Ipsilateral mid-third clavicle fracture with grade V acromioclavicular joint dislocation

We report the case of a 20-year-old man with an ipsilateral mid-third clavicle fracture with grade V acromioclavicular joint (ACJ) dislocation. The combination of these two injuries is rare. A literature search produced various treatment algorithms. In this case, the patient was successfully treated with a Bosworth screw.This work was carried out in the Department of Orthopaedics, William Harvey Hospital, Ashford, Kent, UK     

成人结肠冗长症的诊治(附42例分析)

目的：探讨成人结肠冗长症的诊断与围手术期处理经验，提高对该病的诊治水平。方法：回顾性分析42例成人结肠冗长症的临床资料，并作了随访观察。结果：32例患者（75．7％）有顽固性便秘，18例患者（42．9％）存在反复不完全肠梗阻，16例患者（38．1％）便秘与腹泻交替出现，以便秘为主。39例经X线钡剂灌肠透视确诊。急诊手术3例，择期手术39例。41例（97．6％）病理检查于镜下可见典型改变。42例均行不同长度的肠段切除，4例加行乙状结肠固定术。术后随访率为83．3％（35／42），28例症状消失，4例仍有症状，保守治疗有效果，3例再次手术，术后症状消失。结论：典型的病史和X线钡剂灌肠可确诊成人结肠冗长症，外科手术是治疗本病的最终有效措施。     

经尿道气化电切治疗前列腺增生

目的 探讨经尿道气化电切术(TUVP)治疗前列腺增生(BPH)的安全性和有效性.方法 对161例前列腺增生患者行TUVP治疗,其中伴全身症状和泌尿系并发症2种以上的高危患者、前列腺重量＞50g的患者共68例.平均年龄72.5岁,经围手术期处理后行TUVP治疗.结果 所有患者均安全度过围手术期.随访3～24个月,平均IPSS从26.6下降至6.6、MFR从6.2ml/s上升到18.6ml/s、PVR从376ml下降到8.9ml.结论 TUVP治疗BPH以及高危重度BPH是安全有效的,强调术中对前列腺尖部采用电切治疗以避免术后尿失禁等并发症的发生.     

残胃癌临床诊治分析

目的分析和总结残胃癌的外科诊断、治疗及预后情况。方法对1990年以来收治的35例残胃癌的发病率、临床表现、治疗情况和预后进行回顾性分析。结果首次胃切除以胃溃疡为主,占65.7%,首次手术BillrothⅡ式占82.9%(29/35)。残胃癌早期缺乏特异的症状,主要为上腹部隐痛不适,首次手术距临床诊断残胃癌的间隔时间平均为16.3年。本组残胃癌手术切除率及根治性切除率分别为77.1%和54.3%,根治性切除患者1、3、5年生存率分为78.9%、52.6%、36.8%,Ⅰ期、Ⅱ期患者的5年生存率为72.7%。结论胃良性病行手术治疗时以BillrothⅠ式为首选,定期胃镜检查是早期诊断残胃癌的关键,根治性切除是治疗残胃癌的有效方法及影响残胃癌预后的重要因素。     

消化道类癌的诊断与治疗(附44例报告)

目的探讨消化道类癌的诊断与治疗. 方法回顾性分析我院1990年1月～2005年4月44例消化道类癌的临床资料. 结果本组44例中直肠(包括直肠乙状结肠交界处)类癌29例发生率最高65.9%(29/44),结肠4例9.1%(4/44),阑尾1例2.3%(1/44),小肠2例4.5%(2/44),十二指肠2例4.5%(2/44),胃5例11.4%(5/44),肝1例2.3%(1/44).44例中治疗了39(39/44,88.6%),其中手术切除14例,内镜下粘膜切除术(EMR)20例(5例EMR后病理断端残余癌细胞又追加手术局部切除),内镜下直接钳除5例,5例未治疗.直径≤1 cm 30例占68.2%, 26例全部治愈,15例(50%)行EMR完全切除,其中20例肠镜随访10～84个月,均无复发,预后好;直径1～2 cm 4例占9.1%,手术局部切除,1例1年后肝转移;直径>2 cm 10例占22.7%,均位于直肠外,8例手术,2例未治疗,3例死亡,5例有远处或淋巴结转移,预后差.44例中6例发生远处或淋巴结转移,转移率13.6%. 结论内镜是诊断消化道类癌的首选方法,≤1cm的类癌可在内镜下行EMR切除.     

