BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complic...BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complication after ileostomy closure.AIM To evaluate the efficacy and safety of the micro-power negative pressure wound technique(MPNPWT)in preventing incisional SSI.METHODS This was a prospective,randomized controlled clinical trial conducted at a single center.A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021.Patients were randomly allocated into an MPNPWT group and a control group.The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing.The surgical outcomes were compared between the MPNPWT(n=50)and control(n=51)groups.Risk factors for incisional SSI were identified using logistic regression.RESULTS There were no differences in baseline characteristics between the MPNPWT(n=50)and control groups(n=51).The incisional SSI rate was significantly higher in the control group than in the MPNPWT group(15.7%vs 2.0%,P=0.031).However,MPNPWT did not affect other surgical outcomes,including intra-abdominal complications,operative time,and blood loss.Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups(P=0.069 and 0.843,respectively).None of the patients experienced adverse effects of MPNPWT,including skin allergy,dermatitis,and pain.MPNPWT also helped heal the infected incision.Our study indicated that MPNPWT was an independent protective factor[odds ratio(OR)=0.005,P=0.025)]and diabetes was a risk factor(OR=26.575,P=0.029)for incisional SSI.CONCLUSION MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.展开更多
BACKGROUND Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors.However,the ...BACKGROUND Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors.However,the traditional interrupted suturing technique used in enterostomy closure surgery has several issues,including longer surgical incisions and higher incision tension,which can increase the risk of postoperative complications.To address these issues,scholars have proposed the use of a“gunsight suture”technique.This technique involves using a gunsight incision instead of a traditional linear incision,leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection.Building on this technique,we propose an improved gunsight suture technique.A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture,which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes,thereby reducing the risk of postoperative complications.AIM To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.METHODS In this study,a retrospective,single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the Department of Colorectal Surgery of Qilu Hospital from April 2017 to December 2021.The patients were divided into two groups:135 patients received sutures using the improved gunsight method,while the remaining 135 patients were sutured with the traditional interrupted suture method.We collected data on a variety of parameters,such as operation time,postoperative pain score,body temperature,length of hospital stays,laboratory indicators,incidence of incisional complications,number of wound dressing changes,and hospitalization costs.Non-parametric tests and chi-square tests were utilized for data analysis.RESULTS There were no statistically significant differences in general patient information between the two groups,including the interval between the first surgery and the stoma closure[132(105,184)d vs 134(109,181)d,P=0.63],gender ratio(0.64 vs 0.69,P=0.44),age[62(52,68)years vs 60(52,68)years,P=0.33],preoperative body mass index(BMI)[23.83(21.60,25.95)kg/m²vs 23.12(20.94,25.06)kg/m²,P=0.17].The incidence of incision infection in the improved gunsight suture group tended to be lower than that in the traditional interrupted suture group[(n=2/135,1.4%)vs(n=10/135,7.4%),P<0.05],and the postoperative hospital stay in the improved gunsight suture group was significantly shorter than that in the traditional interrupted suture group[5(4,7)d vs 7(6,8)d,P<0.05].Additionally,the surgical cost in the modified gunsight suture group was slightly lower than that in the traditional suture group[4840(4330,5138)yuan vs 4980(4726,5221)yuan,P>0.05],but there was no significant difference in the total hospitalization cost between the two groups.CONCLUSION In stoma closure surgery,the improved gunsight technique can reduce the incision infection rate,shorten the postoperative hospital stay,reduce wound tension,and provide better wound cosmetic effects compared to traditional interrupted suture.展开更多
