823例小儿唇裂手术麻醉的分析

８２３例小儿唇裂手术麻醉的分析李胜德，顾振华仅就我们１９８５～１９９２年间施行的８２３例小儿唇裂手术的全身麻醉情况整理分析如下。临床资料８２３例病人中，３岁以下者为６０７例（７３．７６％），年龄最小者为３个月。最大者为１２岁，全部病例均不包括与腭裂同...     

改良Senning术在完全型大动脉转位治疗中的应用

完全型大动脉转位（ＴＧＡ）是一种常见的紫绀型复杂先天性心脏病,占所有先天性心脏病的７％～８％〔１〕。自１９９３年８月至１９９８年５月,我院共为１１例ＴＧＡ病儿实行改良Ｓｅｎｎｉｎｇ术,疗效满意,报告如下。临床资料　本组病儿中男７例,女４例。年龄１．５～１２．３岁,平均（４．９±４．０）岁;体重７～２５ｋｇ,平均（１３．３±５．４）ｋｇ。所有病儿均口唇及四肢末梢发绀,杵状指趾,有缺氧发作和心脏杂音。术前均行Ｘ线胸部正侧位平片、超声心动图、心血管造影检查明确诊断。其中伴房间隔缺损２例,房缺加永存左上…     

前颌过分前突的双侧唇裂修复术

我们仿宋儒耀［１］直线法修复前颌过分前突的双侧唇裂５２例,收到较好效果。１　临床资料　　本组５２例,年龄６个月～１岁３１例,１～３岁１４例,３～６岁７例。４０例为双侧完全裂,１２例为混合裂,全部病例都合并有双侧完全或不完全腭裂及牙槽裂。２　手术方法沿用宋儒耀直线法［１］,定点画线及手术步骤略有改动（图１,其中前唇直线为直线法,点线为改进法）。将前唇略展平定点,ｂ点较直线法略向中移,以设计出近似正常的人中形态（幼儿人中宽度在４～６ｍｍ）,而不是以前唇原有形态作为人中,这样形成的唇高ａ—ｂ线较直线法…     

延迟关胸在心脏直视手术中的应用

延迟关胸在心脏直视手术中的应用黄建华张广福杨文东李凡东梁家立李海波从１９９０年１月至１９９５年１２月，我们共行心脏直视手术８５３例，有４例病儿延迟关胸，现报告如下：临床资料本组男３例，女１例；年龄１．５～３岁。３例为重症法乐四联症，１例为右室双出口（...     

狼疮肾炎治疗与随访

狼疮肾炎（ＬＮ）是系统性红斑狼疮（ＳＬＥ）的主要死亡原因,经环磷酰胺（ＣＴＸ）冲击治疗以来,存活率已明显提高。我们主要对本院５０例ＬＮ经ＣＴＸ冲击治疗和１０年随访资料进行回顾性分析。 资料与方法 １．临床资料：１９９０～１９９９年诊治的１１８例ＬＮ,男１８例,女１００例;年龄１５～７０岁,平均（３５±１８）岁,发病时间２月～３年,平均１８个月。肾活检１４例,其中系膜增殖型６例,弥漫增殖型４例。局灶增殖型２例及膜性２例。 ２治疗方法：（１）ＣＴＸ冲击治疗组：５０例,１２ｍｇ／ｋｇ加入１０％葡萄糖５０…     

肝段切除术治疗早期肝内胆管结石

早期的肝内胆管结石由于临床症状轻,如何选择治疗是胆管外科尚待解决的课题。我科自１９９３年１月～１９９８年１月采用肝段切除术治疗早期的肝内胆管结石１３例,取得了良好的疗效,现报道如下。临床资料１３例中男１０例,女３例。年龄２１～３８岁,平均２８－４岁。病程３个月～１年,平均６－７个月,合并糖尿病者１例。１３例均有慢性右上腹疼痛,４例伴有低热,均无寒战、高热或黄疸。１３例行Ｂ超及ＣＴ检查,诊断符合率分别为７５－０％（９／２２）、１００％（１２／１２）,行ＥＲＣＰ检查８例,诊断符合率为８７－５％（７／…     

心内膜心肌纤维化手术治疗1例

心内膜心肌纤维化手术治疗１例阎兴治，况竹生，李正伦病儿男，９岁。腹胀，双下肢水肿３年，口唇发绀、夜间端坐呼吸１个月。４年前有“心包炎”史。查体：血压１２／１０ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ），肘静脉压３．３３ｋＰａ（１ｋＰａ＝１０．２０ｃｍＨ２Ｏ）...     

