改良经后路椎体间融合术治疗腰椎滑脱症

目的探讨单枚Cage加自体骨块椎间融合的改良经后路椎体间融合(PLIF)治疗腰椎滑脱症的疗效。方法自2000年12月～2006年6月,笔者在椎弓根螺钉系统复位固定的基础上用1枚Cage加1块自体骨椎间融合的手术方法治疗腰椎滑脱症46例,崩裂性滑脱24例,退变性滑脱22例。其中男25例,女21例;年龄29～67岁。部位:L3、42例,L4、523例,L5S121例。根据Meyerding滑移分度法:Ⅰ度22例,Ⅱ度19例,Ⅲ度5例。结果随访8～72个月,平均25个月。根据Nakai疗效评定标准:优23例,良22例,可1例。术后滑脱复位44例,Ⅲ度恢复到Ⅰ度2例。结论Cage加自体骨块融合的改良PLIF手术治疗腰椎滑脱症,具有固定坚强、较好维持椎间高度、良好的椎间骨融合、疗效确实等优点。     

外剥内扎加选择性松解部分内括约肌治疗嵌顿痔的临床研究

目的探讨外剥内扎加选择性松解部分内括约肌治疗嵌顿痔的临床疗效。方法将300例嵌顿痔随机分为两组,治疗组在外剥内扎基础上选择性松解部分内括约肌,对照组采用常规外剥内扎手术,对两组患者的术后疗效、愈合时间、术后并发症等进行观察分析。结果对照组与治疗组在愈合时间、术后并发症方面有显著差异。结论外剥内扎加选择性松解部分内括约肌治疗嵌顿痔,操作简单、安全,住院时间短,术后并发症轻,疗效可靠。     

Cystic lymphatic malformation of bladder presenting as a pelvic mass

We report a 5-year-old boy with a cystic lymphatic malformation (LM) of bladder, and the imaging characteristics of the lesion are reported. Cystic LM of the urinary system is rare, and a location in the bladder is extremely rare. The exact mechanism of the lesion that occurs in bladder is unknown. This case is different from the 3 cases reported before, for it is only presented with a palpable pelvic mass and the lesion did not penetrate full thickness of bladder. Although imaging examinations are helpful in the definition of cystic LMs, no characteristic findings are available to diagnose a cystic LM of the bladder before surgery. The diagnosis is always made after surgical intervention. Surgical excision is ideal, and an extensive operation is not warranted because the lesion is benign. Once excised completely, the prognosis of the disease is good.     

动态增强MRI对肝脏良恶性肿瘤的鉴别诊断

目的:通过分析动态增强磁共振成像法对肝细胞癌、肝转移瘤及海绵状血管瘤的诊断准确性,评价其在肝脏良恶性肿瘤鉴别诊断中的价值。方法:动态增强法采用快速梯度回波(FLASH序列),以病灶为中心取矢状位或斜位成像;每次5-8层,采集时间约10-20秒,用同一序列共重复扫描9次。结果:在动态增强MRI成像中,15例肝细胞癌表现为注射造影剂后15-45秒后呈迅速、中度不均匀强化,75秒后强化迅速消退;另2例未见明显早期强化,后期仍呈低信号。肝转移瘤表现为轻度、逐渐周边强化,延时期仍呈轻度环形强化。海绵状血管瘤表现为逐渐增强的、由周边向中心扩展的显著强化,延时期仍不消退,呈显著高信号。结论:动态增强MRI能有效地显示肝脏肿瘤内的血液动力学变化,能为鉴别诊断提供可靠的依据,对肝脏肿瘤的准确诊断有极其重要的价值。     

痔上黏膜环切钉合术与Milligan—Morgan术治疗Ⅲ、Ⅳ度内痔2年疗效比较

目的比较痔上黏膜环切钉合术（PPH）与Milligan—Morgan术（MMH）治疗Ⅲ、Ⅳ度内痔的远期疗效。方法按照完全随机分组原则将100例Ⅲ、Ⅳ度内痔患者分别采用PPH（PPH组，42例）和MMH（MMH组，58例）手术，观察并比较两组患者术后的远期疗效差异。结果PPH组与MMH组术后2年比较，在出现肛门溢液（2．38％比20．69％，P=0．007）、皮赘（9．52％比25．86％，P=0．040）和细便（2．38％比18．97％，P=0．027）方面PPH组术后少见，总的并发症发生率（9．52％比25．86％，P=0．040）和总排便功能异常（9．52％比29．31％，P=0．017）方面PPH组术后也少见，两组差异有统计学意义。在痔脱垂复发（14．29％比10．34％，P=0．549）、症状改善满意度（92．86％比87．93％，P=0．636）和总的症状复发（19．05％比25．86％，P=0．424）方面两组差异无统计学意义。结论PPH与Milligan-Morgan术治疗Ⅲ、Ⅳ度内痔的远期疗效无显著差异，但PPH安全、并发症少、对排便功能影响小。     

Instrumented posterior lumbar interbody fusion for patients with degenerative lumbar scoliosis

