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1.
目的:比较分析应用一次性包皮环切缝合器与袖套包皮环切术的临床疗效和手术并发症。方法:106例包皮过长(或包茎)患者按手术日期单双号分为一次性包皮环切缝合器组(50例)与袖套式包皮环切术组(56例)。比较两组患者的手术时间、术中出血量、术中疼痛程度、术后疼痛程度、切口愈合情况及术后并发症。结果:一次性包皮环切缝合器组与袖套式包皮环切术组手术时间分别为(31.38±2.93)min和(11.82±1.96)min;术中出血量分别为(1.14±0.94)ml和(7.89±2.31)ml;术中疼痛评分分别为(0.80±0.70)分和(3.02±1.22)分;术后24小时疼痛评分分别为(1.90±0.80)分和(4.45±1.03)分;术后并发症发生率分别为4.0%(2/50)和17.87%(10/56);切口愈合时间分别为(14.06±1.15)d和(14.39±1.57)d;外观满意率分别为98%(49/50)和83.93%(47/56)。与袖套式包皮环切组相比,一次性包皮环切缝合器组手术时间短、失血量少、术中及术后患者痛苦小、外观满意率高且并发症发生率低(P0.05),术后伤口愈合时间差异无统计学意义(P0.05)。结论:应用一次性包皮环切缝合器是对袖套式包皮环切术的改进及创新,具有患者手术效果好、并发症发生率低、患者满意度高及易于接受等优势。  相似文献   

2.
【摘要】目的观察包皮环切缝合器手术与传统包皮环切术的疗效对比。方法回顾性分析2015年7月至2016年7月间采取2种不同方法进行的包皮环切术共203例,其中传统手术114例,包皮环切缝合器手术89例,比较2种手术的手术时间,术中出血量,疼痛感,术后并发症发生情况,切口愈合时间及阴茎外形满意度。结果环切缝合器手术的手术时间,术中出血量,术中疼痛VAS,术后伤口愈合时间均明显小于传统手术(P<0.05);阴茎外形满意度高于传统手术(P<0.05);环切缝合器手术的术后出血、伤口感染及切口裂开等并发症发生率低于传统手术(P<0.05);包皮水肿发生率2组无差异。结论环切缝合器在包皮环切术的应用,具有简便、快捷、微创、美容及并发症低的优点。  相似文献   

3.
目的总结一次性包皮环切缝合器、经典式及袖套式包皮环切术的经验,比较三种包皮环切术式的各自特点。方法回顾性分析于2014年7月至2016年7月期间在我院行包皮环切术(应用一次性包皮环切缝合器、经典式及袖套式包皮环切术分别为112例、123例及108例)患者的临床资料,比较三种术式手术时间、术中出血量、疼痛评分、术后并发症发生率、阴茎外观满意率等指标。分析三种手术各自特点和经验总结。结果应用一次性包皮环切缝合器、经典式及袖套式包皮环切术手术时间分别为5.6±3.5 min、25.6±6.7 min及34.3±5.4 min(P0.001),术中出血量分别为2.0±0.7 m L、12.3±5.8 m及4.1±2.3 m L(P0.001),术后24 h疼痛评分分别为3.1±1.1分、5.4±1.2分及3.5±0.9分(P0.001),术后并发症发生率分别为9.8%(11/112)、16.3%(20/123)及11.1%(12/108)(P=0.286),术后阴茎外观满意度分别为97.3%(109/112)、85.4%(105/123)及95.4%(103/108)(P=0.001)。以上数据比较,差异均有统计学意义。结论三组手术方式各有优缺点,应用一次性包皮环切缝合器操作简单、手术时间短、术中出血量少、术后阴茎外观满意率高,但费用偏高;而袖套式包皮环切术相对于经典式包皮环切术手术时间稍长,但术中出血量明显减少、术后疼痛评分低且阴茎外观满意度较高,因此,对于青春期男性及成人患者可考虑推荐袖套式包皮环切术。  相似文献   

