带血管蒂肠浆肌层环贴术防治肠瘘

本文报导用带蒂血管肠浆肌层环贴术防治各种复杂肠瘘,经过十一年的临床观察,疗效满意。本文还着重介绍了手术方法及操作过程中应注意的问题。     

A DEBT TO ALEXIS: THE BEAUMONT-ST MARTIN STORY

This paper is based on the book Experiments and Observations on the Gastric Juice and the Physiology of Digestion, originally published in 1833. The book held in the Cowlishaw Collection of the Royal Australasian College of Surgeons is the Edinburgh edition of 1838, which contains a preface by Andrew Combe, MD. The paper explores several aspects of the BeaumontSt Martin story, from St Martin's original injury and the primary care undertaken by Dr William Beaumont, whose numerous studies of the actions and reactions of the stomach were made possible because St Martin was left with a permanent gastric fistula. While the debt we owe to Beaumont is often acknowledged, patients are not mere machines and surgeons must recognize that surgery also owes a debt to its patients; in this case, to Alexis St Martin for what he permitted by way of experiment.     

Primary aortoduodenal fistula caused by duodenal tuberculosis without an abdominal aortic aneurysm: Report of a case

A 66-year-old man died of massive gastrointestinal hemorrhage caused by a fistula between the third portion of the duodenum and the abdominal aorta. An autopsy revealed that duodenal tuberculosis had resulted in the development of a fistula into the aorta with no pathological changes, and no active pulmonary tuberculosis was found. Duodenal tuberculosis and primary aortoduodenal fistula (ADF) without an aneurysm are both extremely rare. Thus, we report herein a unique case of primary aortoduodenal fistula without an abdominal aortic aneurysm, but associated with duodenal tuberculosis, and review the current literature.     

Activity of lateral vestibular nucleus neurons during locomotion in the decerebrate Guinea pig

Summary The influence of locomotor activity upon neurons in the lateral vestibular nucleus was investigated in precollicularly-postmamillary decerebrate guinea pigs. Out of 95 recorded neurons, 24 were identified as vestibulospinal and 71 had no descending projections. Locomotor activity occurred either spontaneously or was prompted by electrical stimulation of the mesencephalic locomotor region. Natural vestibular stimulation was supplied by tilting the animal about its longitudinal axis. Locomotor rhythmic limb muscle activity was accompanied by an increase in the firing frequency in the vast majority of investigated neurons. The increase in frequency was observed at the beginning of ipsilateral forelimb extensor muscle activity. Only in a few non-vestibulospinal neurons was the spontaneous activity depressed during locomotion. An increase in evoked responses was observed in almost all vestibulospinal neurons and in two thirds of the neurons without descending projections. A decrease in evoked responses was observed in one quarter of non-vestibulospinal neurons. During locomotion, the mean and maximal frequencies of evoked neuronal impulse activity changed, but the phase lag of these changes was not altered significantly. The results suggest an enhancement of vestibulospinal influences during locomotion, thus providing a high level of tonus in antigravitational muscles. This is interpreted as a mechanism to ensure that equilibrium is maintained during motion in different gaits and postures.     

Rupture of an isolated internal iliac artery aneurysm into the rectum: Report of a case

Aneurysmal rupture into the intestinal tract is a rare but disastrous complication of an internal iliac artery aneurysm. We report herein the successful surgical repair of a fistula between a huge aneurysm of the right internal iliac artery and the rectum in an 81-year-old man. After a femoro-femoral cross-over bypass had been performed, the aneurysm was opened and its patent arterial branches were ligated with sutures. The fistula was then intra-aneurysmally sutured and covered with an omental flap. The diagnostic and therapeutic approaches to this severe complication are discussed with a review of the literature following the presentation of this case.     

经单侧椎板开窗夹闭硬脊膜动静脉瘘

目的　总结经单侧椎板开窗入路夹闭硬脊膜动静脉瘘的经验。方法　回顾性分析了 5 6例经脊髓MR和脊髓血管造影确诊的硬脊膜动静脉瘘患者经单侧椎板开窗夹闭瘘口的临床资料。结果　 5 4例患者术后行脊髓血管造影复查 ,显示瘘口全部消失。 38例患者术后 6个月行脊髓MR复查 ,显示脊髓周围的血管流空影完全消失 ,T2 像髓内高信号影消失或明显减少。 5 4例患者获随访 ,随访时间 3～ 36个月 ,2 4例症状完全消失 ,2 7例症状改善 ,3例无变化。结论　经单侧椎板开窗夹闭瘘口的手术方法是硬脊膜动静脉瘘的首选治疗方法。     

Recognition and management of patients with high-risk vesicovaginal fistulas: Implications for teaching and research

Vesicovaginal fistulas (VVFs) occurring as a result of obstetric trauma are a vast problem in Nigeria and Ghana, where at least 20 000 women await repair, and fewer than 50 physicians have the necessary expertise. Through a series of conferences those VVFs that are at high risk and those at low-risk for repair failure, were identified. A clinic was established where repair of low-risk VVFs was done on an ongoing basis in a remote region of Ghana. A visiting surgical team was utilized to repair the difficult, or high-risk, VVFs, which included 4–6 cm VVFs (3), recurrent VVF (1), combined VVF and RVF (rectovaginal fistula), a large 5 cm juxtacervical VVF (1), and a vesicouterine fistula (1). Management of these patients and others with VVF repair complications is discussed.     

TOTAL LARYNGECTOMY WITH PRIMARY VOICE RESTORATION

Forty-three patients were prospectively studied following tracheo-oesophageal puncture at the time of laryngectomy (primary voice restoration). Blom-Singer voice prostheses were used. The surgery was regarded as successful if a patient continued to use the voice prosthesis as the major means of communication with clear intelligibility 4 months after the operation. Using this criterion, the success in this series was 70%. No attempt was made to assess the quality of speech. Complications and causes of failure are discussed.     

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目的 探讨外伤性十二指肠损伤的处理及影响预后的因素。方法 对1992年1月至2002年月1月收治的32例外伤性十二指肠损伤病例的临床资料进行回顾性分析。结果 术前确诊19例(59．4％)，漏诊13例(40．6％)；治愈29例(90．6％)，死亡3例(9．4％)；发生并发症9例(28．1％)。十二指肠瘘是主要的并发症。结论 简单而合理的手术方式是治疗十二指肠损伤的重要措施。早期手术，有效的十二指肠减压和术后肠外营养是影响预后的主要因素。     

多层螺旋CT血管成像诊断颈动脉海绵窦瘘

目的探讨颈动脉海绵窦瘘(CCF)的解剖病理基础及螺旋CT血管成像(MSCTA)表现,提高MSCTA对CCF的诊断能力。方法12例经DSA证实的CCF均进行了螺旋CT平扫、增强扫描及血管成像重建。结果CCF的MSCT及CTA表现为:海绵窦扩大及眼上静脉扩张12例,并与颈内动脉同时显影;其他属支静脉扩张6例;对侧海绵窦扩大4例,与DSA检查结果一致。患侧眼球突出12例。颅底、眶壁骨折5例。眼球壁模糊、增厚5例。脑挫伤、出血4例。眼外肌增粗1例。结论螺旋CT及其血管成像诊断CCF简单、快捷、准确、可靠,特别是在外伤性CCF中,是首选的检查及诊断方法。