三点加连续缝合止血法在耻骨上前列腺切除术中的应用

目的比较耻骨上前列腺切除术和改进的三点加连续缝合方法的止血效果。方法103例在我院行耻骨上前列腺切除术的良性前列腺增生症患者,分为传统手术方法组和三点加连续缝合方法组,分别比较手术时间、止血效果和疗效。结果传统对照组57例手术时间(122±38)min,出血量(449±292)ml,冲洗液转清(7.8±3.7)d。三点加连续缝合组46例手术时间(87±18)min,出血量(140±30)ml,冲洗液转清(1.5±1.0)d。两组手术时间无统计学差异(P>0.05),但出血量、冲洗液转清等指标均有统计学差异(P<0.05)。两组疗效无统计学差异(P>0.05)。结论三点加膀胱颈连续缝合止血法在传统的手术方法上改进后,无增加手术的时间和难度,但止血效果更好,可在开放性前列腺切除术中推广应用。     

单向倒刺可吸收缝线在胆总管探查一期缝合中的应用

目的探讨单向倒刺可吸收缝线连续缝合在腹腔镜微创胆总管探查一期缝合中的效果及安全性。方法回顾性分析宝鸡市中医医院2014年1月～2017年11月收治的行胆总管探查一期缝合患者共138例临床资料,根据缝合方案不同分为A组(69例)和B组(69例),分别采用普通和单向倒刺可吸收缝线行连续缝合;比较两组手术相关临床指标和术后并发症发生率。结果两组手术时间、术中出血量及术后总住院时间比较差异无统计学意义(P0.05);B组术中胆总管缝合时间显著少于A组(P0.05);两组术后急性胆管炎和胆漏发生率比较,差异无统计学意义(P0.05)。结论单向倒刺可吸收缝线连续缝合用于行微创胆总管探查一期缝合患者能够有效缩短缝合用时,降低操作难度,且未导致术后并发症发生风险增加,价值优于普通可吸收缝线。     

耻骨后根治性前列腺切除术在前列腺手术与未曾手术患者的应用

<正>根治性前列腺切除术(radical retropubic prostatectomy,RRP)是治疗局限性前列腺癌(prostaticcancer,PCa)最有效的方法[1]。我们把2003年1月至2008年6月因前列腺增生手术后发现PCa而行RRP的20例编为A组,将同期前列腺未曾手术过的连续20例PCa行RRP的编为B组,对A、B两组进行比较,以评价前列腺术后RRP的手术难度和疗效。     

倒刺缝线在初次全膝关节置换术中的随机对照研究

目的对比倒刺缝线与可吸收缝线用于初次全膝关节置换术的临床效果。方法选取2015年1月至2016年10月在我科行同期双侧全膝关节置换术患者31例,并将每位患者两侧膝关节随机分组,一侧膝关节术中采用倒刺缝线连续缝合关节囊(实验组),另一侧膝关节术中采用可吸收缝线连续缝合关节囊(对照组)。术后比较两种缝合方式在手术关闭关节囊时间、术后伤口并发症发生率及缝线费用方面的差异。结果倒刺缝线关闭关节囊时间(5.16±0.91)min与可吸收组(9.21±1.36)min相比,差异有统计学意义(P0.05)。伤口并发症发生率方面比较,倒刺缝线组6.45%,可吸收组9.68%,两组相比差异无统计学意义(P0.05)。单从缝线费用方面比较,倒刺缝线组(780元)与可吸收组(65元)相比差异有统计学意义(P0.05)。结论倒刺缝线在全膝关节置换术中与传统可吸收缝线相比,安全有效,使用方便,可以缩短手术时间,提高手术效率,值得临床推广。     

