多功能电离子手术联合曲安奈德治疗耳廓瘢痕疙瘩的临床疗效

<正>耳廓瘢痕疙瘩是一种纤维组织增生性疾病,以皮损处成纤维细胞大量增生,细胞基质内胶原、蛋白多糖、糖蛋白等物质过量沉积以及胶原纤维排列紊乱为主要病理改变。本院于2013年1月至2015年1月,对48例患者实施多功能电离子手术联合糖皮质激素曲安奈德治疗,取得了良好的效果,现作报道。1资料与方法1.1一般资料选取本院2013年1月至2015年1月收治的96例耳廓瘢痕疙瘩患者为研究对象,按照随机     

自体静脉再造神经室吻合周围神经36例分析

四肢损伤并发周围神经损伤临床常见,采用显微外科手术修复可使其术后优良率达９０％。但神经断端吻合处的瘢痕增生及组织粘连常影响神经再生的速度,干扰神经轴突顺利向前延伸。１９９４～１９９８年,我们将自体静脉移植包裹于神经吻合口处作为屏蔽纤维组织增生的材料,...     

右下肺硬化性血管瘤1例

患者男性,56岁,因“咳嗽、咳痰伴右侧胸部隐痛5天”入院。病程中患者无咯血、发热、盗汗等症状。查体无明显阳性体征。肺部CT平扫可见右下肺一类圆形软组织影,边缘光滑清晰,无毛刺,与胸膜有粘连,纵隔内未见淋巴结肿大。纤支镜提示左支气管黏膜充血,右下肺后段开口稍狭窄,黏膜增生,未见阻塞、新生物。CT引导下经皮肺活检,病理检查可见纤维组织增生,多边形上皮细胞呈乳头状及片状排列,间质血管增生并玻璃样变性,少量淋巴细胞、浆细胞以及泡沫状组织细胞浸润（见图1）,诊断肺硬化性血管瘤。患者拒绝外科手术治疗,随访一年病变无明显进展。     

硅酮凝胶喷雾剂局部喷涂对兔耳增生性瘢痕影响的实验研究

目的通过检测硅酮凝胶喷雾剂对兔耳瘢痕动物模型瘢痕纤维组织的影响,探讨硅酮凝胶喷雾剂对增生性瘢痕的作用及其可能机制。方法将8只新西兰大耳白兔随机分为空白对照组与硅酮凝胶喷雾剂组,并在每只兔耳腹侧面制作创面建立病理性瘢痕模型。于创口制备术后第28天始在瘢痕部位喷抹硅酮凝胶药物,于术后第56天处死动物,切除耳部瘢痕,HE染色检测瘢痕组织的增生指数(HI)及成纤维细胞数密度(NA),VG染色检测瘢痕组织胶原纤维面积密度(AA),同时采用免疫组织化学法检测Smad3表达水平。结果硅酮凝胶喷雾剂组(硅酮凝胶组)的成纤维细胞胞体变小,胶原纤维较稀疏,排列有序;HI、NA和AA均明显低于空白对照组(P均0.01);免疫组织化学法检测发现硅酮凝胶组瘢痕组织中Smad3蛋白的表达水平明显低于空白对照组(P0.01)。结论硅酮制剂可抑制Smad3的表达,抑制成纤维细胞增殖及胶原形成,避免过量纤维组织形成,进而抑制瘢痕增生。     

重复剖宫产手术720例分析

［摘要］　目的　总结重复剖宫产手术的经验，以减少手术损伤和手术并发症的发生。方法　回顾分析720例行重复剖宫产手术患者的术中情况、手术方法和手术结果。结果　术中发现重度粘连50例，无一例发生肠管、膀胱损伤；瘢痕愈合不良80例。12例胎盘部分粘连，附着于子宫原瘢痕部位，出血较多，经局部缝合等处理止血。1例胎盘广泛植入原瘢痕部位，出血凶猛，行子宫切除。完全性前置胎盘2例，经常规处理后仍出血较多，即行子宫切除。所有患者术后无严重并发症发生。结论　对于重复剖宫产重度粘连、切口愈合不良者采用剖宫产手术方法安全可行。     

32例Oddi括约肌功能障碍患者临床病理分析

目的提高对Oddi括约肌功能障碍的认识,探讨本病的临床病理特征,以提高对Oddi括约肌功能障碍诊治水平.方法对32例因上腹部疼痛无其他原因解释而行内镜下逆行胰胆管造影或内镜下乳头括约肌切开术患者进行了乳头黏膜组织的活检,对活检标本常规石蜡包埋,HE染色,显微镜下观察,记录其病理改变.同时记录经内镜逆行胰胆管造影（ERCP）下乳头黏膜的病理变化.结果内镜下乳头黏膜主要为充血水肿（90.6%）、糜烂（78.1%）、出血（56.2%）等.ERCP见胆总管扩张,合并十二指肠乳头旁憩室者占59.4%.病理组织学表现为乳头黏膜慢性炎症、急性炎症、腺体增生、黏膜下纤维组织增生等.结论Oddi括约肌功能障碍的病因和病理尚不清楚,其乳头组织的病理改变主要为炎性反应,炎症反应在Odd括约肌功能障碍的发病中具有重要的意义,这可能为诊断和治疗本病提供新的靶点.     

