医用壳聚糖创面修复膜对阑尾炎手术伤口恢复的效果

目的探讨医用壳聚糖创面修复膜对阑尾炎手术伤口恢复的临床效果。方法行开腹手术治疗的60例阑尾炎患者,随机分为观察组和对照组,各30例。两组术后均给予常规伤口处理,观察组在此基础上加用医用壳聚糖创面修复膜。比较两组疗效。结果观察组伤口愈合效果显著好于对照组,愈合时间显著短于对照组,差异均具有统计学意义（P〈0.01）。结论医用壳聚糖创面修复膜能够促进阑尾炎手术伤口更好更快的恢复,使用方法简单,适用范围广泛,值得临床考虑。     

小面积深度创面的手术修复

临床实践中，部分伴有骨骼、肌腱、神经等组织暴露的小面积深度创面，治疗难度较大，手术方法也复杂多样。我科自1995-01～2002-01共收治了多种原因所致的小面积深度创面98例，经选用不同的手术方法进行修复，治疗效果较好，均痊愈出院。现就手术方法的选择予以总结。     

深度烧伤创面的皮瓣修复的临床治疗分析

目的探讨深度烧伤创面的皮瓣修复的疗效。方法回顾分析40例患者的临床资料。结果 42例均一次修复成功,40例皮瓣全部成活,外形及功能恢复满意,拇指修复后需二次整形2例;30例患者得到随访,随访时间6～30个月,皮瓣修复处外观满意,见皮瓣色泽嫩白,柔软且弹性好,功能部位如手足功能恢复满意,修复效果明显优于皮片移植,患者自我感觉良好。结论深度烧伤患者创面进行皮瓣修复的效果良好,患者创面外观及功能改善明显,恢复情况较好,值得临床推广。     

壳聚糖抗菌凝胶促进宫颈微波手术创面愈合78例

目的 观察壳聚糖抗菌凝胶促进慢性宫颈炎患者宫颈微波手术治疗后创面愈合的作用。方法 将接受宫颈微波手术的慢性宫颈炎患者149例随机分成治疗组78例和对照组71例。治疗组分别在手术后、手术第1周和4周时使用壳聚糖抗菌凝胶涂覆在宫颈创面处。对照组手术后不予特殊用药。两组患者均于手术后、手术第1,4,8和12周进行随访检查,观察宫颈创面水肿、结痂、脱痂、愈合情况、阴道出血量以及分泌物性状,记录不良反应及实验室指标。结果 与对照组比较,治疗组手术后创面愈合时间平均缩短1.83周(P<0.01);治疗组手术后第4周阴道出血发生率为56.41%,明显低于对照组的77.46%(P<0.01),同时手术后第1周及第4周治疗组出血量更少(P<0.01),出血持续时间更短(P<0.01);治疗组手术后第1,4,8周炎性分泌物的发生率分别为89.74%,26.92%,2.56%,均明显低于对照组的100.00%,56.34%,19.72%(均P<0.01);治疗组手术后第1周及第4周宫颈黏膜水肿的发生率分别为15.38%和6.41%,均明显低于对照组的73.24%和32.39%(...     

表皮生长因子对创面修复作用的临床观察

目的：观察表皮生长因子（rhEGF)对创面的修复作用。方法：选择30例各类创面,同时选择同体相似深度,相应部位30个创面作对照,创面清创后将浸透rhEGF的双层纱布敷于创面上,外敷凡士林油纱,无菌纱布包扎。每日或隔日换药,观察至愈合。结果：总显效率70%,可使浅Ⅱ度、深Ⅱ度创面分别提前3d、3.2d愈合,3例慢性创面平均18d愈合。结论：rhEGF对浅Ⅱ度创面有非常明显的促进创面愈合作用,对深Ⅱ度创面、慢性创面也有促进愈合作用。     

硅基创面修复材料对临床各种创口愈合的影响分析

目的探究硅基创面修复材料对于临床各种创口愈合的临床效果。方法选自本院2011年1月~2013年1月收治的因各种原因出现创面伤口的患者100例,以自身对照方法进行研究。对照组创面使用一次性自粘无菌敷料进行治疗,实验组创面应用硅基创面修复材料进行治疗。对比两组创面各项临床指标。结果相对于对照组创面,实验组创面新鲜手术切口创面拆线时间、创口愈合时间以及临床治疗效果等,均有显著优越性,对比差异有统计学意义（P〈0.05）。结论对各种创口应用硅基创面修复材料进行治疗,其愈合时间会大幅度缩短,收到令人满意的临床治疗效果,且患者治疗后不会有严重不良反应,具有安全高效的优点,值得临床推广。     

