Hem-o-lok结扎锁在后腹腔镜肾切除术肾蒂血管处理中的应用

目的:探讨后腹腔镜肾切除术中应用Hem-o-lok结扎锁处理肾蒂血管的价值。方法:我们为63例患者行后腹腔镜肾切除术并采用Hem-o-lok结扎锁处理肾蒂血管,其中肾动脉近端用大号Hem-o-lok2枚结扎,远端用2枚钛夹夹闭后剪断,肾静脉用加大号Hem-o-lok近端2枚、远端1枚结扎后剪断。结果:本组手术时间90~255min,平均135min;出血量20~180ml,平均45ml;术后住院时间5~8d;术中肾蒂血管处理满意,术中、术后未发生严重并发症。结论:腹腔镜肾切除术中用Hem-o-lok结扎锁分别处理肾动静脉,安全可靠,经济实用,值得临床推广应用。     

The OTSC® Proctology clip system for anorectal fistula closure: the ‘Anal Fistula Claw’: Case report

Abstract

Surgical treatment of high or complex anal fistulas often renders unsatisfying results. This is the report of the first successful closure of such anal fistula using a special Nitinol clip and applicator, the OTSC® Proctology system (Ovesco AG, Tuebingen, Germany): A 54-year old female patient was suffering from a high transsphincteric anal fistula. After seton drainage of the fistula for ten weeks, the fistula track was debrided using a special fistula brush. After transanal clip release from the applicator, the internal fistula opening was adequately closed by the clip. Eight months after clip closure the fistula had healed and the clip was removed using the OTSC® Proctology Clip Cutter. Fistula closure using the OTSC® Proctology system represents a promising sphincter-preserving minimally invasive procedure.     

Colonic anastomosis with the nickel-titanium temperature-dependent memory-shape device

BACKGROUND: This study was prompted by our successful experience with a compression anastomosis clip (CAC) in an animal model. METHODS: The study sample included 20 patients scheduled for colonic resections, of whom 10 underwent anastomosis with the CAC and 10 with staplers. RESULTS: Neither group had anastomotic or other complications, except for 1 patient in the CAC group in whom a subphrenic infected hematoma developed after left hemicolectomy with splenectomy. CONCLUSIONS: Our study demonstrates that this CAC is safe and simple to use, coming close to the "no touch surgery concept" and is of low cost compared with the staples used today.     

改良输卵管银夹节育效果的前瞻分析(附480例报告)

目的观察经改良后输卵管银夹节育术的效果。方法改良夹在中山YZ-Ⅱ银夹的基础上对回钩与上夹臂接触距离及限钉高度加以改进,使用临床前瞻性研究法,事先设计好标准化表格备填,将对象随机分为两组。改良夹组480例,并与使用原夹组480例对照。结果使用原夹者3个月无复孕,6个月复孕2例,12个月复孕2例,24个月3例,36个月无复孕;改良后的银夹3、6个月无复孕,12个月复孕1例,24、36个月无复孕。两组对比差异有显著性(P<0.05)。结论改良后的银夹绝育效果更加可靠。     

Intraocular Lens Implantation: A Review

Intraocular lens implantation has been developing over the past 15 years in Europe and is now becoming popular in the United States. Lens materials and designs as well as surgical techniques are still being evaluated. The overall results are excellent, with a small increase in complications being the price paid for a dramatic increase in visual rehabilitation.     

Ultrasound demonstration of clip migration to Skin within 6 weeks of 11-gauge vacuum-assisted stereotactic breast biopsy

A 39-year-old woman underwent 11-gauge vacuum-assisted stereotactic biopsy of a cluster of calcifications at the 5 o'clock location in the left breast. Initial clip placement was confirmed by mammograms to be at the biopsy site. The patient experienced episodic minimal bleeding at the skin entry site when she went home. The patient presented 6 weeks later with a history of progressive discomfort and lump at the stereotactic breast biopsy scar site. Ultrasound confirmed clip migration to the skin incision site. The clip was removed percutaneously by the radiologist, relieving the patient of her symptoms.     

