Endoscopic versus open component separation in complex abdominal wall reconstruction

Background

Open component separation has a high wound complication rate. Newer endoscopic approaches are described with no comparative trials.

Methods

A retrospective review (2005-2009) of patients undergoing open or endoscopic component separation was performed.

Results

Forty-four cases were identified (22 endoscopic; 22 open). All perioperative variables were the same except age (65 open vs 55 endoscopic; P < .05). Hospital length of stay was 11 days in the open group versus 8 days in the endoscopic group (P = .09). Wound complications were 52% in the open group versus 27% in the endoscopic group (P = .09). Wound-related interventions occurred in 45% of the open group and 33% of the endoscopic group. Hernia recurrences rates were similar (open, 32%; endoscopic, 27%; P = .99).

Conclusions

Open and endoscopic components separation have similar rates of recurrence. The endoscopic group had shorter lengths of stay and less major wound complications. The endoscopic approach may be the ideal technique for complex abdominal wall reconstruction.     

复杂性手指离断再植方法的选择

随着人们生活水平的不断提高,患者对断指要求再植的迫切程度以及再植后的功能、外形要求越来越高。但临床上,几乎一半为复杂性断指,由于对部分复杂性断指的认识不足及处理方法不当,仍有不少断指放弃再植或再植后失败,因此复杂性断指再植一直是手外科领域重视的课题。自2003年11     

Diagnostic potential of the peptide‐mediated magnetic separation (PMS)‐phage assay and PMS‐culture to detect Mycobacterium avium subsp. paratuberculosis in bovine milk samples

Controlling the spread of Johne's disease, caused by Mycobacterium avium subsp. paratuberculosis (MAP ), in domestic livestock is challenging. Current diagnostic methods lack sufficient sensitivity to detect subclinically infected animals, and thus, better diagnostic methods are needed. This study was carried out to investigate the diagnostic potential of two novel peptide‐mediated magnetic separation (PMS )‐based tests—a PMS ‐phage assay and PMS ‐culture—both of which have been developed and optimized to detect viable MAP cells in bovine milk. Individual milk samples (50 ml) were obtained from 105 “non‐infected” and 40 “MAP ‐infected” animals (classified as such on the basis of prior faecal culture and serum‐ELISA results) in three dairy herds and tested in parallel by the PMS ‐phage assay and PMS ‐culture. Diagnostic sensitivity (DS e) and specificity (DS p) of the PMS ‐phage and PMS ‐culture methods were determined relative to the MAP infection status of the animal contributing the milk sample. The PMS ‐based tests applied individually showed moderate DS e (PMS ‐culture 0.250 and PMS ‐phage assay 0.325) and high DS p (0.962 and 1.000, respectively). When results of the two PMS ‐based tests were combined, DS e increased substantially to 0.525, and the DS p was calculated to be 0.962. It was concluded that combined application of the PMS ‐phage assay and PMS ‐culture provided the most complete picture regarding the presence of viable MAP in bovine milk samples. A comprehensive validation of the PMS ‐based assays relative to currently used diagnostic methods (faecal culture and serum‐ELISA ) would be the next step in assessment of the diagnostic potential of these novel PMS ‐based methods.     

中药挥发油膜法高效富集的油水分离原理研究及其新型膜分离过程的探索实践

膜分离作为新型化工单元操作,可在温和、低成本条件下实现物质分子水平的“高效、低耗”分离,以膜材料为“芯片”再造分离流程可实现物质分离过程“短流程化”,已成为化学工程的重点研究方向之一。通过总结笔者项目组10多年来将膜技术应用于中药油/水分离过程的研究探索,面向中药产业的绿色发展,提出:通过基础研究与应用研究相结合创制新型膜材料,是实现“用”材料和“优化”材料的关键。因此,将多尺度科学的创新性成果有效应用于膜过程分离原理的揭示,利用膜技术的“高效、节能、降耗”等特征实现中药挥发油生产过程的节能减排,构建以膜分离技术为核心的新型分离过程、分离流程及其专属装备,必将为传统产业关键技术的更新换代、新兴产业重大关键技术的研发提供持续性的支持和引领。      

硬膜外自控镇痛技术在脊柱内镜手术中的应用研究

探讨硬膜外自控镇痛在脊柱内镜手术应用的临床效果。选择120例脊柱内镜手术治疗腰椎间盘突出症患者,随机分为对照组(0.2%罗哌卡因+0.2%利多卡因局麻),0.1%罗哌卡因+舒芬太尼组(0.1%罗哌卡因+0.3 μg/mL舒芬太尼硬膜外自控镇痛),0.2%罗哌卡因+舒芬太尼组(0.2%罗哌卡因+0.3 μg/mL舒芬太尼硬膜外自控镇痛),采用视觉模拟(VAS)评分法评估手术中镇痛效果,采用改良Bromage 评分评估术毕运动神经阻滞程度,统计0.1%罗哌卡因+舒芬太尼组和0.2%罗哌卡因+舒芬太尼组自控镇痛泵(PCA)按压次数和用药量。结果显示0.2%罗哌卡因和0.3 μg/mL舒芬太尼硬膜外自控镇痛应用于脊柱内镜手术,可以达到明显的镇痛效果,满足手术需要,又同时保留患者双下肢运动功能,即有“感觉和运动阻滞分离”现象,从而避免脊柱内镜下马尾神经损伤的可能,值得在临床上推广。     

