From July 1978 to July 1990, 11 operative methods for reconstruct the gluteal motors were performed in 733 cases. The result was satisfactory. The authors first introduced the Clinical material, then discussed principally how to selecte the operative type and some technical points to improve the result. It was thought that Obers operation was simple, easy and its result was reliable. So, it was taken as the method of priority in restoring the gluteal motors in this hospital.
目的:比较低位直肠癌几种术式的复发率及5年生存率的差异,探讨术式的选择。方法:收集我院2001～2008年收治268例低位直肠癌病例资料,按局部切除,TME+DIXON、TME+MILES分成三组,对术后复发率及5年生存率进行回顾分析。结果:局部切除组12例,2年局部复发2例,复发率16.%,TME+DIXON组192例,总保肛率84.%,2年复发45例,复发率16.%,5年生存率61.%,TME+MILES术64例,2年复发11例,复发率17%,5年生存率59%,三组病例2年复发率相近,统计学数据显示无显著性差异(Pgt;0.5)。结论:对低位直肠癌,可根据病灶大小,病理学类型,Dukes分期等把握术式选择的适应症:保肛术式为首选, Miles术为最后的选择。
ObjectiveTo compare the effectiveness of improved and traditional Kirschner wire tension band fixation in treatment of type C patellar fractures.MethodsBetween January 2017 and January 2019, 26 patients with type C patellar fractures were treated with improved Kirschner wire tension band fixation (group A), and 24 patients were treated with traditional Kirschner wire tension band fixation (group B). There was no significant difference in gender, age, injury cause, disease duration, and side and type of fracture between 2 groups (P>0.05). The operation time, intraoperative blood loss, the visual analogue scale (VAS) scores at 1 and 3 days after operation, the fracture healing time, and the occurrence of complications (skin irritation of Kirschner wires, failure of internal fixation, fracture reduction loss) were recorded, and the knee function was evaluated by Lysholm scoring standard in 2 groups.ResultsThe operation time in group A was significantly less than that in group B (t=−4.742, P=0.000). There was no significant difference in the intraoperative blood loss and VAS scores at 1 and 3 days after operation between 2 groups (P>0.05). All incisions healed by first intention. All patients were followed up 8-15 months, with an average of 11 months. The fracture healing time was (3.3±0.6) months in group A and (3.2±0.6) months in group B, showing no significant difference (t=0.589, P=0.559). At last follow-up, the knee joint function was evaluated according to Lysholm scoring standard. And there were 15 cases of excellent, 8 cases of good, and 3 cases of fair, with an excellent and good rate of 88.5% in group A; there were 8 cases of excellent, 7 cases of good, 7 cases of fair, and 2 cases of poor, with an excellent and good rate was 62.5%. The difference between 2 groups was significant (Z=2.828, P=0.005). The internal fixators were removed after the fracture healed in 2 groups. At last follow-up, no skin irritation of Kirschner wires occurred in group A, but 3 cases in group B. X-ray films reexamination showed that 5 cases of internal fixation failure and no fracture reduction loss were found in group A, while 9 cases of internal fixation failure and 1 case of fracture reduction loss in group B. The incidence of complications in group A was 19.2% (5/26), which was significantly lower than that in group B (54.2%, 13/24) (χ2=6.611, P=0.010).ConclusionCompared with the traditional Kirschner wire tension band fixation, the improved Kirschner wire tension band fixation in treatment of type C patellar fracture can shorten the operation time, reduce the incidence of complications, and benefit the functional recovery of knee joint.
ObjectiveTo evaluate the safety and advantages of modified Bacon one-time operation in laparoscopic radical resection for ultra-low rectal cancer.MethodsThe medical records of all patients who underwent laparoscopic modified Bacon procedure for ultra-low rectal cancer treated by Professor SONG Junmin Medical Group of our department from August 2018 to June 2020 were analyzed retrospectively. According to the different methods during the operation, the patients were divided into a modified Bacon one-time operation group (modified Bacon group, n=26) and a Bacon secondary operation group (traditional Bacon group, n=33). The perioperative period data and follow-up results were observed and compared.ResultsA total of 59 ptients were collected, including 26 cases in the modified Bacon group and 33 cases in the traditional Bacon group. There were no significant differences in gender composition, age, etc. baseline data between the two groups (P>0.05). All surgery were successfully completed. There were no conversion to laparotomy, intraoperative or postoperative massive bleeding, severe infection and other serious complications and perioperative period death. The incidence of anastomotic leakage in the modified Bacon group was lower than that of the traditional Bacon group [0.0% (0/26) versus 18.2% (6/33), P=0.030]. There were no significant differences in the incidences of postoperative anastomotic bleeding, anastomotic stricture, rectal irritation, and external intestinal necrosis between the two groups (P>0.05). And the number of dissected lymph nodes, operation time, intraoperative blood loss, the first exhaust time, and postoperative hospital stay had no significant differences between the two groups (P>0.05). There were no significant differences in the severity degree and total score of low anterior rectectomy syndrome (LARS) between the two groups at 3 and 6 months after operation (P>0.05). However, the total LARS score at 6 months after operation was lower than that at 3 months in the same group (P<0.001). By the end of the last follow-up (January 2021), there was no obvious difference in the anal shape between the two kinds of surgery. There was no recurrence or death during the follow-up period.ConclusionModified Bacon one-time operation for ultra-low rectal cancer is safe and feasible, which could achieve natural orififice specimen extraction surgery and ultra-low limit sphincter preservation, reduce occurrence of postoperative anastomotic leakage and external intestinal necrosis, times of operation, and shorten total length of stay and reduce total cost of hospitalization.
