术中持续有限扩张术的临床应用

自1993年5月以来,临床应用术中持续有限扩张术(ISLE),为21例病人进行即刻创面修复。其中18例效果良好,3例效果欠佳,临床有效率达85.7%。实践证明,ISLE 可成功地应用于全身各部位。其临床效果与组织缺损的宽度和扩张后所增加的皮肤组织量以及持续扩张的时间有关。     

术中持续有限扩张术的临床应用

自１９９３年５月以来，临床应用术中持续有限扩张术（ＩＳＬＥ），为２１例病人进行即刻创面修复。其中１８例效果良好，３例效果欠佳，临床有效率达８５．７％。实践证明，ＩＳＬＥ可成功地应用于全身各部位。其临床效果与组织缺损的宽度和扩张后所增加的皮肤组织量以及持续扩张的时间有关。     

Apatite cement containing cis-diamminedichloroplatinum implanted in rabbit femur for sustained release of the anticancer drug and bone formation

To treat malignant bone tumors, anticancer drugs are administered systemically, simultaneously with surgical therapy. However, drugs administered systemically have considerable invasive action on bone and other organs, and are also associated with various side effects. A bone-cementing material that can maintain high concentrations of anticancer drug at local sites and which can improve local structural weakness after tumor resection would constitute an ideal therapeutic means of treating malignant bone tumors. We therefore applied the concept of a drug delivery system and developed an implant containing calcium phosphate cement and the anticancer drug, cis-diamminedichloroplatinum (CDDP). The results of a sustained release test showed that the in-vitro cumulative release ratio of an implant containing 20% CDDP was over 60%, and a release rate of 0.1 mg/day was maintained. Experiments in vivo, using adult rabbits implanted with 10% CDDP, showed that the platinum (Pt) concentration in local bone marrow was an average 3200 μg/tissue·g 6 weeks after implantation. The concentration of Pt in the systemically administered group was 0.2 μg/tissue·g at 6 weeks. The Pt concentrations in other organs of the implanted group were: 3 μg/tissue·g or less in the kidney, and 2 μg/tissue·g or less in liver. These values were lower than those in the systemically administered group (3.5 and 2.1 μg/tissue·g, respectively). Local bone formation was observed by 12 weeks after implantation. Our implant maintained high Pt concentrations at local sites and the bone that formed reinforced the implant. Received: February 7, 2001 / Accepted: July 23, 2001     

不同剂量盐酸坦洛新缓释片治疗早泄的临床疗效

目的 探讨不同剂量盐酸坦洛新缓释片治疗早泄的临床疗效. 方法 2010年9月至2011年1月收治的早泄患者80例,随机数字表法均分为0.2和0.4 mg盐酸坦洛新缓释片组,观察临床疗效和治疗前后患者CIPE-5评分的变化,并进行组内和组间比较. 结果 两组各脱落2例,原因均为服药后出现头晕、眩晕、体位性低血压.0.2和0.4 mg组患者治疗前阴道内射精潜伏期分别为(0.98±0.47)、(0.89±0.47)min,治疗后分别为(4.40±1.86)、(6.40±5.10) min,差异有统计学意义(P＜0.01).在夫妻性生活满意度、性生活焦虑减轻程度及延迟射精困难减轻程度方面,0.4 mg组均优于0.2 mg组. 结论 大剂量、长周期盐酸坦洛新缓释片治疗早泄可延长射精潜伏期,提高夫妻性生活满意度.     

