In order to preserve more normal tissue in situ in case of severe traumatic rupture of spleen, simultaneous ligation of splenic artery and vein was performed successfully on animals and then was applied for clinic use. The preserved splenic tissue all survivied and functioned well. Patients with severe traumatic rupture of spleen grade Ⅳ-Ⅴ were all cured by ligation of both the splenic artery and vein at the same time.
Objective To evaluate the effectiveness of interference screw and flexor hallucis longus tendon as augmentation material in repair of chronic Achilles tendon rupture. Methods From October 2004 to June 2007, 32 patients (35 feet) with chronic Achilles tendon rupture were treated, including 21 males (22 feet) and 11 females (13 feet) and aging 32-85 years. The disease course was 4-132 days. There were 29 patients with hoofl ike movements history and 3 patients withoutobvious inducement. The result of Thompson test was positive in 31 cases (33 feet). The score was 56.09 ± 7.25 according to the American Orthopaedic Foot and Ankle Society ankle-hindfoot scoring system (AOFAS). MRI indicated that the gap of the chronic Achilles tendon rupture was 0.5-5.0 cm. Medial foot incision associated with medial heel incision or only medial heel incision was made to harvest flexor hallucis longus tendon. The tendon should be 3 cm longer than the end of the Achilles tendon, then fix the tendon to the calcaneus. Results Wound dehiscence occurred and wound healed after dressing change in 1 case; wound healed by first intention in other patients. Thirty-two patients were followed up for 12-32 months (mean 19.4 months). The AOFAS score was 94.22 ± 4.63, showing statistically significant difference when compared with that before operation (P lt; 0.01). The results were excellent in 28 cases, good in 3 cases and fair in 1 case. No sural nerve injury, posterior tibial nerve injury, plantar painful scar, medial plantar nerve injury and lateral plantar nerve injury occurred. Conclusion Flexor hallucis longus tendon transfer offers a desirable outcome in operative recovery, tendon fixation and compl ications.
Objective To evaluate the clinical result of allogeneic tendon in treatment of chronic Achilles tendon rupture.Methods FromJuly 1996 to November 2000, 6 cases of chronic Achilles tendon rupture were treated by use of allogeneic flexor tendon to repair Achilles tendon with Bosworth way. Five cases were followed up 27-53 months with an average of 38.5 months.Results According to Arner-Lindholm criteria for curative result, the result was excellent in 1 case and good in 4 cases.Conclusion Allogeneic tendonin repair of chronic Achilles tendon is effective. It can avoid the injury and complication caused by autograft.
Objective To study the relationship of hepatitis B virus （HBV） to spontaneous rupture of hepatocellular carcinoma （HCC-SR） and its mechanism. Method The related literatures about theory of HCC-SR were consulted and reviewed. Results The injury of small arteries was usually followed in patients with HCC-SR， which was related to vascular autoimmune injury caused by the HBV infection. The small arteries in which immune complex deposited were readily injured， as a result HCC-SR happened while vascular load increased. Conclusion The HBV infection resulted in vascular autoimmune injury maybe a important factor in the pathogenesis of HCC-SR.
Objective?To investigate clinical characteristics， diagnosis， and treatment for patients with spontaneous esophageal rupture， and improve clinical diagnostic and treatment level.?Methods?We retrospectively analyzed the clinical data of 34 patients with spontaneous esophageal rupture who were treated in Subei People’s Hospital from January 1996 to June 2010. There were 28 male patients and 6 female patients with their age ranging from 32 to 80 years old (mean 57.6 years old). Main clinical manifestations included severe chest and abdominal pain after vomiting， fever， dyspnea and shock. The duration between disease onset and establishing diagnosis ranged from 4 hours to 7 days. Thirteen patients received conservative treatment including chest drainage， retrograde gastrointestinal decompression and enteral nutrition through jejunostomy. Twenty one patients received surgical treatment including layered anastomosis of the ruptured esophagus， retrograde gastrointestinal decompression and enteral nutrition through jejunostomy.?Results?All the patients were cured without in-hospital death. The mean hospital stay of the 13 patients who received conservative treatment was 46 days， while that of the 21 patients who received surgical treatment was 17 days. All the ruptured esophagus were one-stage healed. All the 34 patients were followed up from l to 8 years， including 11 patients in the conservative treatment group and 19 patients in the surgical treatment group， but 4 patients was lost during follow-up. All the patients had a normal diet without symptoms of esophageal stricture， reflux esophagitis or chronic thoracic empyema.?Conclusion Spontaneous esophageal rupture is a thoracic emergency with a high misdiagnosis rate and mortality．Early diagnosis， early surgical repair of ruptured esophagus and satisfactory chest drainage play a vital role in the treatment for patients with spontaneous rupture of esophagus.
