增生性瘢痕组织中血管形成的形态学

目的 研究血管形成在增生性瘢痕形成过程中的作用。方法 通过免疫组织化学方法采用CD34抗体对增生性瘢痕组织的微血管进行染色。结果 增生期的增生性瘢痕组织中微血管的含量明显高于萎缩期的增生性瘢痕及正常手术后瘢痕。结论 瘢痕的增生可能具有一定的血管依赖性。     

RU486配伍米索前列醇中止瘢痕子宫早孕的安全性及可行性探讨

采用RU486配伍米索前列醇中止早孕188例,其中27例为瘢痕子宫。结果显示188例用药后完全流产率为91．48％;27例瘢痕子宫组为100％;161例非瘢痕子宫组为90．06％,两组完全流产率的差异无显著性意义,P>0．05,且两者绒球排出时间及出血时间亦无明显差异,瘢痕子宫组无一例严重并发症。提示RU486配伍米索前列醇口服中止瘢痕子宫早孕者安全、有效,并非其禁忌证,推荐为首选方法之一。     

改装滚轮微针促进人增生性瘢痕皮肤对醋酸曲安奈德的吸收

目的考察改装滚轮微针在人增生性瘢痕皮肤中对醋酸曲安奈德的促透作用。方法采用亚甲蓝和H-E染色法观察不同针长的微针刺入人增生性瘢痕皮肤的形态;建立高效液相色谱法测定醋酸曲安奈德含量;采用洗脱法、匀浆法分别考察给药1、12h时增生性瘢痕皮肤醋酸曲安奈德在体吸收特性;采用经皮水分流失(TEWL)测量法、激光多普勒血流量法考察其皮肤刺激性。结果所优选的针长500μm滚轮微针能有效穿透角质层,形成的微孔分布相对均匀;微针处理1、12h后,分别有27.42%、60.64%药物吸收进入皮肤。给药12h,皮内注射醋酸曲安奈德皮肤中滞留药量较给药1h下降至45.98%,而微针、直接涂布醋酸曲安奈德乳膏分别增加到2.73、4.18倍,微针组皮肤中滞留药量是直接涂布乳膏组的3.56倍(P<0.05)。皮内注射12h皮肤药量分布并不均匀,均值为(4.83±5.51)μg,微针组均值为(0.93±0.14)μg,分布相对均匀。TEWL法显示微针处理与皮内注射的皮肤刺激性差异无统计学意义,但激光多普勒血流量法显示皮内注射的皮肤刺激性是微针处理的8.40倍。结论改装滚轮微针处理后涂布醋酸曲安奈德乳膏较皮内注射醋酸曲安奈德在人增生性瘢痕中吸收均匀、皮肤刺激性较小,但其瘢痕治疗效果尚有待进一步验证。     

经阴道手术治疗剖宫产术后子宫瘢痕部位妊娠

目的探讨经阴道手术治疗剖宫产术后子宫瘢痕部位妊娠（caesareanscarpregnancy,CSP）的价值。方法对我科2009年8月至2012年8月收治的符合CSP诊断标准的21例患者行经阴道手术治疗,采用腰硬联合麻醉,膀胱截石位,按阴道手术常规操作,于宫颈阴道部与阴道前壁交界处,横向切开阴道前壁,上推膀胱腹膜反折2—3cm,暴露子宫前壁下段,见到病灶后,酌情切开子宫前壁下段,吸出病灶。结果2l例CSP行经阴道病灶切除联合子宫修补术,术后平均住院4（3～5）d。均获随访,所有患者手术后3周内血绒毛膜促性腺激素（p—humanchorionicgonadotrophin,p．HCG）降至正常,1～2个月月经恢复正常。结论经阴道手术治疗子宫瘢痕部位妊娠效果确切,疗效好,恢复快,值得临床推广应用。     

子宫瘢痕妊娠子宫动脉栓塞术治疗侧支动脉形成的危险因素调查

目的研究调查子宫瘢痕妊娠子宫动脉栓塞术(uterine artery embolization,UAE)治疗侧支动脉的形成的危险因素。 方法选取本院收治的子宫瘢痕妊娠患者127例为研究对象,所有患者均于UAE手术治疗时进行观察,评估患者术后侧支动脉的发生率,根据侧支动脉形成情况将患者分为侧支动脉组和非侧支动脉组,对两组患者的基础资料、临床各项检查指标等进行组间对比分析,并采用单因素分析和多因素Logistic回归分析探讨影响子宫瘢痕妊娠患者UAE术后侧支动脉形成的危险因素。 结果经统计观察显示,在子宫瘢痕妊娠UAE手术期间共形成侧支动脉患者45例,发生率为35.43%。经单因素分析显示,侧支动脉组和非侧支动脉组患者在年龄、体重指数(body mass index,BMI)、吸烟史、饮酒史、孕周、文化程度、据上次剖宫产间隔、子宫肌瘤病史等基础、临床资料比较差异无统计学意义(P＞0.05)。而两组患者在前置胎盘、盆腔炎症、妊娠期合并症、人工流产手术史、剖宫产次数等发生率差异有统计学意义(P＜0.05)。通过设计Logistic多元回归分析方案并进行相应的变量赋值,经多因素分析显示前置胎盘史、盆腔炎症史、妊娠期合并症发生率高、人流手术史、剖宫产次数多等均为子宫瘢痕妊娠UAE治疗时侧支动脉形成的高危因素。 结论我院子宫瘢痕妊娠UAE治疗期间侧支动脉形成有着较高的发生率,其中前置胎盘史、盆腔炎症史、妊娠期合并症发生率高、人流手术史、剖宫产次数多等均为侧支动脉形成的独立危险因素,应引起临床医师的高度关注。     