BACKGROUND Colorectal foreign bodies are commonly encountered during surgery.They are frequently observed in men 20 to 90 years of age and have bimodal age distribution.Surgical management is necessary for cases of re...BACKGROUND Colorectal foreign bodies are commonly encountered during surgery.They are frequently observed in men 20 to 90 years of age and have bimodal age distribution.Surgical management is necessary for cases of rectal perforation.However,surgical site infections are the most common complications after colorectal surgery.CASE SUMMARY We discuss a case of rectal perforation in a patient who presented to our hospital 2 d after its occurrence.The perforation occurred as a result of the patient inserting a sex toy in his rectum.Severe peritonitis was attributable to delayed presentation.CONCLUSION Vacuum-assisted closure was performed to treat the wound,which healed well after therapy.No complications were noted.展开更多
Gastrointestinal perforations,which need to be managed quickly,are associated with high morbidity and mortality. Treatments used to close these perforations range from surgery to endoscopic therapy. Nowadays,with the ...Gastrointestinal perforations,which need to be managed quickly,are associated with high morbidity and mortality. Treatments used to close these perforations range from surgery to endoscopic therapy. Nowadays,with the development of new devices and techniques,endoscopic therapy is becoming more popular. However,there are different indications and clinical efficacies between different methods,because of the diverse properties of endoscopic devices and techniques. Successful management also depends on other factors,such as the precise location of the perforation,its size and the length of time between the occurrence and diagnosis. In this study,we performed a comprehensive review of various devices and intro-duced the different techniques that are considered effective to treat gastrointestinal perforations. In addition,we focused on the different methods used to achieve successful closure,based on the literature and our clinical experiences.展开更多
The crack tip strain gauge method in the compliance technique was used to determine the opening load of notched crack of axle steel,and the nonlinear finite element ADINA program, to which the cyclic stress-strain cur...The crack tip strain gauge method in the compliance technique was used to determine the opening load of notched crack of axle steel,and the nonlinear finite element ADINA program, to which the cyclic stress-strain curve of axle steel was applied,was used to analyze the stress-strain field ahead of the crack tip and the opening load of notched crack.The results of both the compliance technique and the numerical method were in good agreement.In this pa- per,the concept of the sensitive point is proposed and the key to the determination of the crack opening load in the experiment is to place a strain gauge at sensitive point.It is certified by both experimental and numerical methods that the sensitive point has the best linear relation- ship character and the value of strain is much greater.展开更多
Aims and Objectives: The aim of the study was to compare the effect of complete and partial wound closures on postoperative sequelae and complications after surgical removal of impacted mandibular third molars. Patien...Aims and Objectives: The aim of the study was to compare the effect of complete and partial wound closures on postoperative sequelae and complications after surgical removal of impacted mandibular third molars. Patients and Methods: One hundred and twenty patients who required 121 surgical extractions of mandibular impacted third molars were included in the study. Patients were randomly divided into 2 groups based on wound closure after surgery. In group 1 (complete wound closure, n1 = 60) patients had their extraction sockets completely closed by mucosal flap while in group 2 (partial wound closure, n2 = 60) patients had their extraction sockets partially closed. Data collected included maximum inter-incisal distance (MID) and facial width which were recorded both preoperatively and postoperatively. What also recorded were postoperative pain intensity and postoperative complications. Results: There were 50 (41.7%) males and 70 (58.3%) females (male to female ratio of 1:1.4);age range was 18-40 years and the mean was 26 ± 10 years. The mean ages of patients in both groups showed no significant difference (group 1 = 26.5 ± 7.2;group 2 = 27.1 ± 8.1). The pain was maximal at the first postoperative day review and it gradually reduced in intensity towards the preoperative values for both groups. The pain