输尿管口囊肿的微创手术治疗

目的评价输尿管口囊肿的微创手术治疗方法及其疗效。方法回顾性分析25例行经尿道电切（TURU）手术治疗输尿管口囊肿患者资料。男9例，女16例；年龄18—61岁，平均38岁；单侧18例，双侧7例；单纯输尿管囊肿22例，异位输尿管囊肿3例。结果25例患者手术一次成功22例，手术平均时间15min，术后平均住院3d。术后定期B超、膀胱造影随诊，随诊时间1—9年，3例异位输尿管囊肿合并重复肾、输尿管畸形患者存在术后膀胱输尿管返流，2例再次行开放手术后痊愈。结论TURU是治疗成人输尿管口囊肿的有效方法；当合并存在重复肾输尿管畸形或术后膀胱输尿管返流时，应采用输尿管膀胱抗返流手术。     

Assessing the Stiffness of Spinal Fusion in Animal Models

The clinical goal of spinal fusion is to reduce motion and the associated pain. Therefore, measuring motion under loading is critical. The purpose of this study was to validate four-point bending as a means to mechanically evaluate simulated fusions in dog and rabbit spines. We hypothesized that this method would be more sensitive than manual palpation and would be able to distinguish unilateral vs bilateral fusion. Spines from four mixed breed dogs and four New Zealand white rabbits were used to simulate posterolateral fusion with polymethyl methacrylate as the fusion mass. We performed manual palpation and nondestructive mechanical testing in four-point bending in four planes of motion: flexion, extension, and right and left bending. This testing protocol was used for each specimen in three fusion modes: intact, unilateral, and bilateral fusion. Under manual palpation, all intact spines were rated as not fused, and all unilateral and bilateral simulated fusions were rated as fused. In four-point bending, dog spines were significantly stiffer after unilateral fusion compared with intact in all directions. Additionally, rabbit spines were stiffer in flexion and left bending after unilateral fusion. All specimens exhibited significant differences between intact and bilateral fusion except the rabbit in extension. For unilateral vs bilateral fusion, significant differences were present for right bending in the dog model and for flexion in the rabbit. Unilateral fusion can provide enough stability to constitute a fused grade by manual palpation but may not provide structural stiffness comparable to bilateral fusion.     

腕管综合征96例分析

自1993年1月-2000年12月,诊治腕管综合征96例,其中手术治疗31例,现将有关资料进行分析。1临床资料1.1一般资料本组96例,男25例,女71例;年龄为26～63岁,平均43岁。16例为双侧性,病程最短为1周,最长为10年。病因:腕部外伤史17例,手部关节酸痛史23例,18例女性患者认为发病与妊娠或     

完全腹腔镜规则性肝切除的解剖基础与技术问题

目的探讨腹腔镜规则性肝切除的解剖基础与技术问题。方法 2 0 0 2年 7月至2 0 0 2年 11月 ,治疗原发病灶位于左半肝但未侵及左肝门的原发性肝癌 4例、肝血管瘤 2例、肝囊肿伴感染 1例。肝切除步骤包括显露第 1肝门 ,游离肝周韧带 ,解剖并离断 2、3级肝门 3管 ,解剖第 2肝门并夹闭肝左静脉 ,离断肝实质和切断肝左静脉。结果 7例完全在腹腔镜下完成手术 ,左半肝切除 2例、左外叶切除 4例、肝方叶切除 1例。均成功地在矢状部对 2至 3级肝门的 3管进行解剖和离断。手术时间为 15 0～ 32 0min ,平均 (2 5 3± 5 9)min。出血量 2 0 0～ 10 0 0ml,平均 (4 5 0± 2 6 1)ml。结论腹腔镜规则性左肝切除术是安全可行的 ,对 2级肝门 3管的解剖和离断是行肝段或左半肝切除时控制出血的关键。     

合并异常冠状动脉法洛四联症和右心室双出口一期根治术

目的 总结合并异常冠状动脉的法洛四联症和右心室双出口一期根治术的经验，探讨有关外科技术的改进。方法1995年6月至2002年6月完成该类一期根治术12例，其中2例采取了肺动脉移位、3例在游离的左前降支下加宽右室流出道、5例改变右室切口并在冠状动脉下缝合、2例经肺动脉和右房疏通流出道。结果无手术死亡。随访3个月～6年，无晚期死亡和并发症发生。结论合并异常冠状动脉的法洛四联症和右心室双出口的一期根治手术是可行的，且效果良好，但必须采用适当的外科技术以保护异常的冠状动脉。     

