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。     

Grundlagen der Versorgung offener Frakturen

Open fractures are frequently caused by high-energy trauma, e.g. road traffic accidents or falls from a height and often lead to persisting functional impairment and disability. Due to the complex nature of the injuries several operations are often neccessary before full recovery can be achieved. This results in significantly prolonged courses of treatment and long stays in hospital. Compared with closed injuries complications, such as impaired wound healing, infections or nonunion occur much more frequently in open fractures during the course of treatment. The goals of treatment include infection prevention, fracture healing and complete restoration of function of the affected limb. Besides adequate initial treatment and prompt transport to the nearest suitable hospital, early initiation of antibiotic therapy is of pivotal importance. The initial management includes an accurate diagnosis of the injury, which must be as complete as possible, thorough debridement and fracture stabilization.     

严重烧伤脏器并发症的内源性细胞损伤机制研究进展

It is of great importance to know the endogenous mechanism in burn-induced organ injuries,not only for the understanding of pathophysiological processes after burn,but also for guiding the clinical tre...     

A 2000 patient retrospective assessment of a new strategy for burn wound management in view of infection prevention and treatment

Infections in burn patients are still the principal cause of complications in burn injuries. The aim of this study is to assess a new strategy for burn wound management in view of infection prevention and treatment in the experience of the Burn Treatment Center in Siemianowice Śląskie. The applied methodology involved the analysis of patient records describing the hospital''s epidemiological situation between 2014 and 2016. The analysis also included the use and cost of antibiotics, silver‐containing dressings, and other antiseptics relative to the number of sepsis cases, including those caused by Pseudomonas aeruginosa, as well as the mortality ratio. The total costs of prevention and treatment of infections were reduced, while the use of silver‐containing dressings and antiseptics increased. The number of patients with sepsis decreased, including cases caused by P. aeruginosa, and the mortality ratio was reduced. Introducing a strategy for burn wound‐oriented infection prevention and treatment in burn patients provides a number of benefits. It is also cost‐effective. Using locally applied active dressings and antiseptics can be a welcome choice for often‐unnecessary antibiotic therapy of a suspected or existing burn wound infection.     

Immunologie und Sepsissyndrom beim Brandverletzten

Despite significant advances in burn surgery and critical care, severe burn trauma defined as injuries covering more than 25% of the total body surface area, is still associated with high mortality and morbidity. Burn trauma is a whole body injury where peripheral dermal injury rapidly results in systemic inflammation and inflammatory core organ damage. The severe disturbance of internal homeostasis involves all vital organ systems and obligates early referral to specialized burn centers. Treatment of severely burned patients is a multifaceted challenge directed by pathophysiologic events which progress from local skin destruction, disruption of physicochemical and microvascular barriers to breakdown of peripheral and central circulation, organ failure and ultimately death. While early intensive care focuses on maintenance of tissue oxygenation and perfusion, surgical treatment deals with management of the burn wounds as a source of inflammation and infection. Here wound debridement and coverage is essential to abrogate systemic effects of inflammation and limit pathogen invasion. While control of early burn stages minimizes mortality due to burn shock, subsequent burn sepsis continues to be a formidable challenge for physicians and the main cause of burn mortality.     

An ultrathin poly(l‐lactic acid) nanosheet as a burn wound dressing for protection against bacterial infection

Burn wounds are highly susceptible to bacterial infection due to impairment of the skin's integrity. Therefore, prevention of bacterial colonization/infection in the wound is crucial for the management of burns, including partial‐thickness burn injuries. Although partial‐thickness burn injuries still retain the potential for reepithelialization, the complication of wound infection severely impairs the reepithelialization even in such superficial burn injuries. We recently developed a biocompatible nanosheet consisting of poly(l ‐lactic acid) (PLLA). The PLLA nanosheets have many useful and advantageous biological properties for their application as a wound dressing, such as sufficient flexibility, transparency, and adhesiveness. We herein investigated the suitability of the PLLA nanosheets as a wound dressing for partial‐thickness burn wounds in mice. The PLLA nanosheets tightly adhered to the wound without any adhesive agents. Although wound infection with Pseudomonas aeruginosa in the controls significantly impaired reepithelialization of burn wounds, dressing with the PLLA nanosheet markedly protected against bacterial wound infection, thereby improving wound healing in the mice receiving partial‐thickness burn injuries. The PLLA nanosheet also showed a potent barrier ability for protecting against bacterial penetration in vitro. The ultrathin PLLA nanosheet may be applied as a protective dressing to reduce environmental contamination of bacteria in a partial‐thickness burn wound.     