手术切口连续皮内缝合联合康倍外涂对术后切口愈合及瘢痕增生的影响

目的探讨手术切口连续皮内缝合联合康倍外涂改善术后切口愈合及瘢痕增生的效果。方法将200例甲状腺、乳腺、腹部开放手术患者随机分为观察组及对照组各100例,对照组于术中按照传统方法以丝线间断缝合皮肤切口并于术后按常规对切口及切口周围进行清洗消毒;观察组术中以3-0可吸收缝线行皮内连续缝合,术后在常规换药基础上予康倍均匀涂抹于切口创面。观察两组切口愈合情况及术后3、6、1 2个月切口瘢痕增生情况。结果观察组切口愈合及瘢痕增生情况均显著优于对照组（P〈0.01）。结论手术切口连续皮内缝合联合康倍外涂可促进术后切口愈合、减轻瘢痕增生。     

可调式肛镜缝扎器在痔上黏膜环切吻合术中的应用效果观察

目的观察可调式肛镜缝扎器在痔上黏膜环切吻合术中的应用效果。方法将90例行痔上黏膜环切吻合术的痔疮患者,随机分为A、B组,各45例。A组术中采用可调式肛镜缝扎器缝合,B组术中采用普通肛镜缝扎器缝合。结果两组治愈率分别为97.8%、95.6%,两组相比P〉0.05。两组手术切口均一期愈合。A组手术时间、荷包缝合时间均短于B组（P均〈0.01）,需缝扎的止血点少于B组（P〈0.05）。结论 痔上黏膜环切吻合术中采用可调式肛镜缝扎器缝合可缩短手术时间且操作简单、方便、缝合效果好。     

乙型肝炎肝纤维化麻鸭球结膜微循环及血液流变学特点

目的:观察鸭乙型肝炎肝纤维化动物模型的球结膜微循环及血液流变学特点。方法:用鸭乙型肝炎病毒(DHBV)阳性血清反复攻击建立鸭乙型肝炎肝纤维化动物模型,并检测球结膜微循环、血液流变学指标,肝纤维化指标、肝脏病理组织学变化。结果:用DHBV反复攻击造模后,其病理组织学改变具有肝脏细胞炎症,肝纤维组织增生,血清肝纤维化指标升高(P<0.01),球结膜微循环明显障碍(P<0.01),血液流变学改变(P<0.01)。结论:乙型肝炎肝纤维化麻鸭具有明显的微循环障碍及血液流变学改变。     

结直肠肿瘤JNET分型病理改变基础的初步研究

目的 探讨结直肠肿瘤JNET分型的病理改变基础。方法 收集贵州医科大学附属医院内镜中心2015年1月—2018年6月行窄带光成像放大内镜检查并取得术后病理标本的结直肠肿瘤患者资料,对其内镜JNET分型及病理特征(表面小凹上皮脱落、表面黏膜坏死结构、表面黏膜筛网状结构、纤维组织反应增生、黏膜肌无残留、癌性间质反应)进行回顾性分析。结果 共纳入81例结直肠肿瘤患者,病变长径均>1.5 cm,其中内镜治疗74例,外科治疗7例。表面黏膜筛网状结构出现频率为JNET 2A型(2.78%)<3型(20.00%)<2B型(42.80%),组间比较差异均有统计学意义（P均<0.05）;纤维组织反应增生、黏膜肌无残留、癌性间质反应出现频率均为2A型、2B型<3型,3型与2A型、2B型比较差异有统计学意义（P均<0.05）。表面小凹上皮脱落、表面黏膜坏死结构在JNET分型与病理诊断相符组与不符组间出现频率差异有统计学意义（P均<0.05）。结论 JNET分型中2B型提示病理特征为黏膜表面筛网状结构,3型提示病理特征为纤维组织反应增生,黏膜肌无残留,癌性间质反应。表面小凹上皮脱落、表面黏膜坏死结构可能是影响JNET分型诊断准确性的病理干扰因素。     

Comparison of cecal abrasion and multiple-abrasion models in generating intra-abdominal adhesions for animal studies

