腹壁CT三维重建技术在切口疝诊治中的意义

目的:探讨CT三维重建技术在切口疝诊治中的意义。方法:回顾分析2009年11月至2010年7月,在我院治疗的10例切口疝病人,在CT加密平扫的基础上应用GE公司ADW4.2工作站进行三维重建;同时测量了腹壁缺损,计算体积,并进行统计分析。结果:10例病人均能根据三维图像,测量疝的直径(mm)、面积(mm2)和体积(cm3);3例病人测量了腹腔容积,腹腔容积与体质量指数的相关性分析指数为0.140。结论:CT三维重建技术能清晰显示切口疝的缺损,并能精确计算出体积;其经济花费是病人可接受的。其能补充许多普通CT无法提供的临床数值,是一项较好的检查方法。     

Extra-articular techniques in anterior cruciate ligament reconstruction: a literature review

This annotation considers the place of extra-articular reconstruction in the treatment of anterior cruciate ligament (ACL) deficiency. Extra-articular reconstruction has been employed over the last century to address ACL deficiency. However, the technique has not gained favour, primarily due to residual instability and the subsequent development of degenerative changes in the lateral compartment of the knee. Thus intra-articular reconstruction has become the technique of choice. However, intra-articular reconstruction does not restore normal knee kinematics. Some authors have recommended extra-articular reconstruction in conjunction with an intra-articular technique. The anatomy and biomechanics of the anterolateral structures of the knee remain largely undetermined. Further studies to establish the structure and function of the anterolateral structures may lead to more anatomical extra-articular reconstruction techniques that supplement intra-articular reconstruction. This might reduce residual pivot shift after an intra-articular reconstruction and thus improve the post-operative kinematics of the knee.     

Ischial pressure sore reconstruction using an inferior gluteal artery perforator (IGAP) flap.

Perforator-flap technique has revolutionised the practice of free tissue transfer with the goal of muscle sparing for function and strength. These concepts are being widely explored for breast reconstruction. The field of pressure-sore reconstruction presents a new application for this technique, preserving muscle for function in ambulatory patients and for future reconstruction in paraplegic patients. Just as the superior gluteal artery perforator flap holds promise for sacral and trochanteric reconstruction, the inferior gluteal artery perforator flap may provide a muscle-sparing alternative for ischial reconstruction. A case report of the successful use of an inferior gluteal artery perforator flap for ischial pressure-sore reconstruction is described, including the surgical technique employed for flap harvest, and 2 year's follow-up.     

腹腔镜胃肠手术中消化道重建方式的选择和技术难点

消化道重建是腹腔镜胃肠手术中的关键步骤．目前使用器械吻合多于手工吻合．但相比传统手术尚无明显优势。腹腔镜远端胃大部切除常用的消化道重建方法有胃十二指肠吻合（毕Ⅰ式）、胃空肠Roux-en-Y吻合和胃空肠吻合（毕Ⅱ式）;腹腔镜全胃切除术的重建术式很多．但目前认为最合理且成熟的方法首推无储袋的食管空肠Roux-en-Y吻合．而采用经口底钉座置入装置（OrVilTM）进行吻合更容易掌握,并能进行更高位置的吻合;腹腔镜近端胃大部切除的重建方法主要是胃食管吻合。腹腔镜直肠手术的消化道重建。特别是低位、超低位直肠癌根治术的消化道重建目前较理想的是吻合器结肠直肠吻合和手工缝合的结肠肛管吻合：绝大多数结肠手术后的肠道重建均通过取标本的辅助小切口拖出体外进行。期待更新的理念与器械的出现．以进一步简化消化道重建的手术步骤．使之更趋快捷、安全和有效。     

Anatomic posterior cruciate ligament reconstruction with allograft

This article describes the anatomic posterior cruciate ligament reconstruction technique. This technique combines the double bundle technique with the tibial inlay technique in a single reconstruction using an Achilles' tendon allograft. Key technique points are described including patient positioning, graft preparation, surgical approach, and graft fixation. Immediate postoperative care and results from the author's practice are also discussed.     

