改良截石位在妇科腹腔镜手术中的应用

目的 探讨改良截石位在妇科腹腔镜手术中的应用效果。方法 将146例妇科腹腔镜手术患者随机分为对照组和改良组各73例，对照组采用常规截石体位，将托腿架关节端置于胭窝处，托腿板支托患者大腿。改良组采用改良截石位，即将托腿架按患者仰卧屈髋高度固定于手术床上，托腿板支托小腿肌肉丰满处且使膝关节以上和腹部近于水平位。观察两组手术时间、术后24h并发症发生率及首次下床活动时间。结果 改良组手术时间较对照组显著缩短（P〈0．01），术后24h并发症发生率较对照组显著降低（P〈0．05，P〈0．01），首次下床活动时间显著早于对照组（P〈0．01）。结论 改良截石位能为妇科腹腔镜手术患者提供良好的手术环境，有效预防术后并发症，提高腹腔镜手术安全性和有效性。     

改良截石位在妇科腹腔镜手术中的应用

目的 探讨改良截石位在妇科腹腔镜手术中的应用效果.方法 将146例妇科腹腔镜手术患者随机分为对照组和改良组各73例,对照组采用常规截石体位,将托腿架关节端置于腘窝处,托腿板支托患者大腿.改良组采用改良截石位,即将托腿架按患者仰卧屈髋高度固定于手术床上,托腿板支托小腿肌肉丰满处且使膝关节以上和腹部近于水平位.观察两组手术时间、术后24 h并发症发生率及首次下床活动时间.结果 改良组手术时间较对照组显著缩短(P＜0.01),术后24 h并发症发生率较对照组显著降低(P＜0.05,P＜0.01),首次下床活动时间显著早于对照组(P＜0.01).结论 改良截石位能为妇科腹腔镜手术患者提供良好的手术环境,有效预防术后并发症,提高腹腔镜手术安全性和有效性.     

截石位手术专用托盘的制作与应用

手术托盘作为术中器械传递和存放的平台，需根据手术部位及手术体位要求的不同进行放置和调整。其中肛周及会阴部位的手术常需在截石位下完成，传统的手术托盘因底座和支架较大，体位安置后不易摆放，或摆放后不方便术者使用。为此，笔者自行设计并制作了截石位手术的专用器械托盘。经过临床应用，效果良好，介绍如下。     

截石位手术专用托盘的制作与应用

手术托盘作为术中器械传递和存放的平台,需根据手术部位及手术体位要求的不同进行放置和调整.其中肛周及会阴部位的手术常需在截石位下完成,传统的手术托盘因底座和支架较大,体位安置后不易摆放.     

自制器械托盘在截石位手术中的应用

临床上截石位手术配合时,器械护士常在医生背后或侧面传递器械,所递器械污染机会较大且违反无菌操作规程.鉴此,我院自行研制一种截石位手术专用器械托盘,经临床使用,效果满意,介绍如下.     

改良截石位悬腿架在肛肠手术中的应用

截石位是肛肠外科手术最常见的手术体位之一，但截石位手术常用的标准支腿架除引起患者不适外，还有可能损伤下肢神经或导致下肢深静脉血栓。我院自行设计制造了一种改良截石位悬腿架，临床应用于混合痔手术、肛瘘切除术、痔上黏膜环形切除钉合术等手术时间大约15-30min的肛肠外科手术，患者感到舒服，效果满意。现介绍如下。     

妇科腔镜手术患者人字形与截石体位的比较研究

目的 探讨人字形分腿位与截石位对妇科腔镜手术患者的影响.方法 将200例实施妇科腔镜手术患者随机分为对照组和观察组各100例.对照组采用常规截石体位;观察组采用人字形分腿位,即采用可分腿板式手术床,无需安装托腿架,双下肢平放于腿板上,腿板水平分开角度90°～1 00°.结果 观察组体位安置耗时(237.00±58.00)s,对照组(151.00士17.00)s,两组比较,差异有统计学意义(P＜0.01);观察组体温、血压、心率变化幅度小于时照组(均P＜0.01),麻醉苏醒期平稳性、术后舒适度改变等指标优于对照组(均P＜0.01).结论 与截石位相比,人字形分腿住手术野暴露充分,摆放简便,可有效预防并发症的发生,提高手术安全性.     

