肢端皮肤角化过度增生症的手术治疗

目的介绍肢端皮肤角化过度增生症１０例的治疗体会，其中掌跖角化病９例，疣状表皮结构不良１例。方法采用病变皮肤切除皮肤移植术治疗，其中两例有深部组织外露和放射性溃疡选用皮瓣修复，其余行皮片移植。结果１０例均获满意效果，追踪观察８年以上，无复发，能保持接近正常的功能活动。结论手部以皮片效果最佳，足底应用皮瓣修复，耐磨性较皮片为好，但因皮瓣缺乏纤维隔结构，走路时皮瓣与深部组织间产生相对滑动，也容易造成破溃，必须注意妥为保护     

肢端皮肤角化过度增生症的手术治疗

目的介绍肢端皮肤角化过度增生症10例的治疗体会,其中掌跖角化病9例,疣状表皮结构不良1例。方法采用病变皮肤切除皮肤移植术治疗,其中两例有深部组织外露和放射性溃疡选用皮瓣修复,其余行皮片移植。结果 10例均获满意效果,追踪观察8年以上,无复发,能保持接近正常的功能活动。结论手部以皮片效果最佳,足底应用皮瓣修复,耐磨性较皮片为好,但因皮瓣缺乏纤维隔结构,走路时皮瓣与深部组织间产生相对滑动,也容易造成破溃,必须注意妥为保护。     

乳头、乳晕角化过度病一例

1　病例介绍女,19岁。自15岁初潮乳房开始发育,随即出现对称性双乳头、乳晕全皮肤逐渐肥厚,呈米粒样疣状隆起,高出正常皮肤约1ｃｍ。乳晕直径45ｃｍ,色素沉着,呈棕褐色蘑茹状(图1)。局部无异常感觉,乳头无溢液,双乳未触及肿物,无触痛。妇科及其它系统检查无异常发现。图1　术前Ｆｉｇ1　Ｐｒｏｐｅｒａｔｉｏｎ1996年12月入院后,在局麻下行双侧乳晕及乳头四周病变皮肤切除,保留乳头,切除深度至浅筋膜。病变组织切除后,双侧隆起之乳头回复正常高度。分别在切除后之圆形乳晕创面外3、9点处各行三角形正常皮肤切除,并于游离后拉拢缝合,以适当缩…     

经蝶窦手术治疗家族性肢端肥大症

作者报告一组家族性弧立型肢端肥大症的表兄妹３人，都具有典型的临床表现和内分泌学、影像学和病理学改变，均接受经口鼻蝶窦垂体生长激素腺瘤全切除而治愈。谱系调查涉及此家族４代６５人，无近亲婚配和类似患者，提示为常梁色体不规则显性遗传。此症手术治疗效果良好。     

逆行岛状皮瓣在肢端皮肤缺损中的临床应用

逆行岛状皮瓣在肢端皮肤缺损中的临床应用温晓阳胡文斌廖劲松四肢大面积皮肤复合组织缺失，如何早期有效地进行修复是临床上的一大难题。作者从１９８８年～１９９６年，采用８种带蒂逆行岛状皮瓣移位对１３９例四肢肢端创面进行修复，取得满意的临床效果，报道如下。临床...     

什么是皮肤角化症

青年教师王芳有一个活泼可爱的小男孩,夫妇二人视若掌上明珠,可是前几天王老师给孩子洗澡时发现孩子背部和胳膊上的皮肤怎么突然变得粗糙起来,摸起来好像小刺一样扎手,她急忙带孩子上医院找皮肤科医生咨询就诊,原来孩子患了“皮肤角化症”。皮肤角化症是怎样发生的呢?这还得从皮肤的解剖生理知识说起。皮肤是人体的第一道防线,也是一件天然的外衣,是由表皮、真皮、皮下组织和毛囊、汗腺、皮脂腺、毛发和指(趾)甲     

13例肢端恶性黑色素瘤的治疗

目的对肢端恶性黑色素瘤患者的整形外科治疗作初步的临床分析.方法自2000年2月至2003年11月,对13例患者的肢端恶性黑色素瘤行功能性根治切除后,采用皮瓣覆盖的方法修复创面.其中治疗性淋巴结清扫者4例,选择性淋巴结清扫者3例.结果术后随访1～5年,观察肿瘤根治效果及手足功能及外观状况.13例患者中12例得到随访,10例患者无恶性黑色素瘤复发,手足功能及外观良好.结论对肢端恶性黑色素瘤原发灶行整形外科治疗,在保证肿瘤根治效果的同时可获得更好的手足功能及外观.     

