经肛门入路Soave手术治疗先天性巨结肠(附9例报告)

目的:总结经肛门入路Soave手术治疗先天性巨结肠的经验体会.方法:采用经肛门入路Soave方式行先天性巨结肠根治术9例.结果:全部病例手术顺利,术后无大便失禁、肛门狭窄及复发等并发症.结论:经肛门入路Soave手术治疗先天性巨结肠具有创伤小、恢复快等优点,临床应用时应掌握其适应证.     

腹腔镜腹股沟疝修补术(附38例报告)

目的:探讨腹腔镜经腹膜腹股沟斜疝无张力修补术(transabdominal preperitoneal prosthesis,TAPP)的安全性和有效性。方法:38例腹股沟疝患者均采用TAPP治疗,其中直疝9例,斜疝21例,股疝1例,双侧疝2例,复发疝5例。结果:所有患者均手术成功,平均手术时间(40.3±15.8)min,平均住院时间(5.4±1.6)d,随访0.5~3年,均未复发。结论:TAPP是治疗腹股沟疝安全有效的方法。     

腹腔镜治疗小儿疝及鞘膜积液180例报告

目的：探讨腹腔镜治疗小儿腹股沟斜疝及交通性鞘膜积液的新方法。方法：行腹腔镜手术治疗小儿腹股沟斜驰及交通性鞘膜积液180例,其中小儿腹股沟斜疝150例,右侧80例,左侧40例,双侧30例;单侧斜疝中20例有对侧隐性疝;交通性鞘膜积液30例,右侧20例,左侧10例。均在腹腔镜下行内环口荷包缝合高位结扎术＋积液抽出术。结果：手术时间单侧疝平均5-10min,双侧疝10～20min。术后平均1．5d出院,皮肤切口无需缝线。无并发症发生。随访6～24个月,平均12个月,未见复发。结论：腹腔镜下内环口高位结扎术＋积液抽出术具有安全有效、创伤小、无瘢痕、康复快、住院时间短、操作简便、无需特殊器械等优点,无阴囊感染、睾丸扭转及缺血坏死、切口感染、髂腹沟及髂腹下神经损伤、腹股沟区疼痛麻木等并发症发生,疗效满意。     

Inguinal hernia is a common complication in lower midline incision surgery

Inguinal hernia is a known complication after radical retropubic prostatectomy (RRP). We have investigated whether other types of lower midline incision surgery in males increase the risk of inguinal hernia. Male patients operated with open prostatectomy for benign prostate hyperplasia (n = 95), pelvic lymph node dissection for staging of prostate cancer (n = 88), or cystectomy for bladder cancer (n = 76) were identified and were sent questionnaires in which they were asked about postoperative inguinal hernia morbidity. Two-hundred and seventy-one men operated with RRP had previously received a similar questionnaire. The answers were compared with those from a control group of 953 men who had not undergone surgery. Annual attributional hernia morbidity and Kaplan–Meier hernia-free survival were calculated. The cumulative incidence of post-operative inguinal hernia and annual attributional hernia morbidity after the respective surgical procedures were clearly higher during the early years post-operation than for nonoperated patients. Inguinal hernia is a common postoperative complication in males after all the lower midline incision surgery investigated.     

Internal Hernias: Clinical Findings,Management, and Outcomes in 49 Nonbariatric Cases

Internal hernia, the protrusion of a viscus through a peritoneal or mesenteric aperture, is a rare cause of small bowel obstruction. We report the clinical presentation, surgical management, and outcomes of one of the largest series of nonbariatric internal hernias. Ten-year retrospective review of patients at our institution yielded 49 cases of internal hernias. Majority of patients presented with symptoms of acute (75%) or intermittent (22%) small bowel obstruction. While 16% of CT scans were suspicious for internal hernia, in no cases the preoperative diagnosis of internal hernia was made. The most frequent internal hernias were transmesenteric (57.0%) and 34 hernias (69%) were caused by previous surgery. All internal hernias were reduced and the defects were repaired. Compromised bowel was present in 22 cases and 11 patients underwent small bowel resection. The mean postoperative hospitalization was 10.9 days. The overall mortality rate from our series is 2%, and the morbidity rate is 12%. Transmesenteric hernias, as complications of previous surgeries, are the most prevalent internal hernias. Preoperative diagnosis of internal hernia is extremely difficult because of the nonspecific clinical presentation. However, if discovered promptly, internal hernias can be repaired with acceptable morbidity and mortality. Poster presentation at Digestive Disease Week, May 22, 2006, Los Angeles, California, USA.     

