Boari膀胱肌瓣术治疗中下段输尿管癌患者的生存分析

目的：研究针对中下段输尿管癌患者的保肾治疗策略中采用Boari膀胱肌瓣术治疗的疗效。方法：回顾性 分析湘雅二医院泌尿外科从2002年7月至2007年6月采用Boari膀胱肌瓣术和输尿管癌根治术治疗中下段输尿管癌患者 的临床资料及其随访情况,收集肿瘤大小、病理分级、分期、肾功能水平、住院时间等数据并结合患者生存情况 进行统计学分析。结果：共有39例患者进行了手术治疗,包括Boari膀胱肌瓣术16例,输尿管癌根治术23例。中位随 访时间为53个月(10~84个月),18名患者死亡,其中Boari膀胱肌瓣术组死亡6例,输尿管癌根治术组死亡12例。2组 的5年无膀胱癌复发存活率分别为63%和59%(P>0.05),5年肿瘤特异性生存率分别为73.8%和73.5%(P>0.05),5年生存 率分别为61%和57%(P>0.05),总体存活率分别为64.8%和58.1%(P>0.05)。2组间术前肾功能无明显差异[肌酐清除率 57(32~104) mL/min vs 55(30~102) mL/min,P>0.05],术后Boari膀胱肌瓣术组肾功能优于输尿管癌根治术组[肌酐清 除率55(35~102) mL/min vs 43(30~89) mL/min,P<0.05]。Cox比例风险回归模型多因素分析发现肾功能水平、肿瘤大 小、病理分级和病理分期是影响肿瘤患者总生存期的独立因素(P<0.05),肿瘤越大、病理分级和分期越高,患者死 亡风险越大,而术后高水平的肌酐清除率可以降低疾病的死亡风险。结论：Boari膀胱肌瓣术治疗中下段输尿管癌是 可行的方式。相比输尿管癌根治术,Boari膀胱肌瓣术治疗后的生存率并无明显差别,而且能保护患者肾功能。     

探讨口腔修复前行牙周整复术在临床中的价值

目的：对口腔修复前行牙周整复手术进行临床的分析和探讨。方法：回顾性分析进行固定修复前行牙龈和牙槽嵴修整手术从而来改善牙龈颈缘的不协调患者。随机选取98例病患,并采用对比分析方法。结果：观察组49例患者牙周整复术后,效果良好。在专业人事1年多随访观察,3例牙龋尽缩后萎缩,改做牙龈瓷修复整形,其余46例恢复良好,随访期间均未发现不良现象发生。在对照组49例中41例效果良好,随访1年后,5例牙龈退缩后萎缩,改做牙龈瓷修复整形,术后比较2组患者的恢复疗效,效果良好的观察组高于对照组（Х^2＝3．97,P〈0．05）。结论：利用高频电刀促使牙龈成形,其优点在于牙龈缘的形态清晰、IE血迅速、创伤小、切割准确、患者疼痛较轻。口腔修复前行牙周整复术修整牙龈,使其达到完美效果。     

Le traitement chirurgical de la ténosynovite de De Quervain chez le sportif : à propos de 22 cas

De Quervain's tenosynovitis is an inadequacy between the abductor pollicis longus and extensor pollicis brevis tendons and the osteo-fibrous tunnel in the first extensor compartment of the wrist. The authors report a retrospective study of 22 patients from different sport who have been treated surgically. The mean age was 36 years old with net mal predominance. The diagnosis was mainly clinical. The surgical approach is considered with the recurrence of the painful symptoms in spite of a well-done medical management. The surgical technique consists of an incision of the sheath. The sheath palmar flap has been sutured with skin (Le Viet plasty). At two and half years follow-up, the functional results were good in all the patients. However, non-aesthetic scars were noticed in 4 patients. Surgery is indicated after failure of medical management. We use a longitudinal surgical approach to avoid the radial nerve lesions. Le Viet procedure using the palmar flap of the pulley fixed to the dermis works as a barrier and maintains the tendons sliding on the radial styloid groove.     

