激光治疗喉癌前病变

目的在手术治疗喉癌前病变的同时,最大限度的保留和恢复喉的正常发音功能。方法应用激光外科手术治疗喉癌前病变77例,其中采用声带黏膜上皮层切除术治疗声带黏膜白斑及轻度不典型增生23例;采用声带黏膜剥脱术治疗中、重度不典型增生44例;激光切除成人型喉乳头状瘤10例。结果23例声带黏膜白斑及轻度不典型增生者术后2个月发音恢复正常;44例中、重度不典型增生者术后3～5个月发音逐渐恢复正常;10例喉乳头状瘤患者术后发音明显优于经颈进路手术的发音。结论嗓音显微外科手术既能分层切除声带病变,又能最大限度的保留和恢复喉的发声功能,是治疗喉癌前病变首选的微创性方法。     

球囊扩张椎体成形术治疗骨质疏松型椎体压缩骨折

目的:评价球囊扩张椎体成形术治疗骨质疏松型椎体压缩骨折的临床疗效。方法:对52例82个骨质疏松型压缩骨折的椎体,采用球囊扩张椎体成形术进行治疗。测量术前和术后椎体高度、Cobb′s角、术前和术后VAS评分并进行统计学分析。结果:平均随访9个月(37周,4～99周);椎体前柱和中柱分别增高了4.6、3.9mm(P<0.05);Cobb′s角增加了3.4°(P<0.05);VAS评分增加了7分(P<0.05);术后无不良反应和并发症;骨水泥外渗率为9.8%。结论:球囊扩张椎体成形术治疗骨质疏松型椎体压缩骨折安全有效,可恢复椎体高度,改善患者的生活质量。     

骨伤熏洗液治疗慢性软组织损伤的临床研究

骨伤熏洗液是我科在新疆名老中医王继先主任医师的经验方基础上,经科学方法制备而成的纯中药制剂,根据临床前药理和毒理研究,证明该制剂治疗伤后肢体功能障碍有较好的疗效和安全性[1].为进一步证实其安全性和疗效的可靠性,我们作了部分病例的临床观察,并设克痛王擦剂为对照组,共治疗60例.报告如下. 1临床资料 1.1一般资料临床观察60例创伤后肢体功能障碍(慢性软组织损伤)患者,其中治疗组40例,对照组20例,大部分是住院病人,其余为家庭病床、门诊病人,一般情况见表1.     

乳糜性髋关节炎1例报告

郜某 ,男 ,48岁 ,汉族。因右髋酸痛不适 6个月 ,加重伴发热 1个月 ,右髋功能障碍 1日收住入院。诉右髋关节半年前无明显原因出现酸困沉重不适 ,无下肢肿胀 ,行走活动无受限 ,Ｘ线检查无异常。近 1个月来症状加重 ,但于休息、晨起后症状能缓解。目前突伴发热 ,右髋疼痛加重 ,不能负重行走 ,故来院。查体Ｔ 38.3℃ ,痛苦面容 ,右髋活动受限 ,呈半屈半伸位 ,Ｔｏｍａｔｈ’ｓ征阳性 ,髋关节压痛 ,局部无肿胀 ,皮色皮温正常 ,下肢无肿胀 ,膝踝关节正常。血常规ＷＢＣ17× 10 9/Ｌ ,Ｎ87% ,ＥＳＲ6 0ｍｍ/ｈ。Ｘ线片示右髋关节囊肿胀 ,骨结构正常…     

几丁糖预防CO2激光声带切除术后声带粘连短期观察的实验研究

Objective To observe the effect of immediate topical application of chitosan on preventing anterior giottic stenosis (AGS) after microsurgical resection of both vocal fold with CO<,2> laser , including the anterior commissure, in a canine model. Methods Sixteen canine larynges were injured by microresecting procedure of both vocal folds with CO<,2> laser. The dogs were randomly divided into two groups, chitosan group and control group. The chitosan and isotonic sodium chloride solution(control) were used for 5 minutes immediately after surgery. One week after the initial surgery, three dogs in each group were randomly selected , ultrastructure of fibroblast were examined with transmission electronic microscope and expression of basic fibroblast growth factor(bFGF) and traansforming growth factor betal (TGF-β1) were evaluated by enzyme-linked immunosorbent assay(ELISA). Three weeks after surgery, the rest dogs' glottic web were lysed and repeatedly treated with chitosan and isotonic sodium chloride solution respectively. The glottic wound healing and AGS formation were examined every week, and all larynges were harvested and examined histologically six weeks after the initial surgery. Results Transmission electronic microscope examination of the ultrasmcture of fibroblast indicated that chitosan inhibited the proliferation of fibroblast. Chitosan increased the expression of bFGF and TGF-β1, and bFGF and TGF-β1 in chitosan group, which was significantly higher than that in control group (z = -2.887 and -2.005, P =0.002 and 0.041). Chitosan decreased the extent of AGS formation. Three weeks after the surgery, the AGS lesion in the control group affected mean 49% of the length of the vocal folds from the anterior commissure to the vocal process, while chitosan group affected mean 7%, which was significantly less than the extent of web formation in the control group, (z = - 2. 619, P = 0. 008). The grade of collagen content in chitosan group was significantly lower than that in control group (P = 0. 003). Conclusion Chitosan is effective in preventing AGS after CO<,2> laser cordectomy.     

