尿液转流在尿道下裂术后复杂性尿瘘术中的应用

目的:评价尿液转流在修复尿道下裂术后复杂性尿瘘术中的作用。方法:将40例尿道下裂术后复杂性尿瘘患者随机分为尿液转流组和非尿液转流组两组进行比较。结果:尿液转流组:25例患者术后尿道皮肤瘘复发两例,手术成功率99.2%。非尿液转流组:15例患者中有6例(40%)发生尿瘘复发。结论:尿道下裂术后复杂性尿瘘修复术中应用尿液转流有较好的效果。     

尿道下裂术后两种不同尿液引流方式的临床护理和效果观察

目的探讨尿道下裂术后2种不同尿液引流方式的临床护理和效果。方法选取我院泌尿外科2014年8月~2016年8月收治的46例接受尿道下裂成形术治疗的患者为研究对象。根据术后尿液引流方式不同分为A、B两组,其中A组22例患者采用新尿道内留置支架管的方式引流,B组24例患者采用耻骨上膀胱造瘘管+新尿道内留置支架管的方式引流,两组患者均按照尿道下裂术后护理常规实施术后护理,并根据尿液的不同引流方式给予相关护理。结果两组患者均顺利完成手术治疗,术后采用耻骨上膀胱造瘘管+新尿道内留置支架管方式引流尿液的B组尿瘘及尿道狭窄发生率显著低于实施新尿道内留置支架管引流尿液的A组,两组比较差异有统计学意义(P0.05)。结论尿道下裂术后采用耻骨上膀胱造瘘管+新尿道内留置支架管方式引流尿液,能有效保持尿液及分泌物的充分引流,减少管道堵塞的发生,减少术后尿瘘和尿道狭窄的发生,提高了手术成功率,提高了患者满意度。     

阴囊纵隔血管蒂皮瓣尿道成形I期治疗尿道下裂26例

目的：介绍阴囊纵隔皮瓣尿道成形术I期修复尿道下裂的方法。方法：于阴囊纵隔部设计以纵隔血管为蒂,宽1.5～2cm,长等于尿道外口至冠状沟距离的皮瓣,切取后成形尿道,修复下裂。结果：本组26例皮瓣全部成活,成形尿道排尿通畅。术后6例出现尿漏,4例换药治疗后自行愈合,2例半年后行瘘修补。随访6月至2年,无尿瘘及尿道狭窄,阴茎功能及外形满意。结论：阴囊纵隔皮瓣尿道成形术是I期治疗尿道下裂的良好方法。     

Ⅰ期尿道成形术治疗尿道下裂(附126例报告)

目的:总结Ⅰ期手术治疗尿道下裂的方法及疗效.方法:分析本科室2008年9月至2010年3月期间收治的尿道下裂126例患者,其中98例为采用侧背侧皮瓣的OUPFⅡ法;另28例阴茎下弯畸形较严重,采用切除尿道板加尿道口旁皮瓣的OUPFⅣ法的治疗方法和效果等临床资料.结果:126例中115例病例得到治愈,治愈率为91.3%.11例出现术后并发症:10例术后并发尿瘘,均为针尖样尿道皮肤瘘口,其中3例多发瘘口,7例单发瘘口,均已行补瘘术.另1例为尿道外口狭窄,定期行尿道扩张术可获得满意疗效.结论:OUPF法尿道成形手术适合于几乎所有尿道下裂患者,是一种很好的手术方法,具有手术时间短,取材方便,术后恢复快,阴茎外观满意,尿道狭窄、尿瘘、阴茎下弯畸形等并发症少等优点.     

阴囊纵隔血管蒂皮瓣尿道成形Ⅰ期治疗尿道下裂26例

目的:介绍阴囊纵隔皮瓣尿道成形术Ⅰ期修复尿道下裂的方法.方法:于阴囊纵隔部设计以纵隔血管为蒂,宽1.5～2cm,长等于尿道外口至冠状沟距离的皮瓣,切取后成形尿道,修复下裂.结果:本组26例皮瓣全部成活,成形尿道排尿通畅.术后6例出现尿漏,4例换药治疗后自行愈合,2例半年后行瘘修补.随访6月至2年,无尿瘘及尿道狭窄.阴茎功能及外形满意.结论:阴囊纵隔皮瓣尿道成形术是Ⅰ期治疗尿道下裂的良好方法.     