Long-term results of fascial sling procedure

In a retrospective study 108 patients (average age: 56.5 years) could be evaluated, who were treated with a fascial sling plasty because of pure genuine stress incontinence (n=90) or combined stress/urge incontinence (n=18). 72 patients (66.6%) had recurrent incontinence after previous surgery. The average follow-up was 5 years.Patients without previous surgery related to urinary incontinence (n=36) showed the best results and remained continent in 78% (n=28).Patients with 1 to 4 (average 1.4) previous surgical procedures because of incontinence (n=52) remained continent in 62% (n=32), and in those who had between 1 and 6 (average 3.6) previous surgical procedures using even alloplastic material the continence rate dropped to 60% (n=12). In patients with pure genuine stress incontinence the overall success rate was 74.7%, whereas in cases with a proven preoperative urge component, the success rate dropped to 37%. Fascial sling plasty is a very useful procedure to treat patients with primary and especially recurrent urinary incontinence, when a functional urethra is missing. However, one has to be very cautious with patients in whom a preoperative urodynamic evaluation shows detrusor instability.     

On-pump beating-heart mitral valve plasty without aortic cross-clamping

Patients with ischemic cardiomyopathy often have mitral regurgitation, which should be corrected for better long-term survival. Mitral valve surgery is usually performed during cardiopulmonary bypass under the arrested heart condition. The ascending aorta is cross-clamped and the heart is arrested using a cardioplegic solution. However, because ischemic cardiomyopathy patients often have a severely atherosclerotic ascending aorta and low cardiac function, aortic cross-clamping and cardiac arrest increase the risk of postoperative thromboemboli and low cardiac output syndrome. Under the on-pump beating-heart condition, we performed mitral valve plasty concomitant with coronary artery bypass grafting, tricuspid annuloplasty, left ventricular aneurysmectomy, and the maze procedure without aortic cross-clamping for a patient with ischemic dilated cardiomyopathy and bradycardial atrial fibrillation. The patient had no postoperative complications and recovered rapidly. Thus, to prevent serious postoperative complications, on-pump beating-heart mitral valve surgery without aortic cross-clamping may be a suitable surgical option for patients with ischemic cardiomyopathy.     

The lange operation for untreated remote ruptures of the achilles tendon

Surgical Principles Bridging of a small to medium-sized defect of the Achilles tendon using a 2 to 3 cm broad strip of tendinous tissue from the ipsilateral gastrocnemius muscle displaced distally. This technique has been first described by M. Lange [3].     

对重睑术同时去除部分眶脂肪的几点看法

根据逾千例重睑手术的临应经验，对目前在重睑术中采取的部分眶脂肪切除的做法提出看法。认为对外观臃肿的上睑可分多脂性、松弛性、肌性三型。据其特点每型在手术中应采取不同的方法，并提出对眶脂肪的部分切除要采取慎重态度，不提倡千篇一律的做法。     

舌形瓣成型术防逆流在胰胆外科中的应用

用成年狗小肠及猪肠,对防逆流的六种不同术式模拟肠麻痹、肠梗阻的情况下进行防逆流作用的比较。实验结果表明,舌形瓣优于其它术式。临床应用于复杂胆道及胰、十二指肠切除共7例,取得了近期满意效果。胰、十二指肠切除Mackado—舌形瓣成型术消化道重建后无胰胆漏,亦无胰胆管返流。胆道空肠十二脂肠吻合舌形瓣成型术胆流重建,除具有同类手术所共有的优点外,吻合口空肠粘膜可不与胃酸接触,从而避免吻合口空肠肠溃疡的发生。     

Parapubic hernia and diabetes insipidus

According to the current literature parapubic hernia is regarded as a relatively rare pathology. The causative defect is usually related to pelvic surgery, traumatism, or bone malformation. Surgical treatment is difficult, because aponeurotic tissue on which to anchor a mesh on the caudal aspect of the defect is missing. This report describes a case of an incisional pubic hernia related to megabladder in a woman affected by diabetes insipidus and with a past clinical history of multiple pelvic interventions. As far as we are aware this report adds a new pathogenetic issue for parapubic hernias not previously described in the literature.     

耳郭软骨皮下筋膜组织复合物在鼻尖整形中的应用

目的：介绍自体耳郭软骨皮下筋膜组织复合物在鼻尖整形中的应用方法。方法：应用耳郭软骨皮下筋膜组织复合物对57例就医者实施手术。结果：术后鼻尖塑形满意，无畸形，无并发症发生。结论：应用耳郭软骨皮下筋膜组织复合物可保护鼻尖皮肤，鼻尖塑形满意，值得推广应用。