等离子射频消融术与常规剪切术治疗会厌囊肿疗效比较

目的：探讨低温等离子射频切除术治疗成人会厌囊肿的效果以及与常规剪切术相比的优势。方法60例成年患者,随机分为等离子射频切除组与常规剪切组,低温等离子射频切除组应用 ArthroCare（美国）系统及Evac70刀头,常规剪切组应用腹腔镜剪刀进行常规剪切及止血,双盲观察记录两种方法的手术时间、术后疼痛VAS 评分、会厌充血肿胀程度、伪膜脱落情况及术后并发症。结果等离子射频切除组手术时间快于常规剪切组,术后第1～6天等离子射频切除组疼痛低于常规剪切组,伪膜开始脱落时间不存在差异,术后第8天等离子射频切除组伪膜脱落更多,术后第1～3天等离子射频切除组充血会厌肿胀更轻,两组患者均未发生术后呼吸困难及出血。术后随访12个月,所有患者均无复发。结论低温等离子射频切除会厌囊肿效果较好,与常规剪切术相比,手术时间短,患者术后前6天疼痛更轻,恢复更快。     

Carbon dioxide laser and Apligraf for a painful plantar hypertrophic scar

We report on a patient with a large, painful hypertrophic scar on the plantar aspect of the left foot who was treated with carbon dioxide laser and a skin substitute (Apligraf) and followed up for longer than 1 year. To our knowledge, no other case reports have been published on the use of a skin substitute to gain coverage and resolution after excision of a hypertrophic scar by carbon dioxide laser.     

胸外科长柄电刀在会厌囊肿切除术中的应用

目的：探讨应用胸外科长柄电刀切除会厌囊肿的疗效。方法将66例会厌囊肿患者随机分成胸外科长柄电刀切除组（实验组）及常规摘除组（对照组）,每组33例。两组均在气管插管静脉复合全麻下行支撑喉镜下手术,比较二组术中出血量、手术时间、术后疼痛程度、术后疗效。结果实验组与对照组比较,前者术中出血量明显减少,手术时间明显缩短,术后疗效明显好,差异具有统计学意义（P ＜0．05）;两者术后疼痛程度比较,差异无统计学意义（P ＞0．05）。结论采用胸外科长柄电刀在支撑喉镜下切除会厌囊肿具有术中视野清晰、出血量少、手术时间快短、术后疗效好等优点。     

ShikaniTM Seeing Optical Stylet-aided tracheal intubation in patients with a large epiglottic cyst

Large epiglottic cysts can block the glottis,leading to serious consequences.This condition presents a challenge in terms of airway management for anesthesiologists during induction of anesthesia.We report the use of a ShikaniTM Seeing Optical Stylet combined with a Macintosh laryngoscope to aid tracheal intubation in seven patients with large epiglottic cysts.Use of this technique can avoid cyst rupture and allow smooth,safe intubation.     

A huge epiglottic cyst causing airway obstruction in an adult

An epiglottic cyst causing airway obstruction is rare in an adult. Early definitive diagnosis and management obviate an unnecessary tracheostomy. We report a case of a 64-year-old woman who arrived at our hospital with progressive stridor and foreign body sensation when swallowing for 6 weeks. A hot potato voice and biphasic stridor were remarkable upon physical examination. Indirect mirror and fibroscopic examination revealed a huge epiglottic cyst. The neck lateral X-ray and computed tomography scan demonstrated a huge cystic mass over the epiglottis. A 2.5 x 3.0 cm cystic mass was removed with endoscopic CO2 laser after needle decompression. The patient was discharged on the third day after surgery without complications. An epiglottic cyst in an adult seldom causes upper airway obstruction and is easily ignored by clinicians. We emphasize that complete airway evaluation including routine check-up of the larynx is mandatory for patients with intractable obstructive airway disease. Endoscopic laser surgery is effective in the surgical removal of an epiglottic cyst.     

