"插入式"输尿管肠管吻合在原位肠道膀胱替代术中的应用

目的 探讨"插入式"输尿管肠管吻合在原位肠道膀胱替代术中的手术效果和临床疗效.方法 对38例原位肠道膀胱替代术中75侧行"插入式"输尿管肠管吻合术患者进行随访,通过影像学、膀胱尿道镜、病理学、实验室检查等观察临床疗效.结果 术后平均随访(31.65±14.14)个月,吻合口狭窄率4%(3/75);抗返流率100%;无吻合口漏;膀胱尿道镜下,输尿管种植部位形成乳头,钳取7例患者乳头表面小块上皮组织作病理检查,其中乳头基底部2例为肠黏膜上皮,乳头尖端5例为移行上皮;所有患者复查肾功能均在正常范围,血Cr 54-135 μmol/L,BUN 3.2～9.4 mmol/L.结论 "插入式"输尿管肠管吻合术是一种较理想的输尿管肠管抗返流吻合术式.     

梗阻性左半结肠癌I期切除吻合术的探讨

目的探讨急性梗阻性左半结肠癌I期切除、吻合的可行性。方法采用术中肠管切开减压，近远端肠管顺行灌洗，I期肿瘤切除、吻合。结果15例患者除1例吻合口瘘经引流冲洗后治愈，余病例全部I期愈合。结论左半结肠癌引起肠梗阻，严格掌握手术适应证，合理围手术期处理，术中肠管减压、灌洗及术后扩肛，I期切除吻合术是安全可取的。     

再次泪囊鼻腔吻合术的临床分析

本文报告了１０例慢性泪囊炎患者，行泪囊鼻腔吻合术后，发生吻合口阻塞，再次行泪囊鼻腔吻合术，手术治愈率１００％。并就其阻塞的原因、防止方法、治疗方法进行了讨论     

术前静脉造影对静脉管壁及其吻合效应的实验研究

以动物实验模拟行静脉造影后,肉眼观察,并以透射电镜和扫描电镜动态观察经灌注固定的局部静脉管壁和内皮细胞的改变,发现造影剂回流的静脉管壁在较长的时间内处于扩张状态,同时穿刺注射造影剂的部位出现较严重的淤血和血栓形成。内皮细胞连接有较广泛裂开、剥离及内皮下组织暴露。在受损严重的区域还可见有微血栓形成。造影1天后内皮细胞受损最为严重,至第3天基本恢复。血管吻合实验表明,术前3天静脉造影不影响直径为2.5mm静脉的吻合通畅率。     

黏膜瓣式食管胃吻合术抗反流的食管动力学研究

目的寻找一种实用有效的抗反流食管胃吻合术式。方法将食管癌和贲门癌患者464例随机分为黏膜瓣式食管胃吻合术组(A组,175例)、器械食管胃吻合术组(B组,151例)和单纯手工缝合食管胃一层吻合术组(C组,138例)。应用同位素测定胃食管反流指数和24h监测pH值,进行3组间的食管运动功能比较。结果同位素测定胃食管反流指数显示,A组反流阳性率为0,B组为33.3%,C组为6.7%。食管运动功能及24h监测pH显示,A组检测各项指标均接近正常值,B、C组与正常值比较,差异具有统计学意义(P<0.05)。结论黏膜瓣式食管胃吻合术式具有优异的抗反流功能,并能有效地防止食管癌、贲门癌术后反流性食管炎的发生。     

Development of sutureless vascular connecting system for easy implantation of small-caliber artificial grafts

A novel sutureless vascular connecting system, an assembly with a delivery rod, an introducing sheath, and a connecting device, was developed for easy implantation of small-caliber vascular grafts less than 2 mm in internal diameter. A microporous stainless tube (length 2 mm, external diameter 1.6 mm, wall thickness 65 µm, pore diameter 400 µm, pore-to-pore distance 500 µm) was designed to serve as a connecting device. The feasibility of the system was tested using two types of preliminary animal experiments. One animal model consisted of graft implantation into the rat abdominal aorta (1.5 mm in diameter). The connecting device was inserted into the proximal and distal ends of the aorta through the introducing sheath by pushing the delivery rod with the connecting device placed over it. Subsequently, the aortic segments were inserted into both ends of model grafts made of segmented polyurethane (1.8 mm in internal diameter) and were fixed with banding silk threads from the exterior. The procedure was completed within 20 min without requiring specialized microsurgery techniques. Blood leakage and obstruction did not occur. The second model consisted of an end-to-end anastomosis between rabbit common carotid arteries (2 mm in diameter), which was performed within several minutes of blood flow interruption. Scanning electron microscopy demonstrated that the luminal surface of the device was fully covered with endothelial cells (ECs) after 1 week as a result of transluminal ingrowth of native ECs through the micropores in the device. This endothelialization may prevent early thrombus-induced occlusion. This simple and “easy-to-learn” technique will promote the development of small-caliber arterial grafts, and furthermore, it may have potential for clinical application.     

