Intraoperative angiography in reconstructive surgery of aorto- iliac occlusions

In a group of 182 patients who underwent surgical treatment for aortoiliac occlusions 172 had to be subjected to intraoperative distal angiography. The operative tactics in this case was determined by the degree of affection of the peripheral vessels and the character of collateral circulation, which were appraised from the findings of the operative angiograms. According to this, all patients were divided into 4 groups. Two patients developed complications linked with faulty appraisal of the drainage paths.     

不同术式治疗下腰椎结核的疗效分析

目的：探讨和分析应用不同术式治疗下腰椎结核的适应证和临床效果。方法：回顾总结2001年6月至2008年10月行手术治疗的下腰椎结核72例,男38例,女34例;年龄16～70岁,平均38．5岁;病程4个月-2年,平均6．8个月。其中单椎体受累10例,2个椎体受累50例,3个椎体12例。下腰椎前凸角度（L4-S1）33．0°—-5．0°,平均13．1°。手术方式包括：（D28例行经后路病灶清除、椎弓根系统内固定后外侧植骨融合术;②32例行经前路病灶清除、椎间植骨后路椎弓根系统内固定术;（3）12例行经皮穿刺置管脓肿引流术（PCD）。疗效评价根据治愈率、植骨融合率、下腰椎曲度矫正状况及临床症状恢复情况（JOA评分）评定。结果：所有患者获得随访,时间1．5-8年,平均3．6年。PCD组首次置管治愈10例,2例重新置管引流后治愈;其中1例半年后因复发行病灶清除融合术。切开病灶清除融合组术后1年植骨融合率95．0％（57／60）。患者皆治愈,手术并发症主要包括髂总静脉损伤3例,硬膜撕裂2例,经术中、术后处理,未造成机体残余损害。下腰椎前凸角度35．0°-16．0°,平均27.3°,最终随访时为33．0°-15．0°,平均25．6°。依照JOA腰腿痛疗效标准（29分法）,术前为（15．2±3．4）分,术后最终随访时为（25．6±2．4）分,与术前比较均有统计学差异（P〈0．01）。结论：下腰椎结核应根据病变特点的不同选择不同的术式治疗,手术治疗能促进下腰椎结核病灶愈合,缓解临床症状,矫正畸形,避免远期并发症。     

闭合性胰腺损伤的诊治（附17例报告）

目的　分析闭合性胰腺损伤的诊断与治疗方法。方法　对 17例闭合性胰腺损伤患者的诊断、手术方式、手术效果及并发症的处理进行总结分析。结果　 17例中 ,发生并发症 4例 ,死亡 1例。结论　胰腺损伤术前很难做出诊断。诊断的关键是剖腹探查 ;胰腺损伤的手术方式较多 ,应根据胰腺损伤的具体情况选择合理的手术方式 ,才能减少并发症和死亡率的发生     

Surgical treatment of patients with morbid obesity

Indications for operative procedures, preoperative preparation, operative methods and postoperative management of the patients are discussed on the basis of an experience with the surgical treatment of 46 patients with morbid obesity. The surgical treatment is believed by the authors to be indicated for morbid obesity of the IIIrd and IVth stages when conservative measures proved to be unsuccessful. Positive results were obtained in most the patients operated upon. Two patients died after operation.     

无症状胆囊结石处理的临床研究

目的　探讨无症状胆囊结石的临床处理原则。方法　将健康体检中发现的无临床症状胆囊结石 13 6例 ,前瞻性非随机分为 2组 :(1)预防胆囊切除组 66例 ;(2 )治疗性胆囊切除组 70例。比较两组间术后病理、并发症发生情况及手术难易程度有无差别。结果　两组间术后病理、并发症及手术难易程度均差异有显著 (P <0 .0 5～ 0 .0 2 5 )。结论　对无症状胆囊结石患者 ,应强调有选择地进行预防性胆囊切除 ,而不应一味地等到发生胆石症的一种或数种合并症后才进行手术治疗。     

Optimization of surgical treatment of patients with recurrent inguinal hernia

The results of surgical treatment of 687 patients, ageing 22-78 yrs old and suffering inguinal hernia recurrence, are analyzed. The operative intervention choice was established in accordance with presence of the certain hernia type as well as inguinal dehiscence height and degree of atrophic changes in musculo-aponeurotic structures of inguinal channel. After the operation inflammatory complications were observed in 50 (7.3%) patients and they were eliminated, using adequate conservative measures. In 2 (0.3%) patients the operative wound suppuration have occurred. In 2 (0.36%) patients the hernia recurrence have occurred in far remote period as a consequence of the operative wound suppuration.     