几丁糖预防CO2激光声带切除术后声带粘连短期观察的实验研究

Objective To observe the effect of immediate topical application of chitosan on preventing anterior giottic stenosis (AGS) after microsurgical resection of both vocal fold with CO<,2> laser , including the anterior commissure, in a canine model. Methods Sixteen canine larynges were injured by microresecting procedure of both vocal folds with CO<,2> laser. The dogs were randomly divided into two groups, chitosan group and control group. The chitosan and isotonic sodium chloride solution(control) were used for 5 minutes immediately after surgery. One week after the initial surgery, three dogs in each group were randomly selected , ultrastructure of fibroblast were examined with transmission electronic microscope and expression of basic fibroblast growth factor(bFGF) and traansforming growth factor betal (TGF-β1) were evaluated by enzyme-linked immunosorbent assay(ELISA). Three weeks after surgery, the rest dogs' glottic web were lysed and repeatedly treated with chitosan and isotonic sodium chloride solution respectively. The glottic wound healing and AGS formation were examined every week, and all larynges were harvested and examined histologically six weeks after the initial surgery. Results Transmission electronic microscope examination of the ultrasmcture of fibroblast indicated that chitosan inhibited the proliferation of fibroblast. Chitosan increased the expression of bFGF and TGF-β1, and bFGF and TGF-β1 in chitosan group, which was significantly higher than that in control group (z = -2.887 and -2.005, P =0.002 and 0.041). Chitosan decreased the extent of AGS formation. Three weeks after the surgery, the AGS lesion in the control group affected mean 49% of the length of the vocal folds from the anterior commissure to the vocal process, while chitosan group affected mean 7%, which was significantly less than the extent of web formation in the control group, (z = - 2. 619, P = 0. 008). The grade of collagen content in chitosan group was significantly lower than that in control group (P = 0. 003). Conclusion Chitosan is effective in preventing AGS after CO<,2> laser cordectomy.     

第四代金属-金属表面髋关节置换假体的临床应用

目的 探讨第四代金属-金属表面髋关节置换假体(ASR)的临床应用效果.方法 选择我院2007年1月-2008年3月收治的股骨头缺血性坏死(27例)和髋关节骨性关节炎(15例)患者为研究对象.根据术前X线影像学评估,术中股骨头形态处理较好的20例(23髋)患者作为ASR组,其余22例(24髋)患者作为XL-ASR组,分别行金属-金属髋关节表面置换和大头全髋关节置换.假体采用Depuy公司生产的第四代金属-金属表面髋关节置换假体(ASR)及大头全髋关节置换系统(XL-ASR),两组平均随访1年以上并进行临床对照.比较两组患者手术前后髋关节Harris评分、髋关节活动范围(ROM)、股骨偏心距、双下肢不等长差值、手术切口、手术时间等指标.结果 (1)术前ASR组和XL-ASR组髋关节Harris评分分别为(56±18)分和(54±22)分,差异无统计学意义(P＞0.05);术后分别为(92±18)分和(92±20)分,差异无统计学意义(P＞0.05).(2)治疗后ASR组优10例,良6例,可4例,差0例;XL-ASR组优12例,良8例,可2例,差0例,两组疗效间差异无统计学意义(P＞0.05).(3)随访1年,ASR组和XL-ASR组髋关节ROM提高的度数分别为(33.1±2.2)°和(34.8±3.1)°,差异无统计学意义(P=0.507);但术后6个月ASR组ROM提高的度数显著高于XL-ASR组[(37.7±2.3)°和(29.3±3.2)°,P=0.008].(4)ASR组股骨偏距、双下肢不等长差值、手术切口、手术时间分别为(-3.1±4.7)mm、(3.3±3.1)mm、(14.4±3.0)cm和(120±20)min;XL-ASR组分别为(5.7±9.1)mm、(6.7±4.6)mm、(11.3±2.6)cm和(70±14)min,差异均有统计学意义(P＜0.05).结论 ASR治疗年轻及活动量较大患者早期随访结果较好,术后获得了较好的髋关节功能并恢复髋关节的生物力学,保留了骨量.但与XL-ASR比较,ASR手术的操作难度大、手术创伤大、操作时间长.     

