硅胶假体隆乳术后多器官并发症1例报告

乳房假体置入后主要有假体移位、假体破裂或渗漏、纤维包膜挛缩等远期不良反应。我科收治1例硅胶假体隆乳术后并发胸腔、心包腔等多体腔积液、混合性结缔组织病及乳房皮肤破溃等多器官并发症患者,现报道如下。     

奥美定隆乳注射患者术后取出的手术方式分析

探讨奥美定隆乳注射患者术后取出的手术方式。对我科收治的奥美定注射患者,根据其临床表现、B超和MRI检查分成包膜硬结型、散在团块型、液态游走型及混合型,对不同类型的患者采取不同的手术方式。比较其愈合时间、术后并发症及复发情况。乳腔镜手术在伤口愈合时间上显著短于乳晕切口包块取出术。液态游走型或混合型患者行乳腔镜下包块取出术,术后伤口感染、疾病复发率显著高于乳腺切除组。包膜硬结型、散在团块型可行乳腔镜包块取出术、乳晕切口包块取出术或乳腺部分切除术,以尽量保留乳腺的完整,液态游走型或混合型应行乳腺全切术以彻底根治。     

负压外引流治疗假性胰腺囊肿3例体会

我院1980——1991年间收治假性胰腺囊肿3例,均用较简便的负压外引流术治疗,3周内彻底治愈,出院随访1～11年,效果满意无复发,现将方法介绍如下:经 B 超定位后,取最靠近囊肿壁处做皮肤切口。开腹后分离粘连达囊肿壁,切开囊壁,尽量将囊腔内腐败组织取出,打通囊腔中间隔或狭窄处,特别要注意寻找那些隐藏较深的腔隙,务必将其打通,用手指扩大各个间隙和洞口,使刮匙和海棉钳     

几丁糖预防硅凝胶假体隆乳术后包膜挛缩的临床观察

目的观察几丁糖对预防硅凝胶假体隆乳术后包膜挛缩的临床效果。方法采用经腋路切口或乳晕切口,在胸大肌后剥离腔穴,实验组44例(88侧乳房),于术中植入假体后在乳房假体植入的腔穴内注入医用几丁糖15mL,并按摩均匀;对照组48例(96侧乳房),除未使用几丁糖外,其他处理措施均与实验组相同。结果术后假体包膜挛缩阳性率对照组为8%,实验组为19.8%,两组间差异具有统计学意义(P<0.05)。结论几丁糖对预防硅凝胶假体隆乳术后的包膜挛缩有一定的作用。     

甲钴胺百会穴注射对50例腔隙性脑梗死的疗效观察

目的观察甲钴胺百会穴注射法治疗腔隙性脑梗死的疗效和安全性。方法将100例腔隙性脑梗死患者随机分为治疗组和对照组,治疗组50例患者用丹参注射液30mL加入生理盐水(糖尿病患者)或5%葡萄糖液(无葡萄糖使用禁忌者)200mL静脉滴注,1次/天,加用甲钴胺百会穴注射:0.5mg/次,1次/天;对照组50例患者用丹参注射液30mL加入生理盐水(糖尿病患者)或5%葡萄糖液(无葡萄糖使用禁忌者)200mL静脉滴注,1次/天。两组疗程均为15d。观察临床症状改善程度和副作用。结果加用甲钴胺百会穴注射组治疗腔隙性脑梗死总有效率达96%,明显高于对照组(78%),两组经统计学检验有显著性差异(P<0.05)。结论甲钴胺百会穴注射法是治疗腔隙性脑梗死的有效方法之一。     

聚丙烯酰胺水凝胶取出后重新行假体置入隆乳术30例临床分析

聚丙烯酰胺水凝胶（polyaerylmaidehydroger，PAHG）作为一种医用软组织填充材料，自1997年引人我国以来，广泛应用于注射隆乳。单体的丙烯酰胺具有神经毒性，注射用PAHG产品中的残留丙烯酰胺的安全性问题始终是人们关注的焦点。实际应用中也发现，由于操作不规范等原因，注射隆乳后可有PAHG异位、包膜增厚、畸形及疼痛等并发症。2005—03—2008—10我们接诊了30例曾实施了PAHG注射隆乳的妇女，经手术切开取出注射物，同时实施乳房假体置人隆乳术，取得了满意效果，现报告如下。     

囊腔内高压注入肿胀液负压抽出聚丙烯酰胺水凝胶

目的探索一种无痛、安全、有效、简便的注射式隆胸后聚丙烯酰胺水凝胶(PAHG)清除法。方法接受PAHG注射丰胸患者41例82侧,在局部浸润麻醉的同时,用高压注射泵将肿胀液注入PAHG分布的囊腔后,再进行负压抽吸,反复冲洗。术后加压包扎,并常规使用抗生素。随访3～24月。结果41例手术均得以顺利完成,注射物能完全或基本完全抽出,随访期内未见并发症发生。结论囊腔内高压注入肿胀液后用负压抽吸PAHG的方法镇痛效果好,安全有效,方法简便,值得推广。     

