Pea术式治疗中高位肛门直肠畸形的并发症及对策

目的探讨Pena术式治疗中高位肛门直肠畸形的并发症及预防治疗措施。方法回顾性分析行Pena肛门成形术的58例中高位肛门直肠畸形患儿的临床资料及肛门排便功能情况、并发症，采用肛门功能临床评分标准进行评价。结果58例中优良者45例（83．3％），差者9例（偶有污粪6例，大便失禁1例，便秘2例），有并发症者8例（14．8％），其中直肠黏膜脱垂3例，粪便潴留2例，大便失禁1例，尿漏1例，直肠回缩1例。结论真正理解Pena的“无血、解剖式”手术技术的精髓，提高手术技巧和精细操作，加强术后康复训练是减少并发症的关键。     

Pea术式治疗中高位肛门直肠畸形的并发症及对策

目的探讨Pea术式治疗中高位肛门直肠畸形的并发症及预防治疗措施。方法回顾性分析行Pea肛门成形术的58例中高位肛门直肠畸形患儿的临床资料及肛门排便功能情况、并发症,采用肛门功能临床评分标准进行评价。结果58例中优良者45例(83.3%),差者9例(偶有污粪6例,大便失禁1例,便秘2例),有并发症者8例(14.8%),其中直肠黏膜脱垂3例,粪便潴留2例,大便失禁1例,尿漏1例,直肠回缩1例。结论真正理解Pea的"无血、解剖式"手术技术的精髓,提高手术技巧和精细操作,加强术后康复训练是减少并发症的关键。     

Which cystography in the diagnosis and grading of vesicoureteral reflux?

The gold standard procedure for the evaluation of vesicoureteral reflux (VUR) is the radiographic voiding cystourethrography (VCUG); direct radionuclide voiding cystography (DRVC) is an alternative method for detecting VUR. A new imaging procedure, voiding urosonography (VUS) with contrast medium, has recently been introduced. We have carried out a comparative study of these three techniques in 157 patients (aged 6 weeks–4.7 years). VUS showed the presence of VUR in 91 of 311 renal units; VCUG detected reflux in 64 of 233 renal units, and the DRVC in 23 of 78 renal units. VCUG and VUS were compared in 118 patients, and both procedures showed the same grade of reflux in 56 refluxing units (kappa value 0.92); in six cases the reflux grade was greater at VUS than at VCUG. Seven cases of reflux detected by VUS were not identified on VCUG. VCUG did not show a grade of VUR that was higher than in VUS in any patient. In the identification of 4°–5° grade reflux, the sensitivity of VUS reached 100%. VUS and DRVC were found to be equally effective in the detection of VUR (kappa value 0.85). In conclusion, we found that VUS is a useful method for the diagnosis and grading of patients with VUR.     

Beger术式在胰头部手术治疗中的应用

目的总结Beger术式在临床胰头部手术治疗中的应用经验。方法对1999年10月~2007年5月4例住院病人施行了Beger术式并对手术适应证以及手术技能进行了分析讨论。结果本文病例的Beger手术均顺利进行,手术死亡率为0,仅1例发生胰瘘,且治愈恢复良好。结论对于胰头部的良性疾患,Beger术式是可行且安全有效的手术方式。     

A trapdoor procedure for chondroblastoma of the femoral head: a case report

Chondroblastoma located in the femoral head is one of the locations accounting for frequent recurrence. One of the reasons for this is the difficulty in obtaining appropriate surgical access to it for adequate removal of tumors. The authors present and illustrate a trapdoor procedure for the surgical treatment of chodroblastoma in the epiphysis of the femoral head. The surgical approach was made over the great trochanter and a trochanteric osteotomy was performed. The capsulotomy was made anteriorly and posteriorly, and the hip was dislocated anteriorly. Using a scalpel and an osteotome, the edges of a trapdoor segment were sharply dissected and the rectangular segment was lifted back to reveal an underlying subchondral tumor. The tumor tissue was thoroughly curetted and autologous cancellous bone was grafted. The trapdoor was replaced without any additional fixation, and the femoral head was reduced. The patient recovered good hip function without pain, and showed no recurrence of chondroblastoma at 5 years after surgery. The trapdoor procedure enabled sufficient access to complete curettage and autologous cancellous bone grafting for the chondroblastoma of the femoral head. This procedure proved to be a useful surgical approach for the treatment of chodroblastoma in the epiphysis of the femoral head in this case.     

