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The Use of Laparoscopic Subtotal Cholecystectomy for Complicated Cholelithiasis

摘要:目的:探討腹腔鏡膽囊大部分切除在復雜膽囊結石手術中應用的可行性及安全性。方法:回顧性分析2003年1月至2008年10月間41例行腹腔鏡膽囊部分切除術的復雜膽囊結石病人。行腹腔鏡膽囊切除術指征為:膽囊管不能明確辨認時,諸如:膽囊積膿、Mirris綜合征、Calot三角致密粘連呈“冰凍樣”、萎縮性膽囊等。手術方法為:切除膽囊前壁,取凈結石,腹腔置管引流。結果:41例復雜膽囊結石病人中1例中轉開腹手術外,其余全部在腹腔鏡下完成,手術時間為45～145分鐘,平均(57.42±19.41)分鐘,1例術后出現膽漏,其余術后住院時間為2～7天。 結論:在膽囊三角不能安全辨認前提下,對于復雜膽囊結石行腹腔鏡膽囊部分切除術是一種安全的手術方式,不但能簡化手術、降低手術風險,而且能避免行開腹手術治療。Abstract: Objective: To study the possibility and safty of laparoscopic subtotal cholecystectomy in complicated cholecystectomy. Methods: Laparoscopic subtotal cholecystectomy was performed when the cystic duct cannot be identified safely, such as empyema cholecystitis, Mirris syndrome, frozen Calot’triangle, shrunken gallbladder. The operation consists of resecting the anterior wall of the gallbladder, removing all stones, and placing a large drain. 41 patients who underwent a laparoscopic subtotal cholecystectomy between 1 January 2003 and 31 October 2008 were retrospectively analyzed. Results: Fortyone cases of complex laparoscopic cholecystectomy were performed. 1 cases in which were changed to open cholecystectomy. Operating time was 45145 min, average (57.42±19.41) min. 1 cases were reoperated because of the bile leak. Hospital stays were 27 days. Conclusion: Laparoscopic subtotal cholecystectomy is a viable procedure during cholecystectomy in which Calot’s triangle cannot be safely dissected. It may simplify the operation and decrease the risk in complicated cholecystectomy and averts the need for a laparotomy.

Spleen Traumatic Rupture Treated by Ligature of Splenic Artery Combined with Partial Splenectomy

目的 總結應用脾動脈結扎加脾部分切除術治療外傷性脾破裂的臨床經驗。方法 對本院近8年間收治的64例接受脾動脈結扎加脾部分切除治療的脾外傷患者的臨床資料進行回顧性分析，重點分析脾部分切除術的手術方法、臨床療效和適應證。結果 術中雙重結扎脾動脈，然后根據脾臟損傷的情況決定保留脾臟的部位，保證殘脾不少于原脾體積的30%。全組無手術死亡病例，術后出現早期并發癥者16例（25.0%），其中發熱8例，脾窩積液1例，腸梗阻2例，左側胸腔積液3例，切口感染2例，均經對癥處理后治愈。結論 對部分外傷性脾破裂患者的治療選擇脾動脈結扎加脾部分切除術是安全可行的。

CLINICAL RESEARCH ON PARTIAL SPLENECTOMY IN SPLENIC TRAUMA(REPORT OF 74 CASES)

目的 探討外傷性脾破裂脾部分切除術的手術要點及術后脾功能變化。方法 對74例外傷性脾破裂行脾部分切除術者進行回顧性分析，其中不規則脾部分切除術30例，規則性脾部分切除術44例，獲1～8年隨訪者55例。結果 ①脾創面用明膠海綿雙層三疊片處理療效肯定，②術后各種感染率低于脾臟全切者，③術后免疫功能無變化，④成人保留脾塊無再生傾向。結論 脾外傷脾部分切除術療效肯定，安全可行。只要保留有正常血循環的1/3脾臟，其免疫功能無明顯影響。

