矩形瓣成形术治疗严重内眦赘皮

我院自１９９０年以来，引用、改进矩形瓣成形术，对严重内眦赘皮１４例２６个内眦进行整复，取得了良好的效果。文中阐述了手术设计、方法及本术式的优点和注意事项，并与其它常规术式做了比较，认为矩形瓣成形术是一种较为理想的严重内眦赘皮整复法。     

矩形瓣成形术治疗严重内眦赘皮

我院自1990年以来,引用、改进矩形瓣成形术,对严重内眦赘皮14例26个内眦进行整复,取得了良好的效果。文中阐谜了手术设计、方法及本术式的优点和注意事项,并与其它常规术式做了比较,认为矩形瓣成形术是一种较为理想的严重内眦赘皮整复法。     

先天性小眼症的手术治疗

采用手术治疗先天性小眼症。通过矩形瓣成形术矫正严重的内眦赘皮，并缩小内眦间距离，同时行外眦开大术。临床报告１５例，其中１０例采用矩形瓣法，效果良好。矩形瓣成形术是治疗先天性小眼症严重内眦赘皮的一种良好的方法。     

先天性小眼症的手术治疗

采用手术治疗先天性小眼症。通过矩形瓣成形术矫正严重的内眦赘皮，并缩小内眦间距离，同时行外眦开大术。临床报告１５例，其中１０例采用矩形瓣法，效果良好。矩形瓣成形术是治疗先天性小眼症严重内眦赘皮的一种良好的方法。     

重睑术同期矫正内眦赘皮的新术式探讨

目的：探索重睑成形术同期行内眦开大术的新术式。方法：采用常规重睑成形术切口，在内眦赘皮处设计新的与重睑成形术切口相连接的上睑内侧单“Z”成形＋去除一个三角瓣的新术式。对112例（224只眼睛）就医者进行手术，并进行为期6个月以上的随访。结果：对随访的就医者的重睑形态和内眦部形状进行评估，重睑基本为平行性重睑，内眦已完全敞开，赘皮消失，手术效果满意。结论：本术式能充分矫正内眦赘皮（逆向内眦赘皮除外），术后形态良好，是一种效果稳定，结果满意的术式。     

七瓣成形与五瓣成形的应用

五瓣成形术与七瓣成形术均利用局部有限的皮肤组织松解瘢痕挛缩。我们分别于１９８８年至１９９４年运用五瓣成形术整复瘢痕挛缩１９例，内眦赘皮７例；七瓣成形术整复瘢痕挛缩１２例，均获得满意效果。本文就手术设计、原理、操作、适应证进行比较分析，得出：①两者几何学上有区别，并认为七瓣成形术由五瓣成形术演变而来；②理论计算与临床运用表明七瓣成形术后延长率大于五瓣成形术，同样条件下七瓣成形松解瘢痕挛缩比五瓣成形彻底；③五瓣成形较适用于如腋、虎口处蹼状瘢痕，以及内眦赘皮的整复；七瓣成形较适用于“蹼”狭小的瘢痕挛缩如指蹼瘢痕挛缩及主轴需延长较多者如手指掌侧瘢痕挛缩的整复。     

皮肤三角瓣去除加内眦韧带缩短法矫正内眦赘皮

目的探讨内眦赘皮矫正的最佳手术方法。方法采用了"Z"成形术式,"Y-V"法及皮肤三角瓣去除加内眦韧带缩短法矫正内眦赘皮。结果本组43例,采用了"Z"成形术式和"Y-V"法矫正的内眦赘皮12例中4例瘢痕明显,5例内眦间距重新增宽,采用皮肤三角瓣去除加内眦韧带缩短法31例中术后均未发生血肿、感染、皮肤坏死等并发症。结论"Z"成形术式,"Y-V"法都有不同程度的瘢痕遗留和皮瓣坏死,部分内眦间距重新增大,而皮肤三角瓣去除加内眦韧带缩短法切口隐蔽,外观无瘢痕,避免了皮瓣坏死和内眦间距重新增宽的弊端。     

