股骨远端骨折手术治疗体会

目的探讨不同的手术策略治疗股骨远端骨折的临床效果。方法对100例股骨远端骨折患者,分别使用股骨远端解剖钢板、动力髁钢板、逆行股骨髁上交锁髓内钉、L形髁钢板进行治疗。比较治疗的优良率。结果股骨远端解剖钢板治疗优良率89.47%。逆行股骨髁上交锁髓内钉优良率90.48%。L形髁钢板优良率68.97%。动力髁钢板优良率93.55%。总优良85例(85.00%)。结论四种方式均有较好的效果,应根据不同骨折类型选择正确的固定方式和固定材料。     

经尿道双极等离子体前列腺剜除术的并发症分析

【摘要】 目的 探讨经尿道双极等离子体前列腺剜除术(TUPKEP)治疗良性前列腺增生(BPH)的疗效。方法 对本院2009年3月~2012年4月收治的368例良性前列腺增生患者采用经尿道双极等离子体前列腺剜除术的临床资料进行回顾性分析。结果 368例患者手术均获完成。平均手术时间(55.1±19.2)min,术中平均出血量(88±26)mL,切除腺体平均重量(60.5±26.3)g,留置尿管时间(4.8±1.3)天,术后住院时间(5.9±1.8)天。并发症中,前列腺包膜穿孔4例,其中1例膀胱前列腺连接部穿孔行腹腔引流;12例术后拔除尿管后出现排尿困难,经重置尿管后缓解,轻度尿失禁38例,张力性尿失禁12例,无真性尿失禁发生;膀胱颈挛缩5例,输血6例,逆行射精86例,尿道狭窄10例,阴茎勃起功能障碍(ED)39例,无TUR综合征及再次手术病例。术后患者IPSS、QOL、RVR 、Qmax与术前比较差异有统计学意义(P<0.01)。结论 TUPKEP手术时间、术后留置尿管时间和住院时间较短,术中出血量、并发症少,是治疗前列腺增生的安全有效的方法,其并发症可控可防。     

经尿道等离子前列腺剜除术与电切术治疗高危良性前列腺增生的比较

【摘要】 目的 探讨经尿道等离子前列腺剜除术(TUPKEP)与经尿道等离子前列腺电切术(TUPKRP)治疗高危良性前列腺增生(HrBPH)的安全性和有效性比较。方法 回顾性分析128例高危BPH 患者接受TUPKEP及TUPKRP两种手术方式,就两组患者的手术时间、出血量、前列腺腺体切除量、术后膀胱冲洗时间、尿管停留时间、术后住院天数、手术并发症等进行比较;对两组患者术前、术后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、残余尿量(PVR)、最大尿流率(Qmax)进行比较。结果 68例行TUPKEP,60例行TUPKRP,所有128例患者安全度过围手术期。两组患者术前情况比较无统计学差异;两组患者手术后的QOL、PVR、IPSS、Qmax与各自术前比较,其差异有统计学意义(P<0.01),但上述指标在两组之间比较的差异并无统计学意义(P>0.05)。TUPKEP组在手术的出血量、手术时间、术后膀胱冲洗时间以及术后的住院时间要明显小于TUPKRP组(P<0.05);同时,TUPKEP组前列腺腺体切除量也高于TUPKRP组(P<0.05)。结论 TUPKEP 与TUPKRP在治疗高危BPH中,二者的临床疗效相当,但TUPKEP在手术时间、术后膀胱冲洗时间和住院时间较TUPKRP短,而且出血量和并发症均较少少,是治疗高危良性前列腺增生症的安全有效的方法。     

急性硬膜外血肿的手术治疗体会

【摘要】 目的 总结急性硬膜外血肿的临床诊治经验。方法 回顾性分析自2005年至2012年间在我院住院治疗的75例急性硬膜外血肿患者的临床资料的临床资料;所有患者均行骨瓣开颅血肿清除手术治疗。结果 75例患者中59例治愈,8例好转,2例重残,6例死亡,总有效率为89.33%。结论 急性硬膜外血肿是临床上的急重症,通过早期积极的手术治疗,可以取得满意的疗效。     

Anterior decompression with single segmental spinal interbody fusion for Denis type B thoracolumbar burst fracture: a midterm follow-up study

Purpose

Our goal was to observe the midterm results of a case series of Denis type B thoracolumbar burst fracture treated with anterior decompression with single segmental spinal Interbody fusion.

