负压闭式引流加内固定治疗肢体开放性骨折

目的　探讨负压闭式引流 (VS)加一期内固定治疗开放性肢体骨折伴软组织污损的效果。　方法2 0 0 0年 5月～ 2 0 0 2年 11月对 14例 (18个创面 )开放性肢体骨折并软组织广泛污损患者进行了治疗 ,面积 10 cm×15 cm～ 2 5 cm× 90 cm,无其他头、胸、腹合并伤。其中男 9例 ,女 5例。年龄 15～ 6 8岁。受伤至手术时间 :2～ 9小时 30分钟。创面中度污染 12个 ,重度以上污染 6个。手术彻底清创 ,骨折经钢板或交锁髓内钉内固定后 ,缺损创面用多聚乙烯醇 -明胶海绵高分子复合材料 (Vacuseal)覆盖封闭 ,术后接 5 0～ 6 0 k Pa的负压 ,5～ 7天后行植皮或皮瓣修复。另选伤情、创面大致相同 ,用传统换药二期内固定手术方法治疗的 14例患者作为对照组。　结果　 VS治疗组创面均完全愈合 ,无全身及局部并发症 ,随访 4～ 6个月骨折愈合良好。与对照组比较 ,治疗时间、住院总体费用及并发症发生率等均明显降低 ,差异有统计学意义 (P<0 .0 1)。　结论　VS使创面引流充分 ,降低感染发生率 ,刺激肉芽生长 ,配合一期内固定治疗开放性骨折伴软组织广泛污损创面是一种简便、有效、经济实用的方法。     

术中即时扩张术的临床应用

采用术中即时扩张的方式,为14例因烧伤瘢痕和色素痣切除术后皮肤软组织缺损进行直接缝合修复,取得了良好效果。对手术方法、适应证和注意事项进行了讨论。认为这是一种简便易行的方法。     

术中即时扩张术的临床应用

采用术中即时扩张的方式，为１４例因烧伤瘢痕和色素痣切除术后皮肤软组织缺损进行直接缝合修复，取得了良好效果。对手术方法、适应证和注意事项进行了讨论。认为这是一种简便易行的方法。     

四肢软组织缺损及感染创面的显微外科修复

为了总结应用显微外科技术修复四肢软组织缺损及感染创面的经验，对应用不同种类的皮瓣或肌皮瓣移位、移植修复的８３例患者进行了随访。结果表明，８３例皮瓣均成活；８２例切口Ⅰ期愈合，１例胫前溃疡骨外露，术后伤口轻度感染，经４周换药治愈。全部患者经６个月～４年随访，功能恢复满意。认为，四肢软组织缺损及时修复，皮瓣供区选择应就近避远，修复方法应就简避繁。正确处理创面，合理设计皮瓣，术后使用有效的抗生素等，有助于修复成功。     

四肢主干血管急性损伤的诊治

目的 对３０８例四肢主干血管急性损伤进行回顾分析。方法 本组共３０８例,其中开放性损伤１８１例,闭合性损伤１２７例。男２９９例,女９例。年龄最大６２岁,最小６岁,平均２４．５岁。对该种损伤患者尽早施行手术清创、探查。具体修复方法为：（１）单纯修补缝合受损的血管。（２）血管端端吻合术。（３）血管移植。结果 ３例因吻合口血栓形成发现较晚而截肢。１例因肢体血循环重建时间较长,术后出现骨筋膜室综合征肾功能     

应用瘢痕组织瓣修复单侧唇裂继发鼻畸形

目的：探讨上唇瘢痕组织瓣在单侧唇裂继发鼻畸形矫治术中的应用。方法：应用Millard术式原理，不切除上唇瘢痕，而是用以形成两型瘢痕组织瓣，用来矫治不同情况的鼻畸形。结果：1985年起应用本法共矫治单侧唇裂继发鼻畸形51例，皮瓣全部成活，效果良好。结论：本法增加了可供利用的组织量，适用于矫治可供利用的组织量不足时的单侧唇裂继发鼻畸形。     