腹腔镜辅助小切口甲状腺结节手术的临床应用

Objective To study the feasibility, superiority and experience of minimally invasive laparoscopic-assisted surgery of the thyroid using ultrosonic scalpel. Methods In a period from January, 2006-August, 2008, 56 patients of the department of general surgery, the hospital of Heilongjiang Province were diagnosed as thyroid node. The size of the nodes ranged from 5.0 cm×4.2 cm to 3.5 cm×2.0 cm in uhrosonography. An incision of about 1.5-2.0 cm was made 1.0 cm above the suprasternal notch and the operation was performed with ultrosonic scalpel assisted with laparoscope. Partial thyroideetomy of lateral thyroid was performed in 20 cases, subtotal thyroidectomy in 25 cases, subtotal thyroidectomy of unilateral thyroid and partial thyroidectomy of contralateral thyroid respectively in 1 case, partial thyroidectomy of bilateral thyroid in 10 cases. Results All 56 cases have undergone minimally invasive laparoscopic-assisted surgery successfully in 50-146 min and no complications occurred. Fifty five cases were confirmed to be benign lesion pathologically. Conclusion Laparoscopic-assisted surgery of the thyroid is an effective with a good cosmetic result.     

上颌骨Le Fort I型截骨进路切除巨大鼻咽纤维血管瘤

目的:探讨上颌骨LeFortI型截骨进路切除累及翼腭凹、颞下凹巨大鼻咽纤维血管肿瘤的可行性。方法:采用矫正上颌骨先天或后天畸形的LeFortI型截骨术式进路,切除位于鼻咽部、筛窦等深在部位的纤维血管瘤。结果:该进路术野显露充分,取得了理想的治疗效果。结论:上颌骨LeFortI型截骨进路是切除鼻咽、颅底部纤维血管瘤的理想进路。     

Factors leading to long-term hospitalization after laparoscopic appendectomy.

BACKGROUND: Randomized studies demonstrate that laparoscopic appendectomy yields better results compared with open techniques. We sought to identify factors that determine an extended hospital stay among patients undergoing laparoscopic appendectomy. METHODS: This was a prospective study including 669 patients undergoing laparoscopic appendectomy. We analyzed variables that can predict the length of hospital stay. RESULTS: Of 669 patients undergoing laparoscopic appendectomy, 141 stayed in the hospital for > or = 5 days (Group 1), and 97 stayed in the hospital for < or = 1 day after surgery (Group 2). The univariate analysis demonstrated that fever (P<0.0001), nausea and vomiting (P=0.060), leukocytosis (P<0.0001), gangrened or perforated intraoperative appearance of the appendix (P<0.0001), and appendix position behind the ileocecal junction (P<0.001) were related to a longer hospital stay. The multivariate analysis through logistical regression showed that the factors independently and significantly associated with an extended hospital stay were presurgical fever, appendix position behind the ileocecal junction, and intraoperative gangrened or perforated appearance of the appendix. CONCLUSION: Fever, appearance, and position of the appendix are factors related to an extended hospital stay.     

Surgical treatment of intercostal hernia with implantation of polypropylene mesh

The intercostal hernia of the lung is a very rare extraordinary disease that requires operation because of the complaints and potential complications. The authors review cases of their operations and analyze the subsequence and treatment. Three patients have been treated for intercostal lung hernia in our treatment. The causes of this disease were a previous thoracotomy in one case and fits of coughing in the other two cases. The diagnosis was set up on the grounds of the specific clinical symptoms, thoracic X-ray and CT scan. The hernia was dissolved with percostal stitches and with the suture of the thoracic musculature in two cases. Plastic operation of the thoracic wall by implanting a polypropylene surgical mesh (Prolen, Ethicon, Johnson & Johnson) was performed in the case of the third patient and later in the first two patients due to recrudescence. In one case the authors were constrained to resect the dystelectasial lung in the hernial sac. The three patients had been operated five times. Relapse of hernia was detected in two patients, in whom the intercostal space had been reconstructed with percostal stitches. We did not detect any relapsing in those two patients at 33 and 66 months after the second operation with mesh implantation. The third patient who got mesh implant immediately did not relapse 12 months after the operation. Intercostal lung hernia is an indication of operation. A plastic operation of the thoracic wall combined with the implantation of a surgical mesh is recommended to close the hernial orifice, which is suitable for treating both primary and relapsed hernias. Recurrence is rare in those patients treated with this method.     

干下漏斗部室间隔缺损的外科治疗

４６例干下漏斗部室间隔缺损，占同期室缺手术治疗的２３．２％（４６／１９８）。缺损位于肺动脉瓣下３４例，漏斗部１２例。用带垫片褥式缝合修补２１例，补片修补２５例。全组无死亡。术后直接缝合组有主动脉关闭不全２例、残余分流２例，残留杂音３例。笔者认为，适时手术，选择适当的进路、应用补片修补、正确判断和处理主动脉瓣病变及对合并肺动脉狭窄者予以流出道补片加宽，是提高本病手术疗效的关键。