CURRENT SITUATION OF SURGICAL TREATMENT OF INFERIOR POLAR FRACTURE OF PATELLA

Objective To investigate the advance in surgical treatment of inferior pole fracture of patella and to explore the existing problems and further research directions. Methods Domestic and foreign l iterature in recent years on patella fracture was extensively reviewed, the surgical treatment of inferior pole fracture of patella was summarized by combining the research findings with cl inical experience. Results The surgical treatment of inferior pole of patella fractures included retaining the integrity of the patella and partial patellectomy of inferior pole of patella and extending knee installationreconstruction. There were kinds of ways to retain the integrity of the patella, such as circular wire fixation, tension bandfixation, NiTi-patella concentrotor fixation, basket plate fixation, reforming McLaughl in way and polydioxanone suture netfixation; the latter category is partial patellectomy and extensor device reconstruction. Every surgical way had its advantages and l imitations. Conclusion Most studies tend to retain the integrity of the patella, but some researches have shown that partial resection of inferior pole of patella had no significant effect on knee function. It is important to obtain the security excisional range and elongation range postoperative by experiment for regulating the treatment of comminuted fractures of inferior pole of patella.

The application of modified fast-track surgery in the perioperative period of open partial hepatectomy

Objective To verify the feasibility and effectiveness of the modified fast-track surgery (FTS) in the perioperative period of open liver resection. Methods A prospective randomized controlled trial was carried out in 188 consecutive patients undergoing open liver resection between March and December 2014 in the Department of Liver Surgery of West China Hospital. The modified fast recovery procedure and standard rehabilitation procedure were compared in terms of length of hospital stay after operation, hospitalization cost, complications and readmission rate. Results A total of 188 consecutive patients were enrolled in the trial. The analysis included 87 patients in the modified fast recovery group and 89 in the standard rehabilitation group. Compared with the standard rehabilitation group, the modified fast recovery group had a shorter length of hospital stay [(5.70±1.47)vs. (7.26±1.96) days] and a lower cost [(42.7±6.7)vs. (47.3±12.5) thousand yuan], and the differences were statistically significant (P<0.05). There were 20 complication cases in the modified group and 39 in the standard group with significant difference (P=0.003). There was no significant difference in the rate of readmission between the two groups (P=1.000). Compared with the standard group, patients in the modified group had less pain 8 hours, the 1st and 2nd days after surgery, better postoperative activities of daily living, more initiative cough times and off-bed activity times, longer duration of movement, and earlier bowel recovery and exhausting, and all the above differences were significantly different (P<0.05). Stepwise regression analysis showed that postoperative complications and bowel recovery and exhausting time were independent related factors for postoperative hospital stay (P<0.001). Conclusions Multimodal analgesia-based fast recovery procedure is feasible and effective in the perioperative period of partial hepatectomy. It can shorten the time of hospitalization and reduce the cost of hospitalization.

PARTIAL HEPATECTOMY FOR INTRAHEPATIC STONES

Thirty-six partial hepatectomies for patients with symptomatic intrahepatic stones is reported.Partial liver resection should be done when the liver containing strictrue(s),dilated ducts and stones.Meanwhile,additional procedures should be performed togather with partial hepatectomy,i,e,common duct exploration and drainage,cholangiotomy and cholangioplanty,and cholangeoenterostomy,according to the location of stones and ductal strictures.Postoperative long-term follow-up in this series showed that the results of 86.2% of patients were satiffactory.Partial hepatectomy can be considered as a better treatment of choice for the stones confined to one segment or lobe of liver or combined with multiple strictures of ducts.

