改良缝皮法在妇产科腹式手术横切口中的应用

目的 :探讨腹式手术横切口不同缝合方法对皮肤愈合的影响。方法 :用改良式缝皮法对 2 0 0例腹式横切口皮肤缝合。结果 :缝皮在 1～ 2 min内完成 ,术后疼痛轻 ,188例未要求用镇痛剂 ,占 94% ,全部甲级愈合 ,无皮下硬结 ,术后随访 180例 ,切口愈合疤痕纤细 ,与皮肤皱折一致。结论 :改良缝皮法简单、省时 ,术后疼痛轻 ,缩短住院时间 ,切口愈合好。     

Endoscopic closure of mucosal defects with metallic clips after endoscopic mucosal resection in patients with intramural tumors of the stomach: A retrospective study

Background: Representative complications of endoscopic mucosal resection to treat intramural gastric tumors include bleeding and perforation. The purpose of the present study was to clarify whether endoscopic closure of mucosal defects using metallic clips decreases the incidence of delayed bleeding following endoscopic mucosal resection. Patients and Methods: The records of 187 intramural tumors of the stomach in the 181 patients that were treated by endoscopic mucosal resection between 1992 and 2001 were reviewed retrospectively. The patients were classi?ed into two groups. The ?rst group included patients who received endoscopic mucosal resection but were not treated by endoscopic mucosal closure. The second group included patients who were treated with endoscopic mucosal closure using metallic clips after endoscopic mucosal resection. The incidences of delayed bleeding following endoscopic mucosal resection in these two groups were evaluated. Results: Delayed bleeding following endoscopic mucosal resection was observed in 13 of 96 (13.5%) of the lesions of the ?rst group. Delayed bleeding was encountered in only two of 91 (2.2%) lesions of the second group. Conclusions: Endoscopic closure of mucosal defects with metallic clips after endoscopic mucosal resection in gastric lesions was useful in decreasing the incidence of delayed bleeding following endoscopic mucosal resection.     

不同缝合方式对痔切除术切口愈合影响的临床观察

目的:探讨缩短痔切除术的切口愈合时间。方法:150例痔切除术患者随机分为3组,A组50例行间断褥式外翻缝合痔术后切口,B组50例行单纯间断缝合痔术后切口,C组50例以开放切口处理。结果:A组患者切口愈合时间平均为(12.6±3.1)d,短于B组的(16.4±5.3)d和C组的(16.6±2.9)d(P<0.01),而B组和C组的切口愈合时间差异无显著性(P>0.05)。结论:闭合式痔切除术采用间断褥式外翻缝合有临床价值。     

Early reattachment does not reverse atrophy and fat accumulation of the supraspinatus--an experimental study in rabbits.

INTRODUCTION: Reattachment of the supraspinatus (SSP) tendon after spontaneous rupture leads to improved shoulder function. Whether this improvement of function is due to a reversal of muscle atrophy and fat accumulation known to occur after SSP rupture is still debated. Our previous study of late reattachment of SSP (12 weeks) failed to confirm a reversal of muscle atrophy and of fat accumulation. PURPOSE: To find out whether earlier reattachment (6 weeks) reverses atrophy and fat accumulation of the SSP. MATERIAL AND METHODS: Reattachment group: in seven rabbits unilateral supraspinatus detachment, reattachment after 6 weeks and killing 6 weeks later. Detachment group: in seven rabbits unilateral supraspinatus detachment and killing 12 weeks later. The contralateral shoulders served as controls (n=14). Determination of the supraspinatus constituents: muscle, extra- and intramuscular fat in volume and cross-sectional area. RESULTS: Muscle tissue in the reattachment group (8.6 ml+/-1s.d.=0.6) and in the detachment group (8.9 ml+/-0.9) were less than in control supraspinati (10.2 ml+/-0.9, both p<0.05). Extra- and intramuscular fat in the reattachment group (8.7%+/-3.2) was greater than in both, the detachment group (4.6%+/-3.5), and control supraspinati (2.8%+/-1.7, both p<0.05). CONCLUSION: In the rabbit, reattachment of the SSP at 6 weeks did neither reverse muscle atrophy nor fat accumulation during the ensuing 6 weeks. However, earlier reattachment (6 weeks) when compared with later reattachment (12 weeks) prevented an increase in fat accumulation. On the other hand, the delay before reattaching the tendon did not lead to an increase in muscle atrophy.     

