美容整形外科手术麻醉安全管理

正近年来我国整形美容手术数量增长迅猛,2009年国际美容整形外科学会统计结果显示,我国美容整形外科手术年量逾200万例,位居世界第3位。2014年调查结果显示,我国整形外科医师数量亦位居世界第3,估计全国美容整形数量超过450万例。整形美容手术最常见的5类手术包括:眼睑手术、吸脂手术、隆乳手术、脂肪移植手术、鼻整形手术。美容整形手术的麻醉安全管理特点美容整形手术的特点我国美容整形手术在公立医院     

整形美容与麻醉意外的护理探讨

<正>现代社会人对美的要求越来越高,在韩国、日本等国家进行整形美容相当普遍[1],受术者都希望安全、舒适、副作用少、危险性小、效果良好。近年来,国内外连续发生多起整形美容麻醉安全事件,暴露了整形美容行业中存在严重影响整形手术的麻醉医疗安全问题。在出现这些问题之后,深层原因是麻醉和麻醉护理问题,笔者从麻醉安全与麻醉意外的急救护理方面作进一步的分析与探讨,现将结果报道如下。1原因分析1.1术前检查不完善和不重视:由于一些整形美容机构担心顾客流失或放弃,利用冲动心理即刻安排     

关于开展以“中国医疗整形美容行业监管与发展”为主题的征文活动通知

为了配合将于2010年11月6-7日在京召开的"中国医疗整形美容行业监管研讨会"和"中国医疗整形美容行业发展高层论坛",中国整形美容协会决定,开展以"中国医疗整形美容行业监管与发展"为主题的征文活动。本次征文活动由《中国生物美容》杂志社承办,相关要求如下:     

妇科几项美容整形手术失误的剖析

妇科整形美容作为整形美容外科的一个分支，近年来发展迅速，很多整形美容院开展了妇科整形手术，越来越多的美容整形医师涉足该领域。广大女性对美好生活的向往和良好的求美的愿望，给妇科整形美容市场带来了巨大商机。然而，由于众多的非妇科医师进行妇科美容整形手术，致使存在很多问题和隐患。我们近年来接待很多来自全国各地曾接受过妇科整形美容手术而失败的患者，其中以阴道紧缩术、处女膜修复术和小阴唇塑形术问题最为多见，给患者造成经济负担和精神、心理、生理及肉体的痛苦。     

卫生部医管司关于委托中国整形美容协会研究起草《医疗整形美容机构连锁管理指导意见》的函

中国整形美容协会:你会《关于承办起草〈医疗整形美容机构连锁管理指导意见〉(征求意见稿)的请示》(中整协[2009]26号)收悉。随着社会经济的迅速发展,医疗整形美容行业发展迅猛,各种新技术、新材料应用广泛,非公有制医疗整形美容机构蓬勃发展,较好地满足了人民群众日益增长的相关需求。     

“美容整形诚信工程”实施办法

一、意义倡导行业自律,以德执业,塑造美容与整形行业的良好形象。二、参加对象1.机构:中国医师协会美容与整形医师分会单位会员。2.人员:中国医师协会美容与整形医师分会会员。3.相关生产企业:中国医师协会美容与整形医师分会企业会员单位。三、医疗美容与整形机构承诺诚信内容     

失败整形手术的修复终点站

背景：亚洲整形美容会议称整形手术“返工”多 在上海举行的第七届亚洲整形美容会议上，与会专家指出，目前无论是韩国还是中国，为数不少的整形手术都是修复性手术。我国整形美容手术的不满意率已高达5％，在国内整形美容界极具影响力的整形修复专家张宗学教授指出：相对于初次整形手术来说，修复手术难度更大，风险也更大，因此，整形消费者不要盲目追求做“日式整形”或“韩式整形”，而要根据自身特点谨慎选择，并在手术前与医生进行认真沟通，客观评价手术要求及术后效果。若第一次手术失败了，则要选择正规医疗机构进行修复，尽可能降低手术再度失败的风险。[编者按]     

第三届中国医疗整形美容行业 发展高峰论坛在京举行

由中国整形美容协会和国药励展联合主办的第三届中国医疗整形美容行业发展高峰论坛暨中国国际医疗整形美容产业博览会（ChinaAscetics＆PlasticsSurgeryExpo—CAPS）于2013年12月7日-8日在北京国际会议中心隆重举行。     

微创整形美容外科系列讲座（五）——鼻部微创整形手术

鼻位于面部中央,它的大小、高低,须和面部相协调,其外形的完整和合乎美学比例的结构对一个人的面貌极为重要,因此,鼻部手术对改变面部印象很重要。像李嘉欣、古天乐等明星,都拥有俊挺、秀气的鼻子。鼻美容整形手术经历了漫长的进程,尤其是近一个世纪以来,美容整形技术的迅速提高,鼻美容整形及其相关研究已成为相对独立的一个分支学科。目前,隆鼻术在我国美容整形手术中的数量位居第三。     

