Search

外傷性脾破裂的腹腔鏡手術治療

Laparoscopic Cholecystectomy after Upper Abdominal Surgery

目的 探討上腹部手術后腹腔鏡膽囊切除術(LC)的可能性及手術方法與技巧。方法 回顧性分析我院2005～2009年期間對有上腹部手術史行LC的23例患者的臨床資料。結果 23例患者中慢性結石性膽囊炎18例，膽囊息肉5例。既往均有上腹部手術史，其中胃大部切除術后19例,胃平滑肌瘤切除術后2例,脾破裂修補術后2例。采用閉合法穿刺建立氣腹，分離粘連，暴露膽囊全貌及Calot三角，順行或逆行切除膽囊。23例中LC成功21例; 因粘連致密，膽囊管無法辨認，中轉開腹2例。手術時間45～140 min，平均67 min。全組無明顯出血、內臟損傷、膽管損傷、膽汁漏等并發癥發生。結論 部分上腹部手術后膽囊良性疾病行LC術可行。

APPLICATION OF ALLOGRAFT AND AUTOLOGOUS BONE GRAFT IN POSTEROLATERAL LUMBAR FUSION

Objective To evaluate the cl inical effect of local autogenous bone chips extended with allogeneic bone grafts in the posterolateral lumbar fusion. Methods From March 2005 to April 2007, 22 cases which underwent posterolaterallumbar fusion with allograft bone mixed with local autograft bone were analyzed retrospectively. The postoperative temperature, drainage flow and heal ing time of the incision were analyzed; postoperative lumbar pain was evaluated by visual analog scale (VAS) and JOA score; the postoperative efficacy was assessed by MacNab criteria and Oswestry disabil ity index (ODI); the fusion rate was defined by Jorgenson fusion criteria. Results All cases were followed up for 17-35 months with an average of 21 months, the wound all healed by first intention; no red swell ing, exudation and infection occurred. The excellent and good rate was 81.8% for JOA score (excellent in 4 cases, good in 14 cases, fair in 4 cases), 77.3% for MacNab criteria (excellent in 4 cases, good in 13 cases, fair in 5 cases) and 90.9% for ODI index (excellent in 3 cases, good in 17 cases, fair in 2 cases). The postoperative X-ray fusion rate within 1 year was 90.9%. Conclusion Allograft bone mixed with local autograft bone can achieve good efficacy and fusion rate in posterolateral lumbar fusion.