Medial collateral ligament reconstruction with allograft using a double-bundle technique

Medial collateral ligament (MCL) reconstruction has been a topic of controversy in regard to the need for surgical reconstruction as well as the type of surgical reconstruction to be performed. Combined anterior cruciate ligament (ACL) and MCL reconstruction has been found to be associated with a higher incidence of postoperative arthrofibrosis than isolated ACL reconstruction; performing these reconstructions in a staged format has been proposed to avoid this devastating complication. We present a technique for MCL reconstruction that physiometrically re-establishes both anterior and posterior stabilizing components of the MCL and is performed with a limited soft-tissue dissection. This technique can easily be combined with an ACL allograft or hamstring reconstruction without need for staged or significantly delayed procedure. The technical details of this technique allow for stable fixation of an allograft reconstruction to allow for immediate postoperative knee range of motion with low patient morbidity because of the limited surgical approach.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 4 (April), 2002: E19     

腹腔镜胃肠手术消化道重建方式的探讨

腹腔镜下消化道重建是腹腔镜胃肠手术的重点和难点.近年来,随着腹腔镜吻合技术的进步,腹腔镜胃肠手术消化道重建方式不断完善更新,最终将形成有别于传统开放手术的技术体系.本文就目前腹腔镜胃肠术后消化道重建的现状和发展趋势做一总结.同时,结合笔者的经验,重点就腹腔镜胃癌术后反式抵钉座置入术、腹腔镜直肠癌术后超低位保肛技术、原位肛门重建技术逐一介绍和分析.     

改良Langenbeck、Limberg手术及提肌吊带成形术联合治疗单侧完全性腭裂

目的探讨利用改良Langenbeck手术联合Limberg手术及提肌吊带成形术来治疗单侧完全性腭裂的临床治疗效果。方法本组共58例,均为单侧完全性腭裂,应用3种手术联合修复,包括改良Langenbeck手术、Limberg手术、提肌吊带成形术。术后随访3个月到4年,观察腭部创口愈合及腭咽闭合情况。结果随访50例患者中无1例发生腭瘘,术后腭咽闭合情况佳。结论3种手术联合修复治疗单侧完全性腭裂简单易行、远期效果佳,是一种临床上值得推广的方法。     

Reconstruction of the biliary tract

The history of biliary reconstruction is a record of almost 100 years of surgical advancement. A reasonable technique is now available and applies not only to reconstruction after injury in the course of cholecystectomy but also to reconstruction after resection of tumor or in the treatment of sclerosing cholangitis, choledochocyst, or biliary calculi. A successful technique requires a dissection that does not compromise blood supply to the proximal duct, the use of a single layer of interrupted sutures, the temporary placement of a stent, and the use of bowel at the hilus of the liver without tension. As in most operative procedures the actual performance of the reconstruction is relatively easy in slender, good surgical subjects, but operative decisions and the actual technique used in locating the proximal duct and in suturing deep in the right upper quadrant can make reconstruction a difficult procedure.     

Tibial inlay technique with quadriceps tendon-bone autograft for posterior cruciate ligament reconstruction

Surgical reconstruction of the posterior cruciate ligament (PCL) is indicated in a PCL-deficient knee with symptomatic instability and injury to other ligaments. However, the choice of graft tissues remains controversial. The tibial inlay method has the benefit of preventing the acute turn associated with transtibial reconstruction and permitting accurate anatomic placement of the graft. This study describes an arthroscopic-assisted inlay technique for PCL reconstruction using quadriceps tendon-patellar bone autograft. This technique is a reasonable alternative for PCL reconstruction.     

