左心室巨大室壁瘤不同左心室成形方法的对比研究

目的研究左心室巨大室壁瘤的左心室成形方法,对改进的左心室心内膜环缩技术和传统的线性缝合技术进行近、远期疗效对比。方法自1992年1月至2004年12月,对148例左心室巨大室壁瘤患者进行手术治疗,按照手术中左心室成形方法不同分为两组,传统术式组:89例,采用传统的线性缝合成形技术;改良术式组:59例,采用改良的心内膜环缩成形技术,旷置梗死的心肌组织,再缝合环缩后的切口。采用多次信访、电话随访和门诊复查相结合的方法对两组患者术后的近、远期疗效进行对比观察。结果手术死亡5例(3.4%),其中传统术式组4例,改良术式组1例(P=0.320)。术后主要并发症为低心排血量和心室颤动。随访134例(93.7%),随访时间51.4±27.0月。远期死亡21例,术后早期心功能Ⅲ级以上是影响远期死亡的危险因素(P=0.000)。改良术式组5年和8年生存率明显优于传统术式组(91.6%vs.76.3%,P=0.040;91.6%vs.61.4%,P=0.000)。两组心功能分级(NYHA)和左心室射血分数(LVEF)术后早期和随访期间较术前改善和升高(P<0.05),改良术式组改善更明显。两组左心室舒张期末内径(LVEDD)术后早期与术前比较明显减小(P=0.000),但随访30个月时有重新增大的趋势(P=0.046)。传统术式组随访30个月时LVEDD扩大比率明显高于改良术式组(38.8%vs.16.7%,P=0.030)。结论左心室巨大室壁瘤的手术近、远期疗效满意,保持适当的左心室形态和容积是手术的关键。心内膜环缩法进行左心室成形是一种简单有效的手段,其远期结果优于线性缝合法。     

The knit stitch

Intracorporeal suturing is essential to advanced laparoscopy and is a rate-limiting step in many procedures. We have outlined an improved method of intracorporeal knot tying which is easier to learn, faster, and more consistently performed than current methods. Conventional intracorporeal knot-tying technique was compared to the knit-stitch method by ten volunteer surgeons. Each participant tied ten conventional-style knots in a video trainer. Surgeons were then taught the knit-stitch method and tied an additional ten knots. Knot-tying times were recorded and compared. Participants were asked to choose the method they preferred. The knit-stitch method was demonstrated to be faster than the conventional method for all participants, regardless of level of training or laparoscopic expertise (mean 63±19 vs 97±48 s; P<0.001). The difference was most marked in participants with the least laparoscopic suturing experience. The knit-stitch was preferred by 90% of the surgeons. Reasons cited for this preference were ease of learning, conservation of instrument motion, better utilization of the nondominant hand, and ability to work with shorter suture.Knit stitching is a faster, more consistent method of intracorporeal suturing. It is preferred because of its simplicity, efficiency, and potential to further reduce tissue trauma during the course of laparoscopic suturing.     

Endoscopic therapy of weight regain after bariatric surgery

Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological, anatomical and metabolic factors. Surgical revision of these patients has significant risks and limited benefits. Endoscopic revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective, safe, less invasive and even reproducible treatment. We herein discuss the indication, selection and feasibility of different endoscopic techniques that could be used in the management of weight regain following primary bariatric surgery. Future research could optimize a personalized approach not only in the endoscopic management but also in combination with other therapeutic modalities for weight regain after bariatric surgery.     