Methods

Twenty patients with Denis type B thoracolumbar burst fractures underwent anterior decompression with single segmental spinal Interbody fusion. They underwent clinical and radiologic follow-up for at least three years after the surgery.

Results

The mean follow-up period lasted 57 months. To the last follow-up, there were no cases of internal fixation loosening, failure and other complications. Titanium mesh or interbody bone grafts were in good position. Spinal kyphosis was not observed. Interbody fusion was achieved for all cases. The average fusion time was 4.5 months. Based on visual analogue scale (VAS) pain scores, percentage of vertebral body height loss and Cobb angle, the difference was statistically significant between the preoperative period and postoperative one year or final follow-up (P < 0.05). Results at postoperative one year and final follow-up were better than the preoperative period. However, the difference was not significant between postoperative one year and final follow-up (P > 0.05).

Conclusions

Good midterm results on clinical and radiologic evaluation of anterior decompression with single segmental spinal Interbody fusion for suitable patients with Denis type B thoracolumbar burst fracture can be achieved. The incident rate of relative complications is low.     

Proposal of a New Classification for Stage III Colorectal Cancer Based on the Number and Ratio of Metastatic Lymph Nodes

Background

The objective of this retrospective study was to determine whether the current staging system for stage III colorectal cancer (CRC) is appropriate and to assess the value of the metastatic lymph node ratio (LNR) in predicting the prognosis of patients with stage III CRC.

Methods

From 2000 to 2006 inclusively, 245 patients with stage III CRC underwent curative resection. The follow-up was closed in March 2012. Kaplan–Meier survival curves and log-rank tests were used for the survival analysis.

Results

Survival time of patients with T3N1M0 was significantly better than that for patients in other subgroups of stage IIIB and similar to that of patients with stage IIIA disease. The greatest survival difference was found with 0.30 as the LNR cutoff point for patients with current stage III CRC. Survival time of patients with LNR ≤ 0.30 was significantly better than that of those with LNR > 0.30. rN1 included stage III patients with LNR ≤ 0.30, and rN2 included patients with LNR > 0.30. Survival time of patients with T4aN1(rN2)M0 staging was significantly worse than that for patients with T4aN1(rN1)M0 staging and similar to that of patients with stage IIIC CRC.

Conclusions

We propose an algorithm to incorporate LNR into the current American Joint Committee on Cancer staging system. In it the patients with T3N1M0 are excluded from the current stage IIIB and included in the stage IIIA group. Also, patients with T4aN1(rN2)M0 are excluded from the current stage IIIB group and included in the stage IIIC group.     

Characterizing the learning curve of the VBLaST-PT© (Virtual Basic Laparoscopic Skill Trainer)

Background

Mastering laparoscopic surgical skills requires considerable time and effort. The Virtual Basic Laparoscopic Skill Trainer (VBLaST-PT^©) is being developed as a computerized version of the peg transfer task of the Fundamentals of Laparoscopic Surgery (FLS) system using virtual reality technology. We assessed the learning curve of trainees on the VBLaST-PT^© using the cumulative summation (CUSUM) method and compared them with those on the FLS to establish convergent validity for the VBLaST-PT^©.

Methods

Eighteen medical students from were assigned randomly to one of three groups: control, VBLaST-training, and FLS-training. The VBLaST and the FLS groups performed a total of 150 trials of the peg-transfer task over a 3-week period, 5 days a week. Their CUSUM scores were computed based on predefined performance criteria (junior, intermediate, and senior levels).

Results

Of the six subjects in the VBLaST-training group, five achieved at least the “junior” level, three achieved the “intermediate” level, and one achieved the “senior” level of performance criterion by the end of the 150 trials. In comparison, for the FLS group, three students achieved the “senior” criterion and all six students achieved the “intermediate” and “junior” criteria by the 150th trials. Both the VBLaST-PT^© and the FLS systems showed significant skill improvement and retention, albeit with system specificity as measured by transfer of learning in the retention test: The VBLaST-trained group performed better on the VBLaST-PT^© than on FLS (p = 0.003), whereas the FLS-trained group performed better on the FLS than on VBLaST-PT^© (p = 0.002).

Conclusions

We characterized the learning curve for a virtual peg transfer task on the VBLaST-PT^© and compared it with the FLS using CUSUM analysis. Subjects in both training groups showed significant improvement in skill performance, but the transfer of training between systems was not significant.