高血压脑出血微创外科治疗的预后因素分析

目的探讨影响高血压脑出血（HICH）微创外科治疗预后的相关因素。方法回顾性分析经微创手术治疗的HICH病人106例,总结其临床特点和疗效,并采用单因素和Logistic多因素回归分析,总结影响预后的有关因素。结果单因素分析显示：平均动脉压（MAP）、术前意识状态、血肿形态、出血部位、血肿量、血肿与脑室关系、血肿再发及术后并发症等因素与HICH微创外科治疗临床预后有关（P〈0.05）。多因素回归分析显示：术前意识状态、术后并发症及出血部位与HICH微创外科治疗预后密切相关（P〈0.01）。结论微创外科手术治疗HICH具有简单、安全、疗效好等优点;术前意识状态、术后并发症、出血部位是影响其预后的重要因素。     

The lumbar and lumbosacral facet-syndrome. Diagnostic measures,surgical treatment and results in 119 patients

Summary The authors present their diagnostic and therapeutic protocol as well as the surgical outcome in a series of 119 patients with the lumbar facet syndrome.By use of different surgical techniques such as translaminar screw fixation (n=56), Louis plate fixation (n=36), Cotrel-Dubousset instrumentation (n=11) and soft system stabilization according to Graf (n=14) excellent, good, satisfactory, moderate and poor results were obtained in 78 (67%), 20 (17%), 14 (12%), 4 (3%), and 1 (1%) instances, respectively.     

Hygiene in Operationsabteilungen – Empfehlungen des Nationalen Referenzzentrums für Krankenhaushygiene

Zusammenfassung. Viele Hygienema?nahmen in Operationsabteilungen sind durch wissenschaftliche Untersuchungen nicht belegt. Die in dieser Arbeit vom Nationalen Referenzzentrum für Krankenhaushygiene, das 1996 vom Bundesgesundheitsministerium eingerichtet wurde, zusammengestellten Empfehlungen stützen sich auf die Ergebnisse wissenschaftlicher Untersuchungen und trennen so die unbedingt notwendigen von den weniger bzw. nicht sinnvollen Ma?nahmen.

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Summary. Many hygienic procedures performed in operation units are not supported by scientific investigations. The following recommendations by the National Reference Center for Hospital Epidemiology, founded by the German Ministry of Health in 1996, are based on the scientific literature and separate necessary from less necessary and unnecessary procedures.

     

Anterior lumbar fusion using a hybrid interbody graft

Summary This is a radiographic report of 40 patients (20 men, 20 women) who underwent anterior lumbar interbody fusions (73 levels) utilizing a “hybrid” interbody graft composed of femoral cortical allograft (FCA) bone and iliac crest cancellous autograft bone. The average age at surgery was 38 years (range 17–64 years), and follow-up averaged 1.4 years (range 1.0–2.4 years). Nineteen of the patients had undergone previous lumbar surgery. Thirty-two patients (63 levels) underwent anterior fusion combined with some type of posterior fixation, and eight patients (10 levels) had no posterior fixation. Types of posterior fixation included: for 20 patients (36 levels) Steffee variable screw placement fixation, for 10 patients (23 levels) translaminar facet screws (TFS), for 1 patient (3 levels) Knodt rods and for 1 patient (1 level) facet screws. Based on the persistence of lucent lines at the graft-host interface, three patients (one level each) were felt to have non-unions at their latest follow-ups at 1.4, 1.5 and 2.0 years, respectively. Two of these patients had no posterior fixation, and the other had TFS fixation. The overall fusion rate was 96% (70 of 73 levels). The fusion rate for all levels treated with posterior fixation was 98% compared with 75% for those without fixation. Intervertebral disc heights (IVDH) were measured on all films and corrected for magnification with computer assistance. On average, the IVDH was increased postoperatively but returned to preoperative values at follow-up. IVDH loss was independent of the type of instrumentation used. No complications arose from the use of the hybrid graft. Incorporation of the allograft portion of the graft is slow and was felt to be complete in only 7 of the 73 levels at follow-up. We conclude that the hybrid interbody graft technique is a safe and reliable method for performing anterior lumbar interbody fusions and should be combined with some type of posterior fixation. Long-term follow-up will be required to assess the behaviour of the allograft until incorporation is complete.     

针式腹腔镜在泌尿外科的应用现况

针式腹腔镜是新近出现的直径只有2 mm的腹腔镜设备,目前已用于普通外科、妇产科等一些疾病的治疗上.在泌尿外科方面,针式腹腔镜在肾上腺切除术、小儿隐睾固定术等手术上也得到了应用.虽然对针式腹腔镜手术的定义仍存在争议,目前2 mm的器械也尚有局限性,但其相对于传统腹腔镜有明显的优点,如损伤比传统腹腔镜手术更小、美观性更好、住院时间更短、恢复更快.针式腹腔镜将是常规腹腔镜发展的必然结果.