上下泪小管同时断裂35例手术分析

目的探讨上、下泪小管同时断裂的手术治疗方法。方法上、下泪小管同时断裂共35例,按手术方式分为两组。A组:27例同时行上、下泪小管吻合术;B组:8例仅行下泪小管吻合术。结果A组27例较少发生内眦角变形、睑外翻,上下泪点复位良好。结论为求上、下泪小管断裂术后能达到解剖复位及功能复位,同时行上、下泪小管断裂吻合效果较好。     

Cleft closure for the treatment of unhealed perineal sinus

OBJECTIVE: Despite improvements in surgical practice, persistent perineal wound sinus is still a common complication after proctectomy. This study presents the success of a modified cleft closure technique in dealing with this problem. METHODS: From May 1997 patients with a persistent perineal sinus after surgery underwent a cleft closure - similar to that performed for patients with pilonidal sinus disease. RESULTS: Eight patients (6 male, 2 female) with an average age of 52 years underwent a cleft closure for a persistent perineal sinus after surgery. Four patients had undergone a proctocolectomy (ulcerative colitis), 2 an abdominoperineal excision of the rectum (adenocarcinoma) and 2 a proctectomy (1 Crohn's disease, 1 complication of diverticular disease). Symptoms had been present for an average of 41 months (range 5-152 months) and 3 patients had undergone other procedures attempted previously to deal with the problem. The first three patients had the procedure as an inpatient with an average stay of 4.7 days. The next 5 patients had the procedure as a day case (2 local anaesthetic, 3 general anaesthetic). Two patients developed a postoperative wound infection and all but one wound had healed completely by 8 weeks. In this patient the procedure was repeated to achieve healing. There was no other associated morbidity and no postoperative deaths. There have been no recurrences to date. CONCLUSION: Modified cleft closure for persistent perineal sinus is a simple procedure with low morbidity that can be performed under local anaesthetic in the day surgery unit.     

Hip Arthroscopy Without a Perineal Post: A Safer Technique for Hip Distraction

Pudendal nerve palsy is a reported complication of hip arthroscopy. We report a technique using a deflated taped beanbag rather than a perineal post. The patient is placed in the supine or lateral position on a fracture table. The beanbag is contoured around the patient’s flank and thorax. The distal aspect of the beanbag is placed no further than the iliac crest, and care is taken to avoid compression of the posterior aspect of the axillary region or the posterior humerus. The molded beanbag is deflated, a blanket is positioned over the abdomen and lower thorax, and with the use of 3-in-wide cloth tape, the patient and beanbag are secured to the operative table circumferentially. The superior margin of the deflated beanbag remains firm, preventing compression of the thorax and avoiding compromised ventilation. The arm on the operative side is placed across the chest and secured to avoid obstruction of the operative field. This patient positioning provides sufficient stability for adequate traction and good visualization while minimizing the risk of a pudendal nerve palsy.     

Value of spiral CT in hemodynamically stable patients following blunt chest trauma

Introduction: Features of spiral CT (SCT) — fast scanning, dynamic injection of contrast allowing optimal vessel opacification, and supplemental multiplanar imaging — promises to provide increased accuracy in the diagnosis of acute and non acute thoracic vascular disease. Recent work demonstrating the cost effective triage of hemodynamically stable patients after blunt chest trauma for angiography based on dynamic CT findings has prompted an investigation into the accuracy of SCT in this clinical setting. Methods: A retrospective review of all patients seen in the emergency department over the period of one year for aortic, thoracic, or blunt chest trauma evaluation was performed (74 patients) and all SCT scans available were reviewed and data reformatted for optimal delineation of pathology using maximum intensity projection and multiplanar reformation. The accuracy and predictive positive and negative values of SCT were calculated with respect to angiography, surgical, and/or clinical follow up evaluation. Results: Twenty three (31%) patients went directly to angiography owing to mediastinal widening on chest film and hemodynamic instability, of which four were positive and required emergent surgery. Seven hemodynamically stable patients (9%) had noncontrast SCT owing to mediastinal widening on chest film, all of which had angiography with none having great vessel trauma. Fourty four hemodynamically stable patients (60%) had contrast enhanced SCT (ceSCT), of which five (11%) were abnormal and underwent angiography, four of these were positive for aortic damage, one for a subclavian artery laceration. Of the remaining 39 patients who had normal ceSCT; five had angiography, all of which were normal. Of the remaining 34 patients that had normal ceSCT none had adverse outcome on clinical follow-up, minimum of 12 months. Conclusion: The predictive positive value for aortic trauma of ceSCT in blunt trauma is 80%, with a predictive negative value of 100%, indicating that it is feasible for SCT to be a first line exam in blunt chest trauma in the future.     

