应用中心静脉导管行耻骨上膀胱穿刺造口术165报告

前列腺增生导致急性尿潴留，在导尿困难的情况下，耻骨上膀胱造口术是解决尿潴留最直接、最有效的方法。我院2005年1月-2010年1月采用中心静脉导管替代硅胶造口管行耻骨上膀胱穿刺造口治疗前列腺增生导致急性尿潴留165例，疗效满意，现报道如下。     

可控膀胱造瘘术治疗逼尿肌无反射性神经源性膀胱

2004年6月至2006年4月我科对3例逼尿肌无反射性神经源性膀胱患者行可控膀胱造瘘术,效果满意,报告如下。1临床资料1.1一般资料本组3例,均为男性,平均年龄54(46~59)岁,平均病程6.7(2~10)年。均以进行性排尿困难为主要临床表现,1例10年前因外伤致T12~L2压缩性骨折导致截瘫,1例有糖尿病史11年、脑梗塞4年,1例10年前患格林巴利。1例查体可触及胀大膀胱,1例查体下腹部饱满,膀胱顶脐下3指,1例留置导尿中。3例均行超声检查,其中1例膀胱尿潴留,1例膀胱内小结石,前列腺钙化,残余尿132m l。1例行CT检查示膀胱多发憩室,前列腺钙化。1例血糖为20.4 mmol…     

中心静脉穿刺新进针点的可行性研究

目的 通过对一种新的颈内静脉置管与高位前路颈内静脉置管进行比较,评价其可行性.方法 选择心脏手术病人60例,随机分为2组,每组30例,Ⅰ组一种新的途径行颈内静脉置管,Ⅱ组高位前路颈内静脉穿刺置管.观察记录总穿刺成功率、一次试穿成功率、置管成功率及并发症.观察中心静脉导管位置,并均于术后x线摄胸部平片.结果 Ⅰ组穿刺总成功率100%,一次穿刺成功率93.33%,均显著高于Ⅱ组(93.33%和60.00%)(P<0.01),Ⅰ组患者无误穿动脉、气胸、血胸及导管异位等并发症发生.结论 该新的穿刺方法具有操作容易、安全性大、穿刺置管成功率及一次穿刺成功率高等特点,是经皮中心静脉置管有实用价值的方法之一.     

中心静脉穿刺新进针点的可行性研究

Objective To evaluate the feasibility of a new approach to internal jugular vein (IJV) catheterization. Methods Sixty patients undergoing cardiac surgery were randomly divided into two groups (n=30). In group Ⅰ, a new method was used. In group Ⅱ, IJV catheterization from a high medial approach. The overall succcess rate of puncture, the success rate of puncture at first attempt, the success rate of cannulation and complication were recorded. Chest X-ray was taken for confirmation of the position of catheter in subclavian vein. Results The overall success rate of puncture was 100% and the success rate of puncture at first attempt was 93.33% in group Ⅰ, which is significantly higher than those in group Ⅱ(P<0.05). No complication occurred in group Ⅰ including arterial puncture, pneumothorax, hematothorax and difficult catheter placement. In group II there were 3 arterial punctures. Con-clusion This new method is a reliable and safe technique in patienst as compared with the high medial approach.     

中心静脉穿刺新进针点的可行性研究

Objective To evaluate the feasibility of a new approach to internal jugular vein (IJV) catheterization. Methods Sixty patients undergoing cardiac surgery were randomly divided into two groups (n=30). In group Ⅰ, a new method was used. In group Ⅱ, IJV catheterization from a high medial approach. The overall succcess rate of puncture, the success rate of puncture at first attempt, the success rate of cannulation and complication were recorded. Chest X-ray was taken for confirmation of the position of catheter in subclavian vein. Results The overall success rate of puncture was 100% and the success rate of puncture at first attempt was 93.33% in group Ⅰ, which is significantly higher than those in group Ⅱ(P<0.05). No complication occurred in group Ⅰ including arterial puncture, pneumothorax, hematothorax and difficult catheter placement. In group II there were 3 arterial punctures. Con-clusion This new method is a reliable and safe technique in patienst as compared with the high medial approach.     

