改良睫状体缝合术治疗外伤性睫状体脱离

目的 评价改良的睫状体缝合术治疗外伤性睫状体脱离的临床效果.方法 20例(20眼)外伤性睫状体脱离进行改良的缝合复位术,主要是只针对断离区进行水平叠错式缝合.分析临床资料并评价其疗效.结果 18眼术后视力不同程度提高.所有患眼术后眼压均提高,18眼眼压恢复至正常.3眼术中出现前房积血.结论 改良的睫状体缝合术治疗外伤性睫状体脱离效果良好.     

A Comparison of Continuous and Interrupted Suturing in Laparoscopic Pyeloplasty

Background:

Laparoscopic pyeloplasty is one of the most common reconstructive procedures performed by urologists. Both continuous and interrupted sutures are being practiced for ureteropelvic anastomosis. The success rate and the complications associated with the suturing technique needs evaluation. We analyzed the results from of our patients who underwent laparoscopic pyeloplasty using both techniques.

Objective:

To review the outcome differences among patients undergoing laparoscopic pyeloplasty regarding suturing technique.

Materials and Methods:

All patients who underwent laparoscopic, transperitoneal dismembered pyeloplasty of the primary pelviureteric obstruction were analyzed. The primary outcome was successful pyeloplasty, as assessed by the resolution of symptoms and T½ <10 minutes. The secondary outcomes were the complication rate and the operative parameters. The difference in the parameters was assessed by Student t test analysis.

Results:

Of the 107 patients we studied, 65 had interrupted suturing and 42 had continuous suturing. The success rate was not significantly different among the 2 groups. The mean suturing time, postoperative drainage volume, postoperative hospital stay, and total cost of the procedure were significantly less in the continuous suturing group.

Conclusion:

The continuous suturing technique is preferred over the interrupted suturing technique for laparoscopic pyeloplasty because the success rates are equal and the postoperative stay, suturing time, drain output, and cost of the procedure are better.     

Study of Two Techniques for Midline Laparotomy Fascial Wound Closure

To study the results of two techniques, simple interrupted closure and continuous with intermittent Aberdeen knot technique for midline laparotomy fascial wound closure. A random selection of 200 midline laparotomy cases was done. In one group (group A) of 100 cases, midline fascial wound closure was done with continuous sutures with intermittent Aberdeen knot technique using Prolene No. 1 suture material. In the other group (group B) of 100 cases, closure was done with the technique of simple interrupted sutures with Prolene No.1 suture material. Comparison of both the techniques regarding preoperative status and postoperative complication such as incisional hernia, wound dehiscence, suture sinus formation, stitch granuloma, and chronic wound pain was done according to clinical examination and recorded in the pro forma prepared. In group A, postoperative complications were incisional hernia 3 %, wound dehiscence 4 %, and suture sinus formation 1 %. In group B, postoperative complication were incisional hernia 5 %, wound dehiscence 4 %, and suture sinus formation 1 %. All these complications were statistically insignificant, in both group comparisons. While the complication such as stitch granuloma 3 %, chronic wound pain 3 %, and wound infection 4 % in group A was significantly less than in group B where the complication of stitch granuloma was 12 %, chronic wound pain 13 %, and wound infection 13 % (P value 0.03, P value 0.018, and P value 0.048, respectively). Both the techniques, simple interrupted suture closure and continuous with intermittent Aberdeen knot closure for midline laparotomy fascial wounds, show a similar rate of postoperative complication such as incisional hernia, wound dehiscence, and suture sinus formation. But the continuous suturing with intermittent Aberdeen knot technique is a better option to prevent complications such as stitch granuloma, chronic wound pain, and wound infection, which are higher in the simple interrupted fascial wound closure technique.     

用传统方法行腹腔镜阑尾切除的可行性研究

目的:探讨腹腔镜下按传统方法切除阑尾的可行性。方法:回顾性分析2005年1月至2006年2月47例腹腔镜阑尾切除术资料,均使用3孔法腔内缝合打结技术,35例阑尾残端结扎后行荷包缝合包埋,另12例阑尾残端单纯结扎后不予包埋。对其术前的临床资料、手术时间、并发症及术后恢复情况进行纪录。结果:全部手术均在腹腔镜下成功完成,残端包埋组手术时间较单纯结扎组明显延长(24.5min、33.8min),术后平均住院时间差异无显著性(2.1d、2.3d),未发现伤口感染及腹腔脓肿。结论:腹腔镜下按传统方法处理阑尾是安全可行的。     

The role of laparoscopic-assisted myomectomy (LAM).

