新鲜羊膜移植治疗严重角膜溃疡临床观察

目的 探讨羊膜移植及羊膜联合板层角膜移植治疗严重角膜溃疡的可行性并进行疗效分析.方法 对25例(25眼)浸润<2/3基质厚度的角膜溃疡行多层羊膜移植治疗;对10例(10眼)溃疡深度达2/3角膜厚度甚至达后弹力层或伴溃疡穿孔者行单层羊膜联合板层角膜移植治疗.结果 术后角膜溃疡愈合34眼,有效率97.1%,28眼视力不同程度提高.结论 羊膜移植及羊膜联合板层角膜移植治疗严重角膜溃疡并发症少,疗效确切,具有较高的安全性.     

临时结膜瓣治疗真菌性角膜溃疡的临床效果

目的 探讨临时结膜瓣治疗真菌性角膜溃疡的临床效果.方法 采用临时结膜瓣植入的方法 治疗真菌性角膜溃疡51例(51眼),术后随访6个月.结果 本组51例,49例治愈,2例治疗失败,治愈率为96.08%.平均治愈时间(14.10±4.81)d.角膜新生血管形成2例(4.08%).术后裸眼视力≥0.3者19例(37.25%),0.02～0.1者21例,2例治疗失败,视力永久丧失,其余视力有不同程度提高.结论 临时结膜瓣能促进真菌性角膜溃疡愈合,并且角膜新生血管形成少,但对晚期病例疗效不理想.     

不同术式羊膜移植治疗翼状胬肉的临床效果探讨

目的探讨不同术式羊膜移植治疗翼状胬肉的临床效果。方法收集2016-02～2017-03该院收治的150例150眼翼状胬肉患者资料,随机分为观察组和对照组,各75例(眼)。观察组的手术方式为翼状胬肉切除+新羊膜移植术,对照组的手术方式为翼状胬肉切除+常规羊膜移植术。观察两组患者术后临床治疗效果及术后复发情况。结果两组患者术后未复发患者在术后10 d角膜上皮完全愈合,结膜切口愈合良好。经1年随访,观察组和对照组的治愈率分别为94. 7%、70. 7%,复发率分别为6. 7%、13. 3%。两组间比较差异有统计学意义(P 0. 05)。结论采用羊膜移植法治疗翼状胬肉,可保护患者自身结膜完整性、减少损伤、有效提高手术成功率,其中新羊膜移植术操作简便,可推广应用。     

翼状胬肉切除加结膜瓣转移治疗翼状胬肉疗效观察

目的 探讨翼状胬肉切除加结膜瓣转移对翼状胬肉的治疗效果.方法 对230例(275只眼)翼状胬肉患者行翼状胬肉切除加结膜瓣转移手术,并观察疗效.结果 本组手术顺利,随访6～36个月,275只手术眼中6只眼复发,复发率为2.1％.移植部结膜瓣裂开4只眼,给予重新缝合,延长至10 d拆线,均痊愈;术毕术眼疼痛203例,11例疼痛难忍,予0.5％丁卡因滴术眼后,疼痛缓解1～2h,之后疼痛可耐受,2～3d后疼痛消失.结论 翼状胬肉切除加结膜瓣转移治疗翼状胬肉效果好,复发率低.     

羊膜移植治疗眼表疾病36例

目的观察羊膜移植治疗眼表疾病的疗效。方法采用羊膜移植治疗原发、复发性翼状胬肉,角结膜酸、碱、热烧伤,睑球粘连患者36例42眼。结果手术均获成功。术后未发生排斥反应。翼状胬肉未复发。睑球粘连者眼球的运动功能恢复。角结膜烧伤者均痊愈。除睑球粘连患者外,其余患者术后视力不同程度提高。结论羊膜移植治疗眼表疾病可恢复患者的眼表结构及功能,明显改善患者视力。     

结膜瓣覆盖术治疗难治性角膜溃疡58例报告

2004年12月-2006年12月，我们对58例难治性角膜溃疡患者，采用了传统的结膜瓣覆盖术进行治疗，效果满意。现报告如下。     

结膜遮盖联合羊膜移植治疗角膜穿孔19例

角膜穿孔是多种感染性和非感染性角膜破坏性病变的最终结果,如果处理不当,将会造成严重后果。2007年8月～2010年4月,我们采用结膜遮盖联合多层羊膜移植的方法治疗角膜穿孔19例,效果良好。现报告如下。     

