经肝动脉灌注平阳霉素碘油乳剂对兔正常肝脏组织的影响

目的：探讨平阳霉素碘油乳剂（PLE）经肝动脉灌注对兔正常肝脏组织的影响。方法：14只4～5个月龄日本大耳白兔，体重（2.5±0.2）kg，按注入生理盐水或PLE的量分为假手术组、实验A组（低剂量组）和实验B组（高剂量组）。各组兔均开腹穿刺肝动脉，按分组剂量注入PLE。术后1，2，4，6周取病理切片，HE染色，光镜下观察肝脏组织学改变;免疫组织化学（免疫组化）染色标记血小板衍化生长因子B链（PDGF-B），并行图象分析。结果：A组HE染色肝细胞呈一过性水样变，变性在2周时最重，至6周已明显减轻。B组HE染色2周时肝细胞明显水样变，4周时可见汇管区纤维组织增生，6周时部分肝组织出现明显假小叶结构。免疫组化染色显示，PDGF-B在肝细胞胞膜及纤维间隔中有明显表达。结论：经肝动脉灌注PLE可导致正常肝脏组织产生不同程度的肝纤维化;PDGF-B参与了肝纤维化的病理过程。     

小鼠全肝缺血再灌注时肺泡巨噬细胞TLR2的激活与肺损伤的机制

目的：探讨肺泡巨噬细胞Toll样受体2（TLR2）的激活机制及其在肝脏缺血再灌注（HIR）中肺损伤的意义。方法：用野生型小鼠C3h/Heouj和TLR4缺失小鼠C3h/Hej建立HIR动物模型。于再灌注1，6，12h后经支气管肺泡灌洗液获取肺泡巨噬细胞，采用荧光定量PCR方法检测TLR2/4mRNA的表达。同时检测支气管肺泡灌洗液中内毒素及肿瘤坏死因子（TNF）的水平，肺组织湿干重比值，肺组织髓过氧化物酶的浓度，并进行肺组织学评分。结果：C3h/Heouj组HIR缺血再灌后各时点肺泡巨噬细胞TLR2/4mRNA表达升高，TLR2mRNA表达持续升高，TLR4mRNA6h达到最高值。同时C3h/Heouj组HIR后支气管肺泡灌洗液中TNF水平明显升高，肺损伤加重，肺组织湿干重比值持续升高，肺组织髓过氧化物酶持续增加(P<0.05)。C3h/Hej组HIR后TLR2mRNA表达仅轻度升高，且支气管肺泡灌洗液中TNF水平低于C3h/Heouj组(P<0.05)，肺损伤轻于C3h/Heouj组(P<0.05)。结论：HIR可致肺泡巨噬细胞表面TLR4的激活，可上调TLR2的表达，从而可加重HIR时的肺损伤。     

原位肝移植中受体血管异常时的肝动脉重建

摘要：目的 探讨原位肝移植中动脉异位重建的方法及效果。 方法 回顾性分析我院10年来的440例肝移植中36例因受体血管异常而行异位重建的方法及术后处理措施等。 结果 36例中行供肝动脉与受体肾下腹主动脉吻合20例，与肾上腹主动脉吻合10例，与胃左动脉吻合4例，与脾动脉吻合2例。5例围手术期死亡，但吻合口通畅，31例存活3个月至4年无血管相关并发症，仅1例术后2个月因胆道缺血坏死行再次肝移植。 结论 肝移植时受体肝动脉有病变或异常改变时，应将受体肾下或肾上腹主动脉、脾动脉、胃左动脉与供肝动脉进行异位重建，可取得满意效果。     

