假体隆乳术后形态不佳的矫治

目的探讨假体置入隆乳术后形态不佳的原因和矫治方法。方法根据临床表现将乳房不佳分为5种类型：圆球型、上部膨隆型、下坠型、单侧双乳型及不规则型。通过松解纤维囊、纤维囊折叠缝合、重新分离隆乳腔隙、更换假体、乳房悬吊术等方法，进行矫治再次隆乳术。结果经过至少6个月随访观察，本组106例均获得了满意的手术效果。结论隆乳术后乳房形态不佳主要与假体体积过大、腔隙分离不到位、假体移位、乳房下皱襞过度分离、纤维囊挛缩及引流、包扎位置不当等因素有关，针对不同原因实施相应的手术方法矫治，能够获得满意的手术效果。     

包膜囊上再置乳房假体隆乳术

目的探究隆乳术后包膜囊挛缩的手术治疗方法。方法采用原切口(腋窝顶或乳房皱襞下)，对隆乳后包膜挛缩者采用包膜囊保留并在其浅层再置人假体的方法进行治疗。结果治疗12例14侧乳房包膜囊挛缩症均取得良好效果。结论保留挛缩的包膜囊并在其浅层置人假体的乳房假体包膜囊挛缩治疗术具有创伤小、出血少、操作简便、安全性高、复发率低、并可通过腋窝顶小切口完成等优点，是治疗乳房假体包膜囊挛缩的较好方法。     

隆乳术并发症的超声影像学诊断

目的 探讨隆乳术后并发症的二维超声和彩色多普勒超声的影像学表现及临床意义。方法 对21例隆乳术后并发症行7．0～11．0MHz的高频二维超声及彩色多普勒超声检测，全部检测所见均得到手术证实。结果 隆乳术后出现假体折叠、移位、包膜挛缩、硬化、硅胶囊破裂渗漏等，均有较特异的二维超声图像，其邻近组织有少量或较多的彩色血流信号和多普勒频谱表现。结论 超声影像学检查是隆乳术并发症的可靠检测手段，具有较高的临床诊断价值。     

局部浸润麻醉在隆乳术中的应用

目的 探讨局部浸润麻醉方法在隆乳术中的应用效果。方法 将2％利多卡因20ml加0．5％布匹卡因5ml配制成120ml局部麻醉液，采用局部浸润麻醉方法为568例受术者行隆乳手术，根据胸部神经、肌肉的解剖特点，行合理的分布药量和准确有效的注射。结果 568例隆乳术者，局部浸润麻醉方法均有效，且麻醉效果良好。无一例受术者因分离腔穴时产生疼痛而影响手术操作或停止手术。结论 局部麻醉效果理想可靠，方法简单易行，适用于任何术式的隆乳术。而在分离腔穴时产生的疼痛主要是因注射层次不当和药量分布不均所致。与麻醉方法无关；其麻醉效果与假体置入层次或乳腺胸大肌是否发达无因果关系。     

膨体聚四氟乙烯假体在隆鼻术中的应用

目的介绍膨体聚四氟乙烯(e-PTFE)假体在隆鼻术的应用体会。方法自2004年3月至2005年6月,采用国产e-PTFE假体为87例求美者行隆鼻术,并对假体的设计、雕刻、制作及置入时的注意事项进行介绍。结果随访其中的81例求美者3~12个月,3例求美者于术后7d时发现鼻背部有轻度不对称,经手法按压得到矫正;1例求美者术后3d因污染了术区造成感染,将假体取出,6个月后重新隆鼻,效果较好;余77例求美者效果满意。结论采用国产e-PTFE假体行隆鼻术,特别是修复鼻尖低平者具有安全、手感好、外形逼真、并发症少等优点。e-PTFE是一种较理想的隆鼻材料。     

Alloplastic injectable biomaterials for soft tissue augmentation: a report on two cases with complications associated with a new material (DermaLive) and a review of the literature

A wide variety of biological and alloplastic injectable biomaterials are available for soft tissue augmentation, but the ideal material has not yet been discovered. Biological materials such as collagen and hyaluronan yield temporary results, while injectable alloplasts are apt to cause varying degrees of foreign body reactions that may result in lumps and chronic inflammation.We present two cases (one is the first filed case in the world) of migratory subcutaneous inflammatory masses secondary to injection of acrylic hydrogel (DermaLive), which is an alloplastic biomaterial recently introduced into the market in Europe. Histology revealed foreign body reaction to acrylic hydrogel with granuloma formation containing multinucleated giant cells. Following this, further reports on complications have been reported elsewhere in Europe. The use and development of injectable materials, as well as alternative methods and future directions are reviewed.     

