显微神经外科技术及翼点入路在鞍区肿瘤手术的应用

目的：总结98例鞍区肿瘤患者经翼点入路显微手术治疗及翼点入路应用体会。方法：按照翼点入路各项操作步骤行鞍区肿瘤切除98例，介绍了操作方法并讨论显微神经外科技术在鞍区肿瘤手术中的应用，及不同部位肿瘤作相应手术操作调整的方法。结果：鞍区肿瘤应用翼点入路进行显微手术操作可良好显露鞍区及肿瘤各显微解剖结构以及手术操作平台，使其肿瘤全切率及患者预后得到明显提高。结论：显微神经外科技术及翼点入路手术操作的掌握和熟练程度的提高是显微神经外科技术的关键及获得良好手术效果的基础。     

硬膜外腔阻滞对胸部手术应激反应的影响

目的 观察硬膜外腔阻滞对胸部手术应激激素和细胞因子的影响。方法20例食管癌手术病人,随机分为两组,每组10例,即全麻复令硬膜外腔阻滞(GEA)组和全麻(GA)组,分别测定麻醉诱导前、手术2h、手术4h、术毕、术后1d及术后3d的血浆去甲肾上腺素、肾上腺素、血清促肾上腺皮质激素(ACTH)、皮质醇、C-反应蛋白、IL-6及IL-10的水平。结果 血浆去甲肾上腺素和血清皮质醇GEA组术中术后无显著改变,但GA组术毕和术后1d显著升高(P<0.05),术后3d恢复至术前水平,组间比较前者有显著差异(P<0.05)。两组血浆肾上腺素、IL-10术中术后均无显著变化。两组血清ACTH、IL-6及CRP术中术后均显著升高(P<0.05),组间比较无显著差异。结论 硬膜外腔阻滞可以减轻胸部手术的应激反应。IL-6是较CRP更灵敏的反映组织损伤的炎性指标。     

显微外科技术治疗周围神经陈旧性损伤

目的探讨应用显微外科技术治疗需再次手术的周围神经损伤的方法和疗效。方法对33例周围神经损伤第一次手术效果差的患者,应用显微外科技术进行再次手术治疗。结果本组获得随访30例,共41条神经,随访时间为9个月～6年,平均为27个月,优良率为73.2%。结论对周围神经损伤初次手术效果差的患者,应尽早再次手术探查,应用显微外科技术,选择合适的手术方式,可取得较满意的手术疗效。     

Double-bundle technique: Endoscopic posterior cruciate ligament reconstruction using tibialis posterior allograft

Recently, attention has been given to the double-bundle technique for treating the posterior cruciate ligament (PCL)-deficient knee. We present an arthroscopic PCL reconstruction using a double-bundle technique with 3-stranded tibialis posterior (TP) allograft that has not been described before. The anterolateral bundle of the PCL is reconstructed using 2-stranded TP allograft and the posteromedial bundle using 1-stranded TP allograft. Three-stranded TP allograft will be an alternative graft choice for PCL reconstruction.     

门脉高压症断流术后上消化道再出血的外科治疗探讨

目的探讨门脉高压症断流术后上消化道再出血的外科治疗方法及其疗效.方法对(1999-2000)年本科收治的34例门脉高压症断流术后上消化道再出血的病人行外科治疗及疗效分析.其中肝功能Child A组10级,B级18例,C级6例.治疗前钡餐或胃镜检查确诊.结果有14例行非手术外科治疗,2例经药物治疗止血;4例行胃镜下食道静脉套扎(EVL)止血,效果较好;6例行食管胃底曲张静脉脉硬化剂注射,2例行三腔二囊管止血,疗效不确切,再出血率62.5%(5/8).20便行手术治疗,9例行肠腔分流,2例(2/9)术后再次发生上消化道出血;术中食管胃底曲张静脉缝扎1例,食管胃底曲张静脉硬化剂注射2例,术后均再次出现上消化道出血;贲门血管再次离断2例,改良食管下段横断术3例,术后近远期疗效均可;贲门周围血管离断加肠腔分流水2例,术后有1例上消化道再出血.结论胃镜下食道静脉套扎术在非手术止血中效果较好,适合于不不宜手术的病人.手术治疗常选肠腔分流.对前次断流不彻底需再次断流,再次断流门静脉压仍高,则考虑行断流加分流.     

