414例输精管注射粘堵术随访报告

１９９２年４月至１９９３年１２月共施行输精管注射粘堵术４３４例，对其中的４１４例进行了１８个月－４２个月随访２９例术后再孕，其中孕后检查出精子者２５例，表明手术失败率为６％。术后发生血肿３例、感染２例，并发症率为１．２％。认为精客注射射粘堵术是一种并发症低，效果可靠，且为群众乐于接受的男子节育方法。     

输精管粘堵后复通术八例报告

<正> 经皮输精管注射粘堵法(简称输精管粘堵)已临床应用20年逾60万例,此法不作皮肤切口,不游离、切断输精管,大大减少了组织损伤所致的某些并发症。但输精管粘堵后手术复通的情况究竟如何?现将我们所施行的8例输精管粘堵后的复通情况报道如下。一、对象和方法     

影响显微外科输精管吻合术后复孕的多因素研究

目的：探究影响显微外科输精管吻合术后复孕的因素。方法：对５６例输精管结扎术后要求复育者进行了显微输精管吻合术，术后两年随访５０例，复通率达１００％，复孕率达６０％。以抗精子抗体、精子穿卵试验、输精管结节精子肉芽肿、精液质量等２１个指标对孕组和未孕组进行了对照观察。结果：经过Ｌｏｇｉｓｔｉｃ回归等方法进行统计学处理，筛选出术后ＳＩＴ、精子存活率、精子密度、ＩＢＴ结合ＩｇＡ或ＩｇＧ、ＭＡＲ、ＴＡＴ和精子活动率等８个影响吻合术后受孕的主要因素，其中前２个最为主要。结论：影响显微外科输精管吻合术后复孕的主要因素有８个，其中以术后的ＳＩＴ和精子存活率最为重要。     

可复性输精管注射栓堵术后并发症(附49例报告)

1990年12月～1991年8月，本站共做可复性输精管注射检堵术1974例，截止1997年6月共收治术后并发症49例。1992年随机对1974例受术者中的508例（术后3～8个月）作了随访。现将诊治的49例术后并发症，结合随访结果作一总结，供同道参考。1临床资料年龄：25～48（平均33．47）岁；术后发病时间：3d～6年。其中半个月以内者9例，半个月至1年28例，1年以后发病者12例，1年以内发病者占75．5％；49例中左侧23例，右侧用树，双侧6例；近单丸端输精管炎18例，栓子周围炎12例，输精管明囊疾管9例，阴囊湿疹1例；阴囊血肿1例。2诊断标准2．至近在九端输…     

腔房转流术治疗布加氏综合征2例报告

报告腔房转流术治疗布加氏综合征２例，其中例１为Ⅲ型，例２为Ⅱ型，近期疗效满意。例１原因罕见，为输精管粘堵剂误注入精索静脉及下腔静脉所致，值得警惕。     

三种男性绝育术的远期效果分析

目的选择更为安全的长效男性绝育手术方式。方法将接受手术者随机分为3组:直视钳穿绝育术、可复性输精管栓堵绝育术及注射药物绝育术,每组各200例。分别于术后0.5年、1年、2年进行精液分析,并对3种术式的并发症发生率进行统计。结果术后0.5年及1年精子消失率最高的是直钳法,最低的是栓堵法。术后2年精子消失率粘堵法最高,栓堵法最低。术后并发症粘堵术的发生率最低,其次为栓堵,最高的为直钳法。结论直视钳穿绝育术近期、远期精子消失均高于另外2种手术方式。手术后并发症低于另外2种手术方式。直视钳穿绝育术优于可复性输精管栓堵绝育术及注射药物绝育术。是男性绝育术的首选方式。     

影响显微外科输精管吻合术后复孕的多因素研究

通过采用作者改良的显微外科输精管吻合法和总结查找近睾端输精管液中精子的方法，对56例输精管结扎术后要求复有者进行了输精管管吻合术．术后2年随访50例，复通率达100％，复孕率达60％、以抗精子抗体、精子穿卵试验、输精管结节精子肉芽肿、精液质量等21个指标对孕组和未孕组进行了对照现实，经过Logistic回归等方法进行统计学处理，筛选出术后SIT、精子存活率、精子密度、IBT结合IgA和IgG、MAR、TAT和精子活动率等8个影响吻合术后受孕的主要因素，其中前2个最为主要。     

