成人先天性膈肌膨出症

１９７０－１９８４年手术治疗１２例成人先天性膈肌膨出症，平均年龄４４岁，其中安全型８例，局限型４例。临床表现以胃肠道不全梗阻为主，部分病人可长期无症状。胸透是诊断是最佳及最简便的方法，肺功能检查结果可反映膈肌功能手术治疗膈肌膨出症近期疗效尚可，但远期疗效不佳。认为手术适应证为因该病所致呼吸窘迫、且药物治疗无效。     

限局性膈膨升的超声诊断及其价值

本文报告了采用彩色多普勒超声诊断仪检查的26例限局性膈膨升病例,并分析限局性膈膨升的超声检查方法、声像图特征、鉴别诊断及X线与超声诊断限局性膈膨升的利弊。认为限局性膈膨升有其独特的超声声像图特征,超声对该病的诊断具有简便、迅速、准确的优点。如能结合X线检查,可进一步提高其准确性。     

Congenital diaphragmatic eventration in an adult: a diagnostic dilemma

Eventration of the diaphragm is a rare condition where the muscle is permanently elevated, but retains its continuity and attachments to the costal margins. It is seldom symptomatic and often requires no treatment, but may be confused with a traumatic rupture of the diaphragm. We present a 51-year-old man with previously-undiagnosed congenital eventration, mimicking traumatic rupture of the diaphragm. The role of clinical examination, imaging and diagnostic laparoscopy to differentiate between eventration and traumatic rupture of the diaphragm are discussed.     

下唇动脉岛状唇瓣一期矫正双侧唇腭裂术后鼻唇畸形

目的　报道下唇动脉岛状瓣修复双侧唇腭裂术后鼻唇畸形的效果。方法　以一侧下唇动脉为蒂,根据上唇缺损程度设计相应的下唇部复合组织瓣,Ⅰ期修复双侧唇裂术后鼻唇畸形１５ 例。唇瓣面积最小１５ ｃｍ ×０８ ｃｍ ,最大２ ｃｍ×１２ ｃｍ 。结果　全部唇瓣均完全成活,外观十分满意。结论　下唇动脉蒂岛状复合组织瓣血供可靠,成功率高,术后外形好,是双侧唇腭裂术后鼻唇畸形的理想修复方法。     

单侧唇裂继发鼻畸形的修复

目的探讨单侧唇裂继发鼻畸形的修复方法。方法根据鼻畸形的特点和形成原因,手术切口沿鼻翼缘轮廓线、鼻小柱基底,充分显露鼻翼软骨,使鼻翼外侧脚旋转复位,鼻腔填塞预制纱垫以利塑形;同期延长鼻小柱。结果22例单侧唇裂继发鼻畸形患者均得到满意外观,患侧鼻翼隆起,恢复正常弧度,鼻孔对称,切口隐蔽,术后瘢痕不明显。结论依据鼻畸形特点及形成原因个性化设计鼻翼缘、鼻小柱基底切口并妥善处理鼻翼软骨的修复方法合理,操作简单,灵活性强,动态效果满意,并发症少,瘢痕不明显。     

Surgical correction of unilateral and bilateral facial palsy

Unilateral and bilateral facial palsies are debilitating and depressing conditions for the patient. For the past 30 years attempts have been made to improve the reanimation of these patients. The ability to transfer axons over significant distances with nerve grafts and the transfer of muscle that can be revascularised by microvascular surgery greatly improves results of this surgery. The revascularisation of muscle has been the important step forward but the re-focusing of interest in this condition has brought about a number of peripheral advances.     

单侧唇裂鼻畸形Ⅰ期矫正临床分析

目的:探讨婴儿期早期修复唇裂,同期矫正鼻畸形的效果。方法:采用Millard术式,同时经唇裂手术切口入路恢复大翼软骨、鼻肌的正常解剖位置,通过剪断口轮匝肌和鼻前棘的异位附着点纠正鼻小柱的偏斜,将患侧鼻翼软骨提到与健侧同一高度,并行贯穿褥式缝合固定。结果:共治疗26例患儿,随访6~26个月,效果满意。结论:在唇裂修复同期进行鼻畸形的矫正,可获得即刻的手术效果和较为满意的远期疗效,该方法能消除严重的唇裂鼻畸形,并可能降低再次手术及手术难度。对于单侧唇裂鼻畸形患者而言,是值得推荐的手术方法。     

Congenital midline sinus of the upper lip

A congenital lip sinus is a rare condition that has been reported to occur in both the upper and lower lips, either in isolation or in association with congenital deformities such as a cleft lip and palate in Van der Woude syndrome. The prevalence of lower lip sinuses has been estimated to be about 0.00001% of the white population. Upper lip sinuses are even more uncommon. To date, there have been several case reports of upper lip sinuses and fistulas, but no similar cases have been described in Singapore. We herein report a case of congenital upper lip sinus presenting as a recurring upper lip abscess and review the current literature on this condition.     

