单层宽边吻合,大网膜包裹吻合口在食管癌贲门癌术中的应用

单层宽边吻合、大网膜包裹吻合口在食管癌贲门癌术中的应用公维营，邓峰，刘玉欣，李作玉食管癌、贲门癌切除术吻合方法很多。我院自１９９２年３月～１９９５年９月对１２０例食管癌、责门癌进行切除，采用食管胃单层宽边吻合、大网膜包裹吻合口，取得了较好的效果，现报...     

大网膜移植治疗巨大肝包虫残腔胆汁瘘30例报告

1990～ 1998年我科采用大网膜移植填充巨大肝包虫残腔并胆汁瘘 ,疗效满意。临床资料本组追踪随访 30例 ,占同期 (46例 )随访率 6 5 %。男性18例 ,女性 12例 ,年龄 7～ 6 4岁 ,平均 32岁。包虫残腔10ｃｍ× 10ｃｍ～ 2 0ｃｍ× 13ｃｍ ,平均 16ｃｍ× 12 5ｃｍ ,单腔 2 1例 ,双腔 9例。内囊摘除后即出现胆瘘 2 3例 (76 7% ) ,瘘口直径 0 5～ 3ｍｍ ,均为多发瘘 ,术中证实内囊感染 6例。肝功能测定 :胆红素代谢异常 18例 ,转氨酶类均有不同程度改变。Ｃａｓｏｎｉ皮内试验阳性率 90 %以上。肝包虫内囊摘除后 ,用 2 8%高渗盐水杀灭头节 5～ …     

山羊大网膜移植治疗腹膜粘液瘤

１９８８年至今，收治４例腹膜粘液瘤，２例行粘液瘤切除后行山羊大网膜移植治疗。１例子２０个月后死亡；１例随访７年，一般情况良好。对腹膜粘液瘤的诊治问题进行了讨论。     

大网膜移植治疗股骨头坏死的实验研究

目的 探讨大网膜在临床治疗股骨头坏死中的可行性,为临床治疗股骨头开辟一个新的方法。方法 在动物股骨头坏死的模型上应用大网膜移植观察股骨头血管与血运改变的情况。结果 在8～12周发现在大网膜移植的B组有新生的微血管和大网膜的微血管相连,骨细胞核的碎裂和溶解明显消失,血管中的血液流动趋于正常,骨小梁由稀疏变得致密,陷窝明显减少。结论 大网膜移植在治疗股骨头坏死中为其提供了血管再生的条件,改善股骨头缺血,为股骨头缺血坏死的治疗开辟了一条新的途径。     

Wada氏手术加带蒂大网膜移植治疗漏斗胸的术后监护

１９９３￣１９９６年采用改良Ｗａｄａ氏手术胸骨翻转加带蒂大网膜移植治疗漏斗胸７例，取得了满意效果。对术后护理工作进行了总结，并重点阐述了术后病人的体位，观察局部皮肤颜色，心肺功能监护，保持创面引流通畅及腹壁情况监测等护理内容。     

吻合血管的游离大网膜移植治疗全头皮撕脱伤

吻合血管的游离大网膜移植治疗全头皮撕脱伤李平生吴和康郭文荣何向阳我院自１９９０年６月至今共收治全头皮及大部分头皮撕脱伤１４例，其中９例伴有较大面积颅骨裸露者采用吻合血管的游离大网膜移植的方法治疗，获得成功。报道如下。临床资料本组９例均为女性，年龄１８...     

带蒂大网膜移植治疗肺切除后支气管残端瘘

带蒂大网膜移植治疗肺切除后支气管残端瘘王景林陈书山支气管残端瘘是肺切除术后严重并发症之一。１９８３年以来，我们在应用带蒂大网膜移植治疗脓胸的基础上，修补支气管残端瘘４例，经临床观察和随访，疗效满意。１临床资料与方法本组共４例，均为男性；年龄２６～４８...     

Accessory Scrotum with Penoscrotal Transposition and Retrocerebellar Arachnoid Cyst: A Case Report

A 2-year-old boy presented with an accessory scrotum associated with penoscrotal transposition and a perineal lipoma. He also had a retrocerebellar arachnoid cyst. The accessory scrotum was resected with concurrent scrotoplasty. The retrocerebellar arachnoid cyst was seen on a subsequent brain computed tomography scan and was left untreated because there was no evidence that the volume was increasing.     

