Altemeier手术在嵌顿性直肠脱垂急诊处理中的应用

Objective To evaluate the perineal rectosigmoidectomy(Altemeier procedure) in the emergent management of acute incarcerated rectal prolapse. Methods Clinical and follow-up data of 9 patients with acute incarcerated rectal prolapse undergone Altemeier procedure were retrospectively analyzed. Results The mean operation time was 1.7 (range 1.0-1.5) hours. The mean total blood loss during surgery was 109 (50-200) ml. The mean time to the first bowel movements was 2.8(1-6) days after surgery. The hospital stay was 5.3 (3-10) days. There were no postoperative complications such as anastomotic leakage, intra-abdominal infection, or urogenital dysfunction. One patient developed thrombosis in the mesorectum and one patient had symptoms of anal discomfort. After a mean follow-up of 3.5 (5 months-6.5 years) years, no patient had recurrent prolapse. Six months after operation, anal function was Kirwan grade Ⅰ in 8 cases and grade Ⅱ in 1 case. All the patients were satisfied with the result. Conclusion Altemeier procedure can result in good postoperative anal function when treating incarcerated rectal prolapse, which shonld be the first choice in emergency treatment.     

腹腔镜辅助改良Soave术治疗成人先天性巨结肠症

Objective To evaluate the clinical value of laparoscopy-assisted modified Soave procedure for Hirschsprung disease in adults.Methods Twenty-eight patients with a preoperative diagnosis of Hirschsprung disease underwent laparoscopy-assisted modified Soave procedure between March 2005 and December 2009.Clinical data were retrospectively analyzed.Results There were no conversions to open surgery.The mean operative time was (165±12) minutes (range:135-185 minutes).Estimated blood loss ranged from 50 to 250 ml,and no patients required intraoperative blood transfusion.Postoperative pathologic examination showed Hirschsprung diseases in 19 patients and Hirschsprung allied diseases in 9.Only two patients developed rectal cuff infection and three mild seepage.Other patients had no postoperative complications.The mean hospital stay was (17.5±1.0)days.No fecal incontinence or recurrent constipation occurred during follow-up.Conclusion Laparoscopyassisted modified Soave procedure is safe and effective for Hirschsprung disease.     

腹腔镜下扩大性膀胱部分切除联合盆腔淋巴结清扫术治疗脐尿管癌

Objective To discuss the techniques and clinical efficacy of laparoscopic partial cystectomy with bilateral pelvic lymphadenectomy for urachal adenocarcinoma. Methods From July 2006 to April 2008, 4 patients with urachal adenocarcinoma were managed by the laparoscopic procedure. Three patients were male, the other one was female, with a median age of 51 (range 42 to 66)years. The mean size of tumors was 3.4(rang 1.9 to 5.4)cm in diameter. Three of them were diagnosed as mucinous adenocarcinoma, the other one was adenocarcinoma. There was 1 patient at stage Ⅱ , and the other three as stage Ⅲ according to Sheldon Stage. Four patients were performed by transperitoneal approach. The boundaries of resection were similar to the open surgery, including resection of the tumor with normal margins, the peritoneum lateral to the two medial unbilical ligaments,the posterior sheath of the rectus muscle and the muscle fibers of the rectus muscle below it, and bilateral pelvic lymphanodes. Results The procedure was successfully in all 4 patients, with a mean operative time of 220(range 150 to 350)min, a mean estimated blood loss of 180 (range 120 to 290)ml.No significant intraoperative or postoperative complications occurred, except for an inferior epigastric artery injury in 1 case. The mean postoperative in-dwelling urinary catheter time was 6 (range 5 to 7)d, and the mean postoperative hospital stay was 6 (range 5 to 8)d. All 36 resected lymph nodes (range 8 to 11) were negative. At a median follow-up of 25(range 15 to 36) months, there was no evidence of recurrent disease by radiologic or cystoscopic evaluation. Conclusion Laparoscopic partial cystectomy and bilateral extended pelvic lymphadenectomy in selected patients with urachal tumors could be a safe, feasible, minimally invasive procedure.     