进展期胃癌术中植入中人氟安的临床效果及预后观察

目的探讨进展期胃癌患者术中腹腔内植入中人氟安进行腹腔化疗的临床效果、安全性及远期预后的影响。 方法选取2013年7月至2015年7月接受胃癌根治术的178例进展期胃癌患者进行回顾性研究：其中研究组65例进行术中腹腔植入中人氟安进行腹腔化疗,对照组113例未行任何腹腔化疗,两组术后均行常规化疗。采用SPSS19.0软件进行统计分析,手术相关指标比较采用均数±标准差描述,采用独立t检验;并发症率及3年生存率采用χ²检验;生存时间分析采用Kaplan－meier法;P值<0.05表示差异有统计学意义。 结果两组在手术时间、术中出血、术后恢复时间及并发症发生率上差异无统计学意义(P>0.05)。两组半年及1年生存率差异无统计学意义(P>0.05),研究组患者术后的2年及3年生存率高于对照组,差异有统计学意义(P<0.05)。 结论进展期胃癌患者术中腹腔内植入中人氟安疗效可靠,安全性较高,远期效果还需进一步研究。     

眶隔释放前置重睑术的临床应用

目的：探讨一种具有上睑提升作用且不改变上睑提肌解剖形态的重睑成形方法。方法：采用重睑切口设计,去除切口下唇适量眼轮匝肌,离断眶隔与提上睑肌腱膜的融合,眶隔释放,离断眶隔脂肪与提上睑肌腱膜间束带连接,去除疝出的眶脂,眶隔膜断端下缘折叠、前置缝合于提上睑肌腱膜在睑板融合处,勾带提上睑肌腱膜缝合皮缘切口。结果：采用该法在形成自然重睑弧的同时,获得不同程度的上睑提升效果。结论：该方法未改变提上睑肌解剖形态,解除了眶隔膜与提上睑肌腱膜的融合、眶脂与提上睑肌腱膜间束带连接并将眶隔膜前置缝合,从而减轻了提上睑肌腱膜的上提阻力,加固和增强了提上睑肌腱膜-睑板的上提联动,获得了上睑提升的效果,增加了角膜暴露率,从而加强了重睑的效果。     

The sustained release of cefotaxim from a fibrin-cefotaxim compound in treatment of osteitis

Summary Following a survey of the literature regarding clinical examinations and experimental studies of local absorbable carrier for an antibiotic in treatment of osteitis, a study is presented concerning clinical experience with 46 patients treated with a cefotaxim-loaded fibrin sealant. In connection with simultaneous focal sanitation the clinical results were satisfying. When autogenous cancellous bone was added at the same time, only one surgical operation was necessary in some cases to show results equivalent to other methods. Postoperatively, the cefotaxim levels in the blood and in the wound drainage fluid were measured. The serum cefotaxim concentrations were low and only identifiable for a period of 36h, whereas the wound drainage fluid contained very highly effective antibacterial concentrations over a measured period of 3.5 days. The best results were seen in cases of hematogenic osteomyelitis. The disadvantage of this system is the quick release of the antibiotic by diffusion. Therefore, high concentrations can be obtained only for a short period of several days.

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Zusammenfassung Nach einem Literatürfiberblick über die klinisch und experimentell untersuchten lokalen resorbierbaren Trägersubstanzen für ein Antibiotikum zur Behandlung der Osteitis wird über klinische Erfahrungen an 46 Patienten berichtet, die mit einer Fibrin-Cefotaxim-Plombe behandelt worden waren. Die klinischen Ergebnisse sind bei gleichzeitiger chirurgischer Herdsanierung günstig. Bei gleichzeitiger Beimischung autologer Spongiosa können zum Teil in einem einzigen Eingriff Ergebnisse erzielt werden, die anderen Verfahren gleichwertig sind. Bestimmungen der Cefotaxim-Konzentrationen im Serum and in der Drainageflüssigkeit zeigten niedrige Werte im Serum über einen Zeitraum von 36 Std. Die Drainageflüssigkeit hatte demgegenüber einen sehr hohen Wirkstoffspiegel über 3.5 Tage. Die besten Resultate werden bei der hämatogenen Osteomyelitis erzielt. Der Nachteil dieses Systems muß in der Abgabe des Antibioticums allein durch Diffusion gesehen werden, wodurch ein hoher Wirkstoffspiegel nur zeitlich begrenzt aufrechterhalten werden kann.