胆囊癌GBC-SD细胞经顺铂处理后的survivin表达及意义

目的: 探讨经顺铂（DDP）处理胆囊癌细胞后survivin表达及其与肿瘤细胞耐药之间的关系。 方法:采用MTT比色法测定胆囊癌细胞对4种化疗药物的敏感性。RT-PCR检测survivin mRNA的表达。Western blot检测survivin蛋白表达的变化。结果:GBC-SD细胞对化疗药物的敏感性从高到低依次为DDP>ADM>5-FU>MMC。化学药物处理后的第1天，3组胆囊癌细胞的survivin mRNA表达水平均降低;其中0.5μg/mL DDP＋GBC-SD组下降了10%，3μg /mL DDP＋GBC-SD组下降36%，6μg /mL DDP＋GBC-SD组下降了28%。第3天，0.5μg/mL DDP组和3μg/mL DDP组GBC-SD细胞的survivin mRNA表达与第1天比较，分别上升22%和64%，但6μg/mL DDP组仍持续降低，仅为第1天的66%。0.5μg/mL DDP组和3μg/mL DDP组作用3d后的GBC-SD细胞中survivin蛋白含量分别升高了15%和12%，而6μg/mL DDP组则下降了80%。 结论:低浓度的DDP即能诱导胆囊癌细胞内survivin的表达增加，这可能是胆囊癌细胞对化疗药物产生耐药性的因素之一。     

左侧结肠癌性梗阻一期切除吻合治疗:附58例报告

摘要：为探讨左侧结肠癌并急性肠梗阻理想的处理原则和方法,回顾分析58例左侧结肠癌并发急性肠梗阻行一期切除吻合术患者的临床资料。本组均成功手术，无手术死亡，术后除7例有切口不同程度液化感染外，无吻合口漏、腹腔感染等并发症，均痊愈出院。提示：对能耐受手术切除的左侧结肠癌并发梗阻，在必要的围手术期处理前提下，一期切除吻合是可行的。避免了横结肠造口、二期手术、癌肿扩散及并发症的发生。     

骨盆骨折合并盆腔血肿的髂内动脉介入栓塞治疗

笔者采用明胶海绵或不锈钢圈栓塞双侧髂内动脉治疗骨盆骨折合并盆腔血肿7例，其中6例患者术前处于休克前期或休克期，血压低，出血明显，栓塞成功后，出血停止，血压回升，栓塞后2d血压恢复正常基础水平。提示：双侧髂内动脉栓塞对治疗骨盆骨折合并盆腔血肿效果明显，是一种有效的治疗手段。     

经外膜缓释雷公藤内酯醇抑制自体移植静脉内膜增生

目的:探讨经外膜缓释雷公藤内酯醇（triptolide）对自体移植静脉内膜增生的抑制作用。方法:健康雄性新西兰大白兔24只，建立颈外静脉-颈总动脉移植模型。随机将动物等分为3组。空白组移植血管不给任何处理， F-127多聚凝胶对照组在移植血管外膜喷洒20 %F-127多聚凝胶0.5 mL，实验组在移植血管外膜喷洒携带雷公藤内酯醇300μg的F-127多聚凝胶0.5 mL。术后2周取标本。用组织形态学方法检测血管内膜增生程度，免疫组化检测标本中bcl-2和Fas的表达，TUNEL法检测标本中血管平滑肌细胞(VSMC)凋亡的水平。结果:静脉移植2周后，与空白组和F-127对照组比较，实验组血管内膜增生明显受抑制（P<0.05），bcl-2的表达［（18.2±8.4） %］显著减少，而Fas的表达［（21.4±8.9） %］显著增加，凋亡细胞［（28.4±7.6） %］也显著增加（P<0.05）。结论:经外膜缓释雷公藤内酯醇可有效抑制移植静脉内膜增生，这一作用可能系通过促进VSMC凋亡而实现的。     

股动脉假性动脉瘤外科治疗18例分析

回顾性分析股动脉假性动脉瘤18例的临床资料。1例因介入穿刺引起的股动脉假性动脉瘤行局部压迫治疗,15例行假性动脉瘤切除术,2例行股动脉结扎术。结果示1例股动脉结扎术患者术后出现肢体坏死，行膝上截肢后康复出院，另17例痊愈出院。提示对股动脉假性动脉瘤行动脉瘤切除、股动脉端端吻合可作为首选的手术方式。     