整形美容中常见的医学伦理学问题分析

整形美容行业是一个新兴产业，已成为中国第四大服务行业。整形美容技术是一种以提高审美 能力为目标，通过手术、医疗器械、药物等医疗技术手段，对人的外形进行重构和塑造的一种医疗技术。 虽然整形美容技术可以帮助众多求美者美实现华丽蜕变，但也可能会对受术者造成人身伤害、精神伤害及 经济伤害等安全性问题。上述问题引起了临床对整形美容技术的技术能力、技术目的及其技术后果的反 思。本文重点讨论了整形美容行业目前所面临的诸如整容目的歧化、技术所造成的精神损伤等医学伦理问 题，并对其原因进行分析，以期促进我国整容行业的进一步发展。     

关于做好美容外科进修医师工作的几点思考

随着社会的发展,物质生活水平的提高,人们对美的追求不断提升,大多数求美者希望通过医 学美学美容治疗进一步使自己的外观得以美化,各种医疗美容科、美容中心、美容医院纷纷建立,推动了 美容外科专业的迅速发展,掀起大量非美容专业毕业的外科医师进修美容热潮。为了提高进修质量,为医 美行业输送合格的医美人才,本文从当前美容外科现状、做好美容外科医师具备的条件等就如何做好美容 外科进修医生带教工作进行探讨,因材施教,正确引导,全面培训,以便能更好地帮助美容外科医师完成 进修工作,使其通过进修后真正融入医美行业,服务社会。     

Anticoagulation management in hip fracture patients on warfarin

The management of patients admitted with a fracture requiring surgery who are taking warfarin anticoagulation is unclear. We examined the anticoagulation management for 33 hip fracture patients on warfarin at the time of admission. Hospital course and complications were recorded on all patients. The mean INR on admission was 3.2 and prior to surgery 2.2. Eight patients (24%) had percutaneous cancellous screws for an intracapsular fracture regardless of the admission INR. In 21 (64%) patients, surgery was delayed whilst the INR came down, with an average delay of 72 h from admission to surgery. No specific treatment to lower the INR, other than wait and watch policy adopted in 11 (33%) of these patients. Pharmacological methods used to reduce the INR were fresh frozen plasma in nine cases, and intravenous Vitamin K in four patients. One patient died from post-operative haematemesis and three died from medical complications unrelated to the warfarin therapy. There were no wound haematomas or other bleeding complications. Delaying surgery whilst waiting for the INR to fall to acceptable levels may result in significant delays to surgery and we would recommend a more aggressive policy to enable earlier surgery.     

Aesthetic/Cosmetic Surgery and Ethical Challenges

Is aesthetic surgery a business guided by market structures aimed primarily at material gain and profit or a surgical intervention intended to benefit patients and an integral part of the health-care system? Is it a frivolous subspecialty or does it provide a real and much needed service to a wide range of patients? At present, cosmetic surgery is passing through an identity crisis as well as an acute ethical dilemma. A closer look from an ethical viewpoint makes clear that the doctor who offers aesthetic interventions faces many serious ethical problems which have to do with the identity of the surgeon as a healer. Aesthetic surgery that works only according to market categories runs the risk of losing the view for the real need of patients and will be nothing else than a part of a beauty industry which has the only aim to sell something, not to help people. Such an aesthetic surgery is losing sight of real values and makes profit from the ideology of a society that serves only vanity, youthfulness, and personal success. Unfortunately, some colleagues brag that they chose the plastic surgery specialty just to become rich aesthetic surgeons, using marketing tactics to promote their practice. This is, at present, the image we project. As rightly proposed, going back a little to Hippocrates, to the basics of being a physician, is urgently warranted! Being a physician is all that a “cosmetic” surgeon should be. In the long run, how one skillfully and ethically practices the art of plastic surgery will always speak louder than any words.     

整形与美容医疗器械临床试验风险管理

整形与美容行业发展迅速，医疗器械产业规模也在逐渐扩大。但我国现阶段医疗器械临床研究 管理方案尚需进一步完善，部分科研机构管理观念较弱，导致部分伪劣商品流入市场。本文主要总结整形 与美容医疗器械临床试验发展现状及存在的问题，并提出医疗设备临床研究和临床试验管理策略，以期 提升医疗器械临床研究人员对风险的认知，健全与完善整形与美容医疗器械临床试验风险的管理。     

应用功能性健康型态模式调查整形美容患者的护理需求

目的了解整形美容患者护理需求,为引导护理人员采取科学、规范的方法正确对患者实施健康评估,明确护理问题,为患者提供优质的护理服务提供参考。方法参考Gordon功能性健康型态评估模式,自行设计整形美容患者护理需求调查表,对76例接受整形美容手术的患者进行调查,其中修复整形患者39例,美容整形患者37例。结果修复整形患者最强烈的前3项需求是:压力-应对3.27±0.22、自我感知-自我概念2.98±0.51、认知-感知2.96±0.43;美容整形患者最强烈的前3项需求是:自我感知-自我概念3.69±0.47、角色-关系3.32±0.61、健康感知-健康管理3.01±0.42。患者对活动-运动、营养-代谢、排泄的护理需求最低。结论修复整形患者与美容整形患者总体护理需求均为中等水平。修复整形患者对压力与应对需求最高,排泄需求最低;美容整形患者对自我感知与自我概念需求最高,排泄需求最低。护士需评估患者个体需求,引导患者正确认识外表形象,重视对整形美容患者心理护理,关注患者的压力及睡眠问题。     

Is laparoscopic pyloromyotomy superior to open surgery?

