Comparison of modified gunsight suture technique and traditional interrupted suture in enterostomy closure

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.

Endovascular technique using a snare and suture for retrieving a migrated peripherally inserted central catheter in the left pulmonary artery

We report a successful endovascular technique using a snare with a suture for retrieving a migrated broken peripherally inserted central catheter(PICC)in a chemotherapy patient.A 62-year-old male received monthly chemotherapy through a central venous port implanted into his right subclavian area.The patient completed chemotherapy without complications 1 mo ago;however,he experienced pain in the right subclavian area during his last chemotherapy session.Computed tomography on that day showed migration of a broken PICC in his left pulmonary artery,for which the patient was admitted to our hospital.We attempted to retrieve the ectopic PICC through the right jugular vein using a gooseneck snare,but were unsuccessful because the catheter was lodged in the pulmonary artery wall.Therefore,a second attempt was made through the right femoral vein using a snare with triple loops,but we could not grasp the migrated PICC.Finally,a string was tied to thetop of the snare,allowing us to curve the snare toward the pulmonary artery by pulling the string.Finally,the catheter body was grasped and retrieved.The endovascular suture technique is occasionally extremely useful and should be considered by interventional cardiologists for retrieving migrated catheters.

Clinical Analysis on the Effectiveness of Conservative Compression Suture Technique to Conserve Fertility on Pernicious Placenta Previa

Objective: To evaluate the effectiveness of conservative compression surgical suture techniques used for the management of pernicious placenta previa to conserve fertility in the subsequent pregnancies. Study Design: This was a non-comparative retrospective study of 188 patients diagnosed with pernicious placenta previa who underwent cesarean section in The First Hospital of Jilin University, China, from 1 January 2013 to 1 January 2018. Successful group was defined as those in which the intraoperative bleeding was managed by either modified CHO or by B-lynch suture technique and those who had further intervention including hysterectomy were designated as failure group. Results: Out of 217 patients, 188 met inclusion criteria and 29 patients were excluded. In 188 cases, 183 (97.34%) cases successes and 5 (2.65%) cases had hysterectomy. Among included group, 118 patients (62.76%) had undergone emergency cesarean section and 70 patients (37.23%) underwent elective cesarean section. The emergency group had significantly lesser gestation period of gestation at the time of cesarean section (P = 0.021) and lower neonatal weight (P = 0.001) than that of elective group. The estimated blood loss during surgery was 500 - 3200 ml (mean: 925 ml). Additionally, the amount of bleeding was found to be significantly more in patient with intraoperative complication (P = 0.007) and in patient with implanted placenta (P 0.001). Conclusion: The conservative compression suture technique including modified CHO and B-lynch suture technique during the cesarean delivery is a feasible, safe and effective alternative conservative surgical technique for the management of bleeding in case of pernicious placenta previa. Besides good surgical outcome and proper neonatal result this technique also reduces the rate of hysterectomy, thus conserving the fertility.

Brace suture technique(背带式缝合)术治疗剖宫产产后出血40例临床观察

目的探讨Brace suture technique(背带式缝合)术治疗剖宫产产后出血的临床疗效和安全性。方法将75例剖宫产术中子宫收缩乏力性出血产妇随机分为2组:治疗组40例采用子宫Brace suture technique(背带式缝合)治疗,对照组35例采用传统方法治疗。结果治疗组产妇的手术时间、产后出血量、产褥病率与对照组比较差异有显著性(P<0.05)。2组均无严重并发症和不良反应。结论子宫Brace suture technique(背带式缝合)治疗剖宫产宫缩乏力所致的产后出血疗效明显,方法简单安全,值得临床推广。

Cauterization technique for suture erosion in transscleral fixation of intraocular lenses

Transscleral suturing is a commonly applied technique to fix intraocular Implants in the sulcus.A major problem after transscleral implantation is suture erosion that normally happens in the late post-surgery period and may result In an Increased incidence of endophthalmitis.Here we describe an original cauterization method by using a glass rod to melt the exposed suture end without damaging the suture knot in the sclera to avoid suture exposure in sclera-fixed IOL implantation.This is a simple,quick and effective technique that can be performed without conjunctiva incisions and will help to reduce suture erosion related complications.