Acute cholecystitis. Early diagnostic study using cholescintigraphy with Tc99m-IDA

34 patients admitted for suspected acute cholecystitis were evaluated using 99mTc IDA cholescintigraphy. The results of these studies are reviewed and compared with other diagnostic tests and the subsequent clinical diagnosis. Cholescintigraphy proved to be a safe, simple, highly accurate and sensitive technique. Therefore, 99mTc-IDA cholescintigraphy is proposed as the initial procedure of choice in the evaluation of patients with suspected acute cholecystitis.     

皮肤扩张术在整形外科的临床应用

对25例病人进行了皮肤软组织扩张术,扩张器容量为50～600ml。术后7～10天开始注水,注水总量超过扩张器容量的15%～20%,维持1～4周后行第二次手术,术中再即时扩张30分钟。除1例扩张器外露失败外,其余均获满意效果。讨论了手术注意事项。     

持续恒速皮肤扩张术在儿童瘢痕治疗中的应用

目的：研究用于儿童的持续恒速皮肤扩张方法及安全灌注速度。方法：对12例儿童皮肤瘢痕患者，用微型液体泵作恒速皮肤扩张。结果：利用微泵作恒速扩张中，注水速度设置为0.2-0.3mL/h/100mL，可使患者全程无痛，扩张器内压保持在30－50mmHg之间。12例儿童患者注水扩张时间为6－18天，住院时间18－37天，Ⅱ期手术修复效果满意。结论：持续恒速皮肤扩张法适合儿童皮肤瘢痕治疗，安全灌注速度为0.2-0.3mL/h/100mL。     

持续软组织扩张术护理及并发症控制

目的：探讨持续软组织扩张的护理技术。方法：选择78例患者做软组织扩张术，用4种灌注设备作注水（气）扩张，对手术后伤口，负压引流管，注水（气）过程和出现的并发症进行护理观察。结果：78例患者手术切口顺利愈合。4种持续扩张方法均能达到快速扩张效果，扩张时间8天－21天。有9个部位出现并发症，经对症护理全部得到控制，并发症发生率占总扩张部位的4．13％。结论：采用持续扩张法能减轻护理工作量，护理重点在手术切口观察，负压引流管和灌注设备的管理。     

Complete aortic root reimplantation facilitates preservation of the aortic valve.

The optimal technique for preservation of a retainable aortic valve is yet to be defined. We present a new facilitated procedure allowing for reimplantation of the complete aortic root in selected patients with acute type A aortic dissection or ascending aortic aneurysm.     

Subdural haematomas in the elderly: experience with treatment by trephine craniotomy and not closing the dura or replacing the bone plate.

A surgical technique was devised to treat chronic subdural haematomas (SDH) in elderly patients. Initial good results encouraged the author to use this technique in elderly patients with acute SDH. This small group is also reported. The goal was to do definitive, not expectant or incremental surgery on these fragile patients who have a high incidence of co-morbid conditions and cerebral atrophy, and to obliterate the subdural space by allowing the skin to sink into the cranial defect. The surgical technique consists of trephine craniotomy and not closing the dura or replacing the bone plate. Experience with six elderly patients with acute SDH and 23 patients with chronic SDH is reported. Of six patients with acute SDH, mean age 80 years, 2 months, three died, all with a Glasgow Coma Score (GCS) less than 9. Three recovered to preoperative status, one with initial GCS of 7 and the other of 8. Of 23 patients with chronic SDH, mean age 77 years, 21 recovered to preoperative status. The two deaths were in patients with GSC of 5 and 7. There were no recurrent SDH or postoperative surgical or cosmetic complications. All patients were followed for at least 6 months. These excellent results suggest that the procedure could be considered as a first procedure in the elderly patient. At first glance, the operation appears to be overly aggressive, but it is an example of 'aggressive-conservative' treatment which produces good long-term results with few complications and no need for second operations.     

