内窥镜辅助下经口咽前路寰枢椎减压术

目的：探讨内窥镜辅助下经口咽前路寰枢椎减压术的临床效果。方法：1998年8月～2004年8月对38例陈旧性寰枢椎脱位患者采用内窥镜辅助下经口咽前入路减压术，其中18例行一期经口咽入路减压和后路枕颈内固定术：15例行经口咽前路寰枢椎复位钢板内固定术；5例不可复型仅行经口咽前入路减压术。结果：平均随访38个月（6～96个月）。术后患者临床症状均明显改善，上颈段脊髓减压改善率达89.3％。发生颅内感染1例，前路钢板松脱1例。结论：与常规减压方法相比，内窥镜辅助下经口咽前路寰枢椎减压手术创伤小，操作精细、准确，术中与助手可协同操作。     

Specific selection of osteosynthetic material in the treatment of thoracic or lumbar spinal injuries by the posterior approach

Summary The authors report 165 cases of thoraco-lumbar lesions with neurological dysfunction. All the patient were operated. They analyze the neurological and mechanical results and indicate the use of different osteosynthesis apparatus according to the type and level of lesions.Harrington's rods seem to give more precise repositioning while Roy Camille's plates give more stability. When the posterior wall of the spinal canal is intact, Kempf's compression rods can be used.Thoraxic spine injuries seem to be an indication for Harrington's rods, while lumbar injuries seem to call for Camille's plates.     

Counterfactual (‘if only’) thinking in women with chronic widespread pain

The study explored the counterfactual thinking that women with chronic and widespread pain showed in response to what they themselves considered to be particularly stressful situations. Counterfactual thinking in 125 women sick‐listed due to chronic and widespread pain was investigated in terms of structure, function and control focus. The women were asked, for each of three types of problems that they indicated in a questionnaire to affect them most strongly, to describe a typical occurrence of it and to complete a counterfactual sentence in connection with it of the type ‘If only . . .’. The majority of counterfactuals pertained to predominantly somatic problems (e.g. musculo‐skeletal problems, pain and fatigue) classified as being affective rather than preparative and self‐focused rather than external, whereas in counterfactuals relating to predominantly psychological/psychosocial problems a preparative function and an external focus were more prominent. The numbers of problems listed and the numbers of situations responded to counterfactually were positively correlated. The counterfactuals, although often related to somatic problems, generally concerned psychological or psychosocial matters such as finances and paid or unpaid work. A contextual approach to elucidating counterfactual thinking based on subjects' own experiences is seen as providing valuable insight into what bothers them most. Copyright © 2006 John Wiley & Sons, Ltd.     

Elective laparoscopic-assisted colectomy for sigmoid diverticulitis.

OBJECTIVES: The aim of this study was to evaluate the safety and effectiveness of laparoscopic-assisted sigmoid colectomy for diverticulitis and to assess its postoperative advantages. METHODS: From 1999 to 2001, 5 patients were selectively operated on with a laparoscopic-assisted procedure for uncomplicated sigmoid diverticulitis. In the preceding period (September 1997 through December 1998), 4 patients underwent open procedures for the same pathology. The surgical indication with the same criteria was restrictive: at least 2 acute episodes had occurred that were treated with hospital admission and that were separated by an adequate period (2 months) of medical therapy. RESULTS: No conversions of laparoscopy to an open procedure were necessary. Age, sex, weight, morbidity, and mortality were similar between the 2 groups. Operative time was 180 minutes for laparoscopy and 120 minutes for laparotomy. Postoperative resumption of peristalsis was 24 hours versus 4 days, resumption of alimentation was on the second postoperative day versus the fifth postoperative day, and hospital stay was 7 days versus 12 days for laparoscopy and laparotomy, respectively. CONCLUSION: This study shows the feasibility and the advantages of elective laparoscopic-assisted colonic resection for uncomplicated sigmoid diverticulitis. The advantages of the laparoscopic approach are the lower need for analgesics and the more precocious ambulation, canalization, resumption of alimentation, and the shorter hospital stay.     