阴茎阴囊转位合并尿道下裂分期手术修复（附43 例报道）

目的：探讨阴茎阴囊转位合并尿道下裂的手术方法及分期手术修复的临床意义。方法：回顾性分析2005年1 月至2012 年 6 月间兰州军区兰州总医院收治的43 例阴茎阴囊转位伴尿道下裂的病例资料并分析手术方式及术后随访外观情况。结果：43 例 患者经2 期阴囊成形术后疗效满意,其中2 例伴严重尿道下裂患者经分手术后达到预期效果,术后随访6 个月至7 年。所有患者 在阴茎阴囊复位后经同期或分期尿道成形术后最终均达到尿道下裂修复的标准。结论：阴茎阴囊转位合并尿道下裂应及早手术 矫正治疗。分期手术方法使操作简化,阴茎阴囊复位整形效果满意,最终尿道成形术后预后良好,术后并发症少,是一种安全可行 的手术方式,但性器官发育后易复发,术后要随访至青春期以后。     

阴茎阴囊转位合并尿道下裂分期手术修复（附43例报道）

目的：探讨阴茎阴囊转位合并尿道下裂的手术方法及分期手术修复的临床意义。方法：回顾性分析2005年1月至2012年6月间兰州军区兰州总医院收治的43例阴茎阴囊转位伴尿道下裂的病例资料并分析手术方式及术后随访外观情况。结果：43例患者经2期阴囊成形术后疗效满意,其中2例伴严重尿道下裂患者经分手术后达到预期效果,术后随访6个月至7年。所有患者在阴茎阴囊复位后经同期或分期尿道成形术后最终均达到尿道下裂修复的标准。结论：阴茎阴囊转位合并尿道下裂应及早手术矫正治疗。分期手术方法使操作简化,阴茎阴囊复位整形效果满意,最终尿道成形术后预后良好,术后并发症少,是一种安全可行的手术方式,但性器官发育后易复发,术后要随访至青春期以后。     

括约肌间瘘管结扎术与切开挂线术治疗复杂性肛瘘的疗效比较

目的:比较括约肌间瘘管结扎术与切开挂线术治疗复杂性肛瘘的临床疗效,探讨复杂性肛瘘的最佳手术方式。方法:选择同期复杂性肛瘘患者80例,根据患者自愿的原则,随机均分为对照组(n=40例)和观察组(n=40例),对照组采取切开挂线术治疗,观察组采取括约肌间瘘管结扎术治疗,比较两组患者治疗后临床疗效及术后状况。结果:治疗后两组患者临床满意例数比较,差异具有统计学意义(P0.05);平均住院时间、平均创口愈合时间、术后明显疼痛、肛门功能障碍、局部出血感染和术后6个月复发例数比较,差异均具有统计学意义(P0.05),观察组优于对照组。结论:手术治疗复杂性肛瘘时,应首选括约肌间瘘管结扎术治疗,可提高临床疗效,促进创口愈合,减少术后并发症。     

口腔颌面部肿瘤患者术后缺损的外侧皮瓣修复术与前臂皮瓣修复术对比研究

摘要 目的：探讨口腔颌面部肿瘤患者术后缺损的外侧皮瓣修复术与前臂皮瓣修复术对比。方法：选取遂宁市中心医院（我院）2015年8月到2020年8月共收治的120例口腔颌面部肿瘤患者,所有患者通过肿瘤切除术后均出现组织缺损现象,对所有组织缺损的患者依照不同的皮瓣修复方式分为两组,其中应用外侧皮瓣修复术的68例患者分为外侧皮瓣修复组,应用前臂皮瓣修复术的52例患者分为前臂皮瓣修复组,对比两组的皮瓣修复效果,治疗后的口腔功能恢复情况,瓣成活率、术后皮瓣危象率以及血管吻合时间,并发症情况。结果：外侧皮瓣修复组的总有效率为95.59 %,前臂皮瓣修复组的总有效率为84.62 %,外侧皮瓣修复组明显高于前臂皮瓣修复组（P＜0.05）;外侧皮瓣修复组患者的外形修复、语言功能、咀嚼功能、吞咽功能以及口腔闭合评分明显高于前臂皮瓣修复组（P＜0.05）;两组的皮瓣成功率均比较高对比无明显差异（P＞0.05）,两组的术后皮瓣危象率比较低,对比无明显差异（P＞0.05）,血管吻合时间对比无明显差异（P＞0.05）;对比两组并发症发生情况发现,外侧皮瓣修复组的总并发症发生率为2.94 %,前臂皮瓣修复组并发症发生率为17.31 %,外侧皮瓣修复组明显低于前臂皮瓣修复组（P＜0.05）。结论：对口腔颌面部肿瘤患者术后缺损患者应用外侧皮瓣修复术能够提升患者的皮瓣修复效果,提升患者的口腔功能恢复情况,减少并发症的发生,安全性好,值得临床应用推广。     

