(承2007年第6期) 6.2 盆腹膜重建的种类和方法 6.2.1 盆底隔离法如前所述,因超低位直肠/肛管癌浸润会阴直肠隔、盆侧壁及肛周扩约肌群而实施了新腹会阴局部扩大切除术,因T4期直肠癌浸润子宫阴道或膀胱前列腺部分组织而实施了盆腔脏器局部扩大切除术,因局部复发性直肠癌而实施了腹会阴联合再切除术,因各种原因对中晚期直肠癌实施了Hartmann手术,以及因技术不确定性而实施了传统腹会阴联合切除术,无论手术切除范围或术者的操作技巧如何,由于病变性质决定了这类手术只能定位于根治性(R0)与姑息性(R2)之间的程度.因此,初次切除只是获得治愈或延长生存期的第一步,接下来是盆腔放疗或局部内放射治疗,最后,尚存在局部复发的高风险,若发生,可经会阴骶尾部再次甚至多次对复发癌行局部姑息性切除.因而预先有效的盆底隔离就可避免再手术时的小肠损伤,这就是盆底重建术的主要功能和适应证之一.……
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.
Objective To discuss the operative technique and curative effect of minor-incision cholecystectomy. Methods The clinical data of 672 patients with application of mini-cholecystectomy from June 2001 to June 2009 were analyzed. Perioperative management and operative technique were emphasized. Results Six hundred and fifty-two cases (97.0%) were cured with mini-cholecystectomy and 20 cases (3.0%) with incision lengthened. Operation time was （40.0±10.0） min. One case with hemorrhoea during operation was cured by interventional embolotherapy. Bile duct injury was found in 1 case during operation， and adopted suture with T tube. There were no infection of incisional wound or death in this study. Conclusion On the basis of skillful conventional cholecystectomy, by controlling indication and improving operative technique, it is an economical and safe way to perform minor-incision cholecystectomy.