半骨盆切除术后输尿管镜进镜困难一例报告

<正>输尿管镜技术已有百年发展史^[1],少有绝对禁忌证^[2],但目前仍有很多进镜困难案例出现。本文报告了1例半骨盆切除术后6年,诊断双侧输尿管结石,行输尿管镜手术治疗的病例。该患者腹盆腔脏器由于失去一侧骨盆支撑,发生明显移位,给手术进镜带来了困难。     

腹腔镜左半肝切除术4例报告

目的探讨应用腹腔镜手术完成左半肝切除的可行性。方法腹部trocar的放置同LC,惟剑突下trocar的置放稍偏向左侧。CO2气腹压力10-12mm Hg,超声刀切断镰状韧带、冠状韧带、左三角韧带,切除胆囊。肝门血流阻断方式分别选择不阻断1例、间歇阻断1例、选择性阻断2例,胆囊窝中点至肝门左侧方向,应用超声吸引刀（Cavitron Ultrasonic Surgical Aspirator,CUSA）、电凝等器械向肝实质内分离至肝门左侧方。解剖左肝管、左门静脉横部后,将其分别结扎切断。肝内分离结扎切断肝左静脉,切除左半肝。结果3例左肝管狭窄结石合并继发左肝叶纤维化,肝脏分离过程仅有少量出血,电凝止血效果良好。1例肝血管瘤,病变位于左外叶及左内叶上段,仅于显露结扎切断左肝静脉时出现小量活跃出血,予以缝合止血。4例手术时间分别为390、255、384、330min,术中出血量分别为360、500、370、280ml。术后3-6个月随访：3例左肝管狭窄结石胆道镜检查肝内外胆管正常,1例肝血管瘤一般状态良好,恢复正常生活,体重增加3kg。结论腹腔镜左半肝切除术可行,术后恢复快,但行此类手术应慎重,一要具备相应的设备器械,二要有开腹肝切除和腹腔镜手术经验的医师行此手术。     

胸腹肢体开放伤一例报告

患者,男,35岁.胸腹肢体被尖刀连续捅刺12刀1 h.面色苍白、四肢冷湿、神志淡漠、憋气伴呼吸困难,血压50/0 mmHg,心率140次/min,经皮测血氧饱和度78%.立即开通四条静脉通道快速补液,左、右胸部均被尖刀刺入,伤口向外冒气及血,上腹部有三处刀伤刺入腹内,左下腹一处刀伤刺入腹内,右上肢三处刀伤,右大腿两处刀伤,左颊一处刀伤.     

左前臂远端腕掌部毁损伤急诊手再造一例

患者　男,45岁。于1998年4月15日因左前臂远端腕掌部被石头压砸伤3h入院。检查:左前臂下1/4腕掌部毁灭性损伤,拇指第一掌骨中段以远和虎口及食中指掌指关节以远组织结构完好,但无血供。环小指挫灭。前臂近端无明显挫伤和骨折,血管神经肌腱无抽脱伤。急诊在臂丛阻滞麻醉下行手再造。常规清创,将远端拇主要动脉、第一指掌侧总动脉、头静脉起始部分、头间静脉,拇指固有神经、第一～三指掌侧总神经及拇长短伸屈肌,食、中指指总伸肌和指深屈肌断端标记,保留有虎口及指蹼相连的拇、食、中三指及其伸屈肌腱,保留第一掌骨远1/2,切除第二、三掌骨及掌…     

左腕部合并左小腿毁损性离断伤再植1例

1病例资料 患者男,38岁.因左腕及左小腿煤石砸伤后肢体离断4h入院.查体：一般情况差,眼睑及甲床苍白,左腕部见皮肤环形碾挫伤,仅掌侧约2cm皮肤与部分指深屈肌腱相连,碎裂的数块腕骨外露,创缘不规则,撕裂并挫灭的肌腱（肌肉）、血管、神经组织外翻,伤口出血明显;左小腿下1/3处离断,仅有后侧宽约2cm皮条与近端肢体相连,伤处肌腱、肌肉组织挫灭,胫腓骨断端外露,伤口内布满煤灰等异物,重度污染.     

左半结肠癌并急性梗阻一期切除术23例报告

我院１９９０年至１９９５年对未行肠道准备而行一期切除吻合术治疗结肠癌并急性梗阻患者２３例，男１５例，女８例，年龄３５～６８岁，平均５８．４岁。肿瘤位于结肠脾曲６例，降结肠３例，乙状结肠１４例。病史１２小时至１２天，平均５．７天。在切除结肠肿瘤后将结肠...     