Laparoscopic myomectomy has recently gained wide acceptance. However, this procedure remains technically highly demanding and concerns have been raised regarding the prolonged time of anesthesia, increased blood loss, and possibly a higher risk of postoperative adhesion formation. Laparoscopic-assisted myomectomy (LAM) is advocated as a technique that may lessen these concerns regarding laparoscopic myomectomy while retaining the benefits of laparoscopic surgery, namely, short hospital stay, lower costs, and rapid recovery. By decreasing the technical demands, and thereby the operative time, LAM may be more widely offered to patients. In carefully selected cases, LAM is a safe and efficient alternative to both laparoscopic myomectomy and myomectomy by laparotomy. These cases include patients with numerous large or deep intramural myomas. LAM allows easier repair of the uterus and rapid morcellation of the myomas. In women who desire a future pregnancy, LAM may be a better approach because it allows meticulous suturing of the uterine defect in layers and thereby eliminates excessive electrocoagulation.     

A reliable and efficient technique for laparoscopic needle positioning

Needle positioning can be a difficult, frustrating, and time-consuming step during laparoscopic suturing. Utilizing the reliable and efficient technique described in this article, needle positioning is expedited. This technique is applicable for any type of needledriver or suture. Received: 1 October 1998/Accepted: 7 April 1999     

A comparison of robotic, laparoscopic, and hand-sewn intestinal sutured anastomoses performed by residents

BACKGROUND: Robotic surgery offers all the advantages of laparoscopy with additional increased accuracy. The use of robotic surgery has increased in the past 5 years. It has proven particularly useful in complex surgical procedures such as intracorporeal intestinal anastomosis. As the prevalence of robotic surgery increases, so will the need for residents to be able to perform surgery using the robotic system. Our goal was to compare hand-sewn, laparoscopic, and robotic suturing techniques performed by midlevel residents using a porcine intestinal model. METHODS: Fifteen residents unfamiliar with the robotic suturing technique participated in performing an initial hand-sewn suture line and then were randomized with cross-over to laparoscopic or robotic suturing. Completion time, leak pressure, number of sutures per cm, and difficulty level were assessed. RESULTS: The mean leak pressure for hand-sewn, laparoscopic, and robotic suturing was 9.5, 3.2, and 11.4 mm Hg, respectively. The laparoscopic group had 6 and the robotic group had 1 suture line that was inadequate for testing. Suture breakage was common in the robotic group. The anastomosis was considered hard by 92% in the laparoscopic group versus 17% in the robotic group. The time it took to complete 1 cm of anastomosis was .9, 8.7, and 8.3 minutes for hand-sewn, laparoscopic, and robotic suturing, respectively. CONCLUSION: The robotic suture line performed by midlevel residents was superior to laparoscopy, although the time for anastomosis was equivalent.     

睫状体脱离缝合复位手术失败原因的探讨

目的：探讨失伤性睫状体脱离睫状体缝合复合手术失败的原因，方法：对17例经过睫状体缝合复位失败的患者，进行检查，分析失败的原因，并根据失败的原因再次施行睫状体缝合复位手术。结果：再次手术的17例中14例眼压大于12.33mmHg，占82．3％；3例在7．10－12.23mmHg之间（1mmHg=0.133kPa)；9例视力在0．1－0．5者，占53％，3例视力在0．1以上，占17．6％，结论：睫状体脱离的断离口未查到或遗漏、睫状体漏缝合，手术范围估计不足，针距过大以及3点及9点脱离未予缝合是导致睫状体脱离缝合复位手术失败的主要原因，避免上述因素，可以帮助提高手术的成功率。     

缝外膜肠线支架减张输精管吻合术

本文报告一种在肉眼下行吻合的缝外膜肠线支架减张输精管吻合新方法.此法与外膜肌层法、全层不锈钢支架法和单纯全层法等对照地进行了动物实验及临床应用研究.自1980年3月以来,在临床上,上四法分别做了30、30、13及13例,术后分别随访到30、28、12及11例;其复精率分别是90%、82.1%、33、3%及27.3%;其复孕率分别是71.4%、60.7%、16.7%及0%.其结果显示,本法较其他肉眼下的输精管吻合法更加简便易行,效果满意.     

普通器械、子宫血管缝扎的全腹腔镜子宫切除56例

目的探讨采用普通器械、子宫血管缝扎的全腹腔镜子宫切除术（total laparoscopic hysterectomy,TLH）的安全性。方法 2009年6月～2010年10月,采用杯状举宫器,单、双极电凝等常用腹腔镜器械,子宫血管缝扎的方法行TLH 56例。子宫正常大小12例,如孕8～10周24例,如孕9～12周20例。结果 56例均于腹腔镜下完成手术,联合卵巢囊肿剔除3例,盆腔粘连松解7例,腹腔镜阑尾切除术2例。无中转开腹。手术时间76～146 min,（97.6±11.6）min;术中出血量55～105 ml,（85.7±23.5）ml。术后住院4～5 d。术中及术后均未出现并发症。56例随访6～9个月,无异常。结论普通器械、子宫血管缝扎应用于TLH,能有效阻断子宫血供,操作简单,安全有效,值得在基层医院推广应用。