4.
目的:比较一次性包皮环切吻合器与一次性包皮环切缝合器两种术式的临床疗效。方法:将自2013年6月至2015年3月来我院就诊的320例包茎和包皮过长患者随机分成两组,采用两种手术方法,其中采用一次性包皮环切吻合器158例,采用一次性包皮环切缝合器162例,对其安全性、疗效及术后并发症等方面进行比较。结果:吻合器组和缝合器组手术时间分别为(5.6±1.3)min和(5.4±1.2)min,失血量(1.2±0.8)ml和(1.3±0.9)ml,迟发性出血发生率分别为3.16%(5/158)和4.32%(7/162),花费(1 121.2±15.6)元和(2 142.6±10.8)元,伤口愈合天数(16.1±7.2)d和(7.5±2.3)d,术后伤口感染率15.82%(25/158)和7.41%(12/162),术后1个月水肿率9.26%(15/162)和29.11%(46/158)及患者随访满意度63.92%(101/158)和90.12%(146/162),两组比较前3项差异均无统计学意义(P0.05),后5项差异有显著性,缝合器组疗效均显著优于吻合器组(P0.05),但缝合器组花费贵于吻合器组。结论:应用一次性包皮环切缝合器进行包皮环切术,除费用较贵外,其疗效更好、并发症更少、患者恢复更快、满意度更高,值得在临床中推广应用。  相似文献   

5.
目的:探讨一次性包皮环切缝合器在包皮环切术中的安全性及有效性。方法:将到门诊就诊的包茎和包皮过长要求手术的患者随机分成2组,采用两种手术方法,一次性包皮环切缝合器组129例,传统组120例,对其安全性及疗效性等方面进行对比。结果:包皮环切缝合器组和传统组手术时间分别为(4.02±0.69)min和(30.8±4.05)min;出血量分别为(1.07±1.29)ml和(8.72±2.15)ml,手术时疼痛评分分别为(0.81±0.81)分、(2.42±1.15)分;术后24 h疼痛评分分别为(1.84±1.02)分、(4.99±1.36)分;术后并发症发生率分别为13.95%(18/129)、9.17%(11/120);创口愈合时间分别为(13.99±9.06)d、(17.48±3.49)d;术后外观满意率分别为98.4%(127/129)、95.0%(109/120);治疗费用分别为(2215.62±17.67)元、(576.47±15.58)元;与传统手术组相比,一次性包皮环切缝合器组手术时间短,失血量少,患者痛苦小,创口愈合时间短,外观满意率高(P均0.05),但术后并发症发生率较高(P0.05),且治疗费用较高(P0.05)。结论:采用一次性包皮环切缝合器行包皮环切术时具有良好的临床效果,值得临床推广应用。  相似文献   

6.
目的:比较使用一次性包皮环切缝合器行包皮环切缝合术、包皮环扎术、传统包皮环切术治疗包茎、包皮过长的临床疗效。方法:应用一次性包皮环切缝合器手术(A组)、包皮环扎术(B组)、传统包皮环切术(C组)对276例(每组92例)包茎、包皮过长患者进行治疗,观察手术时间、术中出血量、术中及术后24 h疼痛评分(VAS),术后感染、出血(血肿)、水肿、包皮畸形等并发症的发生,并作对比分析。结果:A组、B组手术时间分别为(6.52±2.45)min、(7.24±1.86)min;术中出血量分别为(1.93±0.82)ml、(1.51±0.72)ml;术中疼痛评分分别为(1.37±0.68)、(1.20±0.79)均低于C组(28.36±4.22)min、(9.52±3.29)ml、(3.06±0.75),(P0.05);但B组术后24 h疼痛评分(3.18±0.82)明显高于A组(1.85±0.63)、C组(1.82±0.75),(P0.05);A组术后总体并发症发生率为(5.43%)低于B组(14.13%)(P0.05),A组与C组、B组与C组之间无差异(P0.05)。结论:使用一次性包皮环切缝合器行包皮环切缝合术操作简单、安全、微创、美观,值得进一步研究开发与临床推广应用。  相似文献   

7.
目的:观察使用一次性包皮环切缝合器治疗包茎和包皮过长的临床疗效及安全性。方法:将180例包茎和包皮过长患者随机分为缝合器组(包皮环切缝合器组,n=120)和传统组(背侧切开包皮环切手术组,n=60),观察两种包皮环切手术的出血量、手术时间、切口愈合时间、术后疼痛、水肿、切口美观度及术后并发症(瘀斑、血肿、感染及再手术率等)等指标。结果:缝合器组和传统组术中出血量分别为(2.3±1.3)ml和(15.6±2.9)ml;手术时间分别为(7.1±1.4)min和(22.6±4.6)min;切口愈合时间分别为(12.0±2.9)d和(16.3±3.1)d;术后24 h疼痛评分分别为(1.9±1.3)分和(5.2±1.7)分;水肿程度及切口美观度明显优于传统组(P0.05);缝合器组不存在拆线疼痛,传统组需要拆线存在拆线疼痛。结论:使用包皮环切缝合器完成包皮环切手术具有操作简单、手术快捷、切口美观、并发症少及痛苦小等优点。  相似文献   