BPH患者组织学前列腺炎与PSA、前列腺体积、PSAD、IPSS、Qmax及PVR的相关性研究

目的:探讨BPH患者组织学前列腺炎与PSA、前列腺体积、PSA密度(PSAD)、IPSS、最大尿流率(Qmax)及残余尿量(PVR)的相关性。方法:手术切除或经尿道前列腺电切术(TURP)治疗的BPH患者673例。按照是否伴有组织学前列腺炎将患者分为两组:A组:BPH伴组织学前列腺炎;B组:BPH不伴有组织学前列腺炎。比较两组患者PSA、前列腺体积、PSAD、IPSS、Qmax及PVR。结果:A组PSA水平为(5.64±2.48)μg/L,前列腺体积(43.66±13.11)ml,PSAD 0.129±0.048,IPSS(24.72±5.39)分,Qmax(6.94±3.23)ml/s,PVR(124.90±49.80)ml;B组PSA水平为(4.97±1.99)μg/L,前列腺体积(40.41±11.44)ml,PSAD 0.123±0.034,IPSS(23.40±6.21)分,Qmax(7.75±3.52)ml/s,PVR(112.73±50.03)ml。A组PSA水平、前列腺体积、IPSS和PVR均明显高于B组(P<0.05);A组Qmax明显低于B组(P<0.05);PSAD两组间差异无统计学意义(P>0.05)。结论:组织学前列腺炎能明显增加患者的PSA水平、前列腺体积、IPSS和PVR,降低患者Qmax。但是组织学前列腺炎与PSAD无关;组织学前列腺炎是影响BPH临床进展的重要因素。     

中线剖腹后比较二种筋膜缝合方法的随机临床试验英

关腹部切口最佳方式的争论集中在缝线(可吸收性还是永久性)和筋膜缝合方法(间断还是连续)的选择上。(1)缝线:有人报道用永久性缝线后窦道形成和疤痕疼痛分别占8%和17%。因此目前倾向于使用可吸收线。但可吸收线又有强度不够导致切口哆开和切口疝的危险。为解决此难题,吸收缓慢的缝线,如聚葡糖酸酯(polyglyconate)和polydioxanone已应用到外科领域。它们在术后28天能保持原有强度的50%。(2)缝合方法:连续缝合具表面平整、能自动调节拉力、张力在整个切口分布均匀等优点,可能的缺陷是异物量较多和一旦断裂即造成切口全长哆开。为研究其临床关联性,作者设计随机临床试验,以中     

心脏手术中剩余Prolene缝合线的应用

随着高分子化学应用到医用缝线上来,手术中不可缺少的医用缝合线也在不断推陈出新,目前,各种规格和型号的可吸收线和不可吸收线以其明显优势在心脏外科手术中被普遍使用,如无损伤线和Prolene缝合线等.而使用的同时,难免产生剩余线或半头线,因价格贵,弃之浪费.在心脏外科手术切口缝合中,笔者将剩余线用于切口缝合,应用效果满意,介绍如下.     

心脏手术中剩余Prolene缝合线的应用

随着高分子化学应用到医用缝线上来，手术中不可缺少的医用缝合线也在不断推陈出新。目前，各种规格和型号的可吸收线和不可吸收线以其明显优势在心脏外科手术中被普遍使用，如无损伤线和Prolene缝合线等，而使用的同时，难免产生剩余线或半头线，剀价洛贵，弃之浪费。在心脏外科手术切口缝合中，笔者将剩余线用于切口缝合，应用效果满意，介绍如下。     

可吸收生物缝合线在普外科中的应用

目的　探讨可吸收生物缝线在普外科手术中的应用价值。方法　将 12 0例施行普外科手术患者分为两组 ,观察可吸收生物缝线和普通丝线对切口愈合的影响。结果　可吸收生物缝线组患者切口并发症明显低于普通丝线缝合组 (P <0 .0 5 )。结论　可吸收生物缝线是手术缝合材料的一种创新 ,对减少切口并发症有重要的临床意义。     

预防性内减张缝合在腹部外科手术中的应用

目的 介绍腹部手术应用可吸收缝线行预防性内减张缝合的方法,并评价其优越性.方法 将249例患者按照前瞻性随机对照方法,分为试验组120例,对照组129例.二组均使用人工合成可吸收缝线行分层腹壁筋膜连续缝合法闭合腹壁切口,试验组加用1号Dexon可吸收缝合线行预防性皮下内减张缝合.观察对比二组患者术后切口裂开、切口感染、脂肪液化、皮下血肿、切口疝发生情况.结果 试验组切口裂开、切口疝发生率与对照组比较差异有统计学意义(χ2=5.899,P=0.037;χ2=8.029,P=0.030);二组切口感染率、脂肪液化率、皮下血肿发生率无统计学意义(χ2=0.216,P=0.771;χ2=0.015,P=1.000;χ2=0.421,P=0.610).结论 Dexon可吸收缝线预防性内减张缝合可以有效地防止切口裂开,减少切口疝,值得推广使用.     

