结肠癌急性梗阻一期切除吻合术中不灌洗肠腔的探讨

研究一种结肠癌急性梗阻一期切除吻合的更简单、合理、安全的术中处理方法。方法肠切开减压后，用左右手交替挤压法清洁肠道，不灌洗肠腔、使肠吻合后吻合口处持续有少许较稀薄的肠内容物通过。结果采用本方法清洁肠道一期切除吻合的结肠癌急梗阻更３８例，术后无一例发生吻合口漏。     

The failed probing

The management of failed probing for congenital nasolacrimal duct obstruction is given by a panel of authors. Treatment options examined are repeat probing, inferior turbinate infracture, closed lacrimal intubation and dacryocystorhinostomy. There is considerable variation as to the timing of these interventional techniques.     

Haemangioma of the nasal bone

A 16 year-old female presented for her cosmetic deformity with a slowly progressing swelling of insidious onset on the upper part of the bridge of the nose slightly towards the left side for 3 year duration. Clinical & radiological examination revealed an intra-osseous tumor of nasal bone. Histopathologically the tumor was a cavernous haemangioma of nasal bone. A follow up study upto 13-year showed no recurrence. A detailed search of world literature is carried out with clinical history & history of trauma. It could that nasal bone haemangioma is separate disease entity. The patients usually seek advise for their cosmetic deformity & sometime for nasal bleeding.     

Single layer anastomosis in the upper gastrointestinal tract

A total of 466 single layer upper gastrointestinal anastomoses were made in 349 patients during an 11-year period. Six (1.3 per cent) anastomoses leaked. Radiological leakage was seen in one of 24 (4.2 per cent) oesophagogastric/jejunal anastomoses. There were no leaks after 66 gastrojejunal anastomoses; one of 84 (1.2 per cent) gastroduodenal anastomoses leaked and was converted to a gastrojejunal anastomosis. Two of 121 (1.7 per cent) biliary-enteric anastomoses leaked and both were successfully managed without reoperation. Two of 171 (1.2 per cent) enteroenteric anastomoses leaked, both in patients with established intraperitoneal sepsis which proved fatal. Of the 349 patients, 13 (3.7 per cent) died in hospital or within 30 days of operation but in only two was anastomotic leakage implicated. Single layer appositional upper gastrointestinal anastomoses are simple, safe and economic.     

功能性单心室的外科治疗

目的 为了使更多的先天性心脏病患者得到纠治，回顾性总结手术治疗功能性单心室的临床经验。方法 手术纠治127例功能性单心室患者，年龄7个月－12岁，体重7．5－39kg，其中丰唐手术（Fontan operation)72例，半Fontan术3例，双向上腔静脉肺动脉吻合术51例，肺动脉环缩术1例。结果 早期Fontan术19例，死亡11例；改良Fontan术53例，死亡10例；半Fontan术死亡1例；双向上腔静脉肺动脉吻合术死亡4例；总手术死亡率20．5％。结论 功能性单心室必须早期得到纠治，控制肺动脉血流，预防严重缺氧。双向上腔静脉肺动脉吻合术能减少功能性单心室的容量负荷，保持足够的心排血量。改良Fontan术是功能性单心室的最佳手术方案。     

ASA disease: the clinical relationship of nasal polyposis to ASA intolerance

Summary We studied the complex relationship between nasal polyposis and ASA (acetylsalicylic acid) intolerance in 154 patients with nasal polyps. The clinical histories of all patients were reviewed, and diagnostic tests for immune or allergic causes and the responsiveness of patients to challenges with ASA-substitutive drugs were analyzed. A third of our patients tested were found to have positive personal histories of atopy and 35% showed ASA intolerance. Although 40% had bronchial asthma, only 16.8% of all patients had positive tests for allergy. We were unable to find a specific mechanism to explain the relationship between nasal polyposis and ASA intolerance and further investigations are still required.     