静脉镇静镇痛技术在隆乳术中的临床应用

目的介绍静脉镇静镇痛技术在局部麻醉隆乳术中的应用效果和体会。方法将606例ASAⅠ、Ⅱ级隆乳术患者分为四组,分别采用负荷剂量后持续输注异丙酚-芬太尼(P-F组,n=56)、咪唑安定-芬太尼(M-F组,n=130)、异丙酚-芬太尼-氯胺酮(P-F-K组,n=68)或咪唑安定-芬太尼-氯胺酮(M-F-K组,n=352)复合液的给药方法,调整注速维持镇静深度在改良的警觉/镇静评分2或3分。结果四组患者术中的镇静镇痛效果均满意,呼吸循环功能基本稳定,均在停药3~10min后清醒,但P-F-K组和M-F-K组患者的术中疼痛发生率及程度显著低于P-F组和M-F组。术后随访所有患者均对麻醉效果满意,仅P-F组和P-F-K组分别有11例和5例患者有模糊术中记忆。结论镇静镇痛技术是适用于隆乳局部麻醉手术简单、安全有效的理想麻醉方法,复合使用小剂量氯胺酮能明显减少术中疼痛的发生率,其中以咪-芬-氯复合镇静镇痛的术中疼痛和记忆发生率最低,程度最轻,是适于该手术的最佳镇静镇痛方法。     

固体硅胶隆鼻术后感染排异的原因与预防探讨

感染及排异是固体硅胶隆鼻术较为严重的并发症。其发生原因主要在于手术适应证掌握不当；硅胶假体的质量不过关，假体的修雕成形不佳，假体消毒处理不严；手术操作及术后处理欠妥等。提出了加强术前体检及适应证的掌握，选择质量过关的硅胶假体，努力提高术者的审美及专业技术水平，设计修雕成形出恰当的假体，并注意规范假体的消毒处理，这都可有效减少感染及排异并发症的发生。强调手术操作时尽量减少局部组织的损伤，勿剥破鼻部的皮肤及粘膜，并做好术后的处理及护理，这同样也是减少感染排异并发症的关键。     

隆乳术后27例取除假体者原因分析

通过对隆乳术后27例取除假体者的原因进行分析,进一步揭示了目前隆乳术中仍存在的某些不足,发现术后感染、疼痛、假体破裂或外露、包膜挛缩、病人心态失衡等都是造成假体取出的直接原因。认为采取高质量的假体胸大肌下间隙隆乳是降低并发症提高隆乳术质量的关键。     

Drotaverine hydrochloride for augmentation of labor.

OBJECTIVES: To study the use of drotaverine hydrochloride for acceleration of labor and relief of labor pains. METHODS: In this double-blind placebo-controlled randomized study, 100 primigravidas in uncomplicated spontaneous labor at term were given drotaverine hydrochloride or placebo (distilled water) intramuscularly. Labor events, including pain (assessed by a visual analog scale and a verbal rating scale), neonatal outcome, and side effects of the drug were recorded. Student's t-test was used for analysis. RESULTS: Forty-four patients in the drug group and 40 in the placebo group had complete data for analysis after decoding. In drotaverine group, there was a mean 15% reduction in the duration of the first stage of labor and a mean 19% reduction in the second stage. The maximum shortening of the first stage (28%) was observed when drotaverine was administered when cervical dilatation was 4 cm (P=0.044). There were no adverse fetal effects, but atonic postpartum hemorrhage was more common in the drotaverine group. There was no relief of pain with the drug except in the fourth stage of labor. CONCLUSIONS: Drotaverine hydrochloride is safe and effective in accelerating labor, but not effective in lessening labor pain.