31例眼睑恶性肿瘤切除后Ⅰ期修复的总结

眼睑恶性肿瘤切除术后,眼睑修复时机的选择,对保持眼睑功能和美容的效果起着十分重要的作用,术式的选择是决定手术成功关键.采用眼睑全层缺损行异体巩膜片移植,替代睑板、滑行球结膜瓣前徙替代睑结膜的眼睑再造术,对31例眼睑恶性肿瘤切除,同时进行眼睑再造术.术后无排斥反应,眼睑闭合良好,外形满意.结论认为,较大范围的眼睑恶性肿瘤切除的患者,采用异体巩膜片移植、滑行结膜瓣前徙眼睑再造术能达到保持眼睑功能和美容的效果,是理想的眼睑恶性肿瘤切除后Ⅰ期修复临床决策.     

应用烧伤整形外科技术治疗大面积皮肤撕脱伤

探讨大面积皮肤撕脱伤的治疗方法。分析总结大面积皮肤撕脱伤及合并损伤17例,根据伤情综合应用清创撕脱皮肤缝合、带蒂真皮下血管网皮瓣回植、撕脱皮肤反取皮回植、组织瓣转移修复、游离皮片移植、头皮取皮术、异体／异种皮移植、创面持续负压吸引VSD等治疗方法,观察创面修复、肢体外观及功能恢复情况。结果17例患者经综合治疗后创面均愈合。功能部位均予全层皮片或皮瓣修复;19处创面有深部组织外露,予皮瓣或肌瓣修复;随访6个月～3年,所有肢体功能良好。根据皮肤软组织损伤情况而综合运用多种烧伤整形外科技术修复大面积撕脱伤可缩短疗程,并最大可能保留受伤区域的功能与外观,改善患者生活质量。     

带腓肠神经腓骨复合组织瓣移植修复前臂尺侧缺损

观察以带腓肠神经的腓骨复合组织瓣移植修复前臂尺侧缺损的临床效果。对15例前臂尺侧复合组织缺损的患者实行带腓肠神经的腓骨复合组织瓣移植修复术。结果15例组织瓣全部成活,前臂功能恢复良好。应用带腓肠神经的腓骨复合组织瓣移植修复前臂尺侧缺损,是一种治疗复合组织缺损的有效手术方法。     

带腓肠神经腓骨复合组织瓣移植修复前臂尺侧缺损

观察以带腓肠神经的腓骨复合组织瓣移植修复前臂尺侧缺损的临床效果.时15例前臂尺侧复合组织缺损的患者实行带腓肠神经的腓骨复合组织瓣移植修复术.结果15例组织瓣全部成活,前臂功能恢复良好.应用带腓肠神经的腓骨复合组织瓣移植修复前臂尺侧缺损,是一种治疗复合组织缺损的有效手术方法.     

乳晕月牙状切口与传统切口手术治疗男性乳房发育症的比较研究

探讨乳晕月牙状切口切除男性乳房发育症的手术方法及美容效果.回顾性分析5年来在局麻或全麻下,分别采用乳晕月牙状切口(46例)和传统沿乳晕弧形切口或放射状切口(32例)保留乳头乳晕手术治疗男性乳腺发育症,比较两种术式的手术时间、术中出血量、切口隐蔽程度、患者满意度及住院费用等临床资料的差异.乳晕月牙状切口潜行切除增生的乳腺腺体与传统切口相比,切口更小而隐蔽,术后外观美容效果更好,是治疗男性乳房发育症的一种理想术式.     

国内同行关于异体颜面移植的讨论

换脸术为严重毁容患者重获美容带来了新希望。但是就像很多新生事物一样,在国内引起了激烈的争论。我们以丁香园上的帖子为基础,对国内同行的争论进行了总结,以期对异体颜面移植这一成果有一深入的认识。通过初步分析可以看出,虽然对于这一课题争论比较大,但是广大医护人员还是认可此次手术,并认为这是创新。     

国内同行关于异体颜面移植的讨论

换脸术为严重毁容患者重获美容带来了新希望.但是就像很多新生事物一样,在国内引起了激烈的争论.我们以丁香园上的帖子为基础,对国内同行的争论进行了总结,以期对异体颜面移植这一成果有一深入的认识.通过初步分析可以看出,虽然对于这一课题争论比较大,但是广大医护人员还是认可此次手术,并认为这是创新.     

