The constrictor knot is the best ligature

Introduction

An ideal ligature should tighten readily and remain tight. Ligature failure can be a critical complication of invasive procedures in human and veterinary surgical practice. Previous studies have tested various knots but not the constrictor knot.

Methods

A new test bench was employed to compare six ligatures using four suture materials. As tension in a ligature is not readily measured, the study employed a surrogate measurement: the force required to slide a ligature along a rod. Benchmark values tested each suture material wrapped around the rod to establish the ratio between this force and the ligature tension for each material. Each ligature was tested first during tightening and then again afterwards. The benchmark ratios were employed to calculate the tensions to evaluate which ligature and which suture material retained tension best.

Results

The model provided consistent linear relationships between the tension in the suture and the force required to pull the ligature along the rod. The constrictor knot retained tension in the ligature best (55–107% better than the next best ligature). Among the suture materials, polydioxanone had the greatest ability to retain the tension in a ligature and polyglactin the least.

Conclusions

The constrictor knot showed superior characteristics for use as a ligature, and should be introduced into teaching and clinical practice for human and veterinary surgery. The new test bench is recommended for future testing of ligatures as well as objective comparison of suture materials.     

Patent ductus arteriosus ligation in premature infants in the United States

Background

Patent ductus arteriosus (PDA) is a condition that commonly affects premature and low birth weight (BW) infants at times necessitating surgical intervention. We examined outcomes after surgical ligation (SL).

Materials and methods

We analyzed the Kids' Inpatient Database for premature infants diagnosed with PDA, admitted at <8 d of age. Patient demographics, disposition, morbidity, and mortality were analyzed. All cases were weighted appropriately to project nationally representative estimates.

Results

A total of 63,208 patients were identified with diagnosis of PDA. Of these, 6766 (10.7%) underwent SL. Lower gestational age (GA) and BW patients had higher incidence of PDA and rates of SL. Overall survival was 90.8% for the cohort. Survival for the SL group was 88.0% and 91.2% for the non-SL group; however, infants undergoing SL had higher survival rates up to 28 wk and 1250 g for GA and BW, respectively. GA did not affect post-SL survival adversely. Rather, lower BW was associated with extremely high mortality rates. Black infants and boys had lower survival compared with other races and girls, respectively. Larger hospitals had higher survival rates, but hospital location, teaching status, and type did not affect survival. Payer status and income quartile did not affect survival.

Conclusions

PDA and SL are more common in lower BW and GA groups. Higher survival rates are found for infants with SL versus non-SL in the lowest BW and GA groups. Morbidity and mortality are not affected by SL timing. BW, rather than GA, determines survival of infants undergoing SL.     

延龄草甾体皂苷抗大鼠急性心肌缺血有效成分的研究

目的:探讨延龄草中3个甾体皂苷单体抗急性心肌缺血的生物活性作用.方法:取SD雄性大鼠90只随机分为9组,分别为假手术组、模型组、地奥心血康组(60.0 mg/kg)、偏诺皂苷元-3-O-α-L-吡喃鼠李糖基(1→2)-β-D-吡喃葡萄糖苷单体高剂量组(Y2TH)29.14 mg/kg、偏诺皂苷元-3-O-α-L-吡喃鼠...     

胸外科手术后并发乳糜胸62例临床分析

目的探讨胸外科手术后并发乳糜胸的诊治方法。方法对986例肺癌患者术后并发乳糜胸17例（1．72％）和11669例食管癌患者术后并发乳糜胸45例（2．69％）资料作回顾性分析。结果肺癌组,开胸手术乳糜胸发生率1．34％,胸腔镜手术2．56％;食管癌组,开胸手术乳糜胸2．38％,胸腔镜手术4．24％。62例术后并发乳糜胸患者中,38例经保守治疗,37例治愈,1例死亡,手术24例均治愈,总治愈率为98．4％（61／62）。结论胸外科手术,特别是胸腔镜手术,应重视乳糜胸的发生;术后乳糜胸以手术治疗为主,对于乳糜胸引流量较少的患者,也可采用保守治疗。     

门静脉分支结扎后门静脉压力变化与肝再生的关系

目的 探讨90%门静脉分支结扎后大鼠门静脉压力变化与肝再生的关系.方法 45只雄性SD大鼠行90%门静脉分支结扎术,其中5只进行假手术作为对照.观察不同时相点门静脉压力和非结扎侧肝脏质量变化,光学显微镜下观察非结扎侧肝细胞的形态学变化,免疫组织化学方法检测未结扎侧肝细胞的增殖细胞核抗原(PCNA),TUNEL法检测未结扎侧肝细胞的凋亡情况,并进行定最分析.采用Pearson相关分析和t检验分析数据.结果 95%(38/40)的大鼠存活.结扎侧肝叶进行性萎缩,非结扎侧肝叶占全肝质量的比例随时问推移而增加,12 h内增加较缓慢,仅为10.75%;而1～5 d则增加速度明显加快,达到27.57%;7～28 d达到平台期,缓慢增加到32.37%.术前门静脉压力为(9.1±1.8)cm H_2O(1 cm H_2O=0.098 kPa);结扎后立即升高,12 h达到高峰(15.8±2.7)cm H_2O,与术前比较差异有统计学意义(t=6.847,P<0.05);1～28 d由(13.6±2.3)cm H_2O逐渐下降为(9.3±2.0)cm H_2O.术前大鼠PCNA阳性细胞计数为7%±3%,术后12 h至3 d由14%±5%上升至21%±6%,第5天达到高峰为26%±7%,与术前比较差异有统计学意义(t=9.129,P<0.05),随后逐渐恢复正常.TUNEL法检测结果显示,术前大鼠肝脏和术后各时相点大鼠未结扎侧肝脏仅见极少量凋亡细胞.大鼠门静脉压力与非结扎侧肝叶肝细胞PCNA的表达在术后1、3、5 d呈正相关(r=0.913,0.896,0.908,P<0.05),在术后14 d时相点呈负相关(r=-0.926,P<0.05).结论 大鼠90%门静脉分支结扎术后,引起未结扎侧肝细胞的活跃再生,再生后的肝脏可恢复原来的质量;肝再生以肝细胞增殖加速为主,而非肝细胞凋亡减少;门静脉压力变化在肝再生过程中可能发挥重要作用.     