13例肢端恶性黑色素瘤的治疗

目的对肢端恶性黑色素瘤患者的整形外科治疗作初步的临床分析。方法自2000年2月至2003年11月,对13例患者的肢端恶性黑色素瘤行功能性根治切除后,采用皮瓣覆盖的方法修复创面。其中治疗性淋巴结清扫者4例,选择性淋巴结清扫者3例。结果术后随访1~5年,观察肿瘤根治效果及手足功能及外观状况。13例患者中12例得到随访,10例患者无恶性黑色素瘤复发,手足功能及外观良好。结论对肢端恶性黑色素瘤原发灶行整形外科治疗,在保证肿瘤根治效果的同时可获得更好的手足功能及外观。     

肠病性肢端皮炎患儿的护理

目的探讨肠病性肢端皮炎患儿的护理方法。方法对158例门诊及住院的肠病性肢端皮炎患儿进行科学治疗与护理，以1：8000高锰酸钾溶液清洗皮损，外搽氧化锌油、红霉素软膏等，重点护理四肢末端皮肤及腔口周围皮损，同时保护毛发、指（趾）甲不受损伤。结果所有患儿皮损均于1周左右治愈。结论皮肤护理对肠病性肢端皮炎患儿有一定辅助治疗作用。     

乳腺增生症的手术治疗

目的 探索手术治疗乳腺增生症的意义及其方法，方法对有手术指征的病人，酌选用区段切除、皮下乳腺切除、单纯乳房切除等不同术式，并对合适病人同期行乳房美容手术。结果 523例病人均经病理检查证实为乳腺增生症，所有病人术后效果良好，同期行美容手术（40例）之乳房外形均感满意。结论 乳腺一症经系统的中西医结合治疗无效者，可考虑手术治疗，但需严格掌握手术适应证。     

Surgical treatment of parathyroid hyperplasia

BACKGROUND: To review a series of 11 patients affected by hyperplasia of parathyroid glands and to discuss diagnostic and therapeutic tools. METHODS: A series of 11 patients out of 44 (= 25%) with primary hyperparathyroidism has been retrospectively reviewed. They underwent surgery in I surgical Department of OORR of Bergamo. All 11 patients were submitted to ultrasound and computed tomography examination before surgery, without any localisation of hyperplastic or adenomatous tissue. An exploring cervicotomy was performed with subtotal parathyroidectomy after the anatomopathological result of hyperplasia. RESULTS: No adverse effects related to surgery were observed. All patients could be considered as cured with a median follow-up of 36 months. CONCLUSIONS: Among hyperparathyroidism, hyperplasia is an underhand form and even if the laboratory diagnosis is simple, the imaging techniques cannot always localise the pathologic tissue. Personal experience shows the role of subtotal parathyroidectomy (removal of 3 parathyroid glands and a half of the last one) confirmed by the absence of adverse effects or relapse with a median follow-up of 36 months.     

Surgical treatment of limb lymphedema

Among 286 patients suffering from limb lymphedema seen in the outpatient clinic in the period 1977-1983, 13 were operated upon. The indication for operation and its type were dictated mainly by the gravity of the clinical findings and the failure to respond to conservative measures. Various conservative and surgical regimes are briefly reviewed emphasizing the way they were incorporated into this series. Six patients who underwent excisional operative procedures and five of the seven patients who underwent lymphatic venous bypass procedures benefitted from the operation and the adjuvant therapy.     

