68例腮腺肿瘤病人的术后护理

腮腺肿瘤的治疗方法主要是手术。由于腮腺与面神经在解剖上密切相连，因此，术后可能发生暂时性及永久性面神经功能障碍及其他并发症。术后密切观察，发现问题及时处理甚为重要。1987～t997年我科对68例腮腺肿瘤进行了手术治疗，对付后所发生的并发症及主要护理问题，采取了相应的护理措施，取得一定效果。总结如下。Ill＄床资料和方法68例中，男33例，女35例，年龄14～72岁，平均45．5岁。病程1个月至40年，平均1年半。腮腺肿瘤直径＜2cm6例，2—6cm58例，＞6cm4例。瘤体原发于腮腺浅叶49例，深叶19例。病理类型：良性肿瘤55例，恶性肿瘤1…     

腮腺肿瘤术后Frey综合征预防的初步研究

目的探索预防腮腺肿瘤术后Frey综合征发生的临床方法。方法将100例因腮腺肿瘤于2001年至2004年在我院接受腮腺浅叶或全腮腺切除术的患者分为研究组和对照组,每组各50例。研究组在腮腺及肿瘤切除术将结束时,在腮腺术床面神经各分支表面与皮瓣之间插入胶原蛋白片,作为隔离填充,阻止神经错位生长。对照组术中不植入隔离物,其他方面与研究组匹配。术后半年以上,用同一问卷收集患者资料,进行分析评价。结果随访时间为10～39个月,平均16个月。研究组Frey综合征发生率为20％（10／50）,对照组为60％（30／50）（X^2=15．04,P〈0．001）,术后颜面轮廓明显凹陷畸形的出现率两组分别为44％和80％（X^2=12．26,P〈0．001）。结论这种手术方式将Frey综合征的发生率由60％降至20％,为腮腺术后Frey综合征的预防提供了一种简单而有效的方法,同时患者术后颜面轮廓畸形也获得明显改善。     

红外线烤灯照射在胃肠道肿瘤术后腹部切口愈合中的疗效观察

【摘要】 目的 探讨红外线烤灯照射在胃肠道肿瘤术后切口愈合过程中的临床疗效。方法将250例行胃、结直肠肿瘤手术患者分对照组和红外线照射组。对比两组患者,腹部切口平均愈合时间、切口感染率和住院总费用等三方面的差异。对照组:患者术后腹部切口用碘伏常规消毒换药,每两天一次至拆线。红外线照射组:患者术后腹部切口用烤灯照射20 min bid+碘伏常规消毒换药每两天一次至拆线。结果〓红外线照射组患者腹部切口愈合时间为6.92±1.81天,明显短于对照组患者切口愈合时间7.99±3.91天,P<0.01。红外线照射组患者腹部切口感染率2.19%明显少于对照组患者切口感染率11.50%(P<0.05)。红外线照射组患者的总住院费用5.61±0.70万元并不高于对照组5.64±0.73万元(P>0.05)。结论〓红外线烤灯照射能明显缩短胃肠道肿瘤患者术后腹部切口愈合时间,降低切口感染率,且不增加患者住院总费用。     

负压引流方式的改进与腮腺手术后美容效果

目的：探讨负压引流开口选择在腮腺手术的应用,分析与腮腺术后涎瘘相关的临床因素。方法：将临床上需要手术治疗的腮腺疾病患者154例随机分为传统方法（橡皮条引流）组（52例）、负压引流低位颈部开口组（83例）与负压引流发际内开口组（19例）,记录术后涎瘘发生及伤口愈合情况。结果：负压引流低位颈部开口组的涎瘘发生率10.84%,负压引流发际内开口组的涎瘘发生率10.52%低于传统方法组17.31%,但传统方法组（橡皮引流条引流）与负压引流颈部开口组间差异无显著性（P〉0.05）,负压引流低位颈部开口组与负压引流发际内开口组差异无显著性（P〉0.05）。结论：负压引流发际内开口结合短暂的加压包扎能取代传统方法,具有临床应用价值。     

