Ability of new obturation materials to improve the seal of the root canal system: A review

New obturation biomaterials have been introduced over the past decade to improve the seal of the root canal system. However, it is not clear whether they have really produced a three-dimensional impervious seal that is important for reducing diseases associated with root canal treatment. A review of the literature was performed to identify models that have been employed for evaluating the seal of the root canal system. In vitro and in vivo models are not totally adept at quantifying the seal of root canals obturated with classic materials. Thus, one has to resort to clinical outcomes to examine whether there are real benefits associated with the use of recently introduced materials for obturating root canals. However, there is no simple answer because endodontic treatment outcomes are influenced by a host of other predictors that are more likely to take precedence over the influence of obturation materials. From the perspective of clinical performance, classic root filling materials have stood the test of time. Because many of the recently introduced materials are so new, there is not enough evidence yet to support their ability to improve clinical performance. This emphasizes the need to translate anecdotal information into clinically relevant research data on new biomaterials.     

术中结肠镜检在腹腔镜结直肠肿瘤切除术中的应用

目的 探讨术中结肠镜在腹腔镜结直肠肿瘤切除术中的临床应用价值.方法 对28例结直肠肿瘤患者施行腹腔镜结直肠肿瘤切除术时,术中使用结肠镜对肿瘤定位以确定切缘,肠管吻合后使用结肠镜观察吻合口有无吻合口漏及吻合口出血,并对并存结直肠息肉行结肠镜下切除.结果 28例均成功完成定位和手术,无中转开腹.平均手术时间190(120-230)min,术后平均住院天数9.5(7-12)d.术中结肠镜检发现吻合口出血和吻合口漏各1例,近端结肠腺瘤性息肉3例.术后并发症主要为1例切口脂肪液化,无吻合口漏和狭窄,无吻合口出血,术后病理标本残端无肿瘤细胞残留、浸润.结论 在腹腔镜结直肠肿瘤切除术中应用肠镜能快速、精确确定切除范围,弥补了腹腔镜手术的缺陷,减少腹腔肿瘤细胞脱落,肿瘤根治彻底,可靠观察吻合口情况,有效预防和治疗吻合日出血和吻合口漏的发生,值得临床推广.     

肝移植术后胆道并发症的诊断与治疗

目的 探讨肝移植术后胆道并发症的诊断与治疗.方法 分析2007-2009年肝移植术后不同类型胆道并发症的患者的临床资料,评价胴道并发症的类型,处理方式及术后恢复情况.结果 肝移植术后胆道并发症患者23例,包括胆漏患者12例,计胆管吻合口漏7例,肝断面胆管漏3例,胆囊管漏1例,迷走胆管漏1例;移植术后胆管狭窄患者11例,其中吻合口狭窄4例,非吻合口性狭窄7例.7例吻合口漏患者中,胆管重建2例(Roux-en-Y吻合和胆肠襻式Warren吻合);胆道吻合口修补1例;单纯依靠外引流管引流1例,活体双供肝肝移植的患者剖腹探查纠正胆漏失败后行再次肝移植1例;行经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)植入支架2例.肝断面胆管漏3例中,行肝断面胆管缝扎1例,ERCP联合B超引导下穿刺引流2例,引流2个月后胆漏闭合,拔除引流管,但是随后又出现胆道狭窄,ERCP术后,病情好转.胆囊管漏1例,行胆囊管缝扎.迷走胆管漏1例,行胆囊床缝扎.吻合口狭窄的患者4例,3例经ERCP治愈,1例行胆肠吻合重建胆道后治愈.非吻合口性狭窄的7例,行ERCP治疗3例,ERCP失败后,行经皮肝穿刺胆管引流(percutaneous transhepatic cholangiographic drainage,PTCD)1例;再次肝移植3例,2例患者术后恢复良好,1例死于严重感染.结论 肝移植术后胆道并发症危害大,关键在于预防.     