Objective evaluation of burn and post-surgical scars and the accuracy of subjective scar type judgment

Background The true proliferation degree of burn and operation scars during their maturation was poorly defined. The objective of this study was to provide a quantitative evaluation of the proliferation degree of deep-partial thickness burn and surgical suture wound scars after wound healing and the accuracy of subjective judgment of scar types. Methods A total of 423 patients in the burn group and 667 patients in the suture wound group were enrolled in this study. Objective scar measurement （by negative-positive moulage） was carried out at 3, 6 and 12 months after wound healing in 1090 patients from different regions in China. The Kruskal-Wallis H test and chi-square test were used in the statistical analysis. Results The median degrees of scar proliferation were 0.03 cm at 3 months, 0.03 cm at 6 months and 0 cm at 12 months in the burn group and 0.05 cm, 0.04 cm and 0.04 cm respectively in the suture wound group. At 3 and 6 months post wound healing, there was no significant difference in scar proliferation between the groups （P 〉0.01）. After 1 year, burn scars displayed evidence of atrophy （P 〈0.01）. Although the degree of scar proliferation differed among the four scar types （P 〈0.01）, the ranges of scar height in the four scar types largely overlapped when judged in a subjective manner, especially in proliferation and superficial scars. Conclusions Scar atrophy occurs after one year in burns, but not in the surgical suture wound group. It is important to take anti-scar therapy for surgical wounds as well as burn wounds. The various scar types could not be judged precisely in a subjective manner.     

Spinal cord injury-induced lesional expression of the repulsive guidance molecule (RGM)

The repulsive guidance molecule (RGM) is involved in the formation of the central nervous system (CNS) during development by modulating guidance of growing axons. However, a role of RGM in CNS injury remains to be established. We studied the expression of RGM in the spinal cord of rats with spinal cord injury (SCI). After SCI, RGM+ cells accumulated in lesions and peri-lesional areas. During the first days after SCI, RGM expression was confined to neurons, ballooned neurite fibers/retraction bulbs, smooth muscle/endothelial cells, and to leucocytes infiltrating the lesion. Lesional RGM expression was frequently confined to hypertrophic beta-APP+ and RhoA+ neurites/retraction bulbs. With maturation of the lesion, we observed RGM expression by components of the developing scar tissue (cicatrix), such as fibroblastoid cells, reactive astrocytes and in addition a pronounced extracellular RGM deposition resembling neo-laminae. Frequent RGM+, RhoA+ coexpression by lesional retraction bulbs represent first preliminary evidence of RGM to exert growth inhibitory effects by the second messenger system RhoA. To date, RGM is one of the most potent axonal growth inhibitors identified and present in axonal growth impediments (i) oligodendrocytes; (ii) the plexus choroideus and (iii) components of the developing scar.     

Open port placement through the umbilical cicatrix

Peritoneal access and creation of pneumoperitoneum are the key initial steps of laparoscopic surgery. This is commonly achieved by either introducing Veress needle or by gradual dissection of all the layers of the abdominal wall and then introducing a port under direct vision. The two techniques are extremely safe, but large outcome studies have found slightly increased complications with the Veress needle. Randomized trials do not support such finding and both techniques continue to have their enthusiasts. We hereby describe an open method of initial port placement, wherein the port is introduced through the umbilical cicatrix under direct vision.     

Bcl-2 mRNA和Bax mRNA在增生性瘢痕中的表达及意义

【目的】观察Bcl-2 mRNA和Bax mRNA在增生性疲痕和正常皮肤组织内的表达特征及其对增生性瘢痕形成的影响。【方法】收集20例增生性疲痕和20例正常皮肤组织，常规制作石蜡包埋切片，Bcl-2 mRNA和Bax mRNA染色方法为分子原位杂交染色法。【结果】Bcl-2 mRNA和Bax mRNA杂交信号阳性产物定位于胞浆。增生性疲痕Bcl-2 mRNA表达阳性率及其评分明显高于正常皮肤（P〈0．01）；增生性瘢痕Bax mRNA表达阳性率及其评分与正常皮肤无明显差异（P〉0．05）。【结论】Bcl-2基因表达增强可能是瘢痕中细胞凋亡减少，形成增生性瘢痕的机制之一。