组织断离

Methods All severed composite tissues of 48 cases were replanted in situ through artery and vein anastomosis or vena arterialization.

对48 例离断复合组织块采用缝合动脉主干或分支、静脉或静脉动脉化进行原位再植。

Severed finger composite tissues should be replanted positively through anastomosing inherent digital arteries、veins or their branches or vena arterialization to improve the survival ratio.

手指离断复合组织块应积极再植，通过缝合指固有动脉或其分支、缝合静脉或静脉动脉化，增加再植成活率。

The uncovered tracts and the liver wound surface were managed by some of the methods combined such as high frequency electrocoagulation, titanium clamp, suture, hemostatic gauze oppression, argon-beam coagulation, protein glue adherence, and Endo-GIA switcher. The total operative outcome, operating time, blood loss, postoperative complications and postoperative hospital stay were summarized in order to assess feasibility and safety of the clinical laparoscopic liver resection.Results: 1. Laparoscopic liver resection with clamp dissection method needs only the ordinary laparoscopic equipment. It has a low cost but causes a little more bleeding. 2. Laparoscopic liver resection operated by microwave tissue coagulation method had very little bleeding when dissecting hepatic parenchyma. The operative field is clear and the cost is low. It is a safe, convenient and effective method. 3. Ultrasound dissector is a relatively ideal appliance for laparoscopic liver resection at present because ofless bleeding during operation. But the speed is slow thus prolongs the operation time. Its separating intensity is not strong enough, and it can only be applied to patients without hepatic cirrhosis. 4. Ligsure has clamp dissection and electrocoagulation functions. It can carbonize hepatic tissue including the tracts whose diameters are less than 7mm. It has some advantage in dissecting. However, it has the shortcomings of the clamp dissector during coagulating. 5. Hand-assisted laparoscopic liver resection can make use of the flexibility and feeling of the operators left hand.

结果：1、钳夹分离切肝法不需特殊仪器设备，只要具备常规的腹腔镜器械即可实施，成本低，肝断面较易渗血；2、微波固化切肝法肝实质出血很少，视野清晰，成本低，操作简单，是一种安全、简便、有效的方法；3、超声刀是目前较为理想的切肝器械，术中出血少，但是，切割速度慢，手术时间长，而且，切割强度有限，适用于无肝硬化的肝切除；4、Ligsure具有挤压粉碎及高频电凝止血两大功能，可使包括7~以下管道的肝组织碳化、形成焦痴，具有一定的优势，但是，也存在分离钳电凝止血的缺点；5、手辅助腹腔镜肝切除可以利用术者左手的灵活性及手感，便于术中显露、分离、控制出血等，可随意协助右手及助手的主要操作，缩短了手术时间，大大提高了腹腔镜肝切除的安全性，李朝龙等的改良方法，同样达到了手辅助目的，又节省了费用；6、小切口腹腔镜辅助切肝法可以使用剖腹肝切除常规器械及剖腹肝切除技术，操作简单、可靠，适用于肝左外叶切除及右肝第V段切除；7、Endo一GIA切肝法在离断肝组织的同时闭合管道结构，多用于肝左静脉、门静脉分支、管径较大胆管的切割，缺点是不能用于较厚肝组织的切割，而且价格昂贵；8、临床巧例腹腔镜肝切除均获得成功，手术时间最短1.5h，最长sh，平均125 min，多数在100 min左右，手术出血量最少50 ml，最多500 ml，平均1 78 ml，除2例合并严重肝硬化的原发性肝癌患者术后出现少量腹水，1例术后发生胆漏外，其余无并发症，发生胆漏的1例患者术后住院40d，多数在术后一周左右出院，术后住院时间5一40d，平均gd。

The dissecting of samples in group2 were difficult. The root of pulmonary artery and ascending aorta failed to be unfolded because fibrous tissue was tough, right and left fibrous trigone were too firm to be solved by hand. Cardiac muscle fibers couldn't be stripped along myofibrillar trajectory since they were prone to break because of their friability.

组2的心脏解剖困难，表现为纤维组织坚韧，游离肺动脉非常困难；徒手无法松解左、右纤维三角，肺动脉和主动脉根部的游离非常困难；心肌纤维坚硬、质脆，解剖时容易断离成碎块，无法沿纤维走行方向剥离。

Historically, isolated FCL injuries have been treated by direct repair,2 augmentation with a strip of the common biceps tendon,3,38 augmentation with a portion of the iliotibial band,3 imbrication and advancement with a bone block,7,13 or reconstruction using allograft tissue at nonanatomic attachment sites.4,6,24,29 However, to our knowledge no anatomic approach to reconstructing nonrepairable isolated FCL injuries has been published.

过去FCL离断伤通过直接修复[2]、股二头肌总腱增强[3，38]、部分髂胫束增强[3]、骨块重叠改良[7，13]或同种异体组织移植在非解剖重建治疗[4，6，24，29]。然而，就我们所知，尚未发现不可修复的FCL离断伤后解剖学重建的报道。

Objective To explore the methods of replantation for severed finger composite tissues.

目的 探讨不同手术方式对手指离断复合组织块再植的临床疗效。

METHODS: Through vestibular and columellar approach, the major alar cartilage and nasalis were repositioned to the normal anatomical positions, the deviated septum and columella were corrected by cutting the abnormal attachment of the orbicular muscle to the anterior nasal spine.

鼻唇畸形二期修复时做鼻翼缘前庭合并鼻小柱切口，矫正大翼软骨、鼻肌、鼻小柱及鼻中隔的异常解剖位置，离断鼻中隔的异常附着，部分患者去除多余的鼻中隔组织，并将鼻中隔软骨末端可靠固定在正确的位置，与软组织逢合固定，或与前鼻棘等骨性组织缝合固定，同时矫正偏斜的鼻小柱等软组织，通过鼻部软、硬组织的矫正，恢复鼻的正常形态。

Amputation organizations were drawed by homemade iris hook, drawing to limbal incision,suturing through cornea incision anterior lip to 0.5mm away from iris root with 100 nylon line,and then the root of the iris suture about 0.5mm, and then were ligatured and sutured through the corneal incision posterior lip.

使用自制的虹膜钩勾取离断的虹膜组织，拉至角膜缘切口处，用100尼龙线经角膜切口前唇、缝合虹膜根部约0.5mm，然后再穿过角膜切口后唇出针，结扎缝线。

With Death guitarist Schuldiner adopting vocal duties, the band made a major impact on the scene.

随着死亡的吉他手Schuldiner接受主唱的职务，乐队在现实中树立了重要的影响。

But he could still end up breakfasting on Swiss-government issue muesli because all six are accused of nicking around 45 million pounds they should have paid to FIFA.

不过他最后仍有可能沦为瑞士政府&议事餐桌&上的一道早餐，因为这所有六个人都被指控把本应支付给国际足联的大约4500万英镑骗了个精光。