旋转V形瓣内眦赘皮矫正联合切开重睑成形术

目的探讨旋转V形瓣内眦赘皮矫正联合切开重睑成形术的临床效果。方法对103例内眦赘皮患者,设计一尖端向下的V形瓣,向外旋转至内眦上方,矫正内眦赘皮,同时联合切开重睑成形术。结果所有患者术后获随访3~12个月,均未见内眦部明显瘢痕,内眦及重睑形态均良好,效果满意。结论采用旋转V形瓣内眦赘皮矫正联合切开重睑成形术,可获得较好的术后效果,值得临床推广应用。     

矩形皮瓣法联合重睑成形术矫正单睑内眦赘皮

目的 探讨矩形皮瓣法联合重睑成形术矫正单睑内眦赘皮的方法及其临床疗效.方法 根据内眦赘皮的解剖学特点,针对内眦部相对短缺的皮肤和眼轮匝肌的异常结构,设计矩形皮瓣,矫正内眦赘皮,同期设计重睑线,行重睑成形手术.结果 对所有患者随访4～10个月,新内眦成形良好,瘢痕不明显,睑裂变长,重睑线形态满意,眼外观自然.结论 对于内眦赘皮单睑,矩形瓣法联合重睑成形术是一种效果确切、瘢痕隐蔽的方法.     

严重反向型内眦赘皮的改进矩形瓣修复12例报告

反向型内眦赘皮是内眦赘皮的一种类型。 1992年以来我院对Ｈｙａｋｕｓｏｋｕ和Ｆｕｍｉｉｒｉ之矩形瓣法[1] 作调整改进 ,用以整复严重的反向型内眦赘皮 ,报告如下。一、手术方法1.设计 :参考矩形瓣法之基本设计 ,将三角瓣Ｔ瓣设计向上睑部旋转。取平视时瞳孔中央与鼻背中线的中点为新内眦点ｎ ,取赘皮中点为ｍ。ａｂ为ｍｎ中垂线 ,长度为其一半。设计ｃ、ｄ两点于赘皮里面皮肤距边缘 2ｍｍ处 ,并使角ｃａｂ与角ａｂｄ成 85° ;此时ａｃ、ｂｄ略长于边长ａｂ2ｃｍ。再设计ｂｅ、ｅｆ等长于ａｂ ,角ａｂｅ为 45° ,角ｂｅｆ约 5 8°(图 1)。…     

Practical maneuvers in abdominal surgery

Good anesthesia is essential to proficient surgery. The advantages of certain operative positions and incisions have been emphasized. Particular stress has been placed upon the importance of minimizing surgical trauma and methods of accomplishing this have been suggested. A few anatomical points of considerable importance and not generally appreciated have been restated. A number of practical maneuvers that have been found helpful in surgery of the abdomen have been described.     

Surgical treatment of posttraumatic cystic and tethered spinal cords

Posttraumatic syringomyelia as a cause of progressive neurologic deterioration has been well described. More recently, the noncystic posttraumatic tethered cord has been associated with identical progressive neurologic deterioration. A retrospective analysis of patients treated surgically with spinal cord untethering and/or cyst shunting to arrest a progressive myelopathy from a posttraumatic tethered and/or cystic cord was performed. Emphasis was on outcome using the American Spinal Injury Association (ASIA) sensory and motor scoring systems. During an 18-month period from May 1993 to December 1994, 70 patients with spinal cord injury were operated upon for tethered and/or cystic spinal cords because of a progressive myelopathy and deteriorating ASIA sensory/motor scores. Fifty-nine patients had follow-up data 1 year postoperatively. At the 1 year follow-up, there was small improvement in light touch sensory scores (0.67 points), pinprick scores (1.3 points), and motor scores (0.41 points) demonstrating that the progression of the myelopathic process was arrested. Thirty-four of these 59 patients had no previous surgery to their spinal cords. At 1 year follow-up, light touch scores improved on average 2.38 points, pinprick scores 3.88 points (p < 0.05), and motor scores 1.47 points, suggesting better outcome with first-time surgery. Of this latter group, 64.3% regained a lost function, 62.5% saw improvement in spasticity, 55.6% had substantial improvement in neurogenic pain, and 95.8% felt that surgery prevented further neurologic deterioration.     