The Optimal Suture Technique for Mitral Valve Replacement in an <i>Ex Vivo</i>Animal Model

Objective: This study compared and evaluated three suture methods in order to find the method with the best durability for mitral valve replacement. The methods evaluated are horizontal mattress suture with subanular pledgets, horizontal mattress suture with supraanular pledgets and continuous running suture. Methods: Thirty hearts were explanted from newly terminated pigs. The hearts were randomized in the three groups. After an atriotomy, the mitral valve was cut out, and a patch was sutured into its place. An air pump model was connected to a balloon which was placed in the left ventricle through aorta and continuously filled with air to a maximum of 300 mmHg. The peak pressure at rupture was noted. If no rupture occurred before reaching 300 mmHg, the suture was found competent. Results: Two out of ten hearts in the continuous running suture-group had myocardial rupture within a pressure of 300 mmHg. In the remaining eight hearts there were no ruptures within 300 mmHg. In the two groups sutured with horizontal mattress with pledgets placed either subanular or supraanular, no rupture of myocardium occurred. When comparing continuous running suture with the horizontal mattress with subanular pledgets or the horizontal mattress with supraanular pledgets, the 1-sided Fishers’ exact was 0.237. At 5% significance level, there was no difference between the three suture methods. Conclusion: There was no statistically significant difference between the durability of the three suture methods, though rupture was only evident in the continuous running suture line. Since it is the surgeon’s choice to select the optimal suture technique, our study should be a reminder for the surgeon to reflect on the suturing factors that have an influence on successful mitral valve replacement.

A standardized technique for safe pancreaticojejunostomy:Pair-Watch suturing technique

AIM:To prevent pancreatic leakage after pancreaticoje-junostomy,we designed a new standardized technique that we term the "Pair-Watch suturing technique".METHODS:Before anastomosis,we imagine the faces of a pair of watches on the jejunal hole and pancreatic duct.The first stitch was put between 9 o'clock of the pancreatic side and 3 o'clock of the jejunal side,and a total of 7 stitches were put on the posterior wall,followed by the 5 stitches on the anterior wall.Using this technique,twelve stitches can be sutured on the first layer anastomosis regardless of the caliber of the pancreatic duct.In all cases the amylase activity of the drain were measured.A postoperative pancreatic fistula was diagnosed using postoperative pancreatic fistula grading.RESULTS:From March 2007 to July 2008,29 consecutive cases underwent pancreaticojejunostomy using this technique.Pathologic examination results showed pancreatic carcinoma(n=14),intraductal papillary-mucinous neoplasm(n=10),intraductal papillary-mucinous carcinoma(n=1),carcinoma of ampulla of Vater(n=1),carcinoma of extrahepatic bile duct(n=1),metastasis of renal cell carcinoma(n=1),and duodenal carcinoma(n=1).Pancreaticojejunal anastomoses using this technique were all watertight during the surgical procedure.The mean diameter of main pancreatic duct was 3.4 mm(range 2-7 mm).Three patients were recognized as having an amylase level greater than 3 times the serum amylase level,but all of them were diagnosed as grade A postoperative pancreatic fistula grading and required no treatment.None of the cases developed complications such as hemorrhage,abdominal abscess,and pulmonary infection.There was no postoperative mortality.CONCLUSION:Our technique is less complicated than other methods and very secure,providing reliable anastomosis for any size of pancreatic duct.

Looped,Broad,and Deep Buried Suturing Technique for Wound Closure

This study explores the clinical application of the circular wide and deep(looped,broad,and deep buried,LBD)suture technique for scar resection and examines its clinical effec­tiveness for scar treatment.From June 2017 to March 2019,a total of 68 patients with scars were sutured using LBD technique,and recovery was achieved 24 months postoperatively.In all 68 patients,postoperative scars were slightly evident in two cases of cervical scar,one case of leg scar,and one case of chest scar.In addition,the remaining 62 patients were completely satisfied with the outcome.The LBD suturing technique could provide sus­tained and stable tension-reducing effects postoperatively and significantly improve scar formation in patients.This method is most applicable to incisions with tension.Therefore,it should be more widely used for clinical scar treatment.