手法张力美容切口治疗乳腺纤维瘤的体会

目的:探索一种治疗彻底、创伤少、瘢癍痕小、费用低的乳腺纤维瘤治疗方法。方法:回顾近3年来465例采用手法张力美容切口治疗乳腺纤维瘤患者的临床资料。结果:465例手术均最大限度争取行乳晕或腋窝皱褶或乳腺下方皱褶切口。切口均甲级愈合，无明显瘢痕，双乳对称，外形功能无影响，站立时切口不明显。结论:手法张力美容切口治疗乳腺纤维瘤是一种适合大部分乳腺纤维瘤患者的手术方法，具有治疗彻底、创伤少、瘢痕小、费用低。     

胆道再手术原因分析：附828例报告

目的:分析导致再次胆道手术的原因，以期减少胆道再手术率。方法:总结1990—1999年间收治的再次胆道手术患者828例的临床资料，对胆道疾病再次手术的原因进行归类分析。结果:再手术的主要原因是结石复发或残留，占65.10%;结石合并Oddi括约肌狭窄占33.82%;单纯Oddi括约肌狭窄占9.54%;胆管损伤性狭窄和胆肠吻合口狭窄占10.39%;胆道系统肿瘤占6.52%。结论:胆道再手术的主要原因仍以结石复发或残留为主，其次为Oddi括约肌狭窄;损伤性胆管狭窄等与手术有关的因素不容忽视。减少胆道再次手术的关键在于初次手术的彻底性和手术方法的合理性。     

压力治疗联合点阵CO2激光治疗增生性瘢痕的疗效观察

目的观察压力治疗联合点阵CO₂激光治疗增生性瘢痕的临床疗效。方法回顾分析2018年1月至2020年6月收治的烧伤后增生性瘢痕患者74例。其中,对照组采用压力治疗(42例);观察组采用压力联合点阵CO₂激光治疗(32例)。治疗结束6个月后采用温哥华瘢痕量表(VSS)进行瘢痕评分,以视觉模拟评分法(VAS)进行瘢痕瘙痒及疼痛评分,并记录不良反应发生情况。结果观察组VSS评分显著高于对照组(P<0.05),且瘢痕的瘙痒及疼痛较对照组明显减轻,差异有统计学意义(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论压力治疗联合点阵CO₂激光是一种安全有效的治疗增生性瘢痕的方法。     

二氧化碳点阵激光美容用于皮肤病的临床价值观察

目的 分析二氧化碳点阵激光美容用于痤疮后瘢痕治疗的临床价值。方法 选择2019年9月-2022年 9月我院收治的痤疮后瘢痕患者100例,随机分为对照组和研究组,各50例。对照组予以常规药物治疗,研 究组予以二氧化碳点阵激光美容治疗,比较两组临床疗效、美观满意度及皮损计数。结果 研究组治疗总 有效率为98.00%,高于对照组的84.00%（P＜0.05）;研究组美观满意度高于对照组（P＜0.05）;研究组治 疗后各个皮损计数少于对照组（P ＜0.05）。结论 二氧化碳点阵激光美容对痤疮后瘢痕患者的治疗效果、 皮损状态、患者外貌美观度均有积极影响。     

Stimulation of the healing of aseptic wounds using laser irradiation

On the basis of experimental studies conducted on 535 albino Wistar rats and clinical observations over 125 patients, and from complex appraisal of morphological, biochemical, and tensiometric data the conclusion is drawn that optimal operative cutting of tissues is achieved by means of far infrared carbon dioxide laser beam with a wavelength of 10.6 microns. Comparison of these characteristics showed the strength of the postoperative scar to be much less in intraoperative tissue cutting with a steel scalpel or high-energy beam of an AIG laser with a wavelength of 1.06 microns. Low-intensity laser radiation increased the strength of the postoperative scar in the early periods in all groups. Tissue cutting with a high-energy carbon dioxide laser beam with a wavelength of 10.6 microns in combination with pre- and postoperative exposure of the zone of the incision to low-intensity 0.89 micron wavelength laser beam considerably increases the strength of the postoperative scar and is the method of choice in the treatment of aseptic wounds.     