perceptionsin patients in group 2 were however significantly lower than those of group 1 on days 1 and 3 but not statistically different on day 7. The mean difference in the postoperative and preoperative MID was greatest on the 1st postoperative day and gradually became smaller on the subsequent review days. Comparison of this mean difference between the 2 groups however showed a significant difference in the 2 groups only on day 7. Maximal swelling was noted in both groups on the third postoperative day. A comparison of the mean facial width between the two groups showed no statistically significant difference on all the review days. The postoperative complication rate was 5% in both groups. Conclusions: The results of the study indicate that there was a comparative reduction in postoperative sequelae namely pain and trismus after impacted mandibular third molar surgery when a partial wound closure technique was done. However, there was no significant difference in the postoperative complication rate between the two groups.展开更多
AIM:To investigate twenty-year experience evaluated the use of the PolysorbR(an absorbable lactomer)staples for distal pancreatic resection.METHODS:The data on 150 patients[92 men,58women,mean age 52(24-72)years]who u...AIM:To investigate twenty-year experience evaluated the use of the PolysorbR(an absorbable lactomer)staples for distal pancreatic resection.METHODS:The data on 150 patients[92 men,58women,mean age 52(24-72)years]who underwent distal pancreatectomy(DP)in the last 20 years were collected prospectively from an electronic database.The diagnosis was confirmed by endoscopic retrograde cholangiopancreatography,sonography,computed tomography and/or magnetic resonance imaging.The indications for DP were focal pancreatic necrosis,spontaneous pancreatic fistulas,abscesses,pseudocysts,segmental chronic obstructive pancreatitis in the tail,traumatic disruption,and benign(cystadenomas,insulinomas,or glucagonomas)or malignant tumours.The distal resections were performed without splenectomy in 29 of the 150 patients(19%).In the event of splenectomy,the splenic artery and vein were individually ligated,the TA-55 Auto Suture stapler,loaded with Premium PolysorbR 55 staples(5.5mm),was placed across the gland,and the trigger was pulled,the action of which produced two staggered absorbable suture lines.The gland distal to the stapler wasthen amputated with a scalpel on the TA-55 stapler and the two rows of staples were left in the proximal pancreatic stump.After the distal resection,a drainage tube was inserted into the pancreatic bed.RESULTS:The average duration of the operation was150 min(range:90-210 min)and no transfusion was indicated during the operation.After DP in one patient a type B fistula was diagnosed,which was treated successfully by conservative treatment comprising of 12-d octreotide medication(3×0.1 mg/d)and jejunal feeding.The incidence of postoperative pancreatic fistula was therefore0.6%.Another 2 patients suffered postoperative pancreatitis,which was also conservatively treated.Reoperations were performed in 2 patients on the first or second postoperative day,necessitated by bleeding from the retroperitoneal region.The morbidity was 3.3%(5 patients),but no mortality occurred in the postoperative period.Overall,the postoperative period was uneventful without any complications(pancreatic fistula,abscess,bleeding or wound infection)in 145 patients.The length of the postoperative stay ranged between 8 and 16 d.For the 145 patients who had no any postoperative complications,the hospital stay was 8 or 9 d.No mortality occurred in the follow-up period(6 or 12 mo postoperatively);but 6 mo after surgery one patient suffered a pseudocyst following recurrent pancreatitis and was treated with cystojejunostomy.CONCLUSION:Our clinical results demonstrated that the application of absorbable lactomer staples for distal pancreatic resection is a safe alternative to the standard closure technique.展开更多
Based on Edong Yangtze River Bridge, which is the second longest hybrid girder cable stayed bridge with 926 m long main span, the influencing factors and crucial techniques of the main span closure method for long spa...Based on Edong Yangtze River Bridge, which is the second longest hybrid girder cable stayed bridge with 926 m long main span, the influencing factors and crucial techniques of the main span closure method for long span hybrid girder cable stayed bridge are studied. After theoretical analysis, numerical evaluation and practical test, the loading assistant closure method is employed in Edong Yangtze River Bridge. The loading assistant closure method, with better thermal adaptability and less influence on bridge line and the forced status, can meet the requirements of the unstressed state control method. Based on the mentioned advantages, the loading assistant closure method is applicable to long span hybrid girder cable stayed bridges. The conclusion can provide a reference for the further design of the similar brid^es.展开更多
