异体手移植的组织配型探讨

目的：研究组织配型在异体肢体移植中的基础作用和意义。方法：对患者和供者进行ABO血型和Rh血型，群体反应性抗体（PRA）检测及淋巴细胞毒性试验，测定人类白细胞抗原（HLA），结果：ABO血型（B－B）Rh血型相符，PRA和淋巴毒性交叉实验均为阴性，人类白细胞抗原（HLA）配型HLA－B，D，DR，DQ位点有4个抗原相合，手术后联合免疫抑制剂，移植双手成功，结论：理想的组织配型可避免异体手移植发生排斥反应，提高异体手移植成功率。     

巨指症9例治疗体会

目的 介绍巨指症的手术治疗与疗效。方法 对9例巨指症病人分别采用巨指修剪术及神经松解术、巨指截指术、巨指部分切除与足趾移植再造术。结果 术后经0．5－15年（平均5年9个月）的随访，2例巨拇指修剪术术后外形仍显臃肿，功能不理想，其余7例术后功能与外形均满意。结论 根据巨指发生的指别与指数，巨指增生的程度，尤其是骨、关节以及神经增生程度，选择最佳的手术方案。     

吻合静脉修复手掌皮肤逆行撕脱伤

目的 探讨一种手掌皮肤逆行撕脱伤的手术修复方法。方法 在显微镜下行清创术，术中仔细寻找损伤的静脉，然后将其吻合，建立血运以修复手掌皮肤逆行撕脱伤。结果 14例撕脱皮肤全部成活，手部外形正常，皮肤感觉在3个月－1年内恢复正常。结论 该手术方法操作简单，安全可靠，值得推广。     

手缺损的重建

手是人类创造文明的重要器官,手缺损的重建一直是临床医学的一大难题。美容假手仅有装饰用途,工具手、Kruckenberg前臂分叉成形术因作用有限,现已少用。肌电假手为义肢市场主流产品,但其动作准确性有待提高;显微外科再造手有感觉功能,可代偿部分手功能,但外形欠佳。前臂残端移植一个足趾即再造手指控制的电子假手,使动作准确度提高,是现阶段一项较为理想、值得推广应用的新技术。近年来开展的同种异体手移植已成功报道10余例,由于免疫排斥反应需长期服用免疫抑制剂,尚不宜作为常规手术推广,但一旦有效解决移植免疫问题,相信异体手移植将是手缺损重建的最佳方法。     

Antithrombin III prevents deleterious effects of remote ischemia-reperfusion injury on healing of colonic anastomoses

BACKGROUND: Antithrombin III is known as the most important natural inhibitor of thrombin activity and has been shown to attenuate local harmful effects of ischemia-reperfusion injury in many organs. In recent animal studies, delaying effect of remote organ ischemia-reperfusion injury on healing of intestinal anastomoses has been demonstrated. In this study, we investigated whether antithrombin III reduces deleterious systemic effects of ischemia-reperfusion injury on healing of colonic anastomoses in rats. METHODS: Anastomosis of the left colon was performed in 24 rats that were divided into three groups: sham operated control (group I, n = 8), 30 minutes of intestinal ischemia-reperfusion by superior mesenteric artery occlusion (group II, n = 8), antithrombin III treated group (250 U/kg before and after the ischemia-reperfusion, group III, n = 8). On postoperative day 6, all animals were sacrificed, and bursting pressure and tissue hydroxyproline content of the anastomoses were assessed and compared. RESULTS: On postoperative day 6 the mean bursting pressures were 149.6 +/- 4.8, 69.8 +/- 13.5, and 121.8 +/- 8.7 mm Hg for groups I, II, and III, respectively (P = 0.000). Mean tissue hydroxyproline concentration values were 389.5 +/- 29.6, 263.1 +/- 10.0, and 376.0 +/- 33.8 microg/mg for groups I, II, III respectively (P = 0.005). CONCLUSIONS: This study showed that, antithrombin III treatment significantly prevented the delaying effect of remote organ ischemia-reperfusion injury on anastomotic healing in the colon. Further clinical studies are needed to clarify whether antithrombin may be a useful therapeutic agent to increase the safety of the anastomosis during particular operations where remote organ ischemia-reperfusion injury takes place.     