腮腺浅叶肿瘤手术方式的探讨

腮腺浅叶良性肿瘤临床上十分常见，尤以腮腺多形性腺瘤为多，根据传统的手术方法，在切除肿瘤时需将腮腺浅叶切除，同时结扎腮腺导管。笔者在做肿瘤切除时，根据肿瘤的部位、大小，试保留部分腮腺浅叶和腮腺导管。1995年以来笔者采用此法对63例腮腺浅叶肿瘤施行手术，现报告如下。     

日舒安联合红外线照射预防老年患者会阴湿疹的效果观察

目的 观察日舒安联合红外线照射预防老年会阴湿疹的效果。方法 将96例易发生会阴湿疹老年患者随机分为观察组（46例）和对照组（50例），分别给予日舒安擦洗联合红外线照射和单纯日舒安擦洗的护理。结果 观察组发生会阴湿疹2例（4．3％），对照组发生会阴湿疹10例（20．0％），两组比较，差异有显著性意义（P〈0．05）。结论 日舒安联合红外线照射能有效预防老年会阴湿疹的发生。     

乳腺癌术后负压引流的临床体会

乳腺癌患者行根治术后腋窝区引流多数同道主张持续负压引流，以达到充分引流创面渗血及淋巴液，从而避免了皮下积液、积血、创口感染及皮瓣坏死等并发症。我们就此测定了负压数据，应用于临床46例，认为较为可靠，并摸索出一套简易而有实效的负压引流装置，现报告如下。临床资料一、一般资料：我院1990～1996年，共收治乳腺癌91例，除外合并有糖尿病、原发性血小板减少症等可能影响创口愈合的疾病患者5例，余下86例，年龄为23～71岁，平均为48．7岁。女性85例，男性1例。肿块大小直径3～7cm。随机分成两组，其中40例采用自动负压吸引器负压…     

腮腺区肿瘤术后发生面神经损伤的原因分析

目的:分析腮腺区肿瘤术后发生面神经损伤的原因。方法:对48例腮腺区肿瘤手术患者资料进行回顾性分析,统计分析各种因素下发生面神经损伤的概率。结果:21例患者出现面神经损伤,发生率43.75%。若腮腺区肿瘤为恶性肿瘤、病程较长、肿瘤位置靠近面神经以及多次手术者发生术后面神经损伤概率较高。结论:手术解剖方式、肿瘤病理病程以及多次手术等因素都与患者术后面神经损伤密切相关。     

日舒安联合红外线照射预防老年患者会阴湿疹的效果观察

目的 观察日舒安联合红外线照射预防老年会阴湿疹的效果.方法 将96例易发生会阴湿疹老年患者随机分为观察组(46例)和对照组(50例),分别给予日舒安擦洗联合红外线照射和单纯日舒安擦洗的护理.结果 观察组发生会阴湿疹2例(4.3%),对照组发生会阴湿疹10例(20.0%),两组比较,差异有显著性意义(P＜0.05).结论 日舒安联合红外线照射能有效预防老年会阴湿疹的发生.     

腮腺肿瘤切除术的美容考虑与处理

目的:探讨小切口在腮腺良性肿瘤切除术中的临床应用、美学处理及利用腮腺残端组织修复组织缺损的方法。方法:选择肿瘤直径<2cm,发生在腮腺下极良性肿瘤患者32例,采用下颌升支后缘切口,解剖面神经下颌缘支及下颊支,保留腮腺导管,行腮腺肿瘤及区域性腮腺切除术,用腮腺残端组织瓣转移修复下颌后区组织缺损。结果:32例患者术后伤口愈合良好,随访2年,无术后复发及味觉出汗综合征患者,瘢痕短,局部凹陷不明显,无永久性面瘫发生。结论:针对发生在腮腺下极且直径<2cm的良性肿瘤,经小切口切除肿瘤,用腮腺残端组织转移修复缺损的手术方式,减少了手术创伤及并发症,改善局部组织凹陷,获得满意的手术效果和美学效果。     