羊膜移植治疗早期严重眼烧伤的观察与护理

目的探讨基层医院羊膜移植治疗早期严重眼烧伤的可行性并对护理效果进行评价。方法选择严重眼烧伤的患者80例（102眼）,随机分为治疗组40例,对照组40例,治疗组给予新鲜羊膜治疗,对照组给予常规治疗,术后随访1年,比较患者视力的提高和术后主要并发症的发生情况。结果所有患者术后刺激症状减轻．52眼视力较术前有提高,9眼视力无变化。无角膜穿孔及眼球萎缩严重并发症发生。两组患者出院时视力间差异有统计学意义（P〈0．05）。各并发症发生率间差异有统计学意义（P〈0．05）。结论新鲜羊膜移植术可用于重建早期严重眼烧伤后眼表微环境,减少眼烧伤后的严重并发症。     

局部双蒂肌瓣移植联合VSD治疗胫骨中段骨外露12例疗效观察

目的观察局部双蒂肌瓣移植联合负压封闭引流术(VSD)治疗胫骨中段骨外露的效果。方法对12例胫骨中段骨折骨外露患者行局部双蒂肌瓣移植联合VSD治疗,据创面大小及形状选择合适的医用海绵并裁剪,覆盖于创面后采用连续缝合将海绵边缘与创面边缘皮肤缝合固定。将生物透性薄膜粘贴密闭整个创面并用系膜法密封引流管。术后接床头中心负压装置,持续40～60 kPa负压吸引。7～10 d后拆除引流管,创面肉芽生长良好行中厚皮片或全厚皮片植皮,肉芽生长欠佳予外科换药或清创,二次行VSD治疗并待创面肉芽新鲜后植皮。植皮7～8 d后拆除加压敷料。结果 1例因分泌物较多行二次VSD治疗,12例创面肌瓣血运好,植皮均成活。随访3～8个月,无骨外露及感染复发;患者植皮后均获得保护性皮肤感觉。踝关节功能最差者跖屈30°,背屈0°,最佳者与健侧无明显差别。结论局部双蒂肌瓣移植联合VSD治疗胫骨中段骨外露操作简单,效果确切。     

结膜新月形切除联合巩膜固定术治疗中重度结膜松弛症的疗效观察

目的：观察结膜新月形切除联合巩膜固定术治疗中重度结膜松弛症的临床疗效。方法采取结膜新月形切除联合巩膜固定术对27例（41眼）中重度的结膜松弛症患者进行治疗,术后随访1年。结果术后37眼裂隙灯下检查松弛的球结膜完全消除,结膜褶皱消失,结膜切口愈合良好,有效率为90.24％。结论结膜新月形切除联合巩膜固定术是治疗中重度结膜松弛症的安全可靠、疗效满意的方法。     

Modified gunderson conjunctival flap combined with an oral mucosal graft to treat an intractable corneal lysis after chemical burn: a case report

Following a severe chemical injury, persistent corneal melting presents as a threatening condition for loss of vision or the eyeball itself. Keratoplasty (both lamellar and penetrating) and amniotic membrane transplantation have been the usual modes of therapy. However, these may not halt the persistent melting process. We introduce here an alternative surgical procedure to resolve corneal melting and preserve the globe. This case concerns the right eye of a 36-year-old male who had suffered from severe ocular alkali chemical burns and sustained intractable corneal melting, despite receiving corneal transplants three times, a limbal stem cell transplantation once, a scleral graft twice, and amniotic membrane transplantation eight times. To circumvent the impending perforation, we performed a modified Gunderson conjunctival flap combined with an oral mucosal graft. The corneal melting was halted, and the eyeball was preserved. The combination of an oral mucosal graft to the modified Gunderson conjunctival flap provided an easy alternative to resolve a case of intractable corneal melting and impending perforation.     

Tentative surgical repair of leaking filtering bleb with amniotic membrane transplantation--a case report

To repair a traumatic leaking cystic bleb in a 50-year-old male patient who had received multiple glaucoma filtering surgeries with the application of mitomycin-C, an amniotic membrane covered over the leaking bleb and sutured it to the adjacent conjunctiva with 10-0 nylon was done. The anterior chamber gradually formed after the amniotic membrane transplantation (AMT) and intraocular pressure returned to the level before trauma. Three weeks after the operation, the amniotic membrane was removed. No more leakage from the bleb was observed during four months follow-up. However, another bleb revision surgery was performed later to repair recurrent bleb leakage. Although conjunctival advancement or free conjunctival autograft have been reported to repair leaking bleb successfully, the simple primary method of using AMT is still encouraged in repair of a ruptured bleb with tentative maintenance of adequate filtration.     

