目的:探討低能量CO2激光切除扁桃體切除術中手術技巧與并發癥的關系,以改進手術技巧,減少手術并發癥。方法:對我科51例低能量CO2激光扁桃體切除術的患者進行回顧性研究分析。觀察、記錄扁桃體切除所需手術時間、術中出血量、術后疼痛時間及程度、術后創面反應程度、術后再出血、術后術區瘢痕共6項指標。結果:低能量CO2激光扁桃體切除術主要的并發癥是術后較輕的傷口疼痛、術中少量出血,無術后再出血及術后術區瘢痕。結論:低能量CO2激光扁桃體切除術,出血量少,術后疼痛小,反應輕,手術方法易掌握,提高手術技巧可進一步減少低能量CO2激光扁桃體切除術并發癥,更好體現低能量CO2激光扁桃體切除術是扁桃體切除術中一種安全、有效、微創的術式。
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．
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.
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 benefits of using a stapler tractor in the treatment of segmental bronchus during lung segmentectomy through detailed video replay analysis of surgical procedures. Methods We collected data from patients who underwent segmentectomy performed by the same surgical team in the Department of Thoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, from November 2020 to August 2023. After excluding data that lacked analysis parameters, the remaining patients were divided into four groups based on the methods used for dissociating segmental bronchus: a stapler tractor group (group A), a stapler with bronchial stretching group (group B), a stapler only group (group C), and a silk ligature group (group D). Then, we compared baseline data and videotaped surgical details across all groups. Surgical details included the success rate of one-time segmental bronchus dissociation and severance, the time taken for successful one-time dissociation and severance of the segmental bronchus, the incidence of bleeding during bronchus dissociation, the conversion rate to thoracotomy during surgery, and surgical outcomes such as total operative time, postoperative hospitalization days, postoperative thoracic drainage volume, and pulmonary air leakage rate. Results The study included 325 patients (203 in the group A, 62 in the group B, 29 in the group C, and 31 in the group D). There was no statistically significant difference in baseline data among the four groups. However, significant differences were found in terms of total operation time, postoperative hospitalization days, intraoperative blood loss, segmental bronchial stump length, postoperative air leakage rate, hemorrhage rate during segmental bronchial dissociation, and conversion to thoracotomy rate among the four groups (P<0.05). ConclusionUsing a stapler tractor for dissociating segmental bronchus in lung segmentectomy results in shorter operative time, less risk of intraoperative bleeding, and less surgical complications. This study provides valuable evaluation methodologies through the analysis of video replay surgical details, contributing to the improvement of lung segmentectomy quality.