Comparative gross and histological study of the effects of scalpel, electric knife, and carbon dioxide laser on skin and uterine incisions in dogs

This study concerns the gross histological effects of scalpel, electric knife, and carbon dioxide laser incisions on skin and uterine tissue in dogs. Tissue studies comparing the carbon dioxide laser with the scalpel and electric knife have frequented the literature. However, a gross and histological comparison specifically involving uterine tissue is not presently known to have been reported. The evaluation on this series of animals considers both the skin and the uterus in an abdominal approach to evaluate the carbon dioxide laser for potential intrauterine surgery. Tissue sampling of both skin and uterus at 2, 6, and 8 weeks postoperatively were histologically examined to evaluate healing rates and degree of scar formation.     

The short pulse carbon dioxide laser versus the colorado needle tip with electrocautery for upper and lower eyelid blepharoplasty

BACKGROUND/OBJECTIVE: Various techniques for blepharoplasty have been described, including those performed with the assistance of the short pulse carbon dioxide laser and those performed with the assistance of the Colorado microdissection needle attached to an electrocautery unit. Although the superiority of the carbon dioxide laser to cold steel has been demonstrated for the performance of eyelid blepharoplasty, no studies have ever compared the carbon dioxide laser to the Colorado needle. STUDY DESIGN/MATERIALS AND METHODS: This is a paired comparison study in which 12 healthy patients underwent bilateral blepharoplasty of their upper and/or lower eyelids by a single surgeon. For each patient, a short pulse carbon dioxide laser was used on one side, and a Colorado needle attached to an electrocautery unit was used on the other. Intraoperative times were recorded. At five post-operative visits patients were evaluated for post-operative healing parameters including edema, erythema, scar width, and bruising. Finally, excised tissue was assessed histologically for thermal damage. RESULTS: Comparing both techniques, no difference in patient or physician-measured parameters of healing were noted up to 1 month post-operatively. However, Colorado needle assisted blepharoplasty resulted in slightly shorter intraoperative times. It also resulted in less thermal damage on a histologic level, although these differences were not clinically significant. CONCLUSIONS: For the performance of blepharoplasty, the Colorado needle tip with electrocautery offers benefits equivalent to those of the short pulsed CO2 laser but has the advantage of shorter intraoperative times and lower cost.     

036 A New Method for Skin Abrasion Therapy using the Pulsed Carbon Dioxide Laser with Scanner

We have treated superficial skin lesions using pulsed carbon dioxide laser with scanner (NIDEK COL‐1040). We can choose the shape, size and power of irradiation programmed in the scanner. It makes the treatment more effective and uniform to combine the scanner mode with the pulse mode. However, for a lesion of complicated shape, it is difficult to avoid skin damage caused by multiple irradiations to a small area and/or irradiation to the normal skin. The result may be unsatisfactory with pigmentation or unsightly scar in such case. As the water‐solvability is a characteristic of the carbon dioxide laser beam, we used water film around the lesion to avoid unexpected irradiation to the normal skin. This method provided us better results.     

Early postoperative single treatment ablative fractional lasing of Mohs micrographic surgery facial scars: A split‐scar,evaluator‐blinded study

Background/Objectives

Despite precise surgical technique, some postoperative facial scars will depress and widen over time, likely due to weakened or inadequately replaced collagen fibers in the underlying dermis. The purpose of this study is to evaluate whether a 10,600 nm ablative carbon dioxide (CO₂) fractional laser used early in the post‐surgical setting results in improved postoperative facial scars after a single treatment session.