射頻凝血器行脾部分切除術治療脾臟占位一例

腎臟部分切除術患者快速康復護理與傳統護理的對照研究

目的評估快速康復護理在腎臟部分切除術患者圍手術期應用的可行性及安全性。 方法將2010年1月－2013年7月收治的144例腎臟部分切除患者，按住院號尾數的奇偶分為快速康復組（75例）和傳統護理組（69例），分別實施快速康復措施與傳統護理方法，觀察比較兩組患者圍手術期恢復的相關指標，評價快速康復護理的效果。 結果快速康復組術后恢復6個指標優于傳統護理組（P＜0.05），平均住院時間短于傳統護理組（P＜0.05），且兩組并發癥發生率差異無統計學意義（P＞0.05）。 結論運用縮短術前禁食時間、早期下床活動、早期由口進食、早期拔除引流管等快速康復措施是安全有效的，可加速患者術后康復，縮短術后住院時間，值得推廣應用。

A COMPARATIVE STUDY ON SHORT-TERM EFFECTS OF ARTHROSCOPIC PARTIAL MENISCECTOMY INTREATING MEDIAL VERSUS LATERAL MENISCUS INJURIES

【Abstract】 Objective To compare the short-term effects of arthroscopic partial meniscectomy in treating medial versuslateral meniscus injuries. Methods From January 2003 to January 2006, 207 patients with meniscus injury(without intraarticularligament injury) underwent arthroscopic partial meniscectomy. The medial meniscus injury group included 115 cases, 50males and 65 females; aged 14 to 78 years(mean 46.9 years); 66 left knees and 49 right knees. Twenty-six cases had injury histories,the delayed time from injury to surgery ranged from 6 d to 6 months (mean 2.1 months). The lateral meniscus injury group included92 cases, 18 males and 74 females; aged 16 to 62 years (mean 41.1 years); 57 left knees and 35 right knees. Twenty-four caseshad injury histories, the delayed time from injury to surgery ranged from 9 d to 6 months (mean 1.9 months). Lysholm score systemwas applied and the scors of pre- and post-operation and were compared between two groups. Results The period of followupranged from 12 to 45 months (mean 31.5 months). In medial meniscus injury group and lateral meniscus injury roup, theLysholm score increased from 61.3±16.9 and 57.4±17.6 preoperation to 95.0±7.9 and 93.3±7.4 postoperation respectively. Therewas statistically significant difference between preoperation and postoperation (P lt; 0.01), and there was no statistically significantdifference between two groups（P gt; 0.05）. The excellent and good rates for function of knee joint were 97.39% (excellent in 107cases, good in 5 cases and fair in 3 cases) in medial meniscus injury group and 100%(excellent in 80 cases and good in 12 cases)in lateral meniscus injury group. Conclusion Arthroscopic partial meniscectomy is a safe and effective treatment for meniscusinjury, there is no diference in short-term effects in treating medial versus lateral meniscus injuries.

非環形PPH術聯合外痔切除術治療混合痔環形脫出的療效評價

目的比較非環形齒線上痔及直腸黏膜部分切除釘合術（PPH術）+外痔切除術與普通PPH術+外痔切除術治療混合痔內痔環形脫出的療效。 方法前瞻性收集2014年1月至2014年12月期間由中國中醫科學院西苑醫院、中國航天科工集團731醫院及內蒙科爾沁右翼中旗醫院收治的以內痔環形脫出為主要癥狀的混合痔患者469例，隨機分為觀察組245例（行非環形PPH術+外痔切除術）和對照組224例（行PPH術+外痔切除術），術后隨訪1年，比較2組患者的臨床療效。 結果觀察組患者的手術時間、術中出血量、住院時間和限制外出時間均短于對照組（P＜0.01），且輕微并發癥和需二次手術的并發癥發生率也均低于對照組（P＜0.01）。隨訪期間，所有患者的痔出血均無復發，但觀察組有2例痔脫出復發，對照組有1例痔脫出復發。 結論對混合痔內痔區的環形脫出，非環形PPH術+外痔切除術的治愈率接近普通環形PPH術+外痔切除術，但前者的需二次手術的并發癥發生率明顯降低。