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目的 探讨原发骶前肿瘤的诊断和手术治疗方法。方法 分析1983-1999年治疗的23例原发骶前肿瘤病人的临床资料。结合文献进行讨论。结果 23例中先天性肿瘤为最常见类型。肛门指诊结合B超和CT检查对于术前评估非常重要。手术路径以经骶尾入路和经会阴入路最为常见。结论 如无手术禁忌证，所有原发骶前肿瘤均应予手术切除，应根据肿瘤的具体情况选择恰当的手术路径，术中应避免神经血管损伤，并尽可能完整切除肿瘤。     

Correlation of diagnostic procedure with surgical findings in carotid stenosis

Authors are discussing dilemma about necessary diagnostic procedure in making decision for surgical treatment of the carotid disease. Attitudes are changing and the old opinion of the necessity for angiogram of extra cranial blood vessels is substituted by the opinion that CDS (Color Duplex Scan) is satisfactory in the majority of cases to indicate of the surgical treatment. Comparing the invasive and noninvasive diagnostic's with operative findings, authors empirically confirm the given hypotheses, looking back to the cases where angiogram is necessary. The following issues were discussed: Estimate of the locaton of maximal shrinking, degree of shrinking, length of shrinking and characteristics of plaque as the most important parameters for indication and operative tactics. Diagnostics with CDS is shown as reliable with high degree of matching with operative findings.     

酚妥拉明治疗室间隔缺损合并肺动脉高压的临床意义

目的　探讨酚妥拉明对治疗室间隔缺损合并重度肺动脉高压的临床意义。　方法　 33例室间隔缺损合并重度肺动脉高压患者应用彩色多普勒超声心动图检测静脉注射酚妥拉明后肺动脉收缩压 (PASP)的变化。根据静脉注射酚妥拉明后肺动脉收缩压下降程度不同分为 A组和 B组。 A组 :2 1例 ,肺动脉收缩压下降≥ 2 .6 7k Pa(2 0mm Hg) ;B组 :12例 ,肺动脉收缩压下降 <2 .6 7k Pa(2 0 mm Hg)。比较两组术后低心排血量综合征、心律失常、死亡例数等。　结果　两组肺动脉收缩压均下降 ,A组肺动脉收缩压下降明显 ,其手术疗效好于 B组。A组术后发生低心排血量综合征和心律失常较 B组低 (P<0 .0 5 )。　结论　酚妥拉明试验对室间隔缺损合并重度肺动脉高压手术治疗及预后的评估具有指导作用     

Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options

Despite recent advances in pharmacological management of rheumatoid arthritis, forefoot deformity, with its symptoms, remains a common problem, often requiring operative treatment. Typical deformities in these patients comprise hallux valgus and deformity of the lesser metatarsophalangeal (MTP) joints and toes. With regard to the lesser rays the standard operative procedure, advocated for the disabling forefoot pain in these patients, remains metatarsal head resection. It should be considered that with increasing success of pharmacological treatment the degree of forefoot deformity in these patients is becoming less and that resection of the lesser MTP joints is becoming more and more superfluous. This supports a trend towards metatarsal head-preserving surgery. The optimal treatment of the hallux deformity remains unclear. Fusion of the first MTP joint is, generally, recommended. This article will discuss the current surgical options in rheumatoid forefoot pathology.     

Operative treatment of congenital torticollis

There were 47 patients with congenital muscular torticollis who underwent operative release. After a mean follow-up of 74 months (60 to 90), they were divided into two groups, one aged one to four years (group 1) and the other aged five to 16 years (group 2). The outcomes were assessed by evaluating the following parameters: deficits of lateral flexion and rotation, craniofacial asymmetry, surgical scarring, residual contracture, subjective evaluation and degree of head tilt. The craniofacial asymmetry, residual contracture, subjective evaluation and overall scores were similar in both groups. However, group 2 showed superior results to group 1 in terms of the deficits of movement, surgical scarring and degree of head tilt. It is recommended that operative treatment for congenital muscular torticollis is postponed until the patient can comply successfully with post-operative bracing and an exercise programme.     

Primary prophylaxis of venous thromboembolism in surgical patients

Venous thromboembolism is a major risk for surgical patients during the perioperative period. Prevention of perioperative venous thromboembolism remains a critical component of surgical patient care. The risk for venous thromboembolism in surgical patients can be stratified by their risk factors and by the type of operation. Pharmacological prophylaxis for venous thromboembolism includes unfractionated heparin, low-molecular weight heparin, fondaparinux, warfarin, antiplatelet therapy, and direct thrombin inhibitors. Mechanical devices such as graduated compression stockings, intermittent pneumatic compressions, and venous foot pumps are also effective modalities for venous thromboembolism prophylaxis. The optimal preventive measure of venous thromboembolism should be based on the degree of risk for venous thromboembolism with the intensity of prophylaxis while balancing potential treatment benefits and risks in each individual patient. The epidemiology of venous thromboembolism, the methods for achieving venous thromboembolism prophylaxis, and the approach to institute venous thromboembolism prophylaxis in surgical patients undergoing various operative interventions are reviewed in this article.     