放射治疗在脊柱骨巨细胞瘤治疗中的价值

作者回顾性评价放射治疗在脊柱骨巨细胞瘤（ＧＣＴ）治疗中的价值。本组１０例（男６例，女４例），年龄１８～３４岁（平均２７岁）。发病部位：颈椎６例，胸腰椎２例，腰、骶椎各１例。Ｊａｆｅ分级：Ⅰ级３例，Ⅰ－Ⅱ级２例，Ⅱ级１例，Ⅲ级２例，未分级２例。治疗方法：（１）单纯放疗治疗颈椎ＧＣＴ３例。（２）先放疗后手术治疗胸腰段ＧＣＴ２例。（３）先手术后放疗治疗颈椎ＧＣＴ３例，腰椎ＧＣＴ１例。（４）手术配合术前与术后放疗治疗骶椎ＧＣＴ１例。随访１．５～２９年（平均１４年）均无复发。５例生活自理，４例恢复工作，１例恢复较差。本组无放疗后恶变。作者认为，脊柱解剖复杂，难以将肿瘤彻底切除，所以手术配合术前术后放疗对脊柱ＧＣＴ的治疗有重要意义。     

婴幼儿唇裂修补术中气道处理的探讨

婴幼儿唇裂修补术中气道处理的探讨钟钒，黄起中１９７８～１９９２年，作者等处理婴幼儿唇裂修补术麻醉１４７例。男８６，女６１例，年龄２月～３岁，体重４．５～１３．７５ｋｇ合并腭裂２３例，合并先天性心脏病３例。术前３０ｍｉｎ予阿托品０．０２ｍｇ／ｋｇｉｍ。...     

腹腔镜在肾囊肿治疗中的应用

１９９２年１２月～１９９５年１２月应用腹腔镜治疗单纯肾囊肿３１例。年龄２１～７２岁，平均５３岁。男１６例，女１５例。囊肿最大直径４．５～１１．４ｃｍ，平均７．７ｃｍ；左肾１７例，右肾１１例，双肾３例。肾上极６例，下极１２例，中部１２例，多发１例。手术采用经腹腔途径１９例，经后腹膜腔途径１２例。３１例全部治疗成功。手术时间１５～１８０分钟，平均８０分钟。其中经腹腔途径平均８５±３６分钟，经后腹膜腔途径平均６５±２５分钟。术后平均住院日３．６２±１．５３天，其中经腹腔组３．３９±１．３２天，经后腹膜腔组３．８０±１．３２天，术后随访１～３６（１７．１０±９．５５）个月，未见复发     

Nasal airflow and olfactory function after the repair of cleft palate (with and without cleft lip).

OBJECTIVE: The objective of this study was to examine nasal airflow and olfactory functions in patients with repaired cleft palate compared with matching normal controls. STUDY DESIGN: The all-cleft group consisted of 25 patients with hard palate cleft comprising 15 patients with unilateral cleft palate and lip (UCLP); 2 with CP but no cleft lip (UCLP subgroup) and 8 patients with bilateral cleft lip and palate (BCLP subgroup). All had had surgical correction of the palate in infancy. The control group consisted of 20 nonaffected orthodontic patients. The median age of both groups was 14 years. The tests included the following: (1) nasal airflow measured by anterior rhinomanometry, (2) smell threshold for isoamyl-acetate determined using a 3-way forced choice method, (3) a self-administered questionnaire regarding the subjective perception of smell sense function, and (4) orthonasal and retronasal smell identification (correct/incorrect) and hedonics using visual analog scale (VAS). RESULTS: The respective test results follow. (1) When compared with the control group, the total airflow in the UCLP subgroup was significantly lower especially on the affected side; while in the BCLP subgroup it was lower than in the control group bilaterally. No significant difference was found between the cleft side of UCLP and BCLP subgroups. (2) The smell threshold of the UCLP subgroup was significantly higher than that of the control group and BCLP subgroup. No significant differences were found between right and left nostrils within the BCLP patients and between them and the control group. (3) No difference was found between the groups regarding the subjective perception of smell. (4) No significant differences were found between the UCLP and BCLP subgroups and between the all-cleft group and the control group, except for one item, regarding orthonasal and retronasal smell identification and hedonics. CONCLUSION: Although nasal airflow is significantly lower and the smell threshold higher on the cleft side, the day-to-day function of the sense of smell of cleft patients is similar to that of normal controls.     