影响显微外科输精管吻合术后复孕的多因素研究

通过采用作者改良的显微外科输精管吻合法和总结查找近睾端输精管液中精子的方法。对５６例输精管结扎术后要求复育者进行了输精管吻合术，术后２年随访５０例，复通率达１００％，复孕率达６０％，以抗精子抗体，精子穿卵试验，辅精管结节精子肉芽肿，精液质量等２１个指标对孕组和未孕组进行了对照观察，经过Ｌｏｇｉｓｔｉｃ回归等方法进行统计学处理，筛选出术后ＳＩＴ，精子存活率，精子密度、ＩＢＴ给合ＩｇＡ和ＩｇＧ、ＭＡＲ     

大隐静脉移植替代粘堵后的输精管

大隐静脉移植替代粘堵后的输精管时德，白磷祥，孙英信输精管粘堵是一种较为成功的男性绝育手术。然而该法术后欲使输精管再通，恢复生育能力相当困难。我们试用大隐静脉移植替代输精管获得成功。１．临床资料：本组３例年龄２６～３１岁不等。３例中２例因小孩意外死亡，...     

输精管结扎术残端处理方式与再通关系的研究

用７种残端处理技术完成的２３７３例输精管结扎术的一项前瞻性研究表明，术后２年随访时共有７８例查见精子，其中２７例配偶受孕，精子阳性率为３．２９％，再孕率１．１４％。各种术式的精子阳性率：附睾端开放加包埋０．５５％，两端单纯结扎１．４１％，结扎加筋膜包埋２．６３％，石碳酸烧灼３．１７％，精囊端折叠３．７１％，结扎加电灼４．７５％和不作包埋的附睾端开放７．５３％。经统计学处理各种术式的精子阳性率之间差异有非常显著意义（Ｐ＜０．０００１）。由不同手术者完成的相同术式结果分析表明，除石碳酸烧灼组以外，其余各组皆无组内差异。７个残端处理组的并发症发生率有显著差异（Ｇ＝２０．９６，Ｐ＜０．０１）、其中不作包埋的附睾端开放组并发症发生率达２．１７％，折叠组的出血和感染等发生虽少，但术后近期局部结节反应发生率达４．７７％。本研究表明，输精管残端处理方式的不同可能影响术后节育效果和安全性，但手术者经验和技术水平也起很大作用。     

Surgical complications of esophageal resections: our experience with 168 operations

We performed 346 operations for oesophageal cancer between 1 June 1991 and 31 May 2001. 168 of them were resections. The resection rate was 48.5 percent. The most frequently performed operation was subtotal resection of the oesophagus with the removal of paraesophageal lymph nodes. Reconstruction was usually performed with gastric tube pulled up retrosternally according to Akiyama with cervical oesophago-gastrostomy (135/168). In 24 patients intrathoracic oesophago-gastrostomy and in 9 patients other type of reconstruction was performed. Considerable co-morbidity was present in 88 percent of our patients (148/168). Alcohol dependency was noted in 88 patients however we suspect there were patients who did not admit alcohol abuse. Extended resection i.e. other organs' resection together with the oesophagus was performed in 59 patients. Postoperative recovery was uneventful in 49.4 percent (83/168) of our patients. Surgical complications occurred in 28.6 percent. Anastomotic leak was observed in 21 cases (12.5 percent). The most severe complication was necrosis of an organ used in reconstruction (7 patients, 4.2 percent). 23 patients (13.7 percent) died in the postoperative period, 7 of them (4.2 percent) because of surgical complication. Statistical analysis proved that the R status and the extension of resection had no influence on the frequency of complications and mortality rate except for when the removal of the entire stomach or gastric stump was performed in one sitting with the oesophageal resection. The frequency of anastomotic leakage is grossly affected by the anastomosis technique and whether it was in cervical or in thoracic position.     