胃镜下经假体取上消化道异物26例

目的采用胃镜下经假体取上消化道异物，以避免操作过程中对咽食管的损伤，提高异物取出的成功率，避免手术。方法2002年6月～2004年12月的26例吞服异物或食道吞钡检查确诊为上消化道异物、适宜作胃镜检查的病人，均先作上消化道造影检查，了解异物所在部位、大小、形态。将假体放入门齿至食管上段，然后经假体放人胃镜。胃镜达到食管后缓缓寻腔进镜，根据异物形状、大小分别选用适当器械，操作所用时间约20min左右。结果26例上消化道异物经此种方法均顺利取出，无明显咽部及食道损伤，成功率100％。结论采用胃镜下经假体取上消化道异物，对凡是吞人的异物，有内镜检查适应征的病人均可通过假体取出。     

膨体聚四氟乙烯假体在隆鼻术中的体会

目的：介绍膨体聚四氟乙烯（ePTFE）行隆鼻术的临床体会。方法：于鼻小柱设计＂V＂形切口,分离后掀起鼻小柱皮瓣,用特制的剥离器沿鼻骨于鼻背筋膜下分离腔隙,用蚊式钳在鼻小柱贴鼻翼软骨内侧前面向下分离至鼻前棘。将雕刻好的膨体聚四氟乙烯假体用假体置入钳置入。结果：本组62例患者,1例患者术后因局部碰伤出现鼻背歪斜,行二次手术,术后满意。3例患者术后发现鼻背部有轻度不对称,经手法按压得到矫正。其他58例患者术后均较满意。结论：ePTFE作为隆鼻材料,术后不易发生移位,弧度自然,不透光,不随冷热温度变化,稳定性佳而且术后肿胀程度轻,恢复期短,是比较理想的鼻整形材料。     

腔隙性脑梗塞85例临床分析

腔隙性脑梗塞或腔隙性卒中,是发生于脑深部穿动脉闭塞所致的脑缺血性软化,最终形成豌豆或粟粒大小的腔隙。国内外已有报导。本文将我院1983～1986年经临床和CT证实的腔隙性梗塞85例作一分析及文献讨论。临床资料 1.一般资料     

高龄乳腺癌患者保乳术4例

目的探讨乳腺癌保乳术在高龄患者中的应用效果。方法对4例高龄乳腺癌患者进行保乳手术。结果全组患者均保乳成功,疗效确切,美容效果优良,患者及家属满意,随访2年无转移复发。结论高龄患者实行保乳术,既减少了手术创伤,降低手术风险,又满足高龄患者生理及生活社会需求。     

Long term health effects of breast augmentation: A review

In this paper we have reviewed the existing scientific evidence with regard to long term health effects of breast implants. Two areas of concern have been voiced in the literature. Firstly the fear of an increased risk of cancer, specifically breast cancer, after cosmetic augmentation and secondly the potential relationship with the development of connective tissue disorders. In regard to the potential increased risk of breast cancer we conclude that no scientific evidence exists for a cause-effect relationship between silicone-gel filled implants and breast cancer. In fact all epidemiologic studies have found lower than expected risk estimates. Although some early studies have suggested that the presence of implants cause a delay in diagnosis and thus lead to a worse survival and prognosis, the evidence for this is unconvincing. In the large scale cohort studies no detrimental effect on survival was found. Data on the possible risk difference for other cancers are too scarce to permit a firm conclusion. With respect to connective tissue disorders, we conclude that the epidemiologic studies reported to date do not support a cause-effect relationship between silicone implants and connective tissue disorders. Some circumstantial evidence, such as the presence of autoimmune phenomena, granuloma formation and a distinct HLA phenotype in women with dermatomyositis after implantation, is available indicating that a plausible biologic mechanism could exist. Overall, however, the evidence does not permit the conclusion that silicone-gel filled implants cause connective tissue disorders.     

乳晕入路注射自体脂肪隆乳的治疗体会

目的探讨提高自体脂肪注射隆乳成活率和减少并发症的方法。方法用肿胀法抽吸自体脂肪经过冲洗纯化,采用乳晕入路注射至胸大肌后间隙、胸大肌内、乳腺后间隙和皮下组织层。结果本组患者32例,术后随访6个月~1年,患者乳房均有明显增大,效果理想。无1例出现感染、液化、钙化等并发症。结论采用乳晕入路注射更易塑形,减少并发症的发生。     

肋间神经阻滞麻醉下隆乳术与乳房神经支配的解剖学研究

在肋间神经阻滞麻醉下行乳房假体植入隆乳术具有操作简便,管理简单,手术中患者痛苦小的特点,我们对乳房的支配神经（主要是肋间神经外侧皮支前支）进行了解剖学研究并在临床开展了108例肋间神经阻滞麻醉下隆乳术,本文对乳房的神经支配,肋间神经阻滞麻醉下隆乳术的优点,镇痛原理和注意事项等问题进行了讨论。     