OBJECTIVE: Surgery for degenerative lumbar scoliosis remains challenging for spine surgeons even with the application of pedicle screw instrumentation. This retrospective study assesses the outcomes of instrumented posterior lumbar interbody fusion (PLIF) for degenerative lumbar scoliosis. METHODS: From April 2000 to April 2004, 26 patients with degenerative lumbar scoliosis were treated with instrumented PLIF. Mean age of the 15 females and 11 males was 64.2 years (range, 51 to 77 y). Clinical and radiographic outcomes were retrospectively reviewed for each case at a minimum follow-up of 2 years (median follow-up, 3 y; range, 2 to 6 y). At final follow-up, patients were classified as "satisfied" or "dissatisfied" according to self-reported outcomes. RESULTS: At most recent follow-up, the average Oswestry Disability Index score was significantly lower than the preoperative score (25.8 vs. 58.0; P<0.001). Twenty (76.9%) patients reported that they were satisfied with their surgical outcomes. The average lumbar scoliosis angles were significantly less than preoperative angles (7.4 vs. 16.5 degrees; P<0.001), resulting in a reduction in mean scoliosis angles of 55.2%. The average angles of lumbar lordosis were significantly higher than preoperative angles (30.1 vs. 22.2 degrees; P=0.001), an increase in mean lumbar lordosis angles of 35.6%. No perioperative deaths or major medical complications occurred. Five patients had adjacent segment degeneration and 4 (80%) of 5 reported dissatisfactory outcomes. Further study is required to identify the etiologies of adjacent segment degeneration and methods for avoiding such degeneration. CONCLUSIONS: Analytical results demonstrate that instrumented PLIF after laminectomy in patients with degenerative lumbar scoliosis is an effective and safe procedure.     

医用美容胶原注射的临床疗效观察

目的 评估胶原注射矫治皮肤缺陷的效果。方法 对不同种类的皮肤缺陷注射医用美容胶原。结果 用胶原注射矫治皮肤缺陷共103例,近期效果优良率为85．5％,未见严重并发症。结论 胶原注射矫治皮肤缺陷的方法安全、简便、有效。     

糖尿病大鼠膀胱逼尿肌超微结构的改变

目的观察糖尿病大鼠逼尿肌细胞超微结构的改变。方法建立非胰岛素依赖型糖尿病(NIDDM)大鼠模型,利用透射电镜观察其逼尿肌细胞内超微结构,应用Imaginetool图像分析软件检测粗面内质网面积和线粒体密度。结果NIDDM组逼尿肌细胞内单位面积平均(115.28μm2)胞质中粗面内质网面积在大鼠被喂养第4、12、24周分别为(4.376±2.321)μm2、(4.794±2.323)μm2、(5.377±2.318)μm2,较对照组的(0.462±0.316)μm2、(0.468±0.314)μm2、(0.476±0.319)μm2明显扩大(p<0.05),线粒体相对密度分别为(0.996±0.063)、(1.019±0.062)、(1.027±0.064),较对照组的(0.827±0.055)、(0.828±0.056)、(0.830±0.058)明显下降(p<0.05)。结论非胰岛素依赖型糖尿病逼尿肌细胞内质网扩张,提示其合成蛋白质功能增强,可能与糖尿病的逼尿肌收缩亢进、不稳定膀胱的情况有关;而线粒体水肿明显,密度下降,提示逼尿肌细胞能量代谢障碍,是引起逼尿肌收缩功能障碍的始动因素。     

大鼠肾移植模型手术改良技巧探讨

目的  探讨大鼠肾移植模型手术的改良方法。方法  供体Sprague-Dawley(SD)大鼠21只, 受体Wistar大鼠42只。采用双侧供肾。受体左肾切除后借助自制导管, 行受体肾动脉与供体肾动脉、受体肾静脉与供体下腔静脉端端吻合, 供体输尿管带膀胱瓣与受体膀胱吻合, 最后切除右肾, 腹腔内注入头孢米诺10 mg, 关腹。记录手术时间, 动、静脉吻合时间, 冷、热缺血时间等手术数据; 术后大鼠存活3 d认为模型建立成功, 计算建模成功率, 分析死亡原因。结果  供体手术时间为(32.7±5.6)min, 供肾修整时间为(4.2±1.1)min。受体手术时间为(42.3±4.9)min, 其中动脉吻合时间为(10.1±3.2)min, 静脉吻合时间为(13.9±2.5)min, 尿路重建时间为(6.3±1.4)min。热缺血时间为(5.4±1.8)s, 冷缺血时间为(56.2±7.3)min。42只受体大鼠中, 建模成功40只, 成功率为95%。另2只受体大鼠死亡, 其中1只死于血管吻合口出血, 1只死于尿瘘引致的腹膜炎。结论  采用改良的血管端端吻合法建立大鼠肾移植模型具有操作简单、手术时间短、成功率高的特点。     

经脐单孔腹腔镜与标准三孔后腹腔镜肾上腺切除术的疗效比较

目的对比12例经脐单孔腹腔镜（E-NOTES）和23例标准三孔后腹腔镜肾上腺肿瘤切除术,评价E．NOTES肾上腺切除术的实用性、安全性及疗效。方法2008年6月至2012年6月天津医科大学第二医院手术治疗的肾上腺良性肿瘤35例,其中E．NOTES肾上腺切除术12例,标准三孔后腹腔镜肾上腺切除术23例。所有手术均为同一术者完成。对两种术式的手术时间、术中平均出血量、术后胃肠道功能恢复时间（以排气为标准）、术后住院天数、并发症发生率、手术总费用等进行比较并进行统计学分析。结果E-NOTES肾上腺手术12例全部成功,标准三孔组1例因损伤肾静脉转开放手术,其余22例均顺利完成。两组在性别、年龄、肿瘤大小、功能性腺瘤所占比例及术后胃肠功能恢复时间方面差别无统计学意义。单孔组平均手术时间比标准组较长（分别为98．75min和80．87min,P=0．02）,但术中平均出血量较少（分别为35．00ml和64．34ml,P=0．01）,术后住院天数较短（分别为3．75d和5．21d,P=0．02）,手术费用较低（分别为12444．70元和14624．42元,P=0．001）。结论E．NOTES肾上腺肿物切除术安全有效,尽管手术时间较长,但在术中平均出血量、术后住院天数、术中及术后并发症发生率、手术总费用方面优于标准三孔手术。