膝关节周围肿瘤切除术后引导式健步走效果研究

目的探讨引导式健步走对膝关节周围肿瘤切除后人工关节重建功能的效果。方法将60例膝关节周围肿瘤患者予肿瘤切除、人工关节重建术治疗。术后患者随机分为对照组与观察组各30例,对照组进行常规术后功能锻炼,观察组进行引导式健步走训练,比较两组患者康复疗效、膝关节功能、肌力及活动舒适度。结果经训练后观察组康复疗效、膝关节功能、肌力及活动舒适度显著优于对照组(P0.05,P0.01)。结论采用引导式健步走,制定不同阶段的行走方案可促进患者人工关节的功能重建及适应,使训练过程均达到最佳效应,取得良好的康复效果。     

Bone flap salvage in acute surgical site infection after craniotomy for tumor resection

Craniotomy surgical site infections are an inherent risk and dreaded complication for the elective brain tumor patient. Sequelae can include delays in resumption in adjuvant treatments for multiple surgeries if staged cranioplasty is pursued. Here, the authors review their experience in operative debridement of surgical site infections with single-stage reimplantation of the salvaged craniotomy bone flap. A prospectively maintained database of a single surgeon’s neuro-oncology patients from 2009 to 2017 (JRF) was queried to identify 11 patients with surgical site infection after craniotomy for tumor resection. All patients underwent a protocol of aggressive operative debridement including drilling the bone edges and intraoperative flap sterilization with single-stage reimplantation, followed by tailored-antibiotic therapy. Ten of the 11 patients with frankly contaminated bone flaps from surgical site infection were able to be salvaged in a single-stage procedure. Five of these patients underwent adjuvant chemotherapy and/or radiation without secondary complication. There was one treatment failure in a delayed fashion which required additional surgery for craniectomy; however, this occurred after adjuvant treatment was administered. Surgical debridement and bone flap salvage is safe and cost-effective in managing acute surgical site infections after craniotomy for tumors. Additionally, this practice is likely beneficial in expediting the resumption of cancer therapy.     

股骨肿瘤瘤段切除后修复重建的体会

目的总结股骨肿瘤切除后修复重建的经验教训。方法手术治疗16例股骨肿瘤患者,9例股骨近端肿瘤患者中7例采用瘤段切除＋假体重建,2例股骨转子部肿瘤应用瘤段切除＋Gamma钉＋骨水泥固定;4例股骨干肿瘤采用瘤段切除＋带锁髓内钉＋骨水泥重建;3例股骨远端肿瘤采用瘤段切除＋膝关节假体置换。结果 16例获随访,时间1年2个月～13年。按Enneking肢体肌肉骨骼肿瘤外科治疗重建术后功能评估标准进行评估：4～5分12例,3分3例,1分1例。结论严格掌握适应证、无瘤无菌操作、彻底灭活肿瘤截骨端是降低复发率的关键。有效的组织修复和功能重建不但可以保留股骨骨肿瘤切除后的肢体,而且具有良好的功能。     

Segmental limb reconstruction after tumor resection

Limb salvage of large segmental and osteoarticular defects after tumor resection has become the standard of care for most patients with musculoskeletal tumors because overall survival is the same when compared with that seen in amputation patients. This study examines limb salvage for the surgical management of large segmental defects in terms of local recurrence, complications, and functional outcome in both primary and metastatic lesions. We retrospectively identified 32 patients with benign or malignant tumors of bone who underwent resection and limb salvage reconstruction by means of a custom or modular metal implant between 1985 and 1995. The most common tumor sites were the proximal femur (41%), distal femur (37.5%), and proximal humerus (12.5%). Primary bone lesions accounted for 18 patients (56%); metastatic disease accounted for 14 patients (44%). Osteosarcoma (n = 11) and chondrosarcoma (n = 3) were the most frequent primary tumors. The overall limb salvage rate (91%) was high, yet complications (28%) were common. Except for 3 patients who underwent amputation after prosthetic failure, all surviving patients were independent with or without assistive devices at latest follow-up. In patients with advanced metastatic disease, average survival was 7.6 months. No cases of aseptic loosening or implant breakage were observed in patients followed up for 2 years or more. Treatment after tumor resection with a limb salvage prosthetic reconstruction has shown good functional outcomes with an acceptable complication rate. This modality, therefore, offers patients a more favorable functional outcome with a more energy-efficient gait when compared with limb amputation.     

