Hem-o-lok结扎锁在腹腔镜阑尾切除术中的应用

目的总结腹腔镜阑尾切除应用Hem-o-lok结扎锁处理阑尾根部的经验。方法 2009年5月～2011年6月对284例急性阑尾炎和40例慢性阑尾炎急性发作行腹腔镜阑尾切除术,超声刀切断系膜至阑尾根部,16 mm Hem-o-lok结扎锁(Weck Closure Systems)处理阑尾根部。根部近心端1～2枚Hem-o-lok结扎锁夹闭,远心端以超声刀切断。结果 324例均顺利完成手术,未发生严重并发症。阑尾根部处理顺利,所有病例均用结扎锁完成,无结扎锁滑脱现象。手术时间20～70 min,平均35 min。术中出血2～20 ml,平均10 ml。术后住院3～5 d,平均4 d。300例随访5～14个月,平均7个月,无切口感染、再发右下腹痛等发生。结论腹腔镜阑尾切除术中应用Hem-o-lok结扎锁处理阑尾根部,安全可靠,经济实用,操作方便,值得临床推广应用。     

应用金属夹缝合胃壁全层缺损的动物实验

目的探讨应用金属夹缝合胃全层缺损的可行性、安全性和有效性。方法48只新西兰大白兔按随机数字表法分为4组,每组12只。在胃体部全层切开直径2cm的缺损后,第1组不缝合胃壁缺损．第2组用金属夹夹闭胃壁黏膜层．第3组用金属夹夹闭胃壁全层,第4组用3-0丝线缝合胃壁全层。分别于术后第3天和第7天处死各组动物,大体观察创面愈合情况;测定创面爆破压;并取创面组织,行苏木精-伊红染色和Masson染色,评价创面炎性反应及组织纤维增生情况。结果第1组动物术后34h内全部死亡,其他各组动物均良好存活．所有存活动物无腹腔内出血和感染表现。第2、3组与第4组相比,手术耗时短[（45．8±1．6）min和（42．5±1．5）min比（48．0±1．4）min,P〈0．05];第3天创面爆破压低]（36．9±4．6）mmHg和（39．8±4．1）mmHg比（50．5±4．2）mmHg,P〈0．05];第7天创面爆破压3组间差异无统计尝意义[（95．0±7．9）mmHg、（97．8±6．8）mmHg和（98．5±7．0）mmHg,P〉0．05]。相同时间点创面苏木精．伊红染色显示金属夹缝合组炎性反应较轻,Masson染色反映创面愈合无明显差别。结论应用金属夹缝合胃部全层缺损,无论夹闭胃黏膜层或全层组织,均能达到与手术缝线缝合相同的临床愈合效果和质量。     

The anal fistula claw: the OTSC clip for anal fistula closure

Aim Surgical closure of high or complex anal fistulae is often a difficult challenge. A special Nitinol clip, the OTSC clip (Ovesco AG), was evaluated for fistula closure in a porcine model. Method A total of 20 fistulae were created in 10 animals by seton insertion. Four weeks after fistula induction the setons were removed: one internal fistula opening per animal was left untreated as control whereas the other opening was closed by the OTSC clip using a specially developed transanal clip applicator. The safety and technical feasibility of the clip application were tested. Another 4 weeks later, fistulae were macroscopically assessed for closure. For histological examination, the anorectum including the fistula tract was excised en bloc. Results Four weeks after clip placement, all external and internal fistula openings were macroscopically closed. The clip application site presented with an increased scarring. Microscopically, 40% of residual tracts and a more intense chronic inflammation were seen in the untreated control fistulae. After clip placement, 10% of the fistulae persisted associated with a higher density of collagen fibres indicating a better fistula scarring and healing. No unexpected side‐effects or complications caused by the clip were observed. Conclusion Fistula closure using the OTSC clip represents a promising sphincter‐preserving minimally invasive procedure. This study demonstrated the safety and feasibility of the ‘anal fistula claw’ for fistula closure. In spite of limitations of the porcine model the results justify clinical applications and further investigations.     

Caudate lobectomy by the third porta hepatis anatomical method: a study of 16 cases

BACKGROUND: The treatment for primary tumor in the caudate lobe of the liver is difficult because of its unique anatomical location. This study was undertaken to improve operative techniques and results by a new anatomical method of caudate lobectomy. METHODS: Clinical data of 16 patients who had had caudate lobectomy for the liver from January 1996 to November 2004 were retrospectively analyzed. The third porta hepatis anatomical method was performed in all 16 patients. Operative time, intraoperative blood loss, postoperative complications were recorded. The 1-, 3-, and 5-year survival rates of 13 patients with caudate lobe carcinoma were followed up. Anatomical status, operative routes, operative procedures, liver blood supply were evaluated. RESULTS: The operation was successful in the 16 patients. The operative time was 255±70 minutes and blood loss 740±402 ml. None of the patients died from massive bleeding during the operation, nor did complications such as biliary fistula and liver failure occurred. In 13 patients with malignant tumor, 7 died from recurrence and metastasis of the tumor and the other 6 are still alive at the end of follow-up. One patient has survived for 6 years. The 1-, 3-, and 5-year survival rates in the 13 patients were 83.9%, 58.7% and 39.2%, respectively. CONCLUSION: Caudate lobectomy by the third porta hepatis anatomical method can improve operative effect and increase the resection probability for solitary tumor in the caudate lobe.     

