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。     

颈部开放性血管损伤的救治

目的总结开放性颈部血管损伤的救治经验。方法回顾性分析2000年1月至2012年6月期间解放军第89医院普通外科和全军创伤骨科研究所收治的26例颈部血管损伤患者的临床资料。结果 26例患者24例获得成功救治,其止血彻底,无继发性出血,无因脑部供血不足产生的功能障碍;2例分别因颈内静脉和颈内动脉损伤致窒息或呼吸心跳骤停死亡。2例患者颈部伤口延期愈合。结论对于开放性颈部血管损伤,保持呼吸道通畅、抗休克、压迫及手术探查止血是成功救治的基础;对损伤的大血管首选吻合;娴熟的血管外科和显微外科技术是血管修复重建成功的重要手段。     

双足(踇)甲皮瓣组合移植再造拇指末节

目的 介绍游离双足(踇)甲皮瓣组合移植再造拇指末节的术式.方法 以健侧手指测量数据为依据,设计切取双足(踇)趾腓侧小部分骨甲皮瓣,通过“镜影式”组合两个复合组织瓣再造拇指末节.结果 临床应用6例6指全部存活,术后随访3～9个月,再造拇指指腹饱满,两点分辨觉5～8mm,外形逼真,指甲生长良好,关节活动度正常.双侧(踇)趾供区直接缝合后均Ⅰ期愈合,双足(踇)趾对称,外观良好,关节活动无影响,无功能障碍.结论 双足(踇)甲皮瓣组合移植再造拇指末节,供区创伤小,保留了(踇)趾外形和趾甲,再造拇指末节外形逼真,是再造手指较为理想的手术方式.     

足踝部大面积皮肤软组织缺损的综合治疗

我科对足部皮肤软组织缺损面积大,创面感染深达骨、关节的25例患者,在彻底清创的基础上进行外科分期治疗,一期负压封闭引流（VSD）,二期皮瓣覆盖,三期全厚皮片植皮覆盖剩余创面,取得较好的临床效果.报告如下.     

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.     

远端蒂腓肠神经营养血管肌皮瓣的临床应用

[目的]介绍带肌肉的腓动脉穿支蒂腓肠神经营养血管皮瓣修复小腿下段及踝足部软组织缺损的临床效果.[方法]自2004年6月以来,应用带肌肉的腓动脉穿支蒂腓肠神经营养血管皮瓣修复小腿下段及足踝部软组织缺损16例,其中胫骨下段开放性骨折伴软组织缺损6例,胫骨下段软组织缺损伴慢性骨髓炎5例,足后跟足底软组织缺损伴跟骨表层组织缺损3例,跟骨骨髓炎伴窦道2例,皮瓣面积30 cm×10 cm～6 cm×4.5cm,切取的腓肠肌瓣面积4 cm×3 cm～9 cm×6 cm,肌肉厚度1～3 cm,皮瓣面积比肌瓣的面积要大.[结果]术中观察切取的肌皮瓣的肌肉面、皮瓣边缘渗血均活跃,血运良好;术后皮瓣全部成活.经5～17个月随访,开放性骨折伤口Ⅰ期愈合,无感染,骨髓炎无复发,肌皮瓣质地优,外形满意,大部分恢复感觉,行走及负重良好.[结论]带肌肉的腓肠神经营养血管皮瓣血运丰富,成活可靠,操作简便,是修复小腿下段及足踝部软组织缺损的一种有效可行的方法.     

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...