降主动脉瘤的腔内移植物治疗

目的 探讨腔内移植物治疗降主动脉瘤的可行性。方法 12例降主动脉瘤接受了血管腔内技术治疗,包括5例真性动脉瘤、6例Stanford B型夹层动脉瘤及1例假性动脉瘤。13枚支架型血管在局部（n=2)或全身麻醉（n=10)下经一侧股动脉切开安装在病变部位。结果 腔内技术成功率100％。无瘤体破裂、截瘫、脏器及肢体缺血等并发症。早期并发症：3例早期内漏血。CT及MRA随访1－30个月：5例真性动脉瘤4例被完全旷置,1例内漏转化为持续性。6例Stanford B型夹层入口4例一期封堵满意,2例少量内漏血自愈,4例假腔内完全血栓形成2,例部分形成。1例假性动脉瘤效果满意。结论 腔内移植物治疗降主动脉瘤是一种安全、可靠、实用的新方法。但其远期治疗效果有待继续观察,尤其是夹层动脉瘤的腔内治疗具有更多的不确定性。     

呼吸对全腔肺动脉吻合术后肺循环血流的影响

目的探讨呼吸对全腔肺动脉吻合术后肺循环血流的影响。方法对15例全腔肺动脉吻合术后的患儿进行超声检查,观察在静息及深呼吸条件下肺循环血流的变化特征。结果应用外管道的患儿,静息状态下,肺动脉为持续性前向血流,血流速为（38.0±2.3）cm/s;深吸气时前向流速增大为（67.0±3.5）cm/s;深呼气时前向流速减小为（26.0±2.3）cm/s,与静息状态时相比,差异均有极显著性意义（P＜0.01）。应用内隧道的患儿,其肺动脉血流同时要受心动周期的影响,静息状态下,上腔静脉为持续性血流,血流速为（42.0±2.1）cm/s;深吸气时流速增大为（71.0±4.3）cm/s;深呼气时流速减小为（21.0±1.0）cm/s,与静息状态时相比,差异均有极显著性意义（P＜0.01）,且无反向血流。应用人工血管外管道的患儿,吸气时,下腔静脉为峰值（37.0±2.3）cm/s的前向血流,呼气时为峰值（33.0±1.7）cm/s的反向血流;应用带瓣的同种血管外管道的患儿,吸气时下腔静脉为峰值（47.0±1.9）cm/s的前向血流,呼气时无前向流,且无明显反向血流。结论呼吸是全腔肺动脉吻合术后肺循环的另一能量来源;带瓣外管道可以减少或完全防止下腔静脉呼气时的反向血流。     

胆囊癌89例临床分析

目的 探讨提高胆囊癌疗效的途径。方法 对１９８５－１９９６年间收治的８９例胆囊癌患者的临床资料进行回顾性分析。结果 ８９例患者中男３１例,女５８例。男：女之比为１：１.８７。胆囊癌合并胆囊结石者占４０％,术前Ｂ超论断符合率为７９％（６２／７８）。ＣＴ诊断符合率为９２％（４３／４７）,术中及术后病理确诊占１８％（１６／７７）。本组７例漏诊,７７例行探查手术,５０例切除胆囊。切除率６５％,其中根治 切除２８例,根治率３6％。本组行根治性切除者１、３、５年生存率分别为７７％、５４％和２７５;行姑息性切除者１、３、５年生存率分别为４１％、１２％和６％（与根治切除相比Ｐ均＜０.０５）。仅行探查术者中位生存期３个月,且均在１年内死亡。结论 早期发现和根治性手术是提高胆囊癌患者生存率的有效方法,避免术中漏诊对预后有重要意义,对晚期胆囊癌应行扩大根治术。     

