自制黎氏管持续冲洗引流 治疗先天性巨结肠术后吻合口瘘护理体会

摘 要：目的：总结自制黎氏管对治疗先天性巨结肠术后吻合口瘘盆腔冲洗引流的治疗及护理体会。方法：对3例巨结 肠术后吻合口瘘的患儿采用自制黎氏管进行24小时持续冲洗引流联合全胃肠外营养 （TPN） 进行治疗。将自制黎氏管置入 吻合口旁（自制黎氏管由一粗一细两管组成，由细管持续滴入生理盐水，由粗管持续引流出来）至引出液完全清亮7～10天 为止。结果： 3例患儿均未造瘘，通过自制黎氏管持续冲洗引流后治愈。 结论：自制黎氏管持续冲洗引流治疗巨结肠术后吻 合口瘘是一个实用有效的方法，避免了近端肠造瘘，减少了患儿的损伤痛苦。     

Suction devices

Suction devices are integral to the safe delivery of anaesthesia and critical care. They are involved in clearing and aspirating body fluids, blood and debris, as well as employed in scavenging waste gases and diathermy fumes, intraoperative cell salvage systems, and tertiary devices such as vacuum mattresses and specialized wound dressings. All suction devices require three essential components, namely a source of vacuum, a reservoir/collection vessel and suction tubing. Other components of a suction device include an on/off switch, a vacuum regulator, vacuum gauge, filters, an overflow safety trap, an overfill protection device in the collection vessel, and a catheter. Several different types of catheter are available for use in different clinical situations. Vacuum and flow are the main physical principles underlying suction devices. The source of vacuum may be a fixed centrally piped system or a portable device using electrical, pneumatic or manual power. Pneumatically powered suction devices utilize the Bernoulli principle and Venturi effect. The efficiency of each system depends upon principles of displacement, degree of negative pressure and time taken to reach this, the internal resistance of the suction apparatus and the viscosity of the material to be aspirated.     

射频辅助腰腹部吸脂联合下腹壁整形术的临床效果

目的 探究射频辅助腰腹部吸脂联合下腹壁整形术的临床效果。方法 选取2021年3月-2023年3月 于我院行吸脂手术的80例患者为研究对象，采用随机数字表法分为常规组和研究组，每组40例。常规组采 用传统吸脂术，研究组采用射频辅助腰腹部吸脂联合下腹壁整形术，比较两组手术抽吸量、手术时间、腰 围周径减少量、消肿时间及满意度。结果 研究组手术抽吸量、腰围周径减少量均大于常规组，消肿时间短 于常规组（P＜0.05）；两组手术时间比较，差异无统计学意义（P＞0.05）；研究组满意率及满意度评分 均高于常规组（P＜0.05）。结论 射频辅助腰腹部吸脂联合下腹壁整形术的整体效果较好，可提高手术抽 吸量，缩小腰围周径，且术后消肿时间较短，恢复较快，患者满意度较高。     

机械取栓器取栓效果的影响因素

目的研究取栓口形状、抽吸流量以及血流速度对旋切抽吸式取栓器血栓抽吸效果的影响,为旋切抽吸式取栓器的设计和优化提供理论支持。方法建立3种取栓口("L"、"8"和"0"型)模型,研究取栓口形状对取栓的影响;以"8"型取栓口为基础,设置不同抽吸流量(75、100、125、150 mL/min)以及不同血液入口流速(0～10 cm/s,间距为1 cm/s),分析抽吸流量和血液流速对取栓效果的影响。结果 "L"型取栓口无法均匀地抽吸血栓,"8"型与"0"型取栓口的取栓效果差别不大,但"8"型取栓口附壁血栓清除率优于"0"型取栓口。当抽吸流量大于100 mL/min时,继续增大抽吸流量对取栓效果的提升有限。当血液流速小于1 cm/s时,抽吸效果最佳;随着血流速度增加,取栓效果逐渐下降。结论取栓口的形状、抽吸流量以及血液流速对取栓效果影响明显。选择宽而短的取栓口形状设计、适当提高抽吸流量以及降低血液流速,对取栓效果的提升有显著影响。研究结果可为旋切抽吸式取栓器的优化设计作指导。     

持续排气法在后腹膜腹腔镜手术中预防皮下气肿的应用研究

目的 探讨保持气腹压力的持续排气法在预防经腹膜后入路腹腔镜手术皮下气肿的应用效果。方法 以2020年10月至2021年9月收治于常州市第一人民医院经腹膜后入路行腹腔镜肾部分切除术的101例患者为研究对象。将其随机分为观察组（n=49）与对照组（n=52）。对照组术中使用常规人工间歇吸引排气法，观察组采用持续吸引排气法。比较两组患者术中气腹实际压力值、擦拭镜头次数、手术时间及术后皮下气肿的发生率、住院时间等指标。结果 观察组49例患者中，有4例发生皮下气肿，且均为1～2级；对照组52例患者中，10例发生了1～2级皮下气肿，3例发生了3～4级皮下气肿；两组比较，差异有统计学意义（P<0.05）。且观察组术中擦拭镜头次数[（3.18±0.99）次]少于对照组[（6.41±2.91）次]，手术时间[（135.73±45.40）min]及住院天数[（15.50±3.89）d]亦短于对照组[（158.71±61.95）min及（16.04±4.24）d]，差异均有统计学意义（P<0.05）。另，术中持续腹压监测曲线图表明，观察组术中腹腔内实际气腹压力波动于11～13 mmHg，较对照组（5～18mmHg）更趋于平稳。结论 保持气腹压力稳定的持续排气法可明显提高腹膜后入路腔镜手术操作的流畅性，缩短手术时间，减少患者术后皮下气肿发生率，有一定推广应用价值。     

