V-Y推进皮瓣联合其他皮瓣修复拇指末节损伤

[目的]探讨V-Y推进皮瓣联合指背动脉逆行岛状皮瓣瓦合修复拇指末节离断伤或脱套伤的临床疗效。[方法]回顾性分析2017年3月—2019年8月收治的无再植条件的拇指末节离断伤或脱套伤23例患者的临床资料。10例为无再植条件的拇指末节离断伤,13例为末节脱套伤。分别采用V-Y推进皮瓣与指背动脉逆行岛状皮瓣修复伤指掌、背侧创面。2块皮瓣供区直接缝合。[结果]46块皮瓣全部成活,V-Y推进皮瓣面积为1.8 cm×0.6 cm～2.5 cm×1.8 cm,指背动脉逆行岛状皮瓣面积为2.2 cm×1.5 cm～3.0 cm×2.6 cm。随访时间8～18个月,平均（12.30±2.46）个月。拇指末节外观良好,指端无疼痛、耐寒;背侧供区仅残留线性瘢痕。皮瓣静态两点辨别觉：V-Y推进皮瓣为4～7 mm,指背动脉逆行岛状皮瓣为5～9 mm。伤指总活动度与健侧拇指比较差异无统计学意义。手部外观评定：15例非常满意,8例满意。[结论] V-Y推进皮瓣联合指背动脉逆行岛状皮瓣修复拇指末节离断伤或脱套伤,操作简便,供区损伤小,临床疗效满意。     

不牺牲足趾的修饰性第2足趾趾甲瓣再造手指末节

目的:探讨应用第2足趾趾甲瓣修复手指末节脱套伤同时保留第2足趾全长的手术方法和效果。方法:2018年4月-2020年6月,共收治手指末节脱套伤16例,其中男11例,女5例;年龄18~45岁,平均29岁;均为手指末节脱套伤,其中示指5例,中指7例,环指3例,小指1例;受伤至手术时间0.5~3.0 h,平均1.5 h。应用...     

29例末节撕脱性断指的再植

本院自2004年至今，共收治29例末节撕脱性离断伤，经再植成活28例，功能满意，报道如下。     

邻指逆行指动脉皮瓣修复手指末节皮肤脱套伤

手指末节皮肤脱套伤目前尚无十分理想的修复方法。 1995年～ 2 0 0 0年我们应用邻指逆行指动脉皮瓣修复 11例 ,效果较好 ,报告如下。1　临床资料本组男 9例 ,女 2例 ,年龄 17～ 4 5岁。均为机器致伤手指末节皮肤、软组织套状撕脱、指骨及肌腱外露。其中食指 4例 ,中指 2例 ,环指 3例 ,小指 2例。均于伤后 5小时内手术。手术方法 :食、环指末节皮肤脱套伤分别采用中指桡、尺侧逆行指动脉皮瓣修复 ;中、小指末节皮肤脱套伤分别采用环指桡、尺侧逆行指动脉皮瓣修复。按伤指皮肤、软组织缺损的大小 ,沿供指中节侧方向背侧及掌侧设计皮瓣 ,皮瓣呈…     

同侧手掌皮下埋藏法手术治疗第2～5指末节离断伤的远期疗效观察

目的探讨同侧手掌皮下埋藏法手术治疗第2～5指末节离断伤的远期临床疗效。方法回顾性分析自2008-08—2010-10采用同侧手掌皮下埋藏法手术治疗的15例(19指)无血管吻合条件的末节手指完全离断伤。术中均行神经吻合术。术后3周取出埋藏手指,凡士林敷料包扎,定期伤口换药。结果末节断指均顺利成活,10指第2次手术后2周完全表皮化,7指术后3周完全表皮化,2指术后4周创面完全愈合。断指远端较健侧略细,外形饱满,颜色红润,指甲平整、光滑。15例均获得随访,随访时间平均8(5～10)年。末次随访时参照中华医学会手外科学会上肢部分功能评定试用标准评价伤指关节活动度:优14指,良5指。19指离断平面以远皮肤感觉均达S3以上,6例伤指静态两点辨别觉达4～15 mm。患者均对伤指外观表示满意。结论采用同侧手掌皮下埋藏法手术治疗无再植条件末节手指离断伤具有操作简单、并发症少、伤指外形美观、功能恢复好等优点,术中可修复指神经,经过长期随访观察后疗效满意。     

皮下包埋法治疗末节离断伤

2001年8月至2002年10月，我们应用皮下包埋法治疗末节离断伤15例16指，断指全部存活，并获得较好的外观和功能。     

手指末节多段断指再植

我院于2000年6月～2002年2月共收治手指末节多段离断病人5例，即病人手指末节离断，离体末节断为两段的损伤，均实行再植手术，完全存活，报道如下。１资料与方法１．１临床资料本组5例7指，男4例，女1例；年龄17～34岁。按Ya-mano末节断指分区：Ⅰ区为指动脉弓以远的部分；Ⅱ区为远侧指间关节至指动脉弓处；Ⅲ区为中节指骨远1/3至远指间关节处。本组7指(2指有部分皮肤相连)均为锐器伤，缺血时间4～12h，断面整齐，指段完整，无挫伤，无血管、神经束撕脱。１．２手术方法采用臂丛麻醉，指根部环扎橡皮筋止血，患手行常规清洗消毒，离体指段…     