Abstract Background The formation of postoperative adhesions is a common problem in abdominal surgery that may lead to serious complications. Appropriate animal adhesion models are essential for the investigation of adhesiogenesis and the development of new anti-adhesive products. Although animal models have been developed to study the process of adhesion formation in the abdomen, they are not effective in generating adhesions located over small bowel where adhesions are most commonly observed in clinical practice. Methods Twenty-nine Sprague Dawley rats were subjected to standardized cecal abrasion (group 1; n=9), or two types of multiple abrasion, in which cecal and 3 or 5 abrasions were performed on small bowel (group 2, n=10; and group 3, n=10). An observer blinded to the randomization assessed the difficulty of adhesiolysis on a 6-point scale, and the locations of the adhesions were recorded 21 days after the initial surgery. Results Adhesiolysis was significantly more difficult in group 3 than in group 1 (p=0.01). The number of animals that had adhesions between the small bowel segments and the total number of locations where small bowel adhered were significantly greater in group 2 and 3 than in group 1 (p<0.05 for all comparisons). Conclusions Abrasions to the small bowel created consistent adhesions that have clinical characteristics of intra-abdominal adhesions as compared to the standard cecal abrasion model and that can be used in future animal studies on adhesions.     

The esophageal and small-bowel manifestations of progressive systemic sclerosis. A pathophysiologic explanation of the roentgenographic signs.

Goetz suggested progressive systemic sclerosis as replacement for sclerderma because of recognized systemic visceral involvement. Gastrointestinal manifestations are caused by atrophy and fibrous replacement of the submucosa and muscularis of the bowel. The clinical picture, roentenographic findings, pathology, and pathophysiology of this condition are discussed.     

Evaluation of postoperative adhesions in rats submitted to peritoneostomy with polypropylene mesh associated to nitrofurazone

BACKGROUND: Peritoneal injuries, common in per and postoperative, lead to the formation of adhesions. The use of polypropylene mesh increases the postoperative adhesions incidence. Based on the fact of nitrofurazone accelerates the healing process, a possible action on peritoneal adhesions was cogitated. AIM: To evaluate postoperative adhesions in rats submitted to peritoneostomy with polypropylene mesh fixation associated to nitrofurazone. METHODS: Thirty-three Wistar rats were separated into three groups of eleven animals each one. In group I was performed the laparotomy with exposition of the abdominal cavity followed by the laparotomy suture; in group II was performed the resection of a abdominal wall fragment followed by polypropylene mesh fixation on the gap and in group III was performed the same done in group II, but the mesh was previously impregnated with nitrofurazone. After 45 days the animals were sacrificed and necropsied. RESULTS: Seven animals of group I had no adhesions (degree 0), two had degree 1 adhesions and two had degree 2. In group II, one animal was classificated as degree 3 and ten as degree 4. In group III, one had degree 0, eight had degree 3 and one had degree 4 (one animal died before 45 days). All adhesions found involved the abdominal wall; ten animals had adhesions involving only omentum (group I = 4; group II = 1 and group III = 5); eleven animals had adhesions involving omentum, small bowel and other abdominal organs (group II = 10; group III = 1); three animals had adhesions involving only small bowel, all belonged to group III. Fourteen animals had adhesions involving small bowel, of these ten belonged to group II (nine with more than one fixation point) and four belonged to group III (three with just one fixation point). CONCLUSION: The association of nitrofurazone with polypropylene mesh did not reduce significantly the postoperative adhesions incidence in rats, but reduced the intensity and severity of these adhesions.     

Anastomotic rupture of aortic grafts.

Proximal suture line disruption is one of the severe complications of synthetic vascular grafting for arteriosclerotic aortic disorders. The pathology of clinical and experimental cases revealed that a small bite of each stitch cut into the host aorta and became disrupted. Making each stitch as large as possible in the host aorta is the first procedural choice for aortic replacement surgery. Protecting the anastomotic line with a synthetic mesh cloth wrapping is preferable.     

Anastomotic suture materials and experimental colorectal carcinogenesis

Local tumor recurrence following restorative surgery for colorectal cancer may occasionally result from the promotion of a neoplastic lesion in a zone of proliferative instability adjacent to the anastomosis. The aim of this study was to compare the influence of three anastomotic suture materials, including stainless steel (as a model of surgical stapling), on colorectal carcinogenesis in an experimental animal model. The transmural implantation of stainless steel sutures into the distal descending colon of albino Swiss rats during the postinitiation phase of tumor induction resulted in significantly fewer animals exhibiting perianastomotic tumors 12 weeks later (3 of 21 animals) when compared with either polyamide (Nurolon^®; Ethicon, Edinburgh, United Kingdom) (14 of 20 animals;P<0.001) or polyglycolic acid (Dexon Plus^®; Davis and Geck, Gosport, United Kingdom) sutures (17 of 21 animals;P <0.001). The findings were similar when the same materials were used to resuture a longitudinal colotomy. For both operative procedures, the type of suture material had no influence on the incidence of large bowel tumors distant from the anastomotic site. These results suggest that stainless steel staples may promote fewer perianastomotic large bowel tumors than certain more conventional suture materials and, therefore, may be safely employed in colorectal cancer surgery.Provisional results from this study were read at the meeting of the Surgical Research Society of Great Britain and Ireland, Belfast, Northern Ireland, January 1988.Supported by a grant from the Research Support Group of the Greater Glasgow Health Board.     