Surgical Treatment of Posttraumatic Cystic and Tethered Spinal Cords

Abstract

Posttraumatic syringomyelia as a cause of progressive neurologic deterioration has been well described. More recently, the noncystic posttraumatic tethered cord has been associated with identical progressive neurologic deterioration.

A retrospective analysis of patients treated surgically with spinal cord untethering and/or cyst shunting to arrest a progressive myelopathy from a posttraumatic tethered and/or cystic cord was performed. Emphasis was on outcome using the American Spinal Injury Association (ASIA) sensory and motor scoring systems.

During an 18-month period from May 1993 to December 1994, 70 patients with spinal cord injury were operated upon for tethered and/or cystic spinal cords because of a progressive myelopathy and deteriorating ASIA sensory/motor scores. Fifty-nine patients had follow-up data 1 year postoperatively. At the 1 year follow-up, there was small improvement in light touch sensory scores (0.67 points), pinprick scores (1.3 points), and motor scores (0.41 points) demonstrating that the progression of the myelopathic process was arrested. Thirty-four of these 59 patients had no previous surgery to their spinal cords. At 1 year follow-up, light touch scores improved on average 2.38 points, pinprick scores 3.88 points (p < 0.05), and motor scores 1.47 points, suggesting better outcome with first-time surgery. Of this latter group, 64.3% regained a lost function, 62.5% saw improvement in spasticity, 55.6% had substantial improvement in neurogenic pain, and 95.8% felt that surgery prevented further neurologic deterioration.     

An evaluation of the use of retrospectively acquired preoperative AOFAS clinical rating scores to assess surgical outcome after elective foot and ankle surgery

The use of retrospectively acquired preoperative AOFAS rating scores in clinical research to assess the outcomes of elective foot and ankle surgery has not been validated. The data obtained utilizing this methodology may misrepresent the results and lead to spurious conclusions. This investigation compared preoperative AOFAS Ankle-Hindfoot scores obtained before and after surgery from patients who had undergone elective surgery to determine if retrospectively acquired scores match those collected prospectively. Only two out of 47 patients (4%) recalled identical AOFAS scores. The mean difference between the preoperative scores (preoperative score obtained after surgery minus preoperative score obtained before surgery) was -5.3 points. Fifteen patients (32%) had preoperative scores that differed by 20 points or more. Kappa statistics found little agreement among the five elements that comprised the two preoperative scores when responses obtained before and after surgery were compared to one another. The results suggest that preoperative clinical rating scores obtained after elective surgery are a poor predictor of the patient's preoperative condition and that studies which employ retrospectively acquired preoperative AOFAS clinical rating scores may overestimate the benefit of surgery.     

膨体聚四氟乙烯与固体硅胶隆鼻术后肿胀的临床分析比较

目的:临床分析比较膨体聚四氟乙烯和固体硅胶两种假体隆鼻术后的肿胀厚度消退速度,为医生与就医者选择膨体聚四氟乙烯或者固体硅胶假体提供临床资料依据。方法:将就医者分为膨体聚四氟乙烯假体组和固体硅胶假体组,运用面部三维重建技术,观察比较两组就医者在隆鼻术前、术后1天、术后3天、术后5天和术后7天肿胀厚度的变化。结果:隆鼻术后1~7天,无论是膨体聚四氟乙烯组还是固体硅胶组肿胀厚度都降低。术后1、3、5、7天比较膨体聚四氟乙烯组与固体硅胶组肿胀厚度,差异无统计学意义(P0.05)。结论:膨体聚四氟乙烯组与固体硅胶组隆鼻术后肿胀厚度消退速度趋于一致,无显著差异。从术后肿胀的角度告知医生和就医者,在隆鼻术时选择膨体聚四氟乙烯或者固体硅胶假体均可,在肿胀厚度消退速度方面的区别不大。     

Ultrasound-guided nerve block: brachial plexus block

Ultrasonographic guidance has been introduced as an aid to nerve localization, for brachial plexus blockade in the interscalene and infraclavicular regions. Ultrasound-guided interscalene approach and infraclavicular approach were established as an excellent method to provide good analgesia during surgery and relieve post-surgical pain after shoulder or upper arm surgery and forearm or hand surgery respectively. Single shot injection and continuous catheter approach in both nerve blocks were described together with clinical key points based on the ultrasound images.     

