超声定位联合毫针引导取浅表非金属异物探讨

[目的]探讨在超声定位和毫针引导下取浅表非金属异物的经验和方法。[方法]选择1999年至2012年体表留有非金属异物的患者34例,均先用超声多角度扫描确定非金属异物位置、大小、数量、形态和异物周围组织反应情况,以异物体表投影点为毫针刺入点,在超声监测下逐步调整进针角度及深度,缓慢抵近并标定异物。固定毫针,以此针为引导,逐层切开,找到并取出异物。[结果]本组33例均能顺利找到并一次性取出非金属异物,1例分两次清除,无异物残留,未损伤重要组织,创面愈合均良好。非金属异物以玻璃、砂石、竹、木质为主。[结论]超声定位、毫针引导取浅表非金属异物是一种操作简单、安全、值得推广的好方法。     

带血管肩胛冈骨瓣转位脊柱前方植骨融合术的应用解剖学

在４０例成人尸体标本上，对颈横动脉及其浅支的走行、分支进行解剖学观察。结果表明：血管走行恒定，颈横动脉长１０．５±１．３ｃｍ，浅支与肩胛冈支长４．８±０．８ｃｍ、外径２．１±０．３ｍｍ。颈横动脉浅支及其肩胛冈支为蒂的肩胛冈骨瓣转位脊柱前方植骨融合术具有可行性。     

改良腮腺浅叶部分切除术治疗38例腮腺良性肿瘤临床分析

目的 探索改良腮腺浅叶部分切除术对腮腺良性肿瘤的治疗效果.方法 选取38例腮腺良性肿瘤患者为研究对象,采用改良腮腺浅叶部分切除术,联合使用超声刀和生物修复膜,观察其临床疗效.结果 手术时间为(70.5±10.2) min,术中出血量为(60.6±25.5) mL.所有患者术后随访6个月～1年,无复发和永久性面瘫出现;3例患者有短暂性耳垂麻木,术后3～6个月恢复正常;患者未出现明显进食时皮肤潮红和出汗等味觉出汗综合征表现;未出现明显面部凹陷畸形.结论 腮腺浅叶部分切除术联合使用超声刀和生物修复膜治疗腮腺良性肿瘤,不仅能缩短手术时间,减少出血量,还能减少术后复发和并发症的发生.     

腮腺多形性腺瘤区域性切除术与浅叶切除术的比较研究

目的 比较腮腺多形性腺瘤区域性切除术与浅叶切除术两种术式的术后复发率及并发症发生情况,为临床合理选择术式提供依据.方法 总结1998年1月～2004年6月间收治的腮腺多形性腺瘤61例,其中24例采用腮腺区域性切除术,37例行腮腺浅叶切除术,随访时间3～9年.结果 采用腮腺区域性切除手术的病例术后面瘫、Frey综合征、涎瘘的发生率均低于腮腺浅叶切除术,而肿瘤的复发率无明显差异.结论 区域性切除术手术创伤小,并发症少,还可以保存腮腺一定的功能,可作为腮腺多形性腺瘤临床治疗的首选术式.     

Gastric Changes in Coronary-Operated Patients with Low-Dose Aspirin

Low-dose aspirin is widely used in patients operated on for coronary disease as secondary prevention of coronary artery occlusion. The changes caused by aspirin in therapeutic doses to gastric mucosa are well documented, but the effect of long-term low-dose aspirin is not so well known. Forty-six volunteer coronary-operated patients with daily low-dose aspirin were interviewed postoperatively, and an upper gastrointestinal tract endoscopy was performed and biopsy specimens taken 3 months after the operation. The findings were compared with a normal population sample of 358 persons from a study previously published. There were significantly more erosions and ulcers or fresh scars in the study group than in the control population-11 of 46 patients and 24 of 358 patients, respectively. The presence of superficial gastritis was similar. Mostly, the lesions were asymptomatic. History of peptic ulcer disease, use of other ulcerogenic drugs, smoking, and alcohol consumption had no predictive value for acute lesions. In contrast, the lesions were associated with chronic superficial gastritis and infection.     