Comfortable suture angle with optimized trocar position aids renorrhaphy during retroperitoneal laparoscopic partial nephrectomy

BackgroundThis study investigated a comfortable suture angle (CSA) with optimized trocar position for closing the defect during renorrhaphy in retroperitoneal laparoscopic partial nephrectomy (LPN). The feasibility, usefulness, and safety of achieving the CSA with modified trocar position were determined for different tumor types.MethodsTwo optimized trocar positions were introduced for different tumor types. A suture angle was based on the tumor plane of the superficial parenchyma defect and the line formed by the needle holder. Preliminary surgical simulations determined a CSA that combined the least suture time with the greatest ease of performance. Achieving the CSA was attempted during renorrhaphy of 106 enrolled patients undergoing retroperitoneal LPN. Patients’ characteristics, operative features, and follow-up information were collected and analyzed.ResultsFor 89 (83.96%) patients, a CSA was successfully reached and parenchyma recovered. The remaining 17 patients were successfully sutured, but the attempt to achieve a CSA failed. For the CSA group, the suture, clamping, and overall operative times were significantly less than that of the non-CSA patients. The groups were similar regarding estimated blood loss, positive surgical margin, and rates of glomerular filtration reduction and complications. Univariable analyses determined that tumor location, growth pattern, and R.E.N.A.L. nephrometry score (RNS) may influence the success of this approach. Multivariable analyses indicated that only tumor location and RNS were independent factors affecting successful achievement of the CSA.ConclusionsThrough different kidney position changes, the CSA could be used to ease the suture process. It is feasible and safe to perform a CSA with optimized trocar position during LPN. Tumor location and RNS may influence the approach to get a CSA.     

Video-assisted thoracoscopic suturing of apical bullae

We prospectively studied thoracoscopic suturing of apical bullae in the management of primary spontaneous pneumothorax. From June 1993 to July 1994, we performed 29 such procedures in 27 patients. (All males ranging in age from 15 to 40.) Bullae less than 2 cm in diameter were imbricated (18), while larger bullae were resected and repaired with 3/0 polypropylene suture (11). Postoperative morbidity was minimal. Averaged postoperative parenteral narcotic (Pethidine) requirement was 88 mg, chest drainage was 1.7 (range 1–4) days, and hospital stay was 2.5 (range 1–7) days. There was no recurrence after a mean follow-up of 10 months. In comparison, 32 patients prior to this study period underwent staple resection of apical bulla. Demographic data in the two groups were similar. Averaged Pethidine requirement in the staple group was 98 mg, chest drainage was 1.8 (range 1–5) days, and hospital stay was 2.6 (range 1–7) days. There was no statistical difference in the two groups with respect to pain medication, chest drainage, or hospital stay. The technique of thoracoscopic suturing can be easily acquired. In view of the high cost of staple-cutters, endoscopic suturing should be considered as a viable alternative to staple resection of apical bullae in the treatment of primary spontaneous pneumothorax.Presented in part at the 4th World Congress of Endoscopic Surgery, Kyoto, Japan, June 16–19, 1994 [6]     

Laparoscopic transgastric suturing for bleeding peptic ulcers

Background: Peptic ulcers are a frequent cause of upper G.I. bleeding. Since endoscopic methods may be unsuccessful, we have studied the feasibility of a new laparoscopic approach on a porcine model to control the bleeding of these ulcers with transgastric suturing. Methods: After approval of the Animal Ethics Committee, 20 pigs (20 kg) were anticoagulated with intravenous sodium heparin (400 U/kg), and anesthetized. A nasogastric tube was inserted and a 15 mmHg pneumoperitoneum was created. Two 10-mm trocars and one 5-mm trocar were inserted through the abdominal cavity for laparoscopic guidance of three 7-mm endoluminal trocars inside the stomach through the anterior wall. Two posterior gastric ulcers were mechanically made on each pig by a lift and cut technique. Ulcers were observed for at least 1 min for evidence of continued bleeding. First, bleeding ulcers were treated with sclerosing agents (epinephrine and ethanolmine oleate 5%); following sclerotherapy, ulcers were sutured intraluminaly with 2-0 silk, with intracorporeal knots. Results: Ulcers created extended into the vascular submucosa and averaged 7 mm in diameter. Bleeding rate was variable, but significant (2 cm³/min) in 40%. It was technically possible to suture these ulcers in 80%. Bleeding was controlled in 95% of cases with sclerotherapy and intraluminal sutures. One perforation of the posterior gastric wall occurred and four endoluminal trocars had to be reinserted after dislodgement. Conclusions: It is possible to technically control bleeding ulcers in most cases with a laparoscopic transgastric technique using sclerosing agent and intraluminal sutures. This approach is promising for future human application; also, the intragastric suturing skills developed may be useful for other surgical interventions.Poster presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Orlando, Florida, USA, 11–14 March 1995     