8.
目的:比较2种不同类型的一次性包皮环切缝合器在行包皮环切术中的临床疗效。方法:选取2015年3月~2018年3月,我院收治的包茎及包皮过长的患者438例随机分成两组,采用2种不同类型的一次性包皮环切缝合器行包皮环切术,其中试验组采用A型(钢钉联合硅胶垫片作为缝合介质)包皮环切吻合器226例,对照组采用B型(单纯使用钢钉作为缝合介质)包皮环切缝合器212例,对其安全性、疗效及术后并发症等方面进行比较。结果:两组在手术时间、愈合时间、远期水肿及瘢痕形成发生率等方面的比较差异均无统计学意义(P0.05)。试验组和对照组的术中失血量分别为(0.7±0.6)mL和(1.3±0.5)mL,迟发性出血发生率分别为0.88%和6.13%,钉子完全脱落时间(17.1±3.9)d和(22.7±4.1)d,术后伤口感染率9.73%和5.19%,术后1个月水肿发生率22.6%和10.4%及换药时重度疼痛患者比率27.1%和76.9%,上述6项比较的差异有统计学意义(P0.05)。结论:试验组在止血效果、换药疼痛感、钉子完全脱落时间方面优于对照组。不足之处主要是:近期水肿及感染的发生率更高,但两组的远期疗效相似。  相似文献   

9.
目的:观察自粘弹力绷带在一次包皮环切缝合器术中的安全性和有效性。方法:回顾性分析我院2014~2017年泌尿外科门诊就诊的147例包皮过长患者的临床资料,排除禁忌证,随机分为四组:传统包皮环切术+纱布组(A组)、传统包皮环切术+绷带组(B组)、环切缝合器组+纱布包扎组(C组)、环切缝合器+自粘弹力绷带组(D组),分别对手术时间、术中出血量、阴茎水肿程度进行测量。结果:D组和A组手术时间分别为(9±2)min和(25±3)min,D组和C组术后1h出血量分别为(0.5±0.3)ml和(1.5±0.6)ml,环切缝合器组手术时间较传统环切组缩短(P0.05),而加用弹力绷带后出血量减少(P0.05)。术后7d和14d,四组包皮水肿发生率差异无统计学意义(P0.05)。结论:在包皮环切缝合器术中使用自粘弹力绷带,可减少出血和血肿,并且不会加重包皮水肿,具有较好的临床效果和可行性。  相似文献   

10.
<正>包皮环切术是泌尿外科门诊手术室最常见的手术,目前我院主要开展三种包皮环切术,即传统包皮环切术、商环包皮环切术及一次性包皮环切缝合术,我们发现应用一次性包皮环切缝合器在手术时间、出血量、术后疼痛、并发症、愈合后的美观度、患者满意度方面比传统手术有着更加明显的优势。我们对预的约包皮过长、包茎患者285例患者进行分组治疗,依据患者自愿原则对其中的145例包皮过长或包茎患者行传统包皮  相似文献   

11.
Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI2) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI2), TXB2 (stabile metabolite of thromboxane A2) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI2 release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB2 (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI2 release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A2, presumably contributing to hemodynamic stability within 30 min after MT.  相似文献   

12.
Don Dame 《Artificial organs》1996,20(5):613-617
Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.  相似文献   

13.
Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.  相似文献   

14.
Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.  相似文献   

15.
Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H2O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg−1 followed by 0.15 mg · kg−1 · h−1, n=8) or verapamil (0.1 mg · kg−1 followed by 0.3 mg · kg−1 · h−1, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.  相似文献   

16.
Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.  相似文献   

17.
Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.  相似文献   

18.
Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg?1 i. v. or midazolam 0.05 mg · kg?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg?1 i. v. and 32 μg · kg?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg?1. The mean ED50s, calculated from dose-response curves, were 5.4 mg · kg?1, 3.9 μg · kg?1 and 0.4 mg · kg?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg?1 i. v. or midazolam 0.05 mg · kg?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg?1 and 8 μg · kg?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.  相似文献   

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Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg?1 · min?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min?1 · m?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO2I) and oxygen consumption index (VO2I) were also significantly increased in the dopexamine group (DO2I: from 416±91 to 717±110 ml/m2 · m2; VO2I: from 98±25 to 157±22 ml/m2 · m2), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.  相似文献   

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