Outpatient laparoscopic laser cholecystectomy

Laparoscopic laser cholecystectomy has been performed clinically in the United States since 1988. After refinement of the technique, the procedure was offered on an outpatient basis. Eighty-three patients underwent laparoscopic laser cholecystectomy during the study period. Thirty-seven (45%) had the procedure as an outpatient. Younger patients were more suited for the outpatient procedure and those without previous surgery were more likely to have the procedure done as an outpatient. Weight, operating time, and gallbladder pathology were similar, although patients with acute inflammation of the gallbladder were more likely to require hospitalization. The primary reason for patient admission was patient preference.     

内镜在左半结肠急性梗阻围手术期的应用

目的；探讨内镜技术在左半结肠急性梗阻围手术期应用。以减少一期切除吻合术并发症的可行性。方法：对1998年1月至2001年12月左半结肠急性梗阻在围手术期应用内镜技术治疗的20例病人资料进行回顾性总结。结果：20例病人成功18例（90%），其中13例肠道肿瘤行经内镜放置减压导管，球囊扩张肿瘤狭窄部。7例急性乙状结肠扭转行内镜减压复位，无肠穿孔和出血等并发症发生，成功的18例择期行一期切除吻合术，无吻合口漏发生，结论：左半结肠急性梗阻围手术期应用内镜技术安全可行，且能降低一期切除吻合术的风险。     

水凝胶与硅凝胶生物学性状评价

目的：比较国产聚丙烯酰胺水凝胶、硅凝胶植入香猪乳腺组织后与周围组织之间的关系,从而为临床应用提供理论指导。方法：定时采取植入物及周围组织标本行大体、病理、比重及高效液态色谱检查。结果：水凝胶、硅凝胶在注入香猪乳腺下2周后均出现包绕充填物的纤维组织,1月后稳定,水凝胶组纤维明显薄于硅凝胶组,在引起急、慢性炎症反应、异物刺激反应方面,水凝胶组优于硅凝胶组;1年中在各实验设计时段内,利用液相色谱法,在254nm波长,0．5μg／ml水平上均未检测出水凝胶在香猪体内有丙烯酰胺单体析出。结论：在生理条件下聚丙烯酰胺水凝胶及硅凝胶至少1年以内是稳定的。     

Aortic arch repair for Stanford type A aortic dissection with distal anastomosis to the proximal level of the distal aortic arch

BACKGROUND: In acute type A dissection, replacing the ascending aorta with the transverse aortic arch recently has been recommended for event-free long-term survival. Since 1994, we have performed our new transverse aortic arch replacement, in which the distal end of the graft is anastomosed between the left common carotid artery and the left subclavian artery to reduce the risk by obtaining a good surgical view, resulting in good hemostasis. The "elephant trunk technique" was used in anticipation of a staged descending aortic operation for residual dissecting aorta. We analyzed the surgical survival of patients with Stanford type A aortic dissection undergoing our operative procedure using hypothermic selective antegrade cerebral perfusion. METHODS: We performed our new technique in 27 patients (aged 61 +/- 11 years, 15 male and 12 female patients, 22 patients with acute type A dissection, and 5 patients with chronic dissection). RESULTS: One in-hospital death (3.7% in total: 4.5% in acute dissection, 0% in chronic dissection) occurred in patients undergoing our new technique. Actuarial survival (including early death) was 91% at 5 years after the operation. One late death occurred as the result of a malignant tumor. Four patients underwent a staged reoperation for aneurysmal dilatation of the residual descending aorta or renal and splenic embolism as the result of thrombus from the false lumen 2 to 11 months (mean interval 6 months) after the initial operation. They have been doing well since the reoperation. CONCLUSIONS: Our "distal anastomosis to the proximal level of the distal aortic arch" technique made aortic arch replacement easier and improved the survival of the arch replacement for aortic dissection, especially for acute type A dissection, by securing hemostasis in the suture line. Combining the elephant trunk technique with our new procedure is useful to perform a staged aortic replacement for dilatation and complication of the false lumen in the descending aorta.     