中心静脉穿刺新进针点的可行性研究

Objective To evaluate the feasibility of a new approach to internal jugular vein (IJV) catheterization. Methods Sixty patients undergoing cardiac surgery were randomly divided into two groups (n=30). In group Ⅰ, a new method was used. In group Ⅱ, IJV catheterization from a high medial approach. The overall succcess rate of puncture, the success rate of puncture at first attempt, the success rate of cannulation and complication were recorded. Chest X-ray was taken for confirmation of the position of catheter in subclavian vein. Results The overall success rate of puncture was 100% and the success rate of puncture at first attempt was 93.33% in group Ⅰ, which is significantly higher than those in group Ⅱ(P<0.05). No complication occurred in group Ⅰ including arterial puncture, pneumothorax, hematothorax and difficult catheter placement. In group II there were 3 arterial punctures. Con-clusion This new method is a reliable and safe technique in patienst as compared with the high medial approach.     

中心静脉穿刺新进针点的可行性研究

Objective To evaluate the feasibility of a new approach to internal jugular vein (IJV) catheterization. Methods Sixty patients undergoing cardiac surgery were randomly divided into two groups (n=30). In group Ⅰ, a new method was used. In group Ⅱ, IJV catheterization from a high medial approach. The overall succcess rate of puncture, the success rate of puncture at first attempt, the success rate of cannulation and complication were recorded. Chest X-ray was taken for confirmation of the position of catheter in subclavian vein. Results The overall success rate of puncture was 100% and the success rate of puncture at first attempt was 93.33% in group Ⅰ, which is significantly higher than those in group Ⅱ(P<0.05). No complication occurred in group Ⅰ including arterial puncture, pneumothorax, hematothorax and difficult catheter placement. In group II there were 3 arterial punctures. Con-clusion This new method is a reliable and safe technique in patienst as compared with the high medial approach.     

中心静脉穿刺新进针点的可行性研究

Objective To evaluate the feasibility of a new approach to internal jugular vein (IJV) catheterization. Methods Sixty patients undergoing cardiac surgery were randomly divided into two groups (n=30). In group Ⅰ, a new method was used. In group Ⅱ, IJV catheterization from a high medial approach. The overall succcess rate of puncture, the success rate of puncture at first attempt, the success rate of cannulation and complication were recorded. Chest X-ray was taken for confirmation of the position of catheter in subclavian vein. Results The overall success rate of puncture was 100% and the success rate of puncture at first attempt was 93.33% in group Ⅰ, which is significantly higher than those in group Ⅱ(P<0.05). No complication occurred in group Ⅰ including arterial puncture, pneumothorax, hematothorax and difficult catheter placement. In group II there were 3 arterial punctures. Con-clusion This new method is a reliable and safe technique in patienst as compared with the high medial approach.     

中心静脉穿刺新进针点的可行性研究

Objective To evaluate the feasibility of a new approach to internal jugular vein (IJV) catheterization. Methods Sixty patients undergoing cardiac surgery were randomly divided into two groups (n=30). In group Ⅰ, a new method was used. In group Ⅱ, IJV catheterization from a high medial approach. The overall succcess rate of puncture, the success rate of puncture at first attempt, the success rate of cannulation and complication were recorded. Chest X-ray was taken for confirmation of the position of catheter in subclavian vein. Results The overall success rate of puncture was 100% and the success rate of puncture at first attempt was 93.33% in group Ⅰ, which is significantly higher than those in group Ⅱ(P<0.05). No complication occurred in group Ⅰ including arterial puncture, pneumothorax, hematothorax and difficult catheter placement. In group II there were 3 arterial punctures. Con-clusion This new method is a reliable and safe technique in patienst as compared with the high medial approach.     

中心静脉穿刺新进针点的可行性研究

Objective To evaluate the feasibility of a new approach to internal jugular vein (IJV) catheterization. Methods Sixty patients undergoing cardiac surgery were randomly divided into two groups (n=30). In group Ⅰ, a new method was used. In group Ⅱ, IJV catheterization from a high medial approach. The overall succcess rate of puncture, the success rate of puncture at first attempt, the success rate of cannulation and complication were recorded. Chest X-ray was taken for confirmation of the position of catheter in subclavian vein. Results The overall success rate of puncture was 100% and the success rate of puncture at first attempt was 93.33% in group Ⅰ, which is significantly higher than those in group Ⅱ(P<0.05). No complication occurred in group Ⅰ including arterial puncture, pneumothorax, hematothorax and difficult catheter placement. In group II there were 3 arterial punctures. Con-clusion This new method is a reliable and safe technique in patienst as compared with the high medial approach.     

