固体硅胶隆鼻术假体植入层次的应用研究进展

通过近五年有关隆鼻术硅胶假体植入层次的文献回顾，归出以下两点：１，假体植入鼻背皮下 后并发症较多，不宜采用；２。假体植入层次以较深为宜，但究系于鼻骨膜下是鼻背筋膜下，目前尚有争议，有待进一步研究探讨。     

鼻背的解剖学观察及其在隆鼻术中的意义

本文通过８例死亡两小时左右的新鲜尸体鼻背部的解剖，详细观察了鼻背部的层次和结构，并进行了硅胶假体置入稳定性试验。在显微镜下观察工鼻背组织的微细结构，证实了假体应置入鼻肌鼻背深筋膜复合体与鼻骨之间形成的腔隙内和假体稳定性的力学关系，分析了置入皮下和破坏力学稳定框架产生并发症的原因。否定假体置入骨膜下的观点．     

固体硅胶隆鼻术的解剖学基础

固体硅胶隆鼻术的解剖学基础作者单位：３３６０００江西宜春医专解剖学教研室王向义裘名宜聂云飞固体硅胶隆鼻术是美容整形手术中最常用的手术之一［１，２］。目前普遍认为，隆鼻术后并发症的发生与假体植入层次密切相关。为此，近年来许多学者进行了鼻背层次的解剖学观...     

隆鼻层次及隆鼻术后鼻根部假体漂移的临床解剖学研究

目的:对鼻背部软组织层次进行解剖观察,了解鼻背部软组织特点,以进一步明确隆鼻的层次及隆鼻术后鼻根部假体漂移的解剖学基础。方法:选用10%福尔马林固定头颅标本20例,对标本行大体解剖,沿背部正中线切口逐层解剖,观察鼻背部的软组织层次,相机拍照。结果:鼻背部软组织层次依次分为皮肤、皮下组织、鼻背筋膜层、鼻背筋膜下疏松结缔组织、骨膜及软骨膜。鼻骨和侧鼻软骨结合处存在致密的纤维连接。降眉间肌大多起于鼻骨骨膜,少数起于鼻肌横部。结论:以往所谓的骨膜下隆鼻术实际上应称为双平面隆鼻术,即鼻根处假体置于鼻骨骨膜深层,鼻背、鼻尖部假体置于鼻背筋膜深层;鼻背筋膜下隆鼻术则是整个假体都置于鼻背筋膜深层。在鼻背筋膜和鼻骨骨膜之间存在滑动层和降眉间肌大多直接起源于鼻骨骨膜可能是鼻背筋膜后间隙隆鼻术后鼻根部假体漂移的解剖学基础。建议手术分离隆鼻腔隙时在鼻骨段紧贴鼻骨锐性分离,破坏骨膜及其表面的滑动层,并完全离断降眉间肌在鼻骨骨膜的起点,以尽量避免发生鼻根部假体漂移。     

隆鼻术后硅胶假体外露的原因分析

目的探讨硅胶假体隆鼻术后假体外露的原因及防治措施。方法对16例鼻假体外露患者,手术取出假体,根据假体外露部位、雕刻形态、隧道层次、切口位置等分析假体外露的原因。结果16例患者中,6例假体短臂由鼻小柱侧缘切口穿出,5例假体由鼻尖下点穿出(其中3例为柳叶型假体),3例由鼻前庭切口穿出(其中1例合并感染),2例经鼻背皮肤穿出。取出的假体形态:柳叶型假体雕刻太尖,L型假体短臂过长而长臂宽厚、假体叠加等。12例再次隆鼻,效果满意。结论假体与鼻头、鼻背不相称植入后张力过大或假体形状雕刻欠佳是外露的根本原因。因此,隆鼻术后使假体处于无张力状态及提高假体雕刻技巧是避免假体外露的主要措施。     

隆鼻术的硅胶假体置入层次及稳定性研究

用８例死亡２小时左右的新鲜尸体进行鼻背部解剖，并进行硅胶假体置入稳定性试验。在显微镜下观察了鼻背组织的微细结构，提出鼻肌鼻背深筋膜复合体的概念，证实了假体应置入鼻肌鼻背深筋膜复合体与鼻骨形成的腔隙内和假体稳定性的力学关系，分析了置入皮下和破坏力学稳定框架产生并发症的原因。否定假体置入骨膜下的观点。     

