自体耳软骨与膨体聚四氟乙烯在鼻整形中的应用分析

目的:分析自体耳软骨与膨体聚四氟乙烯在鼻整形中的应用效果。方法:以我院收治的65例行鼻整形的患者为研究对象,所有患者均行隆鼻术,术中采用自体耳软骨与膨体聚四氟乙烯填充材料,即采用鼻小柱蝶型切口联合双侧鼻翼缘切口做手术入路,取自体耳软骨,行自体耳软骨联合ePTFE加强型补片隆鼻术。结果:本组65例患者手术成功率100%,术后近期疗效均良好,鼻型自然美观,手感好。观察随访期间,本组共5例患者出现不良反应,不良反应发生率为7.69%。另外,本组1例(1.54%)患者出现假体下移,后行二次修复手术。结论:应用自体耳软骨与膨体聚四氟乙烯材料行鼻整形术的手术效果良好,提高手术操作水平能有效降低患者术后不良反应的发生率。     

自体鼻中隔软骨、耳软骨和头部真皮联合鼻成形术

目的 探讨采用自体鼻中隔软骨、耳软骨和头部真皮行联合鼻成形术的临床效果.方法 设计鼻小柱开放式切口,以自体鼻中隔软骨行鼻延长术,以自体耳软骨作鼻小柱支柱抬高鼻尖,同时以自体头部真皮植入抬高鼻背.结果 本组31例患者,术后随访3～24个月,1例术后1周出现鼻中隔积液,排出积液后痊愈.所有患者术后鼻部美学效果明显改善,形态自然,无排异反应.结论 自体鼻中隔软骨、耳软骨和头部真皮联合鼻成形术,是鼻尖、鼻背整形的有效手术方法.     

自体耳软骨在单侧唇裂继发鼻畸形整形中的应用

目的 探讨耳软骨在唇裂继发畸形整形中的应用,寻找一种合适的鼻翼软骨支架的替代材料.方法 切取一侧约1.5cm×1.5cm～2.0cm×1.5cm耳甲腔软骨,将耳软骨的一侧插入到鼻翼内侧脚之间,并与内侧脚固定,另一侧固定在鼻翼软骨上,使之成拱形的支架.结果 本组18例患者,均为单侧唇裂术后继发鼻畸形,全部采用耳软骨支撑患侧鼻翼,术后患侧鼻翼形状良好,接近正常鼻翼形状,患者满意度高.结论 耳软骨的弹性及韧性与鼻翼软骨接近,能形成较好的鼻翼支架,鼻翼塌陷基本得到矫正,是较为理想的鼻翼软骨的替代材料.     

自体耳软骨+鼻假体行短鼻延长鼻尖整形的影响

目的 评价在短鼻患者的延长鼻尖整形手术中鼻假体+自体耳软骨的应用效果。方法 选择西安美莱医学美容医院2017年4月-2020年3月短鼻延长鼻尖整形患者80例,采用随机数字表法分成A组和B组,各40例。A组使用鼻假体,B组使用鼻假体和自体耳软骨,比较两组手术成功率、切口愈合时间、满意度、并发症。结果 A组手术成功率、总满意度低于B组（P＜0.05）;A组切口愈合时间长于B组（P＜0.05）;A组并发症总发生率高于B组（P＜0.05）。结论 短鼻患者延长鼻尖整形术中应用自体耳软骨+鼻假体可提高手术成功率、缩短切口愈合时间、减少并发症发生,而且还会提高患者对于整形手术的满意度。     

自体耳软骨在单侧唇裂并发鼻畸形修复中的应用

唇裂术后继发鼻畸形,病因复杂,畸形较严重,修复难度大,而且很难达到预期的手术效果.近年来,我们应用自体耳软骨修复鼻畸形23例患者,解决了鼻畸形修复过程中的组织量不足和薄弱问题,效果满意.现报道如下.     