腹腔镜下扩大性膀胱部分切除联合盆腔淋巴结清扫术治疗脐尿管癌

Objective To discuss the techniques and clinical efficacy of laparoscopic partial cystectomy with bilateral pelvic lymphadenectomy for urachal adenocarcinoma. Methods From July 2006 to April 2008, 4 patients with urachal adenocarcinoma were managed by the laparoscopic procedure. Three patients were male, the other one was female, with a median age of 51 (range 42 to 66)years. The mean size of tumors was 3.4(rang 1.9 to 5.4)cm in diameter. Three of them were diagnosed as mucinous adenocarcinoma, the other one was adenocarcinoma. There was 1 patient at stage Ⅱ , and the other three as stage Ⅲ according to Sheldon Stage. Four patients were performed by transperitoneal approach. The boundaries of resection were similar to the open surgery, including resection of the tumor with normal margins, the peritoneum lateral to the two medial unbilical ligaments,the posterior sheath of the rectus muscle and the muscle fibers of the rectus muscle below it, and bilateral pelvic lymphanodes. Results The procedure was successfully in all 4 patients, with a mean operative time of 220(range 150 to 350)min, a mean estimated blood loss of 180 (range 120 to 290)ml.No significant intraoperative or postoperative complications occurred, except for an inferior epigastric artery injury in 1 case. The mean postoperative in-dwelling urinary catheter time was 6 (range 5 to 7)d, and the mean postoperative hospital stay was 6 (range 5 to 8)d. All 36 resected lymph nodes (range 8 to 11) were negative. At a median follow-up of 25(range 15 to 36) months, there was no evidence of recurrent disease by radiologic or cystoscopic evaluation. Conclusion Laparoscopic partial cystectomy and bilateral extended pelvic lymphadenectomy in selected patients with urachal tumors could be a safe, feasible, minimally invasive procedure.     

改良腱索转移法治疗二尖瓣前叶脱垂(附16例临床分析)

Objective To introduce an operative technique for prolapse of the anterior leaflet of mitral valve. Methods From January 2002 through May 2005, chordal transfer and "edge-to-edge" technique was performed in 16 cases with serious mitral valve re- gurgitation due to prolapse of the anterior leaflet. The etiology was chordal rupture in 12 cases and chordtal elongation in 4. The mean regurgitation area yam (14.76±3.28) cn2. Left ventricular ejection fraction (LVEF) was 33% - 69% before operation. Among those patients, 5 were in NYHA function class Ⅲ and 11 in class Ⅳ. Operations were performed under general anesthesia and car- diopulmonary bypass. First, "edge to edge" technique was performed. The free edge of the prolapsed anterior leaflet was sutyred to corresponding posterior leaflet. Then quadrangular resection was performed to transfer segment of posterior leaflet with its attached chordae. At last, the posterior leaflet was approximated after quadrangular resetion. Echocardiography was performed in each patient before discharge and at the times of follow-up. Results All patients survived the operation. One patient nequired mitral valve re- placement due to anterior leaflet perforation 3 days after the operatiom. The rest were free from reoperation. At the time d follow-up, all these patients were in NYHA functional class Ⅰ. Echocardiography showed neither stenosis nor significant regurgitation of the mitral valve. The cross-sectional area of the mitral valve was 3.3 -4.8 cm2[mean(3.78±0.52)cm2]. The mean regurgitation area was (0.45±0.22) cm2. Both dimension of left atrium and left vantricule reduced significantly. The diameter of left atrium was (48.26± 11.12) mm pre-operation vs. (37.57±9.56) mm post-operation (P=0.028). The ead-diastolic diameter of the left ventricule was (61.43±8.24)mm pre-operation vs (42.35±10.79) mm post-operation (P = 0.008). Conctusion Chordal transfer and "edge- to-edge" technique provides good results for repair of anterior leaflet prolapse of mitral valve.     

改良腱索转移法治疗二尖瓣前叶脱垂(附16例临床分析)

Objective To introduce an operative technique for prolapse of the anterior leaflet of mitral valve. Methods From January 2002 through May 2005, chordal transfer and "edge-to-edge" technique was performed in 16 cases with serious mitral valve re- gurgitation due to prolapse of the anterior leaflet. The etiology was chordal rupture in 12 cases and chordtal elongation in 4. The mean regurgitation area yam (14.76±3.28) cn2. Left ventricular ejection fraction (LVEF) was 33% - 69% before operation. Among those patients, 5 were in NYHA function class Ⅲ and 11 in class Ⅳ. Operations were performed under general anesthesia and car- diopulmonary bypass. First, "edge to edge" technique was performed. The free edge of the prolapsed anterior leaflet was sutyred to corresponding posterior leaflet. Then quadrangular resection was performed to transfer segment of posterior leaflet with its attached chordae. At last, the posterior leaflet was approximated after quadrangular resetion. Echocardiography was performed in each patient before discharge and at the times of follow-up. Results All patients survived the operation. One patient nequired mitral valve re- placement due to anterior leaflet perforation 3 days after the operatiom. The rest were free from reoperation. At the time d follow-up, all these patients were in NYHA functional class Ⅰ. Echocardiography showed neither stenosis nor significant regurgitation of the mitral valve. The cross-sectional area of the mitral valve was 3.3 -4.8 cm2[mean(3.78±0.52)cm2]. The mean regurgitation area was (0.45±0.22) cm2. Both dimension of left atrium and left vantricule reduced significantly. The diameter of left atrium was (48.26± 11.12) mm pre-operation vs. (37.57±9.56) mm post-operation (P=0.028). The ead-diastolic diameter of the left ventricule was (61.43±8.24)mm pre-operation vs (42.35±10.79) mm post-operation (P = 0.008). Conctusion Chordal transfer and "edge- to-edge" technique provides good results for repair of anterior leaflet prolapse of mitral valve.     