Background: We set out to determine whether laparoscopic pyloromyotomy (LPM) is superior to open pyloromyotomy (OPM) in babies with hypertrophic pyloric stenosis (HPS). Methods: We performed a retrospective study of 36 LPM and 36 OPM. Both groups were comparable in terms of sex, age and weight on admission, and blood pH on admission and prior to surgery. In the LPM group, three trocars were used; in the OPM group, a small right upper quadrant transverse muscle-cutting laparotomy was carried out. Results: LPM produces a better cosmetic result, seems to produce less postoperative discomfort, and results in the absence of conversion in a shorter hospital stay. However, the duration of the operation was significantly longer (32 versus 18 min). Moreover, LPM clearly entailed more complications (three mucosal perforations against two, and two reoperations against none in the open group). Conclusions: The actual series does not favor the laparoscopic approach over the open one, in view of the relatively high complication rate. Babies who are operated laparoscopically, however, seem to have less postoperative discomfort, a shorter hospital stay, and a better cosmetic result. As we are confident that the complication rate and duration of the operation will drop with further experience, we will continue to do LPM. LPM is not easy and should only be carried out when substantial experience has been gained in the field of pediatric laparoscopic surgery. Received: 6 September 1997/Accepted: 28 October 1997     

Outcomes of facial cosmetic procedures

Facial cosmetic procedures lend themselves to outcomes studies in ways that traditional reconstructive procedures may not. The most important measures of outcome in facial cosmetic surgery are quality of life and patient satisfaction, in contrast to other, more objective measures such as complications or mortality rates. For this reason, outcomes research in facial cosmetic surgery deserves a special focus of attention. In this article, we review outcomes studies for the more common facial cosmetic procedures, discuss in depth what aspects of patient-related satisfaction have been quantified by these existing studies, and highlight the direction that future outcomes research projects may wish to follow. There exists an abundance of potential interesting areas of study in facial cosmetic surgery, and the application of outcomes research methodology to these realms may allow the facial plastic surgeon to better define the success or failure of each individual facial cosmetic surgery procedure.     

Delayed identification of skeletal injury in multisystem trauma: the 'missed' fracture

Delay in diagnosis of musculoskeletal injury in multiply injured patients may potentially lead to functional or cosmetic disability in survivors. In an 18-month prospective study to determine the incidence and spectrum of delayed recognition of skeletal injury at our Level I trauma center, delayed diagnosis of 39 fractures was made in 26 of 1,006 consecutive blunt trauma patients. The delay in recognition ranged from 1-91 days. Twenty-one (55%) of the fractures were not X-rayed at the time of admission, but nine (23%) fractures were clearly visible on admission films. Four (10%) fractures were missed because of technically inadequate X-rays, and five (13%) had adequate X-rays but could not be identified on admission films. In only two instances was a second anesthetic exposure required for operative therapy. For the patients in this series, the delay of fracture identification was not felt to contribute to additional long-term cosmetic, functional, or neurologic problems. Continued clinical and radiologic surveillance is required in multiply injured patients to prevent musculoskeletal diagnostic failure.     

Traumatic Spigelian hernia. Elective extraperitoneal laparoscopic repair

Traumatic Spigelian hernia is rare. These hernias are usually treated in the same admission through open surgery. We present a case of Spigelian hernia in a high anatomical location following injury, with a cutaneous lesion and preperitoneal hematoma. Delayed parietal repair was performed through extraperitoneal laparoscopy. Elective laparoscopic repair in this case avoided surgery in an injured area, providing clear cosmetic advantages to the patient. We describe a modification to the classical approach to facilitate access to high-lying Spigelian defects.     

Gasless endoscopic thyroidectomy via an axillary approach: experience of 30 cases

Surgery for thyroid disease requires skin incisions that can result in postsurgical problems such as prominent scars, adhesions, hypesthesia, and paresthesia in the neck. To overcome these problems we performed gasless endoscopic thyroidectomy via an axillary approach. Between May 2004 and April 2005, 30 patients underwent gasless endoscopic thyroidectomy via an axillary approach. The mean operating time was 126.8+/-32.4 minutes, and the mean length of hospital stay was 4.3+/-1.1 days. No cases required conversion to open surgery and none involved significant intraoperative complications. Three patients (10.0%) complained of slight hypesthesia or paresthesia in the anterior chest wall, and only 2 patients (6.7%) complained of discomfort while swallowing 4 months after surgery. All patients were satisfied with the cosmetic results. Gasless endoscopic thyroidectomy via an axillary approach is feasible and safe and provides excellent cosmetic results with a minimal degree of postoperative complaints.