78例鼻颅底肿瘤经鼻内镜下手术治疗的临床观察

对78例鼻颅底肿瘤患者经鼻内镜下行微创手术治疗,考察其治疗效果、围术期并发症,并总结可供临床参照的手术操作要点。回顾性分析2012年1月~2014年6月笔者所在医院收治的78例鼻颅底肿瘤患者的临床资料。患者均经鼻内镜下行手术治疗。术后经病理活检确诊,如为恶性肿瘤,患者还需术后接受放射治疗。考察手术完成、肿瘤切除情况(切除率)、围术期并发症的发生及持续随访的结果。78例患者全部顺利完成手术。肿瘤全切率80.8%(63/78),次全切除率14.1%(11/78),大部分切除率5.1%(4/78)。术后病理结果显示良性肿瘤占53.8%(42/78),恶性肿瘤占46.2%(36/78)。围术期并发症的发生率为5.1%(4/78)。无致死病例。持续随访,术后1年良性肿瘤复发率11.9%(5/42),恶性肿瘤复发率25.0%(9/36)。术后3年恶性肿瘤复发率52.8%(19/36),病死率44.4%(16/36)。经鼻内镜下微创手术切除鼻腔、鼻窦侵犯至颅底或颅底的原发良、恶性肿瘤是简便、有效、安全的治疗方法。只要掌握好适应证,制定合理的手术路径,则鼻内镜下微创术切除或部分切除鼻颅底的肿瘤在临床是切实可行的。     

经脐单孔免气腹腹腔镜阑尾切除术

总结经脐单孔免气腹腹腔镜行阑尾切除术的优势。对40例阑尾炎患者行经脐单孔免气腹腹腔镜阑尾切除术。结果手术均获成功,无中转开腹,所有手术患者均痊愈出院,无手术并发症及死亡。经脐单孔免气腹腹腔镜阑尾切除术能扩大腹腔镜阑尾切除术适应证,增加了手术的安全性。而且其良好的美容效果是传统腔镜手术不具备的。     

以中节指动脉弓为蒂逆行指动脉岛状皮瓣修复指端缺损

观察以中节指动脉弓为蒂逆行指动脉岛状皮瓣修复指端缺损的临床效果。对24例指端缺损的患者实行以中节指动脉弓为蒂逆行指动脉岛状皮瓣修复术。结果24例患者皮瓣全部成活,术后随访3个月~6个月,手指功能恢复良好。该手术操作简便,术后功能外观好,是修复指端特别是指腹皮肤软组织缺损的首选手术方法。     

双血供胸大肌皮瓣修补咽颈部缺损

探讨双血供胸大肌皮瓣修补咽颈部缺损的可行性。介绍应用双血供胸大肌皮瓣修补咽颈部缺损36例,窄蒂胸大肌皮瓣修补咽颈部缺损7例。结果前者愈合23例,出血3例,感染5例,咽瘘5例,皮瓣坏死无;后者愈合2例,出血1例,感染1例,咽瘘2例,皮瓣坏死1例。双血供胸大肌皮瓣修补咽颈部缺损更利于术后愈合、预防咽瘘。     

上睑凹陷临床治疗方法的进展述评

上睑凹陷指的是上睑区眶下缘处出现的凹陷,常常与眼睑皮肤松弛下垂同时发生,为上睑老化的临床表现之一。随着人们对眶区年轻化的日渐重视,整形美容医师对纠正上睑凹陷研究出多种治疗方法。我们搜集了关于上睑凹陷临床治疗方法的国内外文献,并综合比较,分析进展趋势。目前的国内外研究中可将治疗方法概括分为三大类：组织的重新定位;注射及填充;以及两种方法的联合应用。而两种方法的联合应用正逐渐成为当今临床的主要治疗趋势。     

Camera-Based Microswitch Technology to Monitor Mouth,Eyebrow, and Eyelid Responses of Children with Profound Multiple Disabilities

A camera-based microswitch technology was recently used to successfully monitor small eyelid and mouth responses of two adults with profound multiple disabilities (Lancioni et al., Res Dev Disab 31:1509–1514, 2010a). This technology, in contrast with the traditional optic microswitches used for those responses, did not require support frames on the participants’ face but only small color marks. The present study was aimed at extending the research evidence available on the aforementioned technology with the involvement of new participants and responses. The participants were three children with profound multiple disabilities. The responses selected for them consisted of mouth closing, eyebrow lifting, and repeated eyelid closures. The results showed that the new technology could be satisfactorily applied with all three children, across the three different responses. All children had large increases in responding during the intervention periods (i.e., when their responses were followed by preferred stimulation). The findings are discussed in relation to the possible impact of the new technology on programs for persons with multiple disabilities and minimal motor behavior.     

