耳甲腔型小耳畸形的耳廓再造术

目的 分析和探讨适合耳甲腔型小耳畸形的耳廓再造术.方法 采用自体肋软骨二期法耳廓再造术对13例(14只耳)耳甲腔型小耳畸形患者实施耳廓再造,一期为肋软骨耳廓支架的成型和移植,二期为颅耳角成形.结果 经过2个月至2年的随访,14只再造耳外形满意,耳解剖结构清晰,并拥有良好的颅耳角,其大小、位置与健侧耳也基本一致.结论 自体肋软骨二期法耳廓再造术是矫正耳甲腔型小耳畸形较理想的手术方法.

Abstract：

Objective To investigate the method of auricular reconstruction for concha-type microtia. Methods Two-staged auricular reconstruction was applied in 13 cases (14 ears) with conchatype microtia. The cartilage auricular framework was fabricated and implanted in the first stage, followed by ear elevation and cranio-auricle angle formation at the second stage. Results The patients were followed up for 2 months to 2 years with satisfactory aesthetic result. The reconstructed ears had a good appearance and position, and were symmetric to the healthy ears. Conclusions The two-staged auricular reconstruction with autologous cartilage framework is ideal for concha-type microtia.     

自体真皮脂肪复合组织块移植修复鼻背塌陷

Objective To investigate the feasibility, rationality and efficacy of the autologous dermal-fat composite tissue used as filling materials in the repair of nasal dorsum collapse.Methods The dermal fat composite tissue block (7.0 cm× 1.0 cm × 1.0 cm) was removed from the buttocks or abdoman as filling materials. 13 cases of nasal dorsum and nasal-shaped misfits were treated by using an umbrella graft of the auricular cartilage plus dermal-fat composite tissue graft to reconstruct natual shape of nasal dorsum and tip. Results The nasal dorsum and tip were repaired in 13 patients with collapsed nasal dorsum. The dermal-fat composite tissue survived well, and the incisions were healed in stage Ⅰ and the incision trace was not obvious. After follow-up for one year, the shape of nose was much satisfactory. Conclusion It is a well-accepted and easy-going procedure to repair collapsed nasal dorsum with autologous dermal-fat or a combination of composite ear cartilage tissue graft, with satisfactory effect and no rejection reactions.     

双扩张器重叠扩张无需植皮的全耳成形术

Objective To investigate a method of auricular reconstruction with overlapping tissue expansion techniques and without skin graft. Methods Two tissue expanders were implanted subcutaneously at the mastoid. 6 patients with microtia(overlapping group)were treated. After completion of skin expansion, the expanders were removed. The autolognus rib cartilage or Medpor scaffolds were implanted. The flap A made by the upper expanded flap was used to cover the upper part of the front and the back of the framework. The flap B made by lower expanded flap was transplanted to cover the lower part of the back of frameworks. The remaining expanded skin was designed to cover the postanricular wound. The other thirteen microtia patients who treated by the traditional auricular reconstruction were selected as control(traditional group). Results Skin graft was not necessary in the patients of overlapping groups. The appearance of the reconstructed ear was very satisfactory. Epidermal necrosis of 0.5 cm × 0.5 cm happened at the distal end of postauricular flap in one case. All the other cases had no complication of infection or framework exposure. The patients were followed up for 3～6 months. Compared with the traditional group, the scar in the costal donor site was inconspicuous in overlapping group(P <0.05). The complication rate was lower and satisfactory rate was higher in overlapping group (P < 0.01 and P < 0.05). But there was hair growth in the helix of reconstructed ear in overlapping group. Conclusions The overlapping expansion can provide enough skin for ear reconstruction. The skin graft is not necessary, resulting less donor site scar and low complications.     

