自体鼻中隔软骨及自体耳软骨联合膨体隆鼻在鼻整形美容中的应用

目的研究分析自体鼻中隔软骨及耳软骨联合膨体隆鼻在鼻整形美容中的应用。方法收集我院2015年8月至2019年8月接受鼻整形的50例患者临床资料,根据手术方案划分为2组进行回顾性分析。22例患者采用膨体隆鼻,设为对照组;28例患者采用自体鼻中隔软骨及耳软骨联合膨体隆鼻,设为观察组。观察两组患者鼻整形效果,比较鼻部形态与患者满意度。结果观察组与对照组患者术后鼻尖宽、鼻尖角、鼻尖高度和鼻长指标比较均有统计学差异(P <0.05);观察组患者总满意率高于对照组,差异存在明显统计学意义(P <0.05)。结论鼻整形美容手术中采用自体鼻中隔软骨及耳软骨联合膨体填充隆鼻整体效果优于单纯膨体隆鼻,患者满意度更高,有推广价值。     

鼻部美容整形综合手术的临床疗效观察

目的:分析鼻部美容整形综合手术的临床疗效。方法:随机抽取法选取2017年1月～12月期间于某院接受鼻部美容整形综合手术患者72例,医生根据患者鼻部外形情况及患者意愿,制定详细完整的鼻部外形综合手术,观察患者临床疗效,并对比患者整形前后对鼻外形的满意度及生活质量。结果:72例患者随访至今未出现并发症,鼻部外形恢复自然,未遗留明显切口瘢痕;术前对鼻部满意度15.3%,术后对鼻部满意度98.6%,生活质量较术前显著提升,P0.05。结论:对鼻外形缺陷患者采取鼻部美容整形综合手术,根据患者鼻部外形情况及患者意愿,制定详细的手术方案,能提高患者对自身鼻外形的满意度及生活质量,临床价值高。     

鼻部整形术自体肋软骨移植构建鼻尖软骨复合体的临床效果观察

目的观察鼻部整形术自体肋软骨移植构建鼻尖软骨复合体的临床效果。方法选取2017年8月-2019年8月深圳乐美医疗美容门诊部收治的鼻部整形患者80例根据不同复合体,分为观察组和对照组,每组40例。对照组接受膨体聚四氟乙烯鼻尖复合体手术,观察组接受自体肋软骨移植构建鼻尖软骨复合体手术,观察2组手术效果。结果手术后,观察组鼻尖突出度高于对照组,创口愈合时间短于对照组(P <0. 01);观察组鼻尖下小叶饱满度、鼻尖旋转度、鼻孔直径及鼻形满意度评分均高于对照组(P <0. 01);观察组并发症发生率为15. 00%,低于对照组的37. 50%(P <0. 05)。结论鼻部整形术使用自体肋软骨移植构建鼻尖软骨复合体可缩短患者创口愈合时间,且并发症少风险低,值得临床推广应用。     

硅胶假体隆鼻联合自体耳廓软骨充填鼻尖预防隆鼻术并发症的效果研究

目的:探讨硅胶假体隆鼻联合自体耳廓软骨充填鼻尖预防隆鼻术并发症的措施及临床效果。方法:回顾性分析2016年1月-2017年10月期间我院收治的行硅胶假体隆鼻联合自体耳廓软骨充填鼻尖术患者100例的临床治疗资料,观察患者的临床疗效、不良反应、患者满意度。结果:100例患者均完成手术治疗,术后拆线时,伤口愈合良好,鼻外形改善效果十分显著,5例患者在术后2d鼻假体出现轻微歪斜,给予加压固定2周后,恢复正常形态,术后,无1例患者出现鼻尖皮肤溃疡、感染、鼻形不佳以及假体外露等严重并发症,均顺利恢复出院,100例患者中,59例患者对隆鼻效果非常满意,38例患者比较满意,总满意度97.0%。结论:硅胶假体隆鼻联合自体耳廓软骨充填鼻尖对患者的鼻外形改善效果显著,且无严重并发症,安全性高,值得在临床上推广和运用。     

35例自体肋软骨耳廓再造术临床治疗探讨

目的探讨利用自体肋软骨治疗耳廓缺损的手术特点及临床疗效。方法回顾性分析35例进行自体肋软骨耳廓再造术治疗的耳廓缺失患者临床诊疗资料,总结手术治疗效果。结果 35例接受手术耳廓再造患者手术治疗全部成功,耳廓外观形态良好,颅耳角无回缩,无并发症发生,患者对治疗效果满意。结论利用自体肋软骨进行耳廓再造手术外观形态良好,并发症少,患者满意度高。     