Novel suturing technique,based on physical principles,achieves a breaking point double that obtained by conventional techniques

BACKGROUND Sutures have been used to repair wounds since ancient times.However,the basic suture technique has not significantly changed.In Phase I of our project,we proposed a“double diabolo”suture design,using a theoretical physical study to show that this suture receives 50%less tension than conventional sutures,and so a correspondingly greater force must be applied to break it.AIM To determine whether these theoretical levels of resistance were met by the new type of suture.METHODS An observational study was performed to compare three types of sutures,using a device that exerted force on the suture until the breaking point was reached.The tension produced by this traction was measured.The following variables were considered:Tearing stress on entry/exit points,edge separation stress,and suture break stress.The study sample consisted of 30 sutures with simple interrupted stitches(Group 1),30 with continuous stitches(Group 2),and 30 with the“double diabolo”design(Group 3).RESULTS The mean degree of force required to reach the breaking point for each of these variables(tearing,separation,and final breaking)was highest in Group 3(14.56,18.28,and 21.39 kg),followed by Group 1(7.36,10.38,and 12.81 kg)and Group 2(5.77,7.7,and 8.71 kg).These differences were statistically significant(P<0.001)in all cases.CONCLUSION The experimental results show that with the“double diabolo”suture,compared with conventional sutures,greater force must be applied to reach the breaking point(almost twice as much as in the simple interrupted suture and more than double that required for the continuous suture).If these results are confirmed in Phase III(the clinical phase)of our study,we believe the double diabolo technique should be adopted as the standard approach,especially when the suture must withstand significant tension(e.g.,laparotomy closure,thoracotomy closure,diaphragm suture,or hernial orifice closure).

Treatment of Keloids in A Child with Surgery Alone:Clinical Application of the LBD Suturing Technique

Keloids are fibroproliferative disorders that can result from cutaneous injuries to the reticular dermis.Recurrence rates as high as 100%have been reported following surgical excision alone.Consequently,a variety of post-surgical techniques have been employed to prevent keloid recurrence,including the use of radiation.Although numerous studies have shown that post-excisional X-rays,electron beams,lasers,and brachytherapy can reduce the rate of keloid recurrence,numerous inconsistencies,including a wide range of definitions for keloid recurrence,render it difficult to compare the outcomes.The treatment of severe keloids in children is much more challenging,and there have been few previous reports.It is generally believed that children with keloids should be treated with nonsurgical treatment such as hormone injections and radiotherapy.For severe keloids,these methods require a long treatment period,and their efficacy is not ideal.Moreover,the side effects of the treatment can affect children’s health.If keloid scars are not effectively treated,they will often seriously affect the physical and mental health of children.The purpose of this review is to discuss case studies of children with severe keloids who were only treated with surgery and their postoperative recovery.In this case,the deep-embedded circular mattress suture technique(LBD,the looped,broad,and deep buried suturing technique)was used in the scar resection.After 18 months of follow-up,the surgical scar was evaluated using the Vancouver Scar Scale(VSS).The scar was stable and did not recur.The child was satisfied.This case shows that it is completely feasible to treat severe keloids with surgery alone,as long as the tension is reduced during the operation to prevent surgical scar hyperplasia.

Can trans-anal reinforcing sutures after double stapling in lower anterior resection reduce the need for a temporary diverting ostomy?

AIM:To evaluate trans-anal reinforcing sutures in low anterior resection using the double-stapled anastomosis technique for primary rectal cancers performed at a single institution.METHODS:The data of patients who received transanal reinforcing sutures were compared with those of patients who did not receive them after low anterior resection.Patients who underwent laparoscopic low anterior resection and the double-stapled anastomosis technique for primary rectal cancer between January2008 and December 2011 were included in this study.Patients with no anastomosis,a hand-sewn anastomosis,high anterior resection,or preoperative chemoradiation were excluded.The primary outcomes measured were the incidence of postoperative anastomotic complications and placement of a diverting ileostomy.RESULTS:Among 110 patients,the rate of placement of a diverting ileostomy was significantly lower in the suture group(SG)compared with the non-suture control group(CG)[SG,n=6(12.8%);CG,n=19(30.2%),P=0.031].No significant difference was observed in the rate of anastomotic leakage[SG,n=3(6.4%);CG,n=5(7.9%)].CONCLUSION:Trans-anal reinforcing sutures may reduce the need for diverting ileostomy.A randomized prospective study with a larger population should be performed in the future to demonstrate the efficacy of trans-anal reinforcing sutures.