胰十二指肠切除术后发生胰瘘的危险因素及血清降钙素原早期预测价值研究

摘要 目的：研究探讨胰十二指肠切除术后发生胰瘘的危险因素及血清降钙素原(PCT)早期预测胰瘘的价值。方法：选取2019年1月~2019年7月间海军军医大学第一附属医院收治的250例胰十二指肠切除术患者,患者均进行胰十二指肠切除术治疗,对患者术后进行随访观察,统计患者术后胰瘘的发生率,依据患者术后是否发生胰瘘将患者分为胰瘘组（n=77）和非胰瘘组（n=173）,对两组患者术后1 d PCT水平进行检测比较。采用单因素和多因素Logistic回归分析的方法对患者的胰瘘发生的影响因素进行分析,采用受试者工作特征曲线（ROC）分析术后1 d PCT水平对胰瘘发生的早期预测价值,并计算其预测胰瘘发生的曲线下面积(AUC)、敏感度和特异性。结果：250例胰十二指肠切除术后患者中有77例患者术后出现胰瘘,胰瘘发生率为30.80%。胰瘘组与非胰瘘组患者术后1 d的PCT水平均升高,且胰瘘组高于非胰瘘组(P<0.05)。单因素分析显示,胰管直径、胰腺质地、血清胆红素水平、白蛋白水平与患者术后发生胰瘘有关(P<0.05)。经多因素Logistic回归分析发现,胰管直径＜3 mm、胰腺质软、血清胆红素水平＞170 μmol/L、白蛋白水平＜30 g/L及术后1 d PCT水平＞0.75 μg/L是患者术后胰瘘发生的独立危险因素(P<0.05)。ROC曲线显示,术后1 d 检测PCT水平预测术后胰瘘发生的AUC为0.827,敏感度为83.23%,特异度为85.71%,PCT截断值为0.75 μg/L。结论：胰十二指肠切除术患者术后有较高的胰瘘发生率,胰管直径、胰腺质地、血清胆红素水平、白蛋白水平及术后PCT水平与患者术后胰瘘的发生密切相关,术后检测PCT对于胰瘘发生有较高的预测价值。     

Management and timing of cleft palate fistula repair

This study reviewed 199 cleft palate repairs resulting in 22 percent fistula formation. Of these, 49 percent were judged to be symptomatic. Of 44 fistulas, 21 required treatment, of which 14 had conventional type surgical closure with an overall success rate of 35 percent. Good surgical technique and good surgical judgment were felt to be important factors both in preventing postoperative fistula and in the success of their repair. Conventional methods of surgical repair of hard palate fistulas were seen to result in a very poor success rate. Orthodontic movement of maxillary segments was seen to contribute to late postoperative fistula formation. Therefore, orthodontic movement should be completed before undertaking surgical repair of anterior palatal fistulas. Finally, the success rate of anterior fistula repair has been dramatically improved by the addition of free periosteal grafts and cancellous bone grafts.     

先天性尿道下裂的矫治（附1000例报告）

目的：总结先天性尿道下裂的矫治经验。方法：尿道下裂患者1000例,年龄1～26岁,平均4岁。冠状沟型118例,阴茎体型593例,阴茎阴囊型189例,会阴型100例。791例采用尿道板切开卷管成形法（TIP）,117例采用Duckett＋Duplay术,92例采用二期手术,一期行阴茎伸直及皮瓣转移,二期行尿道成形术（TIP）。术中遵循微创原则,使用显微器械,尽量保留原有的正常组织结构。结果：随访6月至2年,TIP术741例手术一次成功,Duckett＋Duplay术99例一次成功,分期手术二期成功86例。并发尿道皮肤瘘51例,尿道狭窄17例,尿道憩室6例,均经再次手术治愈。结论：尿道下裂矫治手术中,首先保留尿道板手术,并发症少,成功率高,值得推广,阴茎严重弯曲者或重度尿道下裂患者可选Duckett＋Duplay术或者分期手术。     

