目的 探讨大隐静脉高位结扎及剥脱术后腹股沟切口淋巴瘘发生的原因和防治方法。方法 回顾性分析我院收治的120例(186条患肢)行大隐静脉高位结扎及剥脱术者中术后发生腹股沟切口淋巴瘘患者的临床资料，并对相关文献进行复习。结果 大隐静脉高位结扎及剥脱术后腹股沟切口淋巴瘘发生率为4.3%（8/186）。2例单侧腹股沟切口淋巴瘘患者扩创后予以碘伏纱布填塞创面，于第20天及第23天后淋巴瘘闭合，再行切口二期缝合，7 d后拆线； 3例双侧腹股沟切口淋巴瘘患者切口创面予以医用胶喷洒后碘伏纱布填塞，3 d后淋巴瘘全部闭合，切口二期缝合、加压包扎后7 d拆线。切口均愈合良好。结论 对腹股沟区股根部不恰当的广泛解剖及淋巴结切除的不规范与大隐静脉高位结扎及剥脱术后腹股沟切口淋巴瘘的发生密切相关。术前对大隐静脉准确定位，术中仔细操作、避免广泛剥离、避免切除肿大淋巴结是预防腹股沟切口淋巴瘘的有效措施。淋巴瘘发生后予以医用胶封堵是有效的补救措施。
Objective To explore the effectiveness of cyanoacrylates (Fuaile) for spinal subdural benign tumorectomy to prevent the cerebrospinal fluid leakage. Methods Between January 2009 and March 2013, 35 patients underwent spinal subdural benign tumorectomy. Of 35 patients, Fuaile and gelatin sponge were used after stitch suture for a watertight closure of the dura in 19 cases (trial group), and only gelatin sponge was used after stitch suture in 16 cases (control group). There was no significant difference in gender, age, disease duration, types of tumors, and sites of tumors between 2 groups (P gt; 0.05). The ratio of watertight closure, incision healing, and relative complications were compared between 2 groups. Results All patients in 2 groups achieved watertight closure of the dura intraoperatively. There was no significant difference in operation time, intraoperative blood loss, length of dura incision, hospitalization time, total drainage volume, and drainage time between 2 groups (P gt; 0.05). Primary incision healing was obtained; no delayed healing, infection, or nerve compression occurred in all patients. At last follow-up, the ratios of successful watertight closure of trial and control groups were 89.5% (17/19) and 50.0% (8/16) respectively, showing significant difference (P=0.02). No delayed cerebrospinal fluid leakage or incision infection was found at 1 and 3 months after operation. Conclusion The application of cyanoacrylates for watertight closure of dura in spinal subdural benign tumorectomy is safe and effective.
OBJECTIVE: To study the feasibility of α-cyanoacrylate medical adhesive in fixation of intratemporal facial nerve when nerve was repaired within chitin chamber, and to investigate the nerve regeneration. METHODS: Nerve defect of 6 mm was made in left intratemporal facial nerves of 48 rabbits. All the defects were bridged with chitin chamber and were fixed by α-cyanoacrylate medical adhesive, surgical suture and natural union. Nerve function test and histomorphological examination were carried out at 1 month and 3 months after repair. RESULTS: It was observed that the nerve was fixed firmly to the chamber with no crack or crease by α-cyanoacrylate medical adhesive. The regenerated new nerve fibers were more regular and denser and the neurological function recovered much better in the group fixed by alpha-cyanoacrylate medical adhesive than in the groups those fixed by surgical suture and natural union. CONCLUSION: The medical adhesive is b in adhesion and beneficial to nerve repair; repair of intratemporal facial nerve defect within chitin chamber fixed by alpha-cyanoacrylate medical adhesive is feasible, simple and timesaving.
ObjectiveTo compare the effects of medical glue and stapling in the prevention of postoperative seroma for patients undergoing laparoscopic direct hernia repair. MethodsNinty-four patients were randomly by computer generated randomization number divided into two groups: medical glue group (medical glue was used to fix pseudo-direct hernia sac) and stapling group (staple was used to fix pseudo-direct hernia sac).The time of follow-up was two years.The operative time, length of hospital stay, the pain level on first day and 7th day after operation, postoperative complications (seroma, wound infection, wound bleeding), hospital costs, and hernia recurrence rate within 2 years were observed. ResultsThe medical glue group compared with the stapling group, the operative time was shorter〔(35±5.1) min vs.(41±7.5) min〕, hospitalization time was shorter〔(4±0.51) d vs.(5±0.83) d〕, lower postoperative pain score〔the first day: (5±0.52) scores vs.(6±0.33)scores; the 7th day: (3±0.67) scores vs.(4±0.53) scores〕, and lower cost in hospital〔(5 731±560.50) yuan vs.(8 715±534.33) yuan〕, there were significant difference (P < 0.05).The incidence of seroma and other complications after operation and postoperative 1-year and 2-year hernia recurrence rate showed no significant differences (P > 0.05). ConclusionsThe medical glue has good prevention effects on postoperative seroma for patients undergoing laparoscopic direct hernia surgery, with shorter operative time and lower cost.This method is suitable for all levels of hospitals
ObjectiveTo evaluate the learning curve of CT-guided medical glue localization for pulmonary nodule before video-assisted thoracic surgery (VATS). MethodsThe clinical data of the patients with pulmonary nodules who underwent CT-guided medical glue localization before VATS in our hospital from July 2018 to March 2021 were retrospectively analyzed. The patients were divided into 3 groups: a group A (from July 2018 to August 2019), a group B (from September 2019 to June 2020) and a group C (from July 2020 to March 2021). The localization time, morbidity, complete resection rate and other indexes were compared among the three groups. ResultsA total of 77 patients were enrolled, including 24 males and 53 females aged 57.4±10.1 years. There were 25 patients in the group A, 21 patients in the group B, and 31 patients in the group C. 77 pulmonary nodules were localized. There was no significant difference among the groups in the basic data (P＞0.05). The localization time in the group C was 10.6±2.0 min, which was statistically shorter than that in the group A (15.4±4.4 min) and group B (12.9±4.3 min) (P＜0.01). The incidence of complications in the group C was lower than that in the group A and group B (25.8% vs. 52.0% vs. 47.6%, P=0.04). The success rate of localization of the three groups was not statistically different (P=0.12). ConclusionThere is a learning curve in CT-guided medical glue localization for single pulmonary nodule before VATS. After the first 46 cases, the operation time can be shortened, and the incidence of complications can be decreased.