Less than half of patients aged 65 years or under with myeloma proceed to transplantation: results of a two region population-based survey

In this population-based survey covering two geographically distinct UK regions, we evaluated the number of myeloma patients aged < or =65 years who have not undergone transplantation. The combined data from both of these regions showed that 57% of age-eligible patients were not transplanted. While early death and comorbidity accounted for nearly half of the non-transplanted patients, we examined the other reasons for non-transplantation within each region, assessed regional variations in reasons for non-transplant and looked at possible strategies aimed at increasing the transplantation rate.     

Covering the colon anastomoses with amniotic membrane prevents the negative effects of early intraperitoneal 5-FU administration on anastomotic healing

Purpose  

This study investigated whether covering the colonic anastomoses with amniotic membrane (AM) protects the anastomotic healing from the adverse effects of immediate 5-fluorouracil (5-FU) administration.     

Effects of amniotic membrane on the healing of normal and high-risk colonic anastomoses in rats

Bacground  This study was aimed at examining whether or not the addition of amniotic membrane to a sutured colonic anastomosis improves its healing. Material and methods  Ninety female Sprague Dawley rats were used in the study. Ten served as controls for bursting pressure measurement, while the other 80 animals were divided into four groups: Anastomosis group (NA), high-risk anastomosis group (HRA), anastomosis plus amniotic membrane group (NA-AM), and high-risk anastomosis plus amniotic membrane group (HRA-AM). The last two groups had amniotic membrane covering their anastomoses. Anastomotic evaluation was carried out on the third (NA3, HRA3, NA-AM3, and HRA-AM3, respectively) and seventh (NA7, HRA7, NA-AM7, and HRA-AM7, respectively) postoperative days. The main outcome measures were gross anastomotic healing, adhesion formation, mechanical strength, hydroxyproine content, and parameters of histopathological healing. Results  Anastomotic dehiscence rate was 66.7%, 40%, 20%, and 10% in group HRA7, HRA3, NA7, and NA3, respectively. However, there was no significant difference between groups regarding the dehiscence rate. The adhesion scores were significantly higher in groups NA3 and HRA3 compared with groups NA-AM3 and HRA-AM3, respectively (p < 0.05, p < 0.001). Bursting pressure was significantly higher in groups with amniotic membrane compared without amniotic membrane (p < 0.05, for all comparison). Inflammatory cell infiltration was significantly lower in groups with amniotic membrane compared with groups without amniotic membrane (p < 0.05, for all both comparisons). Neoangiogenesis was significantly higher in the NA-AM3 and HRA-AM3 groups compared with the NA3 (p < 0.01) and HRA3 (p < 0.05) groups, respectively. Fibroblast activity was significantly higher in groups NA-AM3 and NA-AM7 compared with groups NA3 (p < 0.05) and NA7 (p < 0.05), respectively. Collagen deposition and hydroxyproline concentrations were significantly higher in groups with amniotic membrane compared with groups without amniotic membrane (p < 0.05, for all both comparisons). Conclusion  The covering of both normal and high-risk colonic anastomoses with amniotic membrane provides a beneficial effect over conventional suturing of healing. This study was presented as an oral presentation in the 18th World Congress of the International Association of Surgeons, Gastroenterologists, and Oncologists.     

羊膜上皮细胞移植治疗帕金森病大鼠的实验研究

目的 探讨羊膜上皮细胞纹状体内移植对帕金森病（PD）大鼠的治疗作用。方法 采用RT-PCR方法检测入羊膜上皮细胞株FL表达脑源性神经营养因子（BDNF）、神经营养因子-3（NT-3）mRNA;Hoechest33342标记后微移植方法将其移入PD大鼠模型纹状体内，免疫荧光技术检测移植细胞表达BDNF、NT-3状况。结果 羊膜上皮细胞能够表达BDNF、NT-3，植入纹状体内能够存活，并在第2周内明显改善PD大鼠的行为学症状。结论 羊膜上皮细胞可作为表达神经营养因子治疗PD的移植细胞。     

Effects of amniotic membrane on the healing of primary colonic anastomoses in the cecal ligation and puncture model of secondary peritonitis in rats

Purpose  We aimed to investigate the effects of amniotic membrane on primary colonic anastomoses in a rat peritonitis model. Materials and methods  Fifty female Sprague Dawley rats were used in the study. Bacterial peritonitis was induced in all rats by performing a cecal ligation and puncture. Ten rats served as controls for the bursting pressure measurement, while the other 40 animals were divided into two groups (the anastomosis group (P) or the amniotic membrane group (PA)), and all of them underwent colonic anastomosis. The latter group had amniotic membrane covering their anastomoses. Half of the PA and P groups were sacrificed on the third postoperative day (PA3, P3), and the other half on the seventh postoperative day (PA7, P7). Results  The bursting pressures were significantly higher in groups PA3 and PA7 compared with P3 (p < 0.01) and P7 (p < 0.05), respectively. Inflammatory cell infiltration and adhesion scores were significantly lower in groups PA3 and PA7 compared with groups P3 (p < 0.001, p < 0.01, respectively) and P7 (p < 0.001, p < 0.05, respectively). Neoangiogenesis, fibroblast activity, collagen deposition, and hydroxyproline concentrations were significantly higher in groups with amniotic membrane than in groups without amniotic membrane (p < 0.05, for all comparisons). Conclusion  This study showed that the covering of colonic anastomoses with amniotic membrane significantly prevented the delaying effect of intraperitoneal sepsis and provided a safer and stronger anastomosis than suture and that this was the case for both the early and late phases of anastomotic healing in the colon.     