Combination of Clavicular Hook Plate with Coracoacromial Ligament Transposition in Treatment of Acromioclavicular Joint Dislocation

ObjectiveTo evaluate the clinical efficacy of Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate (CHP) combined with coracoacromial ligament transposition for Rockwood III‐V dislocation of AC joint, providing an alternative choice for AC joint dislocation treatment.MethodsTwenty‐five patients diagnosed with Rockwood III‐V dislocation of acromioclavicular (AC) joint, including 18 males and seven females, aged 43.5 ± 2.4 years old on average, who had undergone open reduction and AO CHP in combination with coracoacromial (CC) ligament transposition between January 2010 and December 2015, were retrospectively analyzed. Among them, 17 cases were diagnosed as type III, five cases were type IV, and three cases were type V. The surgery mainly included three main steps: bone flap incision, drilling in the clavicle, and hook plate fixation and AC joint reposition. The treatment efficacy was evaluated through clinical examinations and imaging studies for the shoulder joint, including gross observation and measuring coracoid clavicle distance (CC‐Dist) using orthophoria X‐ray before and 1 year after the surgery, and University of California (UCLA) shoulder rating scale.ResultsAll the patients were followed up three to four times in 18 months (12–24 months) on average, and the UCLA rating results showed that there were 17 excellent cases (68%), five good cases (20%), and three fair cases (12%). The CC‐Dist values after the surgery reduced to 9.7 ± 0.7 mm, which was significantly (P < 0.05) lower compared to that before the surgery (15.8 ± 1.6 mm). Most (88%) of the cases showed almost normal joint function and good anatomical arrangement of the acromioclavicular joint, without any secondary dislocation, and for them, 12 ± 2 weeks on average were needed to regain the normal function of shoulder joint movement.ConclusionDue to the stable fixation, fewer complications, and satisfactory therapeutic effect with great clinical value, the combination of AO CHP and CC ligament transposition is expected to be used for treating Rockwood III‐V dislocation of AC joint.     

完全型大动脉错位伴室间隔缺损、肺动脉狭窄的外科治疗

治疗完全型大动脉错位伴室间隔缺损、肺动脉狭窄(TGA/VSD,PS)的手术方式有Rastelli手术、Lecompte手术、Nikaidoh手术、Yamagishi手术以及动脉转位 左心室流出道扩大术等多种术式,Rastelli手术和Lecompte手术损伤小,但远期并发症多;Nikaidoh手术和Yamagishi手术解剖纠治完全,但手术损伤大;动脉转位术 左心室流出道扩大术适应证相对较狭窄。因此,在TGA/VSD,PS的外科治疗上,应根据患者的自身情况和手术指征采取不同的手术方法。现对上述手术术式的优缺点、适应证、禁忌证、疗效和展望进行综述。     

同种带瓣主动脉用于矫正型大动脉转位合并肺动脉狭窄手术治疗

目的将同种带瓣主动脉经过适宜处理后，用以治疗１８例合并肺动脉狭窄的矫正型大动脉转位（ＣＴＧＡ）患者，其中内脏正位（ＳＬＬ）型１４例，内脏反位（ＩＤＤ）型４例，均合并室间隔缺损（ＶＳＤ）。方法手术缝闭肺动脉瓣口，修复ＶＳＤ，用经过冷冻处理的同种带瓣主动脉管道连接功能右心室和肺动脉。结果术后测压：右心室收缩压为３．３～６．４ｋＰａ（２５～４８ｍｍＨｇ），右心室－肺动脉压差０．６６～３．０ｋＰａ（５～２２ｍｍＨｇ），右心室／左心室压比值０．３～０．６。结论采用同种带瓣主动脉能使患者术后血流动力学指标更接近于人体正常生理状态。     

去顶减压加带蒂大网膜包裹治疗成人多囊肾

目的提高成人多囊肾的手术疗效.方法采用去顶减压加带蒂大网膜包裹术治疗成人多囊肾患者16例.结果14例术后随访1个月至6年,患者主观症状均明显改善,血压下降,肾血流增加,肾功能改善,肾脏平均长径由术前(19.0±5.5)cm降至术后(12.0±2.6)cm,2例内生肌肝清除率术前为51.8ml/min、60.9ml/min,术后为87.5ml/min、92.4ml/min.结论去顶减压加带蒂大网膜包裹术是治疗成人多囊肾的较好方法之一.     

