Disposable circumcision suture device： clinical effect and patient satisfaction

In our experience patients undergoing circumcision are mostly concerned about pain and penile appearances. We conducted a prospective randomized trial to assess the benefits of a new disposable circumcision suture device （DCSD）. A total of 942 patients were equally divided into three groups （conventional circumcision, Shang ring and disposable suture device group）. Patients in the DCSD group were anesthetized with compound 5% lidocaine cream, the others with a 2% lidocaine penile block. Operation time, intra-operative blood loss, incision healing time, intra-operative and post-operative pain, the penile appearance and overall satisfaction degree were measured. Operation time and intra-operative blood loss were significantly lower in the Shang ring and suture device groups compared to the conventional group （P 〈 0.001）. Intra-operative pain was less in the suture device group compared With the other two groups （P 〈 0.001）; whereas post-operative pain was higher in the conventional group compared to the other two groups （P 〈 0.001）. Patients in the suture device （80.57%） and Shang ring （73,57%） groups were more satisfied with penile appearances compared with the conventional circumcision group （20.06%, P 〈 0.05）. Patients in suture device group also healed markedly faster than the conventional group （P 〈 0.01）. The overall satisfaction rate was better in the suture device group （78.66%） compared with the conventional （47.13%） and Shang ring （50.00%） groups （P 〈 0.05）. The combination of DCSD and lidocaine cream resulted in shorter operation and incision healing times, reduced intra-operative and post-operative pain and improved patient satisfaction with the cosmetic appearances.     

子宫背带式缝合治疗剖宫产术中宫缩乏力出血疗效分析

目的探讨子宮背带式缝合治疗剖宫产术中宫缩乏力出血的临床效果。方法回顾性分析2012年6月—2014年1月间来我院接受剖宫产并且术中出现宫缩乏力出血的孕妇87例的临床资料,分析患者术中宫缩乏力出血时采取给中治疗手段的效果。结果 87例术中缩宫乏力出血患者中有37例使用了按摩压迫子宫以及药物治疗止血,其中有13例起效,未起效的患者与其他患者采用子宮背带式缝合治疗,均成功止血,37例常规止血患者平均出血量为（950±30.4）mL,50例子宮背带式缝合患者出血量为（540±21.4）mL。结论与其他止血方式相比,子宮背带式缝合治疗剖宫产术中宫缩乏力出血具有明显优势,用于临床取得了显著效果,因此适合临床推广使用。     

TST加外切缝合术治疗环状混合痔的临床观察

为探讨选择性痔上黏膜切除术（TST）加外切缝合术治疗环状混合痔的效果,将50例环状混合痔患者随机分为观察组和对照组各25例,观察组采用TST加外切缝合术治疗,对照组采用PPH治疗。跟踪随访、观察记录术后疗效及并发症。结果显示,两组疗效差异无统计学意义（P〉0．05）;在术后并发症等方面观察组优于对照组（P〈0．05）。结果表明,TS＇I’加外切缝合术治疗环状混合痔安全性高,治疗效果显著。     

两种不同荷包缝合在吻合器痔上黏膜环切术中的观察比较

目的：观察两种不同的荷包缝合方法在吻合器痔上黏膜环切术（procedure for pro-lapse and hemorrhoids,PPH）中的效果。方法采用改良单荷包缝合法或双荷包双圈缝合法对80例Ⅲ、Ⅳ度痔患者行PPH术,并比较两组的平均手术时间、切除黏膜宽度及完整性、痔团回缩效果、吻合口出血、术后并发症、复发等数据。结果切除环形黏膜的完整性、痔回缩效果、平均住院时间及复发情况两组间差异无统计学意义（P＞0．05）,但双荷包组切除黏膜宽度优于改良单荷包组（P＜0．05）,平均手术时间、吻合口出血情况改良单荷包组优于双荷包组（P ＜0．05）;术后疼痛、水肿、切口出血、肛门不适感或狭窄等并发症均差异无统计学意义（P＞0．05）,但双荷包组中更容易发生术后首次排便出血的情况（P＜0．05）。结论对于一般中重度痔患者,采用改良单荷包缝合可以达到良好的治疗效果并明显缩短手术时间,但对于痔团脱出严重的患者仍建议使用双荷包缝合以求切除足够的痔上黏膜,起到更明显的悬吊效果。     

关节镜下缝合固定对合并外侧半月板外移的早期膝关节骨性关节炎的治疗效果

目的：评价关节镜下缝合固定对合并有外侧半月板移位的早期膝关节骨性关节炎（OA）的治疗效果。方法对8例术前 MRI 检查及术中证实的合并外侧半月板外移的早期膝关节OA 患者进行关节镜下外侧半月板的缝合固定,观察术后治疗效果并进行随访,随访时复查膝关节X 光片观察膝关节 OA 病情进展情况,采用 Lysholm 评分评价手术疗效。结果患者平均随访30个月,术后复查膝关正侧位 X 光片,未见骨性关节炎进展征象。术后膝关节 Lysholm 评分显著高于术前（P ＜0．05）,疗效满意。结论对合并移位的膝关节外侧半月板进行缝合固定,有利于恢复半月板正常功能,可能延缓骨性关节炎的发展。     