全麻下血管化游离皮瓣修复术后患者谵妄的危险因素

Objective To investigate the risk factors for postoperative delirium in patients after vascular free flap reconstruction performed under general anesthesia.Methods Two hundred and sixteen ASA Ⅰ-Ⅲ patients aged 18-80 yr undergoing vascular free flap reconstruction surgery were enrolled in this study.Patient characteristics before and during operation were recorded.The patients were followed up for 5 days after operation.Their level of consciousness,severity of pain and sleep quality were evaluated daily.The patients were divided into 2 groups according to the occurrence of delirium during the 5 days after operation:delirium group and non-delirium group.The method of CAM-ICU was reed in the diagnosis of postoperative delirium.Multivariate logistic regression was used to analyze the risk factors for postoperative delirium.Results logistic regression analysis showed that old age,history of alcohol abuse and sleep diacrder after operation were risk factors for delirium developed after free flap surgery.Conclusion Old age,history of alcohol abuse and sleep disorder after operation were the risk factors for postoperative delirium in patients after vascular free flap reconstruction performed under general anesthesia.     

改良腱索转移法治疗二尖瓣前叶脱垂(附16例临床分析)

Objective To introduce an operative technique for prolapse of the anterior leaflet of mitral valve. Methods From January 2002 through May 2005, chordal transfer and "edge-to-edge" technique was performed in 16 cases with serious mitral valve re- gurgitation due to prolapse of the anterior leaflet. The etiology was chordal rupture in 12 cases and chordtal elongation in 4. The mean regurgitation area yam (14.76±3.28) cn2. Left ventricular ejection fraction (LVEF) was 33% - 69% before operation. Among those patients, 5 were in NYHA function class Ⅲ and 11 in class Ⅳ. Operations were performed under general anesthesia and car- diopulmonary bypass. First, "edge to edge" technique was performed. The free edge of the prolapsed anterior leaflet was sutyred to corresponding posterior leaflet. Then quadrangular resection was performed to transfer segment of posterior leaflet with its attached chordae. At last, the posterior leaflet was approximated after quadrangular resetion. Echocardiography was performed in each patient before discharge and at the times of follow-up. Results All patients survived the operation. One patient nequired mitral valve re- placement due to anterior leaflet perforation 3 days after the operatiom. The rest were free from reoperation. At the time d follow-up, all these patients were in NYHA functional class Ⅰ. Echocardiography showed neither stenosis nor significant regurgitation of the mitral valve. The cross-sectional area of the mitral valve was 3.3 -4.8 cm2[mean(3.78±0.52)cm2]. The mean regurgitation area was (0.45±0.22) cm2. Both dimension of left atrium and left vantricule reduced significantly. The diameter of left atrium was (48.26± 11.12) mm pre-operation vs. (37.57±9.56) mm post-operation (P=0.028). The ead-diastolic diameter of the left ventricule was (61.43±8.24)mm pre-operation vs (42.35±10.79) mm post-operation (P = 0.008). Conctusion Chordal transfer and "edge- to-edge" technique provides good results for repair of anterior leaflet prolapse of mitral valve.     

改良腱索转移法治疗二尖瓣前叶脱垂(附16例临床分析)

