应用腹腔镜技术治疗阑尾残端瘘5例分析

正阑尾残端瘘是阑尾切除术后严重的并发症之一,其发生率在0.7%～3.7%~([1]),一旦发生,往往不能自愈,治疗周期长,给病人带来严重的身心损害和经济负担。研究认为,70%～80%的病人能够通过冲洗引流、肠内肠外营养支持、内镜下阑尾残端夹闭等方法治愈,但仍有近20%的病人在接受3～6个月的保守治疗仍无法治愈,须接受二次手术~([2])。笔者医院将腹腔镜技术应用于阑尾残端瘘病人的再次手术中。现报告如下。     

Reconstruction of a transmetatarsal amputation stump using a salvaged peroneal artery fasciocutaneous flap from the opposite leg: A case report

During lower extremity amputation, the objective is to provide a functional residual limb that permits maximum patient mobility and independence. Preservation of length of the fore part of the foot using salvageable tissue from the amputated part in young patients prevents equines deformity and revision of amputation to a higher level. This can be achieved using tissue available from the amputated part. The spare part concept in reconstructive surgery should be integrated into the trauma algorithm to avoid additional donor site morbidity. Reported here is a young adult patient with crush injuries to both feet, which resulted in amputations. A fasciocutaneous flap raised from one extremity was used to facilitate transmetatarsal amputation stump length preservation of the other extremity.     

残胃癌临床诊治分析

目的分析和总结残胃癌的外科诊断、治疗及预后情况。方法对1990年以来收治的35例残胃癌的发病率、临床表现、治疗情况和预后进行回顾性分析。结果首次胃切除以胃溃疡为主,占65.7%,首次手术BillrothⅡ式占82.9%(29/35)。残胃癌早期缺乏特异的症状,主要为上腹部隐痛不适,首次手术距临床诊断残胃癌的间隔时间平均为16.3年。本组残胃癌手术切除率及根治性切除率分别为77.1%和54.3%,根治性切除患者1、3、5年生存率分为78.9%、52.6%、36.8%,Ⅰ期、Ⅱ期患者的5年生存率为72.7%。结论胃良性病行手术治疗时以BillrothⅠ式为首选,定期胃镜检查是早期诊断残胃癌的关键,根治性切除是治疗残胃癌的有效方法及影响残胃癌预后的重要因素。     

Endoscopic sealing of infected bronchus stump fistulae with fibrin following lung resections

Summary Bronchus stump insufficiency following lung resection, with an average incidence of 4%, is a serious complication which carries a mortality of up to 90%. Operative transthoracic approaches have been largely unsatisfactory because of the high operative risk and rapidly spreading infection. In an experimental study on 18 pigs, endoscopic occlusion of infected bronchus stump fistulae was achieved with fibrin sealant (1 ml, 500 units/ml thrombin, 3500 units/ml aprotinin) applied via a flexible bronchoscope. During autopsy, all bronchus stump fistulae were found to have healed after the second postoperative week. Transitory local abscesses of the pleura could be prevented by high-dose systemic antibiotic therapy for 5 postoperative days but not by antibiotics added to the fibrin sealant. This endoscopic method has already been performed successfully in 3 clinical cases; additional sclerotherapy with (2–3 ml Ethoxysclerol applied around the fistula orifice was carried out before fibrin sealing to stimulate fibrosis. Endoscopic controls demonstrated fistula closure by granulation tissue after 2 weeks. This procedure could become the method of choice for infected postoperative fistulae of the bronchus stump and should be attempted in any case before operative approaches are considered.     

残胃癌的诊治探讨（附5例报告）

本文就宁夏医学院附属医院肿瘤外科1984～1994年6月收治的603例胃癌中的5例残胃癌患者，结合文献对其发病年龄，部位，发病率，生物学行为、临床表现、早期诊断以及残胃癌与胃大部切除术式的关系等进行了探讨，认为：1.以外科手术为主的综合治疗是残胃癌的治疗原则；2．定期随诊是早期发现残胃癌的关键，3．B-Ⅰ式吻合或Roux-en-Y式吻台取代B-Ⅱ式吻合，可避免十二指肠液返流入残胃，减缓残胃癌的发生。     

Tail stump spermatozoa: morphogenesis of the defect. An ultrastructural study of sperm and testicular biopsy

We have studied the ultrastructure of testes biopsies and immotile spermatozoa from a supposed secondary infertile male. A wide range of tail defects has been described in testes and semen. Among these, tail stump spermatozoa occurs rarely. Although the origin of this defect is unknown, testes sections revealed that damage occurs during spermiogenesis at the latest stages during flagellum elongation in spermatids.     