膝关节动脉的血液供应

本文通过动脉灌注,对120侧不同年龄(新生儿至87岁)尸体的膝关节骨性部和软组织的血液供应分别进行了研究。新生儿的膝动脉在软骨内分布呈节段性,软骨骨化后,骨骺和髌骨的动脉间建立广泛的吻合。骺软骨板分隔膝关节的骨骺与干骺端。随骺板的闭合,两者间有血管互相交通。骺板的血液供应来自骺动脉、干骺动脉和滋养动脉终末的毛细血管袢以及骨膜动脉网的小支。髌骨的动脉分3组,发自髌前丛和髌周动脉环。滑膜和髌下脂垫的血管分布丰富。肌睫和韧带在骨的附着处缺乏血管。成人半月板外1/5有血管分布,内4/5无血管。本文对膝关节血管分布的临床意义作了简要讨论。     

Sequence variation of the rDNA ITS regions within and between anastomosis groups in Rhizoctonia solani

Sequence analysis of the rDNA region containing the internal transcribed spacer (ITS) regions and the 5.8s rDNA coding sequence was used to evaluate the genetic diversity of 45 isolates within and between anastomosis groups (AGs) in Rhizoctonia solani. The 5.8s rDNA sequence was completely conserved across all the AGs examined, whereas the ITS rDNA sequence was found to be highly variable among isolates. The sequence homology in the ITS regions was above 96% for isolates of the same subgroup, 66 – 100% for isolates of different subgroups within an AG, and 55 – 96% for isolates of different AGs. In neighbor-joining trees based on distances derived from ITS-5.8s rDNA sequences, subgroups IA, IB and IC within AG-1 and subgroups HG-I and HG-II within AG-4 were placed on statistically significant branches as assessed by bootstrap analysis. These results suggest that sequence analysis of ITS rDNA regions of R. solani may be a valuable tool for identifying AG subgroups of biological significance. Received: 11 February /16 May 1997     

Konsekutive Serie von 100 Colonresektionen mit einer modifizierten fortlaufenden Nahttechnik

Zusammenfassung Es wird anhand einer konsekutiven Serie über eine modifizierte fortlaufende Nahttechnik am Colon berichtet, die gerade bei älteren Patienten eine sichere und rasche Methode der Anastomosierung darstellt. Die klinisch relevante Insuffizienzrate sowie auch die Letalitätsrate betrugen in dieser Serie je 2%, wobei die Ursachen für die Letalität aber keine Folge der Insuffizienz waren. Die Komplikationsrate betrug 11%, die urologischen Komplikationen mit 6% standen hierbei im Vordergrund.

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A consecutive series of 100 resections of the colon using a modified technique of continuous (running away) suture

Summary Based on a consecutive series it is reported about a modified type of continuous suture on the colon, used especially in elderly patients for being a secure and prompt method of anastomosing. The rate of insufficiency and mortality, as far as the clinical relevance is concerned, turns out to be 2% each and there was no relation between mortality and insufficient anastomosis. The complication rate was 11%, whereby the urological complications predominated with 6% of the total.

     

急诊泪小管断裂的吻合术

目的 探讨断裂泪小管内侧断端的位置规律,提高急诊泪小管断裂吻合术的成功率。方法 在手术显微镜直视下沿泪阜下缘的延长线寻找泪小管内侧断端,以直径０．８ｍｍ的实芯硅胶条作为泪小管内支撑,吻合泪小管断端。结果 ２９例均一次吻合成功。结论 掌握断裂泪小管内侧断端的位置规律,使泪小管吻合术易于开展,应用手术显微镜能提高手术成功率。