隆鼻手术中肤色硅胶的应用

部分接受白色硅胶隆鼻术的患者，术后主诉鼻背皮肤红亮，强光下假体透光泛红。作者认为与白色硅胶不能有效地吸收可见光，阻制光的通透有关。使用一种外观暗红色的固体硅胶肤色硅胶用于隆鼻手术１０６例，置假体于鼻背筋膜下，手术均一次成功，无不良反应。因肤色硅胶较白色硅胶能更多地吸收可见光，抑制光在假体的内反射，术后鼻背皮肤红亮发生率由１９．２％降为３．８％；暗室透光检查假体透光发生率由４３．８％降为６．３％。证实肤色硅胶有效地避免了术后假体的透光性及鼻背肤色的改变，提高了美容效果，可推广使用，尤其是鼻背皮肤白而薄，皮下组织少或假体需肥大的患者以使用肤色硅胶为好。     

隆鼻术假体置入层次的探讨

以鼻背软组织的解剖学观察为基础，结合临床应用经验，分析了隆鼻术中放置硅胶假体的不同层次，讨论了各层次解剖特点及操作要点。指出在鼻肌──降眉间肌腱膜浅层或深层放置硅胶假体，均能获得良好手术效果，并对上述两个层次的综合利用提出了见解。     

鼻背筋膜下鼻假体置入隆鼻176例总结分析

目的：寻求隆鼻手术的最佳层次并探讨术中注意事项。方法：对176例鼻梁低平者，行鼻背筋膜下放置鼻假体支架进行隆鼻手术，并进行总结分析。结果：170例术后隆鼻效果满意，满意率达96．6％以上。6例因假体形态不佳、偏移而再次手术，经再次手术后3个月～2年的随访观察，除2例肿胀消退时间较长外，就医者对术后效果均满意。结论：由专科医师实施手术是减少隆鼻术失败的关键。采取一些措施后鼻背筋膜下放置鼻假体支架行隆鼻手术可取得较好手术效果，是一种可行的方法。     

隆鼻术假体置入层次的探讨

以鼻背软组织的解剖学观察为基础，结合临床应用经验，分析了隆鼻手术中放置硅胶假体的不同层次，讨论了各层次解剖特点及操作要点。指出在鼻肌－降眉间肌腱浅层或深层放置硅胶假体，均能获得良好手术效果，并对上述两个层次的综合利用提出了见解。     

左炔诺孕酮硅胶棒应用者子代细胞遗传学研究

目的 :通过对左炔诺孕酮硅胶棒 ( 6根型 )埋植剂应用者子代细胞遗传学指标的检测 ,以期对避孕埋植剂的长期安全性提供依据。方法 :在同一地区随机选择 50名埋植 4年、取药 1年后妊娠夫妇的子代为实验组 ,选择 49名正常夫妇的子代为对照组。静脉采血检测染色体畸变、姊妹染色单体交换 ( SCE)、细胞微核的发生率。结果 :实验组染色体畸变率、SCE频率、细胞微核率平均值与对照组比较 ,均无显著差异 ( P>0 .0 5)。结论 :长期使用左炔诺孕酮硅胶棒 ( 6根型 )对子代不产生潜在的细胞遗传学损伤效应。     

硅胶管搭桥内引流治疗恶性肿瘤致阻塞性黄疸106例分析

目的 探讨晚期胆道、胰腺恶性肿瘤旁路内引流的治疗效果。方法 对106例不能手术切除根治的胆胰恶性肿瘤所引起的阻塞性黄疸病人,采用硅胶管搭桥旁路内引流术。结果 本组无手术死亡,术后黄疸完全消退达到92％,67例得到随访(63.2％)。术后平均生存期为12.3个月,与同期一组41例切除根治术比较(15.7个月),经统计学处理,无显著差异。结论 搭桥旁路内引流术治疗胆胰恶性肿瘤所致阻塞性黄疸,操作简单、创伤小、术后恢复快,不存在术后长期胆汁外流和终生带管等弊端,引流效果确实、可靠,不失为冶疗晚期胆胰恶性肿瘤可取方法。     

Closed-Chest Decannulation of Transthoracically Inserted Aortic Balloon Catheter without Grafting

A method is presented which allows removal of a balloon assist catheter inserted directly (without a graft) through the ascending aorta in the course of heart surgery without the need for reopening the sternotomy incision. The catheter is inserted through the aortic wall under the protection of two purse string sutures which are temporarily tightened using implantable grade silastic rubber tourniquet. The end of the tourniquet is placed subcutaneously in a subxiphoid position. At the time of discontinuation of balloon assist, the balloon can be removed using local anesthesia without reopening the sternum by exposing the end of the tourniquet substernally, removing the catheter, and plugging the tourniquet. The silastic tourniquet may be left in indefinitely or removed through a similar exposure six to eight weeks after the procedure.     