59例30岁以下原发性肺癌的临床及病理

Objective To investigate and analyze the clinical and pathological features of surgical treatment for primary bronchogenic carcinoma in adolescent patients.Methods A retrospective review is presented of patients less than 30 years with surgical treatment of bronchogenic carcinoma between 1969 and 2008.There were59 patients (36 male and 23 female).Mean age was 23 years ( range 8-29 ) .The ratio of men to women patients was 1.7∶1.Forty-nine cases ( 83.0% ) were symptomatic at presentation and 18 cases(30.5% )were misdiagnosed as other diseases.Surgical procedures included radical resection in 46 cases,palliative resection in 3 cases,thoracotomy only for unresectable disease in 7 cases and VATS biopsy in 3 cases.The histological types were 18 adenocarcinomas,13 carcinoids,9 mucoepidermoid carcinoma,5 squamous cell carcimomas,4 small cell lung cancer,3 adenosquamous carcinoma and 4 others.On TNM staging,8 cases in stage Ⅰa,3 cases in stage Ⅰb,9 cases in stage Ⅱ a,12 cases in stage Ⅱb,15 cases in stage Ⅲa,8 cases in stage Ⅲb,4 cases in stageⅣ.Results There were no operative death in radical group.Post-operative atelectasis in 3 cases.One case died from postoperative respiratory failure in explosive group,the postoperative five year survival rate was 27.0%.radical resection group 5-year survival was 35%.Univariate analysis identified TNM stage and surgical procedures as predictors of survival( P <0.05).factors that had no significant effect on overall survival included gender,histologic sbutype and postoperative chemotherapy (P > 0.05).The 5 year survival in stage Ⅰ,Ⅱ,Ⅲa,Ⅲb + Ⅳ were 75.0%,33.3%,14.3% and 0,respectively.The 5 year survival in lobectomy,pneumonectomy and exporsive were 43.0%,18.2% and O,respectively.On multivariate analysis,TNM stage of disease was the only independent predictor of survival ( P =0.000) .Conclusion We should pay attention to adolescent lung cancer and improve the diagnosis rate avoiding of delaying surgical treatment.The five year survival rate of radical resection for adolescent lung cancer was good.They should be treated with aggressive multimodality therapy and surgical resection is the first-line treatment for them.     

自体真皮脂肪复合组织块移植修复鼻背塌陷

Objective To investigate the feasibility, rationality and efficacy of the autologous dermal-fat composite tissue used as filling materials in the repair of nasal dorsum collapse.Methods The dermal fat composite tissue block (7.0 cm× 1.0 cm × 1.0 cm) was removed from the buttocks or abdoman as filling materials. 13 cases of nasal dorsum and nasal-shaped misfits were treated by using an umbrella graft of the auricular cartilage plus dermal-fat composite tissue graft to reconstruct natual shape of nasal dorsum and tip. Results The nasal dorsum and tip were repaired in 13 patients with collapsed nasal dorsum. The dermal-fat composite tissue survived well, and the incisions were healed in stage Ⅰ and the incision trace was not obvious. After follow-up for one year, the shape of nose was much satisfactory. Conclusion It is a well-accepted and easy-going procedure to repair collapsed nasal dorsum with autologous dermal-fat or a combination of composite ear cartilage tissue graft, with satisfactory effect and no rejection reactions.     

Comparison of traditional vascular reconstruction with covered stent in the treatment of subclavian artery injury

