Progressive Failure Analysis of Composite/Aluminum Riveted Joints Subjected to Pull-Through Loading

Out-of-plane mechanical properties of the riveted joints restrict the performance of the wing box assembly of airplane.It is necessary to investigate the pull-through performance of the composite/metal riveted joints in order to guide the riveting design and ensure the safety of the wing box assembly.The progressive failure mechanism of composite/aluminum riveted joint subjected to pull-through loading was investigated by experiments and finite element method.A progressive damage model based on the Hashin-type criteria and zero-thickness cohesive zone method was developed by VUMAT subroutine,which was validated by both open-hole tensile test and three-point bending test.Predicted load-displacement response,failure modes and damage propagation were analysed and compared with the results of the pull-through tests.There are 4 obvious characteristic stages on the load-displacement curve of the pull-through test and that of the finite element model:first load take-up stage,damage stage,second load take-up stage and failure stage.Relative error of stiffness,first load peak and second load peak between finite element method and experiments were 8.1%,-3.3%and 10.6%,respectively.It was found that the specimen was mainly broken by rivet-penetration fracture and delamination of plies of the composite laminate.And the material within the scope of the rivet head is more dangerous with more serious tensile damages than other regions,especially for 90°plies.This study proposes a numerical method for damage prediction and reveals the progressive failure mechanism of the hybrid material riveted joints subjected to the pull-through loading.

Improved laparoscopic transanal pull-through technique for low-rectal cancer resection

Objective： We described the applicability and evaluated the advantages of improved laparoscopic transanal pull-through （ILTPT） for low-rectal cancer resection. Materials： ILTPT was performed in 4 patients. Five or 4 ports were used. After isolation and section of the inferior mesenteric vessels, the rectum and sigmoid colon was mobilized. Total mesorectal excision and dissection of the distal rectum from the puborectalis muscle was carried out under laparoscopic guidance. The sigmoid colon and rectum were exteriorized via the anus. The rectum was divided proximally. Next, a purse-string suture was placed in the proximal segment, and the distal end of the sigmoid colon was returned to the pelvic cavity. The distal rectum was divided with Curved cutter staplermade by Jonson-Jonson company. Dislodging specimen, the continuity of the intestinal tract was restored using PROXIMATE ILS Curved and Straight Intraluminal Staplers CDH29/33 （Ethicon） through the rectum. Results： None of the cases were converted to open surgery. Average operation time was 180 min （range, 160-210 min）. No blood loss or any other complications were noted. Average postoperative stay was 9 days. Complications such as necrosis, anastomotic leakage and stricture, and genitoudnary disorders were not found in any of the patients at the 1 m follow-up. Conclusion： This report suggests that ILTPT is feasible and safe in Anus-Conserving Operation for low Rectal Cancer without auxiliary incision. If only we hold the applicability of ILTPT less trauma, more beautiful.

Development and Pull-through of Climate Science to Services in China

1. IntroductionThe impacts arising from climate change and climate variability pose major challenges to global and regional security and economic prosperity（UNFCCC,2015）.Some regions are more at risk than others, through heightened exposure to climatic hazards, and high vulnerability and exposure to such hazards. China, with its rapid economic development, large and growing population, and frequent occurrence of disasters associated with heavy rainfall, flooding, tropical cyclones,

Literature Review of the Frequency of Reoperations after One Stage Transanal Endorectal Pull-Through Procedure for Hirschsprung’s Disease in Children