Background: Anterior chamber angle (ACA) can be measured by many different techniques. In order for a technique to be a part of the routine eye examination, it has to be quick and easy in good agreement with gonioscop...Background: Anterior chamber angle (ACA) can be measured by many different techniques. In order for a technique to be a part of the routine eye examination, it has to be quick and easy in good agreement with gonioscopy both nasally and temporally. Aim: To investigate variation in ACA measurement between gonioscopy, van Herick technique, anterior segment optical coherence tomography (AS-OCT) and Sirius Scheimpflug-Camera both nasally and temporally. Method: The ACA of 50 eyes of 25 healthy subjects was measured with gonioscopy, van Herick technique, AS-OCT and Sirius Scheimpflug-Camera. The angle was measured both nasally and temporally. Results: No statistically significant difference could be found between gonioscopy, van Herick technique and AS-OCT either nasally or temporally. The Sirius Scheimpflug-Camera on the other hand showed statistically significant difference to gonioscopy (p < 0.0001) both nasally (p = 0.03, p = 0.001, p < 0.0001) and temporally (p = 0.0002, p = 0.001, p Conclusion: This study showed good agreement between three of the four techniques. ACA measurements obtained by the Sirius Scheimpflug-Camera should therefore not be considered interchangeable with those obtained by the remaining three methods.展开更多
目的:探究双层软组织缝合封闭技术在单纯应用抗骨吸收药物引起的发生在下颌骨的中早期药物相关性颌骨骨坏死(medication-related osteonecrosis of the jaw,MRONJ)患者手术治疗中的临床应用效果。方法:选择2021年10月至2022年9月于北京...目的:探究双层软组织缝合封闭技术在单纯应用抗骨吸收药物引起的发生在下颌骨的中早期药物相关性颌骨骨坏死(medication-related osteonecrosis of the jaw,MRONJ)患者手术治疗中的临床应用效果。方法:选择2021年10月至2022年9月于北京大学口腔医院四病区经手术治疗的中早期下颌骨MRONJ患者的病历资料进行回顾性分析,收集患者术前基线临床资料,包括原发疾病、伴发疾病、用药方案(药物种类、用药时长)、MRONJ分期、临床症状、影像学表现等,所有患者在手术中行下颌骨边缘切除术去除坏死骨,运用双层软组织缝合封闭技术关闭伤口,术后定期复查随访,评价双层软组织缝合封闭技术的治疗效果及并发症,并对患者进行疼痛评分和功能状态评价。结果:研究共纳入13例患者(女12例,男1例),年龄(66.69±13.14)岁。原发疾病包括骨质疏松7例,肺癌2例,乳腺癌3例,前列腺癌1例;2例伴发糖尿病,2例伴发心血管疾病,1例伴发干燥综合征。9例患者静脉注射唑来膦酸,平均用药时间(37.7±20.0)个月,7例患者同时服用了来曲唑片等其他药物;3例患者应用地舒单抗注射液,平均用药时间(10.3±11.9)个月;5例患者服用阿仑膦酸钠片,平均用药时间(55.20±27.20)个月,2例患者不同程度地服用醋酸泼尼松片或阿卡波糖片。MRONJ 1期4例,2期9例。13例患者均采用双层软组织缝合封闭技术关闭伤口,术后平均随访11.9个月(9~17个月),13例患者皆治愈,无溢脓等并发症发生。患者术前Karnofsky功能状态评分量表(Karnofsky performance status,KPS)评分为(68.46±14.05)分,术后评分为(82.31±15.36)分,差异有统计学意义(P<0.05)。患者术前疼痛评估视觉模拟评分量表(visual analogue scale,VAS)评分为(5.77±0.73)分,术后评分为(0.38±0.51)分,差异有统计学意义(P<0.001)。结论:双层软组织缝合封闭技术在中早期单纯使用抗骨吸收类药物的下颌骨MRONJ患者中可以取得良好的临床治疗效果,可为用药情况更加复杂的MRONJ患者提供临床治疗思路。展开更多
基金Supported by the Zhejiang Provincial Natural Science Foundation of China,No.LQ20H260002.
文摘BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complication after ileostomy closure.AIM To evaluate the efficacy and safety of the micro-power negative pressure wound technique(MPNPWT)in preventing incisional SSI.METHODS This was a prospective,randomized controlled clinical trial conducted at a single center.A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021.Patients were randomly allocated into an MPNPWT group and a control group.The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing.The surgical outcomes were compared between the MPNPWT(n=50)and control(n=51)groups.Risk factors for incisional SSI were identified using logistic regression.RESULTS There were no differences in baseline characteristics between the MPNPWT(n=50)and control groups(n=51).The incisional SSI rate was significantly higher in the control group than in the MPNPWT group(15.7%vs 2.0%,P=0.031).However,MPNPWT did not affect other surgical outcomes,including intra-abdominal complications,operative time,and blood loss.Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups(P=0.069 and 0.843,respectively).None of the patients experienced adverse effects of MPNPWT,including skin allergy,dermatitis,and pain.MPNPWT also helped heal the infected incision.Our study indicated that MPNPWT was an independent protective factor[odds ratio(OR)=0.005,P=0.025)]and diabetes was a risk factor(OR=26.575,P=0.029)for incisional SSI.CONCLUSION MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.