拇指末节旋转撕脱性离断再植方法探讨

目的探讨拇指末节旋转撕脱性完全离断再植的方法及临床疗效。方法对39例拇指末节旋转撕脱性完全离断患者,采用缩短骨骼融合指间关节的方法进行再植,使一侧指固有动脉在无张力下直接吻合（3例采用静脉移植）,吻合1-2条指静脉及指神经或行动静脉分流重建静脉回流,不能吻合静脉者甲床滴血及指尖侧切滴血。结果39例患指再植术后34例成活,5例坏死,成活率87.2％,成活患指恢复了良好外观、功能、感觉。根据中华医学会手外科学会断指再植功能评定试用标准,优29例,良4例,差1例。结论该手术方式是一种治疗拇指末节旋转撕脱性完全离断再植简单有效的手术方法,成活率高,功能恢复满意,可选择性地应用于拇指末节旋转撕脱性离断患者。     

静脉动脉化再植手指末节离断23例

应用静脉动脉化方法对末节或指尖离断，甚至切割性全拇指离断和旋转撕脱性拇指完全离断均有成功的病例报道。自2003年4月-2007年11月我科对末节或指尖离断伤无动脉可供吻合者，采用静脉动脉化再植23例，成功率较高，现报道如下。     

末节断指再植41例59指临床分析

目的总结手指末节离断再植经验,探讨手术要点及末节再植适应证.方法对4 1例59指末节断指再植病例进行定期随访,系统回顾,全程康复,观察疗效.结果手指末节离断伤发生率高,占同期断指再植病例的25%,末节断指再植成活率达 94.9%,且功能恢复较好.结论手指末节离断伤只要远段指体完整,有可供吻合的动脉,均有再植的必要性.     

Fractures of the distal phalanx

The exposed nature of the peripheral portion of the fingers make fractures of the distal phalanges the most commonof workplace injuries. Most are simply treated by local wound care and protective splinting, both for comfort and to prevent further injury. Articular injuries, however, are more complex and require recognition by the primary examiner so that appropriate treatment can be applied.     

腹腔镜胰体尾切除术与开腹胰体尾切除术临床疗效对比分析

目的 对比腹腔镜胰体尾切除术（laparoscopic distal pancreatectomy,LDP）与开腹胰体尾切除术（open distal pancreatectomy,ODP）的疗效,探讨腹腔镜胰体尾切除术的优缺点.方法 回顾性分析2011年1月至2014年4月施行的17例腹腔镜胰体尾切除术患者与20例开腹胰体尾切除术患者的临床资料,对比两组患者的手术及术后情况.结果 腹腔镜组术中出血量少于开腹组,差异具有统计学意义（P＜ 0.05）;腹腔镜组术后肛门排气时间、禁食时间、住院时间较开腹组短,差异具有统计学意义（P＜0.05）;腹腔镜组手术时间长于开腹组,差异具有统计学意义（P＜0.05）;两组保脾率、术后并发症发生率差异无统计学意义（P＞ 0.05）,开腹组5例胰漏,1例切口感染、1例肺部感染、1例腹腔感染,腹腔镜组4例胰漏.结论 腹腔镜胰体尾切除术是安全可靠的,短期预后优于开腹组,值得临床进一步推广.     

Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer

Background  Laparoscopic-assisted gastric surgery has become an option for the treatment of early gastric cancer. However, there are few reports of laparoscopic surgery in the management of advanced gastric cancer. In this study we describe our experience with laparoscopic-assisted distal gastrectomy (LADG) for advanced gastric cancer (AGC). Methods  Between November 2004 and June 2007, 47 patients with AGC underwent LADG at our hospital, and 45 of those patients were enrolled in this study. These patients were compared with 83 patients who had AGC and underwent conventional open distal gastrectomy (ODG) during the same period. Results  Operation time was significantly longer in the LADG group than in the ODG group. Estimated blood loss in the LADG group was significantly less than in the ODG group. Time to ambulation and first flatus and duration of analgesic medication were significantly shorter in the LADG group. The morbidity and mortality rate were also lower than in the ODG group, with no statistically significant difference. The distance of the proximal resection margin showed no significant difference compared with ODG (6.3 ± 0.9 versus 6.5 ± 0.9 cm; p = 0.228). The mean number of nodes resected with LADG was 35.6 ± 14.2, and that with ODG was 38.3 ± 11.4 (p = 0.269). The mean follow-up for the LADG group was 23.6 months (range 9–40 months). In the LADG group, recurrence was observed in six patients (13.3%). Three patients had recurrence and died after 10 (IIIB), 11 (IIIA), and 13 (IIIB) months. Conclusions  LADG with extended lymphadenectomy for AGC is a feasible and safe procedure and has several advantages. Moreover, this method can achieve a radical oncologic equivalent resection. Indications for LADG with extended lymphadenectomy could be expanded in the treatment of locally advanced gastric cancer.     