Background: Transanal endorectal one-stage pull-through (TERPT) procedure in children with Hirschsprung’s disease (HD) has gained worldwide acceptance. However surgical success is often reported separately, while the necessity for true reoperation is difficult to establish. Aim: To evaluate the incidence of reoperations following TERPT procedure. The findings will be important in counseling and planning childcare for HD patients as well as providing a benchmark for single centers clinical results. Methods: A literature review of reported TERPT operations on children with HD between 1998 through 2011 was performed. Only planned TERPT operation reports were included. Information was collected with particular emphasis on reoperations and their reasons. Results: Out of 26 published articles 23 were included, reporting on 836 children, female/male ratio: 1/3.3, undergoing the TERPT procedure as the only operative intervention with described postoperative courses. The children comprised neonates, 3 years of age (12%). The average follow up was 18.5 (6 - 38) months. The resected bowel length mean was 20.5 cm. Forty-one reoperations were reported (4.9%), including 24 laparotomies, 8 laparoscopies, 6 colostomies and ileostomies in 3 children. Only 2 re-do TERPT were reported (0.2%). Seven patients were considered TERPT failures (0.8%) with 5 requiring diverting colostomies and additional transabdominal pull-through operations. Two myectomies were performed (0.2%). One child with aganglionosis underwent a Duhamel pull through. Two (0.2%) had serious damage to the urinary tract also one child with a vas deferens lesion was reoperated. Two bowel obstructions required adhesiolysis. Eight anastomotic dehiscences (0.9%) required surgery after reparation. One prolapse of the pulled through colon was reported. Six patients (0.7%) suffered anastomotic leaks. Anastomotic strictures rate was 2.8%, all repaired with anal dilatation. Conclusion: The review supports the low incidence of reported reoperations for the TERPT procedure.

Literature Review of the Outcome after One-Stage Transanal Endorectal Pull-Through Procedure for Hirschsprung’s Disease in Children

Background: Transanal endorectal one-stage pull-through (TERPT) procedure in children with Hirschsprung’s disease (HD) is frequently used worldwide. In order to give the families realistic expectations and to plan the medical care for the years after TERPT, the long term outcome is of great importance. Aim: To collect information on the long term outcome reported after one stage TERPT procedure for HD in children 0 - 15 years. Method: A literature review on the outcome of planned TERPT from 2005 through 2012 was carried out. Information was collected on the number of daily stools a few months postoperatively, incontinence and constipation and the measures taken to deal with these. Results: The reports are few and prospective studies were missing. The results show an initial high frequency of daily stools, 12% had later abnormal stool patterns, 21% had fecal incontinence and 10% had problems with constipation. Conclusion: In order to compare the long term outcome, it would be desirable to have uniform regular reports on the daily frequency of passed stools, incontinence and constipation during the first years after TERPT. Such knowledge would be of importance for the information given to the guardians of children with HD preoperatively to TERPT and in the planning of the future care. The findings can, furthermore, provide a benchmark for the outcome from a single centre.

Transumbilical enterostomy for Hirschsprung’s disease with a two-stage laparoscopy-assisted pull-through procedure

BACKGROUND A one-stage laparoscopic operation has recently been considered a favorable option for the management of patients with Hirschsprung's disease(HD)due to its superior cosmetic results.One-stage transanal endorectal pull-through for the treatment of rectosigmoid HD has been widely used in newborns without complications.However,enterostomy is required in some HD cases for enterocolitis and dilated colon.Our transumbilical enterostomy(TUE)and twostage laparoscopy-assisted anorectoplasty were effective and achieved a similar cosmetic effect to one-stage laparoscopy on the abdominal wall in patients with anorectal malformation,but the effect in patients with HD is unclear.AIM To evaluate the safety,efficacy and cosmetic results of TUE in two-stage laparoscopy-assisted pull-through for HD.METHODS From June 2013 to June 2018,53 patients(40 boys,13 girls;mean age at enterostomy:5.5±2.2 mo)who underwent enterostomy and two-stage laparoscopy-assisted pull-through for HD with stoma closure were reviewed at our institution.Two enterostomy approaches were used:TUE in 24 patients,and conventional abdominal enterostomy(CAE)in 29 patients.Eleven patients with rectosigmoid HD had severe preoperative enterocolitis or a dilated colon.26 patients had long-segment HD,and 16 patients had total colonic aganglionosis(TCA).The patients with left-sided HD underwent the two-stage laparoscopic Soave procedure,and the patients with right-sided HD and TCA underwent the laparoscopic Duhamel procedure.Demographics,enterostomy operative time,complications and cosmetic results were respectively evaluated.RESULTS There were no differences between the groups with respect to gender,age at enterostomy,weight and clinical type(P>0.05).No conversion to open technique was required.Two patients experienced episodes of stomal mucosal prolapse in the TUE group and 1 patient in the CAE group(8.33%vs 3.45%,P>0.05).No parastomal hernia was observed in either of the two groups.Wound infection at the stoma was seen in 1 case in the TUE group,and 2 cases in the CAE group(4.17%vs 6.90%,P>0.05).No obstruction was noted in any of the patients in the TUE group,whereas obstruction was found in 1 patient in the CAE group.Enterocolitis was observed in 3 and 5 patients in the TUE and CAE group,respectively(12.50%vs 17.24%,P>0.05).There was no significant difference between the TUE group and CAE group in terms of the incidence of soiling and constipation(P>0.05).The cosmetic result using the scar score in the TUE group was better than that in the CAE group(6.83±0.96 vs 13.32±1.57,P<0.05).CONCLUSION TUE is a safe and feasible method for the treatment of HD,and the staged enterostomy and two-stage laparoscopy-assisted pull-through achieved a similar cosmetic effect to the one-stage laparoscopic procedure.