Objective To introduce an operative technique for prolapse of the anterior leaflet of mitral valve. Methods From January 2002 through May 2005, chordal transfer and "edge-to-edge" technique was performed in 16 cases with serious mitral valve re- gurgitation due to prolapse of the anterior leaflet. The etiology was chordal rupture in 12 cases and chordtal elongation in 4. The mean regurgitation area yam (14.76±3.28) cn2. Left ventricular ejection fraction (LVEF) was 33% - 69% before operation. Among those patients, 5 were in NYHA function class Ⅲ and 11 in class Ⅳ. Operations were performed under general anesthesia and car- diopulmonary bypass. First, "edge to edge" technique was performed. The free edge of the prolapsed anterior leaflet was sutyred to corresponding posterior leaflet. Then quadrangular resection was performed to transfer segment of posterior leaflet with its attached chordae. At last, the posterior leaflet was approximated after quadrangular resetion. Echocardiography was performed in each patient before discharge and at the times of follow-up. Results All patients survived the operation. One patient nequired mitral valve re- placement due to anterior leaflet perforation 3 days after the operatiom. The rest were free from reoperation. At the time d follow-up, all these patients were in NYHA functional class Ⅰ. Echocardiography showed neither stenosis nor significant regurgitation of the mitral valve. The cross-sectional area of the mitral valve was 3.3 -4.8 cm2[mean(3.78±0.52)cm2]. The mean regurgitation area was (0.45±0.22) cm2. Both dimension of left atrium and left vantricule reduced significantly. The diameter of left atrium was (48.26± 11.12) mm pre-operation vs. (37.57±9.56) mm post-operation (P=0.028). The ead-diastolic diameter of the left ventricule was (61.43±8.24)mm pre-operation vs (42.35±10.79) mm post-operation (P = 0.008). Conctusion Chordal transfer and "edge- to-edge" technique provides good results for repair of anterior leaflet prolapse of mitral valve.     

改良腱索转移法治疗二尖瓣前叶脱垂(附16例临床分析)

Objective To introduce an operative technique for prolapse of the anterior leaflet of mitral valve. Methods From January 2002 through May 2005, chordal transfer and "edge-to-edge" technique was performed in 16 cases with serious mitral valve re- gurgitation due to prolapse of the anterior leaflet. The etiology was chordal rupture in 12 cases and chordtal elongation in 4. The mean regurgitation area yam (14.76±3.28) cn2. Left ventricular ejection fraction (LVEF) was 33% - 69% before operation. Among those patients, 5 were in NYHA function class Ⅲ and 11 in class Ⅳ. Operations were performed under general anesthesia and car- diopulmonary bypass. First, "edge to edge" technique was performed. The free edge of the prolapsed anterior leaflet was sutyred to corresponding posterior leaflet. Then quadrangular resection was performed to transfer segment of posterior leaflet with its attached chordae. At last, the posterior leaflet was approximated after quadrangular resetion. Echocardiography was performed in each patient before discharge and at the times of follow-up. Results All patients survived the operation. One patient nequired mitral valve re- placement due to anterior leaflet perforation 3 days after the operatiom. The rest were free from reoperation. At the time d follow-up, all these patients were in NYHA functional class Ⅰ. Echocardiography showed neither stenosis nor significant regurgitation of the mitral valve. The cross-sectional area of the mitral valve was 3.3 -4.8 cm2[mean(3.78±0.52)cm2]. The mean regurgitation area was (0.45±0.22) cm2. Both dimension of left atrium and left vantricule reduced significantly. The diameter of left atrium was (48.26± 11.12) mm pre-operation vs. (37.57±9.56) mm post-operation (P=0.028). The ead-diastolic diameter of the left ventricule was (61.43±8.24)mm pre-operation vs (42.35±10.79) mm post-operation (P = 0.008). Conctusion Chordal transfer and "edge- to-edge" technique provides good results for repair of anterior leaflet prolapse of mitral valve.     

Faculty of Anaesthetists of the Royal College of Surgeons of Ireland

The Faculty of Anaesthetists of the Royal College of Surgeons of England, 35–43 Lincoln's Inn Fields, London WC2A 3PN. Telephone: 01-405 3474.     

深圳市某两所小学流行性腮腺炎突发疫情的流行病学分析

目的：通过对深圳市某两所小学发生的流行性腮腺炎突发疫情的流行病学特点及差异性进行分析,为制定科学、高效的防控策略提供科学依据。方法2013年5～7月深圳市大鹏新区某两所小学爆发流行性腮腺炎,以学校为整体研究对象,分别标记为学校A（24个班,学生1210例）和学校B（27个班,学生1274例）,对比两所小学的疫情流行病学差异性。结果分析发现,学校A流行性腮腺炎发病率为4.30%,发病班级所占比54.17%,均较学校B1.73%和29.63%高,对比差异有统计学意义（P＜0.05）;分析显示学校A学生出现疫病平均年龄为（11.2±1.1）岁,较学校B（9.34±1.0）岁,对比差异明显（P＜0.05）;且两组疫病患儿在接种疫苗率对比上差异无统计学意义（P＞0.05）;但疫情发生时,学校B疫苗紧急接种率明显高于学校A,对比差异有统计学意义（P＜0.05）。结论小学作为流行性腮腺炎爆发的主要场所之一,疫病爆发高峰季节前,针对易感染人群给予相应的疫苗接种等预防控制措施,同时加强流行性腮腺炎的监测,对于降低感染人群数量,减轻、遏制疫情有着积极的意义,值得相关防控部门重视。