湿性皮肤再生技术在皮肤擦伤的应用

目的:探导湿性皮肤再生技术治疗皮肤擦伤的疗效。方法:自2000年1月-2005年10月,治疗头面部、躯干和四肢急性皮肤擦伤共353例,其中采用湿润烧伤膏和暴露疗法治疗(新法组)185例,按传统疗法清创治疗(传统组)168例。结果:新法组7天内痊愈116例,占62．7％;14天内痊愈59例,占3713％;总有效率100％。传统组7天内痊愈82例,占48．8％;14天内痊愈58例,占34．5％;另外28例,占16．7％,发生不同程度的创面感染,痂下积脓,需作再次清创,碘伏湿敷或改用MEBO治疗,创面延期愈合,愈后瘢痕增生明显。结论:湿润烧伤膏和暴露疗法治疗皮肤擦伤与传统疗法比较,具有缩短创面愈合时间,愈后不留瘢痕等优点。     

显微外科技术在尿道下裂修复中的应用

采用显微外科技术行阴囊纵膈皮瓣尿道下裂修复术18例，均获成功。其手术要点为：将阴茎腹侧纤维索条切除，充分伸展阴茎，皮瓣保留足够长度与宽度，克保血运；在显微镜下采用7－0尼龙丝线缝合，形成皮管，不缝皮肤，只缝皮下。硅胶管支架引流，加压包扎阴茎。本文对手术成功的原因进行了初步讨论。     

医院感染流行病学监测分析

介绍了我院１９９３年７月１日～１９９３年１２月２０日出院的１０３１例病人医院感染病率的监测分析，半年中感染率为８．４％，妇产科疗区发病率高于外科疗区，感染部位以泌尿道、下呼吸道、手术伤口为最多，侵袭性操作及易感因素引起的感染在感染病例中分别占４０．２％和５９．８％。     

羊踯躅根治疗慢性肾小球肾炎的实验及临床研究

本文用反复静脉注射小剂量牛血清白蛋白复制家兔慢性肾炎,用羊踯躅根治疗。同时,用该药对慢性肾炎病人进行疗效观察。阳性组兔肾小球呈现中至重度颗粒形免疫荧光,肾组织呈明显慢性硬化性肾小球肾炎改变。尿蛋白±～++。治疗组兔及病人治疗后病变及症状均明显减轻或消失。结果提示循环免疫复合物反复沉着可引起兔类似人类的慢性硬化性肾小球肾炎,羊踯躅根对病变有一定的控制和治疗作用,这可能与其抑制免疫发病机制有关。     

CROHN'S DISEASE: A COLON AND RECTAL DEPARTMENT EXPERIENCE

This study reviewed a series of patients with Crohn's disease managed by surgeons of the Department of Colon and Rectal Surgery, St Vincent's Hospital, Melbourne, since 1978. There were 306 patients: 171 males and 135 females. The mean age at diagnosis was 33.4 years (range 11–93). The distribution of the disease was small bowel 32.3%, small bowel and colon 26.5%, colon 39.9%, and anal disease alone 1.6%. A total of 416 abdominal operations were performed on 204 patients. The commonest indications for surgery were failed medical therapy (21.9%), small bowel obstruction (15.9%), enteric tistula (10.1%), and intra-abdominal abscess (10.1%). The most frequently performed procedures were ileocolic resection with anastomosis (28.8%), small bowel resection (9.4%), and total colectomy and ileostomy (7.0%). Postoperative complications included anastomotic leaks in 4.0%. intra-abdominal abscess formation in 3.6%, and enterocutaneous fistulae developed in 6%. Three patients died during the review period. During follow up (mean 84.4). 30% of patients developed recurrence requiring further surgery at a mean of 72.7 months postoperatively. The most frequent site for a recurrence was the pre-anastomotic terminal ileum (61.7%). In conclusion. the majority of patients with Crohn's disease will require resectional surgery at some stage. This can be performed with a low mortality and morbidity, and a recurrence rate of around 5% per year.