放射性颌骨坏死的术式选择及疗效评价

目的：探讨经济有效的治疗放射性颌骨坏死（RONJ）的手术方式。方法77例RONJ根据颌骨坏死的范围、软组织条件选择不同治疗方式。方案1：骨坏死范围局限,牙龈及周围软组织无明显炎症的采用局部刮治或方块切除术;方案2：骨坏死范围较大、周围软组织炎症明显和（或）伴有明显纤维化的病例在控制炎症后,扩大切除同时行血管化游离复合组织瓣修复。结果21例采用方案1,其中15例一期愈合、6例行二次刮治或方块切除;56例采用方案2,其中软组织条件较好的30例,22例一期愈合,5例延期愈合,3例发生骨组织瓣血管危象,经探查和再吻合后1例正常愈合,2例仍发生组织瓣坏死;软组织炎症明显或伴有局部组织明显纤维化26例中,7例出现骨组织瓣血管危象,探查和再吻合后5例正常,2例出现骨坏死,9例一期愈合,15例局部出现不同程度软组织感染坏死,延期愈合。结论局限性放射性颌骨坏死可采用刮治或方块切除;骨坏死范围较大、软组织条件较好的采用血管化游离组织瓣进行修复;软组织纤维化明显的失败率较高,临床使用时应综合多方因素考虑。     

7.2%高渗羟乙基淀粉(200/0.5)氯化钠注射液对神经外科手术患者术中血流动力学的影响

目的探讨7.2%高渗羟乙基淀粉(200/0.5)氯化钠注射液(HS-HES)对神经外科手术患者血流动力学的影响。方法选择神经外科择期胶质瘤手术患者24例,ASAⅠ或Ⅱ,随机分为HS-HES组(n=14)和羟乙基淀粉(HES)组(n=10)。HS-HES组以500ml/h的速度给予HS-HES 250ml,HES组以1 000ml/h的速度输入HES 1 000ml扩容。记录输注前即刻(T0)、输注后30min(T1)、60min(T2)、70min(T3)、120min(T4)和180min(T5)HR、MAP、CVP、CO、每搏输出量(SV)和每搏变异度(SVV)。结果与T0时比较,T2～T5时两组HR明显增快(P0.05),T3～T5时两组MAP明显降低(P0.05),T1～T4时两组CVP明显升高、CO、SV明显增加,T1～T5时SVV明显降低(P0.05)。不同时点两组HR、MAP、CVP、CO、SV和SVV差异均无统计学意义。结论 HS-HES具有良好的血流动力学调节效应,为神经外科手术患者术中液体管理提供了一个新的选择。     

��Ƶ����Ƣ�����г�������Ƣ����ռλ�Բ���21������

??The clinical applicaion analysis of taken radiofrequency assisted partial splenectomy operations on patients with benign splenic space-occupying lesions XIAO Chang-wu*??QIU Rong??ZHANG Wei??LI Ning. *Department of Hepatobiliary Surgery??Suining Central Hospital??Suining 629000??China
Corresponding author??ZHANG Wei??E-mail??zw68229@sina.com
Abstract Objective To assess the feasibility??safty and clinical practicalty value of taken radiofrequency assisted partial splenectomy operations on patients with benign splenic space-occupying lesions. Methods The clinical data of 21 cases of taken radiofrequency assisted partial splenectomy operations on patients with benign splenic space-occupying lesions from September 2010 to February 2012 were retrospectively analyzed in Suining Central Hospital. These patients were the follows??Splenic non parasitic cysts in 11 cases??splenic hemangioma in 3 cases??splenic hematoma 5 cases??splenic epidermoid cyst in 1 cases??splenic abscess in 1 cases respectively. Results All of operations were completed smoothly??The average operative time was ??67.0±17.5??min and the average of intraoperative blood was ??55.7±10.3??ml. Patients in this group had a transient increase of temperature??but the conventional treatment or observation decreased to normal level a few days later. The complication rate in this group was 9.5% (2/21)??which 1 case of left pleural effusion??1 cases of splenic fossa effusion was observed after a few days??self absorption. The average duration of hospitalization was ??10.0±3.5??d. All patients were followed up and the period of following-up were 1~24 months. During hospitalization and follow-up??no serious complications such as bleeding, abdominal abscess, and thrombosis occurred. No overwhelming postsplenectomy infection (OPSI) occurred??immunological examination showed normal spleen function in All patients. Conclusion Taken radiofrequency assisted partial splenectomy operations on patients with benign splenic space-occupying lesions is feasible??safe and practical which should be developed extensively in clinic.