改良菱形皮瓣修复创面的临床应用

目的应用改良菱形皮瓣修复创面的效果观察。方法采用改良菱形皮瓣对58例圆形或椭圆形的创面进行修复,利用创面邻近处的皮肤,采用旋转和推进相结合的方法直接覆盖创面。结果58例均得到一期修复,所修复创面的皮肤颜色和质地基本与周边皮肤色泽一样。供瓣区术后疤痕不明显,不需要植皮。结论认为采取改良菱形皮瓣对修复一定范围内的创面是一种简单易行方法。     

包皮移植修复小创面的临床应用

创面植皮手术是一种"拆东墙补西墙"的手术,在修复缺损或切除病灶的同时,供皮区形成新的创面或(和)术后瘢痕.自2001年来,我们采用厚断层包皮移植修复下肢、躯干的小创面15例,取得良好效果,报告如下.     

国内伽玛刀与手术治疗三叉神经痛疗效的Meta分析

目的 评价伽玛刀(GKS)治疗与手术治疗三叉神经痛(TN)的疗效及安全性.方法 计算机检索PubMed、中国生物医学文献数据库、中国期刊全文数据库及万方数据库,纳入GKS治疗与手术治疗TN的随机对照试验(RCT),检索时间截止于2012年12月,由2名评价者按照纳入和排除标准独立选择文献,提取资料并评价质量.采用Stata 11.0软件进行Meta分析.结果 最终纳入系统评价的1篇完全RCT文献和4篇回顾性队列研究,纳入患者564例(GKS组293例,手术组271例).对TN疼痛缓解疗效的分析(OR=0.56,95％CI=0.06～5.64,P=0.625),两组间差异无统计学意义.治疗后面部麻木的分析(OR=0.39,95％CI=0.08～1.91,P=0.243),复发情况分析(OR=1.59,95％CI=0.68～3.73,P=0.287),两组间差异无显著性,其他并发症分析(OR=0.30,95％CI=0.15～0.62,P=0.001),两组间差异有统计学意义.结论 GKS与手术治疗TN在对疼痛的有效率、治疗后面部麻木情况、复发情况方面差异无统计学意义,但在改善治疗后其他并发症方面GKS较手术治疗TN存在显著优势.     

Epithelial healing in experimental corneal alkali wounds with nondiluted autologous serum eye drops

Purpose: To evaluate the effects of the topical application of nondiluted autologous serum on epithelial healing as an adjuvant therapy in rabbit corneal alkali wounds.

Methods: Central corneal alkali wounds were produced on the right eye of 16 rabbits, by a 60-second application of a 6-mm round filter paper soaked in 1 N sodium hydroxide (NaOH). One group of rabbits (n=8) was treated with non-diluted autologous serum, the other control group (n=8) was treated with physiologic saline, topically 4 times a day. The epithelial healing of the wounds was followed on a slit lamp with and without fluorescein staining daily for 1 week. On day 7, both corneas of each rabbit were excised and assessed histopathologically.

Results: A significant increase in the epithelial healing rate was observed in the autologous serum–treated corneas compared with the controls. Epithelial hyperplasia was noticed in specimens with thickened surface cells with multilayers, revealing disorganization in both groups. The autologous serum–treated epithelium showed a relatively well-organized appearance.

Conclusion: Nondiluted autologous serum eye drops could be used as an adjuvant therapy for promoting the epithelial healing process during the repair stage of corneal alkali wounds.     

Enhanced healing efficacy of an optimized gabapentin-melittin nanoconjugate gel-loaded formulation in excised wounds of diabetic rats

The present study aimed to design and optimize, a nanoconjugate of gabapentin (GPN)-melittin (MLT) and to evaluate its healing activity in rat diabetic wounds. To explore the wound healing potency of GPN-MLT nanoconjugate, an in vivo study was carried out. Diabetic rats were subjected to excision wounds and received daily topical treatment with conventional formulations of GPN, MLT, GPN-MLT nanoconjugate and a marketed formula. The outcome of the in vivo study showed an expedited wound contraction in GPN-MLT-treated animals. This was confirmed histologically. The nanoconjugate formula exhibited antioxidant activities as evidenced by preventing malondialdehyde (MDA) accumulation and superoxide dismutase (SOD) and glutathione peroxidase (GPx) enzymatic exhaustion. Further, the nanoconjugate showed superior anti-inflammatory activity as it inhibited the expression of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). This is in addition to enhancement of proliferation as indicated by increased expression of transforming growth factor-β (TGF- β), vascular endothelial growth factor-A (VEGF-A) and platelet-derived growth factor receptor-β (PDGFRB). Also, nanoconjugate enhanced hydroxyproline concentration and mRNA expression of collagen type 1 alpha 1 (Col 1A1). In conclusion, a GPN-MLT nanoconjugate was optimized with respect to particle size. Analysis of pharmacokinetic attributes showed the mean particle size of optimized nanoconjugate as 156.9 nm. The nanoconjugate exhibited potent wound healing activities in diabetic rats. This, at least partly, involve enhanced antioxidant, anti-inflammatory, proliferative and pro-collagen activities. This may help to develop novel formulae that could accelerate wound healing in diabetes.     