骨盆骨折致后尿道闭锁的术式选择及应用

目的:探讨经会阴治疗骨盆骨折致后尿道闭锁的术式选择以及疗效。方法:2012年1月至2021年12月,116例骨盆骨折导致后尿道断裂或闭锁患者在我院接受治疗。其中79例首选经会阴尿道狭窄切除端端吻合术,对于闭锁段>3 cm,预估尿道对合张力明显者,则切开阴茎中隔,分离切除附着于耻骨下缘的肌键及瘢痕组织,用4-0可吸收线吻合8针。另37例针对近端尿道瘢痕化明显,保留尿道<5 mm且尿道黏膜不完整,不能保证黏膜-黏膜有效缝合的患者,选择行传统尿道拖入术。结果:术后随访3~24个月,手术总体成功率78.4%(91/116),其中尿道端端吻合77.2%(61/79),尿道拖入81.1%(30/37)。排尿不畅18例(15.5%),其中尿道端端吻合13例,占比16.5%(13/79),尿道拖入5例,占比13.5%(5/37)。手术失败7例(6.1%),其中尿道端端吻合5例,占比6.3%(5/79),尿道拖入2例,占比5.4%(2/37)。尿道端端吻合手术后排尿不畅,原因主要为瘢痕切除不彻底导致再次狭窄,以及吻合段两侧尿道不在同轴水平。尿道拖入排尿不畅,分析原因为套入尿道黏膜瓣膜形成,再次瘢痕化导致狭窄或套入尿道不在同轴水平。手术失败7例尿道再次闭锁,1例拒绝再次手术而选择膀胱造瘘管引流,其余6例半年后再次行端端吻合术。结论:对于后尿道闭锁患者,经会阴尿道端端吻合为首选治疗方案;针对掌握后尿道吻合技术早期或每年收治病例较少的医院,尿道拖入术是一种有效治疗方法。

内镜下微创精准尿道拖入术治疗复杂性后尿道狭窄或闭锁(“大家泌尿网”观看手术视频)

尿道拖入术是治疗复杂性后尿道狭窄及闭锁的有效术式。传统尿道拖入术因创伤大、端端对合不精准等问题常难以达到理想的效果。本团队对传统尿道拖入术进行改良,应用输尿管镜于直视下行尿道端端精准对合,术中无需切开膀胱,全程使用超声刀,减少了术中出血及术后感染的发生,提高了手术成功率,极大地降低了狭窄复发率及术后并发症发生率,实现了微创精准的效果。较短的学习曲线使其可作为骨盆骨折后复杂性后尿道狭窄或闭锁的一种新的治疗方法。本文介绍了该术式具体操作步骤,结合临床数据对其手术疗效进行分析并详细说明其创新点和操作经验。