Purpose:To explore the significance of traditional vascular reconstruction and covered stent for limb salvage after subclavian artery injury.Methods:Patients with subclavian artery injury admitted to Beijing Jishuitan Hospital from January 2010 to December 2018 were retrospectively analyzed.All the injuries have been confirmed by intraoperative exploration,computed tomography angiography or digital subtraction angiography.Complete or partial amputation injuries were excluded.Mild artery defect or partial intimal damage was treated by interventional implantation,while other patients received open surgeries,including direct suture of small defect less than 2 cm and transplantation with autologous vein or artificial blood when the defect was more than 2 cm.Patients were divided into open surgery group and stent implantation group based on the treatment they received.Patients were followed up at 2 weeks(first stage)and 6 months(second stage)after operation to investigate limb salvage.Student's t-test was used to compare the general data between two groups and Chi-square test to analyze the rate of limb salvage.Results:Altogether 50 cases of subclavian artery injury were treated,including 36 cases of open surgery and 14 cases of stent implantation.Combination of nerve injury was observed in 27 cases(75.0%)in open surgery group and 12 cases(85.7%)in stent implantation group.Amputation developed in 3 cases with open surgery and 1 case with stent implantation.Consequently the rate of successful limb salvage was respectively 91.7%(33/36)and 92.9%(13/14),revealing no significant difference(p>0.05).Conclusion:Rapid reconstruction of blood circulation is crucial following subclavian artery injury,no matter what kinds of treatment strategies have been adopted.Interventional stent implantation can achieve a good effect for limb salvage.     

瘦素和瘦素受体在食管癌中的表达及其意义

Objective To investigate the role of leptin and leptin receptor in carcinogensis and development of esophageal carcinoma. Methods The expression of leptin and leptin receptor was detected in 52 cases of esophageal carcinoma tissues and 49 cases of normal esophageal tissues by immunohistochemistry. The correlation between their expression and clinicopathological parameters was also analysized. Results The expression rate of leptin and leptin receptor in esophageal carcinoma was 78. 8% (41/52) and 82.7% (43/52) respectively, and the rate in normal esophagus was 58.3% (28/49) and 59.2% (29/49) respectively. The expression rate of leptin and leptin receptor both had statistically significantly differences between esophageal carcinoma and normal esophagus tissues (P ＜ 0. 05). The expression rate of leptin was associated with position, tumor size, differentiation, lymphatic metastasis and TNM stage (P ＜ 0. 05 ). Conclusion Leptin and leptin receptor were dually expressed in esophageal carcinoma.They played important roles in the process of carcinogensis and development of esophageal carcinoma.     

雌、孕激素受体和Her-2阴性乳腺癌的临床病理特征

Objective To study the clinicopathologic characteristics of triple-negative breast cancer (TNBC) and its value in the prediction of prognosis. Method In this study,500 cases of female breast cancers were examined immunohistochcmically for the TNBC. The clinicopathologic characteristics of the 243 TNBC cases were inspected. Results TNBC accounted for 17.6% (88/500) of the 500 breast cancers. The histological types of the TNBC included mainly infihrative ductal carcinoma, metaplastic carcinoma and medullar carcinoma. Among those, histological grade Ⅲ accounted for 72.7% (64/88) of all the TNBC and was more common than that in hormone receptor positive breast cancers (HR+ group ) and Her-2 overexpression breast cancers (Her-2 group)(P=0.000). The positive rates of CK5/6 and EGFR in the TNBC were 30.7% (27/88) and 34.1% (30/88), respectively. The positive rates of ERCC1 and KIT in the TNBC were 28.4% (25/88) and 34.1% (30/88), respectively, Both of which were higher than those in the HR + group and Her-2 group, respectively (P=0.032 and P=0.026). 3-year survival rate of the TNBC was 71.5% and it was lower than that of HR group (P=0.021) and not significantly different from that of Her-2 group (P=0.474). Conclusions TNBC is the breast cancer with high aggressive pathologic futures and poor prognosis. EGFR and ERCC1 expression were positive in a portion of TNBC cases.     

