综合措施预防膨体聚四氟乙烯隆鼻术后感染的近期随访

目的:探讨预防膨体聚四氟乙烯(ePTFE)隆鼻术后感染发生的综合措施。方法:对2008年1月~2013年12月在我科行膨体隆鼻手术的127例患者的临床资料进行研究和分析,患者均采取了综合措施预防术后感染。结果:本组127例膨体隆鼻术后患者随访6个月~2年,均无感染发生。结论:虽然膨体的微孔结构使其相较硅胶假体更容易发生术后感染,但通过综合预防措施及严格的无菌操作可有效地降低感染的发生率。     

应用膨体聚四氟乙烯假体行再次隆鼻术

既往对隆鼻效果欠佳者进行处理时,多主张先将假体材料取出,3个月后行再次隆鼻术.受术者往往难以接受,多要求于取出鼻假体后立即再次行隆鼻术.我们选择性地在取出隆鼻假体后立即进行膨体聚四氟乙烯(expanded-polyted-ptratluorolthylene,ePTFE)假体再次隆鼻术,取得了满意的临床效果,现报告如下.     

鼻整形术中应用膨体聚四氟乙烯治疗鼻尖低平

目的探讨膨体聚四氟乙烯（expanded pytetraflu-oroethylene，ePTFE）在隆鼻术中治疗鼻尖过低、鼻孔显露的手术方法，以减少传统手术方法的并发症。方法取鼻正中蝶形切口加双侧鼻翼缘切口行ePTFE加强型补片隆鼻术及治疗鼻尖低平。结果应用ePTFE加强型补片为536例患者隆鼻术及治疗鼻尖低平术。术后随访3个月至6年，满意者533例，占99．4％，不满意3例，占0．6％，3例患者术后出现伤口感染，取出ePTFE假体，并于3个月后重新行ePTFE假体隆鼻术，效果满意。结论应用ePTFE在隆鼻术中治疗鼻尖过低、鼻孔显露，可以明显减少传统手术方法的并发症，术后效果理想。     

ePTFE隆鼻术中感染的预防

目的：探讨膨体聚四氟乙烯（ePTFE）隆鼻术中感染发生的原因及预防方法。方法：我们采取了一系列措施预防ePTFE隆鼻术中感染的发生，并对26例受术者的术后情况观察随访6～12月。结果：在采用此套措施后，感染的发生率由之前的13．3％下降至0，两者对比有显著差异（P〈0．05）。结论：在正确使用的前提下，ePTFE是一种理想的隆鼻用组织代用品材料。虽然多孔结构使其容易造成感染，但通过一系列严格的无菌操作可以有效地预防此类并发症的发生。     

自体软骨与硅胶假体隆鼻并发症的Meta分析

目的:对自体软骨隆鼻与固体硅胶假体隆鼻术后并发症的发生进行Meta分析。方法:检索Medline数据库、万方数据库1966年-2017年收录的文献资料,依据关键词检索病历报道及临床研究。所有文献及其摘要由两位评价者独立阅读、筛选后进行分析,并进一步进行系统评价和Meta分析。Meta分析内容为自体软骨和硅胶假体隆鼻术后假体外露、感染、假体形态不满意及再次手术的发生率。结果:硅胶假体隆鼻术后并发症发生率为17.0%明显高于自体软骨隆鼻术的1.4%,差异有统计学意义(P0.01)。其中硅胶假体隆鼻术后假体外露率、形态不佳率及二次手术率均高于自体软骨隆鼻术后,差异有统计学意义(P0.01)。结论:自体软骨及硅胶假体隆鼻术后,除感染发生率外,在形态满意率、假体外露率及二次手术率三个方面,单纯自体软骨隆鼻均优于单纯硅胶假体隆鼻。     

耳甲腔软骨在膨体聚四氟乙烯假体隆鼻术中的应用

目的 探讨耳甲腔软骨移植鼻尖成形在膨体聚四氟乙烯(ePTFE)假体隆鼻术中的临床效果.方法 选择鼻孔缘"蝶"形切口联合鼻小柱基底V形切口的开放式手术方法,切开并分离鼻背皮肤、软组织,显露两侧鼻翼软骨及侧鼻软骨,中线处分离鼻中隔膜部,切取耳甲腔软骨并雕刻成形后,插入两侧鼻翼软骨间,并贯穿缝合于鼻小柱前端,将雕刻好的ePTFE假体插入鼻背并固定,缝合切口.自2009年10月至2011年4月,共对12例求美者施行隆鼻术.结果 术后所有求美者获随访3～12个月,鼻整体外形美观,手感良好,无严重并发症发生,切口瘢痕较轻微.结论 ePTFE假体隆鼻术中,利用耳甲腔软骨行鼻尖成形术,可有效抬高鼻尖,使鼻尖外观圆润、自然,可避免直接用假体作支撑出现假体外露现象.     

