吴瑞甫《外科理法》疽病论治评析

近代福建及新加坡国医名家、教育家吴瑞甫,其《外科理法》以部位病证分类,对疽病之风、火、痰、毒、瘀、气滞等病因认识,及基于阴阳、脏腑、经络的辨证论治体系,皆体现在其具有东南地域医学和民间草药学特色的方药加减中。“盖疽最惧毒气内攻”,《外科理法》病因承绪《外科正宗》,其阴阳辨治疽病,与《外科正宗》和《外科证治全生集》均是相通的。

Surgical Treatment of Intralobar Pulmonary Sequestration

Objective To evaluate the clinical features,diagnosis,treatment,and outcome of intralobar pulmonary sequestration (ILS). Methods Patients who were diagnosed with ILS in our hospital between January 1988 and January 2009 were retrospectively reviewed. We recorded the clinical symptoms,imaging findings,operative technique,complications,and outcome of these patients. Results Forty-seven patients (25 men and 22 women) with an average age of 32.3 years were enrolled. Forty-two patients had symptoms including cough and hemoptysis. Chest X-ray,computed tomography (CT),magnetic resonance imaging (MRI),and angiography were performed. Thoracotomy was performed in 45 patients,while thoracoscopy was performed in 2 patients. Lobectomy was the most common treatment procedure. Massive bleeding developed in 2 patients due to injury of aberrant supplying artery intraoperatively,1 patient had atrial fibrillation,1 patient had thrombosis of upper extremity postoperatively. All patients were confirmed the diagnosis pathologically,4 accompanied with bronchogenic cyst,15 with bronchiectasis,8 with infection,2 with aspergilloma,and 1 with carcinoid. No late complications occurred. Conclusions ILS is rare,surgery is recommended because some patients may have potential severe complications. Contrast enhanced CT and three-dimensional reconstruction is the best diagnostic method. Both thoracotomy and thoracoscopy are appropriate for the selected candidates.

A different approach for sterilization of liver hydatid cysts

TO THE EDITORMany different methods have been used in surgical treatment of liver hvdatid cysts. However, two methods have been frequently used recently： one is used to radically remove the cyst and the other is used to shrink the cyst cavity after treated with scolocidal agents. One of the most important principles for the treatment of hydatid cyst is to avoid the contact of fluid in the cavity with the adjacent tissues during cyst cavity contacts with scolek killers at certain time.

Surgical treatment of anal stenosis

Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy. Anal stenosis represents a technical challenge in terms of surgical management. A Medline search of studies relevant to the management of anal stenosis was undertaken. The etiology, pathophysiology and classification of anal stenosis were reviewed. An overview of surgical and non-surgical therapeutic options was developed. Ninety percent of anal stenosis is caused by overzealous hemorrhoidectomy. Treatment, both medical and surgical, should be modulated based on stenosis severity. Mild stenosis can be managed conservatively with stool softeners or fiber supplements. Sphincterotomy may be quite adequate for a patient with a mild degree of narrowing. For more severe stenosis, a formal anoplasty should be performed to treat the loss of anal canal tissue. Anal stenosis may be anatomic or functional. Anal stricture is most often a preventable complication. Many techniques have been used for the treatment of anal stenosis with variable healing rates. It is extremely difficult to interpret the results of the various anoplastic procedures described in the literature as prospective trials have not been performed. However, almost any approach will at least improve patient symptoms.

Comprehensive Surgical Approaches to Management of Various Facial Nevi

Objective To investigate the effects of the flexible surgical approaches on therapeutic and cosmetic outcomes of facial nevi.Methods From August 2002 to January 2008,16 cases with facial nevi had been treated in our wards with the selected approaches.Surgical approaches including serial excision or one-time radical excision,free skin graft,and expanded flap were adopted in accordance with the individual size and location of the facial nevi.Results All cases experienced complete excision and had satisfactory cosmetic appearance in the end.Conclusion The flexible surgical measures help to minimize the risk of malignant transformation and achieve good cosmetic results.

Orthopedic trauma of limbs associated with vascular injuries

Objective:To evaluate the treatment for patients with major vascular injuries associated with traumatic orthopedic injuries. Methods:A total of 196 patients,aged from 4-67 years with the mean age of 29.88 years,had major vascular injuries associated with traumatic orthopedic injuries and were treated in our hospital in a period of 44 years.The most common mechanism of trauma was blunt trauma (67.3%),open injuries accounted for 32.4% and 54.5% of the injuries were located in the lower extremities.The vascular injury frequently happened in the femoral artery (26.7%)and popliteal artery(20.3%).The treatment principle consisted of aggressive resuscitation,Doppler imaging and stable bone internal fixation with subsequent vascular repair and debridement.The vascular repair for injuries included end-to-end anastomosis(80 cases, 39.6%),interpositional vein graft(94,46.5%),vascular decompression through fracture distraction(18,8.9%), arterial ligation(6,3.0%),vein patch(2,1.0%), bypass graft(2,1.0%),venous repair including autogenous vein graft(9,24.3%)and ligation(28, 75.7%)and prophylactical fasciotomy(15,7.4%). Postoperative amputation was performed in 16 cases (16.3%). Results:No intraoperative death was observed and all fractures united within 6 months.Limbs were salvaged in 180 patients(91.8%).Among these patients,early complications were found in 19 patients(9.7%) and late complications were observed in 8 patients(4.1%). Conclusions:A well-organized approach,based on a specific treatment principle,not only improves clinical outcome but also does good to excellent functional recovery for patients with severe orthopedic injuries and concomitant vascular lesion.

Application of minimally invasive surgery in traumatic brain injury

This article aims to expound the essence of minimally invasive surgery as well as when and how to use it in craniocerebral trauma surgery according to the characteristics of the disease. In neurosurgery, the importance of tissue protection should be from the inside to the outside, i.e. brain→dura→skull→scalp. In this article, I want to share my opinion and our team＇s experience in terms of selecting surgical approaches and incision, surgical treatment of the skull, dura handling, intracranial operation and placement of drainage based on the above theory. I hope this will be helpful for trauma surgeons.