雌、孕激素受体和Her-2阴性乳腺癌的临床病理特征

Objective To study the clinicopathologic characteristics of triple-negative breast cancer (TNBC) and its value in the prediction of prognosis. Method In this study,500 cases of female breast cancers were examined immunohistochcmically for the TNBC. The clinicopathologic characteristics of the 243 TNBC cases were inspected. Results TNBC accounted for 17.6% (88/500) of the 500 breast cancers. The histological types of the TNBC included mainly infihrative ductal carcinoma, metaplastic carcinoma and medullar carcinoma. Among those, histological grade Ⅲ accounted for 72.7% (64/88) of all the TNBC and was more common than that in hormone receptor positive breast cancers (HR+ group ) and Her-2 overexpression breast cancers (Her-2 group)(P=0.000). The positive rates of CK5/6 and EGFR in the TNBC were 30.7% (27/88) and 34.1% (30/88), respectively. The positive rates of ERCC1 and KIT in the TNBC were 28.4% (25/88) and 34.1% (30/88), respectively, Both of which were higher than those in the HR + group and Her-2 group, respectively (P=0.032 and P=0.026). 3-year survival rate of the TNBC was 71.5% and it was lower than that of HR group (P=0.021) and not significantly different from that of Her-2 group (P=0.474). Conclusions TNBC is the breast cancer with high aggressive pathologic futures and poor prognosis. EGFR and ERCC1 expression were positive in a portion of TNBC cases.     

周围神经损伤修复后早期骨骼肌细胞凋亡的初步研究

Objective To explore skeletal muscle apoptosis at the early stage of peripheral never regeneration in rats.Methods A total of 54 male SD rats were randomly assigned to 3 groups ( n = 18/group): denervation group (A), neurorrhaphy group (B), normal control group (C).In group A, a 1 cm segment of the left sciatic nerve was removed.In group B, the left sciatic nerve was transected above the bifurcation and immediately repaired with 10-0 sutures.No surgery was done in group C.The gastrocnemius muscle wet weight served as an indicator of the degree of muscle atrophy.Marker of apoptosis, nuclear DNA fragmentation, was detected using terminal deoxyribnudeotidyl transferase mediated dUTP nick end labeling (the TUNEL method) and observed under confocal microscopy at 2, 14 and 28 days postoperatively.Another portion of the gastrocnemius muscle was homogenized to analyze the activity of caspase-3 and -8 by spectrophotometry.Results TUNEL labeling of fragmented DNA on histological sections in the neuorrhaphy group revealed levels of apoptotic nuclei higher than the control group and lower than the denervation group at the early stage ( ＜ 28days ).The activity of caspase-3 and -8 in the neuorrhaphy group was also higher than the control group but lower than the denervation group.Conclusion At the initial stage of peripheral never regeneration, apoptosis may contribute to muscle atrophy and extrinsic apoptotic pathways may take part in it.     

Restoration of facial contour in Romberg's disease and hemifacial microsomia: experience with 118 cases

The experience with free flaps and conventional reconstructive procedures for 118 patients with Rombergapos;s disease and hemifacial microsomia over a 10-year period is presented. The groin free flap was used most frequently for patients with Rombergapos;s disease, whereas the scapular free flap was used for patients with hemifacial microsomia. The rectus abdominis or the latissimus dorsi free flap was chosen only when additional volume was required. To achieve better contour, secondary procedures, such as defatting the flap, pedicled temporal fascial flaps, cartilage and bone grafts, orthognathic surgery, and bone distraction were performed in severe cases. For patients with Rombergapos;s disease, excellent results were achieved in 35% (n = 28) of mild cases, in 72% (n = 27) out of 38 moderately and in 41% (n = 5) out of 12 severely affected patients. In hemifacial microsomia group (n = 40) excellent results were obtained in 66% of cases.     

半面短小症的手术治疗

目的总结半面短小症手术治疗的方法和经验。方法回顾性分析1982年4月至2004年8月在本院进行手术并有随访记录的58例半面短小症患者的临床资料,根据术前对患者病变的评估分类,采用针对不同累及部位及组织的手术方法治疗,术后3个月起随访,测量患者的面部歪斜角度变化,分别统计患者和医师对手术的满意率。结果手术后骨性面部歪斜角平均缩小4·2°,软组织面部歪斜角平均缩小2·9°;患者对手术的总体满意率为86·2%,医师对手术的总体满意率为84·5%。结论针对不同的部位和累及组织的半面短小症进行个性化的手术治疗是治疗此类疾病的有效方法。     