ObjectiveTo explore the effectiveness of posterior median longitudinal W-shaped incision combined with layer-by-layer combing suture in the treatment of acute closed Achilles tendon rupture.MethodsThe clinical data of 32 patients with acute closed Achilles tendon rupture who met the selection criteria between August 2015 and February 2019 were retrospectively analyzed. There were 25 males and 7 females, with an average age of 33 years (range, 21-48 years). All of them were closed rupture of Achilles tendon caused by sports injury. Physical examination on admission: the rupture space of Achilles tendon was palpable; Thompson sign was positive; the rupture of Achilles tendon was confirmed by MRI and ultrasonography before operation, the distance between the broken end and the insertion point of Achilles tendon was 2-8 cm, with an average of 3.5 cm. The average time from injury to operation was 2.7 days (range, 1-10 days). During the operation, the posterior median longitudinal W-shaped incision of Achilles tendon was used to expose the broken end of Achilles tendon, and the deep and shallow double Kessler end-to-end suture+layer-by-layer combing suture were used to suture the Achilles tendon, and the skin incision was sutured by “V-Y”advancement. The postoperative complications were observed; the healing of Achilles tendon was observed by ultrasonography; at last follow-up, Arner Lindholm criteria was used to evaluate ankle function.ResultsThe 32 patients were followed up 8-24 months, with an average of 12 months. The incision healed by first intention, without the complications of skin necrosis, nonunion, delayed healing, and infection, scar hyperplasia or ulcer, and symptom of peroneal nerve injury. No Achilles tendon rupture and deep infection occurred during the follow-up period. The ultrasonography examination showed that the Achilles tendon was healing. At last follow-up, according to Amer Lindholm evaluation standard, the results of ankle function was excellent in 26 cases and good in 6 cases.ConclusionThe treatment of acute closed Achilles tendon rupture with a posterior median longitudinal W-shaped incision combined with deep and shallow double Kessler end-to-end suture+layer-by-layer combing suture is effective, which can fully exposed the incision, the quality of Achilles tendon anastomosis is reliable, and it can effectively avoid wound complications and iatrogenic injury of gastrocnemius nerve.
Objective
To investigate the feasibility of elective laparoscopic hepatectomy in the treatment of ruptured hepatocellular carcinoma.
Methods
We tried to perform an elective laparoscopic hepatectomy for a middle-aged man who had a ruptured hepatocellular carcinoma without active hemorrhage. The data of this patient was summarized.
Results
The patient received the elective laparoscopic hepatectomy, and the liver lesions were completely removed. The operation was successful. Operative time was 300 min and intraoperative bleeding was 500 mL. Postoperative recovery of this patient was good and no complication occurred. The abdominal drainage tube was removed on 4 days after operation, and he discharged on 8 days after operation. The pathology confirmed that the hepatocellular carcinoma was moderately differentiated and ruptured.
Conclusion
Elective laparoscopic hepatectomy is safe and feasible in the treatment of ruptured hepatocellular carcinoma for specific patient, but this operation needs to be performed by experienced surgeons with laparoscopic skills.
ObjectiveTo investigate diagnosis and treatment of rupture of pancreatic cystic disease.
MethodThe clinical data of 20 patients who were diagnosed as pancreatic cystic disease combined with rupture in the First Affiliated Hospital of Harbin Medical University from June 2011 to December 2015 were analyzed retrospectively.
Results① For the 5 patients with pancreatic cystic tumor, 3 patients of them received distal pancreatectomy and 2 patients of them received Whipple procedure. For the 15 patients with pancreatic pseudocyst, 2 patients received ultrasound-guided cyst puncture and drainage, 2 patients received endoscopic retrograde pancreatic drainage (ERPD), 2 patients received ERPD plus ultrasound-guided cyst puncture and drainage, 1 patient received pancreatic external drainage, 3 patients received pancreatic cyst-gastric anastomosis, 5 patients received pancreatic cyst-jejunal Roux-en-Y anastomosis. ② Pancreatic fistula occurred in 3 patients (Grade A 2 cases, Grade B 1 case), delayed gastric emptying was found in 1 patient, peritoneal effusion occurred in 1 patient. ③ Eighteen of them were followed up from 3 to 60 months with an average 25.6 months, 2 patients recurred and non-surgical treatments were taken.
ConclusionsHow to correctly identify pancreatic cystic tumor with pancreatic pseudocyst is premise of treatment. Pancreatic cystic disease combined with rupture requires urgent therapy. Based on clinical manifestations, optimal selection might achieve a better prognosis.
Objective To investigate the method and curative effect of malposed-suture hanging and fastening method of double-lariat lock catch knot in repairing origin of medial collateral l igament (MCL) rupture. Methods From February 2008 to February 2009, 36 patients with acute MCL rupture were treated with malposed-suture hanging and fastening method of double-lariat lock catch knot. There were 21 males and 15 females with an average age of 40 years (range, 17-58 years),including 19 left knees and 17 right knees. Repture was caused by traffic accident in 5 cases, by fall ing in 11 cases, by kicking in 3 cases, by crush in 4 cases, and by sprain in 13 cases. The X-ray films of double knees at stress state showed the medial joint space of affected knee joint increased 6.5-13.5 mm (11.2 mm on average) when compared with that of normal knee joint. The time from injury to operation was 36 hours to 8 days (3.5 days on average). Results All wounds healed by first intention. Thirty-one cases were followed up 12-20 months (15 months on average). No compl ication of wound infection, deep venous thrombosis, and l igament rerupture occurred. The medial joint space of affected knee joint increased 1.5-5.6 mm (3.5 mm on average) when compared with that of normal knee joint. According to Lysholm assessment standard, the results were excellent in 20 cases and good in 11 cases, the excellent and good rate was 100%. Conclusion Repair of origin of MCL with malposedsuture hanging and fastening method of double-lariat lock catch knot has advantages of less injury, rel iable fixation, and rapid recovery of knee stabil ity.
