乳房下皱襞的组织学和解剖学研究及其临床应用

目的 通过对乳房下皱襞相关组织结构的大体解剖和组织学研究,进一步明确乳房下皱襞的组织学和解剖结构.方法 采用新鲜成年女性尸体行解剖研究,并分别于乳房上缘、乳晕上缘、乳房下皱襞及乳房下皱襞下方4 cm处取材,制作HE染色及改良Gomori′s trichrome 染色切片,并进行图像分析.结果 共研究乳房20只,在乳房下皱襞组可见皮肤真皮层内红色的纤维组织排列平行于乳房下皱襞的长轴,胶原纤维的断面较少,各组的胶原纤维相对含量无明显差异.结论 乳房下皱襞区域无下皱襞韧带结构,真皮内胶原纤维的密度和其他三组相比,无明显差别.     

乳房下皱襞重建术的临床研究进展

对女性乳房的形态和结构来说,乳房下皱襞是一个决定性结构[1].在青春前期该结构一般是无法觉察的, 但是从青春期开始,乳房下皱襞就开始出现并确定乳房的下界范围.从乳房发育开始, 乳房下皱襞就将乳房下极"锚定"在胸壁上[2].乳房下皱襞结构对于乳房美学及乳房重建外科都有重要价值[3].     

乳下皱襞韧带的检验

目的检验乳下皱襞韧带存在的真实性。方法对9例18侧经防腐处理的女性乳房进行了解剖及切面筋膜染色后的观察。结果否定了先前由 Bayati 和 Straalen 等提出的有独立的乳下皱襞韧带的存在。结论证明乳下皱襞的存在是基于乳房下部增厚并密集的 Cooper 韧带所致。     

乳下皱襞韧带的检验

目的　检验乳下皱襞韧带存在的真实性。方法　对９ 例１８ 侧经防腐处理的女性乳房进行了解剖及切面筋膜染色后的观察。结果　否定了先前由 Ｂａｙａｔｉ 和 Ｓｔｒａａｌｅｎ 等提出的有独立的乳下皱襞韧带的存在。结论　证明乳下皱襞的存在是基于乳房下部增厚并密集的 Ｃｏｏｐｅｒ 韧带所致。     

乳房下皱襞不对称的矫治

目的：探讨乳房下皱襞不对称的矫治方法。方法：对11例乳房下皱襞不对称患者,采用乳晕上缘半环形切口,游离乳房后间隙,根据双侧不对称的差值,将过低侧乳房的上极腺体组织弧形切除并向上与胸肌筋膜缝合固定（其中9例同期行隆乳术）,切口上缘皮肤作适当切除。结果：11例患者术后双侧乳房下皱襞基本对称,形态满意,无并发症发生。结论：本方法操作简单,疗效可靠,便于推广应用。     

乳房下皱襞超微结构的研究及临床意义

国内外很多学者对乳房下皱襞进行了大量的基础及临床方面的研究，其研究结果概括起来可大致分为两种观点：一种观点认为乳房下皱襞处存在乳房下皱襞韧带，此韧带结构是形成乳房下皱襞的原因；另一种观点认为并不存在此韧带结构，而只是一些纤维带，这些纤维带不是真正的韧带，它们属于乳腺筋膜的一部分。我们通过对新鲜女性尸体乳房行大体解剖。     

乳房重度下垂的直线切口法乳房成形术

目的 介绍应用直线切口法乳房成形术(Lejour法)治疗重度乳房下垂方法及效果.方法 按Lejour法设计手术切口.该类患者新乳头位置较正常人群可适当下移1～2 cm,新乳房下皱襞上移5～10 cm,通过适当下移新乳头位置及上移新乳房下皱襞达到缩短垂直切口距离.剥离乳腺组织,将下垂乳腺组织从乳腺深层固定于胸大肌第2、3肋水平.皮肤无张力缝合.结果 36例中乳房肥大者30例、体积基本正常者6例,经术后3个月至2年随访,无明显并发症,新乳房外形挺拔自然,患者满意.结论 本术式简便易行,远期效果好,可作为重度乳房下垂的术式之一.     

乳房下皱襞的基础研究及临床应用进展

乳房下皱襞位于乳房下缘，在内侧位于5～6肋，锁骨中线处6～7肋，腋前线处7～8肋，SirAstley Cooper最早在1845年就描述了此结构。乳房卜皱襞是乳房的一个重要结构，对于乳房美学以及乳房整形外科手术都具有重要参考价值。了解乳房下皱襞的组织解剖结构及形成机理对于指导乳房临床相关手术的设计及操作具有重要意义。     

应用轮辐状模板乳房塑形悬吊术

乳房下垂一般是以乳头的位置在乳房下皱襞水平或以下,以及乳房的最低缘在乳房下皱襞以下为诊断的依据.目前,乳房下垂的手术治疗方法有多种,但对于轻、中度乳房松弛下垂或重度下垂而不希望改变乳房体积的求术者,临床较难处理,单纯去处松弛皮肤和腺体悬吊,往往很难达到满意的手术效果.自2004年以来,我们首先创用轮辐状模板乳房塑形悬吊术矫正乳房下垂患者3例,获得满意效果.     

乳晕切口法解剖型假体隆乳术治疗轻度乳房下垂

目的探讨应用解剖型假体(又称泪滴型假体)隆乳术矫正轻度乳房下垂的可行性及临床效果。方法术前依据原乳房三维形态,测量胸乳距、乳房基底宽度、乳头至乳房下皱襞距离等数据,以确定所需采用的假体类型、容量及下垂乳房下皱襞距离,选用乳晕切口对36例轻度乳房下垂者应用麦格410解剖型假体行隆乳术。结果全部隆乳者术后乳房挺拔,下垂基本得到矫正,受术者均表满意。结论应用解剖型假体的隆乳术是目前矫正有增大乳房容积愿望的轻度乳房下垂者的最佳选择之一。     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.