自体鼻中隔软骨与膨体聚四氟乙烯假体联合隆鼻术

目的：探讨鼻中隔软骨与膨体聚四氟乙烯（expanded polytetrafluoroethylene,ePTFE）联合隆鼻治疗鼻尖过低、鼻孔显露的手术方法,以减少单纯假体隆鼻术的并发症。方法：采用鼻正中蝶形切口加双侧鼻翼缘切口取鼻中隔软骨,行鼻中隔软骨联合ePTFE加强型补片隆鼻术并治疗鼻尖低平。结果：术后随访1～6年,评价360例就医者手术效果,优157例,占43.6%;良196例,占54.4%;一般7例,占2%;无效果差的病例。结论：应用鼻中隔软骨联合ePTFE在隆鼻术中治疗鼻尖过低、鼻孔显露,可以明显减少单纯假体隆鼻术的并发症,效果理想。     

鼻中隔软骨联合ePTFE鼻成形术35例分析

目的 探讨自体鼻中隔软骨联合膨体聚四氟乙烯(ePTFE)假体行鼻成形术的方法和效果.方法 通过开放性鼻正中蝶形切口及鼻翼缘切口切取鼻中隔软骨并修整成盾形,将雕刻好的ePTFE假体置入剥离腔隙鼻背成形术,置入雕刻好的鼻中隔软骨移植物行鼻尖成形术.对于鼻头肥大者,于鼻翼软骨外侧脚切除少量大翼软骨及软组织.自2009年9月至2011年5月,采取此方法对35例求美者行鼻成形术.结果 术后随访35例求美者3～12个月,置入的ePTFE假体与受区组织融合良好,无感染、假体外露等并发症发生,鼻尖形态自然,外形满意.结论 利用ePTFE假体行隆鼻术可有效抬高鼻背,组织相容性良好,联合应用自体鼻中隔软骨行鼻尖成形术可获得理想的外形,并可避免单纯由假体作支撑而造成的假体外露、可触及等问题.     

自体耳软骨联合硅胶假体隆鼻的美观效果及恢复速度观察

目的:观察自体耳软骨联合硅胶假体隆鼻术的效果,及对就医者预后的影响。方法:选取2016年8月-2017年8月在笔者医院接受隆鼻术的就医者为研究对象,并分为对照组和观察组。对照组给予传统隆鼻术,即硅胶假体隆鼻术;观察组给予自体耳软骨联合硅胶假体隆鼻术。观察两组就医者的手术效果,比较两组就医者手术时间、愈合时间、并发症发生率等情况。结果:观察组手术优良率为96.67%,高于对照组的73.33%,差异有统计学意义(χ~2=6.405,P=0.011);观察组术后愈合时间为(9.68±1.76)d短于对照组的(12.85±2.01)d,差异有统计学意义(t=6.499,P0.001);观察组就医者假体外露、感染、外形僵硬、假体可触及等并发症发生率为3.3%低于对照组的23.33%,差异有统计学意义(χ~2=5.192,P=0.023);观察组30例就医者1年隆鼻有效维持率为96.67%高于对照组的80.00%,差异有统计学意义(χ~2=4.043,P=0.044)。结论:自体耳软骨联合硅胶假体隆鼻术的手术效果较好,就医者术后愈合快,并发症发生率低,具有良好的应用价值。     

皮肤菲薄者隆鼻方法探讨

目的:探讨鼻部皮肤菲薄者隆鼻术的特点和方法。方法:对于鼻部皮肤菲薄者使用膨体聚四氟乙烯(ePTFE)或固体硅胶-自体真皮复合体隆鼻,可形成自然外形,增加鼻长度及鼻尖高度,避免皮肤过顶发白甚至假体顶出等并发症。结果:2003年10月￣2005年10月共用此方法对21例鼻部皮肤菲薄者(其中6例因以前使用单纯固体硅胶或注射隆鼻后外形不佳原假体取出后皮肤受损但仍要求隆鼻者)实行隆鼻术,均取得良好效果,外形自然,无异物排斥反应。结论:对于皮肤菲薄者及多次隆鼻皮肤受损者使用膨体聚四氟乙烯(ePTFE)或固体硅胶-自体真皮复合体隆鼻可取得满意效果。     

Experience with Expanded Polytetrafluoroethylene (ePTFE Gore‐Tex) Surgical Membrane for Coronary Artery Grafting: Does ePTFE Surgical Membrane Predispose to Postoperative Mediastinitis?

