国产吻合器行痔上黏膜环切术的并发症及应用价值

目的：探讨国产吻合器痔上黏膜环切术（PPH）的并发症及应用价值。方法：总结吻合器痔上黏膜环切术治疗严重Ⅱ度、Ⅲ度、Ⅳ度痔病63例的临床资料。结果：手术时间10-20min，术后平均住院2～5d，无肛门狭窄、无肛门失禁、无复发等并发症。结论：国产痔吻合器是治疗重度痔的一种安全有效方法，创伤少，并发症少，价格低廉，有望替代传统的痔切除术。     

Apical vault repair, the cornerstone or pelvic vault reconstruction

Pelvic organ prolapse remains a difficult problem for pelvic reconstructive surgery. Before new surgical procedures can be developed a good understanding of pelvic anatomy is necessary. It is widely held that the etiology of pelvic organ prolapse is secondary to stretch neuropathy following childbirth and chronic cough or constipation. Several transvaginal and transabdominal procedures have been developed over the years. With the increasing use of laparoscopy, a new variation on existing culdeplasty techniques has been developed. Following anatomical principles, the apical vault repair reestablishes the pericervical ring at the vaginal apex. The incorporation of pubocervical fascia, uterosacral-cardinal ligament and the rectovaginal fascia provides a strong anchor for the vaginal apex. In addition, the repair should help prevent future transverse cystocele, rectocele, enterocele and apical vault prolapse. Early outcome studies suggest that the apical vault repair should be used routinely with laparoscopic urethropexy, laparoscopic hysterectomy and the repair of pelvic organ prolapse. Good apical vault support is considered the cornerstone of pelvic reconstruction.     

吻合器痔上黏膜环切治疗直肠内脱垂的效果

①目的探讨直肠内脱垂的有效治疗方法。②方法对11例直肠内脱垂的病人行吻合器痔上黏膜环切术(PPH)，术后随访1～12个月。③结果全部病人术后均排便通畅，排便时间明显缩短，无明显手术并发症。④结论PPH治疗直肠内脱垂，手术操作简便、安全、疗效可靠，病人痛苦小、恢复快、并发症少，是一种值得推广的治疗方法。     

Transesophageal Echocardiographic Analysis of the Systolic Pattern of the Anterior Mitral Leaflet in Patients with Flat Chest

Transesophageal echocardiography was conducted to determine the systolic pattern of the anterior mitral leaflet in patients with flat chest, and to differentiate it from that associated with mitral valve prolapse. The fronto-sagittal index (an index of chest flattening) was determined in 50 subjects using chest radiographs, and was used to classify them into a flat chest group (index < 0.38, n = 28) and a normal chest group (index ≥ 0.38, n = 22). We then used transesophageal echocardiography to examine the anterior leaflet in these subjects. A significant positive correlation was observed between the fronto-sagittal index and the short-to long-axis diameter ratio of the left ventricle in all patients. These parameters, and the left atrial dimension were lower in the flat than the normal chest group. The clear zone area of the anterior leaflet during mid-to late-systole was significantly larger in the flat chest group. However, no intergroup differences existed in the rough zone area of the anterior leaflet or in the middle scallop area of the posterior leaflet. Mitral regurgitation was observed in 20 and 12 subjects in the flat and normal chest groups, respectively. The maximum mitral regurgitant area did not differ between the two groups. The clear zone area of the anterior leaflet increased significantly following inhalation of amyl nitrite in 22 subjects of both groups, but the other areas did not increase. The mitral regurgitant area decreased or disappeared after amyl nitrite at a similar rate in each group. Thus, the decrease in the antero-posterior dimension of the thorax in subjects with flat chest affects the systolic pattern of the clear zone of the anterior leaflet more than that of the rough zone of the anterior leaflet or the posterior leaflet. This systolic pattern in such patients differs from that associated with mitral valve prolapse.     

Ca2+-and voltage activated K+ channel in apical cell membrane of gallbladder epithelium fromTriturus

The presence of Ca²⁺- and voltage-activated K⁺ channels was directly demonstrated in the apical cell membrane of gallbladder epithelium by patch-clamp single-channel current recording. In K⁺-depolarized epithelial cells, negative pipette potentials induced outward current steps when the patch-pipette was filled with Na⁺-rich solution and these current steps were not affected by the presence or absence of Cl^–. When K⁺-rich solution was in the pipette and K⁺-depolarized cells were examined, the current-voltage relations were linear with a single-channel conductance of 140 pS and polarity was reversed at 0 mV. In excised inside-out membrane patches, raising the free Ca²⁺ concentration of the medium facing the inner side of the membrane from 10^–7 to 10^–6 M evoked a marked increase in open state probability of the channels without affecting the elementary current steps. This suggests that intracellular Ca²⁺ as a second messenger plays a crucial role in the regulatory mechanism of the membrane potential by modulating the high-conductance apical K⁺ channels.     