Mastopexy: Modification of periwinkle shell operation. Ten years of experience

Degrees I and II ptosis and atrophy of the female breast can definitively be corrected by the modified periwinkle shell operation. More problematic are the long-term results after correction of a degree III condition, especially when silastic prostheses for augmentation have been used. The long-term results can be optimized by a combination of dermal and glandular mastopexy and mammary implants.     

Bony regrowth after major erosion of the maxillary following silastic malar augmentation. Case report

Alloplastic malar augmentation has become a routine procedure associated with few complications. Among them, authors have described bony erosion and resorption. The case presented here illustrates an unusual case of maxillary bone erosion after silastic malar augmentation. Implants were surgically removed and no more surgical intervention was performed. After 15 months, contrast-enhanced CT scan has showed nearly complete bony regrowth to an almost normal state. Considering resorption phenomenons following silastic chin implants, Peled et al. reported no long-term sequellae after implant removal and bony regrowth to the presurgical state after 9 months. Accordingly, we conclude that these phenomenons, even spectacular, are always reversible after implants removal and that treatment should just consist in ablation of the offending prosthetic material.     

Silastic replacement of the trapezium for arthrosis—A twelve year follow-up study

Thirty-three patients with 39 Swanson silastic trapezium implants have been studied. Three years after operation no dislocation or evidence of implant wear was found, but re-examination at an average of 12 years after operation revealed dislocations and implant wear in about half of the cases. Cyst formation in surrounding carpal bones was found in twenty cases. The result in terms of pain relief and thumb function was good and comparable to the three-year follow-up. A significant correlation was found between weakness of the pinch grip and dislocation of the implant. No correlation was found between pain and dislocation of the implants, nor between pain and presence of intraosseous cysts.     

Testicular implants

Testicular implants have been in use for more than 50 years with an excellent record of safety and efficacy. The controversy concerning the use of silicone prosthetics in breast implants also affected testicular implants. There is no conclusive evidence associating connective tissue disorders, autoimmunity, or malignancy with silicone implants. Studies show silicone leakage from these implants, but long-term follow-up is required to identify the significance of this finding. Saline-filled silastic shell testicular prostheses will be implanted as part of an ongoing study to monitor various safety parameters, as required by the Food and Drug Administration.     

Gastroscopically Assisted Balloon Tamponade for Massive Bleeding after Silastic Ring Vertical Gastroplasty

We report a case of massive upper gastrointestinal bleeding after silastic ring vertical gastroplasty. The bleeding originated from the staple-line at the insertion point of the silastic ring. A Sengstaken-Blakemore tube tamponaded the area of bleeding, by a new technique whereby the gastroscope was inserted through the gastrostomy orifice and used to guide the placement of the occluding balloon.     

Confidential questionnaire on current surgical practice for hallux valgus

Little has been written about the epidemiology of surgical practice for hallux valgus. Therefore, a confidential postal questionnaire was sent out to members of the British Orthopaedic Foot Surgery Society with mailing addresses in the UK, in which information was gathered about current surgical practice for hallux valgus, and also views and ideas about randomized controlled trials.Sixty-four percent of the questionnaires sent out were returned from a single mailing, and 89% of these respondents were currently carrying out surgical operations for hallux valgus. All currently practising surgeons who responded used osteotomy, the majority used arthrodesis and Keller arthroplasty, and about a quarter of surgeons used silastic implants. This study also showed that there are strongly held and sometimes diverse views about the merits of different commonly used interventions.     

Induction of prostate adenocarcinomas in Lobund Wistar rats by testosterone

Prostate adenocarcinomas were induced in Lobund Wistar rats following subcutaneous implants of silastic chambers containing testosterone propionate. The tumors resembled those that developed spontaneously in the Lobund Wistar rats. Tumors were not induced in ACI rats by the same treatment schedule.