多媒体教学系统提升狗盲肠切除术实践教学质量的研究

<正>多媒体教学系统进行手术实践教学具有重要意义[1-2]。为进一步研究和探讨多媒体教学系统在提升狗盲肠切除术实践教学质量中的实际效果,从而为相关的临床实践教学研究提供指导和帮助,本文选取我校200名2010级临床专业的本科学生为研究对象,针对相关资料进行了比较研究。1资料与方法1.1临床资料本研究所选取的200名学员中,男学员153名,所占比例为76.50%,女性学员47名,所占比例为23.50%,平均年龄为     

微波行兔脾部分切除术后巨噬细胞吞噬功能的研究

探讨微波在行兔脾部分切除术后对脾免疫功能的影响。微波行兔脾部分切除术(PSM)组12只和假拟手术(SO)组6只术后4周,均经耳静脉注射肺炎双球菌悬浮液,并经门静脉注射印度墨汁,全组均行脾组织切片采用H-E染色,检测巨噬细胞的吞噬功能。脾巨噬细胞的吞噬功能分级在PSM组与SO组两组间无显著性差异(P>0.05)。脾重量在两组间也无显著性差异(P>0.05)。微波行兔脾部分切除术能较好保留脾巨噬细胞的吞噬功能,提示微波行保脾手术具有一定的临床应用价值。     

盲肠下外侧韧带的观察及在移动盲肠症应用探讨

在30具尸体标本上解剖观察了盲肠的韧带,在盲肠后壁系膜缘有3条走行方向不同的韧带,分别称为盲肠下外侧、盲肠下、盲肠下内侧韧带。其中盲肠下外侧韧带平均长1.8cm,出现率73.3％.利用盲肠下外侧韧带行折叠式缝合法治疗移动盲肠症68例,效果良好.该术式设计符合解剖生理及生物力学原则。     

骨形成蛋白对兔髁突骨折处血供影响的实验研究

目的 对兔下颌骨髁突骨折断端应用人重组骨形成蛋白（rhBMP），探讨其对骨折两端未行内固定，对位较好情况下骨折愈合处血管生成和血液供应的影响。方法 选择60只兔子，手术前随机分为两组，建立下颌骨髁突骨折模型，一组于骨折断端给予吸附有rhBMP的明胶海绵作为实验组，另一组只放置明胶海绵，作为空白对照组。分别在1、2、3、4、5、6周每组各处死5只兔子，对骨折断端骨折愈合处行肉眼、透射光、组织切片等观察。结果 实验组与对照组比较，手术麻醉到术后苏醒时无明显差别，每只兔子手术前到处死时体质量的变化经分析走行相似。肉眼观察实验组骨折断端表面骨痂形成时间较早，骨重建速度快，重塑后的外观与原有形状相似，而对照组骨痂呈膨隆增生，重塑不佳，局部常有缺损。组织切片以及MVD计数示实验组早期明显的血管生成（P〈0．01）。透射光下实验组充血范围经统计学分析较对照组明显（P〈0．01）。结论 本实验证明骨形成蛋白对未行固定的兔髁突骨折愈合处的血液供应及血管生成有促进作用。     

显微直视下经口咽入路齿状突切除术

目的探讨显微直视下经口咽入路齿状突切除术的适应证、手术方法、并发症及枕颈交界区的稳定。方法在显微镜下对16例颅颈交界区畸形的病人进行经口咽入路行齿状突切除术。其中ChiariI畸形13例,风湿性关节炎引起的颅底凹陷3例。MRI均示有齿状突向后上方突起,延髓、上颈髓腹侧受压。小脑扁桃体下疝并脊髓空洞占6例。所有病例均采用显微直视下经口咽入路齿状突切除术。结果痊愈13例(81%),有效3例(19%)。无死亡、感染和脑脊液漏发生。结论显微直视下经口咽入路是一个直接、安全、有效的治疗颅颈交界区腹侧受压病变方法。     

阑尾和盲肠有关应用的解剖

对57例成人阑尾和盲肠进行了观察。归纳了九种阑尾形状,其中较多见的是迂曲,卷曲、半月、半环等形状。阑尾的位置以盆位和回肠后位较多;阑尾平均长6.7cm;阑尾动脉以一支型多见(80.7％);阑尾根部表面投影多在麦氏点与兰氏点之间(51.9％)。     

浓缩生长因子修复兔髁突全层软骨损伤

背景:浓缩生长因子对组织修复有促进作用,目前尚缺乏其对髁突软骨修复影响的研究.目的:研究浓缩生长因子对兔颞下颌关节髁突全层软骨损伤修复的影响.方法:采集兔静脉血制备浓缩生长因子.建立兔双侧髁突穿透软骨下骨皮质的全层软骨损伤模型,实验侧损伤区充填浓缩生长因子,对照侧自然愈合.分别于术后2,6,12周取材并进行组织形态学观...     