Suture-Button固定技术治疗下胫腓联合损伤的手术效果、并发症分析

目的:探讨Suture-Button固定技术治疗下胫腓联合损伤的手术效果、并发症。方法:选取笔者所在医院收治的92例下胫腓联合损伤患者,采用计算机随机分组法将其分为对照组和观察组,各46例。对照组采用螺钉内固定治疗,观察组采用Suture-Button固定技术治疗。比较两组治疗费用、恢复负重时间、并发症发生情况、手术前后踝关节功能和治疗效果。结果:观察组治疗费用(5021.04±128.63)元,少于对照组的(5105.36±136.74)元,恢复负重时间(10.27±1.38)周,早于对照组的(11.28±1.59)周,差异均有统计学意义(P<0.05)。观察组并发症发生率为10.87%,低于对照组的28.26%,差异有统计学意义(P<0.05)。两组术前、术后6、12个月踝关节功能评分比较差异均无统计学意义(P>0.05);两组术后6、12个月踝关节功能评分均较术前升高,差异有统计学意义(P<0.05)。观察组治疗优良率为95.65%,对照组治疗优良率为91.30%,两组比较差异无统计学意义(P>0.05)。结论:Suture-Button固定技术治疗下胫腓联合损伤效果确切,可有效促进患者足功能恢复,缩短患者恢复负重时间,减少并发症,降低医疗开支。

Facial Asymmetry Correction in Facial Palsy Patients with Silhouette Sutures

Introduction: over the last few decades several techniques static and dynamics, have been performed to improve facial asymmetry and functionality alter suffering facial paralysis. Methods: we present a pilot study to show and evaluate the benefits of a new form of facial suspension, with Silhouette sutures. We performed two patients with total and complete facial palsy due to otical tuberculosis in one case and to parotid carcinoma in the other. Results: one year after surgery, both patients have improved facial asymmetry, mastication and speech production which have lead to a higher self-esteem and major social interaction. Conclusions: static facial suspension with Silhouette sutures is a non invasive alternative to dynamic techniques in patients who don’t want or can’t undergo more complex surgeries.

Prospective Interventional Study to Quantify Barbed Suture Exposure at Vaginal Vault and Assess Post-Operative Risk

Background: The use of barbed suture in laparoscopic surgery is increasing ever since 2008. Published reports of use of unidirectional barbed suture for vaginal vault closure following total laparoscopic hysterectomy (TLH), indicates it is safe. Despite of this many reports of adhesions and bowel obstruction are reported. This complication was never assessed in relation to amount of suture exposure at vaginal vault. We thought of quantifying the barbed suture exposure at vaginal vault and assess the risk of post-operative complications. Objective: The objective was to quantify the exposure of barbed suture at vaginal vault by adopting a uniform technique of vault suturing and assessing postoperative risk related to adhesions at vaginal vault. Method: In 30 patients who underwent TLH, a uniform new technique of vaginal vault closure using barbed suture was used and the portion of suture exposed at vaginal vault was quantified. The patients were followed up for a period of 6 months to assess post-operative risk of adhesions at vault and sequalae. Result: Mean length of suture exposed was 2.64 ± 1.65 mm only. Suture exposure at vaginal vault was seen in 23 (76.67%) out of 30 patients. The suture was exposed on average at 1.57 ± 1.20 places at vaginal vault. Conclusion and Recommendations: The study with an accepted relative error of 5% quantifies barbed suture exposure at vaginal vault. We had adopted a uniform new method of vaginal vault suturing to study and to quantify barbed suture exposure. It was observed that very minimal portion of suture was exposed at vaginal vault. It was exposed at only a couple of places at vaginal vault. Thus, decreasing suture exposure at vaginal vault will reduce its exposure related risk.

Efficacy of staple line reinforcement by barbed suture for preventing anastomotic leakage in laparoscopic rectal cancer surgery

BACKGROUND Anastomotic leakage(AL) is a severe complication in rectal cancer surgery.Various methods, including intracorporeal reinforcing suturing, have been used to reduce the incidence of AL. However, little is known about the efficacy of staple-line reinforcement by barbed suture for preventing AL.AIM To evaluate the efficacy of staple-line reinforcement using barbed suture for preventing AL in laparoscopic surgery for rectal cancer.METHODS We retrospectively reviewed the clinical datum of 319 patients undergoing laparoscopic low anterior resection combined with double stapling technique between May 1, 2017 and January 31, 2021. All surgeries were performed by the same surgical team specializing in colorectal surgery. Patients were divided into two groups depending on whether they received reinforcing sutures. Patients’ baseline characteristics did not show any significant difference between the two groups. We analyzed patient-, tumor-, as well as surgery-related variables using univariate and multivariate logistic analyses.RESULTS There were 168 patients in the reinforcing suture group and 151 patients in the non-reinforcing suture group. AL occurred in 25 cases(7.8%). Its incidence was significantly higher in the non-reinforcing suture group than in the reinforcing suture group(4.8% vs 11.3%, P = 0.031). The multivariate analyses demonstrated that the tumor site, tumor size and presence of staple-line reinforcement were independent risk factors for AL. We divided these patients into two risk groups based on the combination of tumor site and tumor size. Patients without any risk factor were assigned to the low-risk group(n = 177), whereas those having one or two risk factors were assigned to the high-risk group(n = 142). In the high-risk group, the AL incidence considerably decreased in the reinforcing suture group compared with that in the non-reinforcing suture group(P = 0.038). Nonetheless, no significant difference was found in the low-risk group between the two groups.CONCLUSION Staple-line reinforcement by barbed suture may decrease the incidence of AL. A large-scale prospective randomized controlled trial is needed for evaluating the efficacy of staple-line reinforcement for preventing AL.

