77例舌部恶性肿瘤的临床分析

目的:探讨舌部恶性肿瘤的手术治疗意义及采用游离前臂皮瓣和胸大肌肌皮瓣同期修复舌缺损的临床效果。方法:回顾分析近几年皖南医学院附属弋矶山医院口腔医学中心收治具有完整病历记录的舌部恶性肿瘤77例。58例采用舌颈联合根治术,12例采用舌颌颈联合根治术,白斑、原位癌和透明细胞癌各1例行病灶扩大切除术,2例恶性淋巴瘤活检确诊后给予化疗及放疗治疗,2例鳞状细胞癌活检确诊后未治出院;14例同期即刻修复舌缺损,其中11例采用游离前臂皮瓣,3例采用胸大肌肌皮瓣;9例采用预防性气管切开术。结果:2例鳞状细胞癌未治;2例恶性淋巴瘤行化疗及放疗治疗;手术73例,1例术后3个月局部复发;14例同期即刻修复舌缺损,1例术后6个月死亡。结论:彻底切除原发灶及颈淋巴清扫是手术治疗舌部恶性肿瘤的关键,游离前臂皮瓣和胸大肌肌皮瓣是修复术后舌及舌根缺损的理想材料,可以取得良好的临床效果。     

黏骨膜-牙龈瓣在婴儿期单侧完全性腭裂修复中的应用

目的 探索完全性腭裂初期修复手术减少前部腭瘘发生的方法.方法 本院收治的非综合征性唇腭裂患者中,选取单侧完全性85例,在两大瓣后退加腭帆提肌重建修复的基础上,在硬腭前部设计蒂在鼻腔黏膜的黏骨膜-牙龈瓣,去除黏膜后瓦合缝合,严密关闭前部裂隙.结果 手术后3～6个月复查,85例患者术口愈合良好,无患者出现口鼻瘘.结论 运用黏骨膜-牙龈辫,可有效封闭完全性腭裂牙槽嵴裂隙处的口鼻腔通道,显著减少术后口鼻瘘的发生.     

浆肌瓣覆盖食管下半胃粘膜吻合术治疗贲门癌探讨

为预防食管胃吻合口的并发症，作者设计一种适用于贲门癌手术的新吻合方法；即浆肌瓣覆盖食管下半胃粘膜吻合术。本组采用新吻合方法完成５５例贲门癌切除术，均为贲门腺癌。手术后未发生吻合口瘘、狭窄和返流性食管炎等吻合口并发症，作者认为本方法有实用价值。     

筋膜皮瓣术后血流量的动态变化

目的：了解筋膜皮瓣术后血流量动态变化特点。方法：在猪两后肢外侧，分别设计长宽比为２．５：１的带蒂筋膜皮瓣或普通皮瓣，应用Ｈ２清除法，对皮瓣术后血流量变化进行动态观察。结果：两型皮瓣术后早期血流量均明显下降，以后大幅度上升，超过正常值，再逐渐回复到正常值。普通皮瓣血流量上升速度及幅度均不及筋膜皮瓣，其远端血流量持续低于正常值。两型皮瓣术后血流量的动态变化与其再血管化过程中血管面积分数（Ａａ％）变化一致。结论：筋膜皮瓣血流量明显优于普通皮瓣。Ｈ２清除法也是一种较实用的实验皮瓣血流量测量法。     

Blockade of central angiotensin II does not affect the reduction in renal sympathetic nerve activity following a volume load in heart failure rabbits

1. We investigated the role in sympathetic nerve regulation of endogenous angiotensin (Ang)II in the brain in heart failure by examining the effect of losartan on the resting mean arterial blood pressure (MAP), heart rate (HR) and renal sympathetic nerve activity (RSNA) and the reflex reduction in RSNA elicited by acute volume expansion in conscious rabbits. 2. Heart failure was induced with doxorubicin (1 mg/kg, i.v., twice weekly for 6 weeks). On the experimental day, MAP, HR and RSNA were recorded in conscious rabbits before and after losartan (10 microg; n = 6) or Ringer's (control; n = 5) injected in the fourth brain ventricle. Animals were then administered an acute volume load with the plasma expander Haemaccel (Hoechst Marion Roussel, Lane Cove, NSW, Australia; 2 mL/min, i.v., for 30 min). 3. Losartan did not significantly affect the resting basal levels of MAP, HR and RSNA. There was no significant difference between losartan- and Ringer's-treated animals. 4. Volume expansion in the control group elicited a significant reduction of 40% in RSNA. In the losartan-treated group, a similar reduction (42%) was observed. There was no significant difference between the treatments. The administration of losartan did not significantly affect MAP and HR during volume expansion compared with the control group. 5. We conclude that AngII in the brainstem does not play a major role in the maintenance of resting MAP, HR and RSNA or in the reflex reduction in RSNA elicited by volume expansion in the conscious rabbit with doxorubicin-induced heart failure.     