经会阴横切口横缝肛提肌治疗直肠前突性功能性便秘

目的 探讨经会阴横切横缝法治疗直肠前突性功能性便秘的疗效。方法 2011年9月～2013年3月,选取菏泽家政职业学院附属医院直肠前突性功能性便秘38例,采用会阴部横行切口,钝性分离直肠阴道隔,7号线横行缝合两侧肛提肌。结果 手术时间23～40min,平均28min;术中出血8～35ml,平均15ml;术后疼痛I度35例,Ⅱ度3例;肛门坠胀感36例;住院时间6～10d,平均8d。术后随访时间7～12个月,便秘治愈36例,好转2例。结论 经会阴入路横行缝合法治疗直肠前突性功能性便秘疗效肯定,手术安全。     

Reducing blood loss in open radical retropubic prostatectomy with prophylactic periprostatic sutures

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To determine whether the placement of small‐calibre, rapidly absorbed prophylactic periprostatic sutures before the mobilization of the prostate could reduce blood loss during open retropubic radical prostatectomy (RRP).

PATIENTS AND METHODS

In 2007, during open RRP, we began placing prophylactic haemostatic sutures of 4‐0 and 3‐0 plain catgut in the anterior portions of the distal neurovascular bundles (NVBs) and lateral to the proximal NVBs and prostate pedicles before initiating the nerve‐sparing dissection and mobilizing the prostate gland. To evaluate whether this reduced intraoperative blood loss, we compared estimated blood loss (EBL), non‐autologous transfusion rates, and postoperative haemoglobin (Hb) levels between 100 consecutive patients treated immediately before and 100 consecutive patients treated immediately after the adoption of the prophylactic periprostatic suture technique.

RESULTS

Before the use of prophylactic haemostatic sutures, the mean intraoperative blood loss was 1285 mL, and one patient (1%) received an intraoperative non‐autologous transfusion. After the adoption of prophylactic sutures, the mean EBL was 700 mL (P < 0.001), and there were no transfusions. The mean Hb concentration the morning after RRP was 10.9 g/dL before and 11.8 g/dL after the initiation of prophylactic haemostatic sutures (P < 0.001).

CONCLUSION

Prophylactic periprostatic haemostatic sutures significantly reduce intraoperative blood loss during open RRP.     

可吸收止血膜在颅脑肿瘤手术中的应用

目的探讨可吸收止血膜在颅脑肿瘤切除术中的止血效果及安全性。方法选择2009年1月-2011年9月我科颅脑肿瘤手术116例,将116例颅脑肿瘤交替入组依次分为2组：实验组,肿瘤创面常规加应用可吸收止血膜止血;对照组,肿瘤创面采用常规电凝、脑棉等方法止血,比较2组术中止血有效率、术后24h出血量。结果对照组止血有效率为65．5％（38／58）,显著低于实验组96．6％（56／58）（Z=-3．997,P=0．000）。实验组术后24h内出血量（25．1±3．4）ml,显著少于对照组（120．5±6．3）ml（t=-101．488,P=0．000）。结论可吸收止血膜在颅脑肿瘤手术中有良好的止血效果。     

腹腔镜直肠悬吊固定术治疗直肠重度脱垂

目的探讨腹腔镜直肠悬吊固定术治疗直肠脱垂的临床应用价值。方法1998年3月至2007年2月,对4例完全性直肠脱垂患者进行了腹腔镜直肠悬吊固定术。1例采用缝合固定法,将直肠后壁分离、提高,用丝线缝闭直肠前陷凹,并将直肠后壁悬吊固定于骶骨岬前筋膜上,再将乙状结肠缝合固定在左侧腰大肌筋膜。3例采用网片固定法,将直肠游离到肛提肌水平,用1张6cm×9cm的T字型聚丙烯网片置于直肠后方,网片下缘在肛提肌水平环绕直肠,在直肠前方用丝线缝合网片和直肠浆肌层,再将网片上端在直肠后用疝修补钉夹固定于骶骨岬前筋膜,缝合关闭盆底腹膜。再将乙状结肠缝合固定在左侧腰大肌筋膜。结果4例患者手术均顺利,无中转开腹者。手术时间92.5(80-100)min,出血量6.5(5～10)ml。无并发症发生。术后尿失禁和肛门失禁的症状缓解,术后随访2个月至3年均未见复发与便秘出现。结论腹腔镜下行腹腔镜直肠悬吊固定术创伤小、恢复快和安全有效。     

Comparative study of the efficacy of the common topical hemostatic agents with fibrin sealant in a rabbit aortic anastomosis model