自体耳软骨移植79例鼻成形术的临床分析

目的探讨自体耳软骨移植鼻成形术的临床效果。方法针对外鼻短小，鼻尖低平、肥大钝圆。以及部分隆鼻术后效果不佳的国人，在隆鼻的同时切除鼻翼大软骨外侧脚的上外侧部，并水平褥式缝合，将鼻翼大软骨内侧脚缝合，以缩小鼻小柱宽度及延长鼻小柱；切取自体耳软骨，用以抬高及延长鼻尖。结果对本组79例求美者进行了3～18个月的随访，效果稳定，无并发症及继发畸形的发生。结论自体耳软骨移植鼻成形术其方法较好，效果明显，值得在临床上推广应用。     

自体耳软骨鼻中隔前端延长板移植在短鼻矫正术中的应用

自2005年6月至2010年2月,我们采用自体耳软骨鼻中隔前端延长板移植并结合鼻翼软骨塑形等手术方法,矫正先天性和继发性外鼻过短、鼻尖上翘者78例,效果满意.现报道如下.     

用于鼻整形的耳软骨切取与精细雕刻技术

目的:研究适合鼻部整形的耳软骨切取和雕刻新技术。方法:选择580例鼻畸形患者,经耳后10~30mm切口采集耳软骨片。对软骨材料进行精细雕刻,制成不同类型的移植物用于鼻部整形,观察术后效果。结果:经耳后切口采集耳软骨全部获得成功。用精细雕制法完成5类共10个亚型的耳软骨移植物,厚度为1~5mm。1年后随访到270例,耳后皮肤切口均为无瘢痕愈合,鼻部皮下移植的耳软骨没有变形或明显吸收现象。结论:经耳后切口取软骨方便快捷,精细雕刻技术制备的多类型移植物能提高鼻整形效果。     

自体耳软骨移植79例鼻成形术的临床分析

目的探讨自体耳软骨移植鼻成形术的临床效果。方法针对外鼻短小,鼻尖低平、肥大钝圆,以及部分隆鼻术后效果不佳的国人,在隆鼻的同时切除鼻翼大软骨外侧脚的上外侧部,并水平褥式缝合,将鼻翼大软骨内侧脚缝合,以缩小鼻小柱宽度及延长鼻小柱;切取自体耳软骨,用以抬高及延长鼻尖。结果对本组79例求美者进行了3～18个月的随访,效果稳定,无并发症及继发畸形的发生。结论自体耳软骨移植鼻成形术其方法较好,效果明显,值得在临床上推广应用。     

“U”形耳廓软骨在鼻翼缺损修复中的应用

目的:观察应用"U"形耳廓软骨支架修复鼻翼软骨缺损的临床疗效,总结其优越性。方法:本组35例鼻翼缺损患者,采取单侧或双侧耳甲腔、耳屏间切迹和耳屏区域的"U"形耳廓软骨,将其游离移植修复鼻翼支架缺损,并对其疗效进行评估。结果:应用耳甲腔、耳屏间切迹和耳屏区域的"U"形耳廓软骨修复鼻翼缺损,效果良好、可靠,不易遗留供区缺损、畸形。结论:采取的耳甲腔、耳屏间切迹、耳屏区域的"U"形耳廓软骨的局部解剖形态与鼻翼软骨较为相似,应用其修复鼻翼缺损,手术效果可靠,疗效满意,值得推广。     

Systemic antitumor immune response following reconstruction using frozen autografts for total en bloc spondylectomy