The advantage of completely closing the pericardium after a coronary artery bypass grafting is the avoidance of injury of the heart and grafts during a re-operation. However, it would obviously be counterproductive to close the pericardium with a substitute that is predisposed to infection. This study was designed to evaluate the safety of ePTFE surgical membrane in comparison to native pericardium or autologous tissue. Between January 1992 to March 2003, 695 coronary artery bypass graftings were performed. The hearts and grafts were covered with ePTFE surgical membrane (474 cases: ePTFE group), or autologous pericardium and/or other autologous tissue (221 cases: non-ePTFE group). Often, a bilateral dissection of the internal thoracic artery was performed, which lengthened the surgery, the cardiopulmonary bypass, and the aortic clamp, in the ePTFE group. But there was no difference between the ePTFE group (2.1%) and the non-ePTFE group (3.2%) in the development of postoperative mediastinitis. There was also no difference between the two groups in the organism type of the infection. Methicillin resistant Staphylococcus aureus (MRSA) is the most common organism cultured from sternal wound infections; there were five cases in the ePTFE group, and four cases in the non-ePTFE group. In the ePTFE group, the hospital mortality due to postoperative mediastinitis was zero, and there was also no significant difference between the ePTFE group and the non-ePTFE group in time from the drainage operation to discharge; 74.3 days in the ePTFE group, and 81.0 days in the non-ePTFE group. The clinical use of ePTFE surgical membrane for a coronary artery bypass grafting does not appear to be a risk factor for mediastinitis.     

New technique for application of fibrin sealant: rubbing method devised to prevent cerebrospinal fluid leakage from dura mater sites repaired with expanded polytetrafluoroethylene surgical membranes.

OBJECTIVE: The effectiveness of a strong, pressure-tight method for fibrin sealant application was experimentally and clinically evaluated, using expanded polytetrafluoroethylene (ePTFE) surgical membranes. METHODS: Two application methods were examined in two groups. For Group 1, 1 ml each of Solutions A and B was simply sprayed over the surface (spray method). For Group 2, a small amount of Solution A was rubbed into the sutured site and then Solutions A and B were sprayed over the surface (rubbing method). In the experimental study, a moment pressure elevation test and a continuous stepwise pressure elevation test were performed for both groups. The clinical study was conducted using 350 patients undergoing craniotomies. The ePTFE surgical membrane was used for 180 patients but not the other 170 patients. RESULTS: In the experimental study, the bursting pressures were 51.4 +/- 13.0 cm H2O for Group 1 and 129 +/- 35.0 cm H2O for Group 2 in the moment pressure elevation test and 27.0 +/- 6.7 cm H2O and 100 +/- 31.9 cm H2O, respectively, in the continuous stepwise pressure elevation test. The sealing effect was significantly greater for Group 2 than for Group 1 in both tests (P < 0.001). In the clinical study using ePTFE surgical membranes, the rubbing method significantly reduced the incidence of postoperative cerebrospinal fluid leakage (1.4%), compared with the spray method (18.3%), when external decompression was not concomitantly used (P < 0.01). CONCLUSION: The sealing effect of fibrin sealant on cerebrospinal fluid leakage was significantly greater with the rubbing method than with the spray method. The strong sealing effect obtained with the rubbing method is thought to result from firm linkage between the ePTFE surgical membrane and the fibrin sealant and also from fibrin being formed even in needle holes and spaces in the sutured site.     