改良支腿架在截石位手术中的应用

截石位手术应用标准支腿架有可能损伤神经或导致下肢运动和感觉异常。１９９７年１月至１９９８年１２月，我科自行设计制造了一种改良支腿架，临床应用４０例，效果良好。报告如下。１　制作方法取直径１ｃｍ钢管１根，弯制焊接成中空的弧形框架支托。支托用薄海绵垫包绕，固定在标准支腿架上备用。２　临床应用择期手术病人８０例，年龄３５～６８岁。术前均无心、肺和神经系统合并症。其中子宫切除术６０例，直肠癌根治术２０例。随机分为对照组（１组）和观察组（２组），每组各４０例。麻醉后摆截石位。１组将标准支腿架置于病人的膝关…     

改良式保暖被在截石位手术患者中的应用

手术室的室温一般调控在22～25℃,随着麻醉及手术时间的延长,患者身体内的热能逐渐流失,可造成术中低体温发生,增加手术切口感染的风险。普通手术保暖被由于受铺巾限制,不能完全覆盖患者的肩部和外展的手臂,特别是对于截石位手术的患者,因其体位特殊,双下肢的保暖效果更是不尽如人意。针对这一缺陷,我们特制了改良式截石位手术患者     

改良平卧牵引截石位在股骨骨折手术中的应用

股骨闭合复位内固定手术适用于股骨粗隆间骨折以及对位困难的股骨干骨折,术中常需使用G型臂X线机进行定位,故手术体位常采用平卧牵引位,但此手术体位常导致患者术后肌肉及关节疼痛,部分患者有感染的发生.通过改良手术体位由平卧牵引位为平卧牵引截石位,于2006年6月至2008年10月应用于临床213例患者,取得良好效果.报道如下.     

Compartment syndrome after surgery in the lithotomy position

Compartment syndrome developed in five patients after prolonged surgery in the lithotomy position. Four different surgeons performed the operations. Serious morbidity resulted from the syndrome and could have been prevented by consideration of the factors that predispose to its development: tight bindings; direct pressure on the calves; and prolonged time in the lithotomy position. The pathogenesis of compartment syndrome in this group of patients is discussed.     

Compartment syndrome following pelvic surgery in the lithotomy position

We report the cases of two patients who developed compartment syndrome following pelvic surgery in the lithotomy position. These cases highlight this important and potentially devastating complication.     

Aortic endograft thrombosis after colorectal surgery in lithotomy position

Aortic endograft limb occlusion is a serious complication after endovascular abdominal aortic aneurysm repair. We describe a yet unreported cause of endograft limb occlusion, the lithotomy position. Two patients with abdominal aortic aneurysm and colorectal cancer underwent an initial endovascular repair followed by cancer resection in the lithotomy position. Aortic endograft limb occlusion occurred in both patients immediately after the cancer operation. Percutaneous rheolytic thrombectomy was performed successfully in both patients. Pelvic surgery requiring the lithotomy position should be performed with caution in patients with aortic endografts, because it can result in endograft occlusion.     

Bilateral compartment syndrome after colorectal surgery in the lithotomy position

Lower limb compartment syndrome is an unusual but severe complication of prolonged surgery more than four hours in lithotomy position. It is usually a consequence of hypoperfusion of the lower extremities and muscle necrosis may occur. Several risk factors are pointed out: trendelenburg, the hardness of operating table, hypothermia, control hypotension, occlusion of arterial blood flow of the lower extremity, arteritis (and smoking), diabetes, obesity, arterial hypertension, myopathy and an important muscle mass. The symptoms are postoperative pain with neurological signs. A rapid diagnosis and aggressive management (i.e. resuscitation and aponevrotomy) is recommended. Neurological sequelae are sometimes invalidating. Reporting a case of bilateral syndrome, we reviewed the literature and describe the present diagnosis and therapeutic management as well as prevention modalities of this iatrogenic complication.     

Bilateral compartmental syndrome after prolonged surgery in the lithotomy position

Surgical procedures necessitating patient placement in physiologically abnormal positions can be associated with certain injuries usually arising from compression of nerves or muscles. Bilateral compartmental syndrome of the lower extremities is a grave complication, which, if unrecognized, can lead to either permanent neuromuscular dysfunction or limb loss. We report a case of bilateral four-compartment syndrome occurring after prolonged surgery with the patient in the lithotomy position.     

Well leg compartment syndrome during prolonged surgery in the lithotomy position

We experienced a case of the well leg compartment syndrome (WLCS) during total pelvic exenteration in a 54-year-old woman. She was placed in the head down-lithotomy position and her both lower legs were attached with elastic stocking and intermittent pneumatic compression for prevention of deep vein thrombosis. The surgery lasted for 13 hr and 15 min. Her vital signs stayed stable during the procedure. After emergence from anesthesia, she complained of severe bilateral crural pain. We found that her calves were swollen and rigid. Creatinin kinase increased to 40120 U x l(-1) the following morning. She was diagnosed as WLCS, and the left fibula paralysis remained as legacy of WLCS. WLCS during surgery is caused by inappropriate positioning of the lower limbs, in contrast to a compartment syndrome caused by trauma or injury. Its etiology consists of multi-factors e.g., prolonged surgery in the lithotomy position and hypo-perfusion. We emphasize the importance of both prevention and early treatment of WLCS. All anesthesiologists should pay attention to WLCS.