重症急性胰腺炎早期非手术治疗的再认识

目的: 探讨重症急性胰腺炎的早期治疗方法. 方法: 对80例急性重症胰腺炎资料分别采用早期手术治疗和早期非手术治疗的两种方法进行回顾分析,并对病死率及主要并发症进行总结. 结果: 1992年1月~1994年12月的29例患者经早期手术治疗,病死率和并发症发生率分别为55.2%和93.1%,1995年1月~2000年12月的51例经早期非手术治疗,病死率和并发症发生率分别为23.5%和51.0%.两组比较差异有显著性(P<0.01). 结论: 对急性重症胰腺炎患者采用早期非手术治疗能降低病死率和并发症发生率.     

直肠下段癌的手术治疗

目的探讨直肠下段癌手术治疗的方式和效果。方法对１９７７～１９９２年我院收治的７５４例直肠下段癌的临床资料进行回顾性分析。结果７５４例中,切除５７４例,切除率７６１２％。其中根治性切除４６４例,根切率６１５３％。围手术期并发症共计９种,１４４例次,总并发症为２５０８％,本组围手术期无死亡。根治性切除组中,经腹会阴切除３３５例,占７２１９％,局部复发率１３７３％;保肛手术１２９例,占２７８０％,局部复发率１３１８％。１９８５年前保肛率１３２５％,１９８６年后为３２８２％。１９８５年前根治切除组５年生存率５４３４％,１９８６年后为６０７３％（Ｐ＜０．０１）。结论在低位直肠癌的治疗中,如果病例选择适当,保肛手术与腹会阴联合切除术相比较,并不影响远期疗效,但其生存质量明显优于腹会阴联合切除术。     

腹腔镜与开腹手术治疗124例消化性溃疡急性穿孔的对比研究

目的:对比分析腹腔镜下与开腹修补消化性溃疡急性穿孔的手术疗效。方法:2002年1月至2004年12月急诊行消化性溃疡穿孔修补术124例,于腹腔镜下完成65例,传统开腹完成59例,比较两种手术患者的年龄、手术时间、术后下床活动时间、术后排气时间、术后止痛药使用率、术后并发症发生率、住院时间、综合住院费用、药品比例等。结果:2组除患者年龄、性别、白细胞计数及中性粒细胞百分比、手术时间、综合住院费用外,余者差异均有显著性(P<0.05)。结论:腔镜手术修补具有创伤小、康复快、并发症少、住院时间短、美容效果好、医疗效率高等优点,是治疗消化性溃疡急性穿孔较理想的手术方式。     

Rim mandibulectomy for cancer of the oral cavity

Improvements in our understanding of the methods of mandibular invasion by malignancies and refinements in the biomechanical analysis of mandibular osteotomies led us to modify our standard operative procedure for this disease process. Over a 10 year period, we performed rim mandibulectomy to treat oral cavity malignancies with mandibular involvement. This retrospective analysis of 38 patients comparing rim mandibulectomy with the traditional segmental mandibulectomy has demonstrated equivalent local control rates between rim mandibulectomy and segmental resection (75 and 64 percent, respectively). Patients with rim mandibulectomies were more satisfied with their postoperative appearance, and some were able to wear lower dentures if well motivated. In performing the rim mandibulectomy, we found that smooth, curved osteotomies without step-offs resulted in a technically simple operation that was biomechanically sound and had a low complication rate. Rim mandibulectomy, because it is based on sound pathologic principles and does not disrupt the mandibular arch, is an operation that adequately resects the tumor without compromising the cancer operation or the patient.     

开腹胆囊切除术致胆管损伤的防治(附58例分析)

目的探讨开腹胆囊切除术致胆管损伤的预防和处理。方法回顾近３０年北京３家医院开腹胆囊切除术致胆管损伤５８例,分析损伤的部位、类型、发现时间、手术方法和治疗效果。结果本组５８例,痊愈出院５５例,治愈率达９４９％,手术死亡率５１％,随访４４例,随访率８０％,随访平均时间７３年。２例因再次狭窄手术治愈。结论预防损伤是关键。胆囊炎手术处理原则、切除胆囊的方法以及规范手术操作是值得重视的。胆管损伤的处理应根据发现的时间、部位、类型等选择不同的方法。     

Is proximal femoral nailing a good procedure for teaching in orthogeriatrics?