Chitosan as a starting material for wound healing applications

Chitosan and its derivatives have attracted great attention due to their properties beneficial for application to wound healing. The main focus of the present review is to summarize studies involving chitosan and its derivatives, especially N,N,N-trimethyl-chitosan (TMC), N,O-carboxymethyl-chitosan (CMC) and O-carboxymethyl-N,N,N-trimethyl-chitosan (CMTMC), used to accelerate wound healing. Moreover, formulation strategies for chitosan and its derivatives, as well as their in vitro, in vivo and clinical applications in wound healing are described.     

苯妥英钠对大鼠伤口巨噬细胞的影响

本实验旨在研究苯妥英钠(PS)对伤口巨噬细胞(M_ф)的影响. 从置入大鼠背部伤口的聚乙烯醇海绵中收集巨噬细胞, 分别测定其吞噬功能, 肿瘤坏死因子α(TNF_α)和白介素1(IL-1)的释放以及对成纤维细胞增殖调节作用, 通过牵拉伤口组织致其断裂时溢出的水的重量而测定伤口牵张强度. 结果表明, 伤口M_ф的功能在伤后d 5达到高峰, PS 1,10,50 g·L^-1浓度依赖性地增加伤后d 5的伤口M_ф的数量, 吞噬功能, TNF_α和IL-1的释放, 增强M_ф对成纤维细胞增殖的刺激作用, 增强伤口牵张强度. 结果说明PS加速伤口愈合, 与其增强M_ф的功能有关.     

Effect of phenytoin sodium on macrophages in rat wounds

本实验旨在研究苯妥英钠（ＰＳ）对伤口巨噬细胞（Ｍ）的影响．从置入大鼠背部伤口的聚乙烯醇海绵中收集巨噬细胞，分别测定其吞噬功能，肿瘤坏死因子α（ＴＮＦα）和白介素１（ＩＬ－１）的释放以及对成纤维细胞增殖调节作用，通过牵拉伤口组织致其断裂时溢出的水的重量而测定伤口牵张强度．结果表明，伤口Ｍ的功能在伤后ｄ５达到高峰，ＰＳ１，１０，５０ｇ·Ｌ－１浓度依赖性地增加伤后ｄ５的伤口Ｍ的数量，吞噬功能，ＴＮＦα和ＩＬ－１的释放，增强Ｍ对成纤维细胞增殖的刺激作用，增强伤口牵张强度．结果说明ＰＳ加速伤口愈合，与其增强Ｍ的功能有关．     

新型静电纺丝伤口敷料的止血性能及促愈合作用研究

目的 评价新型静电纺丝伤口敷料的止血性能及促创伤愈合作用,为该敷料的进一步开发应用奠定基础。方法 将胶原蛋白和壳聚糖的混合溶液通过静电纺丝技术纺在海藻酸盐无纺布基布上,制备成新型静电纺丝伤口敷料（胶原蛋白-壳聚糖静电纺丝膜复合海藻酸盐敷料,Collagen-Chitosan Electrostatic spinning membrane Alginate Dressing,CCEAD）。通过体外凝血实验、兔耳动脉创伤止血实验和兔背部创伤止血实验评价CCEAD的止血性能。建立大鼠背部全皮层创伤模型,分别在术后3、5、7、12 d拍照计算伤口愈合率,测定CCEAD的促愈合作用;取伤口创面皮肤组织,HE染色观察组织病理学变化;免疫组化染色观察在伤口愈合过程中CD31、FGF-2和TGF-β的表达情况。结果 CCEAD组的体外凝血指数BCI为36.91±6.62,显著小于阳性对照明胶海绵组（69.82±1.83）和阴性对照医用纱布组（79.93±6.30）（P＜0.01）。兔耳动脉创伤止血实验中,CCEAD组的止血时间（107.67±17.62) s短于医用纱布组（163.67±15.50） s（P＜0.05）。兔背部创伤止血实验中,CCEAD组Hb光度吸收值（0.120±0.052）明显低于医用纱布组（0.294±0.021）（P＜0.01）。在促创伤愈合实验中,术后第7天,CCEAD组愈合率为65.70%±4.94%,高于阳性对照壳聚糖敷料组（48.78%±8.33%,P＜0.05）,明显高于医用纱布组（37.76%±6.35%,P＜0.01）。HE染色显示,CCEAD在伤口愈合早期能够促进成纤维细胞生长和新生血管形成,促进肉芽组织的生成。免疫组化结果显示,CCEAD能促进CD31、FGF-2和TGF-β在伤口愈合早期的表达,有利于伤口的愈合。结论 新型静电纺丝伤口敷料（胶原蛋白-壳聚糖静电纺丝膜复合海藻酸盐敷料）止血性能优良,具有明显的促创伤愈合作用,有望开发成新型伤口敷料。     