Surgical management of post-burn skin dyspigmentation of the upper limb

The technique and results of surgery in 23 patients with skin dyspigmentation of the upper limb are presented. The study population was divided into two groups. Group A (n=15 patients) had hyperpigmented skin grafts in the palm or the palmar aspect of the digits. All patients underwent excision of the hyperpigmented grafts and coverage with split-thickness plantar skin grafts. The plantar grafts gave an excellent colour and texture match and all patients were satisfied with the result. Group B (n=8 patients) had post-burn hypopigmentation on the dorsal aspect of digits, hand or forearm. These patients underwent dermabrasion and thin split-thickness grafting harvested from the upper thigh or buttock. All grafts healed well with no residual hypopigmentation. However, the graft was slightly hyperpigmented when compared to the surrounding skin. Despite this complication, all patients were satisfied and considered this slight hyperpigmentation much better than the preoperative hypopigmentation. The pathogenesis of skin dyspigmentation and other treatment techniques are discussed.     

Surgical treatment of mammary hyperplasia during pregnancy

Reduction mammaplasty is an effective procedure and the treatment of choice for symptomatic breast hypertrophy. Two unusual cases of reduction mammaplasty are reported. After uneventful immediate postoperative courses, two unusual wound complications occurred requiring further treatment. It was discovered retrospectively that the two women (21 and 24 years old) were pregnant. There was no other cause to explain the skin problems which were encountered. It is suggested that a pregnancy test may be needed before undertaking reduction mammaplasty. Received: 25 May 1999 / Accepted: 10 August 1999     

促肾上腺皮质激素非依赖性肾上腺皮质大结节样增生的外科治疗

目的 探讨促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)非依赖性肾上腺皮质大结节样增生(ACTH independent macronodular adrenal hyperplasia,AIMAH)的诊治经验. 方法 回顾性分析1972年8月至2010年7月诊治14例AIMAH患者资料.男5例,女9例.年龄26～58岁,平均45岁.临床表现为典型库欣综合征( Cushing syndrome,CS)者10例,表现为体质量增加、高血压或高血糖等非特异性症状者4例.生化检查示皮质醇分泌昼夜节律消失,大、小剂量地塞米松抑制试验均不被抑制.CT检查示双侧肾上腺弥漫性增大伴多发结节.14例均行开放手术治疗,其中单侧肾上腺切除5例;一侧肾上腺全切,对侧肾上腺次全切除6例;双侧肾上腺同时切除3例. 结果 14例病理诊断均为肾上腺大结节样或腺瘤样增生.随访12～120个月,平均69个月,CS症状消失.5例单侧肾上腺切除者术后血、尿皮质醇值恢复正常,对侧肾上腺无明显增大.3例双侧肾上腺切除患者中,1例术后7d发生肾上腺皮质功能危象而死亡,2例术后出现皮质功能减退症状,给予糖皮质激素替代治疗.其他患者病情稳定,无Nelson综合征出现. 结论 AIMAH具有独特的临床症状特点,是CS的一种独立罕见类型.首次手术多行单侧肾上腺切除术,可获较长时间的症状缓解.术后应密切随访患者的皮质醇水平、症状和体征,对症状不缓解或复发者可行对侧肾上腺切除或次全切除.     

Surgical treatment of traumatic lower limb pseudoaneurysm

Objective：To summarize our experience in surgical treatment of traumatic lower limb pseudoaneurysm.Methods：Twenty patients with traumatic lower limb pseudoaneurysm were surgically treated in our department from January 2007 to January 2012.The treatment protocols included interventional covered-stent placement （10 cases）,spring coil embolization （2 cases）,and surgical operation （8 cases）.Surgical operations included pseudoaneurysm repair （2 cases）,autologousvein transplantation （1 case）,and artificial-vessel bypass graft （5 cases）.Results：All the patients were successfully treated without aggravating lower limb ischemia.Pseudoaneurysm disappeared after treatment.A surgical operation is suitable to most pseudoaneurysms,but its damage is relatively obvious and usually leads to more bleeding.It also requires a longer operating time.Compared to a surgical operation,interventional therapy is less traumatic and patients usually have a quicker recovery （P＜0.05）.All patients were followed up once per month for 12-36 months by color Doppler ultrasound examination.There were no cases of pseudoaneurysm recurrence.Conclusion：Both surgical operation and interventional therapy are safe and effective in the treatment of pseudoaneurysm.