以腓动脉肌皮支为蒂的小腿外侧皮瓣修复手部创面

自顾玉东等(1985)以腓动脉为血管蒂的小腿外侧皮瓣修复软组织缺损以来,该皮瓣在临床已得到一定应用.由于切取该皮瓣体位不舒适,需牺牲下肢一条主要动脉,偶有胫后动脉、腓动脉共干,限制了该皮瓣的临床应用.我院1996年10月～2002年12月,采用逆行法解剖分离以腓动脉肌皮支为血管蒂的小腿外侧皮瓣游离移植修复手部创面19例,疗效满意,报告如下.     

游离股后侧穿支动脉皮瓣的解剖学研究及临床应用

目的 通过研究股后侧区的穿支动脉解剖特点和分布规律,设计切取以该区域穿支血管为蒂的游离皮瓣. 方法 利用新鲜尸体8具乳胶加铅灌注标本对股后侧区域内血管解剖结构尤其是穿支血管走行及分布进行研究,筛选口径、长度及走行适合做吻合血管蒂的穿支.临床上实际应用7例,均为穿支游离皮瓣,皮瓣大小:3 cm×8 cm～8 cm×16 cm,第一穿动脉皮瓣3例,第二穿动脉皮瓣2例,第三穿动脉皮瓣1例,第一穿动脉上无名穿支皮瓣1例. 结果 解剖研究发现,该区域适合做游离皮瓣的穿支有4～5条,平均外径0.4～2.8 mm;平均长度2.2 ～9.0 cm.7例穿支皮瓣均成活,随访5～11个月,穿支皮瓣修复创面后皮肤弹性好,皮瓣薄,外形美观. 结论 股后侧区的穿动脉分布较多、口径长度适宜,以该区域设计切取穿支血管游离皮瓣部位隐蔽、可直接缝合供区,临床应用效果满意.     

游离足内侧皮瓣的解剖研究与临床应用

目的 改进和完善以足底内侧动脉深支的内侧支供血的游离足内侧皮瓣的设计和应用技术。方法 基于８只足标本的解剖观测结果,制定独特皮瓣设计方案,应用游离足内侧皮瓣修复手部皮肤缺损４例,改进如下：皮瓣静脉回流选用大隐静脉,缝合皮瓣的隐神经带,利用动脉蒂的伴行静脉与受区动脉吻合,挽救发生动脉危象的皮瓣等。结果 ４例皮瓣均完全存活,效果良好。结论 皮瓣设计例题,将该皮瓣的深静脉动脉化是动脉危象的有效补救措施,     

以颞浅血管为蒂的耳后乳突区皮瓣应用的研究

耳后乳突区皮瓣一直被认为是修复颜面部位最好的供皮区。本文报告对该皮瓣以颞浅血管为蒂作远位移植以修复颜面畸形的研究。 一、应用解剖的研究:①对9具尸体17侧颞浅动脉灌注染料后解剖,发现颞浅动脉在     

足背三叶皮瓣的研究进展

胫前动脉延伸足背动脉分出跗外侧动脉、跗内侧动脉及第1跖背动脉，并供应足背内外及第1跖背区域皮肤血运。许亚军1997年首次在此解剖基础上设计足背三叶分皮瓣修复多个手指皮肤软组织缺损。现分别阐述跗外侧皮瓣、跗内侧皮瓣及第1跖背皮瓣的应用解剖基础。     

上唇动脉逆行鼻唇沟岛状皮瓣的临床应用

目的 探讨扩大鼻唇沟皮瓣旋转范围的新术式。方法 解剖上唇动脉的走行与观察鼻唇沟区域皮肤血供关系，设计上唇动脉逆行岛状鼻唇沟皮瓣移转修复面部软组织缺损。结果 6例皮瓣均一期成活，外形满意。结论 以上唇动脉为蒂的逆行鼻唇沟岛状皮瓣扩大了鼻唇沟皮瓣的旋转范围。该皮瓣血管蒂恒定，血供丰富，有较好的应用价值。     

指固有动脉背侧支岛状皮瓣修复指端皮肤缺损

指端皮肤缺损是手部常见损伤,常用腹部皮瓣、指固有动脉逆行岛状皮瓣或游离趾腹皮瓣等修复,但各种皮瓣均有其优劣之处[1].指固有动脉背侧支岛状皮瓣是一个较新型皮瓣,解剖方便、不损伤手指主要血管[2].我们自2003年2月至2008年10月应用该皮瓣修复指端缺损效果满意.     