Study Design

A prospective randomized, comparative split‐scar study was conducted on 20 subjects between the ages of 20–90. Subjects underwent Mohs surgery for nonmelanoma skin cancer of the face. Subsequent to tumor removal, subjects with a linear scar of 4 cm or greater were enrolled. On the day of suture removal, all subjects had one‐half of their scar randomly selected and treated with a 10,600 nm CO₂ fractional laser (energy = 10 mJ; density = 10%; spot size = 7 mm; pulse = 1). The untreated scar half served as a control. Scars were re‐evaluated 12 weeks later. An independent blinded observer graded the scar halves with the Vancouver scar scale (VSS) immediately prior to treatment and 12 weeks after treatment. Subjects completed a visual analog scale (VAS) at the same time points.

Results

Three months after laser treatment, a significant decrease in VSS and 3 of the 4 of its individual parameters were detected in both control and treated halves of the scar. When comparing the laser group versus the control group, a statistically significant difference was not noted in VSS (P = 0.31) but a statistically significant difference in patient VAS was detected (P = 0.002). No side effects of the laser treatment were noted.

Conclusion

Facial wounds sutured in a layered manner heal well. Patients prefer early fractional CO₂ lasing of surgical scars, though use of the VSS failed to detect an objective difference between laser and control halves of scars. Conservative laser settings, a single session treatment, and VSS insensitivity for surgical scars may influence these findings. Lasers Surg. Med. 47:1–5, 2015. © 2015 Wiley Periodicals, Inc.     

Treatment of nasal ala nodular congenital melanocytic naevus with carbon dioxide laser and Q-switched Nd:YAG laser

Total excision of congenital melanocytic nevi (CMN) is not always feasible. We here present our experience of using carbon dioxide laser and Q-switched neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser to treat nodular CMN of the nasal ala. Q-switched Nd:YAG laser and/or carbon dioxide laser were used to treat eight cases of nasal ala nodular CMN. Carbon dioxide laser was utilized to ablate all visible melanocytic tissue within one session. Ablation was performed so as to reproduce the original anatomical contours as closely as possible. Recurrences were treated in the same way. Q-switched Nd:YAG laser was also used to irradiate all target lesions to achieve the desired end point within one session. The intervals between treatments were at least 8 weeks. Recurrence of melanocytic tissue, scar formation, pigmentation, depigmentation, and the degree of patient satisfaction were recorded at every visit. Two of the eight patients were treated with Q-switched Nd:YAG laser. Although, the lesion lightened in one of them, the hyperplastic tissue persisted. Eventually, these two patients, along with the remaining six patients, were successfully treated with a carbon dioxide laser. We recommend carbon dioxide laser treatment for nodular nasal CMN. This simple treatment does not involve skin flap transplantation and has good cosmetic outcomes. Although Q-switched Nd:YAG laser does lighten some nasal nodular CMNs, it does not eradicate the hyperplastic tissue, and is therefore not an effective treatment for nodular nasal CMN.     

节段设计原则在面部瘢痕外科治疗中的临床应用

目的 探讨节段设计原则在面部瘢痕治疗中的应用。方法 自2012年1月至2014年6月,对38例面部瘢痕患者,在修复面部瘢痕时,以面部张力线、组织器官活动分区,以及面部凹凸曲面为界,将瘢痕分解成多个节段瘢痕,对多节段瘢痕采用手术切除,常规美容外科技术分层减张缝合。于术后3~6个月手术切口愈合稳定后,将留存的节段间点状瘢痕行手术或点阵激光治疗。结果 术后随访1~3年,瘢痕质地、色泽较好,无明显瘢痕挛缩,无明显凹陷畸形。结论 针对面部线型瘢痕,根据面部皮肤张力线对其进行多节段分解,采用手术联合激光等综合手段,可以获得较好的美容效果。     

The use of the carbon dioxide laser in head and neck lymphangioma

The carbon dioxide laser has been used to treat various lesions of the head and neck, ranging from carcinomas to hemangiomas, and even including tatoos. A search of the literature does not reveal any reports of the carbon dioxide laser being used to treat lymphangioma. This report discusses the efficacy of treating lymphangioma of the air and food passages with the carbon dioxide laser, and presents three patients who have been treated in this fashion-two for palliation and one for cure.