改良式Millard法修复单侧完全性唇裂

目的探讨单侧完全性唇裂的修复术式。方法在MillardⅡ’s法的基础上作了改进，取消了8点，充分利用回切，对45例单侧完全性唇裂患者行修复整形。结果全部患者均获随访，手术效果满意，唇部外形静态协调自然，鼻底及鼻翼外侧角恢复满意。结论改良的Millard修复单侧完全性唇裂对唇部和鼻畸形均得到了良好的矫正。     

Effect of unilateral posterior crossbite and unilateral cleft lip and palate on vertical mandibular asymmetry

Objective

Evaluate condylar, ramal, and condylar plus ramal vertical mandibular asymmetry in patients with unilateral posterior crossbite (UPCB) and in patients with unilateral cleft lip and palate (UCLP) compared with subjects having normal occlusion.

Design

This cross-sectional study evaluated panoramic radiographs of three groups of subjects: UPCB, 20 patients; UCLP, 20 patients; and normal occlusion sample, 20 subjects. All subjects were picked at random from Rey Juan Carlos University, Madrid, and all films were traced and measured manually by the same author.

Results

Kruskal–Wallis test revealed no statistically significant differences (P < 0.05) in condylar asymmetry index (CAI), ramal asymmetry index (RAI), and condylar plus ramal asymmetry index (C + RAI) among the three groups. The average CAI for group UPCB was 9.03 ± 7.65; 8.03 ± 6.89 for group UCLP; 6.93 ± 9.87 for normal group. Mean RAI for group UPCB was 2.53 ± 2.52; 2.61 ± 1.22 for group UCLP; 2.65 ± 1.90 for normal group.

Conclusions

Condylar asymmetry was observed in all three groups (UPCB, UCLP and normal occlusion) because condylar asymmetry indexes were higher in each group at the 3 % threshold. No statistically significant differences were found among the three study groups for any of the asymmetry indexes.     

改进Onizuka法修复单侧唇裂

目的 探索一种理想的修复单侧唇裂手术方法。方法 自1997～2002年运用改良Onizuka法治疗单侧唇裂22例。结果 22例患者均获良好外形，无任何并发症。结论 该方法用于修复单侧唇裂效果好，简单易行。     

单侧唇裂鼻畸形的综合整复

目的：矫正单侧唇裂术后鼻畸形。方法：基于对单侧唇裂鼻畸形的解剖学和临床畸形特征的认识和各种修复方法的比较探讨，我们采用了综合修复方法，包括患侧鼻翼软骨的解剖复位，上唇口轮匝肌的解剖复位和耳甲软骨游离植充填鼻翼基底凹陷来完成鼻畸形的矫正。结果：自19992月至今，经58例临床实践效果满意。结论：本手术方法具有切口暴露好，操作方便，临床效果好等特点。     

长庚手术法功能性修复单侧唇裂近期效果观察

目的探讨应用长庚手术法功能性修复单侧唇裂的效果。方法回顾分析应用长庚手术法功能性修复60例单侧唇裂患者,通过对比健患侧测量数据,分析术后鼻唇部结构的对称性、主观评价患者上唇动静形态,评价手术效果。结果 60例患者,59例创口Ⅰ期愈合,1例患儿抓伤致创口Ⅱ期愈合。患侧唇的高度、长度、鼻底宽度与健侧较一致,鼻翼外脚、鼻堤形态自然,患侧人中嵴较明显,红唇部形态自然、丰满,唇珠微突,鼻小柱形态好。大部分患者术后健患侧各项测量指标对称率(即健侧/患侧的比值)位于0.91～1.10之间,接近正常人,各主观评价项平均得分均大于8分,整复效果令人满意。结论长庚手术法功能性修复单侧唇裂可获得良好的功能及形态效果。