(承2007年第6期) 6.2 盆腹膜重建的种类和方法 6.2.1 盆底隔离法如前所述,因超低位直肠/肛管癌浸润会阴直肠隔、盆侧壁及肛周扩约肌群而实施了新腹会阴局部扩大切除术,因T4期直肠癌浸润子宫阴道或膀胱前列腺部分组织而实施了盆腔脏器局部扩大切除术,因局部复发性直肠癌而实施了腹会阴联合再切除术,因各种原因对中晚期直肠癌实施了Hartmann手术,以及因技术不确定性而实施了传统腹会阴联合切除术,无论手术切除范围或术者的操作技巧如何,由于病变性质决定了这类手术只能定位于根治性(R0)与姑息性(R2)之间的程度.因此,初次切除只是获得治愈或延长生存期的第一步,接下来是盆腔放疗或局部内放射治疗,最后,尚存在局部复发的高风险,若发生,可经会阴骶尾部再次甚至多次对复发癌行局部姑息性切除.因而预先有效的盆底隔离就可避免再手术时的小肠损伤,这就是盆底重建术的主要功能和适应证之一.……
Objective To review the complex situation，surgical experience，and surgical technique of laparoscopic cholecystectomy （LC）．Methods The clinical data of 86 patients who underwent LC in our hospital and the consulting hospitals from February 2005 to April 2011 were retrospectively analyzed．According to the complicated conditions，the different surgical techniques were applied during LC such as lamellar dissection，aspirater stripping method，laparoscopic suture，and intraoperative cholangiography．Results The operation time was （68±23）min （25－210 min），blood loss was （55±13）ml （15－200 ml）．LC was successfully performed in 84 of 86 cases．Only two patients received transferring laparotomy because of scar tissue in Calot triangle that was hard to dissect．No severe complications occurred，such as biliary leakage，bleeding after operation，stricture of bile duct，retained calculus，and so on．All the patients were cured before discharge．Conclusion Lamellar dissection，aspirater stripping method，and laparoscopic suture combined with the view of laparotomy can be used to deal with complicated LC successfully．
ObjectiveTo evaluate the application of modified perineal stapled prolapse resection in treatment of external rectal prolapse, and to assess the preliminary efficacy. MethodsClinical data of 11 patients with external rectal prolapse underwent modified perineal stapled prolapse resection in The First Affiliated Hospital of Guangzhou University of Chinese Medicine between December 2013 and August 2015 were collected for retrospectively analysis. ResultsAll patients with external rectal prolapse were performed modified perineal stapled prolapse resection with general anesthesia and (or) epidural anesthesia. The average operation time was (53.6±6.1) min (40-85 min) and the average blood loss was (35.3±10.1) mL (20-60 mL). The time of the first flatus was less than 24 h after operation, the time of the first defecation was (44.6±3.3) h (40-52 h) after operation. The average hospital stay was (9.7±1.8) d (7-12 d) and average cost was (34 635.8±1 268.8) RMB (31 796-36 212 RMB). None of them occurred serious complications such as uncontrollable anastomotic stoma bleeding, anastomotic leakage, pelvic abscess, bowel obstruction, and anastomotic straitness. All of the 11 patients were followed up for (4.7±0.8) months (3-7 months), and all patients did not suffered from recurrence and fecal incontinence during follow-up period. ConclusionsThe essential procedure for modified perineal stapled prolapse resection is cutting the prolapse open at 3 and 9 clock directly at the same time by linear staplers, and dissecting mesorectum before using the contour satpler. Modified perineal stapled prolapse resection is a safe and effective operation technique for the external rectal prolapse.
Objective To investigate the surgical technique of establ ishing a rel iable rat model of orthotopic l ivertransplantation. Methods A total of 200 adult male SD rats weighing 200-250 g and 60 adult male Wistar rats weighing230-280 g were adopted. The weight of donor was 30 g less than that of receptor. Syngeneic group of SD-SD rats (SD-SD group, n=70) and allogeneic group of SD-Wistar rats (SD-Wistar group, n=60) l iver transplantation were performed, respectively. Orthotopic l iver transplantations in rats were performed using modified Kamada’s two-cuff technique. Under the sufficient exposure of the porta hepatis, the l iver was perfused through the cold of perfusion of portal vein without touching the l iver. The anastomosis of the suprahepatic vena cave was sutured end- to-end with 8-0 prolene l ine. Guided by double l ine, the continuity of portal vein was establ ished by cuff method easily. The fluid was supplemented sufficiently after operation to maintain the stabil ization of hemodynamics. Results The time for donor operation and receptor operation was (38.2 ± 2.5) minutes and (45.6 ± 3.5) minutes, and anhepatic time was (15.1 ± 2.2) minutes.The successful rate was 93%. The survival rate after 1 week was 92%. There was a significant difference when compared with traditional method (P lt; 0.05). There were 64 survivals in SDSD group and 57 in SD-Wistar group after l iver transplantation, and the survival time was 2-9 months (mean 145 days) and 8-20 days (mean 10.5 days) respectively. The l iver function recovered well in SD-SD group, while in SD-Wistar group the l iver functional failure and acute rejection occurred in pathology 3-5 days after l iver transplantation, all of which ended with death without any therapy. Conclusion The modified method is proved to be ideal for its advantages of simple operation, short anhepatic phase and high operative successful rate.
目的:探讨低能量CO2激光切除扁桃体切除术中手术技巧与并发症的关系,以改进手术技巧,减少手术并发症。方法:对我科51例低能量CO2激光扁桃体切除术的患者进行回顾性研究分析。观察、记录扁桃体切除所需手术时间、术中出血量、术后疼痛时间及程度、术后创面反应程度、术后再出血、术后术区瘢痕共6项指标。结果:低能量CO2激光扁桃体切除术主要的并发症是术后较轻的伤口疼痛、术中少量出血,无术后再出血及术后术区瘢痕。结论:低能量CO2激光扁桃体切除术,出血量少,术后疼痛小,反应轻,手术方法易掌握,提高手术技巧可进一步减少低能量CO2激光扁桃体切除术并发症,更好体现低能量CO2激光扁桃体切除术是扁桃体切除术中一种安全、有效、微创的术式。