Greater curve approach for laparoscopic gastric bypass: total stapler gastrojejunostomy

BACKGROUND: Gastric bypass is an established bariatric procedure that has undergone multiple modifications to improve its effectiveness. The side-to-side stapled technique is well recognized, but closure of the gastrotomy/enterotomy by the stapler can potentially narrow the Roux limb. Because of this, many surgeons will hand suture the closure of the gastrotomy/enterotomy. To obviate this difficulty, we inserted the linear stapler from the stomach's greater curvature, using a double-stapled anastomosis that minimized the need for hand suturing. METHODS: We performed a retrospective analysis of 307 patients undergoing this technique for laparoscopic gastric bypass. The weight loss and 30-day morbidity and mortality were tabulated and compared with those in other published series. RESULTS: Of the 307 patients, none died postoperatively. The overall 30-day morbidity rate was 15%. Two leaks from the gastrojejunostomy and 2 from the jejunojejunostomy (1.2%) developed. The mean percentage of excess weight loss was 34% at 3 months, 52% at 6 months, 73% at 1 year, 71% at 2 years, and 69% at 3 years. CONCLUSION: The greater curve approach avoids Roux limb obstruction, minimizes the need for hand suturing, and uses standard trocar incisions. Our short-term follow-up results are similar to those of series of other techniques.     

Laparoscopic Medial-to-lateral Colon Dissection: How and Why

Laparoscopic colectomy is a difficult procedure with a long learning curve. We describe in this study our technique for right- and left-sided laparoscopic medial-to-lateral colectomy. The medial approach involves division of the vascular pedicle first, followed by mobilization of the mesentery toward the abdominal wall, and finally freeing of the colon along the white line of Toldt. This approach allows immediate identification of the plane between the mesocolon and the retroperitoneum and renders the dissection fast and safe. Our series of 50 consecutive laparoscopic colectomies supports this concept. We believe that surgeons familiar with this technique will have an important tool in their armamentarium to circumvent some of the challenges of laparoscopic colectomy.     

两种单静脉法与传统Amplatzer法治疗动脉导管未闭

目的探讨两种单静脉入路法和动静脉双入路法治疗PDA各自的优缺点及最佳适应症,为PDA患者选择合理介入治疗方法提供依据。方法103例PDA患者经三种不同介入方法治疗,其中单静脉入路超声法37例,单静脉入路造影法14例,动静脉双入路法52例。PDA的位置、形态、大小经不同方法观察,单静脉超声法经超声观察,单静脉造影法在PDA内或降主动脉近PDA口外造影观察,动静脉双入路在主动脉弓降部侧位造影观察。选择合适型号的Amplatzer伞经股静脉建立的轨道进行封堵。术后15 min经胸超声及心脏听诊判断有无分流。术前、术后均行血流动力学测定,术后3 d、1个月复查超声心动图,观察大动脉水平有无分流及动脉导管未闭再通。结果103例患者全部一次封堵成功,技术成功率100%。术中操作平均透视时间(10.45±4.35)min,心导管检查测肺动脉收缩压由术前轻度增高[(33.2±3.11)mmHg]降为正常[(22.03±5.3)mmHg]。术后即刻所有患者心前区双期连续性杂音消失,术后无残余分流,无任何并发症发生,随访1个月未发生动脉水平分流及动脉导管再通。结论单静脉入路Amplatzer封堵器治疗动脉导管未闭简化了手术程序,不用或减少造影剂用量,缩短了操作透视时间,手术成功率高,疗效可靠,值得推广应用。     

Stoppa入路在骨盆髋臼骨折中的初步应用

目的 探讨在骨盆髋臼骨折中采用耻骨联合上缘横形或下腹正中切口,真骨盆内操作(Stoppa人路)的初步临床经验. 方法对2008年3月至11月问应用Stoppa入路治疗的10例骨盆髋臼骨折患者进行总结.5例骨盆患者均为Tile C型,Stoppa入路复位同定前环的高位耻骨支骨折.髋臼骨折为横行2例,双柱、T型及后柱(四边体粉碎骨折伴中心脱位)骨折各1例,单纯Stoppa入路2例,联合Kocher-Langenbeck及髂腹股沟入路3例. 结果所有骨盆骨折均复位优,所有髋臼骨折均解剖复位.Stoppa入路平均切口长度10 cm(9～12 cm),平均手术时间88 min(75～105 min),半均出血560 mL(250～800 mL),无手术并发症.7例获得4～8个月随访,功能结果均满意. 结论 Stoppa入路可以替代髂腹股沟入路治疗高位耻骨支骨折,也可单独或联合其他入路治疗髋臼骨折,具有操作简单、并发症少的优点.     

Teacher＇s Adjustable Function on the Basis of Learner＇s Needs＇ Analysis

There are the problems that influence English teaching, because the learners have the wrong understandings about the target needs and learning needs. The article analyses and discusses the teaching methods on dealing with the matter. The author thinks the teachers＇ adjustable function counting for much more.