OBJECTIVE: The purpose of this study was to compare the hemostatic efficacy of the common surgical hemostatic agents with fibrin sealant (FS) and to assess their functional strength to secure hemostasis in lieu of placing additional sutures. METHODS: End-to-end anastomosis of transected abdominal aorta was performed in moderately anticoagulated rabbits using 4 or 6 interrupted sutures. The suture line was covered either with gauze alone ("untreated") or with gauze plus Gelfoam, Avitene, Surgicel, FloSeal, or FS, following which blood flow was restored. Blood loss was absorbed by gauze and measured. The surviving rabbits were recovered and the repaired vessel was examined histologically 4 weeks after operation. The investigators were blinded to the treatment groups. Aortic anastomoses using 8 or 12 sutures (untreated) were also performed. RESULTS: Untreated 4-suture anastomosis of aorta resulted in a profuse hemorrhage with an average 108.0 +/- 19.2 (mean +/- SD) ml blood loss and 100% mortality (n = 4). FS application sealed the anastomoses, prevented blood loss (P < 0.01 vs untreated) and exsanguination of the rabbits (n = 4). Other hemostatic agents reduced the bleeding to varying degrees compared to the untreated animals (Gelfoam 66.4 +/- 17.6, Avitene 80.6 +/- 34, Surgicel 66.7 +/- 16.7, FloSeal 44.2 +/- 8.5 ml blood loss, n = 4/group), but the changes were not statistically significant. One to three rabbits in each group survived the operation. Six-suture aortic anastomoses, untreated, resulted in 67.7 +/- 21.8 ml blood loss and 100% survival (n = 6). Application of FS produced immediate and sustained hemostasis in all the animals (P < 0.01 vs untreated). Other hemostatic agents also reduced the bleeding (Gelfoam 42.5 +/- 10, Avitene 50.9 +/- 12.4, Surgicel 32.1 +/- 14, FloSeal 33.9 +/- 5.4 ml blood loss, n = 6/group), but the changes were not statistically significant. The 8- and 12-suture aorta repairs resulted in a moderate blood loss (43.9 +/- 19 and 21.3 +/- 14.9 ml, respectively), followed by a stable hemostasis that precluded the need to use any hemostatic agent. The aortic cross-clamping time of the 12-suture and time to hemostasis for both the 8- and the 12-suture techniques were significantly longer than those of the 4-suture plus FS application (P < 0.01, P < 0.01 and P < 0.05, respectively). CONCLUSION: In a moderate coagulopathy, FS was proven to be the most efficacious hemostatic agent, producing immediate and sustained hemostasis at the arterial anastomotic site. This high efficacy is in part attributed to the strong tissue adhesive property of this agent. FS application may potentially ease the anastomosis and shorten the duration of timely critical vascular procedures.     

A novel technique for approaching the endopelvic fascia in retropubic radical prostatectomy, based on an anatomical study of fixed and fresh cadavers

OBJECTIVE: To present the anatomical basis and details of a technique for an approach to the endopelvic fascia devised to preserve urinary continence. PATIENTS, MATERIALS AND METHODS: For cross-sectional macroscopic observation, seven formalin-fixed specimens of the male pelvic contents including the pelvic wall were serially sectioned at a 5-mm thickness. Semi-serial sections from eight other specimens were examined histologically. Eight fresh cadavers were dissected to mimic the various steps in a retropubic radical prostatectomy. After approaching the endopelvic fascia in an anatomically determined manner to reach the paraprostatic space, the pubic bone was removed and nerves near the rhabdosphincter dissected. To assess the clinical implication of this approach, we examined the time to achieve continence in 23 consecutive patients who had a radical retropubic prostatectomy using the new technique. RESULTS: Sectional macroscopic observation depicted the fascia of the levator ani as a definite structure adherent to but not fused with the lateral pelvic fascia. The thin fascia overlying the levator ani fascia and lateral pelvic fascia represented the true endopelvic fascia. Microscopically, the lower part of the fascia of the levator ani was rich in smooth muscle, which interdigitated with the framework of the rhabdosphincter. In fresh cadavers, the levator ani muscle was removed laterally still covered by its fascia, without visualizing the muscle fibres. Small branches from the pudendal nerve entered the rhabdosphincter. The mean (sd, range) distance from the lowest point of the endopelvic fascia to the point where the sphincteric branch entered the rhabdosphincter was 5.5 (1.8, 3-8) mm. The continence rate at 1, 3, 6 and 9 months after surgery using the new technique was 44%, 83%, 96% and 100%, respectively. CONCLUSIONS: Preserving the fascia of the levator ani helps to protect the levator ani muscle, rhabdosphincter and pudendal nerve branches to the rhabdosphincter. In retropubic radical prostatectomy, this anatomical approach to the endopelvic fascia should preserve or allow the earlier recovery of urinary continence.     