Initial continence testing of sleeved monolayer colonic anastomoses in sheep

It has been said that the most important cause of morbidity and mortality in surgery of the colon, rectum, and esophagus is dehiscence. The new method of anastomosis tested here immediately after its completion is a sleeved continuous monolayer anastomosis with full-thickness proximal bowel joined to the mucosa and submucosa of distal bowel. The 3 to 5-mm sleeve of distal seromuscularis fashioned by prior excision of a ring of distal mucosa is folded over the monolayer anastomosis and tacked on to proximal seromuscularis by a second continuous suture. In this bench study, sleeved seromuscularis monolayer anastomoses were compared for immediate ability to withstand air distention with conventional all-layer continuous and interrupted monolayer anastomoses. The results, even in fresh nonliving bowel, suggest that there may be benefits from sleeving monolayer anastomosesin vivo. It is noted that in the newly fashioned anastomosis, through-the-suture leaks were common on progressive distention, but were observed at higher pressures in sleeved and in extramucosal suture lines than in full-thickness monolayers. Supported by grant no. MS 014 provided by the University of Kuwait.     

First experimental sutureless end-to-end laser anastomosis of the large bowel

Completely sutureless end-to-end large bowel anastomoses were successfully created in New Zealand white rabbits (n = 26) by using a low-energy (0.4-W wave of power) Nd:YAG laser to produce welded anastomoses. In this study, the short-term integrity, degree of narrowing, macroscopic appearance, and microscopic findings were compared with those of the conventional interrupted onelayer anastomosis (n = 24) at zero, one, four, and seven days after surgery. Two rabbits in the laser group died from leakage. All remaining animals had an uneventful postoperative course. The bursting pressures in the laser group at zero, one, and four days were lower than those in the control group. The narrowing index of the laser anastomosis was higher than that of the suture anastomosis at four and seven days. However, the laser anastomoses showed fewer adhesions, no instances of bowel obstruction, and histologic healing with less fibrosis. The technique of laser anastomosis presents a promising alternative to suturing in reconstitution of the large bowel.     

大肠管状腺瘤中微血栓的存在及其意义

目的探讨大肠管状腺瘤黏膜肌层及黏膜下层巾的微血管内微血栓与年龄、动脉粥样硬化、高血压、糖尿病等有血管病变的慢性疾病的关系及其意义。方法选择经病理证实其黏膜肌层及黏膜下层中的微血管内有无微血栓形成的大肠管状腺瘤病例112例，其中97例经电话访问或住院病历证实是否患有动脉粥样硬化、高血压、糖尿病等慢性疾病。结果黏膜肌层及黏膜下层中的微血管内有微帆栓形成的病例：60及60岁以上的病例数明显多于60岁以下的病例数（P〈0．05），患有动脉粥样硬化、高血压、糖尿病等慢性疾病的病例数明显多于无慢性疾病的病例数（P〈0．05）。结论大肠管状腺瘤微血栓与年龄、动脉粥样硬化、高血压、糖尿病等有血管病变的慢性疾病有关，其意义尚需进一步探讨。     

小横切口单层缝合法在阑尾切除术中的应用体会

目的探讨小横切口单层缝合法在阑尾炎切除术中的应用效果。方法回顾性分析2007-01～2010-07应用小横切口单层缝合技术行阑尾切除术治疗阑尾炎317例的临床资料。结果全组病例均成功施行阑尾切除术,均采用小横切口单层缝合法。与常规阑尾炎手术相比,该手术方法具有手术时间短、术后疼痛轻、恢复快、切口短小隐蔽、住院时间短、切口感染率低、费用低等优点。结论小横切口单层缝合法在阑尾炎切除术中简单可行且并发症少,值得在基层医院推广应用。     

Adynamic bowel syndrome. Report of a case with disturbance of the cholinergic innervation.

A case of adynamic bowel syndrome is described. Full thickness biopsies of the large bowel showed the presence of ganglion cells, no acetylcholinesterase positive nerves in the lamina propria, submucosa or among the smooth muscle cells of the circular and longitudinal muscle coats, and absence of the argyrophil plexus. Electron microscopic examination showed replacement of the normal axon bundle by vacuolated tracts with small round bodies in one area--probably viral. Neuronal cytoplasm also showed similar vacuolation. It is suggested that the damage to the cholinergic innervation may be caused by a neurotoxic agent.