Objective To present method and experiences in using the buccal mucosa with the Snodgrass procedure for repair of hypospadias. Methods Between August 2012 and April 2015, 55 boys with hypospadias were treated with Snodgrass procedure combined with buccal mucosa. The age ranged from 1 to 7 years (mean, 4 years). There were 32 cases of distal penile type, 14 cases of proximal penile type, and 9 cases of coronal sulcus type. The buccal mucosa taking from inner cheek was fixed into the incised urethral plate. The urethral plate was tubularized over a catheter. Results All the patients were followed up 3-25 months (mean, 11 months). After operation, 1 patient had urethral stricture and fistula after repaired urethra was infected, and 5 patients had fistula. For the others, the urination was smooth, the appearance of penis was satisfying, the urethral stricture did not occur, and the penis was straightened completely. Conclusion Compared with traditional Snodgrass procedure, the application of buccal mucosa can increase the reconstruction material of urethral and reduce the stricture of the repaired urethra after operation.
的讨论先天性巨结肠的手术治疗。方法回顾106例先天性巨结肠的手术治疗方式及疗效。结果采用改良Duhamel术式治疗先天性巨结肠并发症少，远期排便功能良好。结论改良Duhamel术式适于任何年龄和所有类型的巨结肠，疗效满意。
Objective To modify orthotopic liver transplantation method with two-cuff technique. Methods On the basis of cuff technique, the donor liver was perfused through the abdominal aorta with 20 ml cold perfusate. The anastomosis of the suprahepatic vena cave(SVC) was sutured end-to-end with 8/0 nylon line,and the continuity of infrahepatic vena cave(IVC) and portal vein(PV) were established by means of cuff method respectively.The bile duct anastomosis was performed by internal stent. Results Orthotopic liver transplantations were performed in 360 rats. The time for donor operation and liver preparation was (31.2±5.0) min and (12.0±3.0)min，and the recipient operative and anhepatic time was (45.0±5.5) min and (20.0±2.5) min, respectively. The two-day survival rate was 91.4%.In nonintervention group, one-week survival rate was 86.5%. Conclusion The modified model is easily available and highly reproducible which provides a practical and stable experimental model for the study of liver transplantation.
目的 探讨胰头部肿块型慢性胰腺炎的诊断要点与个体化术式的选择原则。方法 回顾性分析2000年4月至2011年9月期间我院收治的10例胰头部肿块型慢性胰腺炎患者的临床资料。结果 本组平均发病年龄47.3岁，平均病程69.1d，平均总胆红素99.4µmol/L，CA19-9 55～78U/ml。10例B超检查示肝内胆管及胆总管扩张，5例CT检查报告胰头部占位性病变伴主胰管不规则扩张或钙化灶，2例MRCP检查诊断胆总管下段占位。3例术中多点穿刺快速活检后行胆胰管引流术，7例术前误诊为胰头癌或壶腹癌均行胰十二指肠切除，术后出现并发症8例，死亡1例，9例平均随访44.2个月无复发和癌变。结论 把握发病年龄、病程、波动性黄疸等临床特征和CA19-9水平及CT、MRCP等影像检查要点是胰头部肿块型慢性胰腺炎与胰头癌鉴别诊断的关键，用个体化术式合理实施胰十二指肠切除、胆胰管内外引流术是胰头部肿块型慢性胰腺炎外科处理明智的选择。
目的 探讨闭合性十二指肠损伤的诊断与术式选择及其效果。 方法对1980～1999年间收治的33例闭合性十二指肠损伤患者临床资料进行回顾性总结分析。结果 合并伤27例，其中胰腺损伤占24.2%(8/33)，术前诊断率为18.2%(6/33)，术中漏诊率为15.2%(5/33)。术式选择：单纯十二指肠损伤以修补为主，十二指肠裂口较大或缺损者，可采用空肠浆膜覆盖术及十二指肠空肠Y型吻合术等其它术式，合并有胰腺损伤者宜行Graham简化术。同时应行充分的十二指肠减压和腹腔引流。术后并发症发生率为39.4%(13/33)，治愈率为84.8%(28/33)，死亡率为15.2%(5/33)。 结论 十二指肠损伤应重视早期诊断，在剖腹探查中应识别其损伤特征，并掌握切开探查方法，防止漏诊；术式选择宁简勿繁，不同患者适时、适当地采用最佳的诊断和治疗方法是十二指肠损伤手术成功的关键。