Multiple tumor emboli after lung resection

A patient with carcinoma of the lung underwent a left lower lobectomy. For technical difficulties the pulmonary vein was not ligated prior to extensive manipulations of the involved lobe. Following the pulmonary surgery the patient sustained a massive aortic occlusion by a tumor embolus, that was removed by bilateral femoral embolectomies. Three additional documented episodes of peripheral arterial emboli subsequently took place, two of which were tumoral. One tumor embolus into the carotid artery territory eventually caused metastatic spread in the brain. All peripheral emboli were successfully treated by embolectomy. This unique display of multiple tumor emboli, following lung resection for carcinoma, reemphasises the significance of early interruption of the pulmonary vein, in an attempt to reduce the incidence of tumor emboli.     

腮腺切除术中几个美学问题的探讨

目的：探讨腮腺切除术中切口瘢痕、术区凹陷畸形、味觉出汗综合征等几个美学问题的预防方法。方法：对36例腮腺良性肿瘤采用改良的腮腺类＂3＂型切口、耳后筋膜瓣、保留腮腺嚼肌筋膜、保留腮腺总导管及深叶功能等综合术式。结果：切口瘢痕得到有效隐蔽、局部凹陷得以改善、味觉出汗综合征明显降低。结论：腮腺切除术中采用综合的术式,可以大大改善切口瘢痕、术区凹陷畸形及味觉出汗综合征等导致的美学问题。     

Cardiomyoplasty: ventricular reconstruction after tumor resection

OBJECTIVE: Although cardiac transplantation has been performed for complete removal of ventricular tumors, complete surgical resection with ventricular reconstruction is desirable. Thus patients with benign tumors would probably be cured, and those with malignant tumors would have a better prognosis. In this study extensive and complete surgical resection of ventricular tumors is followed by anatomic and functional ventricular reconstruction with a dynamic cardiomyoplasty procedure. METHODS: Seven patients (mean age, 32.7 years) underwent complete resection of ventricular tumors. Histologic types were distributed as follows: fibroma in 2 patients and sarcoma, lymphosarcoma, hemangioma, lipoma, and metastatic angiosarcoma, respectively, in the remaining 5 patients. Six of the patients were considered candidates for heart transplantation because of the extent of tumor invasion. Surgery consisted of 4 steps: (1) tumor resection; (2) coronary artery resection (when invaded by the tumor) and coronary artery bypass grafting; (3) valvular reconstruction (when possible) or replacement; and (4) ventricular wall reconstruction with a pericardial patch for closure of the ventricular defect (neoendocardium) covered by the electrostimulated latissimus dorsi muscle flap (neomyocardium). RESULTS: All patients survived surgical intervention, but 2 late postoperative deaths are reported. Among the surviving patients, early complications played a major role in their postoperative course and consisted of arrhythmias, atrioventricular block necessitating a dual-chamber pulse generator, respiratory insufficiency, and heart failure. Two patients were assisted postoperatively with an intra-aortic balloon pump. On postoperative follow-up (mean, 72.4 +/- 8.5 months), an improvement in the patients' functional status was observed. Patients moved from a mean New York Heart Association functional class of 2.8 to a mean functional class of 1.2. CONCLUSIONS: The excellent long-term evolution without recurrence, ventricular dysfunction, and/or thromboembolic complications implies that cardiomyoplasty could be recommended as an alternative to heart transplantation for the therapy of large ventricular tumors.