外伤性肛门失禁的外科治疗

目前,治疗肛门失禁的手术方法很多,范围从微创手术到技术性很强的复杂设备植入技术,这些手术的指征重叠且至今无统一规定。造成肛门失禁的原因很多,本文着重就创伤原因中的外伤性肛门失禁的治疗作一综述。     

Surgical treatment of traumatic epilepsy

Fifteen patients with traumatic epilepsy were treated surgically. Cortico-electroencephalography was used during the operation. Meningo-encephalo cicatrix was found in 8 patients, scar formation in brain parenchyma in 4, meningoencephalocele in 2, and porencephalia in 1. Seven of the 15 patients were examined by CT, showing more accurate localization of pathological changes. Seizure subsided in 8 patients. Anti-epileptic drugs were still used in 4 patients, but the frequency and severity of epileptic attack were obviously decreased. There was no operative mortality. The indications, techniques of the operation and the postoperative management were discussed.     

创伤性乳糜胸的外科治疗

创伤性乳糜胸是十分严重和较难处理的并发症之一,如得不到及时的诊断和有效处理,往往因大量体液丧失及胸腔大量积液,造成水、离子失衡,低蛋白血症,甚至全身衰竭而危及生命.本文分析6例创伤性乳糜胸的临床资料,并结合文献对有关乳糜胸的病因、诊断、治疗和手术等问题加以讨论.     

创伤性骨化性肌炎的外科治疗

[目的]探讨创伤性骨化性肌炎的成因及外科治疗.[方法]对2000年1月～2007年12月11例经病理证实的创伤性骨化性肌炎外科治疗资料进行临床分析.术前接受消炎痛、二磷酸盐和蛙鱼降钙素治疗.术中予包膜外完整切除关节周围成熟后的骨化灶.[结果]症状消失8例,改善3例.[结论]创伤性骨化肌炎的主要成因是骨伤后治疗和活动不当所致.发病18个月后,待骨化成熟时,可通过手术切除关节周围病灶,改善关节的活动.     

Surgical treatment of pancreatic traumatic injury

Experience of treatment of 52 injured persons with combined pancreatic trauma was summarized. Among combined injuries the thoracic trauma had predominated. Laparocentesis was performed in all patients in emergency. In pancreatic injury a gastroepiploica was cannulated with subsequent infusion of sandostatin and antibiotics. In 11 patients complications after the operation had occurred, mortality was 23.1% (12 patients).     

外伤性三尖瓣关闭不全的外科治疗

目的　总结报告外伤性三尖瓣关闭不全外科治疗的时机、方法和近、远期效果。方法　1984年5月至2 0 0 4年9月,外科治疗8例外伤性三尖瓣关闭不全的病人,均为男性;年龄7～6 7岁,中位数38岁。7例胸部钝伤(其中车祸3例) ,1例刀戳伤。从外伤到手术治疗的间隔时间为1个月～2 0年,中位数19个月。术前心功能(NYHA) 2～4级,平均(2. 3±0. 7)级。均经超声心动图确定诊断。术中发现8例均有前叶腱索断裂,1例同时伴隔叶腱索断裂,且右室和瓣环均有不同程度扩大。3例行三尖瓣成形术,5例成形失败行三尖瓣置换术。结果　全组术后恢复良好,无并发症发生,3例三尖瓣成形术者出院时仅1例轻度三尖瓣反流。术后住院7～2 4d ,平均(16. 6±6. 5 )d。随访7～12 9个月,中位数39个月,心功能均为I级。结论　外伤性三尖瓣关闭不全的外科治疗效果良好,一经确诊为重度反流应尽早手术治疗,以增加三尖瓣成形的可能性。三尖瓣成形术和瓣膜置换术近、远期效果均较理想,但应首先考虑三尖瓣成形术     

Surgical treatment of traumatic facial dimples

Traumatic cheek dimples are commonly encountered following trauma. The majority resolve spontaneously with time. In some cases dimples persist, leaving a cosmetic deformity particularly noticeable with movements of facial expression. We propose an operative technique for such cases where symptoms persist for a year or more. Our operative methods and representative cases are described.     

