集束血管钳在根治性前列腺或膀胱切除术中的应用

目的：探讨集束血管钳在根治性前列腺与膀胱切除术中控制背静脉丛出血与减少尿道括约肌损伤的作用。方法：对14例前列腺癌、膀胱癌患者在行根治性前列腺或膀胱切除术中应用集束血管钳完成背静脉丛的结扎切断。结果：14例手术均顺利完成。术中来自背静脉丛的出血可以得到有效的控制,出血量明显减少;不必对尿道与周围支持组织做过多游离,因而使尿道括约肌功能得到保护。结论：集束血管钳对术中控制背静脉丛出血与减少尿道括约肌损伤具有重要作用。     

Regional mechanical properties and stress analysis of the human anterior lens capsule

The lens capsule of the eye functions, in part, as a deformable support through which the ciliary body applies tractions that can alter lens curvature and corresponding refractive power during the process of accommodation. Although it has long been recognized that characterization of the mechanical properties of the lens capsule is fundamental to understanding this physiologic process as well as clinical interventions, prior data have been limited by one-dimensional testing of excised specimens despite the existence of multiaxial loading in vivo. In this paper, we employ a novel experimental approach to study in situ the regional, multiaxial mechanical behavior of both normal and diabetic human anterior lens capsules. Furthermore, we use these data to calculate material parameters in a nonlinear stress-strain relation via a custom sub-domain inverse finite element method (FEM). These parameters are then used to predict capsular stresses in response to imposed loads using a forward FEM model. Our results for both normal and diabetic human eyes show that the anterior lens capsule exhibits a nonlinear pseudoelastic behavior over finite strains that is typical of soft tissues, and that strains are principal relative to meridional and circumferential directions. Experimental data and parameter estimation suggest further that the capsule is regionally anisotropic, with the circumferential direction becoming increasingly stiffer than the meridional direction towards the equator. Although both normal and diabetic lens capsules exhibited these general characteristic behaviors, diabetic capsules were significantly stiffer at each distension. Finally, the forward FEM model predicted a nearly uniform, equibiaxial stress field during normalcy that will be perturbed by cataract surgery. Such mechanical perturbations may be an underlying modulator of the sustained errant epithelial cell behavior that is observed well after cataract surgery and may ultimately contribute to opacification of the posterior lens capsule.     

Laparoscopic liver biopsy using cup-shaped punch biopsy forceps and argon beam coagulator in children

Needle liver biopsy is insufficient for measuring enzyme activity in liver tissue in child cases of intrahepatic cholestasis because the biopsy specimen obtained is too small. This study was undertaken to validate the feasibility of a new, relatively non-invasive laparoscopic liver biopsy technique combining the use of laparoscopic cup-shaped punch biopsy forceps (CPBF) and an argon beam coagulator (ABC™) handpiece for the diagnosis and examination of liver enzyme activity in cases of intrahepatic cholestasis in children. The authors performed laparoscopic liver biopsy with the combined use of laparoscopic CPBF and an ABC™ handpiece in 10 children aged 4 months to 9 years old. Two 5-mm trocars were inserted in each patient after their abdomens had been filled with carbon dioxide gas at a pressure of 8 mmHg. Four to five specimens (each: 0.5 cm³ in size) were taken at the anterior edge of the left lobe of the liver using laparoscopic CPBF. ABC™ was sprayed on to the cut liver surface to achieve hemostasis. The duration of the laparoscopic procedure ranged from 25 to 64 (44 ± 12.8) min. The maximum intraoperative hemorrhage from the biopsied liver bed was 30 ml. The bleeding was easily controlled using ABC™ for about 1 min. There were no cases of postoperative bleeding, bile leakage from the cut surface, nor intraabdominal infection. There were also no death cases, and only one complication (hydrocele testis) was recorded. Examination by microscopy and assays of enzyme activities were performed using these biopsy specimens, which were sufficient for diagnosis in all patients. Laparoscopic liver biopsy combining the use of laparoscopic CPBF and an ABC™ handpiece can be performed safely, is less invasive, and provides sufficient samples for examination both by microscopy and enzyme activity assays.     