鼻内镜下带吸引高频电刀切除鼻咽血管纤维瘤的治疗效果

目的探讨鼻内镜下带吸引高频电刀切除鼻咽血管纤维瘤的手术方法和治疗效果。方法回顾性分析2009年1月-2015年12月10例鼻咽血管纤维瘤的临床资料,全部患者均在鼻内镜下行带吸引高频电刀切除术,观察术中平均出血量、术后恢复时间、有无残留和复发。结果全部病例的肿瘤均一次性切除,平均出血量465 ml,无术后并发症,无残留,随访6~18个月无复发。结论尽管术前未行血管栓塞术,但在术中控制性低血压基础上,鼻内镜下带吸引高频电刀切除AndrewsⅡ期及以下(肿瘤局限鼻腔、鼻咽部及侵犯鼻窦)的鼻咽血管纤维瘤是可行的。     

3种术式治疗直径>2 cm的肾结石疗效对比

目的：比较经皮肾镜、输尿管软镜及智能控压吸引系统联合输尿管软镜治疗>2 cm肾结石的安全性及有效性。方法：收集2019年1月至2022年3月重庆医科大学附属第一医院泌尿外科采用经皮肾镜、输尿管软镜及智能控压吸引系统联合输尿管软镜治疗>2 cm肾结石的90例患者（每组30例），比较3组手术时间、术中出血量、术后住院时间、住院费用、手术并发症发生情况及术后1个月结石清除率。结果：经皮肾镜组手术时间为（54.1±22.7） min，输尿管软镜组为（53.9±27.0） min，短于智能控压吸引系统联合输尿管软镜组的（81.0±28.2） min，有统计学差异（P<0.05）。输尿管软镜组术中出血量为（3.2±2.1） mL，智能控压吸引系统联合输尿管软镜组为（5.7±4.5） mL，少于经皮肾镜组的（16.1±17.2） mL，有统计学差异（P<0.05）。输尿管软镜组术后住院时间为（1.2±0.5） d，智能控压吸引系统联合输尿管软镜组为（1.5±1.7） d，短于经皮肾镜组的（6.4±5.2） d，有统计学差异（P<0.05）。智能控压吸引系统联合输尿管软镜...     

Within-patient randomised clinical trial exploring the development of microskin implantation in the treatment of pressure ulcers

Pressure injury often seriously affects the life quality of aged patients, especially the long-term bedridden casualties. Widely adopted by different disciplines, negative pressure suction has its role in pressure injury. Microskin implantation has been demonstrated powerful in increasing the expansion ratio of donor area-derived skin and accelerating wound healing by forming “skin islands”. The study was designed to evaluate the efficacy and safety of additional use of bedside microskin implantation in the palliative care of pressure injury of aged patients who cannot tolerate surgical treatment as a supplement for standard negative pressure suction. An open-label within-patient RCT was conducted in aged patients with pressure injury. Sixteen patients were enrolled. After granulation tissues formed, half of a pressure injury was randomised to receive the negative pressure suction as the control group, and the other half exposed to additional bedside microskin implantation as the experimental group. Efficacy was evaluated within 1 month after treatment, and the primary endpoints included the wound healing rate and pressure ulcer scale for healing (PUSH) scores. The secondary outcomes included survival rate of implanted microskin, pain intensity assessment, satisfaction surveys from patients or their family, and pressure ulcer healing complications. Sixteen patients completed the study. After 14 days of operation, 5.63 ± 1.78 out of 10 pieces of implanted microskin survived and formed neonatal epithelium. The wound healing rates of the control group and the experimental group at 1 month were (26.17 ± 9.03%) and (35.95 ± 16.02%), respectively (P < .01). The mean PUSH score before the surgery was 12.38 ± 2.23. At 1 month after surgery, the mean difference of PUSH score from baseline was 2.13 ± 0.96 in the control group and 2.81 ± 0.83 in the experimental group (P < .01). The treatment of microskin implantation did not cause additional pain or complications to the patients. Accompanied by a better ulcer status, the majority of patients or their guardians have a high degree of acceptance towards the microskin implantation. Bedside microskin implantation could accelerate wound healing with lower PUSH scores. As a complementary palliative treatment, supplementary microskin implantation is effective and well tolerated.     

Effect of optimizing the use of endoscope on the efficiency of microdynamic bromhidrosis removal operation

Background

Bromhidrosis, also known as body odor, is a common disease in life, which often occurs in young adults. The histological basis of bromhidrosis is the hyperplasia of apocrine sweat glands.

Objective

To compare the effects of different methods of endoscopy in microdynamic axillary osmidrosis removal on curative effect, complications, and surgical efficiency.

Methods

A total of 149 patients with axillary osmidrosis were treated in our hospital from January 2020 to December 2021. They were treated with endoscopic assistance in the whole process of operation (Group A) and endoscope-assisted exploration after blind rotary cutter suction (Group B), respectively, and the curative effect, complication rate, and surgical efficiency were evaluated.

Results

There was no significant difference in the curative effect and complication rate between the two groups, but the endoscope-assisted exploration group after suction with rotary cutter (Group B) had higher surgical efficiency.

Conclusion

On the basis of professional use of rotary cutter, it is efficient to choose endoscope to check the excision of sweat gland in the operation area and stop bleeding in time after blind suction.