A NEW MODIFICATION OF TRANSANAL SOAVE PULL-THROUGH PROCEDURE FOR HIRSCHSPRUNG’S DISEASE

Background One stage transanal Soave pull-through procedure （TSPP） is a recent popular operation in the treatment of Hirschsprung＇s disease （HD）. With no visible scar and a short hospital stay, it is well accepted by surgeons and mothers. In the conventional Soave procedure, a long rectal muscular cuff left for anocolic anastomosis might increase the incidence of postoperative enterocolitis and constipation. This study presents a modified transanal Soave pull-through procedure （MTSPP） which includes an oblique mucosectomy and an oblique anastomosis with a short split muscular cuff.. Methods A review of two groups of HD patients was made： 112 underwent conventional transanal Soave procedure from 1999 to 2001 （group 1） and 140 underwent modified transanal Soave procedure from 2002 to 2004 （group 2）. A comparison was made between the two groups on operative data and postoperative complications. The data included： age at the operation, operating time, blood loss, time to feeds and hospital stay, occurrence of postoperative enterocolitis or constipation, need for anal dilatation, postoperative bowel function and perianal skin problems. Results There was no significant difference between two groups with respect to age, gender, length of colon resected, operating time, blood loss and hospital stay. However occurrence of postoperative enterocolitis, constipation, anastomotic stricture and time needed for anal dilatation were evidently less in group 2 （MTSPP）. The mean operating time in group 1 was （106 ± 39） minutes with a range of 60 to 170 minutes; in group 2 was （101 ± 36） minutes with a range of 66 to 190 minutes. The average length of the bowel resected in group 1 was （24 ± 7） cm, range 15 to 58 cm; in group 2 was （26 ± 8） cm, range 15 to 70 cm. Two patients, one in each group, required laparoscopic assistance because of long aganglionic colon. Another patient in group 2 required laparotomy because of total colonic aganglionosis. Postoperative complications in group 1 included： temporary perianal excoriation in 34 patients （26 were 〈3 months of age）, enterocolitis in 21, anastomotic stricture in 11, recurrent constipation in 12, cuff abscess in 1, anastomosis leak in 1, soiling in 3 and rectal prolapse in 1. In group 2 post operative complications included： transient perianal excoriation in 37 patients （30 were 〈3 months of age）, enterocolitis in 13, anastomotic stricture in 5, recurrent constipation in 6, anastomotic leak in 1, adhesive bowel obstruction in 1 and soiling in 4. Complete bowel continence was found in 97 children （86.6%） in group 1 and in 129 children （92.1%） in group 2 at one year followup after operation. Conclusions Modified transanal Soave pull-through procedure for HD with oblique mucosectomy and anastomosis and a short split muscular cuff is a safe and feasible operation with low incidence of postoperative complication. It is an encouraging improvement of the conventional transanal Soave pull-through procedure. MTSPP is a preferable choice in the surgery of HD.

A new modification of transanal Swenson pull-through procedure for Hirschsprung＇s disease

Background The one-stage pull-through procedures for Hirschsprung＇s disease （HD） have become popular because it is well accepted by surgeons and mothers with no visible scar and a short hospital stay. It represents the latest development in the concept of a minimally invasive surgery for HD. We introduce a new method of transanal one-stage pull-through for Hirschsprung＇s disease, different from the transanal Scare procedure. Methods One hundred and thirty-four patients aged 9 days to 5 years underwent a transanal one-stage pull-through procedure. The diagnosis was definite by barium enema or rectal biopsies preoperatively. The patients were anesthetized and placed in the lithotomy position. A urinary catheter was optional. Giving anorectal dilatations for half a minute, a pull-through of the rectum above the peritoneal reflection and into the intussusception was performed. Fine silk suturing was performed circumferentially at the level of that point which was used for traction for the distal end. Another circumferential suture was performed parallel 0.5 cm distance above the original one and used for traction for the proximal intestines. The full-thickness rectal wall was truncated between the above two circumferential sutures with cautery. The proximal intestines were pulled down and the mesenteric vessels were dissected with ligation until normal intestines were accessed; the presence of ganglion cells was determined by intraoperative rapid frozen section. The distal end was dissected anteriorly 2.5-3.5 cm above the dentate line. The posterior rectal wall was split longitudinally and dissected to a point 0.5-1.0 cm above the dentate line. The segment of the lesion was resected. The length of bowel resected ranged from 12 to 50 cm （median 16.5 cm）. An oblique anastomosis was made. Results The mean operating time was 70 minutes. Postoperative rectal dilation was not required. The patient tolerated feeding on the first postoperative day. Eighty-eight patients were followed-up. All these patients had 2-3 bowel movements per day at postoperative month 1. They were discharged within 4.5 days after the operation. Six patients presented with complications. All recovered by reoperation or conservative treatments. Conclusion The modification of the transanal Swenson pull-through procedure for Hirschsprung＇s Disease is an easy adaptation to a well-established technique and has a reasonable result.

