically and physiologically an open and semi-closed hemorrhoidectomy. Thirty-four consecutive patients undergoing a hemorrhoidectomy for third-degree hemorrhoids were randomized to receive either an open hemorrhoidectomy (n = 17) or a semi-closed hemorrhoidectomy (n = 17). Postoperative pain was evaluated using an analog scale by the patients themselves. An anorectal physiological study was performed before the operation and 2 months after the operation. Pain at 1 week after operation was significantly more severe after a semi-closed hemorrhoidectomy than after an open hemorrhoidectomy. The postoperative physiological parameters including sphincter pressures did not differ between the two forms of hemorrhoidectomy. However, younger patients and patients having higher sphincter pressures preoperatively had more severe pain at 2 weeks after a semi-closed hemorrhoidectomy. Although both forms of hemorrhoidectomy appear to be almost equivalent, the degree of early postoperative pain may be less after an open hemorrhoidectomy in both young patients and in those patients having high preoperative anal sphincter pressures. Received: January 10, 2001 / Accepted: July 17, 2001     

甲状腺癌行弧形切口颈部淋巴结清扫术临床分析

目的探究低位弧形切口在甲状腺乳头状癌(PTC)功能性颈部淋巴结清扫术中的应用可行性及安全性。方法回顾性分析2012年3月至2014年3月200例PTC伴有颈部淋巴结转移手术患者的临床资料。根据切口形状的不同分为低位组(132例)和传统组(68例),采用SPSS 19.0软件,对两组患者切口长度、淋巴结清扫数目及术后生活质量和外观满意度等连续变量分析使用t检验;术后并发症及复发情况的比较选用χ~2检验,P0.05认定为有统计学意义。结果低位组在手术用时、切口长度均较传统组短(P0.05);在其他颈侧区淋巴结清扫数目上两组间没有明显差别(P0.05),但在Ⅱb区和Ⅴ区淋巴结数目低位组却少于传统组(P0.05)。在切口瘢痕色泽、厚度、柔软程度、血管分部和患者肩部僵硬感、疼痛、麻木感等方面低位组得分均低于传统组(P0.05)。淋巴结转移累及Ⅱa区时,Ⅱb区转移风险增高(r=0.183,P0.001);多区转移时,Ⅱb和Ⅴ区转移风险均增高(r=0.241、0.242,P0.001)。结论低位弧形切口PTC功能性颈部淋巴结清扫术安全可行,并可以明显改善患者术后生活质量,但对Ⅱb区和Ⅴ区以及多区转移的患者,建议仍采用传统的"L"形切口进行手术。