Immediate nipple reconstruction in combination with implant reconstruction using dermal sling

The inferior de‐epithelialized dermal flap with implant is increasingly used for immediate breast reconstruction. We have adapted the technique to provide concurrent immediate nipple reconstruction by recruiting the triangle of skin above the excised nipple as a modified C‐V flap. The safety and efficacy of this technique has been assessed in 15 patients, of which eight were bilateral and seven were unilateral cases. We suggest that this is a safe, reliable, and original technique for immediate nipple reconstruction in patients undergoing immediate breast reconstruction with an inferior dermal sling and implant.     

Computer-assisted prostate reconstruction

The authors report a technique of computer assisted three-dimensional reconstruction using the information obtained from serial sections collected on a digitalizing table. This reconstruction was performed with a popular personal computer: Macintosh. This technique was applied to the reconstruction of the animal prostate.     

分体重建技术在颅面部肿瘤切除一期重建手术中的应用

目的介绍以分体三维重建为基础,综合运用数字化外科学技术方法进行颅面部肿瘤切除一期重建的手术模拟的方法。方法利用螺旋CT扫描数据,通过分体三维重建技术对肿瘤组织与正常颅骨分别进行重建;并在该数字模型上进行肿瘤切除手术模拟;根据切除后的数字模型进行重建手术模拟,设计修补体;通过快速成型技术制作切除模板,塑型模板,个性化修补体等信使工具,保证真实手术与模拟手术的吻合性。结果应用此方法进行手术规划的4例患者真实手术与模拟手术具有较高的吻合度,节省了手术时间,术后效果满意。结论以分体重建为基础的数字化手术模拟对于肿瘤切除一期重建具有重大的临床指导意义。     

Arthroscopic reconstruction for acromioclavicular joint dislocation

We describe an arthroscopic reconstruction technique for acromioclavicular joint dislocation. Subsequent to Baum’s first repair of the coracoclavicular complex in 1886, over 60 operative procedures have been described in the literature. This procedure is the first described arthroscopic approach used in reconstruction for acromioclavicular dislocation. It provides an anatomically correct and structurally sound reconstruction of the coracoclavicular ligament complex. This arthroscopic technique is also a cosmetically pleasing alternative to previously described open procedures for reconstruction of acromioclavicular joint dislocations. As with most arthroscopic procedures, this technique achieves its goals with minimal morbidity and violation of the surrounding soft tissues.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 5 (May-June), 2001: pp 558–563     

Reconstruction of the Labiomental Region With Local Flaps

BACKGROUND: Reconstruction of the labiomental area presents certain difficulties, especially in the assessment and selection of the incision lines to obtain the best cosmetic result. Among the factors influencing the selection of a reconstruction technique are the presence of natural folds and creases, skin laxity, and the size, shape, and orientation of the wound. Many operative techniques have been described for the reconstruction of this region. OBJECTIVE: To describe a combination of reconstruction techniques which restore the form, preserve sensation, and provide function of the labiomental region after ablative surgery. METHODS: We present two patients with reconstruction of the labiomental area where it was possible to preserve the vermilion of the lower lip after wide excision. The method of reconstruction constitutes a of modification of the Bernard method and Schuchardt procedure. RESULTS: Satisfactory results were obtained with preservation of the sensitivity of the lower lip, competent lip seal, and avoidance of microstomia, in addition to a good aesthetic appearance. CONCLUSION: The described technique is a preferable technique in patients for whom vermilion of the lower lip should be preserved after wide excision. The technique restores the form, preserves sensation, and provides function-the principles of a successful reconstruction.     

Breast reconstruction after mastectomy for breast cancer: which reconstructive surgical procedure should be retained?