面动脉穿支皮瓣解剖研究及临床应用进展

目的总结面动脉穿支皮瓣(facial artery perforator flap,FAPF)解剖及临床应用研究现状及进展。方法广泛查阅国内外FAPF解剖研究和临床应用的相关文献,并进行整理、分析和总结。结果面动脉穿支(facial artery perforator,FAP)解剖位置较恒定,其中口角附近面动脉发出的穿支最多,每支FAP均有2支静脉与其伴行。FAPF分为蒂位于下颌缘上、下两种,主要用于中面部缺损的修复;下颌缘以上以面动脉主干穿支皮瓣应用最多,内眦动脉穿支皮瓣及鼻旁动脉穿支皮瓣也逐渐得到推广;下颌缘以下以颏下动脉穿支皮瓣应用最广泛。在临床中,面动脉主干及其分支穿支皮瓣的应用都能获得良好的术区功能和面部外观效果。结论FAPF已成为修复口周和鼻翼等缺损的首选皮瓣,具有成活率高、设计灵活、质地薄、与面部其他部位质地及颜色相近、手术操作相对简便等优点。皮瓣制备中关于保留血管蒂周围组织对于皮瓣静脉回流的影响尚需进一步研究。     

胫后动脉筋膜皮支小腿内测皮瓣的临床应用

目的：研究以胫后动脉的分支胫骨滋养动脉所发出的筋膜皮支为蒂的小腿内侧皮瓣在解剖，临床应用的可行性。方法：对６例手足急性外伤性皮肤缺损或疤痕挛缩整形患者以该游离皮瓣进行修复。结果。６例患者均获得了满意疗效。结论：该皮瓣具有皮下脂肪薄，皮肤质量好，避免牺牲胫后动脉主干等优点，适合于修复手足重要功能区域的皮肤缺损。     

带筋膜蒂的指动脉逆行岛状皮瓣的临床应用

指动脉逆行岛状皮瓣是修复手指软组织缺损的一种有效方法,由于该皮瓣的解剖特点,术后常常出现不同程度的静脉回流障碍.本院自开展手外科以来,先后收治20例,笔者在设计该皮瓣时加带一筋膜蒂,以改善皮瓣的静脉回流,临床应用取得良好的效果.     

内镜除皱术26例报告

目的：总结回顾利用内镜除皱使面部年轻化的手术经验。方法：从1994年开始到2000年底分别利用国产和进口整形外科用内镜和关节镜开展额颞部除皱手术26例,采用额部小切口,在额部、眶周和头顶进行广泛的帽状腱膜下和骨膜下分离,采用缝线和螺钉固定向后滑行的头皮和额部皮肤。结果与结论：全部患者取得了比较好的效果,无并发症发生,与传统的开放除皱术相比较,内镜除皱技术具有解剖清晰、创伤小、出血少、恢复快等优点。本方法适用于轻度和中度的额颞部和眶周皱纹的处理。     

THE ORIGIN OF INVERTED WAVEFORMS IN THE REFLECTION PLETHYSMOGRAM

In reflection plethysmography at the finger inverted pulsewavesare sometimes observed, especially when, during anaesthesia,arterial pressure is measured in the same arm with an inflatablecuff. The origin of this inversion is investigated in two seriesof experiments with volunteers. In the first series of experimentsthe influence of the pressure in the upper arm cuff was investigatedand in the second series the influence of the application pressureof the transducer on the finger. It is concluded that inversionof the pulse waves of the plethysmogram is a local phenomenonrestricted to the reflection method. It is caused by a relativeincrease in the optical density of the surrounding tissue inrelation to the arterial vessels. In the finger it is broughtabout by venous engorgement and it is dependent on the appliedpressure.     

AN IMPROVED ELECTRONIC SIMULATOR FOR THE STUDY OF THE DISTRIBUTION OF ANAESTHETIC AGENTS

Formerly, analogues usedto study the distribution of anaestheticagents have utilized electrical capacitors and resistors torepresent specific physiological volumes and flows. Such modelsare limited in application because the measuring devices disturbthe parameters under observation. This report presents an accountof the development of an improved model which not only permitsthe measurement of stored charges on capacitors (gas tensions)without loading but also more faithfully incorporates the physiologicalmechanisms involved in intrapulmonary gas exchange. Its developmentencouraged a more penetrating analysis of the physiologicalsystem and enabled a fuller comprehension to be gained of thefactors governing anaesthetic management. Preliminary utilizationof this analogue has indicated new concepts of anaesthetic redistributionin the various body compartments.     