Does gastric adenocarcinoma develop after the treatment of gastric lymphoma?

Two adult patients with the diagnosis of gastric lymphoma who developed adenocarcinoma of the stomach 8 years after the treatment are presented. Both patients were treated by subtotal gastrectomy followed by irradiation of 4,000–4,500 cGy to the epigastric region and six courses of chemotherapy (vincristine, cyclophosphamide, prednisolone). In our review of the literature, 16 cases of gastric adenocarcinoma following the treatment of gastric lymphoma were found and listed with details. The factors influencing the development of this secondary carcinoma, mainly those treatment related are discussed. The possible role of both radiotherapy and chemotherapy in shortening the latent period for the development of stump carcinoma is emphasized. © 1993 Wiley-Liss, Inc.     

Maschineller und manueller Bronchusverschluß —ergebnisse einer konsekutiven untersuchungsserie

Zusammenfassung Experimentelle Untersuchungen haben für den maschinellen Bronchusverschluß nach Lobektomie und Pneumonektomie im Vergleich zu anderen Nahtmaterialien die geringste Entzündungsrate und die höchste Zugfestigkeit ergeben. In einer konsekutiven Serie von 233 Lungenresektionen der Chirurgischen Kliniken Köln-Lindenthal und der Klinik für Allgemein- und Abdominalchirurgie der Johannes Gutenberg-Universität Mainz ging die Häufigkeit einer Bronchus-stumpfinsuffizienz von 7,1% nach manuellem Bronchusverschluß auf 2,0% und die insuffizienzbedingte Letalität auf 0,7% bei Anwendung des Klammergeräts zurück. Die wesentlichen Vorteile des maschinellen Bronchusverschlusses sind die Einfachheit der Anwendung, die Schnelligkeit und die Gleichmäßigkeit des Verschlusses. Damit stellen die Klammernahtgeräte bei Lungenresektionen eine wertvolle Ergänzung der Operationstechnik dar.

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Mechanical and manual bronchial closure —results of a consecutive trial

Summary After lobectomy and pneumonectomy in experimental evaluations stapled bronchial closures showed the lowest incidence of inflammatory reaction and the highest strength determined by leakage pressure compared with other suture material. A total of 233 lung resections - performed at Surgical University Clinic Köln-Lindenthal and the Clinic for General and Abdominal Surgery of the Johannes-Gutenberg-Universität Mainz — were reviewed. Mechanical stapling reduced the rate of bronchopleural fistulas to 2.0% compared with 7.1 % after manual suturing. In parallel, mortality related to bronchial stump leakage decreased to 0.7%. Main advantages of bronchial closure with staplers are the simplicity of their use, the speed and the uniformity of the closure. Thereby stapling devices are valuable completions in pulmonary surgery.

     

Prognostic value of early somatosensory evoked potentials during carotid surgery: Relationship with electroencephalogram,stump pressure and clinical outcome

Summary The authors have reported on the prognostic value of continuous monitoring of somatosensory evoked potentials (SEP) in a survey of 25 patients who underwent carotid surgery. SEP recordings were correlated with the EEG, stump pressure (SP) values and clinical outcome. A non-cephalic reference was used for SEP recordings to allow the analysis of both subcortical and cortical components. During surgery the conduction time between SEP peaks relating to the subcortical components remained stable or showed minimum variations in all patients. During carotid clamping, SEP variations were observed in 9 out of 25 cases (36%). The application of an intraluminal shunt was accompanied by the return to normal values in 7 out of 9 patients. In the remaining two cases SEP abnormalities continued post-operatively and were accompanied by new neurological deficits. EEG changes during carotid clamping were associated with SEP modifications in 6 out of 7 cases, although they were not always correlated. Results confirm that SEP recordings provide useful data concerning the function of the CNS in anaesthetized patients and that, being sensitive to CBF changes, SEP monitoring acts as an indicator of cerebral ischaemia.Presented in part at the Third International Evoked Potentials Symposium, Berlin-West, September 28th–October 1st, 1986.     

阑尾残株炎

目的：探讨阑尾残株炎的发病原因,诊断,治疗及预防措施。方法：对4例阑尾残株炎进行回顾性总结分析。结果：阑尾残株炎均因阑尾切除时根部留得过长所致,易误诊误治。结论：阑尾切除时根部应小于0．5cm,对阑尾切除术后右下腹仍疼痛的患,应考虑有阑尾残株炎的可能。