Clinical outcome of arthroscopic reduction and suture for displaced acute and chronic tibial spine fractures

This paper reports the clinical outcome of the arthroscopic reduction and pull-out suture technique in acute and chronic displaced tibial spine anterior cruciate ligament (ACL) avulsion fractures. Between April 1997 and December 2000, 14 patients received an arthroscopic reduction and pull-out suturing of displaced tibial spine fractures (ACL avulsion fractures of tibia). Of 14 cases, ten were acute fractures and four were chronic nonunion fractures, in which all patients showed extension limitation. The mean follow-up period was 51 months (ranging from 30 to 80 months). At final follow-up, review of range of motion, Lachman test, anterior drawer test, KT-2000 arthrometer, Lysholm knee score, and Hospital for Special Surgery (HSS) score were evaluated. Compared to conventional pull-out suturing, several key modifications to surgical techniques were used. In all 14 patients, radiological bony union was detected at mean 12.3 weeks (range, 8–16 weeks) after surgery. All patients were able to return to their preinjury activity and sports level. At final follow-up, full range of motion was achieved in all patients. Anterior draw test, Lachman test, and KT-2000 (less than 3 mm side-to-side) were all negative in 13 patients. One female patient, who was 6 years old at the time of surgery, complained of no subjective instability, but showed Lachman grade I, and 5 mm side-to-side difference in KT-2000. She also revealed 10°̇ difference of genu recurvatum deformity. Two children (including the previously-mentioned 6-year-old female patient) showed leg-length discrepancy of 1 cm—the affected legs being longer—at final follow-up. The mean Lysholm knee scores were 95.6 (range, 92–100) and HSS knee scores were 96.4 (range, 91–100). Arthroscopic reduction with modified pull-out suturing technique in displaced tibial spine ACL avulsion fractures showed excellent union rate for both acute and chronic cases, without instability or extension limitations at minimum two-year follow-up.     

全胃切除后在间置空肠中采用一层缝合法重建消化道的临床研究--附34例报告

目的　本文介绍在全胃切除后应用间置空肠一层缝合法重建消化道的技术方法与可行性。方法　在全胃切除术间置空肠一层间断全层缝合法重建食管空肠吻合口和空肠空肠吻合口。结果　对 3 4例全胃切除患者采用间置空肠一层间断全层缝合法重建消化道。所有患者均顺利康复 ,无吻合口瘘、梗阻或出血等并发症发生。结论　全胃切除术后在间置空肠中采用一层间断全层缝合法重建消化道吻合口是安全可行的     

腹腔镜胆总管切开纤维胆道镜取石胆总管一期缝合60例分析

目的 :探讨腹腔镜下胆总管切开、纤维胆道镜取石后胆总管一期缝合术式的治疗效果。方法 :6 0例胆总管结石病人 (其中原发性胆总管结石 5例 ) ,在腹腔镜下行胆总管切开、纤维胆道镜取石后一期缝合。结果 :手术时间为 (110± 4 0 )min ,失血量为 (5 0± 2 0 )ml,进食时间为 (4 8± 4 )h ,下床活动时间为 (5 5± 7)h ,术后出院时间为 (4 .5± 0 .5 )d ,无一例发生与手术相关的并发症。结论 :腹腔镜下胆总管切开纤维胆道镜取石后行胆总管一期缝合疗效好、安全。只要镜下取净结石 ,肝外胆管无狭窄 ,均可一期缝合。该术式具有创伤小、痛苦轻、恢复快、并发症少等优点 ,值得推广应用     

医用可吸收合成缝合线的细胞毒性及致突变性研究

应用Ｌ－９２９细胞培养、Ａｍｅｓ试验和显性致死试验对医用可吸引合成缝合线进行细胞毒性和致突变研究。实验结果表明：医用可吸收缝合线对细胞增殖度的影响，Ｄ４为９７．６％，Ｄ７为９４．０％。对细胞形态的正常发育没有影响。Ａｍｅｓ试验ＭＲ〈２，显性致死试验、致突变指数与阴性对照组比较无显著差异（Ｐ〉０．０５）均显示阴性反应。表明医用可吸引缝合线不具有潜在的致突变效应。     

缝扎动脉前列腺切除术

耻骨上经膀胱前列腺切除术先缝扎前列腺动脉的手术方法，与其它术式比较，该术式具有易于掌握，出血少，适应症广，可在基层医院推广等优点。