盲肠和回盲襞的应用解剖学研究

目的 观测盲肠的形态和位置，回盲口和回盲瓣的形态、大小。方法 用５３具经福尔马林固定后的尸体，剖腹后精确测定上述指标。结论 低位肠梗阻的临床表现与回盲瓣的位置和形态有一定关系。结论 回盲襞可作为寻找阑尾的标志和覆盖阑尾残端的材料。     

盲肠和回盲襞的应用解剖学探讨

本文选用 53具福尔马林固定尸体剖腹后观测了盲肠的位置、形态 ,回盲口、回盲瓣的形态、大小等 ,并与低位肠梗阻发生呕吐因素作了探讨。此外 ,经 53例回盲襞观测 ,提出它可作为寻找阑尾的标志之一 ;并可游离回盲襞 ,以此覆盖无法作荷包缝合的阑尾残端     

内镜齿突切除术的经下颌下入路解剖

目的 通过颈椎CT影像与内镜下寰、枢椎齿突解剖,为内镜下颅颈交界区手术提供依据。方法 选取150例颈椎高分辨薄层平扫CT测量评估寰枢椎及其毗邻结构关系,估算齿突切除术安全界。3例新鲜灌注尸头,采用STORZ内镜系统及内镜手术器械,经下颌下入路行内镜下寰枢椎齿突解剖。结果 通过CT测量得出寰椎前弓长度均值等,估算齿突切除安全界面积为(240.9±39.92)mm²,其中男性(248.3±49.64)mm²,女性(233.2±24.54)mm²。经下颌下的内镜入路寰枢椎解剖及齿突切除解剖以一侧下颌角与舌骨连线中点处横行切口,显露下颌下三角区域,内镜下经下颌下三角区暴露二腹肌及舌骨大角,沿咽后间隙逐层钝性分离至椎前间隙,暴露椎前筋膜,去除椎前组织后充分暴露寰椎、枢椎齿突、寰枕关节、寰枢关节、及部分枕骨大孔区。结论 通过CT影像学估算齿突切除的安全界面积,结合内镜下颌下入路解剖暴露寰枢椎齿突,在内镜的明视下进行有效、安全的手术器械操作,提示经内镜下颌下入路切除齿突在实现充分减压的同时又能极大程度降低脑脊液漏的发生率,减少感染的机...     

阑尾的应用解剖学探讨

目的 为临床应用提供更多的形态学资料。方法 在106具福尔马林固定的汉族成人尸体上对阑尾及其系膜进行了观测。结果 观察了阑尾的位置、形态、长度、开口形状,动脉分支及阑尾系膜的形态等指数。结论 阑尾位置以回肠前位最多,阑尾的形态以“S”形和扭曲形最多,阑尾开口呈漏斗形者最多,阑尾长度平均为(66.3±0.3)mm,阑尾系膜以三角形最多。     

Adenocarcinoid of the vermiform appendix

Summary Four cases of adenocarcinoid of the appendix were studied. Two tumours were found among 28 cases primarily diagnosed as appendiceal carcinoids. They showed characteristic histological structures with features of both a conventional carcinoid tumour and a mucinproducing adenocarcinoma with goblet cells. All tumours were small and ill-defined; three were associated with fibrous obliteration of the appendiceal lumen. All were diagnosed incidentally by the pathologist in appendices removed en passant or because of acute appendicitis. Three of the tumours appeared well differentiated with a low degree of malignancy similar to that of the conventional carcinoid tumour. In one case however, the tumour was less differentiated with atypical foci and a high mitotic count and had metastasised to peritoneum and both ovaries.     

Adenocarcinoma of the vermiform appendix. A population study.