基金the Natural Science Foundation of Shandong Province,No.ZR2020MH257。
文摘BACKGROUND Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors.However,the traditional interrupted suturing technique used in enterostomy closure surgery has several issues,including longer surgical incisions and higher incision tension,which can increase the risk of postoperative complications.To address these issues,scholars have proposed the use of a“gunsight suture”technique.This technique involves using a gunsight incision instead of a traditional linear incision,leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection.Building on this technique,we propose an improved gunsight suture technique.A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture,which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes,thereby reducing the risk of postoperative complications.AIM To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.METHODS In this study,a retrospective,single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the Department of Colorectal Surgery of Qilu Hospital from April 2017 to December 2021.The patients were divided into two groups:135 patients received sutures using the improved gunsight method,while the remaining 135 patients were sutured with the traditional interrupted suture method.We collected data on a variety of parameters,such as operation time,postoperative pain score,body temperature,length of hospital stays,laboratory indicators,incidence of incisional complications,number of wound dressing changes,and hospitalization costs.Non-parametric tests and chi-square tests were utilized for data analysis.RESULTS There were no statistically significant differences in general patient information between the two groups,including the interval between the first surgery and the stoma closure[132(105,184)d vs 134(109,181)d,P=0.63],gender ratio(0.64 vs 0.69,P=0.44),age[62(52,68)years vs 60(52,68)years,P=0.33],preoperative body mass index(BMI)[23.83(21.60,25.95)kg/m²vs 23.12(20.94,25.06)kg/m²,P=0.17].The incidence of incision infection in the improved gunsight suture group tended to be lower than that in the traditional interrupted suture group[(n=2/135,1.4%)vs(n=10/135,7.4%),P<0.05],and the postoperative hospital stay in the improved gunsight suture group was significantly shorter than that in the traditional interrupted suture group[5(4,7)d vs 7(6,8)d,P<0.05].Additionally,the surgical cost in the modified gunsight suture group was slightly lower than that in the traditional suture group[4840(4330,5138)yuan vs 4980(4726,5221)yuan,P>0.05],but there was no significant difference in the total hospitalization cost between the two groups.CONCLUSION In stoma closure surgery,the improved gunsight technique can reduce the incision infection rate,shorten the postoperative hospital stay,reduce wound tension,and provide better wound cosmetic effects compared to traditional interrupted suture.
文摘BACKGROUND Colorectal foreign bodies are commonly encountered during surgery.They are frequently observed in men 20 to 90 years of age and have bimodal age distribution.Surgical management is necessary for cases of rectal perforation.However,surgical site infections are the most common complications after colorectal surgery.CASE SUMMARY We discuss a case of rectal perforation in a patient who presented to our hospital 2 d after its occurrence.The perforation occurred as a result of the patient inserting a sex toy in his rectum.Severe peritonitis was attributable to delayed presentation.CONCLUSION Vacuum-assisted closure was performed to treat the wound,which healed well after therapy.No complications were noted.
基金Supported by Guangdong Province Universities and Colleges Pearl River Scholar Funded SchemeGuangzhou Pilot Project of Clinical and Translational Research Center,early gastrointestinal cancers,No.7415696196402Guangdong Provincial Bioengineering Research Center for Gastroenterology Diseases
文摘Gastrointestinal perforations,which need to be managed quickly,are associated with high morbidity and mortality. Treatments used to close these perforations range from surgery to endoscopic therapy. Nowadays,with the development of new devices and techniques,endoscopic therapy is becoming more popular. However,there are different indications and clinical efficacies between different methods,because of the diverse properties of endoscopic devices and techniques. Successful management also depends on other factors,such as the precise location of the perforation,its size and the length of time between the occurrence and diagnosis. In this study,we performed a comprehensive review of various devices and intro-duced the different techniques that are considered effective to treat gastrointestinal perforations. In addition,we focused on the different methods used to achieve successful closure,based on the literature and our clinical experiences.
文摘The crack tip strain gauge method in the compliance technique was used to determine the opening load of notched crack of axle steel,and the nonlinear finite element ADINA program, to which the cyclic stress-strain curve of axle steel was applied,was used to analyze the stress-strain field ahead of the crack tip and the opening load of notched crack.The results of both the compliance technique and the numerical method were in good agreement.In this pa- per,the concept of the sensitive point is proposed and the key to the determination of the crack opening load in the experiment is to place a strain gauge at sensitive point.It is certified by both experimental and numerical methods that the sensitive point has the best linear relation- ship character and the value of strain is much greater.