盐酸埃他卡林选择性降压作用的研究

目的 :在清醒正常血压犬和“两肾一夹”肾性高血压犬 (RHD)上 ,观察不同剂量盐酸埃他卡林(iptakalimhydrochloride,Ipt)的降压作用特征 ;在清醒正常血压的Wistar大鼠和脑卒中易感型自发性高血压大鼠 (stroke pronespontaneouslyhypertensiverat,SHRsp)上 ,采用无创心功能监测方法 ,观察Ipt对心功能和血流动力学的作用特征 ,以判断其降压作用和对心功能及血流动力学的影响是否具有选择性。方法 :给清醒正常血压犬和RHD口服不同剂量的Ipt,用听诊法测量移于皮鞘内的颈总动脉血压 ,用触诊法测量心率 ,同时记录Ⅱ导联心电图。给清醒正常血压大鼠和SHRsp静脉注射相同剂量的Ipt,采用清醒无创心功能血流动力学实验方法 ,观察Ipt对对心功能和血流动力学的影响。结果 :在RHD模型上 ,单次口服Ipt0 .1 2 5、0 .2 5、0 .5、1 .0mg·kg- 1 后 ,产生剂量依赖性的降压作用 ,0 .5h开始起效 ,2～ 3h达效应峰值 ,其最大降低SBP幅度分别为 1 3、2 3、2 5、3 6mmHg,降压作用维持时间分别为 4、6、6、1 2h。在清醒正常血压犬上 ,单次口服Ipt 0 .8,3 .2 ,1 2 .8mg·kg- 1 ,其中剂量为 0 .8和 3 .2mg·kg- 1 时 ,血压和心率均无明显变化 ,剂量增至 1 2 .8mg·kg- 1 时 ,在给药后 5h之内可以显著降低收缩压和舒张压 ,其最大降低SB     

Efficacy of Absorbable Clips Compared with Metal Clips for Cystic Duct Ligation in Laparoscopic Cholecystectomy

Purpose: This study was conducted to examine the usefulness and safety of absorbable clips in laparoscopic cholecystectomy (LC). Methods: We retrospectively compared the clinical data of 328 patients who underwent LC using absorbable clips for cystic duct ligation and 444 patients who underwent LC using metal clips for cystic duct ligation. Results: The mean operative time in the absorbable clip group was significantly shorter than that in the metal clip group. The mean intraoperative blood loss and hospital stay were not significantly different between the two groups. The rate of conversion to open laparotomy in the absorbable clip group was significantly higher than that in the metal clip group, at 6.7% vs 2.3%, respectively. The most common reason for conversion was difficult adhesions and inflammation around the gallbladder. The morbidity of the metal clip group was significantly higher than that of the absorbable clip group, at 8.4% vs 4.0%, respectively. The incidence of major postoperative complications requiring laparotomy did not differ between the two groups. There were no deaths in the absorbable clip group, but 1 of the 444 patients (0.23%) in the metal clip group died from disseminated intravascular coagulation on postoperative day 3. Conclusion: The results of this study suggest that absorbable clips are as safe and effective as standard metal clips for vessel and duct ligation in LC. Received: January 28, 2002 / Accepted: July 2, 2002 Reprint requests to: H. Yano     

结直肠局限病变术前定位微创手术治疗探讨

【目的】探讨结直肠局限性病变术前钛夹定位、小切口手术的优越性。【方法】经内镜在结肠病变旁置钛夹，X线下腹壁定位，66例与传统定位法58例进行临床疗效对比分析。【结果】66例钛夹定手术切口小（5～10cm即可），缩短手术时间（1—2h），明显优于传统定位方法。【结论】钛夹术前定位法指导结直肠外科开展微创手术治疗作用明显优于各种传统定位方法，是一种国内尚无报道、有效的，值得推广的新方法。     

Small bowel obstruction at a Filshie clip applicator port site

Laparoscopic Filshie clip sterilisation remains a common method of permanent female contraception. Worldwide, approximately 190 million couples use tubal occlusion (United Nations world population monitoring. United Nations, 2002). Trocar site incisional hernia has been reported as a complication of laparoscopic surgery where a 10-mm port was employed (Tonouchi et al. Arch Surg 139(11):1248–1256, 2004). It is common practice to repair port sites of 10 mm or more to prevent herniation. Port sites of 5 mm are not routinely repaired by most surgeons because it is thought that such iatrogenic fascial defects are not large enough to predispose to hernia (Reardon et al. J Laparoendosc Adv Surg Tech A 9(6):523–525, 1999). We report a rare case of early Filshie clip applicator port site intestinal obstruction following laparoscopic sterilisation. The mechanism of hernia formation and a preventive strategy are discussed.