“ONE-STITCH”技术在肾移植手术中的应用

目的探讨"ONE-STITCH"技术在肾移植膀胱输尿管吻合手术中的临床应用。方法对比总结我中心在2002年1月至2004年12月肾移植手术膀胱输尿管吻合时324例病人应用常规膀胱粘膜下隧道式吻合(内置J型支架管)同121例病人应用"ONE-STITCH"技术(无J型内支架管)的优劣。结果应用常规膀胱粘膜下隧道式吻合的病人,均在术后需拔除支架管,时间不定;15例病人术后出现肉眼血尿(4.6%),46例病人出现尿路感染(14.2%,P<0.05),6例病人因出血严重出现尿路梗阻,4例再次手术清除膀胱内血块,吻合膀胱输尿管;2例患者因肾盂输尿管出血严重而摘除移植肾;17例病人术后早期发生漏尿,放置导尿管引流2周后愈合;而应用"ONE-STITCH"技术行膀胱输尿管吻合的病人7例病人出现尿路轻微感染(5.78%),3例术后早期漏尿,但23例术后出现肉眼血尿(19%,P<0.05),随访6个月-1年,输尿管通畅无狭窄、无肾积水。结论在膀胱输尿管吻合手术中应用"ONE-STITCH"吻合技术方便、省时、可靠、经济,术中无需放置输尿管内支架管,减少了病人的痛苦及术后的并发症,但手术中需注意处理好输尿管残端。

One-stitch anastomosis through the skin with bicanalicular intubation:a modified approach for repair of bicanalicular laceration

AIM:To evaluate the efficacy and safety of one-stitch anastomosis through the skin with bicanalicular silicone tube intubation in repairing of bicanalicular laceration.METHODS:The clinical data of 15 consecutive patients with both superior and inferior canalicular laceration in one eye who underwent surgical repair using one-stitch anastomosis through the skin and bicanalicular stent were retrospective studied.All the operations were performed under surgical microscope,5-0 silk sutures were used and were with bicanalicular silicone tube(diameter was 8mm) intubation,for one lacerated canaliculi one-stitch anastomosis through the skin.The stents were left in place for 3 months postoperatively and then removed.The follow-up period was 3-36 months(average 14 months). RESULTS:In 15 patients,13 patients were cured entirely,1 patient was meliorated,1 patient with no effects.All patients had got good recovery of eyelid laceration with no traumatic deformity in eyelid and canthus.Complication was seen in one case,for not followed the doctor’s guidance to come back to hospital to had the suture removed on the 7thday after operation,when he came at the 15thday,the inferior canalicular wall and eyelid skin were corroded by the suture caused 2mm wound,and the inside silicone tube was exposed,a promptly repair with 10-0 nylon suture was done,the wound healed in a week.There were no early tube protrusions and punctal slits in the patients.CONCLUSION:One-stitch anastomosis through the skin with bicanalicular silicone tube intubation is a good method in repair of bicanalicular laceration in one eye,the cut ends can be anastomosed directly,and with excellent cosmetic results,it is acceptable for the patients.For there is no suture remained in the wound permanently,so there is no suture-related granuloma which may cause obstruction or stenosis of canaliculi.It is simple,economical,effective and safe.

“经皮肤一针吻合法”修复泪小管断裂的临床研究

目的探讨“经皮肤一针吻合法”修复泪小管断裂手术的安全性和有效性。方法回顾性分析32例（32眼）采用“经皮肤一针吻合法”修复的泪小管断裂。下泪小管断裂29例，上泪小管断裂1例，上下泪小管同时断裂2例。手术均在手术显微镜下进行，用5-0丝线缝合，用硬膜外麻醉导管（直径0．8mm）作为泪管支架，术后3个月拔除硬膜外麻醉导管支架。结果32例中，治愈28例（87．50％），基本治愈3例（9．38％），无效1例（3．12％）。拔除支架管后，29例随访1—36个月（平均12个月），3例失随访。所有病例眼睑伤口愈合良好。无眼睑和内眦外伤性畸形。结论“经皮肤一针吻合法”修复泪小管断裂，能直接吻合泪小管的两断段，伤口不长期存留缝线，避免了缝线引起的炎性肉芽肿而造成的泪小管狭窄或阻塞。