种植钉辅助扩弓后腭中缝断裂的有限元模型建立

目的用三维有限元方法分析扩弓时上颌复合体应力蓄积至腭中缝完全断裂过程的力学特点,并验证模型有效性。方法建立包含种植钉的上颌复合体有限元模型。设定腭中缝屈服强度,以每5 ms加载0.25 mm水平横向位移为载荷,加载至腭中缝完全断裂,同时以临床1例种植钉辅助扩弓患者扩弓前后CT影像结果进行对比验证。结果 0～17 ms,腭中缝应力主要蓄积于腭骨水平板、种植钉周围、腭中缝中后方及颧颌缝; 18～60 ms,腭中缝中后部出现裂纹并向前后扩展; 61～71 ms,腭中缝中后部、前部、后部依次发生断裂。结论基于断裂力学的种植钉辅助扩弓的三维有限元模型有效,其计算的断裂过程结果更符合临床实际。研究结果为今后更有效研究种植钉辅助扩弓提供力学参考模型。     

带线锚钉与钢板内固定治疗肱骨大结节骨折的优劣分析

背景:手术治疗肱骨大结节骨折目前普及切开复位钢板螺钉固定,但存在着一些不足。目的:比较切开复位带线锚钉与切开复位钢板内固定治疗肱骨大结节骨折的疗效。方法:回顾性分析2016年1月至2018年12月苏州大学附属第一医院收治的肱骨大结节骨折33例患者的资料,根据内固定方式分为锚钉组(n=7)和钢板组(n=26),分别行切开复位带线锚钉和切开复位钢板螺钉内固定。统计比较2组患者手术时间、切口长度、术中失血量、术后骨折块再移位距离及术后1个月、3个月、末次随访肩关节功能Constant-Murle评分,并记录2组内固定的不良反应情况。结果与结论:①锚钉组手术时间(73.1±10.5)min短于钢板组(98.2±11.9)min,切口长度(7.3±1.1)cm小于钢板组(14.9±1.7)cm,术中失血量(45.0±7.1)m L小于钢板组(141.0±25.9)mL,差异均有显著性意义(P<0.05);②锚钉组术后骨折块再移位距离(3.0±1.8)mm大于钢板组(1.1±2.3)mm,差异有显著性意义(P<0.05);③术后1,3个月及末次随访时,2组之间Constant-Murle评分比较,差异均无显著性意义(P>0.05);④提示与切开复位钢板内固定相比,切开复位带线锚钉内固定治疗肱骨大结节骨折具有手术时间短、创伤小的优势。     

Occult vaginal cancer recurrence after hysterectomy: a case report and literature review

Vaginal cancer is a rare disease of the lower genital tract. We present the case of a 54-year-old woman with occult vaginal cancer after hysterectomy for cervical intraepithelial neoplasia (CIN) III. Despite persistently negative cytology and colposcopy results, a lesion was finally detected by vagino-recto-abdominal examination and she underwent radical parametrectomy and lymph node dissection. We consider the possibility that transabdominal suturing of the vaginal cuff after hysterectomy may reduce the ability to detect subsequent vaginal lesions, and discuss the benefits of a vaginal suture approach. We recommend that suturing the vagina apex transvaginally instead of transabdominally would benefit patients during follow-up.     

Rapid construction of sigmoid bladder augmentation using absorbable staples: Long-term results and comparison to standard colocystoplasty in children with neurogenic bladder

ObjectiveAbsorbable staples facilitate detubularization and reconfiguration of the bowel when performing augmentation colocystoplasty. We compared the outcomes of stapled sigmoid augmentation with standard sutured colocystoplasty.Materials and methodsBetween 2003 and 2011, 108 children underwent bladder augmentation at our institution. Colocystoplasty was used in 30 patients (27.8%). Medical charts of children who underwent stapled (n = 8) or sutured (n = 22) sigmoid augmentation were compared with regard to patient demographics and surgical complications, including anastomotic leak and urolithiasis.ResultsEight children with underwent stapled sigmoid colocystoplasty. Average age at surgery was 8 years (range 4–17 years). Time to detubularize and refashion the bowel segment prior to augmentation was consistently under 5 min. Average length of follow-up was 44 months (range 12–80 months). One patient experienced anastomotic leak. Two of eight children (25%) in the stapled anastomosis cohort developed bladder stones. Twenty-two patients underwent standard sigmoid augmentation during the same time period (average age 8.2 years; range 4–16 years). One of 22 (4.5%) experienced anastomotic leak. Seven of 22 (31.8%) developed cystolithiasis.ConclusionsComplications from stapled sigmoid anastomosis are similar to those from standard colocystoplasty. Use of absorbable staples decreases operating time by avoiding bowel spatulation and suturing, and should be considered in pediatric patients undergoing colocystoplasty.