Looped,Broad, and Deep Buried Suturing Technique for Wound Closure

This study explores the clinical application of the circular wide and deep (looped, broad, and deep buried, LBD) suture technique for scar resection and examines its clinical effectiveness for scar treatment. From June 2017 to March 2019, a total of 68 patients with scars were sutured using LBD technique, and recovery was achieved 24 months postoperatively. In all 68 patients, postoperative scars were slightly evident in two cases of cervical scar, one case of leg scar, and one case of chest scar. In addition, the remaining 62 patients were completely satisfied with the outcome. The LBD suturing technique could provide sustained and stable tension-reducing effects postoperatively and significantly improve scar formation in patients. This method is most applicable to incisions with tension. Therefore, it should be more widely used for clinical scar treatment.     

三层缝合法处女膜修补术

目的：介绍一种新的处女膜修补的手术方法。方法：回顾性分析110例患者,应用三层缝合法行处女膜修补术,术毕处女膜孔径恢复至仅容一眼科镊柄大小,约5-6mm,嘱术后1月复诊。结果：57例（52％）患者术后1月来院复查,其中52例完全愈合,愈合率约为91％,剩余5例中4例裂口裂开但未至基底部,不影响效果,有效率为98％。1例切口完全裂开,应用环形缝线法二次修补,效果基本满意。结论：应用三层缝合法处女膜修补术,切口愈合率较高,同时有微型阴道紧缩的作用,更能模拟处女的正常生理状态,值得推广。     

改进缝合材料在妇产科手术缝合腹壁纵切口中的应用

目的探讨使用改进缝合材料缝合腹壁皮肤纵切口的效果。方法将漯河医学高等专科学校第二附属医院使用免打结双向锯齿缝合线(quill线)缝合腹壁纵切口的85例患者设为观察组,使用传统缝合线的78例患者设为对照组,观察比较两组缝合切口效果及随访结果。结果切口甲级愈合率两组比较差异无统计学意义(P0.05);观察组缝线反应、皮下硬结发生率小于对照组,缝合时间及住院时间短于对照组(P0.05)。结论使用quill缝合线缝合腹壁纵切口,明显缩短了手术时间和住院时间,腹壁不留针眼,切口愈合良好,术后无线结反应,患者疼痛轻,加之不拆线,值得临床推广应用。     

Is nasal septal suturing an alternative technique to nasal packing?: A protocol for systematic review and meta-analysis

Background:Nasal septal suturing is a commonly used alternative treatment to nasal packing after septoplasty. Besides alleviating postoperative discomfort, extensive studies have shown that nasal septal suturing is more effective than nasal packing. However, its clinical benefits remain controversial.Methods:We will perform a systematic review of nasal packings effect-related outcome in comparison to nasal septum suture among septoplasty patients by searching 8 databases, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). All eligible studies will be screened against the inclusion and exclusion criteria. Two independent reviewers will extract the data. Moreover, Review Manage 5.3 will be used for quality assessment and data analysis. Then, the random effects model or fixed effects model will be applied according to the heterogeneity. In conformity with the GRADE criteria, the merits of the evidence and recommended strength will be assessed.Results:This protocol will guide subsequent systematic reviews and meta-analyses. The differences in efficacy between nasal septal suturing and nasal packing after septoplasty will be evaluated in terms of efficiency, adverse reaction, comfort degree, and other factors.Conclusion:This proposed study will explore the possibility of adopting nasal septal suturing as an alternative to nasal packing after septoplasty.OSF registration number:doi: 10.17605/OSF.IO/WF3GX.