壳聚糖对大鼠Ⅲ度烧伤创面成纤维细胞生物学行为的影响

目的研究壳聚糖对烧伤创面成纤维细胞(FB)生物学行为的影响。方法Wistar大鼠分为1%壳聚糖组(W/V)、2%壳聚糖组(W/V)、4%壳聚糖组(W/V)、成纤维细胞生长因子(贝复剂)组(阳性对照组)、自然愈合组(模型组),制备成大鼠Ⅲ度烧伤模型,记录创面愈合时间,计算创面愈合率,用生化法测定各时相点羟脯氨酸(HOP),流式细胞术检测真皮组织中FB细胞周期,TUNEL法检测FB凋亡。结果4%壳聚糖组(W/V)各个时间点创面愈合率都明显高于自然愈合组(P<0.01);2%壳聚糖组、4%壳聚糖组创面愈合时间较自然愈合组缩短(P<0.05);2%壳聚糖组、4%壳聚糖组烧伤后7 d HOP就达最高值,且其值比自然愈合组最高值大;4%壳聚糖组进入S期的成纤维细胞数明显高于自然愈合组(P<0.05,P<0.01),创面凋亡细胞数量低于自然愈合组(P<0.05,P<0.01)。结论壳聚糖能增加烧伤创面修复细胞FB的增殖,凋亡减少,胶原合成增多,可能是壳聚糖促进大鼠Ⅲ度烧伤创面愈合的原因之一。     

Chitosan and its salts for mucosal and transmucosal delivery

This review considers the application of chitosan and its salts in the delivery of drugs intended to act locally towards diseases of the mucosa itself (mucosal delivery), and to undergo systemic absorption by means of transmucosal routes (transmucosal delivery). Those chitosan properties that are particularly useful in mucosal and transmucosal delivery have been reviewed, such as mucoadhesion, penetration enhancement and peptidase inhibition behaviour. Chitosan bioactive properties have also been considered, such as anti-infective, haemostatic, wound healing and immune-stimulating activity. Chitosan is available with a wide range of molecular mass and deacetylation degree: the influence of these properties on polymer performance and solubility has been taken into account. As solubility in particular can strongly limit the results obtained at pH values close to neutrality, particular attention has been paid to chitosan salts and derivatives with modified solubility. Thanks to the presence of positively charged amino groups of the polymer, a subject of increasing interest is the exploitation of its interaction with acidic molecules having potential synergistic behaviour towards bioactive properties, or even with acidic drugs. The aim of the review is to describe not only some properties of chitosan, but also the way they can be modified by the acidic moiety.     

机器人与腹腔镜胃癌手术近期疗效的Meta分析

目的 检索国内外文献,利用高质量文献探讨达芬奇手术机器人与传统腹腔镜治疗胃癌的疗效差异。方法 检索自2002年1月1日至2016年12月31日发表的关于对比机器人及传统腹腔镜手术治疗胃癌的前瞻性文献,并利用改良MINORS评分筛选高质量文献,评价指标包括手术时间、失血量、住院时间、并发症、淋巴结数目、切缘情况。结果 共纳入13篇前瞻性文献,共纳入病例5 378例（腹腔镜组3 813例,机器人组共1 565例）,样本量范围为27～1 297例,两组患者手术并发症发生率差异无统计学意义（OR=1.08,95%CI：0.88～1.32,P>0.05）,术后肠梗阻、切口感染、吻合口瘘的发生率及术后30 d内病死率差异无统计学意义（P>0.05）。腹腔镜组手术时间优于机器人组,差异有统计学意义（MD=-41.03,95%CI：-53.75～-28.31,P<0.05）,机器人组的术中失血量却少于传统腹腔镜组,差异有统计学意义（MD=25.22,95%CI：8.28～42.15,P<0.05）,腹腔镜组所获取的淋巴结数目少于机器人组,差异有统计学意义（MD=-2.20,95%CI：-3.26～-1.15,P<0.05）。而在近端切缘及远端切缘方面,两组差异无统计学意义（P>0.05）。结论 机器人手术与腹腔镜手术均能够达到胃癌根治的效果,腹腔镜手术在手术时间方面优势明显,而机器人胃癌手术在术中失血量、淋巴结的清除数目方面取得了更好的效果。