Palatal fistulas: rare with the two-flap palatoplasty repair

The purpose of this study was to examine the palatal fistula rate after repair with the two-flap palatoplasty technique. This is a retrospective review of 119 consecutive cleft-palate repairs performed over a 5-year interval by a single surgeon. The two-flap palatoplasty technique was used to provide tension-free, multilayer repairs. The age of these children at the time of repair ranged from 7 to 84 months (mode, 9 months). The initial follow-up visit occurred 2 to 12 weeks after the repair operation (mean, 4 weeks). The postoperative follow-up duration ranged from 7 to 48 months. This review of 119 cleft-palate repairs revealed a fistula rate of 3.4 percent (four fistulas in 119 repairs). This experience demonstrates the lowest reported palatal fistula complication rate with use of the two-flap palatoplasty technique.     

Cleft palate fistulas: a multivariate statistical analysis of prevalence, etiology, and surgical management

A retrospective, multivariate statistical analysis of 129 consecutive nonsyndromic patients undergoing cleft palate repair was performed to document the incidence of postoperative fistulas, to determine their cause, and to review methods of surgical management. Nasal-alveolar fistulas and/or anterior palatal fistulas that were intentionally not repaired were excluded from study. Cleft palate fistulas (CPFs) occurred in 30 of 129 patients (23 percent), although nearly a half were 1 to 2 mm in size. Extent of clefting, as estimated by the Veau classification, was significantly more severe in those patients who developed cleft palate fistula. Type of palate closure also influenced the frequency of cleft palate fistula. Forty-three percent of patients undergoing Wardill-type closures developed cleft palate fistula versus 10, 22, and 0 percent for Furlow, von Langenbeck, and Dorrance style closures, respectively. The fistula rate was similar in patients with (30 percent) and without (25 percent) intravelar veloplasty. Age at palate closure did not significantly affect the rate of fistulization; however, the surgeon performing the initial closure did not have an effect. Thirty-seven percent of patients developed recurrent cleft palate fistulas following initial fistula repair. Recurrence of cleft palate fistulas was not influenced by severity of cleft or type of original palate repair. Following end-stage management, a second cleft palate fistula recurrence occurred in 25 percent of patients. Continued open discussion of results of cleft palate repair is recommended.     

Creation of arterio-venous fistulas in patients chronically treated with hemodialysis

The authors present a 5-year experience in formation of the arterio-venous fistulas for hemodialysis. Analysed material includes 58 fistulas in 40 patients. Fistulas were formed twice or more times in 22% of the patients. Thrombus in the fistula was the most frequent complication (10.3%). The authors form arterio-venous fistula "of choice" in the peripheral portion of the forearm anastomosing radial artery with cephalic vein "side-to-end". Such a procedure in other portions of the arm is related to a higher risk of failure. Intra-arterial subtraction angiography is of significant help in the selection of the tactics of secondary operations forming fistula.     

Critical oropharyngocutaneous fistulas after microsurgical head and neck reconstruction: indications for management using the "tissue-plug" technique

Despite advances in head and neck reconstruction with free-tissue transfer techniques, oropharyngocutaneous fistulas continue to present challenging and potentially lethal complications. The authors present a system for prioritizing these fistulas and the surgical management of nine patients in whom critical fistulas developed after microsurgical head and neck reconstruction. The indications for aggressive management of these fistulas were primarily dependent on their location. Three peristomal and six midneck fistulas were considered critical because of the risk of aspiration pneumonia and carotid artery blowout, respectively. Fistulas located in the submental and/or submandibular region were considered noncritical and were managed conservatively. Using the concept of a "tissue plug" for fistula repair, a dermal component (i.e., a deltopectoral or pectoralis major pedicled flap) is guided through the fistula, and with external traction the tissue "plugs" the tract. No sutures are placed directly in the surrounding friable tissue. There were no partial or total flap losses. There were two fistula recurrences in patients who had received postoperative radiation therapy. One of these recurrences was due to tumor recurrence within the previous fistula and was managed with palliative measures. The other fistula recurrence was closed with a local-flap procedure on an outpatient basis. All patients resumed oral feeding, except for the patient in whom tumor recurrence was suspected. This tissue-plug technique can be used in the management of critical peristomal and/or midneck oropharyngocutaneous fistulas not only to obliterate the tract but also to augment volume and vascularity in already damaged, ischemic, and deficient tissue.     