微创小切口自体肋软骨切取术在鼻整形术中的应用观察

<正>随着经济不断发展,人们对面部审美的要求不断提高,面部整形率明显增高~([1,2])。鼻位于面部中央,鼻部的形态和美观度将对个体面部美学造成直接影响。鼻整形是目前开展最多的整形手术之一,经置入各种材料以抬高或隆起鼻部形态,适用于鼻头或鼻梁低平者。膨体聚四氟乙烯是临床常用的鼻整形替代材料,但存在承受力差、排异现象、感染率高等不足~([3,4])。自体肋骨取材简单、支撑力强、无排斥反应且可根据需要实施针对性雕刻,可满足鼻整形患者需求~([5])。本研究针对微创小切口自体肋软骨切取术在鼻整形术中的应用价值进行分析。1资料与方法     

多种材料联合应用鼻整形术的临床体会

目的介绍联合应用自体软骨、聚四氟乙烯(ePTFE)、聚乙烯(Medpor)在鼻部整形美容术中的应用体会。方法通过2010年1月至2012年9月,46例低鼻症患者应用聚四氟乙烯隆鼻时,将自体软骨及聚乙烯应用于鼻尖及鼻小柱处,将鼻尖顶起,从而达到延长鼻小柱,抬高鼻尖的目的。结果本组患者术后随访3~24个月,鼻尖部位均得到较大改善,且低鼻症得以矫正,效果满意。结论聚四氟乙烯联合自体耳软骨、聚乙烯在低鼻症中应用效果较好,值得临床推广。     

Mohs手术联合双侧V-Y皮瓣及光动力治疗鼻部皮肤鳞状细胞癌

目的探讨Mohs手术联合双侧V-Y皮瓣及光动力治疗鼻部皮肤鳞状细胞癌的效果。方法观察2015年1月—2017年12月治疗并完成随访的12例鼻部皮肤鳞状细胞癌患者,所有患者均采用Mohs手术联合双侧V-Y皮瓣及光动力治疗,记录手术时间、术中出血量、术后并发症以及6个月后随访情况。结果手术时间70～168 min,中位手术时间114 min,术中出血量5～30 ml,中位出血量19 ml,患者术后均未出现感染,伤口甲级愈合,术后随访6个月无复发,鼻部外形无移位,患者就医满意度高。结论 Mohs手术联合双侧V-Y皮瓣及光动力治疗鼻部皮肤鳞状细胞癌难度适中,具有出血量少、皮瓣成活率高、术后恢复快、肿瘤复发率低等优点,可作为鼻部皮肤鳞状细胞癌的首选治疗方案。     

自体肋软骨鼻黏骨膜下埋藏术治疗萎缩性鼻炎26例观察

目的:探讨自体肋软骨鼻黏骨膜下埋藏术治疗萎缩性鼻炎的疗效.方法:对26例萎缩性鼻炎采用病人自体肋软骨作为鼻腔黏骨膜下埋藏材料治疗.结果:术后随访1～13年,痊愈1例,显效14例,改善11例,总有效率100%.结论:采用病人自体肋软骨作鼻腔黏骨膜下填充术治疗萎缩性鼻炎疗效好,值得临床推广.     

自体骨或软骨成形术治疗外伤性歪鼻畸形

<正>外伤性歪鼻畸形往往合并鼻腔通气功能障碍,理想的手术方法除能得到满意的鼻外形外,应改善鼻腔通气等生理功能。笔者自1990～2005年行鼻-鼻中隔整形联合自体骨、软骨治疗陈旧性外伤性鼻畸形46例。     

Autologous chondrocytes. Autologous chondrocyte implantation: more data needed

There is no standard surgical treatment for young adults with persistent, incapacitating symptoms of knee cartilage damage. ChondroCelect is the first cell therapy product to be authorised in the European Union. It contains a dense suspension of chondrocytes cultured from a biopsy of the patient's knee cartilage for 4 weeks before being reimplanted. Clinical evaluation of Chondro-Celect only includes one trial, versus subchondral microfracture, in 118 patients. After 3 years of follow-up, there was no difference in the symptom score between the groups. Histological outcome was better after autologous chondrocyte implantation, but methodological problems make it difficult to interpret the observed difference. Long-term functional outcomes remain to be determined. More joint complications occurred after autologous chondrocyte implantation than after subchondral bone microfracture: more frequently symptomatic cartilage hypertrophy (27% versus 13%, possibly related to the implantation technique), joint swelling (22% versus 6.6%), joint effusion (24% versus 9.8%), and joint crepitations (18% versus 6.6%). Autologous chondrocyte implantation was sometimes associated with flu-like syndrome (in 7.8% of patients), which did not occur with the microfracture technique. Autologous chondrocyte implantation is more complex than microfracture. During routine use, there is a risk that one patient will inadvertently receive chondrocytes collected from another patient, leading to a risk of rejection. In practice, this autologous chondrocyte product should only be used by highly specialised teams, and its assessment must continue.     