Krackow锁定缝合法联合改良Kessler缝合法治疗急性闭合性跟腱体部断裂

目的探讨Krackow锁定缝合法联合改良Kessler缝合法治疗急性闭合性跟腱体部断裂的疗效。方法2020年1月~2022年1月我科对162例急性闭合性跟腱体部断裂采用Krackow锁定缝合法联合改良Kessler缝合法手术治疗,术后采用相同的康复计划。采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分和跟腱完全断裂评分(Achilles Tendon Total Rupture Score,ATRS)进行功能评价。结果手术时间24~40 min[(31.9±4.6)min]。切口均为一期愈合,无感染、腓肠神经损伤。2例并发症:下肢深静脉血栓1例,意外导致跟腱再断裂1例。踝关节屈伸活动度恢复时间为4~12周[(7.6±1.9)周],患侧单足提踵恢复时间为10~18周[(13.3±1.8)周],快走或慢跑恢复时间为14~26周[(19.1±1.8)周]。162例随访14~25个月,平均19.0月。AOFAS踝-后足评分由术前(54.4±4.4)分提高到末次随访(98.0±4.0)分(t=-104.402,P=0.000);ATRS评分由术前(52.0±8.3)分提高到末次随访(91.2±2.4)分(t=-62.823,P=0.000)。结论对于急性闭合性跟腱体部断裂的中青年患者,Krackow锁定缝合法联合改良Kessler缝合法可使患者获得更佳的临床结局,早期进行功能锻炼以回归工作与生活。

口腔种植骨增量中的减张技术

临床上,种植位点骨量不足是种植治疗中常遇到的难题。为确保种植区符合种植条件,骨增量手术尤为重要。而骨增量手术成功的关键要素之一是创口无张力的一期愈合。减张技术是获得创口无张力愈合的关键。本文将从减张切口、减张瓣及减张缝合3个方面介绍口腔种植骨增量中的减张技术,以期为临床提供参考。

小鼠肾移植模型:3种创新术式

目的:小鼠肾移植模型手术难度大,成功率低,难以掌握,本研究拟改良并探索新型小鼠肾移植模型,为移植免疫基础研究提供借鉴。方法:分别建立小鼠腹部缝合法原位肾移植模型、腹部套管法原位肾移植模型和颈部套管法异位肾移植模型共57对供受体。供受体采用BALB/c小鼠或C57BL/6小鼠;供受体均选用8~12周龄、体重20~25 g的雄性无特定病原级小鼠。总结和比较3种模型的技术特点和手术时间、并发症、病理学检查等术后早期指标。结果:成功建立3种不同手术方式的小鼠肾移植模型。3组小鼠供肾热缺血时间比较差异无统计学意义(P=0.5104),腹部缝合组的供体手术总时间与腹部套管组和颈部套管组比较最短[(18.3±3.6)min vs(26.2±4.7)min和(22.8±2.5)min;均P<0.0001]。冷缺血时间比较3组差异有统计学意义(P<0.0001),腹部套管组、颈部套管组及腹部缝合组分别为(88.8±6.7)、(60.8±4.1)及(43.3±5.0)min。受体由于吻合方式不同,颈部套管用时最短[(17.6±2.7)min],腹部套管用时最长[(38.8±5.4)min]。受体的总手术时间比较差异有统计学意义(P<0.0001),腹部缝合组、颈部套管组及腹部套管组分别为(44.0±6.9)、(64.1±5.2)及(80.0±6.0)min。在并发症发生方面,32只腹部缝合组中6只发生术中出血,其中1只因为动脉内膜损伤出血,5只为血管开放后出血;6只小鼠发生输尿管并发症,包括输尿管膀胱吻合口狭窄、坏死以及肾盂积水;2只小鼠术后发生腹腔感染。腹部套管组未发生术中出血,但6只出现动脉轻度狭窄,5只静脉狭窄,4只动脉损伤,4只动脉血栓,2只输尿管并发症,没有小鼠在术后发生感染。在颈部套管组中,13只小鼠均未发生术中出血、动脉内膜损伤、动脉/静脉狭窄以及血栓,5只发生输尿管并发症,包括输尿管坏死和感染,是颈部套管组最主要的并发症。3组小鼠在移植后7 d肾功能保持稳定;苏木精-伊红和过碘酸希夫染色显示3种手术方式的移植物在急性排斥反应方面差异均无统计学意义(均P>0.05)。结论:3种术式均能成功建立小鼠肾移植模型,在近期移植物生存期和排斥反应方面未见明显差别。改良后的腹部缝合法以及腹部套管法在研究应用中各有优势,首创的小鼠颈部套管法异位肾移植模型的制备相对简单、小鼠创伤较小,可为异种移植、二次移植及局部淋巴引流探索等研究提供更多选择,但供肾摘取难度大,输尿管感染发生率高,远期存活还需更多模型验证。本研究为不同研究需求下选择小鼠肾移植模型的类型提供了重要借鉴意义。