Robot-assisted thoracoscopic surgery: current status and prospects

The most favorable advantage of robotic surgery is the markedly free movement of joint-equipped robotic forceps under 3-dimensional high-vision. Accurate operation makes complex procedures straightforward, and may overcome weak points of the previous thoracoscopic surgery. The efficiency and safety improves with acquiring skills. However, the spread of robotic surgery in the general thoracic surgery field has been delayed compared to those in other fields. The surgical indications include primary lung cancer, thymic diseases, and mediastinal tumors, but it is unclear whether the technical advantages felt by operators are directly connected to merits for patients. Moreover, problems concerning the cost and education have not been solved. Although evidence is insufficient for robotic thoracic surgery, it may be an extension of thoracoscopic surgery, and reports showing its usefulness for primary lung cancer, myasthenia gravis, and thymoma have been accumulating. Advancing robot technology has a possibility to markedly change general thoracic surgery.     

Surgical strategy for spinal metastases

STUDY DESIGN: A new surgical strategy for treatment of patients with spinal metastases was designed, and 61 patients were treated based on this strategy. OBJECTIVES: To propose a new surgical strategy for the treatment of patients with spinal metastases. SUMMARY OF BACKGROUND DATA: A preoperative score composed of six parameters has been proposed by Tokuhashi et al for the prognostic assessment of patients with metastases to the spine. Their scoring system was designed for deciding between excisional or palliative procedures. Recently, aggressive surgery, such as total en bloc spondylectomy for spinal metastases, has been advocated for selected patients. Surgical strategies should include various treatments ranging from wide or marginal excision to palliative treatment with hospice care. METHODS: Sixty-seven patients with spinal metastases who had been treated from 1987-1991 were reviewed, and prognostic factors were evaluated retrospectively (phase 1). A new scoring system for spinal metastases that was designed based on these data consists of three prognostic factors: 1) grade of malignancy (slow growth, 1 point; moderate growth, 2 points; rapid growth, 4 points), 2) visceral metastases (no metastasis, 0 points; treatable, 2 points: untreatable, 4 points), and 3) bone metastases (solitary or isolated, 1 point; multiple, 2 points). These three factors were added together to give a prognostic score between 2-10. The treatment goal for each patient was set according to this prognostic score. The strategy for each patient was decided along with the treatment goal: a prognostic score of 2-3 points suggested a wide or marginal excision for long-term local control; 4-5 points indicated marginal or intralesional excision for middle-term local control; 6-7 points justified palliative surgery for short-term palliation; and 8-10 points indicated nonoperative supportive care. Sixty-one patients were treated prospectively according to this surgical strategy between 1993-1996 (phase 2). The extent of the spinal metastases was stratified using the surgical classification of spinal tumors, and technically appropriate and feasible surgery was performed, such as en bloc spondylectomy, piecemeal thorough excision, curettage, or palliative surgery. RESULTS: The mean survival time of the 28 patients treated with wide or marginal excision was 38.2 months (26 had successful local control). The mean survival time of the 13 patients treated with intralesional excision was 21.5 months (nine had successful local control). The mean survival time of the 11 patients treated with palliative surgery and stabilization was 10.1 months (eight had successful local control). The mean survival time of the patients with terminal care was 5.3 months. CONCLUSIONS: A new surgical strategy for spinal metastases based on the prognostic scoring system is proposed. This strategy provides appropriate guidelines for treatment in all patients with spinal metastases.     

Primary Malignant Tumours of the Mediastinum and Their Management

Primary malignant tumours of the mediastinum are difficult clinical problems in thoracic surgery from both diagnostic and therapeutic points of view. Three cases of malignant seminoma of the mediastinum have been documented, thus bringing the total number of cases reported in the literature to 78. A case of metastasis to the subcutaneous tissue in malignant thymoma has been documented. Because of the multiple-cell types of these tumours and their ill-defined extent due to involvement of adjacent structures,^ surgery is often difficult. Radiotherapy along with chemotherapy has a definite place in their management, either as a primary treatment in inoperable cases or as a supplement to surgery if the condition is operable