正颌联合正畸矫治唇腭裂术后牙颌面畸形

目的以正颌外科手术联合正畸治疗的方法矫治唇腭裂术后牙颌面畸形。方法1996年以来共矫治此类畸形2l例，采用手术方法如下：Le FortⅠ型截骨术7例；多片段Le FortⅠ型截骨术5例；Le FortⅠ型截骨术加双侧下颌升支矢状劈开术（BSSRO）4例；BSSRO加颏成形术2例：Le FortⅠ型截骨术加下颌体部截骨术2例；BSSRO1例。结果2l例术后均达到模型外科设计要求，术后随访14例，平均25．6个月，九严重并发症及明显复发。12例行术前后正畸治疗者希关系及面部外形均满意，另2例个别牙齿矛台关系欠佳。结论以正颌外科手术联合正畸治疗的方法矫治成年期唇腭裂术后牙颌面畸形可取得满意结果。     

Unrepaired Clefts in the Hard Palate: Speech Deficits At the Ages of 5 and 7 Years and Their Relationship to Size of the Cleft

The purpose of the study was to investigate the relationship between the size of oronasal openings in the hard palate and speech deficits. Audiotape recordings and plaster casts were taken according to standard procedures at 5 and 7 years of age from 22 consecutive children born with complete unilateral cleft lip and palate treated at Sahlgrenska University Hospital, Göteborg, Sweden. The soft palate had been repaired before the age of 12 months, whereas the cleft in the hard palate was left unrepaired, to be closed later. Perceptual judgements of nine speech variables at 5 and 7 years of age were correlated with measures of the area of the residual cleft in the hard palate. "Retracted oral articulation" (to velar place) found in nine of the 22 children correlated significantly with the area of the cleft at the age of 5 years but not later. The establishment of this particular speech error seems to be related to the size of an oronasal opening.     

The clinical observation of difficult laryngoscopy and difficult intubation in infants with cleft lip and palate

BACKGROUND: The aims of this study were to evaluate the incidence of difficult laryngoscopy in infants with cleft lip and palate and to observe its relationships with age, sites, and degrees of deformities. METHODS: A total of 985 infants aged 1 month to 3 years, undergoing repair of cleft lip and palate were included in this study. The infants suffering from unilateral cleft lip, simple cleft palate, and combined bilateral cleft lip and palate were 465, 421, and 79 respectively. They were divided into three groups according to age; 1-6 months group, 6-12 months group and 1-3 years group. RESULTS: The total incidence of difficult laryngoscopy was 4.77%. The incidence of difficult laryngoscopy was closely related to age, sites and degrees of deformities, and micrognathia. The incidence of difficult laryngoscopy was 7.06% in 1-6 months group, 2.90% in 6-12 months group, and 3.13% in 1-3 years group, and was greatest for infants with combined bilateral cleft lip and palate, less for those with left cleft lip and least for those with right cleft lip and simple cleft palate. The incidences of difficult laryngoscopy in infants with and without micrognathia were 50% and 3.83% respectively. The incidences of moderately difficult, difficult, and failed intubations were 1.02%, 0.91%, and 0.102% respectively. CONCLUSIONS: Infants with cleft lip and palate, left cleft lip and alveolus, combined bilateral cleft lip and palate, micrognathia, and age <6 months were the important risk factors for difficult laryngoscopy. Difficult intubation occurred mainly in infants with laryngoscopic views of grade III and IV.     