The use of circular stapler for cervical esophagogastric anastomosis after esophagectomy: surgical technique and early postoperative outcome

Stapled esophagogastric anastomosis after esophagectomy is considered to be superior to traditional handsewn techniques. Linear staplers are usually used. The aim of this study is to evaluate early postoperative results of circular stapler in cervical esophagogastric anastomosis. Records of all patients who underwent esophagectomy during the years 2003–2008 were reviewed. Patients that underwent transthoracic esophagectomy, colon transposition, or linear stapler anastomosis were excluded. Esophagogastric anastomosis was done either handsewn or using circular stapler. Patients underwent either pyloromyotomy, pyloroplasty, or no pyloric intervention. Postoperative leakage was diagnosed either clinically or radiologically. The end-point of this study was the incidence of anastomotic leak in the immediate postoperative period. Eighty-two patients (average age 66 years, male/female, 52/30) met the inclusion criteria. In 30 patients, the anastomosis was handsewn, and in 52 patients, it was done using a circular stapler. Overall operative mortality rate was 4.8% (four patients because of pulmonary or cardiac complications). Anastomotic leak occurred in five ( n  = 5, 16.6%) patients in the handsewn group and eight ( n  = 7, 13.4%) patients in the circular stapler group. Pyloric manipulation had no significant effect over the leakage rate. Routine upper-gastrointestinal (GI) series done on the fifth or sixth postoperative day did not reveal any of the leaks. Cervical esophagogastric anastomosis using an end-to-side circular stapler is feasible and safe, and has comparable outcomes to handsewn anastomosis in regard of leakage rates or other major surgical or general complications. Postoperative GI series seems to be a poor diagnostic tool for anastomotic leakage and could be omitted as a routine study for occult anastomotic leak.     

Diagnosis of complete Cul‐De‐Sac obliteration (CCDSO) by the MRI jelly method

Purpose

To evaluate the usefulness of MRI jelly method (jelly method).

Materials and Methods

Fifty‐five patients (32.7 ± 5 years old) with endometriosis, treated with laparoscopic surgery between January and June 2005 with preoperative MRI using the jelly method. In imaging by the jelly method, 50 mL of jelly used for ultrasound was injected into the vagina, and 150 mL of jelly diluted twice with tap water was injected into the rectum. MRI were inspected for the following seven findings: (Finding 1) Uterine position (anteflexion or retroflexion); (Finding 2) Thickness of the posterior uterine wall (adenomyosis uteri); (Finding 3) Ascites in the Douglas' pouch; (Finding 4) Elevated posterior uterine fornix; (Finding 5) Thickening of the “Haustra”; (Finding 6) Elevated anterior rectal wall; and (Finding 7) Douglas' pouch lesion visualized as a high‐intensity area on a T1‐weighted image. The latter four findings were enhanced with the jelly method. These seven findings were examined for their correlations with video findings of adhesion during surgery.

Results

CCDSO was present in 30 of 55 patients. These seven findings had accuracies of 69.1%, 70.9%, 72.7%, 74.5%, 56.4%, 83.6%, and 81.8% respectively. Findings 6 and 7 showed high accuracy.

Conclusion

These two findings could only be obtained using the jelly method, indicating the usefulness of this method for diagnosing CCDSO. J. Magn. Reson. Imaging 2009;29:365–370. © 2009 Wiley‐Liss, Inc.     

同期整复鼻畸形伴鼻中隔偏曲治疗方法探讨

目的探讨安全有效地治疗鼻畸形伴鼻中隔偏曲的手术方法和效果，方法采用鼻外进路，保留鼻中隔软骨，矫正鼻中隔偏曲，联合单面骨膜带蒂骨瓣折骨法处理骨锥畸形。结果59例患者鼻畸形伴鼻中隔偏曲均1次矫正，随访1～6年无复发和并发症。结论本手术方法具有视野大、操作方便等优点。鼻畸形伴鼻中隔偏曲患者均可通过鼻中隔鼻整形术同期矫正，收到外鼻美容与鼻腔通气功能恢复的双重效果，