Clinical results with an ePTFE inflow conduit for mechanical circulatory support

BACKGROUND: Neurologic complication is an adverse event associated with mechanical circulatory support. To decrease the incidence of embolic cerebrovascular accidents (CVA) during support with the Novacor left ventricular assist system (LVAS), an expanded polytetrafluoroethylene (ePTFE) inflow conduit has been developed and introduced clinically. METHODS: Using clinical data from Europe and Canada, we conducted a retrospective analysis of the incidence of embolic CVA with the ePTFE inflow conduit (n=88) in comparison with the previously used polyester inflow conduits (n=310, including Vascutek n=155 and Cooley n=155). We calculated freedom from embolic CVA, risk reduction for embolic CVA, and linearized rates of embolic CVA. RESULTS: A significant decrease in the incidence of embolic CVA was demonstrated with the ePTFE conduit (ePTFE 10% vs polyester 23%, p=0.002). Kaplan-Meier analysis of freedom from embolic CVA at 180 days after implantation was 86% for the ePTFE group vs 72% for the polyester group (log-rank test, 0.0185). We also found an associated risk reduction of 55% in CVA occurrence in the ePTFE group when compared with the Polyester group (hazard ratio, 0.445; 95% confidence limit, 0.222-0.890; p=0.0221). Linearized CVA rates also were decreased at all time intervals after implantation in the ePTFE group. CONCLUSIONS: Preliminary clinical results with the newly introduced ePTFE inflow conduit provide compelling evidence that the ePTFE conduit material significantly decreases thromboembolic complications during mechanical circulatory support with the Novacor LVAS.     

DL-PLA/CHI复合膜的防硬膜外粘连实验研究

目的　比较消旋聚乳酸 /甲壳素 (DL -PLA/CHI)膜 ,消旋聚乳酸 (DL -PLA)膜 ,几丁糖膜和聚四氟乙烯(ePTFE)膜防止硬膜外瘢痕粘连效果。方法　将 75只新西兰白兔随机分为 5组 ,施以全椎板切除术 ,分别予以放置消旋聚乳酸 /甲壳素 (DL -PLA/CHI)膜 ,消旋聚乳酸 (DL -PLA)膜 ,几丁糖膜和聚四氟乙烯 (ePTFE)膜防粘连处理 ,对照组不作特殊处理 ,通过大体观察、光镜观察瘢痕生长及硬膜外粘连情况。结果　DL -PLA组 ,DL -PLA/CHI组及ePTFE组硬膜外均光滑、无增厚 ,几丁糖组出现个别硬膜外腔隙纤维组织增生粘连。而空白对照组硬膜外纤维组织增生或粘连明显 ,硬膜外腔隙基本消失。几丁糖膜崩解吸收最快 ,DL -PLA/CHI膜较DL -PLA膜的崩解速度有所加快 ,但是机体的炎性反应明显减轻。瘢痕粘连形成的半定量评分结果经秩和检验 ,各实验组与对照组差异有非常显著性意义 ,而实验组之间无显著差异。结论　DL -PLA/CHI薄膜具有可靠的物理屏障作用 ,防止硬膜外瘢痕粘连效果良好。     

熊去氧胆酸对胆肠吻合术后胆道逆行性感染的预防作用

目的：探讨熊去氧胆酸(UDCA)对胆肠吻合术后胆道逆行性感染的预防作用。 方法：将2年间收治的50例接受胆肠吻合术的患者随机分为对照组和观察组。除传统的胆肠吻合术后处理外,对照组于术后给予维生素C,而观察组则给予UDCA。比较两组术后胆道逆行性感染的发生率。所有患者术后随访6个月至2年。结果：观察组术后胆道逆行感染的发生率较对照组显著降低(4.0%vs.32.0%)（P＜0.05）。 结论：胆肠吻合术后应用UDCA安全,可显著降低术后胆道逆行感染的发生率。     

Expanded polytetrafluoroethylene membrane for the prevention of peridural fibrosis after spinal surgery: a clinical study

Peridural fibrosis developing after laminectomy may cause pain that can necessitate reoperation. Many materials have been used as a barrier to invasion of fibrous tissue into the vertebral canal, but the ideal material has not been found. Various studies in animals have achieved favourable results with an expanded polytetrafluoroethylene (ePTFE) membrane. In a prospective, randomized study, we compared postoperative results in 33 patients who had an ePTFE membrane implanted to cover the defect caused by laminectomy during lumbar spine decompression with the results in 33 patients in whom no material was implanted. At operation, an ePTFE membrane was placed after the decompression procedure to cover the laminectomy defect completely. Systematic clinical and MRI follow-up evaluations of patients with and without the membrane were conducted 3, 6, 12, and 24 months postoperatively. The effect of ePTFE membrane implantation over laminectomy sites on postoperative peridural fibrosis, pain and neurological claudication was assessed. The ePTFE-membrane group had a significantly lower rate of epidural fibrosis on MRI (P < 0.0001) and of clinical manifestations of radiculalgia (P = 0.002) compared with the no-material group. Epidural fibrosis that occurred in the ePTFE group was generally less extensive than that in the no-material group. There was no significant difference in the rate of postoperative claudication in the two groups. Significantly more seromas occurred in the ePTFE group (P = 0.0002). There were no infections or other complications in either group. The results showed that placement of an ePTFE spinal membrane over the laminectomy defect produced by lumbar spine surgery provided a physical barrier to invasion of fibrous tissue into the vertebral canal, and patients with the membrane had less postoperative radicular pain. Received: 24 November 1997 Revised: 26 November 1998 Accepted: 2 December 1998     