手术室应用干罐持物钳的效果观察

目的：观察无菌干罐持物钳在手术室的应用效果。方法：在我院手术室使用无菌干罐持物钳5803例中,随机抽样142例行细菌培养,分析其应用效果。结果：在手术（包括Ⅰ类、Ⅱ类手术）中严格执行无技术操作原则,使用无菌干罐持物钳的有效时间为6h。结论：在手术室的环境中,使用无菌干罐持物,可养活污染途径,避免消毒液对人体组织的刺且效果可靠,使用简便,还可节省大量消毒液,适应当前低耗高效的发展趋势,值得提倡和推广使用。     

新产程模式下剖宫产和产钳术对持续性枕后位难产孕妇分娩结局的评估

目的：探索新产程模式下剖宫产和产钳术对持续性枕后位难产孕妇分娩结局的评估。方法:收集2017年至2020年间于浙江省湖州市妇幼保健院收住入院的103例持续性枕后位难产孕妇, 其中以产钳分娩的60例孕妇为研究组,53例以剖宫产术分娩的孕妇为对照组,评估其分娩结局,分析两种分娩方式对孕产妇的影响。采用χ2 检验比较剖宫产及产钳分娩两组的新生儿窒息、产后出血、产时、产后感染、软产道裂伤（包括会阴III度裂伤、阴道裂伤、宫颈裂伤）、切口预后不良的差异。结果：研究组产后出血、产时发热、产后发热发生率[分别为1.66%（1/60）、1.66%（1/60）、3.33%(2/60）,χ2 值分别为（4.514 和5.698、4.826,P值分别为 0.040 和 0.020、0.030）],明显低于对照组[分别为11.32%（6/53）、13.20%（7/53）、15.09%(8/53）],但是研究组会阴III度裂伤、宫颈裂伤、阴道裂伤、发生率为分别为[15.00%（9/60）、13.33%（8/60））、（11.66%（7/60））,明显高于对照组（1.88%（1/53）、1.88%（1/53）、3.77%（2/53））],差异有统计学意义（P值均＜0.05）。但研究组的新生儿窒息发生率及切口预后不良的比例分别为[5（8.33%）、4（6.66%）],略低于对照组[（6（11.32%）、4（7.54%）],差异无统计学意义（χ2值分别为0.286、0.233,P 值均＞0.05）。结论：新产程标准下持续性枕后位难产孕妇选择产钳分娩可明显降低产时、产后感染及产后出血的发生率,但软产道裂伤发生率较高,差异有统计学意义。所以持续性枕后位难产孕妇选择产钳分娩是相对比较安全的分娩方式,但同时需要注意软产道裂伤的发生。     

百克钳在腹腔镜子宫肌瘤剔除术中的应用

目的:分析百克钳在腹腔镜子宫肌瘤剔除术中的应用效果.方法:纳入2017年2月~2019年2月在本院接受腹腔镜子宫肌瘤剔除术治疗的患者92例为观察对象,按照随机双盲法将患者分为百克钳组与超声刀组,各46例.结果:百克钳组患者手术时间、术后排气时间以及住院时间与超声刀组患者均无明显差异(P>0.05);百克钳组患者术中出血量明显少于超声刀组患者(P<0.05).结论:在为子宫肌瘤患者实施腹腔镜子宫肌瘤剔除术治疗的过程中,百克钳的运用减少了患者术中出血量,手术时间以及恢复时间均较短,安全性相对较高.     

84例产褥感染的临床特点及常见致病微生物耐药性分析

目的 研究产褥感染的危险因素及常见致病微生物耐药情况,为临床治疗提供参考。方法 回顾性分析我院2017 年1 月～2019 年12 月发生的84 例产褥感染病例的临床资料,与同时期未发生产褥感染的200 例产妇进行对照研究,分析产褥感染的影响因素,并对分离获得的致病微生物进行耐药性分析。结果 感染组妊娠糖尿病、产钳助产、宫口开全后中转剖宫产患者的分布率高于对照组,差异有统计学意义（P＜0.05）;经多因素Logistic 回归分析,妊娠糖尿病是产褥感染的独立影响因素（P＜0.05）。本研究中共检出致病微生物40 株,其中革兰阴性菌13 株（占32.50%）,革兰阳性菌10 株（占25.00%）,支原体16 株（占40.00%）,衣原体1 株（占2.50%）,革兰阴性菌中以大肠埃希菌最常见,对二代头孢菌素类抗生素耐药率20%。革兰阳性菌以金黄色葡萄球菌最常见,对青霉素及头孢菌素耐药率高,未发现对亚胺培南及万古霉素耐药。结论 产钳助产、妊娠糖尿病、宫口开全后中转剖宫产是产褥感染可能的危险因素,其中,妊娠糖尿病是产褥感染的独立危险因素。目前临床常见致病微生物谱及耐药率未发生明显变化。