Vascular Anatomy of the Rectal Stump After Total Mesorectal Excision

Purpose For many years, poor vascularization of the short rectal stump has been considered the main cause of leakage. The purpose of this study was to evaluate the vascularization of the rectal stump after total mesorectal excision. Methods We studied the iliac vascularization on 28 volunteers with healthy rectum to have an anatomic basis. Then, we studied the vascularization of the rectal stumps after total mesorectal excision by using angio computed tomography at seven and three months after operating on 22 patients; we validated this technique by studying the vascularization using angio computed tomography in 18 rectal specimens from cadavers. Results Both in healthy rectums and in rectal stumps after total mesorectal excision, there is good vascularization substained by middle and inferior rectal arteries. The former is more important and frequent as described in previous literature. Conclusions The vascularization of the short rectal stump is generally well represented even after total mesorectal excision. Reprints are not available.     

Anastomotic leakage after low anterior resection for rectal cancer: Facts,obscurity, and fiction

The subject of anastomotic leakage after low anterior resection (LAR) for rectal cancer remains controversial. Risk factors have been discussed in several studies but the findings are often inconclusive. This review evaluates these studies and separates the known risk factors into those that are well documented, those that are obsolete, and those that require further research. We searched the Medline and PubMed databases using the keywords: “leakage,” “low anterior resection,” “rectal cancer,” “risk factors,” and their combinations. There were no language or publication year restrictions. References in published papers were also reviewed. Each risk factor was evaluated and discussed separately. The evidence suggests that low anastomoses are more prone to leakage. Other well-documented risk factors are male sex, smoking, and preoperative malnutrition. Routine mobilization of the splenic flexure and the use of a J-pouch seem to reduce the leakage rate. The effect of preoperative chemo-radiotherapy is under scrutiny. The indications for a protective stoma remain debatable. Omentoplasty, bowel preparation, the use of a drain, and tumor stage do not seem to affect the leakage rate. The type of operation (open or laparoscopic) and anastomosis (hand-sewn or stapled) is not crucial.     

Monitoring of the biodistribution and biokinetics of dysprosium-165 ferric hydroxide with a shadow-shield whole-body counter

Radiation synovectomy is indicated when conventional pharmacological treatment of chronic synovitis has proved insufficient. In these cases dysprosium-165 ferric hydroxide (DFH) has been demonstrated to be clinically effective. After application of the agent, blood activity measurements and monitoring of activity distribution by gamma camera imaging over the local lymph nodes and the liver are commonly performed for control of possible leakage. In addition, we have used a shadow-shield whole-body counter with a profile facility to evaluate the biokinetics and biodistribution of¹⁶⁵Dy-DFH. Fifteen intra-articular injections were performed in 13 patients who received a median activity of 6.8 GBq (range 0.5-9.9 GBq)¹⁶⁵Dy-DFH. Activity profiles were obtained with the whole-body counter 2, 4 and 6 h after injection of¹⁶⁵Dy-DFH. The doses to non-target organs were calculated using the software MIRDOSE 3. In 10 of 15 treatments, absence of any leakage could be demonstrated. The effect of scattered rays could be observed in 14 measurements. In three patients small amounts of activity could be detected in the urinary bladder and in three patients activity was detected in the local inguinal lymph nodes, while no leakage could be detected by camera imaging. In these cases the individual doses to the bladder were 15 Gy, 65 mGy and 50 mGy, and those to the lymph nodes, 0.54 Gy, 0.89 Gy and 2.41 Gy. The whole-body counter also enabled the monitoring of activity profiles related to more complex pathological structures. In conclusion, using a whole-body counter activity leakage could be detected with much higher sensitivity than by using a gamma camera. The biodistribution of¹⁶⁵Dy-DFH could be determined, and leakage could be localised and related to organs. These results encourage the use of a whole-body counter to identify, the site and extent of activity leakage.     