经鼻蝶窦手术动物模型神经内镜手术训练

目的建立一种活体动物的神经内镜经鼻蝶手术模拟训练方法。方法选择大鼠，建立一套训练计划，完成内镜图像导引下的内镜操作，电凝止血、冲洗和吸引、活检等神经内镜经鼻蝶手术的基本技巧。结果利用大鼠颅脑进行模仿内镜经鼻蝶手术，如在内镜图像导引下操作内镜的方法；熟悉内镜系统、电凝系统、冲洗和吸引设备的使用；熟悉了神经内镜经鼻蝶手术的步骤。结论作为神经内镜实验室训练的重要组成部分，通过利用大鼠颅脑进行模拟神经内镜手术，训练者可以从中获得神经内镜操作基本技巧的练习。     

柱状吊扎加消痔灵注射外痔剥离治疗老年混合痔的疗效观察

为了探讨柱状吊扎加消痔灵注射外痔剥离治疗老年混合痔的临床疗效,将121例老年混合痔患者分为治疗组（61例）和对照组（60例）。治疗组采用柱状吊扎加消痔灵注射,外痔切除;对照组采用外剥内扎术加消痔灵注射。术后对创面愈合时间、疼痛程度等进行比较。结果显示,治疗组住院时间为（9．7±2．9）d,疼痛消失时问平均为（90．8±28．8）h;对照组住院时间为（10．9±3．3）d,疼痛消失时间平均为（104．2±37．5）h。结果表明,柱状吊扎加消痔灵注射外痔剥离是治疗老年混合痔较好的术式之一。     

分段外剥内扎保留齿状线加肛垫悬吊术治疗环状混合痔36例临床观察

为避免过多损伤肛垫,保护齿状线功能,提高外科手术治疗环状混合痔的疗效,减少并发症和后遗症,采用分段外剥内扎保留齿状线加肛垫悬吊术治疗环状混合痔36例。结果显示,治愈33例（91．7％）,好转3例（8．3％）,有效率100％。随访半年,均无复发,无肛门狭窄及肛门失禁,肛门功能正常。结果表明,分段外剥内扎保留齿状线加肛垫悬吊术对肛垫及肛管皮肤损伤小,保留了齿状线的功能,对患者排便反射功能影响小,治疗比较彻底,并发症及后遗症少,临床疗效满意。     

主灶切开支管剥离缝合治疗蹄铁型肛瘘82例疗效观察

为探讨蹄铁型肛瘘的治疗方法,采用主灶切开、支管剥离缝合治疗蹄铁型肛瘘82例。结果显示,82例全部治愈,术后无肛门失禁,随访2年无复发。结果表明,主灶切开、支管剥离缝合治疗蹄铁型肛瘘,对瘘管进行充分剥离,术中对肛门括约肌分层缝合,达到了治疗目的,保证了肛门括约肌的完整性,防止了肛门失禁,提高了疗效。     

内扎外切弧形缝合加肛门切扩术治疗环状混合痔的临床应用研究

为观察内扎外切弧形缝合加肛门切扩术治疗环状混合痔的临床疗效,将200例环状混合痔患者随机分为两组。治疗组100例采用内扎外切弧形缝合加肛门切扩术;对照组100例采用传统外剥内扎术并进行对比观察。结果显示,治疗组与对照组治愈率分别为94％和80％（P〈0．01）,两组间的术后住院时间、创面愈合时间、肛缘水肿、肛门狭窄及术后复发率存在显著性差异（P〈0．01或P〈0．05）。结果表明,治疗环状混合痔时,内扎外切弧形缝合加肛门切扩术具有治愈率高、复发率低等优点,呵减少环状混合痔术后肛门狭窄、肛缘水肿等并发症的发生。