Post-mastectomy breast reconstruction represents a surgical option that may improve psychosocial outcome without modifying patients' survival. Psychosocial impact of used surgical technique and moment of realization of breast reconstruction remains unclear. However, complications are negatively related to patients' satisfaction. There is no guideline for BR indications. Therefore, a review of clinical and cosmetic outcomes of different breast reconstruction modalities was necessary. It permitted to propose a shared decision-making algorithm for the choice of moment and technique of BR according to the presence of radiotherapy that appears to be the main risk factor of clinical outcome of breast reconstruction. It also disclosed some limits in information reliability about clinical outcome of particular associations of breast reconstruction and radiotherapy. Proportion of women pursuing breast reconstruction, and particularly immediate breast reconstruction, is rising. Clinical surveys assessing relation between radiotherapy and clinical and psychosocial outcome of breast reconstruction are urgently expected.     

The suspension technique to avoid the use of tissue expanders in breast reconstruction

BACKGROUND: Immediate or delayed breast reconstruction is usually performed using expansion techniques or pedicled or free flaps. The suspension technique hereby described can reduce the number of surgical stages, as well as donor-site sequelae. TECHNIQUE: The authors describe a new technique of breast reconstruction with implants using a nonabsorbable mesh to create a superior abdominal cutaneous flap, which contributes to the skin envelope of the reconstructed breast. The advantage of this technique is the opportunity to use immediately a definitive prosthesis also in cases requiring a mastectomy with the resection of a large amount of skin, consequently reducing the indications of tissue expanders or myocutaneous flaps. RESULTS: We performed the "suspension technique" in 67 cases of immediate reconstruction and in 6 cases of delayed reconstruction. No further surgery under general anesthesia was necessary in 56 patients (76.7%). In 14 cases (19.2%), a second operation under general anesthesia was necessary for implant replacement, capsula revision, and nipple and areola (NAC) reconstruction. In 3 cases (4.1%), implant removal was necessary due to implant exposition or infection. In 33 patients, only NAC reconstruction was performed under local anesthesia. In our series, capsula contracture was graded as Baker I in 24 cases, grade II in 16 cases, grade III in 9 cases, and grade IV in 1 case. Breast symmetry, patient's satisfaction, and surgeon cosmetic evaluation were respectively scored 7.56, 7.75, and 7.60 (range from 1 to 10). CONCLUSION: In conclusion, this technique can be applied in cases requiring a large skin resection at the time of mastectomy and refusing a reconstruction with myocutaneous flaps or a second surgery, necessary if a reconstruction with tissue expanders is planned.     

Allograft reconstruction of the patellar tendon: 12-year follow-up

We present 12-year follow-up results of a bone-tendon-bone allograft reconstruction technique for a defect of the patellar tendon. Of the reports in the literature, this is the longest follow-up of a reconstruction technique used in the trauma setting and involving complete loss of the patella tendon. This method of reconstruction, using the native patella remnant in conjunction with allograft patella tendon, provides the surgeon with an additional option for this difficult case.     

乳腺癌术后乳房重建时机及术式选择

结合整形外科的理念和手段，在保证肿瘤安全性的前提下对乳腺癌病人进行乳房重建修复，成为乳腺外科领域重要的发展方向。乳房重建可以与全乳切除或部分乳房切除术同时进行，也可以延迟至完成辅助治疗后的适当时间进行，前者称为即刻乳房重建，后者称为延期乳房重建。临床上根据病人的疾病情况和自身的需求来确定重建时机。部分病人采用延迟-即刻乳房重建来降低辅助放疗给重建带来的不利影响，减少术后严重并发症的发生。从重建的技术手段来看，乳房重建有自体皮瓣乳房重建、假体乳房重建以及自体联合假体的乳房重建。植入物重建是即刻乳房重建中最常用的术式。在延期乳房重建中，更常采用自体皮瓣乳房重建或两步法的植入物重建术。     

Immediate earlobe reconstruction with double-crossed skin flaps.

A new technique for earlobe reconstruction is described, illustrated by a case report. This technique uses double-crossed skin flaps from the pre-auricular and retromandibular areas. No skin grafts and no cartilage framework are needed. This technique is particularly indicated for immediate earlobe reconstruction.