腹腔卒中1例

1病例报告患者,男,82岁。因乏力、纳差、腹泻等症状于2008—06—05住院。上腹部CT提示早期肝硬化,胆囊、胰腺、脾脏检查正常,未见腹水。给予肠镜检查,检查后患者感轻度腹痛,恶心,未吐,体温正常,无腹泻、便血等症状,可自由活动。当时考虑为肠镜检查所致不适。患者腹痛逐渐加重。查体：腹部柔软,下腹部压痛,轻度反跳痛,无肌紧张。化验血象正常,便常规正常。     

抗体介导的微循环损伤是移植后远期移植肾失功的主要原因

近几年来,肾移植后移植肾的近期存活率显著提高,但是慢性移植肾失功的发生率仍然较高.造成肾移植后远期移植肾失功的原因尚不明确.目前,因血肌酐浓度缓慢升高而致失功的受者往往未行肾活组织检查(活检),而对行肾活检的受者的诊断也常被含糊地归纳为慢性排斥反应或慢性移植肾肾病.     

带血管蒂腓骨头骨骺截骨整形重建内踝的应用解剖与临床应用

目的 为带血管蒂腓骨头骨骺截骨整形重建内踝提供解剖学依据,并探讨其临床应用效果.方法 20侧2～12岁新鲜儿童下肢标本,对腓骨头及内踝进行形态学测量,根据测量数据推导截骨公式.临床急诊或延期手术,移植截骨改良的腓骨头骨骺复合组织瓣一期修复内踝缺损,随访观察临床效果.结果 腓骨头倾斜角(M)为(170±8)°,关节面内倾角(N)为(145±6)°,纵长为(1.5±0.2)cm,横宽为(1.4±0.2)cm;内踝内翻角(L)为(152±8)°,关节面纵长为(1.25±0.2)cm,横宽为(1.25±0.2)cm.设内踝缺损面与胫骨纵轴的夹角为(Q),截骨角度X=L-N-Q,顶点位于腓骨头倒置后的关节面上1/6处.临床应用6例,全部一期愈合,随访1～3年,内踝发育良好,未发生骺早闭,无内翻畸形,踝关节负重、行走功能正常.结论 儿童腓骨头骨骺与内踝形态有一定的差异,通过截骨可获得满意的供体,同时携带皮瓣可一期修复内踝骨骺及周围软组织缺损并同步发育,是重建儿童内踝创伤性缺损的理想方法.     

腓骨瓣加内外固定结合治疗先天性胫骨假关节

目的 评价利用改良手术方式,治疗先天性胫骨假关节的临床效果.方法 对先天性胫骨假关节10例患儿,采用彻底切除病灶,带监测皮岛的游离或局部转移腓骨瓣移植,环式固定架外固定加髓内针内固定相结合的综合方法治疗.结果 经1～3.5年(平均2.1年)随访,10例患儿中9例胫骨假关节完全愈合,不需支具保护即能负重行走,且随访期间未出现再骨折现象,但均遗留肢体短缩,1例假关节复发.结论 最大限度的避免一切影响骨质愈合因素:彻底切除病变组织,改善局部血循环,牢固的外固定及中心固定,改良术式能提高先天性胫骨假关节的疗效.

Abstract：

Objective To evaluate the long-term results of upgrade method in the treatment of congenital pseudarthrosis of tibia Methods Ten patients with congenital pseudarthrosis of tibia were admitted in this institute. All of them underwent our new operation including resection of the tibia pseudarthrosis, ablation of part of tibia, transplantation of free fibula with flap, and vascular bundle implantation. The long-term results were recorded and analyzed. Results Results was obtained in all 10 cases after 6 months. Nine cases healed completely and could walk with no support. There was no refracture during 1 to 3. 5 years follow-up (mean 2. 1 years). All patients had limb shortening. And only one case recurred. Conclusions The new surgical method, resection of impaired tissue and improvement of blood supply,could get satisfactory results in children with congenital pseudarthrosis of tibia.     

带血管蒂腓骨头骨骺截骨整形重建内踝的应用解剖与临床应用

Objective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.     

60例胃癌p53蛋白的检测

p53基因结构及表达的异常是人类肿瘤最常见的基因改变之一。大约有50%的人类肿瘤有p53基因的突变．我们对60倒胃癌组织中p53蛋白表达水平作了检测，现报道如下。     

第二趾趾腹菱形皮瓣移位改形法一期再造手指

目的 介绍第2趾趾腹菱形皮瓣移位改形法一期再造手指的方法.方法 2002年9月～2006年10月,在传统方法切取第2趾后,根据趾-指腹周径的差值设计趾腹菱形皮瓣,切取血管蒂皮瓣逆转180°将其嵌入第2趾跖侧最狭窄处,一期修整指腹膨大,消除颈部狭窄畸形.应用7例7指,男4例,女3例;年龄18～38岁.损伤原因机械挤压伤5例,重物砸伤2例.无再植条件,无其他并发症,患指缺损范围Ⅲ～Ⅴ度,截指后于急诊或择期行再造术,切取皮瓣范围13 mm×6 mm～16 mm×9 mm.结果 术后皮瓣全部成活.经2～14个月,随访平均6.5个月.消除第2趾腹膨大及颈部狭窄畸形,再造指外形美观.指腹感觉无减退,两点辨别觉6～10 mm,功能恢复良好.根据手外科协会手功能评定标准评定,7例均为优.结论 第2趾趾腹菱形皮瓣移位改形法一期再造手指能消除指腹膨大及颈部狭窄畸形,使再造手指更美观.     

内镜下取刀片2例

内镜下取刀片２例金成兰孙玉芝刘光军陈红雨解放军２０２医院内窥镜中心辽宁省沈阳市１１０００３主题词异物／治疗胃中国图书资料分类号Ｒ６５６６１病例报告例１男，２０岁．于１９９１年９月因打架自吞裤卡１个，后因胃痛于１９９１年１０月来院，镜下见３７ｃ...     

拇指桡侧逆行岛状筋膜皮瓣修复拇指指腹缺损

目的：介绍拇指桡侧血管逆行岛状筋膜皮瓣修复拇指指腹缺损的手术方法及临床效果。方法：自1999年5月一2002年2月，对11例应用拇指桡侧血管逆行岛状筋膜皮瓣修复拇指指腹缺损。在第一掌骨桡背侧设计皮瓣，自甲根部桡侧线至第一掌骨同侧背侧绿的连线为轴心线，轴点位于指间关节近侧1cm以近的轴心线上。切取的皮瓣内含有桡神经浅支，转移后与创面指固有神经断端吻合。结果：19例皮瓣全部成活，随访7—28个月，质地柔软、耐磨，指腹两点辨别觉为6．6—8．1mm。供区无并发症，掌指关节活动正常。结论：该皮瓣具有不损伤主要动脉、神经，操作简便，质地良好，血供可靠等优点，重建的指腹感觉恢复满意，是修复指腹缺损的较好方法。     

胃癌流行病学的内镜调查

胃癌流行病学的内镜调查刘光军金成兰陈红雨孙玉芝Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓｓｔｏｍａｃｈｎｅｏｐｌａｓｍｓ／ｅｐｉｄｅｍｉｏｌｏｇｙ；ｅｎｄｏｓｃｏｐｙ，ｇａｓｔｒｏｉｎｔｅｓｔｉｎａｌ；ｓｔｏｍａｃｈｎｅｏｐｌａｓｍｓ／ｄｉａｇｎｏｓｉｓ主题...