     

庆大霉素-藻酸钙三维缓释微球的药物释放研究

目的研制庆大霉素一藻酸钙三维缓释微球并调控其庆大霉素的释放。使其达到长期局部抗菌的效果。方法制作不同浓度T、S、U组庆大霉素-藻酸钙缓释凝珠,与庆大霉素-骨水泥颗粒Y组进行庆大霉索释放情况比较。通过不同时间点抽取浸泡液,送紫外分光光度法（UV）及金黄色葡萄球菌（SA）培养检测,由此计算出各组包封率、释放率,绘制庆大霉素释放曲线。结果4组样品（微生物法）的包封率及30d药物释放率分别为：U组（53．99％、36．31％）,S组（39．62％、27．55％）。T组（34．20％、30．83％）,Y组（100．00％、48．49％）。U组的包封率较高,30d释放庆大霉素的总量较大,更接近Y组。4组间差异有统计学意义（P〈0．01）。U、Y组庆大霉素的释放明显高于S、T组的释放。各组30d内庆大霉素的浓度几乎都能超过金黄色葡萄球菌的最低抑菌浓度（MIC）．即〉2μg／mI。结论U组载药缓释凝珠30d内的庆大霉索释放较为理想。可作为BMSCs的三维培养支架。     

Slow release of anticancer drugs from porous calcium hydroxyapatite ceramic.

We have developed a new delivery system for sustained release of an anticancer drug (cis-platinum) by enclosure into blocks of porous calcium hydroxyapatite ceramic. The slow release of this drug from this system was confirmed in in vitro experiments. When this system was implanted into normal back muscle, or the tibia, sustained release of cis-platinum was observed during a 12-week period after implantation. The diffusion rate of cis-platinum into blood and other organs (liver, kidney, brain) was less than 10% of that at the implanted site. This delivery system placed into experimental tumors of mice also showed a uniform release of anticancer drug for more than 3 months. Inhibition of tumor growth was more marked after local implantation of this system than after intraperitoneal administration of cis-platinum. These results indicate that this new approach to a drug delivery system may well have an important role in cancer chemotherapy. In bone tumors it is attractive because the mechanical strength of calcium hydroxyapatite ceramic permits partial surgical excision and replacement of the bone defect at the same time.     

Efficacy of a latex Foley catheter with sustained release of chlorhexidine: 1st report: Clinical trials for the prevention of urinary tract infection

Seventy five patients requiring urethral catheterization for over 24 hours were treated with a latex Foley catheter with sustained release of chlorhexidine in a closed drainage system. While the catheter was indwelling, urinary concentrations of chlorhexidine were maintained at the level of 1 to 2 micrograms/ml in average in almost all patients. The catheter was highly effective in preventing the acquisition of catheter-associated bacteriuria in patients with initially sterile urine without systemic antimicrobial therapy. The acquisition rate of bacteriuria was 8, 16, 23, 35 and 74% on day 3, 4, 5, 6 and 7 with the catheter indwelling, respectively. The catheter was not effective in eradicating preexisting bacteriuria. Complications of the catheter were minimal.     

选择性软组织松解技术在重度膝外翻畸形全膝关节置换术中的应用

目的探讨全膝关节置换（TKA）术中对重度膝外翻畸形软组织平衡的处理方法。方法自2003-07—2009-12对29例（32膝）膝外翻畸形（胫股角〉15°）的患者均采用术中局部选择性松解技术实现软组织平衡。分别于术前和术后1、3、6、12、24个月摄膝关节正位X线片、测定膝关节活动度（ROM）和进行HSS评分,评估术后临床疗效。结果 21例（24膝）获得随访,随访时间9~47个月,平均27.2个月。X线片显示假体位置良好,未见明显松动和下沉迹象。术前关节活动度平均（103.5±8.7）°,末次随访时平均（123.3±6.3）°。术前HSS评分平均（62.5±8.6）分,末次随访时平均（86.9±4.6）分。术后均未出现严重并发症。结论局部选择性软组织松解技术在处理重度膝外翻畸形软组织失衡方面疗效确切,该技术损伤小、安全简便,是TKA术中矫正重度外翻畸形较理想的方法。     

Clinical and neuroradiological correlations in a patient with a wandering retained air gun pellet in the brain

The authors present the case of a patient with an air gun pellet wandered from ventricular system in the subarachnoid space of C2–C3, where it was removed successfully by an interlaminotomy.     