带血管肌腱移植的临床应用综述

目的 明确带血管肌腱移植的适应证,评价现有各供区的优缺点。方法 回顾近年来,带血管肌腱移植的实验研究和临床应用,总结包括带足背早上趾肌腱和带桡动脉掌长肌腱等现有各供区的解剖特点和临床用途。结果 带血管肌腱移植适用于血运条件较差的受植床,具有愈合快,粘;宫轻的优点,但现有各供腱均有供区损伤较大的缺点。结论 带血管肌腱移植的应用前景取决于探索新供区。     

超声波在面颈部瘢痕康复中的应用

目的：探讨超声波对面颈部瘢痕的处理效果。方法：应用超声波治疗机,对49例面颈部外伤、手术、烧伤后瘢痕进行治疗。结果：49例创伤后不同时期与形状的瘢痕,应用本法治疗,治愈39例,有效10例,总有效率达100％,结论：超声波对创伤后瘢痕预防和治疗效果佳,在创伤愈合后,接受超声波康复治疗越早效果越好,超声波治疗是创伤早期复康的理想方法之一。     

MINIMAL ACCESS SURGERY OF THE GASTROINTESTINAL TRACT

In the last 5 years, surgery of the gastrointestinal tract has been revolutionized by the application of minimal access techniques. Following initial enthusiasm, which suggested that most abdominal surgery would ultimately be done via this approach, there is now need for appraisal and evaluation of the role of a number of these minimal access techniques when compared with open surgery. Undoubtedly, the most convincing and total application of minimal access techniques has been in the treatment of gallstone disease. Laparoscopic cholecystectomy is now standard therapy for cholelithiasis and endoscopic sphincterotomy with stone extraction is standard therapy for choledocholithiasis. Where the two conditions co-exist, operative cholangiography allows for the recognition of stones in the bile duct at the time of laparoscopic cholecystectorny and provides the potential avenue for treatment. Most major centres also would recommend routine operative cholangiography during laparoscopic cholecystectomy for the detection of unsuspected stones and as an extra safety procedure in the early identification of potential bile duct injuries. The efficacy of laparoscopic appendicectomy and laparoscopic or thoracoscopic treatment of achalasia of the oesophagus also is supported by data from well conducted prospective studies. Doubt remains regarding the advantage of laparoscopic surgery over other approaches in the treatment of gastro-oesophageal reflux, inguinal hernias and jaundice due to non-resectable cancer. For all three of these conditions, prospective trials are underway and the results of these trials should be assessed prior to widespread adoption of the laparoscopic techniques. The application of minimal access surgery for colorectal procedures, peptic ulcer therapy, liver and pancreatic surgery or surgery of the spleen and adrenal has been demonstrated; however, its ultimate place awaits the further development of instruments and a demonstration of efficacy over open approaches before it can be recommended for use in prospectively conducted comparison trials.     

THE USE OF ELECTRICAL IMPEDANCE TECHNIQUES FOR THE MONITORING OF RESPIRATORY PATTERN DURING ANAESTHESIA

Details are given of the results obtained from anaesthetizedpatients when an electrical impedance pneumograph was used tocontinuously monitor respiratory pattern. The method was convenientto use, and faithfully followed changes in pattern. It is necessaryto calibrate each patient initially against a spirometer orsyringe. The impedance pneumograph is particularly useful, whena number of physiological signals are being displayed on a multichannelrecorder, and it has application in patient monitoring.     

雌二醇抗肝纤维化的实验性研究

目的 探讨雌二醇对大鼠肝纤维化的影响及机制，以便对肝纤维化的治疗提供一种新的途径。方法 CCL4诱导大鼠肝纤维化动物模型，观察雌二醇对大鼠肝纤维化形成过程中血清AST、ALT、HA、CIV，以及肝组织胶原纤维沉积的影响。结果 雌二醇降低AST、ALT，HA、CIV及肝组织胶原纤维组织的沉积（P〈0．05）。结论 雌二醇有抑制大鼠肝纤维化进展的作用。     

皮肤环形缝扎术在整形外科中的应用

目的：探讨如何应用环形缝扎术关闭皮肤缺损创面。方法：用不可吸收缝线环绕创缘皮下或皮内缝合一周,收紧缝线打结将伤口缩拢关闭。结果：该法应用于32例共41处创面,术后形成瘢痕短小,外形好。结论：本法封闭创面简便、快速,效果好,可作为整形外科的一项基本技术应用。     

兔VX2肝癌模型的建立及纳米微泡造影剂在模型早期检测中的应用

目的 通过建立一个原发性或转移性兔肝癌模型并应用纳米微泡造影剂对肿瘤进行早期监测,探讨纳米材料在肝癌超声诊断中的应用.方法 通过肿瘤组织块接种法制备兔肝癌模型并利用门静脉插管注射微泡造影剂对比增强显影.结果 模型建立后检测原位成瘤率为83.3％,采用5 MHz的发射频率,肝内主要血管及瘤块1分钟内显影得到增强.结论 靶...