miR-122-5p通过靶向NOP14抑制黑素瘤的细胞增殖

目的探讨在黑素瘤组织中miR-122-5p的表达情况,同时研究miR-122-5p对人黑素瘤细胞株SK-MEL-110和A375细胞 增殖、细胞周期及凋亡的调控效应。方法荧光定量PCR检测miR-122-5p在黑素瘤和色素痣组织中的表达;培养SK-MEL-110 和A375细胞,瞬时转染miR-122-5p inhibitor及阴性对照inhibitor后,荧光定量PCR检测miR-122-5p的表达,MTT及流式细胞 仪方法检测对细胞增殖、周期和凋亡的影响,荧光定量PCR和Western Blot法检测NOP14的mRNA和蛋白水平;应用双荧光素 酶基因报告法进一步验证NOP14是否为miR-122-5p的靶基因。结果miR-122-5p在人色素痣和黑素瘤组织中的相对表达量 分别为1.23±0.270和7.65±1.37。转染miR-122-5p inhibitor后,miR-122-5p在SK-MEL-110和A375细胞中的相对表达量分别 为0.21±0.08和0.17±0.05。miR-122-5p inhibitor可以显著抑制黑素瘤细胞株SK-MEL-110和A-375细胞的增殖能力,明显增加 G1期细胞的比例,但对SK-MEL-110和A-375细胞的凋亡没有明显影响。转染miR-122-5p inhibitor对NOP14 mRNA水平没 有明显的影响,但可以显著提高NOP14的蛋白水平表达。荧光素酶报告基因检测显示,共转染miR-122-5p mimics和野生型 psi-CHECK2-3′UTR质粒组相对荧光素酶活性为0.21±0.14,较NC和野生型psi-CHECK2-3′UTR质粒转染组（0.56±0.1）显著下 降（P<0.01）。结论miR-122-5p在黑素瘤组织中高表达,提示miR-122-5p可能参与黑素瘤的发生发展过程。miR-122-5p 可能 通过NOP14影响SK-MEL-110和A-375细胞的周期,进而抑制细胞的增殖。     

儿童淋巴瘤样丘疹病1例

患儿男,9岁。双上肢、臀部红丘疹、结节1月余,自觉轻度瘙痒。皮肤科检查:双上肢及臀部见散在少量直径0.5~1.5 cm大小的红色丘疹、结节,以双前臂为主,境界清,触之质硬,部分表面覆少许干燥鳞屑,部分周围有红晕,无压痛,无脓疱、坏死、溃疡及萎缩性瘢痕等。皮损组织病理学检查:表皮灶性角化不全,棘层轻度增厚;真皮及皮下脂肪层见大量淋巴组织细胞、嗜中性白细胞和嗜酸性白细胞大致楔形浸润,其中可见一些非典型的大细胞,胞核较大,肾形或空泡状,核仁嗜酸性,并见核分裂像。免疫组化:CD30(15%~20%大细胞+),CD3、CD4及CD8(部分大细胞+),CD56(-),CD20和CD79a(小灶+),CK(-),EMA(+),CD2(部分+),CD5(+),CD7(+),TIA-1(+),Ki-67(约20%+),ALK(-)。原位杂交结果:EBER(-)。诊断:淋巴瘤样丘疹病(A型)。     

莫西沙星联合光动力疗法治疗合并尖锐湿疣的生殖道沙眼衣原体感染的临床观察

目的:探讨莫西沙星联合光动力疗法在治疗合并尖锐湿疣的女性生殖道沙眼衣原体感染中的疗效及安全性。方法:选取2012年5月至2017年2月来广州市第一人民医院南沙医院就诊的合并尖锐湿疣的生殖道沙眼衣原体感染患者91例,分为A组、B组和C组共3组,在均接受5-氨基酮戊酸光动力治疗的基础之上,分别接受莫西沙星、米诺环素和阿奇霉素治疗。对比3组患者的生殖道沙眼衣原体感染治愈率、疣体清除率和不良反应发生率。结果:A组患者生殖道沙眼衣原体感染治愈率分别高于B组与C组患者,其差异具有统计学意义(P0.05)。对3组患者进行至少4周的随访,3组患者不同时间的疣体清除率差异无统计学意义(P0.05),但治疗后3周疣体清除率均高于治疗后1周疣体清除率,其差异具有统计学意义(P0.05)。A组患者不良反应发生率分别低于B组和C组患者,其差异具有统计学意义(P0.05)。结论:莫西沙星联合5-氨基酮戊酸光动力治疗合并尖锐湿疣的生殖道沙眼衣原体感染患者,在保证疣体清除率的前提下,能够提高生殖道沙眼衣原体感染治愈率,降低不良反应发生率,具有临床价值。