个性化纯钛假体矫治半侧颜面短小畸形的临床应用

目的:探索应用计算机辅助设计和制造技术制备的个性化纯钛假体治疗半侧颜面短小畸形的效果。方法:采集4例半侧颜面短小畸形患者的CT图像数据,利用快速成型技术制作患者头颅树脂模型,并进行精确数字化设计,将设计数据输入数控车床,制备出个性化纯钛假体,置入患者下颌骨预定的位置。结果:利用计算机辅助设计和制造技术,为患者制备出个性化纯钛假体,假体置入下颌骨预定位置。术后4例患者伤口均I期愈合。随访1～4年,面部形态恢复满意。结论:利用计算机辅助设计和制造技术制备出的纯钛假体可以治疗半侧颜面短小畸形,该方法具有设计精确,手术时间短,面部形态改善明显的优点。具有一定的临床应用价值。     

以骨延长术为主的半侧颜面短小畸形的综合治疗

目的：探讨以下颌骨延长术为主的半侧颜面短小畸形的现代综合治疗。方法：一期行下颌骨延长术,二期手术取出延长器并根据畸形的特点配合相应的辅助手术,术后接受牙科正畸治疗,共14例,结果：14例患者下同骨延长过程顺利,成骨良好,无成骨不良等并发症,二期手术后面部畸形矫正效果满意,结论：矫正下颌骨畸形是治疗半侧颜面 小畸形的关键,骨延长术是治疗下颌骨畸形的有效方法,二期手术还需要配合相应的辅助方法以完成对该畸形的综合治疗。     

Vascularized bone grafts in the treatment of hemifacial microsomia]

A systematic and theoretic review is performed on the vascularised bone donor sites that may be useful in the case of hemifacial microsomia. A review of the literature reveals that the iliac crest and the scapula are the most commonly used vascularised bone grafts. A case study is included in the paper, showing an hemifacial microsomia reconstruction using a composite fibular vascularised bone graft. They highlight the criterias they think fundamental for choosing the vascularised bone graft donor site regarding the aims of the reconstruction of a Pruzansky grade II or III.     

半面萎缩的自体脂肪颗粒移植治疗

目的对半面萎缩的治疗采用改良自体脂肪颗粒移植技术,提高脂肪成活率,减少术后脂肪液化、坏死、吸收等并发症。方法1999年3月～2004年10月,治疗31例稳定期半面萎缩患者。男12例,女19例;年龄19～28岁,平均23.5岁。根据半面萎缩范围不同分成3型,轻度萎缩9例,中度萎缩19例,重度萎缩3例。根据以往研究结果和文献的总结分析,在脂肪的获取和移植上,采用低位供区、低压抽取、低速离心和多点、多隧道、多层面放射状注射移植。经术前、术后正位、侧位45°及90°照片比较,以及术后表情是否自然,局部有无硬块和囊肿,患者感觉舒适度等评价标准,并根据随访结果决定是否需再次手术。结果术后31例均达到面部外形基本对称。1次注射15例,2次13例,3次3例。第3次注射后较第2次效果好,第2次注射比第1次效果好,且注射量逐次减少。下颌部注射量8～14ml,平均11ml;颊部注射量15～25ml,平均20ml;颧部注射量5～10ml,平均7.5ml;额部注射量18～20ml,平均19ml。患者随访3～5年,未发现感染、硬结、皮下包块、囊肿或其他并发症。患侧皮肤色素增生明显减轻。结论与传统治疗方法比较,自体脂肪颗粒注射移植治疗能达满意面部对称,且无供区损伤及受区并发症,是治疗半面萎缩一种较理想的手术方法。     

Application of free serratus anterior fascial flap for reconstruction of ear deformity due to hemifacial microsomia: A report of two cases