Redo pull-through in total colonic aganglionosis due to residual aganglionosis:a single center’s experience

Background Reoperation for total colonic aganglionosis(TCA)may be required for residual aganglionosis after an initial radical operation.We aimed to investigate the symptoms,management,and outcomes of patients who required a redo pullthrough(Redo PT).Methods Nine TCA patients underwent Redo PT at our center between 2007 and 2017.Their medical records were reviewed.Parental telephone interviews that included disease-specific clinical outcomes were conducted,and post-operative complications and long-termoutcomes(including height-for-age/weight-for-age and bowel-function score)were compared to those of single-pull-through(Single PT)patients(n=21).Results All the nine Redo PT patients suffered obstruction within 1 month after the initial operation that could not be alleviated by conservative treatment.All abdominal X-ray/contrast barium enemas showed proximal bowel dilatation,indicating residual aganglionosis.The median ages at the initial operation and Redo PT were 200 and 509 days,respectively.Reoperation consisted of an intraoperative frozen biopsy and a modified laparotomic Soave procedure in all patients.Postoperative complications included perianal excoriation(n=3),intestinal obstruction(n=2),enterocolitis(n=2),and rectovestibular fistula(n=1).Seven Redo PT patients were followed up for a mean time of 7.162.3 years;six(85.7%)had good growth and four(57.1%)had good bowel-function recovery.Post-operative complications and long-term outcomes were almost equal between the Redo PT and Single PT groups(all P>0.05).Conclusion TCA patients with recurrent obstructive symptoms and dilated proximal bowel may have residual aganglionosis after an initial operation.Redo PT is effective and provides good long-termoutcomes comparable to those of patients who benefited from Single PT.

自升式钻井平台插拔桩技术发展现状及趋势

针对自升式钻井平台在插桩和拔桩过程中面临的土工问题,系统地梳理插桩和拔桩涉及的关键技术。分析插桩过程中的土工试验技术、土体破坏机理、上硬下软地层承载力和桩脚滑移问题;阐述拔桩过程中的拔桩阻力计算方法和减小拔桩阻力方法的研究进展情况。在此基础上,根据目前面临的新挑战,提出今后自升式钻井平台插拔桩技术研究的重点,并预测其发展趋势。

腹腔镜胃癌根治术联合托出式脾门入路淋巴结清扫治疗胃癌的效果观察

目的研究腹腔镜胃癌根治术(LTG)与托出式脾门入路淋巴结清扫(TLND)联合治疗胃癌的效果。方法以前瞻性分析为法,选取2019年1至12月江苏省肿瘤医院收治入院的80例胃癌患者为研究对象,按照随机数字表法将其分为两组:观察组(n=43)与对照组(n=37)。对照组实施开腹手术联合托出式脾门TLND,观察组实施LTG与托出式脾门TLND。比较两组手术近期疗效(手术时间、术中出血量、总淋巴结清扫数量、脾门淋巴结检出数量、腹部切口长度、首次流质食物摄入时间以及术后住院时间)、生活质量、肿瘤学指标[癌胚抗原、甲胎蛋白、糖类抗原(CA)199、CA724]、术后并发症、远期疗效。结果观察组的手术时间为(243.16±47.51)min,长于对照组[(193.42±39.85)min],术中出血量为(114.78±60.84)mL,少于对照组[(201.46±70.49)mL],腹部切口长度、首次流质食物摄入时间以及术后住院时间分别为(6.33±1.15)cm、(5.19±2.31)d、(11.92±2.15)d,均短于对照组[(17.52±4.85)cm、(7.45±2.62)d、(14.99±3.49)d],总淋巴结清扫数量、脾门淋巴结检出数量分别为(25.75±4.31)、(5.23±1.43)枚,均高于对照组[(22.23±3.44)、(3.41±1.62)枚],差异均有统计学意义(P<0.05)。手术后1个月,两组患者生活质量评分中主观症状、社会活动功能、生理功能、心理情绪以及生存质量指数(GLQI)总分均下降,且观察组分别为(60.41±4.75)、(10.65±1.64)、(17.51±3.21)、(12.31±1.02)、(103.39±4.19)分,均明显低于对照组[(66.98±5.13)、(12.28±1.56)、(19.19±3.35)、(13.88±1.34)、(113.27±4.98)分],差异均有统计学意义(P<0.05)。手术后1个月,两组患者血清癌胚抗原、甲胎蛋白、CA199、CA724水平均较手术前降低,且观察组血清癌胚抗原、甲胎蛋白、CA199、CA724水平分别为(10.87±2.33)μg/L、(10.42±5.41)ng/mL、(40.16±7.42)U/L、(6.31±1.03)U/mL,均明显低于对照组[(15.78±2.84)μg/L、(16.49±4.87)ng/mL、(60.46±10.48)U/L、(8.42±1.09)U/mL],差异均有统计学意义(P<0.05)。观察组术后并发症总发生率为4.65%,低于对照组(24.32%),差异有统计学意义(P<0.05)。观察组3年总生存率以及无病生存率分别为93.02%、69.77%,均高于对照组(72.97%、45.95%),差异均有统计学意义(P<0.05)。结论胃癌患者开展LTG与托出式脾门TLND联合治疗效果显著,对于术后康复与生活质量而言有明显改善作用,降低术后并发症,减轻血清内肿瘤因子水平,且3年的总生存率、无瘤生存率较高。