Use of testosterone ointment before hypospadias repair

Fifteen children, aged between 2 and 9 years old, with hypospadias (4 penile; 6 penoscrotal; 3 scrotal; 1 perineal) were administered testosterone ointment before one-stage urethroplasty. Temporary penile growth and skin enlargement were obtained in all. Side effects were negligible. The plasma testosterone level was measured before, during and after testosterone administration. During testosterone stimulation, the plasma testosterone level ranged from 30 to 190 ng/dl, and returned to the normal range a week after administration had been stopped. Primary success of hypospadias repair was obtained in 10 of 15 children (66.7%).     

Effective Use of Alteplase for Occluded Tunneled Venous Catheter in Hemodialysis Patients

Despite their propensity for significant infectious and mechanical complications, tunneled central venous catheters (CVCs) have become a common means of vascular access in the world for patients requiring chronic hemodialysis for end‐stage renal disease. The objective of this study was to explore if cryopreserved solutions of the thrombolytic agent alteplase could be used as an effective, safe, and economically reasonable alternative in hemodialysis patients with occluded tunneled CVC. Patients requiring chronic hemodialysis and presenting with occluded tunneled CVC received a sufficient volume of the alteplase solution to fill the occluded catheter. To make alteplase economically feasible, it was diluted to 1‐mg/mL aliquots and they were stored at ?20°C until use. Eighty‐one patients accounting for 179 attempted clearances were assessable for efficacy. One hundred forty‐seven (82.1%) of the 179 catheter clearance attempts resulted in successful catheter clearance after one dose. Twenty‐seven (15.1%) of all occluded CVCs were successful after two doses whereas five (2.8%) were not. No adverse events were reported. Cryopreserved 1‐mg/mL aliquots of alteplase are safe and effective in the clearance of occluded CVC for hemodialysis patients.     

Use of a urethral splent in one-stage hypospadias repair

Over a 9-month period, 28 patients with distal penile or more proximal hypospadias underwent one-stage surgical repair. Bladder drainage was achieved in the traditional fashion with either an indwelling Foley catheter or suprapubic catheter or by using a modified urethral silicone stent ("splent"). Twenty-two patients had repair with a perimeatal skin flap, and the remaining six patients had major urethral reconstruction with a vascularized preputial island flap. Use of the urethral splent was associated with shorter postoperative hospitalization and minimal short-term complications. The authors' experience has shown that use of a urethral splent for urinary drainage is efficient and effective in postoperative management after hypospadias repair.     

尿道下裂分期手术矫治

重型初治尿道下裂和既往手术后残留严重问题的残废性尿道下裂是尿道下裂矫治中的难题,重建材料的严重缺乏是突出的问题,勉强一期完成矫治常伴有较高的并发症危险和不良的外观。近年来越来越多学者认为对于这些难治性尿道下裂应采取分期手术矫治。本文介绍尿道下裂分期手术矫治的新观念,并分析分期手术的适应证、手术基本要求、手术选择的术中解剖评估以及常用的主要分期手术方式。     

Use of fibrin glue in preventing urethrocutaneous fistula after hypospadias repair

Urethrocutaneous fistula is one of the most common complications after hypospadias surgery.The incidence of fistula development has varied from 4% to 20% in larger series. We sought to investigate the role of fibrin glue (Tisseel manufactured by Baxter India Pvt Ltd, Chennai, India) to reduce the chances of fistula formation in cases in proximal penile hypospadias.

Method

A total of 120 patients with proximal penile hypospadias (patients having urethral meatus at posterior third of penile shaft and at penoscrotal junction) were included in the present study. Patients were randomly allocated into 2 groups of 60 each by using Strata 9 software random number table. In group A, fibrin glue was used as a sealant after hypospadias surgery, whereas in group B, no sealant was used. All the operations were performed by single surgeon using transverse preputial tubularized island flap urethroplasty.

Result

Fistula formation occurred in 6 cases in group A (10%) and 19 cases in group B (32%) (P = .027). The fistulae observed in fibrin glue group A were single and small in size (<1 mm). Multiple (≥2 fistulae) and larger fistulae (>2 mm) were observed in group B. Overall complication was significantly higher in group B (P = .006).

Conclusion

Fibrin glue in hypospadias repair does not eliminate fistula formation. However, it seems that it minimizes the incidence of fistula formation.     

Snodgrass technique for hypospadias repair

ILLUSTRATIONS by STEPHAN SPITZER, http://www.spitzer‐illustration.com