Holmium: YAG laser endoureterotomy for ureterointestinal strictures

PURPOSE: The management of ureterointestinal stricture in patients who have undergone urinary diversion can be challenging. Endourological techniques have been increasingly used in recent years for ureteral stricture. While long-term results may not be as reliable or durable as those of traditional open reconstructive surgical techniques, associated morbidity is much less. The holmium (Ho):YAG laser, which has cutting and coagulating properties, has been demonstrated to have many applications in urology. We report our experience with and long-term results of Ho:YAG laser endoureterotomy for ureterointestinal strictures. MATERIALS AND METHODS: We reviewed the charts and followup history of 23 patients in whom the Ho:YAG laser was used to treat ureterointestinal anastomotic stricture. Strictures were treated percutaneously via the antegrade approach with flexible endoscopes and the holmium laser. A reversed 12/6Fr endopyelotomy stent was left indwelling for 6 weeks postoperatively. Success was defined as symptomatic improvement and radiographic resolution of obstruction. RESULTS: Between 1993 and 2000, 23 patients with a mean age of 61 years underwent endo-ureterotomy using the Ho:YAG laser for 24 ureterointestinal stricture. An overall success rate of 71% (17 of 24 cases) was achieved at a mean followup of 22 months. The success rate of holmium laser endoureterotomy for ureterointestinal stricture at 1, 2 and 3 years was 85%, 72% and 56%, respectively. Seven patients had recurrent strictures of which 4 developed 16 months or more postoperatively. No complications were noted. CONCLUSIONS: Ho:YAG laser endoureterotomy for ureterointestinal stricture disease is a minimally invasive endourological procedure that may provide more durable results than other modalities used for endoureterotomy. The Ho:YAG laser with its ability to cut tissue precisely and provide hemostasis combined with its versatility and compatibility with flexible endoscopes is an ideal instrument for safely performing endoureterotomy.     

带隐神经小腿内侧筋膜皮支皮瓣修复重度虎口挛缩应用体会

自1997年以来,我们采用带隐神经小腿内侧筋膜皮支皮瓣修复重度虎口挛缩7例,重建虎口外形美观,感觉恢复,临床效果满意.现报告如下.     

功能性单心室的外科治疗

目的 为了使更多的先天性心脏病患者得到纠治，回顾性总结手术治疗功能性单心室的临床经验。方法 手术纠治127例功能性单心室患者，年龄7个月－12岁，体重7．5－39kg，其中丰唐手术（Fontan operation)72例，半Fontan术3例，双向上腔静脉肺动脉吻合术51例，肺动脉环缩术1例。结果 早期Fontan术19例，死亡11例；改良Fontan术53例，死亡10例；半Fontan术死亡1例；双向上腔静脉肺动脉吻合术死亡4例；总手术死亡率20．5％。结论 功能性单心室必须早期得到纠治，控制肺动脉血流，预防严重缺氧。双向上腔静脉肺动脉吻合术能减少功能性单心室的容量负荷，保持足够的心排血量。改良Fontan术是功能性单心室的最佳手术方案。     

一期手术矫治先天性主动脉弓中断

目的　探讨先天性主动脉弓中断 (IAA)一期手术矫治的手术方法、疗效 ,总结其临床经验。　方法　对10例少见的先天性 IAA进行一期手术矫治 ,平均手术年龄 2 .7± 2 .4岁 ,其中 5例为 A型 IAA,3例为 B型 ,另 2例IAA合并残存第 5弓狭窄 ;8例患者均合并其它心血管畸形和重度肺动脉高压。一期矫治术中有 7例进行了主动脉弓直接端侧或端端吻合连接术 ,2例行 Gore- Tex管道连接重建主动脉弓 ,1例 IAA合并残存第 5弓狭窄用自身心包补片作狭窄处扩大成形术 ;8例患者于矫治 IAA的同时矫治心血管其他畸形。　结果　术后早期发生心功能不全、心律失常、肺动脉高压危象等并发症 5例 ,其中近 10年仅发生 1例。住院死亡 3例 ,近 10年连续 6例无住院死亡。术后早期 5例肺动脉收缩压 /体循环动脉收缩压 (Pp/ Ps)由术前的 0 .84± 0 .0 4显著下降至正常范围 (0 .2 8± 0 .0 3) ,1例主动脉弓部压力阶差为 30 mm Hg(1k Pa=7.5 mm Hg)。随访 7例 ,平均随访 2 .6± 4 .0年 ,均存活 ,其中有 3例主动脉弓部压力阶差≥ 30 mm Hg。心功能均正常。　结论　先天性 IAA一旦诊断明确 ,应尽早进行一期矫治术 ;主动脉弓直接吻合连接术效果较佳。     

急诊移植带趾伸肌腱趾背皮瓣修复复杂指背缺损

目的 探讨急诊游离移植带1/2趾伸肌腱趾背皮瓣修复复杂指背缺损创面,重建伸指功能的临床疗效.方法 2001年2月至2010年3月,为6例患者急诊行游离移植带1/2趾长伸肌腱的趾背复合组织瓣,修复指背皮肤、肌腱缺损,重建伸指功能,并进行了长期随访观察.结果 6例游离移植趾背复合组织瓣修复指背皮肤、肌腱缺损缺损重建伸指功能,术后皮瓣完全成活,创面一期愈合,经5～10年随访,皮瓣色泽接近正常,质地和外形优良,供受区外形和功能患者满意.结论 急诊游离趾背复合组织瓣修复指背缺损,重建伸指功能,经长期随访疗效观察显示,是一种较好的治疗方法.