缝线桥技术治疗青少年胫骨结节撕脱性骨折

目的 比较缝线桥技术和空心螺钉加压方法治疗青少年胫骨结节撕脱性骨折的疗效。方法 采取回顾性研究,收集了2015年10月至2022年10月枣阳市第一人民医院骨科收治并完整随访的37例青少年胫骨结节撕脱性骨折患者。其中,男36例,女1例;年龄13~17岁,平均15.2岁。根据撕脱骨块的固定方式分为缝线桥组(可吸收带线锚钉双排缝线桥固定,19例)和空心螺钉组(普通空心金属螺钉加压固定,18例)。比较两组患者术后1、2、3个月和末次随访时(>12个月)的膝关节屈曲角度、Bostman功能评分,以及术后3、6个月和末次随访时(>12个月)的Tegner活动评分;记录术后3个月及末次随访膝关节功能满意度(Bostman评分分级);同时记录术后并发症情况。结果 所有患者随访12~24个月,中位随访时间18个月。术后缝线桥组术后1、2个月的膝关节屈曲角度、Bostman功能评分缝线桥组均优于空心螺钉组,差异均有统计学意义(P<0.05),术后3个月及末次随访两组膝关节屈曲角度、Bostman功能评分比较,差异无统计学意义(P>0.05)。术后3个月Tegner活动评分缝线桥组优于空心螺钉组,差异有统计学意义(P<0.05);术后6个月及末次随访Tegner活动评分两组比较差异无统计学意义(P>0.05)。术后3个月患者满意度情况(Bostman功能评分分级)缝线桥组优于空心螺钉组,差异有统计学意义(P<0.05);但末次随访患者满意度情况(Bostman功能评分分级)两组比较差异无统计学意义(P>0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论 相比空心螺钉或结合钢丝张力带固定技术,缝线桥技术固定能达到螺钉固定强度,允许早期开展膝关节屈伸功能锻炼,术后异物激惹少,并发症发生率低,骨折愈合后也无需二次取出内固定。

子宫下段前壁叠瓦式缝合术治疗瘢痕子宫合并前置胎盘伴胎盘植入产妇产后出血的临床效果

目的观察子宫下段前壁叠瓦式缝合术治疗瘢痕子宫合并前置胎盘伴胎盘植入产妇产后出血的临床效果。方法回顾性选取2020年1月至2023年1月诊断为瘢痕子宫合并前置胎盘伴胎盘植入的100例产妇,按照手术治疗方法将其分为试验组(50例,子宫下段前壁叠瓦式缝合术)和对照组(50例,传统局部“8”字缝合术)。比较两组的止血效果、临床指标、血红蛋白水平及术后并发症发生情况。结果试验组的止血总有效率高于对照组,差异具有统计学意义(P<0.05)。试验组的手术时间短于对照组,红细胞输注量、血浆输注量、术后24 h总出血量、术中及术后缩宫素使用剂量、术中及术后欣母沛使用剂量少于对照组(P<0.05)。试验组的术后并发症总发生率明显低于对照组(P<0.05)。结论相较于传统局部“8”字缝合术,子宫下段前壁叠瓦式缝合术可为瘢痕子宫合并前置胎盘伴胎盘植入产妇产后出血的治疗提供一些新思路,是治疗此类患者的一种安全、有效的方法。