文摘Aims and Objectives: The aim of the study was to compare the effect of complete and partial wound closures on postoperative sequelae and complications after surgical removal of impacted mandibular third molars. Patients and Methods: One hundred and twenty patients who required 121 surgical extractions of mandibular impacted third molars were included in the study. Patients were randomly divided into 2 groups based on wound closure after surgery. In group 1 (complete wound closure, n1 = 60) patients had their extraction sockets completely closed by mucosal flap while in group 2 (partial wound closure, n2 = 60) patients had their extraction sockets partially closed. Data collected included maximum inter-incisal distance (MID) and facial width which were recorded both preoperatively and postoperatively. What also recorded were postoperative pain intensity and postoperative complications. Results: There were 50 (41.7%) males and 70 (58.3%) females (male to female ratio of 1:1.4);age range was 18-40 years and the mean was 26 ± 10 years. The mean ages of patients in both groups showed no significant difference (group 1 = 26.5 ± 7.2;group 2 = 27.1 ± 8.1). The pain was maximal at the first postoperative day review and it gradually reduced in intensity towards the preoperative values for both groups. The pain perceptionsin patients in group 2 were however significantly lower than those of group 1 on days 1 and 3 but not statistically different on day 7. The mean difference in the postoperative and preoperative MID was greatest on the 1st postoperative day and gradually became smaller on the subsequent review days. Comparison of this mean difference between the 2 groups however showed a significant difference in the 2 groups only on day 7. Maximal swelling was noted in both groups on the third postoperative day. A comparison of the mean facial width between the two groups showed no statistically significant difference on all the review days. The postoperative complication rate was 5% in both groups. Conclusions: The results of the study indicate that there was a comparative reduction in postoperative sequelae namely pain and trismus after impacted mandibular third molar surgery when a partial wound closure technique was done. However, there was no significant difference in the postoperative complication rate between the two groups.
文摘AIM:To investigate twenty-year experience evaluated the use of the PolysorbR(an absorbable lactomer)staples for distal pancreatic resection.METHODS:The data on 150 patients[92 men,58women,mean age 52(24-72)years]who underwent distal pancreatectomy(DP)in the last 20 years were collected prospectively from an electronic database.The diagnosis was confirmed by endoscopic retrograde cholangiopancreatography,sonography,computed tomography and/or magnetic resonance imaging.The indications for DP were focal pancreatic necrosis,spontaneous pancreatic fistulas,abscesses,pseudocysts,segmental chronic obstructive pancreatitis in the tail,traumatic disruption,and benign(cystadenomas,insulinomas,or glucagonomas)or malignant tumours.The distal resections were performed without splenectomy in 29 of the 150 patients(19%).In the event of splenectomy,the splenic artery and vein were individually ligated,the TA-55 Auto Suture stapler,loaded with Premium PolysorbR 55 staples(5.5mm),was placed across the gland,and the trigger was pulled,the action of which produced two staggered absorbable suture lines.The gland distal to the stapler wasthen amputated with a scalpel on the TA-55 stapler and the two rows of staples were left in the proximal pancreatic stump.After the distal resection,a drainage tube was inserted into the pancreatic bed.RESULTS:The average duration of the operation was150 min(range:90-210 min)and no transfusion was indicated during the operation.After DP in one patient a type B fistula was diagnosed,which was treated successfully by conservative treatment comprising of 12-d octreotide medication(3×0.1 mg/d)and jejunal feeding.The incidence of postoperative pancreatic fistula was therefore0.6%.Another 2 patients suffered postoperative pancreatitis,which was also conservatively treated.Reoperations were performed in 2 patients on the first or second postoperative day,necessitated by bleeding from the retroperitoneal region.The morbidity was 3.3%(5 patients),but no mortality occurred in the postoperative period.Overall,the postoperative period was uneventful without any complications(pancreatic fistula,abscess,bleeding or wound infection)in 145 patients.The length of the postoperative stay ranged between 8 and 16 d.For the 145 patients who had no any postoperative complications,the hospital stay was 8 or 9 d.No mortality occurred in the follow-up period(6 or 12 mo postoperatively);but 6 mo after surgery one patient suffered a pseudocyst following recurrent pancreatitis and was treated with cystojejunostomy.CONCLUSION:Our clinical results demonstrated that the application of absorbable lactomer staples for distal pancreatic resection is a safe alternative to the standard closure technique.