经皮穿针固定治疗桡骨远端骨折合并下尺桡关节脱位

目的探讨经皮穿针固定治疗桡骨远端骨折合并下尺桡关节脱位的临床疗效。方法采用经皮穿针固定治疗42例桡骨远端骨折合并下尺桡关节脱位患者。结果 42例均获随访,时间4~24个月,骨折均获骨性愈合。疗效根据Green-O'Brien腕关节评分标准:优21例,良18例,一般3例,优良率92.9%。结论经皮穿针固定是治疗桡骨远端骨折合并下尺桡关节脱位的有效技术,疗效较可靠,并发症少。     

胫骨远端前外侧锁定钢板治疗胫骨远端骨折

目的：探讨胫骨远端前外侧锁定钢板治疗胫骨远端骨折的临床疗效。方法使用胫骨远端前外侧锁定钢板微创手术复位固定治疗120例胫骨远端骨折患者。结果患者均获随访,时间6～23（13．5±2．7）个月。骨折均骨性愈合。按照 Johner-Wruhs 方法评价功能：优75例,良38例,中5例,差2例,优良率为94．17％。结论应用胫骨远端前外侧锁定钢板微创手术复位治疗胫骨远端骨折,能够获得满意的临床疗效。     

Nephron-sparing management (distal ureterectomy with reimplantation of ureter) for carcinoma of distal ureter: A single-center experience

ObjectiveRadical nephroureterectomy with bladder-cuff excision has been the traditional treatment for upper tract urothelial carcinoma because of its high rate of recurrence. However, given the morbidity of nephrectomy and the risk of developing chronic kidney disease or dialysis-dependent renal failure, the nephron-sparing approach may be preferable in selected patients.Materials and methodsA total of 118 patients who received unilateral distal ureterectomy with reimplantation at a single center in Taiwan were included, using surgical code numbers, from March 2006 to December 2014. A total of 82 patients were excluded due to nonmalignancy and 17 due to concomitant bladder cancer. Finally, 19 patients with primary, solitary, unilateral ureter lesions and confirmed to have ureter malignancy (urothelial carcinoma, n = 18; squamous cell carcinoma, n = 1) were included.ResultsOf the 19 patients (13 males and 6 females) included, the mean age was 69.3 ± 10.7 years. Tumor pathological staging was Tis (n = 1), Ta (n = 3), T1 (n = 2), T2 (n = 6), and T3 (n = 5). Histopathology grading was low grade (n = 3) and high grade (n = 13). No local recurrence was noted; nine patients had bladder recurrence (47.4%), three had distant metastasis (15.8%), and two had progression and finally underwent radical nephroureterectomy (10.5%). The mean time to bladder recurrence was 12.4 months (3–24 months); the mean follow-up time was 28.1 months (1–90 months). The 5-year overall survival rate was 73.7% (14/19); four patients were lost to follow-up, and one patient expired. The mean 5-year progression-free survival was 67.74%. The mean preoperative creatinine level was 1.61 mg/dL, and at 12 months after operation it was 1.56 mg/dL (p = 0.95).ConclusionIn selected patients, distal ureterectomy with reimplantation, in our experience, is a feasible option for distal ureter tumor. Favorable postoperative outcomes with a low local recurrence rate, a low rate of progression to nephroureterectomy, and renal function preservation may prove the value of this modality and should be taken into consideration in suitable patients.     

腹腔镜胰体尾切除术的临床应用(附4例报告)

目的探讨腹腔镜胰体尾切除术(laparoscopicdistalpancreatectomy,LDP)治疗胰体尾肿瘤的临床价值。方法2002年6月～2004年12月行LDP的患者4例(保留脾脏1例),平均年龄39.8岁(31～48岁)。其中胰腺体尾部实性占位2例,囊实性占位2例。结果手术均在全腹腔镜下一次成功,平均手术时间305min(95～465min),平均出血140ml(50～300ml)。1例发生胰漏,经保守治疗痊愈。术后平均住院9.8d(5～18d)。结论LDP创伤小、术后恢复快,是治疗胰体尾肿瘤安全、可行的方法。     

中低位直肠癌的综合治疗

随机临床研究已证实辅助放化疗的作用,德国研究证实术前新辅助放化疗较术后化疗的优势。荷兰的TEM研究中显示肿瘤位置是影响治疗疗效的预后因素。但在具体化疗的实施和与化疗的联合应用,目前没有统一的共识。术前放疗的分割剂量,同期化疗应用和病人的选择存有差异。在治疗选择时需注意综合分析,多学科治疗模式。