Reconstructing congenital auricular defects due to hemifacial microsomia (HFM) is often required to deal with low hairline and defects of the temporal fascia/muscular systems. In this report, we present two cases of HFM patients (16‐year‐old and 20‐year‐old) with positional anomaly of the remnant lobule and 95% low hairline, who were treated with serratus anterior fascial flap (SFF) at the second stage of auricular construction. At the first stage, 3D costal cartilage framework was placed following the removal of hair‐bearing skin, and was resurfaced with the pericranial flap. At the second stage, ear elevation was performed with cartilage block grafting, then the free SFF was used to construct cephaloauricular sulcus because of local fascial defect. The pedicles of SFF, subscapular vessels were anastomosed to the cervical vessels. No complications developed during the follow‐up period of 4 years in both cases and projections of the constructed ears were satisfactorily maintained. The free SFF is naturally thin and flexible with sufficient circulation and it may be an alternative to temporo‐parietal fascia flap in complicated microtia construction in HFM. © 2016 Wiley Periodicals, Inc. Microsurgery 37:436–441, 2017.     

自体真皮脂肪复合组织块移植修复鼻背塌陷

目的 探讨自体真皮脂肪复合组织块在鼻背塌陷修复中作为填充材料的可行性、科学性及修复效果.方法 切取自体臀部或腹部真皮脂肪复合组织块（7.0 cm×1.0 cm×1.0 cm）,作为填充材料,对13例鼻背塌陷、鼻形不良者进行修复,酌情配合耳廓软骨加真皮脂肪复合组织块的伞状移植物,重塑鼻背、鼻尖的良好形态.结果 13例鼻背塌陷者,进行鼻背、鼻尖修复后,真皮脂肪复合组织块存活良好,切口均Ⅰ期愈合,且切口痕迹不明显.经1年随访,鼻外形改善、满意.结论 以自体真皮脂肪复合组织块或结合耳廓软骨移植修复鼻背塌陷,效果满意,且取材方便、无排异反应等,患者易于接受.     

Patient benefit from ear reconstruction with porous polyethylene in severe cases of hemifacial microsomia

Background

Ear reconstructions in patients with severe hemifacial microsomia belong to the most challenging cases. When deciding about the best position for the reconstructed ear, the surgeon has to make a compromise out of different given factors, it being impossible to achieve symmetry to the contralateral side. The present study was initiated to analyze if this difficult patient collective with naturally imperfect esthetical results benefits from the operation by an increase in health-related quality of life.

Methods

For ear reconstruction, the authors used frameworks of porous polyethylene (PPE) covered by a temporoparietal fascia flap. Six patients with microtia and hemifacial microsomia type 3 (three adults and three children) received validated questionnaires determining the effects of the ear reconstruction on the patients’ health-related quality of life (Glasgow Benefit Inventory, GBI, or Glasgow Children’s Benefit Inventory, GCBI, respectively). Scores can range from ?100 (maximal negative effect of the intervention) through 0 (no effect) to +100 (maximal positive effect).

Results

All patients achieved positive GBI or GCBI scores suggesting a benefit from the ear reconstruction. For the adults, the mean GBI total score was 27.8. For the children, the mean GCBI total score was 40.3. Scores were higher compared to a control group of microtia patients without additional facial asymmetries.

Conclusions

In severe cases of hemifacial microsomia, ear reconstruction with PPE can significantly increase patients’ health-related quality of life. Furthermore, PPE frameworks offer different surgical advantages compared to autologous cartilage especially in severe hemifacial microsomia. Level of Evidence: Level III, therapeutic study.     

Microsurgical anterolateral thigh fasciocutaneous flap for facial contour correction in patients with hemifacial microsomia

The correction of facial asymmetry in complex hemifacial microsomia presents a challenging problem for reconstructive surgeons. Numerous microsurgical flaps have been introduced for reconstruction of facial asymmetry. This article reports our experience in facial soft tissue reconstruction with microsurgical anterolateral thigh fasciocutaneous flap transfer in six patients with hemifacial microsomia. This flap, which has a reliable vascular pedicle and relatively thin pliable soft tissue, can provide an ideal treatment for facial asymmetry in hemifacial microsomia.