The effect of moving and static trans-scleral illumination of visual afterimages

The inside of the eye was illuminated by shining a small light through the upper eyelid and the sclera. After viewing a bright light flash, Ss closed their eyes and reported the duration of the afterimage under the following conditions: the light on and moving across the S’s eyelid (moving trans-scleral illumination), the light on but stationary (static trans-scleral illumination), and two corresponding control conditions in which the light was turned off (darkness). Results indicate that when the trans-scleral light is moving, afterimages are seen clearly for periods of approximately the same duration as those seen in complete darkness. However, when the trans-scleral illumination is stationary, the duration of the afterimages is significantly reduced. These results are compatible with other afterimage data that suggest that changes within the field after initial stimulation are needed to prolong afterimages.     

Combination treatment of malignant brain tumors. Results of initial experiences

First experiences with the combined treatment of malignant gliomas (29 cases) are presented in connection with the results reported in literature. The cytostatic therapy has been carried out according to the modified Israel-Scheme of Heiss et al. Using the combined treatment (resection of tumor, radiotherapy and polychemotherapy) a prolongation of survival time to 55 till 80 weeks is noticeable. The patients observed in our study survived on an average 79,8 weeks (operation and chemotherapy) resp. 94,7 weeks (operation, radiotherapy and chemotherapy). Special problems of the cytostatic therapy of malignant brain tumors are considered, among others in relation to the blood-brain-barrier and the tumorcell-kinetics; a further optimation of therapy is necessary.     

交腿皮瓣修复血栓闭塞性脉管炎的足底溃疡

为了探讨应用交腿皮瓣修复对侧血栓闭塞性脉管炎足底溃疡的临床效果,对2008年3月～2011年7月期间收治的8例血栓闭塞性脉管炎足底溃疡的患者进行研究,观察采用交腿皮瓣修复对侧足底渍疡的手术治疗效果。结果显示8例患者术后全部一期愈合,效果良好。因此,应用交腿皮瓣修复对侧缺乏有效动脉血供的血栓闭塞性脉管炎足底溃疡是一种简单...     

阿霉素对心肌影响的实验研究

阿霉素(adriamycin,ADM)临床上广泛用于多种恶性肿瘤的治疗,但ADM可致严重的心肌毒性。目前许多肿瘤疾病采取先化疗后麻醉、手术治疗方案,化疗药对心肌的损伤并没有引起临床医生的足够重视,尤其是麻醉科医生,我们应慎重考虑阿霉素等化疗药对心肌的影响,保障围手术期的安全。     

城中村人群健康:城市化进程中不可忽视的问题

城中村现象是中国城市化进程中出现的新的普遍性现象,它既区别于现代城市,又不同于传统的村落,引发了不同于其他社区人群的健康问题.论述了城中村的特殊性质,分析了当前城中村人群健康问题,并据此提出开展健康教育,保障人群健康建议.     

外周型原始神经外胚层肿瘤1例

原始神经外胚叶肿瘤是一种罕见的、起源于原始神经上皮的恶性小圆形细胞肿瘤,具有多方向分化能力,可发展为神经元性的、胶质细胞性的、甚至间叶组织性质的肿瘤.根据发病部位将其分为中枢型和外周型两种,中枢型多发于脑和脊髓,外周型多见于胸壁、四肢,发生于脊柱者少见.本文就外周型原始神经外胚层肿瘤1例做病例报道,总结该类肿瘤的特点,肿瘤密度/信号不均匀,轻至中度强化,预后差,临床治疗手段主要为外科手术辅以放化疗,术前行增强CT对手术可切除性评估非常有价值.     

Cognitive factors in the concurrent differential conditioning of eyelid and skin conductance responses

The objectives of the study were to (1) determine if differential conditioning of eyelid responses ocurs only among subjects who accurately report knowledge of the CS-UCS relations, (2) assess whether differentially conditioned eyelid responding occurs only after the initial accurate interrial report, and (3) explore characteristics of differentially conditioned skin conductance responses (SCRs) obtained in an eyelid conditioning paradigm, with special attention to whether eyelid and SCR conditioning are similarly related to the subjects’ knowledge of the stimulus relations. Fifty-one male subjects were administered 80 differential eyelid conditioning trials, the CSs consisting of the 1,200-msec illumination of slides containing either grammatically correct or grammatically incorrect phrases. Significant differential SCR and eyelid conditioning was obtained for both V- and C-form eyelid responders, but only for subjects who accurately reported the CS-UCS relations. The initial appearance of SCR and eyelid differentiation was related within the trial sequence to subjects’ recognition of the stimulus relations. Eyelid and SCR conditioning were related similarly to knowledge of the stimulus relations, the exception being that subjects who recognized the stimulus relations late in the trial sequence did not develop reliable eyelid differentiation.