后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿(附29例报告)

目的：探讨后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿的手术方法和疗效。方法：对29例乳糜尿均行经后腹腔镜肾蒂淋巴管结扎术(双侧者只做了一侧)。结果：29例患者手术均成功，平均手术时间110min，术中出血量平均84ml，未见明显的外科并发症，术后平均住院7．9d。患者出院时尿液均清亮，26例单侧乳糜尿患者尿乙醚试验全部阴性。随访1～3年，除1例双侧乳糜尿患者在术后3个月因对侧原因出现乳糜尿外，其余患者均无复发。结论：后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿近期疗效较好．具有术中出血量少、微创、淋巴管结扎彻底、术后住院时间短、恢复快等优点，是目前治疗乳糜尿较理想的手术方式。     

内镜下六连环与单发尼龙绳套扎治疗食管静脉曲张的对比分析

目的探讨内镜下六连环与单发尼龙绳套扎治疗食管静脉曲张的的有效性、安全性。方法将43例肝硬化并食管静脉曲张患者,随机分两组,六连环组26例,单发尼龙组17例,分别采用内镜下六连环及单发尼龙绳套扎治疗,对比观察两组疗效、并发症及操作和套扎圈脱落时间。结果①两组总疗效基本相同(P>0.05)。②两组治疗后近期并发症基本相同(P>0.05),但胸骨后疼痛在单发尼龙组更多见(P<0.01)。③操作及套扎圈脱落时间:两组在操作时间及术后套扎圈脱落时间有显著性差异(P<0.05)。结论两种方法套扎治疗肝硬化并食管静脉曲张疗效相当,六连环套扎操作简便、手术时间短,并发症少。     

套扎法联合补阳还五汤对于直肠息肉的临床价值

目的：本文旨在分析套扎法联合补阳还五汤对于直肠息肉治疗的价值。方法：选取2010年1月-2012年6月在我院进行治疗的直肠息肉患者54例,按照随机的原则将患者分为两组,分别采用套扎法和套扎法联合补阳还五汤治疗。结果：套扎法联合补阳还五汤的治疗有效率明显高于单独使用套扎法的患者,并且有统计学意义（P〈0．05）。结论：套扎法联合补阳还五汤对于直肠息肉的治疗效果较为理想,可以在临床上进一步推广。     

肠淋巴途径在二次打击致大鼠MODS的发病学作用

目的：探讨淋巴途径在二次打击致大鼠MODS的发病学作用。 方法： 结扎肠系膜淋巴管致肠淋巴液断流，以二次打击方法复制MODS模型。Wistar大鼠45只均分为结扎组、未结扎组、假手术组3组，术前及创伤后24 h取血，制备肾、肝、肺、心、肠组织10%匀浆，检测TNFα、NO、MDA、SOD等指标。 结果： 成功复制了MODS大鼠模型。二次打击后，未结扎组大鼠血清TNFα、NO2-/NO3-、NOS、iNOS、MDA均显著高于实验前及假手术组，SOD显著下降（P<0.01，P<0.05）；结扎组大鼠血清NO2-/NO3-、NOS、MDA高于假手术组（P<0.01），TNFα、NO2-/NO3-、iNOS、MDA显著低于未结扎组，SOD显著高于未结扎组（P<0.01）。未结扎组肠匀浆TNFα、NO2-/NO3-、NOS、iNOS、MDA，肾匀浆NO2-/NO3-、NOS、MDA，肝匀浆NO2-/NO3-、MDA及肺、心匀浆NO2-/NO3-均显著高于假手术组，肠匀浆SOD显著低于假手术组（P<0.01，P<0.05）；结扎组肾匀浆NO2-/NO3-、MDA及肝匀浆MDA显著高于假手术组（P<0.01，P<0.05）。结扎组肠、肾、肝匀浆NO2-/NO3-显著低于未结扎组，肠、心匀浆SOD显著高于未结扎组（P<0.01）。 结论： 肠系膜淋巴管结扎阻断了二次打击所致内毒素经淋巴流的移位，抑制TNFα释放，使iNOS生成减少，NO形成降低，减少自由基释放与SOD消耗，MODS的淋巴机制值得重视。     

切胶回收及树脂纯化酶切片段在连接实验中的比较

目的 比较切胶回收及树脂纯化酶切片段在连接实验中的应用效果。方法 将目的片段及载体酶切后分别用切胶回收及树脂纯化，再进行连接，转化受体菌DH5a后挑取菌落筛选阳性克隆，比较其阳性克隆比。结果 切胶回收阳性克隆比为100％，树脂纯化阳性克隆比为67％。结论 切胶回收纯化阳性克隆比明显高于树脂纯化，但树脂纯化操作相对简单、快速，67％的阳性克隆比也已符合一般连接实验的要求。