Background contextTotal en bloc spondylectomy (TES) is a surgery designed to achieve complete resection of a malignant spinal tumor, such as spinal metastasis. Although this procedure decreases the rate of local recurrence, it is questionable whether local control prolongs a patient's survival. In cryosurgery, antitumor immunity is activated after percutaneous cryoablation of tumors. We applied this tumor-induced cryoimmunology to TES surgery and developed a “second-generation TES” that brings about TES enhancing antitumor immunity to prolong a patient's survival.PurposeTo present a second-generation TES applied tumor-induced cryoimmunology and assess the immunity-enhancing effect after implementing this surgery.Study designThis is a retrospective review of prospectively collected data.Patient sampleThe sample consisted of 65 consecutive patients who underwent second-generation TES.Outcome measuresInterferon gamma (IFN-γ) and interleukin-12 (IL-12) before surgery and at both 1 and 3 months after surgery was used to assess the immunity-enhancing effect.MethodsIn second-generation TES, instead of harvesting autograft from the ilium or fibula, the resected lamina and vertebral body from TES are frozen using liquid nitrogen and used as grafted bone for spinal reconstruction. In the most recent 33 of the 65 cases, in addition to the TES procedure, a small amount of the tumor tissue from the resected tumor-bearing vertebra was also placed into liquid nitrogen. This small amount of tumor tissue was then implanted subcutaneously on one side of the axilla at the end of the TES surgery. In 60 of 65 cases, measurement of IFN-γ and IL-12 was performed.ResultsIFN-γ increased after surgery in 45 (75%) of 60 cases. The mean IFN-γ relative concentrations at both 1 and 3 months after surgery, as compared with before surgery, were significantly higher (284%±596% and 275%±354%: p<.05). IL-12 increased after surgery in 44 (73.3%) of 60 cases. The mean IL-12 relative concentrations at both 1 and 3 months after surgery, as compared with before surgery, were significantly higher (277%±385% and 486%±1032%: p>.05 and p<.01) at 3 months. At final follow-up, 13 of the 65 patients died due to progression of metastases (mean 12.6 months after TES), 15 remained free from disease, and 36 patients were alive with disease.ConclusionsThe second-generation TES using frozen tumor-bearing autograft inside a cage affords three benefits: (1) no pain at the bone harvest site, (2) shortening of operation time, and (3) decrease of blood loss. Moreover, our results show that second-generation TES provides not only a local radical cure but also a systemic immunological enhancement.     

自体肋软骨在小耳再造中的应用体会

目的：探讨自体肋软骨在小耳再造中的应用体会.方法：采用自体肋软骨分期修复的方法治疗14例先天性小耳畸形.结果：14例患者对耳畸形修复后的耳廓外形感觉满意.结论：自体肋软骨由于取材于自身组织,无排斥反应、感染率低,易于塑形,术后效果良好.     

Successful transplantation of pediatric en bloc kidneys with bilateral double ureters

We report a case in which en bloc kidneys with bilateral double ureters from a 5-month-old donor were successfully transplanted into a 25-year-old recipient. No stents were used. There were no complications after the transplant. The patient remains well at more than 1.5 years post-transplantation with serum creatinine 1.2 mg/dl. Received: 27 April 1998 Accepted: 24 June 1998     

Long-term results of en bloc transplantation of pediatric kidneys into adults using a vicryl mesh envelope technique

En bloc transplantation of pediatric kidneys into adults is a suitable measure to help correct the shortage of available kidneys. This practice, however, is not widespread because of the high incidence of vascular complications. Our institution has previously described a vicryl mesh technique for en bloc kidneys, with an attempt to reduce the incidence of vascular complications. The purpose of this study was to evaluate the long-term results of recipients with en bloc kidneys stabilized with this technique. The charts of 644 adult renal transplants performed between July 1987 and July 1999 were reviewed. During this period, 14 adult patients have received 14 pairs of en bloc pediatric kidneys using the vicryl mesh technique. All patients received OKT3 as an induction immunosuppression with cyclosporine started 10-14 d after the transplant. The median donor age was 24 months (range 14-84 months), and the median recipient age was 49 yr (range 23-68 yr). The mean recipient weight was 79 kg (range 60-114 kg). The mean cold ischemia time was 14.2 hr. None of the patients developed vascular or urological complications. Delayed graft function and moderate acute rejection occurred in one patient each. At a mean follow-up of 51 months (range 7-96 months), all 14 patients maintained excellent renal function with a mean creatinine of 1.01 mg/dL. Renal measurements pre-operatively and at follow-up ultrasound examinations were available in 9 patients, and the mean length of the kidneys had grown approximately 5.0 cm. These data demonstrate that minimal vascular and immunological complication rates can be achieved with pediatric en bloc kidneys using the vicryl mesh envelope technique.     