Treatment of Necrotic Infection on the Anterior Chest Wall Secondary to Mastectomy and Postoperative Radiotherapy by the Application of Omentum and Mesh Skin Grafting: Report of a Case

We report herein the case of a patient who initially underwent right radical mastectomy for breast carcinoma in 1988, followed by left breast-conserving surgery in 1997. On both occasions she was given postoperative radiation therapy of 50 Gy. Repeated dressings and the administration of antibiotics failed to heal ulcerative infected lesions that had formed on the anterior chest wall in early 1998. In 1999, the sternum and surrounding tissue were debrided and the anterior chest wall was reconstructed by omentum transposition and mesh skin grafting. The patient is currently well and alive without any evidence of recurrence of either infection or breast cancer. Received: March 7, 2001 / Accepted: September 11, 2001     

成人脊髓栓系综合征的诊治

目的研究成人脊髓栓系综合征（ＴＣＳ）的临床诊断和治疗。方法回顾性报告１８例成人脊髓栓系综合征的临床资料。所有患者均经ＭＲＩ证实并行手术松解;根据手术所见和影像学分析其致病机理及手术要点。结果脊髓或圆锥的栓系原因各不相同,包括椎管内肿瘤（６例）、脊髓脊膜膨出（６例）、终丝增粗（３例）、脊髓双裂畸形（２例）及术后粘连（１例）。经８个月～５年随访,其中１４例获得满意疗效。结论成人ＴＣＳ在临床表现及预后等方面有别于幼儿ＴＣＳ。术中应避免损伤圆锥和马尾神经。病程过长及再栓系是疗效不佳的主要原因。     

脊髓栓系综合征诊断及显微手术治疗

目的 探讨小儿脊髓栓系综合征(TCS)的诊断及治疗。方法 对收治的TCS患儿52例,从临床表现、手术方法及疗效方面进行分析。结果 圆锥位置与B型超声、MRI一致,椎管内脂肪瘤皮样囊肿等与MRI一致。采用显微手术脊髓栓系松解治疗并不断改进手术方法,可提高疗效,减少并发症。结论 B超、MRI是检查诊断TCS的最好方法。显微外科手术松解脊髓及神经能使大部分TCS患儿症状减轻或治愈。改进手术方法可提高疗效,减少并发症。     

Mirizzi综合征的诊断与治疗

为探讨Ｍｉｒｉｚｚｉ综合征的诊断和治疗特点，对３４例经手术证实的Ｍｉｒｉｚｚｉ综合征进行回顾性分析。结果显示：术前确诊仅７例（２０．６％），其中ＥＲＣＰ确诊５例。３４例中行胆囊大部分切除术１２例，胆囊切除术７例，胆囊切除及胆管瘘口缝合修补术６例，胆囊大部分切除及胆囊瓣瘘口修补术４例，胆囊切除及肝总管空肠Ｒｏｕｘ－ｅｎ－Ｙ吻合术５例。２５例获随访，随访时间为１～１４年，其中疗效优１８例（７２％），良５例（２０％），欠佳２例（８％）。提示：Ｂ超结合ＥＲＣＰ检查可以提高Ｍｉｒｉｚｚｉ综合征的术前确诊率，手术方式应根据病理损伤程度决定。     

镰刀综合征外科治疗的临床分析

目的 探讨镰刀综合征外科治疗方法的选择。方法 回顾分析我院1999年1月～2004年7月12例镰刀综合征患者的临床资料，10例采用经典房内通道技术；1例采用体外循环，用人工血管将镰刀静脉与左心房相连；1例在非体外循环下直接将镰刀静脉吻合在左心房。结果 12例患者无手术及远期死亡，均无需二次手术。随访1～36个月，所有患者恢复良好，超声心动图显示未见明显的肺静脉回流梗阻。结论 治疗镰刀综合征的手术方法应根据术中异位回流肺静脉的具体位置决定，恰当的方法均可起到良好的手术效果。