肠镜下结肠巨大息肉切除124例临床分析

目的 探讨肠镜下结肠巨大息肉切除的临床可行性、有效性和安全性.方法 回顾性分析2016年1月—2020年2月我院电子内窥肠镜发现直径>2 cm的巨大结肠息肉患者124例,对于蒂粗>1.0 cm的48例巨大息肉分为A组,行钛夹后圈套器电切,对于蒂粗≤1.0 cm的76例巨大息肉分为B组,行钛夹后氩气刀切,观察两组的病理类...     

保乳术后放疗影响标记夹几何体变化的相关因素分析

目的探讨保乳术后全乳调强放疗中标记夹所形成几何体体积、位置、形态的变化规律及相关影响因素。方法回顾性分析2021年10月至2022年9月苏州大学附属第一医院18例保乳术后调强放疗患者, 依据定位CT和放疗0、10、20、30、40、50 Gy时的锥形束CT(CBCT), 读取瘤床标记夹坐标信息, 获取每次摆位误差。利用凸包计算程序构建几何体, 分别计算出几何体基于定位CT的体积(Vct)、6次CBCT的体积(V0～5);比较6次CBCT与定位CT的几何体质心位移(D0～5)和包含度(DI0～5)。照射剂量分别对V0～5、D0～5、DI0～5的影响采用配对t检验或秩和检验;D0～5分别与同次三维方向摆位误差的相关性, V0～5变化率均值(AV)、D0～5均值(AD)、DI0～5均值(ADI)分别与体质量指数(BMI)、全乳体积(VB)、乳轴高(H)、手术至放疗时间间隔(T)的相关性, 均采用Pearson相关分析;几何体所处象限(Q)和几何体于胸壁贴离状态(S)分别对AV、AD、ADI的影响采用单因素方差分析。结果 D5与D0、D1、D2差异均有统计学意义(t=-3.27、-4.52、-...     

食管超声下钛夹基准标记对食管癌内扩边变化的评估作用

目的：通过实时透视食管超声下置入的钛夹位移,评估食管病灶内扩边的影响因素及变化规律。方法对60例食管癌患者,食管超声探察病灶,病灶的上下端置入金属钛夹做基准标记,在模拟放疗体位下直接采集透视图像分析,分别记录平静呼吸和屏气状态下钛夹的空间位移。结果60例患者完成试验,74个病灶,137枚钛夹被置入。透视观察到134个（97．8％）,钛夹脱落中位时间为23天,无Ⅲ度以上钛夹置入相关性不良反应。钛夹运动呈规律性振动,振动频率与呼吸运动和心脏搏动相关。在平静呼吸状态下,钛夹移动的极值和中值分别为：头脚方向：（0．7～14．0 mm,7．5 mm）、左右方向（0．4～5．6 mm,2．0 mm）、前后方向（0．6～9．0 mm,2．3 mm）;在屏气状态下,钛夹移动的极值和中值分别为：头脚方向（0．2～3．3 mm,1．5 mm）、左右方向（0．2～3．3 mm,1．1 mm）、前后方向（0．3～3．7 mm,1．5 mm）。结论呼吸运动、心脏搏动、食管病灶位置影响食管病灶内扩边值,其中呼吸运动是主要因素。食管超声钛夹基准标记下的实时透视技术,安全可靠。     

SD大鼠钳夹脊髓损伤模型的建立

目的探讨构建一种SD大鼠脊髓钳夹损伤模型,用于脊髓损伤（spinal cord injury,SCI）的研究。方法将36只成年雄性SD大鼠随机分成A、B、C三组,每组12只。脊髓损伤组（A组）：用动脉瘤夹钳夹大鼠第10胸椎对应脊髓。假手术组（B组）：只打开椎板,暴露脊髓,不造成SCI。正常对照组（C组）：正常大鼠,不做任何处理。通过行为学观察（BBB评分）、HE染色和神经电生理检测进行判断。结果HE染色结果：A组可见脊髓正常组织被破坏,损伤区可见血管破裂出血,有大片坏死灶,周围神经细胞肿胀变性,内有炎症细胞浸润。B、C两组基本一致,组织结构正常。BBB评分：B组术后1周功能恢复接近正常,评分20分。A组术后第2周开始恢复,到第3周基本停止,最终BBB评分低于6分,两组比较有明显差异（P〈0．05）。神经电生理（SEP）检测：A组可以明显看到SEP的波峰趋于水平,且潜伏期无限延长,与B组相差显著（P〈0．05）。A组内动物BBB评分、SEP无显著性差异（P〉0．05）。结论通过动脉瘤夹钳夹SD大鼠T10脊髓,能够建立良好的脊髓损伤动物模型。     

腹腔镜阑尾切除术中钛夹与丝线的对比研究

目的比较在腹腔镜阑尾切除术（laparoscopic appendectomy,LA）中运用普通丝线及运用钛夹结扎阑尾动脉及阑尾根部的效果。方法回顾性分析54例行LA的阑尾炎患者的临床资料,其中28例使用钛夹（钛夹组）,26例使用丝线（丝线组）。结果手术均获成功,无中转开腹,无并发症发生。钛夹组与丝线组在住院时间、手术时间、术中出血量和手术费用方面均无明显差异（P〉0.05）。结论LA术中使用普通丝线结扎阑尾动脉及根部安全、可靠、经济。