EARLY GASTRIC CANCER WITH WIDESPREAD DUODENAL INVASION WITHIN THE MUCOSA

We report a rare case of early gastric cancer confined to the mucosal layer with extensive duodenal invasion, curatively removed with distal gastrectomy. An 84‐year‐old Japanese woman was referred to our hospital with gastric cancer. A barium meal examination and esophagogastroduodenoscopy revealed an irregular nodulated lesion measuring 6.5 x 5.5 cm in the gastric antrum and an aggregation of small nodules in the duodenal bulb. A biopsy specimen showed well‐differentiated adenocarcinoma. The patient underwent distal gastrectomy with partial resection of the duodenal region containing the tumor and regional lymph node dissection, with no complication. Histological examination of the resected tissue confirmed well‐differentiated adenocarcinoma limited to the mucosal layer and without lymph node metastasis. The cancer extended into the duodenum as far as 38 mm distant from the pyloric ring, and the resected margins were free of cancer cells. Gastric cancer located adjacent to the pyloric ring thus has the potential for duodenal invasion, even when tumor invasion is confined to the mucosal layer. In such cases, care should be taken during examinations to detect duodenal invasion, and the distal surgical margin must be negative given sufficient duodenal resection.     

CSG中医辨证分型与血浆MTL、GAS、SS水平关系的临床研究

目的为探讨慢性浅表性胃炎肝胃不和、脾胃虚弱、脾胃湿热三种中医证型与胃泌素、胃动素和生长抑素三种胃肠激素水平的关系。方法将CSG患者肝胃不和、脾胃虚弱、脾胃湿热三种中医证型各25例及健康成年人25例，用放射免疫分析法测定空腹血浆MTL、GAS、SS。结果CSG的三种中医辨证分型脾胃湿热、脾胃虚弱、肝胃不和的血浆MTL、GAS、SS水平，不仅与健康人有显著差异，且CSG的三种中医辨证分型与血浆MTL、GAS、SS存在着较密切的关系，并有一定的规律性。结论检测CSG患者的血浆MTL、GAS、SS水平，对提高CSG的中医辨证分型有积极意义，结果可作为中医临床参考。     

^32P-胶体内照射治疗浅表实体瘤的疗效观察

目的：评价^32P胶体内照射治疗浅表实体瘤的临床效果。方法：对23例浅表实体肿瘤进行^32P胶体瘤内注射，按照每cm^3肿瘤应用18．5MBq ^32P胶体进行计算，注射总量不超过740MBq，2个月后评价疗效。结果：瘤体内注射^32P制剂后肿瘤生长明显受到抑制，抑瘤率达到69．5％。肿瘤完全缓解的2例（8．69％），部分缓解14例（60．86％），无变化7例（30．43％）。结论：^32P胶体治疗实体肿瘤的疗效肯定，值得进一步研究。     

Superficial granulomatous pyoderma: a case report of two Japanese patients and clinical comparison with foreign patients

Superficial granulomatous pyoderma (SGP) is an unusual variant type of pyoderma gangrenosum characterized by a benign course and specific histological features; it is quite a rare cutaneous disorder in Japan. We reported two Japanese cases of SGP and compared the clinical features of 13 Japanese cases with those of 42 foreign cases. Case 1 was a 53-year-old female who presented with three indolent and ulcerative plaques with elevated edges on the back and the posterior portion of the left thigh. Case 2 was a 74-year-old female who presented with crusted and vegetative erythematous plaques on the left shoulder and left upper arm. Histological examinations revealed a characteristic three-layer granuloma in each case. Laboratory and physical examinations found no abnormalities. Topical corticosteroid, oral administration of minocycline, and/or additional supplementation with corticosteroid were effective. In comparison with foreign cases, Japanese cases show a possible differentiation in the ratio of sex and distribution of the ulcer. Females have a high incidence and the extremities are frequently involved area in Japanese cases. Up to now, 11 cases of SGP have been reported in Japan. To our best knowledge, our patients are the first Japanese cases described in the English literature.