毛细血管压对阻隔延迟皮瓣存活的影响

在新西兰兔背部形成双蒂阻隔皮瓣，阻隔物为医用硅膜，分别测定皮瓣蒂部，末端及中部三点的毛细血管压力值，结果表明，阻隔皮瓣存活长度随迟延时间增加而增加；阻隔双蒂皮瓣中部毛细血管压低于两蒂部，延迟前4天，中部毛细血管压逐渐增高，断远端蒂后，毛细血管压自蒂部向末端逐渐下降，延迟4天后，各部位毛细血管压均明显增高，延迟14天后其存活端毛细血管压值低于即刻皮瓣存活端，提示阻隔延迟明显提高了皮瓣的毛细血管压，阻隔双蒂皮瓣断蒂后其毛细血管压与皮瓣存活距离存在着线性关系，随压力增大而增大。     

腰椎椎体后缘离断症的影像学诊断与探讨

目的 :总结腰椎椎体后缘离断症的影像学诊断特点并探讨其价值。方法 :对 3 2例经手术证实的腰椎椎体后缘离断症患者的影像学表现进行回顾性分析。结果 :3 2例中X线平片显示腰椎椎体后缘离断症 2 1例 (65 6% )、CT平扫显示 3 2例 (10 0 % ) ,行MRI检查 2 1例 ,显示 2 0例 (95 2 % )。结论 :CT平扫是腰椎椎体后缘离断症最可靠的诊断方法 ,MRI可显示髓核退变后突和硬膜囊受压的程度 ,X线平片则是检查的基本方法     

免疫磁珠分离及流式细胞仪分选纯化外周血CD34+/CD90+干细胞

目的　建立人外周血CD34 细胞及其亚群的纯化分离方法。方法　用干细胞采集仪收集了 3例病人的外周血干细胞 ,应用免疫磁珠分离柱快速分离其中的CD34 细胞 ,随后采用分选型EPICSElite流式细胞仪进一步分选出CD34 /CD90 双阳性早期造血干细胞。结果　免疫磁珠分离纯化后CD34 干细胞的纯度可达 83%～ 95 % ,回收率 5 4 %～ 71% ,活细胞率 >95 %。流式细胞仪分选后的CD34 /CD90 细胞纯度可达 90 %以上 ,回收率在 4 0 %～ 5 0 % ,生存率 >95 %。起始标本中CD34 细胞含量越高 ,纯化所得到的干细胞纯度和回收率越高。两种纯化后的干细胞在形态学上有明显的不同。结论　联合应用免疫磁珠分离和流式细胞仪分选 ,可以较高的回收率快速纯化高纯度的CD34 细胞及其亚群     

组织结构分离技术在疝外科中的临床应用

近年来,腹壁组织结构分离技术在国内外主要被应用于腹壁缺损的修补与腹壁重建中,特别是针对腹壁巨大缺损的修补,而联合应用腹腔镜微创技术以及人工合成补片更体现出该技术在腹壁重建中的优势.本文着重就组织结构分离技术的手术原理、适应证、优势、操作方法、并发症及相关应用进展作一综述.     

贴壶腹钝性分离法在冰冻Calot三角腹腔镜胆囊切除术中的应用

目的:探讨贴壶腹钝性分离法在冰冻Calot三角腹腔镜胆囊切除术(laparoscopic choelcystectomy,LC)中的应用价值。方法:回顾分析2006年4月至2012年4月应用贴壶腹钝性分离法为136例冰冻Calot三角患者行LC的临床资料。结果:126例成功完成LC,手术时间40～95 min,平均52.1 min;术后腹腔引流管引流出淡红色或淡黄色渗液,引流量30～120 ml/d,平均62 ml/d;引流管拔除时间1～4 d,平均2 d;术后下床活动、进食时间与普通LC相同,均为术后第1天;术后住院4～7 d,平均5 d;全组未发生肝外胆管损伤及手术死亡,3例(2.20%)术后轻微胆漏经保守处理治愈。2例(1.47%)意外胆囊癌、3例(2.20%)术后胆囊管残留结石患者再次行开腹手术;5例(3.68%)因结石嵌顿剥破胆囊管而中转开腹。结论:LC术中遇Calot三角解剖不清(冰冻Calot三角)时应用贴壶腹钝性分离法可预防胆管损伤、减少中转开腹,扩大了LC的手术适应证,值得有经验的术者推广应用。