成人腰椎峡部裂型滑脱症的微创治疗

Objective To investigate the clinical experiences and technical skills of adult isthmic spondylolisthesis. Methods Twenty-one patients with adult isthmic spondylolisthesis underwent minimally invasive surgery. There were 12 men and 9 women, with the mean age of 51.7 years. Isthmic spondylolisthe-sis occurred at the L4.5 in 7 patients, and at the L5S1 in 14 patients. According to Meyerding classification, 13 cases were of Grade Ⅰ, 7 of Grade Ⅱ, 1 of Grade Ⅲ. Under general anesthesia, guiding by fluoroscopy, the surgeries performed minimally invasive microendoscopic(METRx) techniques for posterior decompression, interbody cage fusion and novel Sextant-R percutaneous pedicle screw techniques for deformity reduction and fixation. Results Seventeen cases were followed up 1 year postoperatively. The average low back pain VAS reduced from preoperative 6.0±2.6 to postoperative 2.9±2.5. The average leg pain VAS decreased from preoperative 6.7±3.3 to postoperative 2.8±1.6. The average ODI decreased from preoperative 44.3% to post-operative 27.1%. The Nakai good and excellent rate was 90%. The mean operative time 170 min, blood loss 160 ml, and postoperative stay in bed 7.5 d. The sagittal spondylolisthesis rate significantly decreased from preoperative 35.5%±2.5% to postoperative 8.3%±7.5%. The lordotic angle from preoperative 11.5°±1.7° in-creased to postoperative 16.8°±9.5°; the intervertebral disc height from preoperative (5.4±2.5) mm increased to postoperative (9.1±3.0) mm. According to Lenke judgement for fusion, complete fusion rate was 76%, in-complete fusion rate was 12%, nonfusion rate was 12%. Conclusion The minimally invasive microendo-scopic (METRx) assisted with a novel Sextant-R percutaneous pedicle screw systems for deformity reduction and fixation to treat adult isthmic spondylolisthesis, is not only a minimally invasive and safe surgical tech-nique, also an effective treatment for deformity reduction and fixation.     

Surgical treatment of haemorrhoids by stapled mucosaresection in the lower rectum: Indication, results, side-effects

Summary   Background:A. Longo’s circular staple procedure for the treatment of haemorrhoidal disease has given rise to controversies around the globe. The circular staple procedure enables patients to return to normal activity fairly quickly and is, as far as postoperative pain is concerned, superior to conventional procedures. However, long-term results are missing and possible complications remain under scrutiny. A study of this new operative procedure goes hand in hand with a critical evaluation of all surgical procedures for the treatment of haemorrhoidal disease. Methods: We operated on noduli haemorrhoidales interni (NHI) of all degrees. By means of a circular stapler, a mucosal cuff in the distal rectum is excised and prolapsed haemorrhoids are lifted into the proximal anal canal where they regress. No further operating step is required for additional noduli haemorrhoidales externi and fissures. Marisks and skin tags are ablated separately. Surgery is performed under general anaesthesia, only in rare cases under spinal anaesthesia. Postoperative wound care is not performed. Symptoms and findings were documented in linear, analogue charts and patients were interviewed preoperatively, on the day of surgery, as well as postoperatively on the second and eighth day and after 1, 6 and 12 months. Results: We operated on 258 patients with an age of 51.2 ± 13.3 years. The average length of surgery amounted to 28 (range: 15–55) minutes, patients were admitted as in-patients for 5.7 ± 2.35 days and the median recovery-phase lasted 7 (IQR: 4–10) days. Analgesia was standardised. All patients were given intravenous Tramadolhydrochloride (100–200 mg) postoperatively. 56.3% did not require additional analgesia and the remaining patients were given Tramadol (4.5 ± 2.0 capsules of 50 mg per patient) orally. 11.0% of the patients required additional strong analgesia parenterally. 13.6% developed urinary retention that required to be catheterized. 42 patients (16.6%) developed secondary bleeding and 10 patients (3.8%) required surgery for haemostasis. Urgent bowel movement was encountered as the most common side-effect with 30.0% of the cases. Major complications did not occur. The downstaging of the haemorrhoidal degree was satisfactory. 5 patients underwent postoperative rubber-band ligation for small remaining nodules and one patient required corretive Milligan haemorrhoidectomy. Conclusions:A. Longo’s stapler resection is a reliable therapy for haemorrhoidal disease causing minimal operative strain. It leads to immediate manageability of symptoms and initiates a healing process of the pathological anatomy of haemorrhoids. Rare cases with patients experiencing considerable pain are documented. Secondary bleeding may occur, but is easily suppressed. Urgent bowel movement is the most common and lengthy side-effect, but generally speaking, patients do not consider it impairing. With rare cases, remaining internal nodules have to be corrected by rubber-band ligation. External haemorrhoids regress spontaneously. If considered impairing, marisks and skin tags are ablated separately.