目的:探討輔助后內側切口及抗滑鋼板治療復雜脛骨平臺骨折的臨床療效。方法:對我院2006年4月至2008年12月的28例復雜脛骨平臺骨折病患(男19例,女9例,平均年齡37歲)進行輔助后內側切口及抗滑鋼板的臨床手術治療。結果:術后隨訪,24例效果良好,4例出現不良反應,經修復后愈合。結論:術后關節功能及切口恢復良好,外側支撐鋼板+后內側抗滑鋼板的雙切口雙鋼板的手術方法是治療復雜脛骨平臺骨折安全、有效的方法,故在臨床上有推廣價值,但有待大規模病例來驗證。
The soft-tissue-cutaneous flap adjacent to the abdominal incisional hernia was ultilized to repair huge hernia in 6 cases with success. Patients were followed up for 2y7 years without recurrence. The operative planning, the technique and the matters needing attention were introduced in details. The soft tissues and skin adjacent to hernia used for repair was easy to obtain and a simple technique. The adoption of this operation in hospitals at the grassroots level was feasible.
目的 總結應用原下腹部正中切口行腹膜前置網片修補腹股溝疝的經驗。方法 回顧性分析19例腹股溝疝類型、手術方法和術后復發資料。結果 傷口均一期愈合。隨訪1～66個月,無遠期傷口感染和疝復發。結論 經原下腹部正中切口行腹膜前置網片修補腹股溝復雜性疝是一種安全和有效的手術方法,但需要術者對腹股溝解剖有透徹的了解和具有豐富的疝手術經驗。
腹壁巨大切口疝的修補是很困難的手術，在一些特殊的病例中，由于患者的全身情況嚴重惡化使得切口疝無法修補，如年老、病態性肥胖及呼吸功能嚴重紊亂的患者。近年來，隨著生物材料在疝和腹壁外科的廣泛應用，對巨大腹壁切口疝的治療已取得了明顯進展。
Objective To summarize the experience of extraanatomic aortic bypass grafting through median sternotomy for onestage treatment of aortic coarctation and associated cardiac diseases, and to improve surgical effect of the diseases. Methods Between July 1997 and July 2008, 31 consecutive patients(20 male,11 female; age 31.9±11.7 years) with aortic coarctation and associated cardiac anomalies underwent onestage surgical repair through median sternotomy. The associated cardiac anomalies included: aortic valve insufficiency or stenosis(n=22); mitral valve insufficiency or stenosis (n=9); patent ductus arteriosus (n=5); ascending aortic aneurysm (n=4); ventricular septal defect (n=3); coronary artery disease (n=2). Extra-anatomic aortic bypass grafting was used to repair the coarctation. Routing of the grafts was: ascendingto posterior pericardial descending aorta (n=9) and ascendingtoinfrarenal abdominal aorta (n=22). Concomitant cardiac procedures included: aortic valve replacement in 16; Bentall procedures in 6; mitral valve repair or replacement in 9; ascending aortic replacement or aortoplasty in 4; patent ductus arteriosus closure in 5; ventricular septal defect closure in 3 and coronary artery bypass grafting in 2. Results One patient died of septic shock 39 days after operation with an inhospital mortality of 3.2%. Mean systolic blood pressure gradient between upper and lower extremities decreased from 64.2±25.3 mm Hg preoperatively to 13.7±10.2 mm Hg postoperatively (Plt;0.05). Twentyseven patients were followed up from 4 to 73 months, there were no late deaths，reoperations or graftrelated complications. Conclusion Extraanatomic aortic bypass grafting can be performed simultaneously through median approach in patients with aortic coarctation and associated cardiac diseases. It is an effective and safe treatment option for onestage surgical repair in adults and adolescents. Both ascendingto posterior pericardial descending aorta and ascendingtoinfrarenal abdominal aorta bypass have favorable results.
目的 探討胸部正中小切口在嬰幼兒先天性心臟病手術治療中的可行性及效果。 方法 將我院 2016 年 5 月至 2016 年 10 月 170 例行手術治療的常見先天性心臟病嬰幼兒患者分為兩組：常規組，85 例，男42例、女43例，年齡（6.9±2.1）個月，采用常規胸部正中切口；小切口組，85 例采用胸部正中小切口，男43例、女42例，年齡（6.4±1.8）個月。小切口手術切口于平第 3 肋間切開，止于劍突起始處上 0.5 cm，剛好放入小胸骨撐開器為好。 結果 兩組患兒體外循環時間差異無統計學意義（P>0.05）。小切口組手術時間略長（P<0.05）。兩組預后沒有差別，但是小切口組傷口長度顯著縮短[（7.8±0.8） cmvs. （4.0±0.5）cm，P<0.05]。 結論 正中小切口基本具有胸骨正中切口的優點，可顯露心臟各部位，滿足絕大部分心臟探查和手術操作需要，必要時仍可向上延長切口使心內操作不受限制等優點，故認為正中小切口在嬰幼兒心臟手術中具有良好的安全性和美觀性。