The treatment of fecal incontinence

The treatment of faecal incontinence includes: the education of the patient, medical therapy, biofeedback and sphincteric exercises, surgical therapy. Conservative, non-surgical treatment is almost always the initial therapeutic approach, except in those cases in which an evident defect of the sphincter muscle is present. Surgical treatment has seen a noteworthy increase in the last fifteen years as a consequence of the development of new surgical techniques. These techniques include: external anal sphincter plasty, pelvic floor plasties, sacral neuromodulation, muscular transpositions with or without electrostimulation, artificial anal sphincter. These procedures may be employed as first or second level treatment depending on the type of pathology considered and its aetiology. The 1st results achieved by surgical treatment authorise us to believe that reconversion with artificial sphincter is a valid alternative to graciloplasty, notwithstanding the fact that its costs are higher. Attentive pre- operative assessment of patients is important. Patients must be strongly motivated and able to manage the new condition. Although further studies are necessary, the degree of satisfactory of the 1st patients operated is the best stimulus for pursuing the development of this technique.     

Evaluation of neurohumoral reactions in the selection of surgical methods for patients with bronchial asthma

The activity of cholino- and adrenoreceptors of blood T-lymphocytes was studied to elaborate the indications for operative interventions various parts of the autonomous nervous system in 117 patients with bronchial asthma. Selective denervation of the root of the lung and glomectomy with denervation of the sinocarotid zone was found to be the most effective type of surgical treatment. The clinical effect of operative treatment is linked with normalization of the activity of cholinoreceptors of blood T-lymphocytes. The high informativeness of the test was demonstrated in predicting the results of operative treatment of patients with bronchial asthma.     

Surgical treatment without recurrences ventral hernias as a social problem

The authors have analyzed social aspects of surgical treatment of postoperative ventral hernias and described results of the surgical treatment of 149 patients. Specific measures used in preoperative preparation and in operative treatment of elderly and senile patients are considered. Long-term results of surgical treatment of 76 patients have been studied who had undergone plasty of the anterior abdominal wall with the application of a reticulate polypropelene explant. This method was shown to be pathogenetic and highly reliable for surgical treatment of postoperative ventral hernias.     

Diagnosis and treatment of nonspecific spontaneous pneumothorax

An analysis of the surgical treatment of 131 patients with spontaneous nonspecific pneumothorax has shown the operative treatment to be widely used after unsuccessful aspiration therapy, recurrent and complicated pneumothorax.     

PPH结合传统术式治疗Ⅱ、Ⅲ度直肠脱垂22例疗效观察

为了探讨治疗成人直肠脱垂的有效方法,采用PPH结合硬化剂注射和肛门紧缩术治疗Ⅱ、Ⅲ度直肠脱垂22例,观察其临床疗效。结果显示,21例一次成功,1例复发经再次手术治愈,有效率达100％,无手术并发症。结果表明,应用PPH结合传统术式治疗Ⅱ、Ⅲ度直肠脱垂,具有操作简单,疗效确切,安全有效等优点。     

胰管结石的分型和外科治疗方式的选择

目的 探讨胰管结石的分型并根据分型选择合理的外科治疗方式.方法 回顾性分析59例胰管结石病人的临床资料,提出胰管结石的分型和外科治疗方式.结果 结合影像学检查和手术探查结果,将胰管结石分为四型五类,各型胰管结石有不同的外科治疗方式.结论 正确分型,合理的治疗方式对于提高胰管结石的治疗效果具有重要意义.     

Operative management of adult high-grade lumbosacral spondylolisthesis

The surgical management of high-grade spondylolisthesis in adults remains challenging and controversial. Symptomatic patients often present with severe pain, neurologic deficits, or deformity. Although there are several surgical options, the decision to proceed with decompression and fusion depends on the patient's presenting symptoms and degree of instability. Posterolateral pedicle screw-rod fixation has improved rates of arthrodesis compared with traditional in situ fusions. Nevertheless, complications with operative management of high-grade spondylolisthesis can be severe.     

Results of surgical treatment of chronic pancreatitis

On the basis of a group of 67 patients studied by the authors, the various techniques for the surgical treatment of chronic pancreatitis are discussed. The average age of the patients covered by this study was 45.7 years, and the male:female ratio was 2.9:1. In more than 82% of the cases a history of chronic alcohol abuse was definitely established. For the drainage operations performed the preferred operative techniques were the pancreaticojejunal anastomosis and, where pancreatic pseudocysts were present, the cystojejunostomy. Resection of the pancreas was performed in a total of 18 patients, the clinical mortality here being 5.6%. In our study also the long-term prognosis for patients with chronic pancreatitis depended, on the whole, less upon the operative technique chosen than upon the subsequent degree of alcoholism.