Modified internal limiting membrane flap technique for large chronic macular hole: Two case reports

Rationale:Internal limiting membrane (ILM) peeling and gas tamponade are the standardized treatments for macular holes (MHs). However, the close rate is low, and postoperative vision is unsatisfactory in large, chronic MHs. Currently, various modifications of the ILM flap techniques are being gradually applied for large MHs in the hope of obtaining better postoperative effects. This study described 2 successful cases achieved by “Sandwich-type” modified ILM flap covering technique in patients with large, chronic MHs.Patient concerns:A 62-year-old woman presented with decreased vision and visual distortion of the left eye for 18 months. Optical coherence tomography (OCT) showed the absence of full-thickness neuroepithelial tissue in the central fovea, with a minimum MH diameter of 742 μm and a base diameter of 1630 μm. A 57-year-old man experienced decreased visual acuity for 8 months. OCT showed the absence of full-thickness neuroepithelial tissue in the central fovea, with a minimum MH diameter of 713 μm and a basal diameter of 939 μm.Diagnoses:Two patients were diagnosed with large, chronic MH based on the OCT results and duration of the hole.Interventions:The 2 patients were treated with the “sandwich-type” modified ILM flap covering technique.Outcomes:Large, chronic MH closure was observed using SD-OCT, and the BCVA improved. The patients were very satisfied with the postoperative results.Lessons:“Sandwich-type” modified ILM flap covering technique may be a safe, effective way for large, chronic MH.     

Reconstruction of the thumb interphalangeal joint from the second toe proximal interphalangeal joint combined with artificial dermis covering: A case report

Rationale:Thumb function is one of the most fundamental components of hand function, and a vast majority of hand functions are derived from thumb motion. Injury of the thumb interphalangeal joint has a tremendous impact on the function of the thumb, and damage to the thumb interphalangeal joint (IPJ) caused by trauma is usually accompanied by dislocation of the surrounding skin; therefore, it is particularly important to restore the thumb anatomy and skin coverage.Patient concerns:A 41-year-old woman presented with IPJ disfigurement accompanied by a local skin defect caused by machine compression of her right thumb. Restoring the appearance and function of the thumb is key to this operation.Diagnoses:Open fracture of the right thumb.Interventions:After detailed preoperative and radiographic evaluation, the appearance and function of the thumb were reconstructed by IPJ grafting and artificial dermis covering.Outcomes:At 4 months’ follow-up, the patient''s visual analogue score was 0, no complications (eg, osteomyelitis, osteolysis, osteoarthritis, and nonunion of the artificial dermis) were observed, and the range of motion of the thumb IPJ returned to 60% of that of the healthy side.Lessons:The innovative application of the second toe proximal IPJ flap combined with double-layer artificial dermis covering to reconstruct the thumb IPJ defect not only solves the problem of skin defects in the recipient area after transplantation in previous cases but also restores the beauty of the recipient area, making it easier for patients to accept this surgical program.     

Esophagectomy and combined lobectomy with a covering latissimus dorsi muscle flap for an esophagopulmonary fistula due to advanced esophageal cancer: report of two cases

We herein describe the successful surgical treatment of two cases of esophagopulmonary fistula (EPF) due to esophageal cancer. Case 1: A 76-year-old man was diagnosed by computed tomography (CT) with an EPF due to esophageal cancer. Initially, antibiotics were given and enteral nutrition was administered. After 12 days, an esophageal stent was implanted. After 20 days, esophagectomy combined with a right middle–lower lobectomy with a covering latissimus dorsi muscle flap (LDMF) was performed. Case 2: A 54-year-old man was given induction chemoradiotherapy (CRT) for advanced esophageal cancer. Forty days after CRT, the patient developed a fever and was diagnosed with an EPF due to esophageal cancer based on CT findings. An emergency esophagectomy combined with a right lower lobectomy with covering by a LDMF was performed. The LDMF was useful to prevent postoperative complications, such as bleeding due to vessel rupture or bronchial stump fistula.