Shikani™ Seeing Optical Stylet-aided tracheal intubation in patients with a large epiglottic cyst

Large epiglottic cysts can block the glottis, leading to serious consequences. This condition presents a challenge in terms of airway management for anesthesiologists during induction of anesthesia. We report the use of a Shikani^TM Seeing Optical Stylet combined with a Macintosh laryngoscope to aid tracheal intubation in seven patients with large epiglottic cysts. Use of this technique can avoid cyst rupture and allow smooth, safe intubation.

     

Laparoscopic excision of splenic hydatid cyst

Hydatid disease of the spleen is a rare condition. The standard treatment is open total or partial splenectomy. Recently hand assisted laparoscopic total splenectomy for splenic hydatid cyst has been reported. A case is described of splenic hydatid cyst in a 45 year old man that was excised laparoscopically; the related literature is reviewed.     

巨大苗勒管囊肿一例

1.资料与方法 患者男,53岁,闪“反复排尿凼难1年”于2008年3月5日入院。患者1年前自觉久坐后,出现排尿费劲,尿不成线、尿频,仅尿多达10余次／晚,伴左下腹部疼痛。无肾区疼痛及肉眼血尿,休息后症状逐渐缓解,故当时未进行任何治疗。此后患者经常不能自解小便,就诊于当地医院,诊断“前列腺增生”,     

Carbon dioxide laser induced airway fire during larynx surgery: case report

The precision intrinsic hemostatic properties of the laser have led to its wide use in modern clinical medicine especially in microscopic airway surgery. However, the intense heat generated by the high energy density of the surgical laser can convert combustible tubes into veritable torches, cause catastrophic fires, and result in severe injury to the patient. This is of particular importance when high energy is used on the continuous mode or when the endotracheal tube is repeatedly hit by the laser at the same spot. Most reported laser-induced complications result from the laser beam inadvertently falling on the areas that are not intended to be exposed. We report a case of a trans-tracheostomy tube fire occurring during carbon dioxide (CO2) laser surgery. Aluminum-tape wrapping did not prevent this complication. It was found that the ignition of a trans-tracheostomy tube was caused by the laser striking an unprotected portion of the tube during resection of granuloma of the trachea.     

Technical points of total laparoscopic choledochal cyst excision

Background  Choledochal cyst excision and biliary enteric reconstruction constitute the best therapy for choledochal cyst. And laparoscopy is currently used to cure this disease now.

Methods  We retrospectively analyzed the clinical data of 34 cases of total laparoscopic choledochal cyst excision between January 2007 and August 2011. All patients underwent in vitro Roux-en-Y hepatoenterostomy.

Results  All 34 patients underwent successful total laparoscopic choledochal cyst excision. The operation time was 200–360 minutes. The duration of hospital stay was 3–7 days. Follow-up observations lasted 1–56 months. One patient developed an anastomotic stoma stricture, but no other cases had postoperative complications. No patients died.

Conclusion  Total laparoscopic choledochal cyst excision is safe and feasible.

     

胰腺段囊性扩张胆管全切除术

先天性胆总管囊肿多累及肝外胆管全程 ,而其胰腺段的切除在实际操作中难度和风险较大 ,是否需要完全切除胰段囊性扩张胆管尚有争议。在我们的随访病例及近期文献报道中发现 ,手术后残留的胰段囊性扩张胆管有发生癌变者。因此 ,完整切除包括胰段在内的囊性扩张胆管非常必要。我院 1995 2 0 0 0年共行扩张段胆管全切除治疗先天性胆总管囊肿 2 5例 ,取得了较为满意的疗效。1　临床资料1.1　一般资料　　 1995年 1月 2 0 0 0年 12月共行胰腺段囊性扩张胆管全切除术治疗累及肝外胆管全程的先天性胆总管囊肿 2 5例。 2 5例中男 9例 ,女 16例 ,年…     

Arthroscopic excision of spinoglenoid notch cyst through two different approaches

With the advent of shoulder magnetic resonance imaging （MRI）, ganglion cysts adjacent to the superior labrum have been increasinglyrecognized.1-3The spinoglenoid notch cyst （SGNC） which causes suprascapular nerve compression has been well documented,3-16 and the association of superior labral anterior-posterior （SLAP） lesions with spinoglenoid cysts has gained more attention.2.5-16 Mostly, the SGNC is approached through7 the labral tear within the glenohumeral joint.