Breast Reconstruction and Tissue Expansion in Irradiated Versus not Irradiated Women After Mastectomy

Thirty-five women whose breast cancer had been treated by radiation and 111 in whom it had not underwent unilateral breast reconstruction with the tissue expansion technique after modified radical mastectomy. Their records were reviewed and in a questionnaire the patients reported their own opinion on the results. The two groups differed significantly, because those patients who had been irradiated had a more painful course of expansion and a less over-expansion. Their reconstructed breasts were harder, had more deformities, and they required significantly more capsulotomies. The irradiated group also reported less satisfaction with the cosmetic results and more unfulfilled expectations. Tissue expansion cannot therefore be recommended as a routine procedure for breast reconstruction in patients after irradiation. However, our results do not show whether other methods are better for these patients.     

微创技术在皮肤扩张器埋置术中的应用评价

目的：利用微创切口埋置扩张器进行皮肤扩张，控制皮肤切口裂开和扩张器外露并发症。方法：选用导管外置式扩张器和传统扩张器，在局部肿胀麻醉下经微创切口置入皮下间隙，注水导管全部外置，对213例皮肤扩张病例进行观察。结果：经病变内垂直小切口埋置扩张器均获成功，局部肿胀麻醉和术中注水扩张可控制出血，无一例患者接受输血。术后进行快速扩张顺利，总并发症发生率为7.4％。结论：经微创切口埋置扩张器损伤小，并发症少，适合快速皮肤扩张术。     

经胆总管刮取组织法诊断壶腹癌（附13例报告）

经胆总管刮取组织法诊断壶腹癌13例,11例刮取组织中腺癌9例,腺瘤伴高度不典型增生、原位癌1例,绒毛乳头状瘤样增生1例。2例疑壶腹癌者刮取未得组织。常规胆总管探查术中适时应用此法有助于诊断未经注意的壶腹癌。在疑壶腹癌病例中采用本法诊断时多能得到阳性结果,但对刮取未得组织者应改用其它方法明确诊断。刮取组织病检诊为腺癌或绒毛肿瘤时有可能遗漏隐藏的恶性病变,故仍应将其完全切除病检。     

¿Es segura y eficaz la colecistostomía percutánea en la colecistitis aguda? Análisis de los efectos adversos asociados a la técnica

IntroductionThe main objective of our study is to assess the safety and efficacy of percutaneous cholecystostomy for the treatment of acute cholecystitis, determining the incidence of adverse effects in patients undergoing this procedure.Material and methodObservational study with consecutive inclusion of all patients diagnosed with acute cholecystitis for 10 years. The main variable studied was morbidity (adverse effects) collected prospectively. Minimum one-year follow-up of patients undergoing percutaneous cholecystostomy.ResultsOf 1223 patients admitted for acute cholecystitis, 66 patients required percutaneous cholecystostomy. 21% of these have presented some adverse effect, with a total of 22 adverse effects. Only 5 of these effects, presented by 5 patients (7.6%), could have been attributed to the gallbladder drainage itself. The mortality associated with the technique is 1.5%. After cholecystostomy, one third of the patients (22 patients) have undergone cholecystectomy. Urgent surgery was performed due to failure of percutaneous treatment in 2 patients, and delayed in another 2 patients due to recurrence of the inflammatory process. The rest of the cholecystectomized patients underwent scheduled surgery, and the procedure could be performed laparoscopically in 16 patients (72.7%).ConclusionWe consider percutaneous cholecystostomy as a safe and effective technique because it is associated with a low incidence of morbidity and mortality, and it should be considered as a bridge or definitive alternative in those patients who do not receive urgent cholecystectomy after failure of conservative antibiotic treatment.