经尿道前列腺电汽化联合撬拨术治疗高龄前列腺增生症

目的探索微创手术治疗高龄前列腺增生症(benign prostatic hyperlasia,BPH)的安全有效新方法. 方法采用经尿道前列腺电汽化(transurethal vaporiyation of prostate,TUVP)联合撬拨术治疗80岁以上BPH 68例. 结果手术时间30～160 min,平均60 min,切除腺体重量12.5～98.5 g,平均37.6 g,术中出血量30～120 ml,平均65 ml,术后住院5～7 d,平均6 d.术后随访0.5～2年,国际前列腺症状评分由(23.5±4.2)分降至(6.5±2.1)分,生活质量评分由(4.6±0.6)分降至(2.2±0.2)分,最大尿流率由(8.7±4.3)ml/s升至(18.0±2.2)ml/s,剩余尿由(176.0±86.7)ml降至(12.2±2.4)ml.与术前相比,术后6个月均得到显著改善(P＜0.01). 结论 TUVP加撬拨术治疗高龄BPH安全有效,并发症少.     

Ilizarov技术矫正儿童僵硬型马蹄内翻足畸形

[目的]探讨Ilizarov技术矫正僵硬性马蹄内翻足畸形的方法和效果。[方法]作者在2000年3月～2005年3月间，使用Ilizarov技术矫正9例11足重度僵硬性马蹄内翻足畸形，将连接于胫骨、跟骨、跖骨的外固定环互相连接、组合成复杂的三维外固定架，通过逐渐调整外固定架矫正畸形，从而使患足达到或接近正常足的外形和功能。[结果]按Garceau标准评定疗效，优6足，良4足，差1足。[结论]Ilizarov外固定架三维矫正马蹄内翻足畸形效果确实，尤其适用于大年龄儿童之僵硬、复发或难治性马蹄内翻足，有一定的临床应用价值。     

胆道镜在腹腔镜胆总管切开取石中的应用技巧

目的探讨胆道镜在腹腔镜胆总管切开取石术中的应用技巧。方法回顾性分析32例胆道镜在腹腔镜胆总管切开取石术中应用的临床资料。结果32例腹腔镜胆总管切开取石术均成功完成，无中转开腹。除胆道残余结石外没有其他并发症。结论胆道镜在腹腔镜下的应用技巧的掌握有利于提高胆道镜取石的效率和效果，有助于腹腔镜胆总管切开取石术的顺利开展。     

Ilizarov牵伸技术在外伤性垂足治疗中的应用

[目的]探讨应用Ilizarov牵拉技术治疗外伤性垂足的疗效。[方法]自2004年12月~2006年2月采用Ilizarov技术治疗8例外伤性垂足患者,其中男5例,女3例;年龄28~52岁,平均34.6岁。垂足产生原因小腿胫前外侧肌群断裂或缺损3例,小腿骨筋膜室综合征2例,腓总神经损伤2例,股骨髁上骨折并腘动脉断裂1例。踝关节强直范围为跖屈50°~65°。术中将准备好的牵拉架套入小腿及足部的相应位置。在钢环对应平面交叉穿入2mm克氏针并固定于Ilizarov牵拉架上,术后3~5d开始以1~2圈/d,4次/d的速度旋转踝关节前、后方的调节螺纹杆,使足环带动患足逐渐背伸,使垂足畸形逐渐得以纠正。当垂足提拉达到或超过中立位后停止牵拉,但继续使用牵拉架固定2~3个月以巩固疗效。[结果]所有患者均获随访,随访时间为10~21个月,平均12.5个月。患足均矫正至中立位,有3例患者踝关节可主动背伸至10°,行走功能均良好。有1例患者1个针道发生感染,经输用抗生素,加强针道护理,保证针道引流通畅,感染逐渐控制。无1例发生皮肤坏死、神经、血管损伤等并发症。全部患者垂足畸形无复发。[结论]应用Ilizarov牵拉技术治疗外伤性垂足较以往的治疗方法有明显的先进性,值得推广。     

Conventional 4-field box radiotherapy technique for cancer cervix: potential for geographic miss without CECT scan-based planning

BACKGROUND: The advantage of 4-field radiation to the pelvis is that the use of lateral portals spares a portion of the small bowel anteriorly and rectum posteriorly. The standard lateral portals defined in textbooks are not always adequate especially in advanced cancer cervix. METHODS: An analysis was done to determine adequacy of margins of standard lateral pelvic portals with CECT defined tumor volumes. The study included 40 patients of FIGO stage IIB and IIIB treated definitively for cancer cervix between 1998 and 2000. An inadequate margin was defined if the cervical growth and uterus were not encompassed by the 95% isodose. RESULTS: An inadequate posterior margin was common with bulky disease (P = 0.06) and with retroverted uterus (P = 0.08). Menopausal status, FIGO stage, associated myoma, and age were of no apparent prognostic significance. Bulk retained significant on multivariate analysis. An inadequate anterior margin was common in premenopausal (P = 0.01); anteverted uterus (P = 0.02); associated myoma (P = 0.01); and younger patients (P = 0.03). It was not influenced by bulk or stage. Menopausal status and associated myoma retained significant on multivariate analysis. CONCLUSION: Without the knowledge of precise tumor volume, the 4-field technique with standard portals is potentially risky as it may under dose the tumor through lateral portals and the standard AP/ PA portals are a safer option.