闭合外伤性纵隔气肿的外科治疗

目的探讨闭合外伤性纵隔气肿的外科治疗。方法回顾分析1991年2月至2004年12月收治的闭合外伤性纵隔气肿患者的临床资料。全组共55例患者,其中38例行纵隔切开引流术,11例行12号针头穿刺排气,4例行开胸减压引流术,2例行保守治疗。结果全组55例患者均康复出院。随访3个月～3年,仅1例合并气胸者于1年后复发气胸,全组无复发纵隔气肿者。结论颈胸部皮下气肿和影像学检查是诊断闭合外伤性纵隔气肿的主要依据,纵隔切开引流术、针刺排气和开胸减压引流术是治疗闭合性外伤性纵隔气肿的有效方法。     

Surgical treatment for traumatic tracheobronchial injuries

Tracheobronchial injury is a relatively rare but often fatal condition due to the injury from the neck to the chest. Different clinical features depend on the site of injury. We experienced 5 cases of tracheobronchial injury; cervical trachea in 2, thoracic trachea in 1, tracheal carina in 1, left main bronchus in 1. Three cases were caused by blunt trauma by traffic accident and 2 cases were due to penetrating injury (stab wound and gunshot wound). Thoracotomy with primary repair for 3 (simple repair, bronchoplasty, pneumonectomy) and cervicotomy for 2 (end-to-end anastomosis) were performed. One patient with severe associated injury died of multiple organ failure after surgery. Accurate diagnosis and the appropriate treatment in the early stage is essential in the treatment of tracheobronchial injury.     

创伤性枢椎滑脱的外科治疗

目的：探讨手术治疗创伤性枢椎滑税的方法和疗效。方法：自1992年1月～2001年9月对17例创伤性枢椎滑税患者进行手术治疗。其中前路C2/3椎体螺钉固定9例；后路枕颈融合5例，C2椎弓根螺钉直接固定3例。结果：所有患者未出现与内固定有关的并发症。17例患者的C2椎弓均取得骨性融合，无畸形愈合，临床效果满意。结论：手术治疗创伤性枢椎滑税具有治疗周期短，疗效确实，并发症少的优点，可以在有条件的大医院实施。     

外伤性部分耳郭缺损的手术治疗

目的：探讨治疗外伤性部分耳郭缺损的适宜方法。方法：1995年7月～2005年4月，分别采用软骨支架＋耳后扩张皮瓣、硅胶支架＋耳后皮瓣＋全厚皮片和局部切除＋对位缝合三种术式，治疗外伤性部分耳郭缺损患者11例，分析总结其临床资料。结果：所有病例术后缺损修复满意，除1例耳垂处皮瓣远端出现0．2cm×0．4cm干性坏死，经换药愈合外，其余病例伤口均一期愈合。术后3～14个月随访结果显示外形良好。结论：外伤性部分耳郭缺损应依据缺损的部位、大小、形状，选择相应的手术方式修复才能取得满意的修复效果。     

Surgical treatment of spontaneous and traumatic pneumothorax

The ten-year experience of the regional hospital thoracic department in treatment of 723 patients with spontaneous pneumothorax and 678 injured persons, suffering complicated thoracic trauma, was summarizd. The tactic and methods of treatment of such patients, using modern technologies and endoscopic operations, was depicted. Comparative analysis of the different methods efficacy, their results, advantages and faults estimation were conducted. Recommendations for application of every method of treatment in various clinical situations were adduced.     

Surgical treatment of traumatic brachial plexus lesions

The introduction of a reliable technique for nerve transplantation and the development of microsurgical neurolysis have made it possible to improve the degree of functional restoration that can be achieved following post-traumatic lesions of the brachial plexus. Although the functional recovery achieved still leaves a great deal to be desired, it is possible to reach a level of functioning that is beneficial for the patient. It is essential for the initial treatment plan to take account of both surgical reconstruction in the region of the brachial plexus itself and subsequent improvement of function by means of appropriate palliation.     

Surgical treatment of traumatic lower limb pseudoaneurysm

Objective：To summarize our experience in surgical treatment of traumatic lower limb pseudoaneurysm.Methods：Twenty patients with traumatic lower limb pseudoaneurysm were surgically treated in our department from January 2007 to January 2012.The treatment protocols included interventional covered-stent placement （10 cases）,spring coil embolization （2 cases）,and surgical operation （8 cases）.Surgical operations included pseudoaneurysm repair （2 cases）,autologousvein transplantation （1 case）,and artificial-vessel bypass graft （5 cases）.Results：All the patients were successfully treated without aggravating lower limb ischemia.Pseudoaneurysm disappeared after treatment.A surgical operation is suitable to most pseudoaneurysms,but its damage is relatively obvious and usually leads to more bleeding.It also requires a longer operating time.Compared to a surgical operation,interventional therapy is less traumatic and patients usually have a quicker recovery （P＜0.05）.All patients were followed up once per month for 12-36 months by color Doppler ultrasound examination.There were no cases of pseudoaneurysm recurrence.Conclusion：Both surgical operation and interventional therapy are safe and effective in the treatment of pseudoaneurysm.