Autologous formalin-fixed tumor vaccine

A novel tumor vaccine consisting of autologous formalin-fixed tumor fragments, cytokine-encapsulated microparticles, and an adjuvant was developed. Although mice experiments revealed mild efficacy, vaccination in a Phase I/IIa clinical trial of patients after resection of hepatocellular carcinoma resulted in significantly longer time before the first recurrence with no problematic adverse effect, than compared to historical control patients operated in the same department. In the followed academic Phase IIb randomized clinical trial, the vaccination significantly improved the recurrence-free survival and overall survival rates in a median follow-up of 15 months. The vaccine will be promising against recurrence of many types of human cancers after resection.     

慢性特发性荨麻疹患者自体血清皮肤试验与治疗

【摘要】目的探讨慢性特发性荨麻疹患者自体血清皮肤试验与治疗效果。方法慢性荨麻疹患者160例都进行自体血清皮肤试验,阳性120例,阴性40例;然后给予特异性免疫疗法。结果阳性组的临床有效率为96．7％,阴性组临床有效率为76．7％,阳性组临床有效率明显高于阴性组（P〈0．05）。阳性组与阴性组均未出现死亡等其他严重的不良反应事件,两组间比较差异无统计学意义（P〉0．05）。结论荨麻疹患者存在着体液免疫与细胞紊乱．基于白体血清皮肤试验的特异性免疫疗法可以作为一种针对自身免疫性慢性荨麻疹的特异疗法推广。     

关节镜下自体肌腱一期重建膝关节前后交叉韧带

目的探讨关节镜下应用自体肌腱同时重建膝关节前后交叉韧带的临床效果。方法对2008年1月至2012年12月收治的19例膝关节前后交叉韧带同时断裂的患者,切取健侧腘绳肌肌腱及双侧腓骨短肌肌腱分别对折成四股。关节镜下同时重建前后交叉韧带,股骨端应用Endobutton固定,胫骨端应用可吸收界面螺钉固定。结果 19例均获随访,平均27.6个月(9⁶6个月)。切口Ⅰ期愈合,无感染。其中新鲜伤11例,陈旧性损伤8例。合并内侧副韧带损伤9例,予以修复。合并外侧副韧带损伤4例。术后3个月膝关节活动范围均超过120°,无伸膝受限。Lyshlom评分(90.6±3.5)分。结论关节镜下自体肌腱一期同时重建膝关节前后交叉韧带方法简便,疗效确切,能有效恢复膝关节的功能。     

靶向注射尿激酶对血透患者动静脉内瘘血栓形成的治疗作用

目的 观察尿激酶靶向溶栓治疗对血液透析患者动静脉内瘘血栓形成的疗效.方法 18例患者于瘘管血栓形成的近心端微泵注射尿激酶25～40万u/小时,平均30万u,观察治疗前后血管波动、血管杂音以及不良反应、血压和肝肾功能.结果 在总共进行的21例次溶栓治疗中,总成功率83.4%(18/21),一次成功率为94.4%(17/18).溶栓成功主要于血栓形成时间和血压关系密切.结论 微泵靶向性注射小剂量尿激酶治疗血液透析患者动静脉内瘘血栓形成的疗效确切,且操作简单,不良反应少,值得临床推广.     

Autologous peripheral hematopoietic stem-cell transplantation in a patient with refractory pemphigus

The aim of this study is to explore the effectiveness of autologous peripheral hematopoietic stem-cell transplantation in the treatment of refractory pemphigus. A 35-year-old male patient presented with a 4-year history of recurrent bullae on his trunk and extremities. The diagnosis of pemphigus was made on the basis of the clinical, histologic and immunofluorescence findings. The patient had shown resistance to conventional therapy with glucocorticoid and immunosuppressive agents. Two months before admission, he complained of hip joint pain. X-ray and CT scan revealed aseptic necrosis of the femoral head. Stem-cell mobilization was achieved by treatment with cyclophosphamide, granulocyte colony-stimulating factor (G-CSF) and rituximab. Peripheral blood stem cells were collected via leukapheresis and cryopreserved for later use. Immunoablation was accomplished by using cyclophosphamide (200 mg/kg; divided into 50 mg/kg on days-5,-4,-3, and-2), antithymocyte globulin (ATG; 10 mg/kg; divided into 2.5 mg/kg on days-6,-5,-4, and-3), and rituximab (1200 mg/d; divided into 600 mg/d on days 0 and 7). Autologous peripheral hematopoietic stem cell transplantation was followed by reconstitution of the immune system which was monitored by flow cytometry. The glucocorticoid was withdrawn immediately after transplantation. The pemphigus titer turned negative 6 weeks after transplantation and remained negative. The patient was in complete drug-free remission with no evidence of residual clinical or serological activity of pemphigus during 1 year of follow-up. The patient’s response suggests that autologous peripheral hematopoietic stem cell transplantation may be a potential “cure” for refractory pemphigus. However, further studies are needed to evaluate the risk-benefit ratio of this approach in patients with pemphigus showing resistance to conventional therapy. __________ Translated from Chinese Journal of Dermatology, 2007, 40(1): 13–15 [译自: 中华皮肤科杂志]