271例婴幼儿完全性唇腭裂一期修复及初步观察

目的 探索婴幼儿完全性唇腭裂一期修复的可行性，并对其效果进行初步观察。方法 对3－12个月婴儿安全性唇腭裂进行了一期修复，同时对24例裂隙宽大的患儿进行术前腭部矫治，对术后1－4年的116例患儿唇的外形及事音进行了初步评价。结果 271例婴幼儿完全性唇腭裂修复手术，术后除2例发生呼吸困难，6例腭部瘘孔形成及5例作品渗血外，全部愈合良好。研究发现19例单侧完全性唇腭裂术前腭部矫治后，齿槽部裂隙左右距离轿治前平均缩小6．1mm；前后距离轿较矫治前平均缩小6．6mm；唇外菜评价优良率达93．1％，语音评价优良率达94．8％。结论 婴幼儿完全性唇腭裂一期是完全的、可行的。术前腭部桥治可明显缩小齿槽部的裂隙，有利于宽大裂隙的修复。婴幼儿完全性唇腭裂一期修复可获良好唇外形及语音功能恢复。     

5459例唇腭裂患者临床资料分析

目的：对20年来唇腭裂的治疗及唇腭裂患者的构成情况进行回顾。方法：对5459例唇腭裂患者病历资料分类整理，进行统计学分析。结果：唇腭裂各类型性别比例差异有显著性意义，唇腭裂患者的首次手术年龄差异有显著性意义，其主要修复方式随年代的变化而不同。结论：唇腭裂患者中男性明显多于女性。自1980年以来，唇腭裂患者的首次手术年龄呈逐渐下降趋势，主要手术方法也有很大的变化。     

Report of a hemohiliac's cleft lip and palate repair — ten year follow-up

Summary The association of cleft lip and palate with hemophilia is rare. Recent advances in hematology have made it possible for hemophiliacs to have surgery without problems, using prior administration of anti-hemophilic globulin. The case reported was a hemophilia B patient with unilateral cleft lip and palate. When primary cheiloplasty was carried out at four months of age, there were serious bleeding problems during and after the operation. Palatoplasty was performed at age two and repair of secondary deformity of the cleft lip at age eight. On both occasions a prothrombin complex was administered, and no problem was experienced in either procedure. A ten year follow-up is presented.     

Vomerine hamartoma in a cleft palate child

A case of a female child born at full term after normal vaginal delivery with bilateral secondary complete cleft palate and vomerine hamartoma mimicking intra-oral midline encephalocoele. Radiologically the tumour was confined to the vomer without intra-cranial extension. The lesion was occupying the oral cavity causing feeding problem. Surgical excision of the tumour at the age of six months and two flaps palatoplasty at the age of twelve months were performed. On histopathology the lesion turned out to be a lipomatous hamartoma of a benign nature. The child was followed for 9 years with no evidence of recurrence and a satisfactory speech. To our knowledge this is the first report of cleft palate with vomerine hamartoma in the English literature.     

婴儿唇腭裂同期修复468例临床分析

目的探讨唇腭裂在婴儿期同期修复的可行性及优缺点。方法回顾性分析我科近十年来同期修复婴儿期唇腭裂468例,对术后3年以上患者进行语音评价。结果468例婴儿均完成唇腭裂同期修复,术后出现并发症173例,死亡1例。其中94例出现不同程度呼吸困难,74例出现腭部缝合口裂开(63例为悬雍垂裂开),2例唇部切口感染,1例因术中缺氧出现脑瘫,2例出现恶性高热(其中1例死亡),1例拔出碘仿纱条后大出血。术后3年以上有278例,随访168例,发音优115例,良48例,差5例。结论婴儿期同时修复唇腭裂虽具有术后语音效果好及其他优点,但呼吸困难及悬雍垂裂开发生率高,良好的麻醉对保证手术成功至关重要。     

Early repair for infants with cleft lip. Retrospective study of 263 cleft lip repairs

This study attempts to define the effect of early repair on the surgical procedure and immediate outcome of cleft lip surgery. The first part deals with 263 consecutive cleft lip repairs (218 infants) categorized retrospectively by age at operation. 123 patients (150 cleft lips) were operated on during the first 4 weeks of life; a subgroup of 40 infants was operated on at a week or less of age; 95 patients (113 cleft lips) were operated at an older age (1 to 12 months). There were no significant difference in immediate surgical result between the groups and there was no apparent difference in the operative results as defined by whether or not the child needed subsequent revision. We are currently encouraging early repair in the full-term baby as the optimum method of management of newborns with cleft lip.