中西医结合治疗隆乳术后并发症的临床应用

目的探讨中西医结合治疗隆乳术后并发症的临床疗效。方法选择在本院就诊的隆乳术后并发症的患者32例,随机分成观察组和对照组两组,对照组患者直接手术;观察组患者口服云南白药0.5g/次,3次/d,3d后进行手术。结果观察组术后总失血量明显少于对照组,具有显著差异（P〈0.01）。结论采用中西医结合治疗隆乳术后并发症疗效佳,建议临床进一步推广。     

聚丙烯酰胺水凝胶注射隆乳术后并发症及临床处理现状

目的 简介医用聚丙烯酰胺水凝胶注射隆乳术后出现各种并发症的种类以及临床处理措施。方法 通过检索医药学有关聚丙烯酰胺水凝胶注射隆乳术的文献资料，对注射隆乳术后患者出现的并发症类型、并发症的处理方法进行综述。结果 注射隆乳患者术后出现并发症种类繁多，以硬结、疼痛、感染、破渍等发生率最高，常常数种并发症共存；有些并发症是由于不恰当的处理所致。临床处理方法以手术取出、病变组织切除较为彻底。结论 聚丙烯酰胺水凝胶注射隆乳术后可以出现多种并发症，并且不能从体内彻底清除，有些并发症是由不恰当处理方法所致。笔者反对聚丙烯酰胺水凝胶体内注射，建议规范处理方法，避免给患者造成更大的创伤，同时对聚丙烯酰胺水凝胶注射体内后对机体健康（包括生理及心理）的影响及注射入人体后的远期变化进行系统研究。     

聚丙烯酰胺注射隆胸患者的聚丙烯酰胺清除及同期置入假体的可行性研究

目的探讨聚丙烯酰胺注射隆胸患者的聚丙烯酰胺清除及同期置入假体的可行性。方法 24例聚丙烯酰胺注射隆胸患者,均来自于2007年1月～2011年6月,在全麻下以乳晕下切口进行手术,将乳房内聚丙烯酰胺负压吸引干净,并且盐水反复多次冲洗,聚丙烯酰胺清除干净后同时植入硅胶假体。结果 （1）术中情况：18例患者聚丙烯囊腔为单囊腔,6例患者聚丙烯囊腔为多个,硅胶假体从肌下间隙置入者20例,胸大肌下间隙置入4例。（2）术后情况：术后均引流出少量血性分泌物,引流管拔除时间术后24h之内者17例,48h之内者7例。24例患者伤口均完全一期愈合,2例患者术后彩超复查发现存在少量聚丙烯酰胺残留。（3）随访情况：最短3个月,最长1年,其中随访1年者18例。1例患者在术后3个月时出现轻微乳房针刺样疼痛,1例患者触觉不佳。22例整体效果满意。结论聚丙烯酰胺清除的同期置入硅胶假体,效果较好,方法是安全可行的。     

Fenfluramine augmentation in tricyclic-refractory depression

The clinical efficacy of lithium augmentation in refractory depression is hypothesized to depend on the ability of lithium to enhance presynaptic 5-hydroxytryptamine (5-HT) function. Since fenfluramine promotes release and inhibits reuptake of presynaptic 5-HT, we assessed its efficacy in augmenting ongoing tricyclic antidepressant treatment of refractory depression. Fifteen patients with DSM-III major depression failed to respond to treatment with desipramine 2.5 mg/kg/day or more (plasma levels of at least 125 ng/ml) given for at least 4 weeks. Fenfluramine 40-120 mg/day was then added to the ongoing desipramine in a placebo substitution design. There was no statistically significant evidence of either transient or sustained clinical improvement during the 2 weeks of fenfluramine augmentation. One patient appeared to respond to the treatment, but one appeared to worsen. Fenfluramine more than doubled steady-state plasma levels of desipramine. These findings suggest that lithium's efficacy as an augmenting agent depends on properties that are not shared by fenfluramine. Fenfluramine cannot be recommended in the routine management of refractory depression.     

Lamotrigine augmentation in unipolar depression

A significant number of patients with unipolar depression fail to achieve remission after one or a series of antidepressants. We present the results of a retrospective chart review of the efficacy and tolerability of lamotrigine as an augmentation drug in treatment-resistant unipolar depression. A previous absence of a response was defined as the clinically significant presence of depressive symptomatology after 6 weeks of treatment with an antidepressant, with at least 3 weeks at the maximum dose tolerated by the patient. The patients were rated retrospectively using the Clinical Global Impression rating scale. Seventy-six percent of the patients improved. Gender, age, basal severity of the episode and degree of previous non response were not statistically significantly associated with response to lamotrigine augmentation. Comorbidity showed a tendency to be negatively related with response to lamotrigine. Three patients abandoned the treatment with lamotrigine due to side-effects. Complaints were excessive somnolence, headache, dizziness, nausea and malaise. Data suggest that lamotrigine is a promising drug for treatment-refractory unipolar depression. Double-blind studies are necessary to confirm its use as an augmentation agent.