Role of sensation in swallowing function

OBJECTIVES: Sensation in the oral cavity and laryngopharynx has long been believed to be crucial for normal swallowing. One illustration of this belief has been intense interest in reconstruction after cancer resection using sensate tissue transfer as a means of improving swallowing function. A contrarian view is that mucosal sensation, by itself, is, in fact, relatively unimportant to swallowing function. STUDY DESIGN: A prospective study was designed to test the hypothesis that normal swallow function can occur with anesthesia of the upper aerodigestive tract mucosa. METHODS: Baseline (sensate) swallowing function of 13 healthy adults was assessed via video endoscopic swallow studies (VESS). Each subject was then topically anesthetized with lidocaine applied to the oral cavity, oropharynx, hypopharynx, and larynx. Swallowing was then reassessed via VESS and compared to the baseline examination to look for differences in function. RESULTS: There was little difference in swallowing ability between sensate and anesthetized states, even though all the subjects felt that their swallowing had been profoundly disrupted after lidocaine was applied. The main difference was a small increase in the time from food administration to swallowing. A few experienced trace aspiration, which was instantly eliminated on subsequent swallows with simple coaching. CONCLUSION: Normal swallowing can occur spontaneously or with simple coaching even with complete anesthesia of the upper aerodigestive tract mucosa. Current beliefs about the value of sensate free flaps and the importance of sensation in swallowing in general may need refinement.     

吻合腓肠浅动脉游离小腿后侧皮瓣修复全手掌软组织缺损

目的：研究修复全手掌软组织缺损的方法。方法：利用吻合腓肠浅动脉的小腿后侧皮瓣移植修复全手掌软组织缺损10例。结果：临床应用10例成活，其中1例于术后72h因动脉过长而栓塞，经取出血栓，再次吻合动脉，皮瓣成活，术后10～15个月随访，皮瓣外形近似正常手掌，两点辨别觉为5cm，感觉为S4。结论：利用吻合腓肠浅动脉皮瓣修复全手掌软组织缺损是一种可选的方法。     

胸大肌皮瓣在晚期口咽癌综合治疗中的应用

本文报道两例晚期口咽癌病例,小结在晚期口咽癌的综合治疗中应用胸大肌皮瓣进行修复手术的经验。对于晚期口咽癌,强调采用合理的计划性综合治疗。对于口咽癌联合根治术后的组织缺损,推荐首选胸大肌皮瓣进行一期修复。     

腮腺筋膜-SMAS-颈阔肌瓣在颊颈部除皱术中的应用

目的 探讨腮腺筋膜-SMAS-颈阔肌瓣在颊颈部除皱术中的应用策略与技巧.方法 在改良传统的SMAS-颈阔肌瓣基础上,设计腮腺筋膜-SMAS-颈阔肌瓣,通过折叠、渐进式提升及悬吊,以弥补SMAS瓣自身张力不足的缺点,分散提升颊颈部软组织.结果 2004年10月至2008年10月,为78例患者行颊颈部除皱术,其中男性2例,女性76例,年龄40～65岁.术后随访6个月～4年,效果满意.结论 应用腮腺筋膜-SMAS-颈阔肌瓣,进行折叠、渐进式提升及悬吊术,是矫正颊颈部软组织松垂的有效手段.     

He-Ne激光对牙周翻瓣术后伤口愈合的作用

目的 研究He-Ne激光在牙周外科手术后对伤口愈合的作用。方法 79例慢性牙周炎患者,共101区接受牙周翻瓣术治疗。53区术后使用25mW He-Ne激光照射,48区不予照射,作为空白对照组。比较两组治疗反应及愈合过程。结果He-Ne激光组与对照组比较,术后疼痛、充血、水肿症状明显减轻。He-Ne激光组伤口愈合时间为(6.396±1.597)d,对照组为(9.813±2.473)d(P<0.01)。结论 牙周翻瓣术后用He-Ne激光照射伤口,有利伤口愈合,适用于临床。