术中即时超量扩张技术在内镜辅助隆乳术中的应用

目的 探索在内镜辅助剥离下隆乳术中先置入扩张器进行即时超量注水扩张,完成后再置换假体的隆乳术方法及临床效果.方法 按照术前设计,腋下入路在内镜辅助下完成双平面剥离后,置入乳房假体前预先置入组织扩张器,注入生理盐水至术前预定假体的容量,观察注水后扩张器大小和位置并调整至合适程度,调整后注水量作为选择假体体积的参考.在此基础上继续即时超量注水至2倍体积,保持扩张30～60 min后,取出扩张器,置入乳房假体,完成手术.结果 120例,术后除3例早期出现血清肿后自然吸收,2例位置不佳进行Ⅱ期调整,1例出现包膜挛缩经修复后好转外,其余通过半年至2年随访,均表现为手感、动感自然,外形和谐对称,满意率达95％.结论 隆乳手术中预先置入扩张器以便进行位置调整,可以避免置入假体后再做调整对假体有损伤,可以通过增减注水量使两侧乳房大小对称,预估最后采用假体的体积,尤适用于两侧乳房不对称患者.有减轻隆乳患者术后乳房胀痛、改善乳房外形和手感的效果.     

人表皮生长因子与碱性成纤维细胞生长因子纳米缓释剂对成纤维细胞的影响

目的:制备碱性成纤维细胞生长因子(bFGF)、人表皮生长因子(EGF)可降解缓释微球,考察其生物活性的保存情况,以及它们对成纤维细胞的作用。方法:采用改良的乳化冷凝法交联制备复合bFGF、EGF的明胶缓释微球,将它们加入成纤维细胞的培养液中,用细胞计数法、四甲基偶氮唑盐微量反应比色法(MTT法)测定细胞增殖情况。结果:复合bFGF、EGF的缓释微球平均粒径(11.32±3.64)μm;培养1天后各组细胞计数、吸光度(A)值差异均无显著性;5天后,两种生长因子缓释微球组细胞计数、吸光度(A)值明显高于对照组;7天后,两种生长因子缓释微球组值仍高于其它组,但差异无显著性。结论:复合bFGF、EGF的缓释微球制备工艺简便,成球性好;能较长时间地持续释放活性bFGF、EGF,可促进成纤维细胞的增殖。     

A bilayer "artificial skin" capable of sustained release of an antibiotic

The most frequent complication of the bilayer "artificial skin", composed of a silicone sheet and collagen sponge described in a previous paper, was infection beneath it. This paper describes a new type of "artificial skin" in which microspheres containing antibiotics were installed beneath the silicone sheet, allowing a continuous release of antibiotics.     

庆大霉素抗菌骨制备及体内外释放特性实验研究

目的 研制一种既有成骨作用又有局部抗感染能力，且有较低免疫原性的新型高效骨植入材料。方法 采用超声和负压双重复合法制备复合庆大霉素抗菌骨并辐照灭菌，通过扫描电镜和微生物测定法分别检测其复合情况及庆大霉素在体内外的缓释特性。结果 明胶复合庆大霉素抗菌骨在体外12d、体内14d持续高于金黄色葡萄球菌最小抑菌浓度，基本达到临床局部抗菌效果。结论 明胶复合庆大霉素抗菌骨具有良好的体内外缓释特性，有望成为感染性骨缺损的理想植入材料。