Background

Proximal femoral nailing is a common operation in orthogeriatrics and a highly standardized procedure. For teaching purposes, this operation is often performed by residents and supervised by attending physicians. The objective of this study is to investigate if teaching this operation influences the surgical in-house complication rate.

Patients and methods

All patients who received a proximal femoral Targon PF nail (Aesculap AG, Tuttlingen, Germany) for trochanteric fractures were included in a cohort at our urban academic teaching hospital between 1998 and 2010. To evaluate potential effects of patient age, we separately analyzed several age groups. Complications including wound infection, hematoma, intraoperative malreduction or implant malpositioning causing revision, pain, cut-out and readmission due to nonunion were recorded.

Results

Our collective consists of 1,516 patients (m/f: 410/1,106). The mean age was 78.7?years (range: 19–103?years). The overall complication rate was 7.9?%. In 857 cases operated by attending physicians, the complication rate was 6.9?%. However in the 659 operations performed by residents, we found a higher complication rate of 9.3?%. Further investigating this difference by χ² test, we found no significance (p?=?0.09). Whilst analyzing the complication rates for the different age groups, we did not find a statistically significant difference except in the age group between 71 and 80?years, for which the odds ratio indicated a 2.6-fold increased complication risk for operations performed by residents (p?=?0.01). Further analysis revealed that this increased complication rate was mainly due to increased numbers of cut-out.

Conclusion

We conclude that proximal femoral nailing is an operation suitable for teaching purposes. However, patients between 71 and 80?years of age seem to be at an increased risk for cut-out if operated by a resident.     

Arthroskopie des oberen Sprungelenks Eine retrospektive Analyse der Komplikationen

The purpose of this retrospective study was to analyse the complications of our arthroscopic procedures at the ankle joint. In all patients we evaluated the treatment protocols and in 111 patients (79.3%) we also evaluated the clinical and radiologic results. All in all we have found complications in 14 patients. In 4 cases we have seen a delayed wound healing, in 2 cases a superficial infection, in 3 cases a deep infection, in 3 cases a neural damage and in 2 cases a phlebothrombosis. Our study show, that the complication rate could be minimized by detailed knowledge of the anatomy, exact preoperative diagnostic and planing of the operation and careful preparation of the portals. The use of a laser also shows a tendency to a lower complication rate.     

Surgery in long-term dialysis patients. Experience with more than 300 cases

Three hundred twelve surgical procedures in patients with chronic renal failure have been characterized. There is a high incidence of operation in this expanding population. Multiple procedures for each patient were found in our 10 year study. Operative mortality was 1 percent and late mortality was about 10 percent per year. The survival curve predicted an 81 percent 2 year rate and a 60 percent 5 year survival rate. The high late mortality was likely related to the underlying disease process and the high proportion of complicating associated illnesses. The gross complication rate was high (64 percent), with the most frequent one being hyperkalemia. Other frequent complications were hemodynamic instability, infections, and fluid overload. A pattern of postoperative time to onset for the various complications was identified. Perioperative management requires aggressive, but appropriate metabolic, hematologic, and pharmaceutical intervention.     

肝外胆管癌的诊治分析

目的：探讨肝外胆管癌的诊断和治疗的体会。方法：回顾性总结手术治疗的32例肝外胆管癌的临床资料、手术方式、手术并发症及生存率，并复习相关文献资料。结果：本组病例获根冶性切除14例，姑息切除2例，胆道引流术16例；手术并发症10例(31.3％)，手术死亡1例(3．1％)。其中22例获定期随访，存活一年以上的有12例(12／22)，至今存活8例。结论:早期诊断、正确的评估、合理的术式选择能提高疗效。降低手术并发症及死亡率。