Reinforced Tension Line Versus Simple Suture: a Biomechanical Study on Cadavers

The aim of our experimental biomechanical study was to compare the strength of two different midline laparotomy suture techniques: simple suture and reinforced tension line (RTL) suture.

Materials and methods : Sixty midline laparotomies on cadavers were performed: simple and RTL sutures in each 30 cases. Cadavers were patients who died in the hospital during the last 24 hours and had no previous abdominal operations and no arterial aneurysm disease. Simple and RTL sutures were made with slowly absorbable polydioxanone (PDS II loop, 1/0 size). The strength of both sutures was measured with tensiometer and expressed in Newton (N). The maximal suture strength was assessed at the moment when the suture tore the tissues.

Results : The simple suture strength was significantly lower than RTL suture strength (86.3 ± 16.8 N vs. 113 ± 16.6 N, p < 0.001). The midline laparotomy suture strength increased up to 31% when RTL suture was performed. The RTL suture strength was significantly higher in all three abdomen regions: epigastric (80 ± 15.7 N vs. 106.6 ± 14 N, p < 0.001), umbilical (86.2 ± 16 N vs. 112.9 ± 14.8 N, p < 0.001) and hypogastric (93.7 ± 17.2 N vs. 120.7 ± 18.1 N, p < 0.001).

Conclusions : The reinforced tension line suture is significantly stronger than simple suture when closing the midline laparotomy. This suture can be used in patients with higher fascia dehiscence or incisional hernia risk.     

经盆腔途径肛提肌外腹会阴联合直肠切除术36例

目的评价对经肛提肌外腹会阴联合直肠切除术（ELAPE）的腹组操作进行改良——即在腹部操作过程中经盆腔途径直视下切断肛提肌治疗低位直肠恶性肿瘤的安全性、可行性及临床疗效。方法2010年1月到2013年3月,福建医科大学附属协和医院结直肠外科对36例低位直肠恶性肿瘤（距肛缘小于或等于5cm）患者行腹腔镜（26例）或开放（10例）手术中经盆腔途径行ELAPE术,术中可根据肛提肌受累情况个体化决定肛提肌切除范围：会阴部操作时无需翻转患者体位。总结该改良术式的初步应用结果。结果除开放手术者术中发生1例直肠穿孔外。其余患者术中均未发生相关并发症及中转手术。手术时间为（220．9±36．8）min,术中出血量为（121．6±99．7）ml。所有标本切断的肛提肌均附着在直肠系膜上,标本的环周切缘阳性率为5．6％（2／36）。术后随访2—27月,未见肿瘤复发或转移。结论经盆腔途径肛提肌外腹会阴联合直肠切除术操作简单、术中可个体化决定肛提肌切除范围、手术时间短和近期肿瘤学效果好。     

耻骨后前列腺癌根治术的技术改进(附32例报告)

目的　改进耻骨后前列腺癌根治术的手术技术 ,减少并发症。　方法　临床诊断为T1和T2 期前列腺癌患者 32例 ,平均年龄 6 8岁。改进耻骨后前列腺癌根治技术 ,包括广泛盆腔淋巴结清扫、保护神经血管束、缝扎背深静脉、多保留尿道后壁组织、膀胱尿道吻合时的膀胱颈部套叠等。　结果　手术时间平均 3.5h ,术中平均出血量 4 5 0ml,输血 1 7例。术后病理报告 :肿瘤局限于包膜内者30例 ,切缘阳性 1例 ,盆腔淋巴结转移 1例。随访 8～ 4 8个月 ,平均 2 2个月 ,均存活。PSA <1ng/ml者2 8例 ,1～ 3ng/ml者 4例。术后 3～ 6个月患者均恢复完全控尿。术后恢复勃起功能者 1 0 / 1 8(5 6 % )例。　结论　耻骨后前列腺癌根治术可有效切除肿瘤、保护控尿功能、保留性功能 ,是局限性前列腺癌的首选治疗方法。