Role of the various parts of the brain stem in the development of acute prolapse of the brain

Acute experiments were carried out on cats by a stereotaxic method to identify the morphological formations stimulation of which leads to the development of acute prolapse of the brain. These formations were found to be the lateral hypothalamic area, the zona incerta, zones H₁ and H₂, the parafascicular, interstitial, and interpeduncular nuclei, and the nucleus of Darkshevich. In response to stimulation of the lateral hypothalamic area, zona incerta, and zones H₁ and H₂, besides the characteristic histological changes of acute prolapse, signs of edema and swelling of the brain also were found.Department of Human Anatomy, Voroshilovgrad, Medical Institute. (Presented by Academician of the Academy of Medical Sciences of the USSR V. N. Chernigovskii.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 84, No. 9, pp. 276–279, September, 1977.     

A technique for temporary control of colostomy prolapse in children

Stomal prolapse is a common complication of colostomies and, if severe, may affect the timing of the definitive procedure. A simple technique for postreduction bowel fixation without stomal revision is presented. The reduced bowel is attached to the parietal peritoneum using a "U" type suture a few centimeters from the stoma. Two short parallel segments of latex tubing prevent the thread from cutting through. Suture and bolsters are removed when adhesions are established. In one of the four children, a percutaneous cecostomy was employed to connect a prolapse of the entire proximal colon.     

Use of the fascial stapler® in proctopexy for rectal prolapse

Proctopexy using synthetic mesh is a popular method of treating rectal prolapse. Suturing the graft to the presacral fascia is time-consuming and can lead to complications. With the fascial staper^®, two parallel rows of three staples are used to quickly and securely anchor the Marlex sling to the sacrum, thus avoiding hemorrhage from the presacral veins. Fourteen patients have been treated with no complications.     

新式阴道前、后壁联合修补术临床分析

目的探讨新式阴道前、后壁联合修补术治疗盆腔脏器脱垂(POP)的临床效果。方法选择2017年1月至2021年1月,于南京医科大学附属淮安第一医院接受手术治疗的120例POP患者为研究对象。根据采用的手术方式,将其分为研究组(n=60,采用新式阴道前、后壁联合修补术)及对照组(n=60,采用腹腔镜下全子宫双侧附件切除术+传统阴道前、后壁修补术)。采用独立样本t检验及χ^(2)检验,对2组患者一般临床资料,术中及术后情况进行统计学比较。本研究经南京医科大学附属淮安第一医院医学伦理委员会批准(审批文号:YX-P-2020-023-01)。所有患者知情同意并与之签署临床研究知情同意书。结果①2组POP患者年龄、人体质量指数(BMI)、产次、绝经者比例及POP脱垂程度比较,差异均无统计学意义(P>0.05)。②研究组POP患者手术时间、术中出血量、总住院时间、术后住院时间及住院费用分别为(88.0±30.6)min、(24.7±36.0)mL、(7.3±2.1)d、(4.6±1.4)d及(10727±1812)元,均短于或低于对照组的(118.0±33.4)min、(56.7±43.8)mL、(9.8±2.3)d、(6.4±1.6)d及(26318±3890)元,并且差异均有统计学意义(t=5.130、4.372、6.218、6.558、28.138,均为P<0.001)。2组POP患者术后3、6、12个月复发率构成比比较,差异无统计学意义(P>0.05)。结论新式阴道前、后壁联合修补术在不增加POP患者术后复发率的基础上,不仅能缩短手术时间、减少患者术中出血量,还可以缩短住院时间、减少住院费用,并且易于操作,适宜推广。     

人文医疗在阴式全子宫切除术联合阴道后壁修补术治疗子宫脱垂合并肠疝患者中的应用

目的探究人文医疗在阴式全子宫切除术联合阴道后壁修补术治疗老年子宫脱垂合并肠疝(阴道后壁膨出)患者中的应用效果。方法选择2018年1月至2019年12月期间天长市中医院收治子宫脱垂合并肠疝患者120例作为研究对象。全部入选病例均行阴式全子宫切除术联合阴道后壁修补术治疗,采用随机数字表法将病例分为对照组和观察组,各60例。对照组给予常规护理,观察组给予人文医疗护理。对比2组患者中文版知觉压力量表(CPSS)评分、抑郁自评量表(SDS)、焦虑自评量表(SAS)评分、心理弹性量表-简表(RS-14)、护理服务满意度、皮质醇(Cor)、心率及平均动脉压。结果护理前,2组CPSS、SDS、SAS及RS-14评分组间比较的差异无统计学意义(P>0.05);护理7 d后,2组CPSS、SDS、SAS及RS-14评分均较护理前降低,且观察组均低于对照组,差异有统计学意义(P<0.05)。观察组患者的满意度(96.67%)较对照组高(80.00%),差异有统计学意义(P<0.05)。观察组手术结束时2组患者的Cor、心率及平均动脉压较对照组低,差异有统计学意义(P<0.05)。结论人文医疗应用于子宫脱垂合并肠疝患者护理中,能够改善其不良情绪,缓解心理压力,减少手术的应激反应,提高患者对护理满意度。