Laparoscopic-assisted abdominoperineal proctosigmoidectomy for rectal prolapse

The inability to completely mobilize the redundant colon in perineal rectosigmoidectomy (Altemeier's procedure) for full-thickness rectal prolapse is a main contributor to the recurrence rate associated with the procedure. However, the presence of a redundant sigmoid after the Ripstein procedure or other rectal sling operations is the main cause of the high rate of postoperative constipation and stool impaction. Low anterior resection as the definitive treatment is associated with the higher morbidity of laparotomy and the risk of anastomotic leak. We describe a laparoscopic-assisted surgical approach which combines the benefits of completely resecting the redundant sigmoid colon as well as the performance of extraperitoneal anastomosis at the level of the anus. Received: 22 April 1996/Accepted: 16 May 1996     

脑挫裂伤水肿转归时间的探讨

目的总结脑挫裂伤后脑水肿发展与消退的时间,为临床治疗提供依据。方法我院4年来收治的脑挫裂伤的患者174例,至少每3d复查一次CT,根据CT影像表现作为观察脑水肿的指标,记录脑水肿随时间演变的过程。结果所有病例脑水肿在3d内达到高峰,但水肿高峰持续时间存在差异,病程中脑水肿的高峰持续时间3～5d7例,6～8d34例,9～11d112例,12d以上21例。脑水肿高峰持续时间与脑水肿严重程度和挫裂伤的严重程度有显著关系。结论大部分脑挫裂伤脑水肿高峰时间比过去我们认识的要长,故使用控制脑水肿药物的时间应适当延长,特别是严重颅脑损伤患者,并应根据不同情况选择脱水剂。     

Successful treatment of blunt trauma involving complete laceration of the pancreas and duodenum in a 7-year-old child: Report of a case

The acute onset of peritoneal signs and shock in a 7year-old boy who had been hit in the epigastrium by a log-seesaw mandated surgical treatment. Enhanced computed tomography (CT) demonstrated complete laceration of the pancreas as well as duodenal injury, and a duodenoduodenostomy with distal pancreaticogastrostomy was subsequently performed. Temporary external drainage of the stomach and distal pancreas led to an uneventful recovery in the early postoperative period. Although the patient's postoperative development was appropriate for his age, the orifice of the distal pancreas spontaneously closed 2.5 years following surgery. We present this report to stress the fact that every effort should be made to preserve the pancreas following abdominal injury in children.     

亚低温冬眠疗法治疗重度脑挫伤的临床研究

目的探讨亚低温冬眠疗法对重度脑挫伤病人的脑保护机理及临床疗效。方法46例重度脑挫伤患者(GCS≤8分)随机分为亚低温冬眠治疗组和常温治疗组。其中亚低温冬眠组22例,入院后4￣12h内行亚低温冬眠治疗,输液泵持续静脉点滴冬眠合剂,将肛温控制在32￣35℃,亚低温冬眠治疗4￣7d,同时检测颈动脉和颈静脉血气、电解质变化、血糖及生命体征等指标。常温组24例除未行亚低温冬眠治疗外,其余综合治疗及监测方法同亚低温冬眠组。两组病人均于伤后3个月根据GOS预后评分判定疗效。结果与常温组比较,亚低温冬眠治疗组脑氧耗明显降低,高血糖情况显著下降,生命体征及电解质等无明显差异,无严重并发症,死残率明显降低,预后显著改善。结论亚低温冬眠疗法具有显著的脑保护作用,临床应用于重度脑挫伤救治安全有效,无严重并发症。