左半结肠切除术

左半结肠切除术和右半结肠切除术相比,本术式的概念在一些手术学中提法不同。许多外科医生对该术式所切除肠管范围及供应血管处理的部位有各自的看法和作法。本文从临床实际出发遵照实用目的。结合本院经验,认为该术式切除范围应包括左半侧横结肠、结肠脾曲、降结肠及上1/2乙状结肠并切除相应的系膜(见图1之暗区)。本术式可分为左半结肠切除术和根治性左半结肠切除术,在后者如术中见中间淋巴结已受累,则切线扩大到虚线部位(见图1),即自根部切断肠系膜下动脉,切除全部乙状结肠。     

超左半肝切除术一例北大核心CSCD

患者男,63岁。因“体检发现肝内占位10d”入院。查体：全身皮肤及黏膜无黄染、出血点及蜘蛛痣。辅助检查：乙肝两对半：HBcAb（＋）,Child-Pugh分级A级。     

半骨盆切除术的临床护理

骨盆部原发性恶性肿瘤,传统的治疗方法包括患侧下肢在内的半骨盆截除术,手术范围广泛,且失去整个下肢,造成了严重残废以及精神上的严重创伤,甚至难以装配假肢,近年来,我科对较局限和低度恶性肿瘤,采取患侧骨盆切除术,股骨头旷置,保留患侧下肢。我科自１９９５年...     

半骨盆内切除术后重建

骨盆截除后骨盆结构和功能的重建对于提高骨盆痰患的治疗与康复水平具有十分重要的意义。本文综述了多种丰骨盆内切除术后重建方法，着重讨论了半骨盆假体置换技术与研究方向。     

Re-ossification of the pelvis following hemipelvectomy for trauma

We present a patient who underwent delayed sub-periosteal hemipelvectomy for control of infection and to enable soft-tissue cover after trauma. At four months after amputation, clinical examination and radiographs demonstrated almost complete re-ossification of the hemipelvis. This has allowed the patient to regain sitting balance and to use a walking prosthesis designed for patients following disarticulation of the hip. After 14 months from injury, no perineal hernia has developed, and no dysfunction of pelvic organs is attributable to heterotopic bone formation or adhesions. The patient's mobility with a prosthesis is similar to that expected of a through-hip amputee.     

左髂骨巨大转移瘤行骨盆重建术1例

1病例资料 患者．男,47岁。左髋部酸痛7个月加重伴活动受限4个月,夜间无法入睡．感左髋部疼痛难以忍受,于2008年6月20日来我院就诊,查体：左髋部未见肿胀、青紫及皮肤破损．局部触摸未及明显包块,左侧腹股沟无肿大淋巴结;左大腿肌肉萎缩明显,患肢术梢血运正常;左上臀部压痛、叩击痛（＋）．无皮肤感觉异常;左髋关节屈伸活动部分受限,余关节活动正常;双下肢等长,左侧股四头肌、股二头肌肌力约Ⅳ级。影像学检查：     

Laparoscopy-assisted left ovarian vein transposition to treat one case of posterior nutcracker syndrome

We report one case of posterior nutcracker syndrome treated by left ovarian vein (LOV) transposition. A 36-year-old woman was suffering from nutcracker syndrome associated with pelvic congestion syndrome. Color duplex scan, computed tomographic scan, and angiography demonstrated a stenosis of a retroaortic left renal vein with proximal dilatation and incompetence of the LOV. The renocaval pullback gradient was 10 mm Hg. The LOV was harvested laparoscopically and transposed into the inferior vena cava. Completion angiography showed a patent reconstruction with no significant gradient. At day 4, an asymptomatic thrombosis was treated by thromboaspiration. Forty months later, the patient remained asymptomatic with a patent transposition. Posterior nutcracker syndrome is a rare condition. When associated with pelvic congestion syndrome due to LOV reflux, it can be treated by LOV transposition.     

Use of the Ilizarov technique to improve limb function following hemipelvectomy. A case report

Various surgical methods have been used for reconstruction after limb salvage surgery for pelvic tumours. We present a case of use of the Ilizarov technique as a second stage adjunct, for the improvement of function, after first stage tumour resection and arthrodesis. This technique is suitable for selected patients with tumour-free survival following the initial resection. Though not described before, our experience indicates it is an alternative to a mammoth one stage internal hemipelvectomy with reconstruction, that is often attempted even though there is a high risk of local recurrence and distant metastasis.