文摘Based on Edong Yangtze River Bridge, which is the second longest hybrid girder cable stayed bridge with 926 m long main span, the influencing factors and crucial techniques of the main span closure method for long span hybrid girder cable stayed bridge are studied. After theoretical analysis, numerical evaluation and practical test, the loading assistant closure method is employed in Edong Yangtze River Bridge. The loading assistant closure method, with better thermal adaptability and less influence on bridge line and the forced status, can meet the requirements of the unstressed state control method. Based on the mentioned advantages, the loading assistant closure method is applicable to long span hybrid girder cable stayed bridges. The conclusion can provide a reference for the further design of the similar brid^es.
文摘Background: Anterior chamber angle (ACA) can be measured by many different techniques. In order for a technique to be a part of the routine eye examination, it has to be quick and easy in good agreement with gonioscopy both nasally and temporally. Aim: To investigate variation in ACA measurement between gonioscopy, van Herick technique, anterior segment optical coherence tomography (AS-OCT) and Sirius Scheimpflug-Camera both nasally and temporally. Method: The ACA of 50 eyes of 25 healthy subjects was measured with gonioscopy, van Herick technique, AS-OCT and Sirius Scheimpflug-Camera. The angle was measured both nasally and temporally. Results: No statistically significant difference could be found between gonioscopy, van Herick technique and AS-OCT either nasally or temporally. The Sirius Scheimpflug-Camera on the other hand showed statistically significant difference to gonioscopy (p < 0.0001) both nasally (p = 0.03, p = 0.001, p < 0.0001) and temporally (p = 0.0002, p = 0.001, p Conclusion: This study showed good agreement between three of the four techniques. ACA measurements obtained by the Sirius Scheimpflug-Camera should therefore not be considered interchangeable with those obtained by the remaining three methods.
文摘目的:探究双层软组织缝合封闭技术在单纯应用抗骨吸收药物引起的发生在下颌骨的中早期药物相关性颌骨骨坏死(medication-related osteonecrosis of the jaw,MRONJ)患者手术治疗中的临床应用效果。方法:选择2021年10月至2022年9月于北京大学口腔医院四病区经手术治疗的中早期下颌骨MRONJ患者的病历资料进行回顾性分析,收集患者术前基线临床资料,包括原发疾病、伴发疾病、用药方案(药物种类、用药时长)、MRONJ分期、临床症状、影像学表现等,所有患者在手术中行下颌骨边缘切除术去除坏死骨,运用双层软组织缝合封闭技术关闭伤口,术后定期复查随访,评价双层软组织缝合封闭技术的治疗效果及并发症,并对患者进行疼痛评分和功能状态评价。结果:研究共纳入13例患者(女12例,男1例),年龄(66.69±13.14)岁。原发疾病包括骨质疏松7例,肺癌2例,乳腺癌3例,前列腺癌1例;2例伴发糖尿病,2例伴发心血管疾病,1例伴发干燥综合征。9例患者静脉注射唑来膦酸,平均用药时间(37.7±20.0)个月,7例患者同时服用了来曲唑片等其他药物;3例患者应用地舒单抗注射液,平均用药时间(10.3±11.9)个月;5例患者服用阿仑膦酸钠片,平均用药时间(55.20±27.20)个月,2例患者不同程度地服用醋酸泼尼松片或阿卡波糖片。MRONJ 1期4例,2期9例。13例患者均采用双层软组织缝合封闭技术关闭伤口,术后平均随访11.9个月(9~17个月),13例患者皆治愈,无溢脓等并发症发生。患者术前Karnofsky功能状态评分量表(Karnofsky performance status,KPS)评分为(68.46±14.05)分,术后评分为(82.31±15.36)分,差异有统计学意义(P<0.05)。患者术前疼痛评估视觉模拟评分量表(visual analogue scale,VAS)评分为(5.77±0.73)分,术后评分为(0.38±0.51)分,差异有统计学意义(P<0.001)。结论:双层软组织缝合封闭技术在中早期单纯使用抗骨吸收类药物的下颌骨MRONJ患者中可以取得良好的临床治疗效果,可为用药情况更加复杂的MRONJ患者提供临床治疗思路。