腹腔镜或机器人辅助Duhamel拖出术后留置肛管时间对巨结肠患儿术后恢复的影响

目的探讨长段型先天性巨结肠及肠神经节细胞发育不良患儿行腹腔镜或机器人辅助Duhamel拖出术后留置肛管不同时间对术后恢复的影响。方法2019年1月~2021年12月29例长段型巨结肠,56例肠神经节细胞发育不良保守治疗无效行微创肛门外横断直肠Duhamel拖出术,术后常规留置肛管,根据实际留置肛管时间的不同分为三组:A组,置管时间≤3天,8例;B组,置管时间4~6天,15例;C组,置管时间≥7天,62例。比较术中及术后疗效。结果三组病例在术后1年内小肠结肠炎发生次数、术后腹胀、肛周不适的发生率比较差异有统计学意义(P<0.05)。结论先天性巨结肠长段型及肠神经节细胞发育不良患儿行微创肛门外横断直肠的Duhamel拖出术后留置肛管时间长,有利于减少术后腹胀、肛周不适及小肠结肠炎的发生率。

竹集成材自攻螺钉拉穿性能试验

对竹集成材-自攻螺钉连接试件进行单轴拉穿加载试验,探究自攻螺钉在竹集成材中的拉穿性能及破坏形态,为自攻螺钉连接设计与工程应用提供基础数据。依据EN 1383-2016木结构试验方法设计8组64个竹集成材-自攻螺钉连接试件,比较竹集成材不同纹理方向和板厚对初始刚度、极限荷载、屈服荷载及延性等影响。试验结果表明:竹集成材自攻螺钉连接试件在节点处的力学性能主要由板材厚度决定,而纹理方向的影响较小。钉节点的破坏形态与竹集成材纹理方向密切相关。自攻螺钉在竹集成材中拉穿破坏形态的横纹弦向和横纹径向存在两种破坏现象,分别为竹集成材表面陷落破坏与整体劈裂破坏。当试件纹理方向相同时,板厚与极限荷载和初始刚度呈现正相关;当试件板厚相同,在横纹弦向上承载能力高于横纹径向。当竹结构满足最小尺寸设计要求时,对于直径6 mm的半螺纹自攻螺钉从横纹弦向钉入板厚30 mm的竹集成材,此时试件拉穿承载性能和延性达到最佳状态,充分发挥了材料的力学性能。

埕岛油田反复插拔桩区域就位风险及预防措施

胜利埕岛油田位于现代黄河水下三角洲,海底地层复杂,沉积物粉土、粉质黏土互层变化大.近年来,动平台作业在同一井口或相近井口反复插拔桩作业次数越来越多.海上动平台反复插拔桩区域存在滑桩、穿刺、液化下沉风险,在该类型区域插桩存在较大隐患.针对该风险进行预防措施分析,降低动平台插桩风险.