深度烧伤修复重建与康复治疗相关问题探讨

With the advances in resuscitation,infection control,and metabolic management,the treatment strategies for burn patients have improved remarkably in the last half century.As a result,more patients with deep burn wound survived,and how to optimize the burn wound care aiming at recovery of the normal appearance and physiologic function of patients has been investigated and discussed widely through both the whole treat-ment strategy making and the new techniques performing.In the present discussion,early tissue reconstruction as well as early wound covering and repair are emphasized by summarizing the improved aesthetic and functional effects obtained by applying the principles of plastic surgery in early burn wound repair,the use of composite skin grafting,the grafting with split-thickness autografts on the preserved denatured dermis or on the preserved healthy fat tissue.etc.Besides these,more attention should be given to the repair and reconstruction in specialized functional parts of the body,such as head and face,neck,hand,female breast.perineum,and joint areas,after a deep burn.The role of rehabilitation during and after the burn wound treatment process is elucidated by demonstrating its potential biophysical mechanism and preventing scar deformity.Adequate treatment of deep burn wound demands a number of important measures in-eluding the timing of surgery,adoption of essential techniques,suitable types of wound covering materials,motivated rehabilita-tion,and necessary psychological therapy.The optimal recovery of damaged part of body after burn should depend on the similar-ity of rebuild tissue structure to simulate the nature of the origi-nal tissue in the cellular,histological,anatomic characteristics,which is the aim of all burn wound care and the basis of the ap-pearance and function repair or reconstruction.     

Modern concepts of treatment and prevention of electrical burns

Electric injuries account for 1,000 deaths in the United States, with a mortality rate of 3--15%. As the widespread use of electricity and injuries from it increase, all health professionals involved in burn care must appreciate its physiological and pathological effects as well as management of electrical current injury. Electric current exists in two forms: alternating current and direct current. The effects of electricity on the body are determined by seven factors: (1) type of current, (2) amount of current, (3) pathway of current, (4) duration of current, (5) area of contact, (6) resistance of the body, and (7) voltage. Electrical accidents can be divided into less than 1,000 V (low-voltage accidents) and greater than 1,000 V (high-voltage accidents). In any electrical accident, the witness must turn off the power source and initiate treatment at the scene of the injury. Low-voltage electric burns almost exclusively involve either the hands or oral cavity. Surgical treatment will vary with the severity of the injury.Burns caused by contact with a high-voltage alternating electric circuit conforms to two types: burns from an electric arc and burns from an electric current. High-voltage electric current injuries have a wide variety of systemic manifestations, including neurologic complications, cardiovascular and pulmonary manifestations, vascular damage, and abdominal, bone, eye and joint complications. An organized approach to the management of these complications is outlined in this article. The best treatment of burn injuries remains prevention. Because the majority of burn injuries are due to occupational electrical injuries, the regional burn centers must work effectively with industry to prevent these potentially life-threatening accidents.     

Paediatric burn injuries in Sub Saharan Africa--an overview

Paediatric burn injuries in Sub Saharan Africa are common and often lead to devastating consequences. Unfortunately relevant and accurate data regarding these injuries is sketchy and incomplete. This paper reviews the available information on the epidemiology of paediatric burns in Africa, associated health problems and contributing environmental factors responsible for these burns. The current status of burn care, the lack of infrastructure, and traditional methods of treatment, further contribute to the unsatisfactory status of overall burn management, prevention, and rehabilitation of burn survivors. A strategy for improving burn care in Africa has been formulated. The management of childhood burns will only be successful if educational, social, fiscal and infrastructure standards are improved. Traditional beliefs and methods cannot be discarded as they play an important role in the management of these children. It is furthermore essential that local and central government organisations support these initiatives. Clearly, the children of Africa deserve better burn care.     

Comparison of combat and non-combat burns from ongoing U.S. military operations

BACKGROUND: Military burns result from either combat or non-combat causes. We compared these etiologies from patients involved in ongoing conflicts to evaluate their impact and provide prevention recommendations. METHODS: All military patients with significant burns treated at the United States Army Institute of Surgical Research from April 2003 to May 2005 were reviewed. Injuries were categorized as having resulted from combat or non-combat causes. Demographics, burn severity and pattern, mortality, and early outcomes were compared. RESULTS: There were 273 burn patients seen with 63% injured in combat. A high early rate of non-combat injuries was noted. Feedback on non-combat burn prevention was provided to the combat theater, and the incidence of non-combat burns decreased. Mean age and time from injury to admission did not differ. The majority of combat injuries resulted from explosive device detonation. Waste burning, ammunition handling, and gasoline caused most non-combat injuries. Combat casualties had more associated and inhalation injuries and greater full-thickness burn size; total body surface area burned was equivalent. The hands and the face were the most frequently burned body areas. Mortality was 5% in combat and 2% in non-combat patients. The majority of survivors in both groups returned to military duty. CONCLUSIONS: The disparity in full-thickness burn size and incidence of inhalation and associated injuries resulted from differing mechanisms of injury, with explosions and penetrating trauma more common in combat wounds. Despite the severity of combat burns, mortality was low and outcomes generally good. Non-combat burns are preventable and have decreased in incidence.     

Versorgung des Brandverletzten

The rate of survival of victims of severe burn injuries has constantly increased over the last decades. This increase is due to consequent and correct preclinical and in-patient treatment based on standardized measures during the initial and following treatment phase in specialized burn centers. The low incidence of severe burn injuries of 1 per 50,000–60,000 inhabitants per year poses a challenge especially to emergency care providers. In addition the initial care is even more challenging regarding thermomechanical combination injuries. Frequent problems in the initial phase are hypothermia caused by an over extended cooling period and incorrect wound dressing management. Inadequate anlagesia as well as incorrect fluid resuscitation based on an incorrect assessment of the burned body surface area is also a cause of treatment difficulties.