非创伤性乳糜胸的电视胸腔镜外科治疗(附4例报告及文献复习)

目的通过4例非创伤性乳糜胸的电视胸腔镜治疗，结合文献探讨非创伤性乳糜胸的病因、诊断和治疗方法。方法4例经临床、实验室、影像学及核医学检查确诊的非创伤性乳糜胸，经电视胸腔镜行胸导管结扎及胸膜固定术。结果3例1次治愈，1例复发，经2次手术治愈，随访1～5年未复发。结论电视胸腔镜外科为非创伤性乳糜胸提供了一种安全、微创及有效的方法。     

动物息肉模型的建立及临床培训

目的:探讨上消化道息肉动物模型的建立方法及其在培训内镜医师息肉治疗技术方面的应用价值。方法:通过在实验动物(猪)消化道制作与人类消化道息肉相似的息肉模型,培训98名内镜医师的内镜息肉切除操作技术,总结内镜医师的技术掌握程度。结果:经过培训,学员在老师指导下均可独立完成息肉模型的制作,并建立不同类型的息肉模型5~10个,选择合适的器械采用不同的方法进行内镜下切除治疗。结论:建立的实验动物(猪)食道、胃息肉模型与人类息肉相似,为内镜下息肉切除提供了较好的动物培训模型,利于被培训医师迅速掌握上消化道息肉切除技术。     

VAC Therapy in Large Infected Sacral Pressure Ulcer Grade IV—Can Be an Alternative to Flap Reconstruction?

Vacuum-assisted closure (VAC) therapy is a new entrant in wound care after growth factors and alginate or hydrocolloid dressing, in the treatment of pressure ulcers. We have been using this technique for diabetic foot ulcers. A young nondiabetic man presented with a large sacral bed sore after high doses of ionotropes in an intensive care unit for treating severe hypotension. His wound was debrided, and instead of flap surgery in such infected wound, he was treated with VAC therapy. The complete wound healing was achieved in 6 weeks and at half the cost of flap surgery. Moreover, the chances of flap failure and its related complications were eliminated.     

Appraisal of Laparoscopic Liver Resection in the Treatment of Liver Metastasis with Special Reference to Outcome in Colorectal Malignancies

Treatment of metastatic liver disease is at the crossroads of an evolutionary transformation with more and more reports reiterating the benefits of resectional therapy in various cancers. A quest for application of laparoscopic approaches to the management of liver metastasis has arisen due to the projected benefits of less morbidity, early recovery, and equivalent oncological outcome in selected malignancies. However, the diverse and heterogenous data on indications, operative technique, and outcome evaluation make a comparative analysis of these studies difficult. This review is an appraisal of technique and outcome of minimally invasive liver resection as reported in the current literature with special reference to treatment of metastatic colorectal cancers.     

高危前列腺癌:以根治性手术为核心的综合治疗策略

高危前列腺癌的生物学行为难以预测,目前仍然是前列腺癌治疗的难点。以根治性前列腺切除术为核心的综合治疗策略能够获得良好的治疗效果。术前对其危险因素进行分层评估,有利于筛选合适的患者进行个体化治疗,进一步改善患者的预后。     

高危肾盂癌患者的简化手术治疗

目的:探讨高危肾盂癌患者的治疗方法。方法:自2009年7月~2012年12月对14例高龄且伴有严重并发症的肾盂癌患者行经腹膜后途径腹腔镜下肾脏+中上段输尿管切除术,术后正规膀胱灌注表柔比星注射液,以预防再发膀胱癌,并定期进行影像学及膀胱镜检查。结果:14例手术全部成功,手术时间63~105min,平均78.3min。术后24~48小时恢复饮食,5~9天出院。术后病理检查2例为鳞状细胞癌,12例为尿路上皮细胞癌;其中2例为浸润性肾盂癌伴肾门处淋巴结转移。术后13例得到随访,1例失访;随访8~36个月,平均21.4个月。1例术后13个月死于肺部转移,2例术后21个月因心肺疾病死亡;2例术后再发膀胱癌,行根治性全膀胱切除。结论:对于高危肾盂癌患者,简化手术,腹腔镜下切除肾脏+中上段输尿管,术后配合正规膀胱灌注化疗是一种有效安全的治疗方法。     