竹胶板钉帽拉穿性能的参数化分析

竹胶板力学性能优良,可应用于建筑的结构构件中,但竹胶板与普通钉子结合难以发挥竹胶板强度高和韧性好的特点,而自攻螺钉由于其优异的抗拔锚固能力和刚度常用于竹木结构的加固连接,两者组合使用于建筑结构中具有较大潜力。钉帽拉穿是竹胶板自攻螺钉连接的一种典型破坏形式,钉帽拉穿性能值得深入研究。以竹胶板厚度、自攻螺钉直径以及自攻螺钉类型为参数对90块竹胶板试件进行单调加载试验,分析其破坏模式、钉帽拉穿承载力及强度等。结果表明:试件的破坏模式为钉帽拉穿破坏;钉帽拉穿承载力与自攻螺钉直径呈正相关,但承载力增幅与直径呈负相关,当径厚比大于1/2时,承载力增幅不明显;钉帽拉穿承载力与竹胶板厚度呈正相关,且竹胶板越厚承载力提高的程度越明显,当径厚比小于1/2时,承载力增幅显著提高,达33.6%。3种自攻螺钉的钉帽拉穿承载力从大到小依次是半螺纹沉头自攻螺钉、全螺纹沉头自攻螺钉、全螺纹圆柱头自攻螺钉;钉帽在预钻孔试件中对承载力起主要影响作用。

da Vinci机器人辅助腹腔镜Soave拖出术治疗先天性巨结肠症

目的探讨daVinci机器人辅助先天性巨结肠Soave拖出术的可行性。方法2015年5～8月行daVinci机器人辅助巨结肠Soave拖出术3例。采用四孔技术，调整患儿体位和trocar位置后，完成daVinci机器人与患儿的对接。肠壁浆肌层活检明确病变范围，单级电凝或超声刀游离直肠、乙状结肠系膜。解除机器人与患儿的对接，转至会阴部操作。电凝分离直肠黏膜达腹膜返折水平，采用改进的Soave技术进行吻合。结果移行区1例位于直肠，1例位于直肠乙状结肠交界处，1例位于乙状结肠上段。手术时间分别为160、170、200min，无术中并发症。住院时间分别为7、7、14d。3例分别随访35、65、88d，1例患儿因吻合口轻度狭窄需每日扩肛，持续1个月后好转，无小肠结肠炎表现。结论daVinci机器人手术系统可安全地应用于婴幼儿巨结肠Soave拖出手术，更清晰地显示系膜血管和盆腔细微的组织结构，操作灵巧，有效避免副损伤。

经肛门结肠拖出术治疗新生儿及婴儿先天性巨结肠

目的 :介绍经肛门结肠拖出术治疗新生儿及婴儿先天性巨结肠。方法 :回顾 4 3例采用经肛门结肠拖出术治疗的新生儿及婴儿先天性巨结肠。患儿年龄 14d至 12个月。方法为在肛门齿状线处切开直肠黏膜 ,向近端游离达盆底腹膜返折处。切除直肠肌鞘后壁约 1 0～ 1.5cm一条。游离乙状结肠达正常结肠后切断。拖出正常结肠与肛门吻合。结果 :4 3例经肛门直肠结肠拖出切除病变肠段顺利完成手术 ,术中出血少 ,术后 1～ 2d进食 ,5～ 7d出院 ,无术后尿潴留 ,无伤口感染及肛门回缩。全部患儿获随访 3～ 9个月 ,排便功能正常 ,无肛门狭窄发生。2例偶有污粪 ,为术后早期病例。结论 :经肛门结肠拖出术操作简便 ,创伤小 ,恢复快 ,术后护理负担轻 ,并发症少。此术式是新生儿和婴儿先天性巨结肠根治性治疗的理想方法。

低位/超低位直肠癌行腹腔镜下经肛拖出式全直肠系膜切除联合应用双吻合器的临床意义

目的:探讨低位/超低位直肠癌患者接受腹腔镜下经肛门拖出全直肠系膜切除结合双吻合器手术的临床意义。方法:选择于2010年1月至2012年11月间就诊于吉林大学第二医院普通外科疾病诊疗中心的46例低位/超低位直肠癌患者,施行腹腔镜经肛门拖出全直肠系膜切除结合应用双吻合器手术。回顾性分析手术成功率、术后并发症及远期治疗效果。结果:46例手术均获成功,无中转开腹,手术时间平均167 min,出血量平均42 mL。术后切缘病理检查均未见癌细胞,无手术死亡病例,无吻合口瘘及输尿管损伤等严重并发症,平均随访12.6个月,无局部或吻合口复发、戳卡种植转移。结论:施行低位/超低位直肠癌腹腔镜辅助下经肛门拖出全直肠系膜切除结合应用双吻合器具有安全可行的优点,并且能够保证足够的肿瘤远端切缘。