(承2007年第6期) 6.2 盆腹膜重建的種類和方法 6.2.1 盆底隔離法如前所述,因超低位直腸/肛管癌浸潤會陰直腸隔、盆側壁及肛周擴約肌群而實施了新腹會陰局部擴大切除術,因T4期直腸癌浸潤子宮陰道或膀胱前列腺部分組織而實施了盆腔臟器局部擴大切除術,因局部復發性直腸癌而實施了腹會陰聯合再切除術,因各種原因對中晚期直腸癌實施了Hartmann手術,以及因技術不確定性而實施了傳統腹會陰聯合切除術,無論手術切除范圍或術者的操作技巧如何,由于病變性質決定了這類手術只能定位于根治性(R0)與姑息性(R2)之間的程度.因此,初次切除只是獲得治愈或延長生存期的第一步,接下來是盆腔放療或局部內放射治療,最后,尚存在局部復發的高風險,若發生,可經會陰骶尾部再次甚至多次對復發癌行局部姑息性切除.因而預先有效的盆底隔離就可避免再手術時的小腸損傷,這就是盆底重建術的主要功能和適應證之一.……
Doubly committed sub-arterial ventricular septal defect (VSD) is a unique type of VSD which is located beneath both the aortic and pulmonary valve. Open-heart repair is traumatic especially for pediatric patient while trans-catheter device closure is also not suitable for this type of VSD. Minimally invasive per-ventricular device closure has been introduced as an alternative method in the treatment of doubly committed VSD with encouraging results. In the review, we will illustrate the surgical technique as well as perioperative management strategy as for this technique in treating doubly committed VSD.
ObjectiveTo explore the clinical application value of simple artery occlusion (SAO) in revealing intersegmental planes during thoracoscopic pulmonary segmentectomy. MethodsA retrospective analysis was conducted on the clinical data of patients who underwent thoracoscopic pulmonary segmentectomy at the First Affiliated Hospital of Xiamen University from February 2022 to December 2023. Patients were divided into a conventional group and a SAO group based on the method used to reveal the intersegmental plane during surgery. The two groups were compared in terms of intraoperative blood loss, operation time, postoperative drainage volume, time to intubation, postoperative pulmonary air leakage, and conversion to open thoracotomy rate. ResultsA total of 318 patients were included. There were 181 patients in the conventional group, including 86 males and 95 females, with an average age (53.35±9.20) years, and there were 137 patients in the SAO group, including 58 males and 79 females, with an average age (55.26±11.46) years. There were no statistical differences in general patient information between the two groups (P>0.05). The SAO group had less intraoperative blood loss [MD=17.568, 95%CI (9.968, 25.168), P<0.001] and postoperative drainage volume [MD=275.587, 95%CI (188.999, 362.175), P<0.001], shorter drainage tube duration [MD=1.000, 95%CI (1.000, 2.000), P<0.001] and operation time [MD=20.709, 95%CI (16.258, 25.159), P<0.001]. The incidence of postoperative pulmonary air leakage complications in the SAO group was lower than that in the conventional group [RR=0.361, 95%CI (0.181, 0.722), P=0.003]. ConclusionSAO can reduce surgical difficulty, shorten operation time, decrease the incidence of postoperative pulmonary air leakage, and enhance the safety of anatomical pulmonary segmentectomy, making it worthy of clinical promotion and application.
Objective To discuss the operative technique and curative effect of minor-incision cholecystectomy. Methods The clinical data of 672 patients with application of mini-cholecystectomy from June 2001 to June 2009 were analyzed. Perioperative management and operative technique were emphasized. Results Six hundred and fifty-two cases (97.0%) were cured with mini-cholecystectomy and 20 cases (3.0%) with incision lengthened. Operation time was （40.0±10.0） min. One case with hemorrhoea during operation was cured by interventional embolotherapy. Bile duct injury was found in 1 case during operation， and adopted suture with T tube. There were no infection of incisional wound or death in this study. Conclusion On the basis of skillful conventional cholecystectomy, by controlling indication and improving operative technique, it is an economical and safe way to perform minor-incision cholecystectomy.
目的 對糖尿病急性代謝并發癥小劑量胰島素的應用方法及技巧進行探討和分析。 方法 以2009年1月－2012年2月收治的50例糖尿病急性代謝并發癥患者為研究對象,按照數字隨機表方法分為對照組和試驗組，每組25例患者。對照組患者在小劑量胰島素的使用上采用常規技巧和方法；試驗組患者在小劑量胰島素的使用上結合實際情況和相關規范進行綜合治療，比較兩組患者小劑量胰島素的應用效果。 結果 經治療，對照組18例患者的臨床癥狀得到明顯改善，顯效率為72%；試驗組25例患者的臨床癥狀均得到有效緩解，顯效率為100%，兩組患者的顯效率比較，差異有統計學意義（P＜0.05）。 結論 使用小劑量胰島素治療糖尿病急性代謝并發癥患者時，結合實際情況和相關規范進行綜合治療臨床效果滿意。