Incidence of cleft palate fistula: an institutional experience with two-stage palatal repair.

The purpose of this study was to determine the incidence of cleft palatal fistula in a series of nonsyndromic children treated at the authors' institution. This retrospective analysis of 103 patients with cleft palate treated by five surgeons between 1982 and 1995 includes 60 boys and 33 girls, whose median age was 18.4 months at the time of surgery. The median length of follow-up was 4.9 years after primary palatoplasty. Cleft palatal fistula was defined as a failure of healing or a breakdown in the primary surgical repair of the palate. Intentionally unrepaired fistulas of the primary and secondary palate were excluded. Extent of clefting was described according to the Veau classification. Statistical examination of multiple variables was performed using contingency table analysis, multivariate logistic regression, and the Wilcoxon rank sum test. The incidence of cleft palatal fistula in this series was 8.7 percent. All of these fistulas were clinically significant. The rate of fistula recurrence was 33 percent. The incidence of cleft palatal fistula when compared by Veau classification was statistically significant, with nine fistulas occurring in patients with Veau 3 and 4 clefts and no fistulas occurring in patients with Veau 1 and 2 clefts (p = 0.0441). No significant differences between patients with and without fistulas were identified with respect to operating surgeon, patient sex, patient age at palatoplasty, type of palatoplasty, and use of presurgical orthopedics or palatal expansion. All three recurrent fistulas occurred in the anterior palate, two in patients with Veau class 3 clefts and one in a patient with a Veau class 4 cleft. The low rate of clinically significant fistula was attributed to early delayed primary closure, with smaller secondary clefts allowing repair with a minimum of dissection and disruption of vascularity.     

Analysis of pharyngocutaneous fistula following free jejunal transfer for total laryngopharyngectomy

The development of a pharyngocutaneous fistula is the most common and troublesome complication in the early postoperative period following free jejunal transfer for total laryngopharyngectomy. However, many aspects of this complication remain unclear. In this study, the authors analyzed their experience with the pharyngocutaneous fistula formation following free jejunal transfers to evaluate its clinical behavior, determine the significance of the anastomotic technique used, and evaluate the role of preoperative radiation therapy on its formation and management. Of 168 patients who underwent free jejunal transfers following total laryngopharyngectomy at the authors' institution between July of 1988 and March of 2000, 23 patients (13.7 percent) with postoperative fistulas were identified. The mean onset of fistula formation was 16 days. Of the 23 fistulas, 13 (56.5 percent) occurred at the proximal and 10 (43.5 percent) at the distal anastomoses. Whereas the majority of the proximal fistulas (69.2 percent) developed near the mesenteric side of the jejunal flap, most of the distal fistulas (90 percent) were located anteriorly. The incidence of proximal fistula formation was higher in patients with a single-layer repair than in patients with a two-layer repair of a proximal anastomosis (80 percent versus 38.5 percent, p = 0.09). The incidence of fistula formation was greater in patients who received preoperative radiation therapy than in those who did not (16.3 percent versus 11.4 percent, p = 0.36). In addition, whereas a majority of fistulas (80 percent) occurred at the proximal anastomosis in patients who did not receive preoperative radiation therapy, most fistulas (61.5 percent) occurred at the distal anastomosis in patients who did receive radiation therapy (p = 0.09). The fistulas closed spontaneously in 15 patients (65 percent). On average, spontaneous closure occurred in 7.4 weeks. Proximal fistulas had a significantly higher rate of spontaneous closure compared with distal fistulas (85 percent versus 40 percent, p = 0.04). The rate of spontaneous fistula closure was higher in patients who had not received preoperative radiation therapy than in those who had (90 percent versus 46 percent, p = 0.07). Surgical closure of the fistula was required in five patients. The fistulas were not repaired in three patients because of recurrent tumor. Twenty patients (87 percent) resumed oral feeding after the closure of the fistula, with 17 (85 percent) of 20 patients tolerating a regular diet and three (15 percent) of 20 a liquid diet only.In conclusion, most fistulas occur at the proximal anastomosis and near the mesenteric side of the jejunal flap, and the use of a two-layer anastomotic technique seems to be associated with a lower incidence of fistula formation at the proximal suture line. Most fistulas close spontaneously, especially ones that occur proximally. Preoperative radiotherapy does seem to increase the risk of fistula formation, especially at the distal anastomotic site and make subsequent resolution of the fistulas more difficult. Most patients are able to resume oral feeding once the fistula is closed.