胸外专科重症监护室过渡性护理对减少食管癌术后肺部感染的作用

目的回顾性分析食管癌术后胸外科专科重症监护室（ICU）过渡性护理对减少术后肺部感染的作用。 方法根据食管癌术后患者是否进入胸外专科ICU接受过渡性护理,分为试验组和对照组。试验组术后转入胸外专科ICU观察治疗2~3 d再转回普通病房,在ICU期间除常规的食管癌术后护理外,重点加强气道管理。让患者转出ICU时能有效自主咳嗽、咳痰,呼吸道无痰储留,能自主或在陪护协助下下地活动。对照组则按食管癌术后护理常规护理。 结果试验组和对照组在年龄、性别、BMI、吸烟指数、高血压史、糖尿病史、哮喘病史、第1秒用力呼气量占用力肺活量百分比（FEV1/FVC）的实测值与预计值比值、最大自主通气量占预测值百分比（MVV%）、食管肿瘤部位、手术术式、美国麻醉医师协会（ASA）分级、手术时间、术中出血量、术后呼吸机辅助呼吸、术后肿瘤TNM分期等可能影响肺部感染发生率的因素差异均无统计学意义（均P>0.05）。试验组术后经鼻/口吸痰管吸痰率高于对照组（66.67% vs 16.67%,P<0.001）。术后肺部感染发生率低于对照组（7.02% vs 27.08%,P<0.001）。术后住院时间少于对照组（13.75±2.21 d vs 16.40±2.79 d,P<0.001）。 结论食管癌术后患者予胸外专科ICU过渡性护理,强化气道管理,可以有效降低肺部感染的发生率,有利于患者康复,减少术后住院时间。     

大肠癌患者术后营养支持方法的临床探讨

为探讨大肠癌患者水后联合营养治疗的作用,我们将442例大肠癌患者随机分为两组,一组手术后行周围静脉营养联合肠内营养治疗（治疗组,212例）．另一组手术后单纯行周围静脉营养治疗（对照组,230例）。结果显示,治疗组患者术后切口、肺部感染及吻合口漏的发生率均低于对照组（P〈0．05）,平均住院时间及住院费用均少于对照组（P〈O．01）。结果表明．加强大肠癌患者术后肠内外联合营养治疗．能有效减少术后并发症的发生,缩短住院时间。     

Adhesion formation and reherniation differ between meshes used for abdominal wall reconstruction

Incisional hernia is a common surgical problem, frequently requiring prosthetic mesh repair. The demands of the ideal mesh seem conflicting; ingrowth at the mesh–fascia interface, without development of adhesions at the visceral mesh surface. Various antiadhesives combined with macroporous mesh and composite meshes were studied for prevention of adhesions to mesh and ingrowth into the fascia. In 60 rats an abdominal wall defect was created and repaired with underlay mesh. Rats were divided into six groups and treated with polypropylene mesh (PPM, control), PPM with auto-cross-linked polymers (ACP) gel, PPM with fibrinogen glue (FG), polypropylene/expanded polytetrafluoroethylene (ePTFE) mesh, polypropylene/sodium hyaluronate/carboxymethylcellulose (HA/CMC) mesh, and polypropylene-collagen/polyethylene-glycol/glycerol (CPGG) mesh. Mesh infection was assessed in the postoperative period, adhesions and reherniations were scored at sacrifice 2 months after operation, and tensile strength of the mesh–tissue interface was measured. Six rats developed mesh infection, half of them were treated with PPM/ePTFE. The PPM/HA/CMC group showed a significant reduction in the amount and severity of adhesions. In animals treated with PPM/ACP and PPM/FG, severity of adhesions was reduced as well. Reherniation rate in the PPM/ACP group was 50% and significantly higher than that in other groups. Rats in the PPM/HA/CMC had the highest tensile strength. PPM/HA/CMC approaches the demands of the ideal mesh best, having superior antiadhesive properties, no reherniation and no infection in this rat model of incisional hernia.