影响结肠吻合口愈合因素的实验研究

通过建立左侧结肠切除再吻合之大鼠模型观察各种因素在吻合口愈合过程中所起的作用。结果提示：左侧结肠切除吻合术后第３、４天，吻合口的抗张强度及羟脯氨酸含量降至最低水平，此时易发生吻合口漏；抑肽酶、二甲基亚砜、超氧化物歧化酶及维生素Ａ均有促进结肠吻合口早期愈合的作用，维生素Ａ还可拮抗氢化考的松延迟结肠吻合口愈合的作用；围手术期化疗对结肠吻合口早期愈合无显著不良影响；左半结肠完全性梗阻行结肠一期切除吻合术，于吻合前行肠减压及吻合后用抗生素液作腹腔灌洗显然有利于吻合口早期愈合。     

显微内镜椎间盘切除术治疗腰椎间盘突出症104例

目的总结104例显微内镜椎间盘切除术（microendoscopic discectomy，MED）手术常见问题的处理经验。方法应用美国枢法模公司椎间盘镜手术系统，对104例椎问盘突出症行MED，总结术中常见问题。结果104例中因出血及粘连改开放手术4例，余100例术中发生硬膜损伤3例，其中1例发生脑脊液漏。100例115个间隙平均每间隙手术时间50min（30～90min），术中出血量平均每间隙80ml（20—400m1）。100例随访3—32个月，平均18个月，疗效按Macnab标准，优65例，良29例，可6例，优良率94．0％（94／100）。结论术中最常见问题为出血及黄韧带切除费时，熟悉黄韧带薄弱部位及切除技巧，了解椎静脉解剖特点及其与腹压的关系，对预防和处理MED术中常见问题，减少硬膜囊及神经根损伤，减少出血对手术时间及疗效的影响至关重要。     

椎体成形术中椎管内骨水泥渗漏对临床疗效的影响

目的探讨椎体成形术中椎管内骨水泥渗漏对临床疗效的影响。方法回顾性分析2009年10月至2011年12月柳州市工人医院收治的260例（337椎）骨质疏松性压缩骨折（OVCF）患者的临床资料,采用经皮穿刺椎体成形术（PVP,238例）或经皮穿刺球囊扩张椎体成形术（PKP,22例）治疗。术后通过X线片和CT检查评估骨水泥渗漏情况,对符合评价标准椎管内骨水泥渗漏占椎管面积百分比等指标进行计算。同时采用视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）进行疗效评估,并观察脊髓神经损伤情况。结果 X线片和CT检查显示椎管内渗漏分别为48例（56椎）和84例（93椎）。符合评价标准的椎管内骨水泥渗漏者37例（44椎）,其中T1～T10段和T11～L1段骨水泥渗漏占椎管面积平均百分比分别为（30.8±1.5）%和（28.2±1.1）%。260例（337椎）患者手术前后VAS和ODI比较,差异有统计学意义（P〈0.05）;37例（44椎）椎管内骨水泥渗漏者术后VAS、ODI与其他患者比较,差异无统计学意义（P〉0.05）,其中3例（5椎）出现神经根性灼痛、麻木症状,其他均表现为阴性症状。结论椎体成形术中椎管内骨水泥渗漏率较高,但对手术疗效并无明显影响。加强监控、严格掌握手术适应证及良好的手术技巧可减少椎管内骨水泥渗漏的发生。     

经皮椎体成形术治疗非骨质疏松性椎体骨折的疗效研究

目的：探讨经皮球囊撑开椎体成形术治疗非骨质疏松性椎体骨折患者的疗效。方法：随机抽取我科2010年1月至2011年1月经皮椎体成形术（ PKP ）手术患者,30例骨质疏松性椎体骨折及30例新鲜骨折,对比PKP 手术后视觉模拟评分（ visual ananlog scale , VAS）评价患者的疼痛程度,椎体高度恢复,Cobb角纠正程度。结果：60例患者68个椎体经过PKP 治疗后,VAS评分,Cobb角,椎体高度均无显著性差异。结论：P KP手术治疗非骨质疏松性椎体骨折可行,可靠,安全,长期效果好。