Surgical site infection in spinal surgery: a comparative study between 2-octyl-cyanoacrylate and staples for wound closure

Background

Surgical site infection (SSI) after spinal surgery is a devastating complication. Various methods of skin closure are used in spinal surgery, but the optimal skin-closure method remains unclear. A recent report recommended against the use of metal staples for skin closure in orthopedic surgery. 2-Octyl-cyanoacrylate (Dermabond; Ethicon, NJ, USA) has been widely applied for wound closure in various surgeries. In this cohort study, we assessed the rate of SSI in spinal surgery using metal staples and 2-octyl-cyanoacrylate for wound closure.

Methods

This study enrolled 609 consecutive patients undergoing spinal surgery in our hospital. From April 2007 to March 2010 surgical wounds were closed with metal staples (group 1, n = 294). From April 2010 to February 2012 skin closure was performed using 2-octyl-cyanoacrylate (group 2, n = 315). We assessed the rate of SSI using these two different methods of wound closure. Prospective study of the time and cost evaluation of wound closure was performed between two groups.

Results

Patients in the 2-octyl-cyanoacrylate group had more risk factors for SSI than those in the metal-staple group. Nonetheless, eight patients in the metal-staple group compared with none in the 2-octyl-cyanoacrylate group acquired SSIs (p < 0.01). The closure of the wound in length of 10 cm with 2-octyl-cyanoacrylate could save 28 s and $13.5.

Conclusions

This study reveals that in spinal surgery, wound closure using 2-octyl-cyanoacrylate was associated with a lower rate of SSI than wound closure with staples. Moreover, the use of 2-octyl-cyanoacrylate has a more time saving effect and cost-effectiveness than the use of staples in wound closure of 10 cm in length.     

胃肠手术患者术后120h内下床活动水平及其影响因素分析

目的了解胃肠手术患者术后120h内的下床活动水平并分析其影响因素。方法采用一般资料调查表、一般自我效能感量表、医学焦虑抑郁量表、促进和阻碍因素问卷及下床活动水平等级评分方法 ,对144例胃肠手术患者进行调查。结果胃肠手术患者术后120h内的平均下床活动水平等级评分为6.5,处于中水平活动状态。不同手术部位、输液总量、尿管留置时间,是否使用尿壶、是否肠内营养的患者,其术后下床活动水平比较,差异有统计学意义(P0.05,P0.01);自我效能、肠内营养等医疗限制及尿壶的使用是影响患者术后下床活动水平的主要因素(P0.05,P0.01)。结论胃肠手术患者术后120h内下床活动现状不理想,应加强健康教育,增强患者的自我效能,为肠内营养患者制定下床活动计划,鼓励患者尿管拔出后下床排尿,以促进患者康复。     

电视胸腔镜手术治疗肺转移瘤38例报告

目的：探讨电视胸腔镜手术（ video-assisted thoracoscopic surgery , VATS ）治疗肺转移瘤的可行性和疗效。方法2004年9月-2012年12月电视胸腔镜手术治疗38例肺转移瘤。均采用双腔气管插管单肺通气,患侧腋中线第7或8肋间做1．5 cm切口为观察孔,置入胸腔镜;胸腔镜引导下分别于腋前线第3或4肋间及肩胛下角线第6或7肋间另做2个操作孔。内镜缝合切割器距肿瘤边缘1．5 cm行楔形切除术,常规清扫或切除区域肿大淋巴结。结果38例行VATS肺楔形切除术。无围手术期死亡,无术后严重并发症,无切口肿瘤种植。1、3、5年累计生存率分别是86．8％、52．6％、31．6％。结论对于有适应证的肺转移瘤采用VATS治疗可行。