We report seven cases of adenocarcinoma of the vermiform appendix occurring in Iceland during 1974-1989. The patients ranged in age from 25-83 years, mean age 55.1 years. There were five males and two females. Five had mucinous adenocarcinoma, two had adenocarcinoma. Four patients presented with symptoms and signs of acute appendicitis and all had surgically resectable disease. Three of these patients were alive with no evidence of disease four months, two years and 15 years after presentation; one death of disease occurred seven years after ileocecal resection. In three cases, the clinical presentation was that of metastatic adenocarcinoma of unknown origin. Of these patients two were diagnosed at autopsy and one after appendectomy for perforated appendicitis. Survival in this group was six weeks, three months and twelve months, respectively. In none of our patients was the diagnosis made preoperatively and no tumors were found in appendices removed incidental to other intra-abdominal operations. The incidence of adenocarcinoma of the vermiform appendix in Iceland during 1974-1989 was approximately 0.2 cases/100.000/year.     

In vivo location of the human vermiform appendix

The anatomic position of the appendiceal tip is cited in many surgical and anatomical texts as being fixed in the retrocecal position in as many as two-thirds of cases studied. The reference most often quoted to support this observation is Wakeley (1933), but this frequency did not correspond to the clinical experience of the surgical staff at the authors' institution. Accordingly, a prospective survey of the in vivo location of the vermiform appendix was undertaken over a 6-month period. The results demonstrated that the retrocecal position was indeed the most common location, but occurred in only 33% of instances. This observation may encourage greater utilization of laparoscopic appendectomy, since it suggests that retroperitoneal dissection will not be necessary to locate the appendiceal tip in the majority of cases. © 1994 Wiley-Liss, Inc.     

Cadaveric topography and morphometry of the vermiform appendix

Our study justified by the frequency of acute appendicitis and the possibility of anatomic variations of the caecoappendicular area attempt to index the topographic variations of the vermiform appendix (v.a.). On 80 fresh native cadavers (62 men and 18 women) without surgical antecedent whose mean age was 36 years (range between 16 and 78 years) we note the morphotype and the height. More over we study the intraperitoneal projection of the Mac Burney point, topography and shape of the cecum and the situation, shape and dimensions of the v.a. We note also the level of implantation of this latter on the cecum, appearance of the mesoappendix and the distance separating the base of the appendix to the ileo-caecal junction. Mac Burney's point permitted to localize appendix in 66%; the cecum has more often than not the form of a bulb (98.7%) and sited in right fossa iliaca. We noted 7 types of topographic disposition; front varieties were more frequent (68.7%) notably the pelvic direction (51.2%) with a medial (72.5%) or a posteromedial (27.5%) establishment on the cecum. The v.a. was more often in the form of worm with a long mesoappendix; his mean length was 106.4 mm (between 65 and 160 mm) and the mean diameter 6.77 mm (range between 4 and 10 mm). The distance which separated the base of the appendix to the ileo-cecal junction varied between 15 to 40 mm with a mean distance of 24.2 mm. Thus in this study, dimensions of the v.a. were very variables. Located in right fossa iliaca he adopted a front topography with pelvic direction and medial establishment on bulbar cecum. In spite of scarcity of ectopic situation of the appendix for which laparoscopic approach is salutary, a similar topographic study during surgical treatment of acute appendicitis will be interesting.     

The position of the vermiform appendix at laparoscopy

Background The vermiform appendix has no constant position and the data on the variations in its position are limited. The aim of this study was to determine the frequency of the various positions of the appendix at laparoscopy. Methods Patients undergoing emergency or elective laparoscopy at a university teaching hospital between April and September 2004 were studied prospectively. The positions of the appendix and the caecum were determined after insertion of the laparoscope, prior to any other procedure and the relative frequencies calculated. Results A total of 303 (102 males and 201 females) patients with a median age of 52 years (range 18–93 years) were studied. An emergency appendicectomy was performed in 67 patients, 49 had a diagnostic laparoscopy, 179 underwent a laparoscopic cholecystectomy and eight had other procedures. The caecum was at McBurney’s point in 245 (80.9%) patients, pelvic in 45 (14.9%) and high lying in 13 (4.3%). The appendix was pelvic in 155 (51.2%) patients, pre-ileal in 9 (3.0%), para-caecal in 11 (3.6%), post-ileal in 67 (22.1%) and retrocaecal in 61 (20.1%) patients. Conclusion Contrary to the common belief the appendix is more often found in the pelvic rather than the retrocaecal position. There is also considerable variation in the position of the caecum.