全脊椎整块切除术--一种治疗原发性恶性脊柱肿瘤的新手术方法

[目的]介绍一种整体切除脊柱原发性恶性肿瘤并使肿瘤治愈成为可能的新手术技术“全脊椎整块切除术”。背景资料：传统切除脊柱原发性恶性肿瘤的方法,是从肿瘤病灶内分块进行逐步切除。而经组织病理学证实,手术切缘较宽或较窄的病灶外整块切除的报告却鲜为有之。[方法]全脊椎整块切除术是在前路椎间支撑器植入,后路脊柱器械固定的情况下进行整块椎板切除和整块椎体切除的新手术技术。有5例息有原发性恶性肿瘤的患者及2侧患有巨细胞瘤的患者施行了这种手术。除l例患者在术后7个月时因肿瘤转移到纵隔而死亡外,其余所有患者的观察期为2～6．5a。[结果]除1例病人之外的所有患者在手术之后均获得了满意的临床效果,并且没有严重的并发症发生。经组织学研究证实,除椎弓根外,均获得了较宽或较窄的手术边缘,但在病变影响到椎管和脊柱的后方时,则需采用病灶内切除的传统方式。1例死于肿瘤转移的患者,其死亡原因与手术没有直接的相关性,且肿瘤切除的部位也没有局部复发的迹象。[结论]全脊椎整块切除术的优势在于,它是将整个椎体分两次予以完全切除,也就是一次切除椎体的一半,这种技术远胜于分块逐步切除的模式,并且是一次性完成整个手术的全过程。“全脊椎整块切除术”为脊柱原发性恶性肿瘤的治疗提供了一个更具有挑战性的手术方法。     

应用双侧耳廓复合组织修复鼻翼缺损

探讨应用双侧耳廓复合组织修复较大鼻翼缺损的可行性及手术方法。沿鼻翼缺损的上方瘢痕缘作弧形切口，设计鼻翼内侧面衬里；于两侧耳廓中上部切取楔形全层复合组织瓣游离移植于受区，以修复缺损外侧面。结果：临床应用双侧耳廓复合组织修复较大鼻翼缺损６ 例，均取得了满意的效果。结论：这种手术方法是可行的；并为修复较大鼻翼缺损提供了简便、安全、可靠的方法。     

Modified total en bloc spondylectomy in thoracic vertebra tumour

Total en bloc spondylectomy (TES) for vertebral tumour was previously reported by Tomita through a single posterior approach using a T-saw. A modified total en bloc spondylectomy (MTES) technique is reported in the present study. The disc puncture needle with a sleeve was used to obliquely puncture from the posterior to the anterior direction. A T-saw was inserted through the sleeve and led out to the operator’s side by the leading clamp. The disc was partially cut with the saw from its medial to lateral aspect. After a spinal fixation rod was applied on the operator’s side, the residual discs on the opposite side were cut as described above. Six patients with thoracic vertebral tumours were operated on using the MTES technique. Five patients showed improvement in their neurological deficits postoperatively. There was no evidence of tumour recurrence at the final follow-up. The MTES is technically feasible with improved practicality and safety.     

3D打印全骶骨假体在全骶骨切除患者腰-髂稳定性重建中的应用

目的:评估3D打印全骶骨假体在全骶骨切除患者腰-髂稳定性重建中的应用价值。方法 :回顾性分析2015年1月～2018年12月于我中心接受全骶骨切除术的42例患者资料。根据重建方式将患者分为3组:假体重建组(14例)采用3D打印全骶骨假体重建,联合重建组(19例)采用包含前方椎体重建的联合重建方案,脊柱骨盆(SPF)重建组(9例)采用单纯SPF重建。比较三组患者的腰-髂稳定性(疼痛及运动功能评分)、内置物生存情况(内置物失败率及生存期)、手术安全性(手术时间、术中出血量及围手术期并发症发生率)。结果:术后平均随访时间为33.6±14.2个月。假体重建组手术平均耗时394.6±128.0min,术中出血量平均为3250.0±1711.4ml,共2例患者发生围手术期并发症。末次随访时,13例患者无需拐杖等辅助行走,12例患者无需使用止痛药。共4例患者发生影像学内置物失败,其中2例需行二次手术,1例因严重疼痛并伴有肿瘤复发接受二次手术,术中因假体与周围骨融合牢固而未取出假体;1例因严重疼痛及运动功能明显受损接受二次手术取出假体。假体重建组平均内置物生存期为49.3(95%CI 40.8～57....