微型钛板在下颌骨骨折中的应用研究

目的探讨微型钛板坚固内固定治疗下颌骨骨折的临床疗效。方法 2005年6月至2009年12月共收治下颌骨骨折病例12例,应用小型钛板固定技术治疗,随访及评价伤口及骨折愈合情况、手术前后咬合关系及开口度的对比。结果术后12例患者均获随访,随访3～6个月。12例患者术后伤口均无感染,伤口均一期愈合。局部咬合关系不良者1例。术后3个月时仅1例患者张口受限。术后3个月时,X线复查未见骨愈合不良或假关节形成者。结论微型钛板坚固内固定治疗下颌骨骨折疗效满意。     

内膜下血管成形术治疗下肢动脉慢性缺血

Objective To assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.     

周围静脉畸形281例手术治疗分析

目的：分析周围静脉畸形的手术治疗经验。方法：1996年12月至2004年4月共手术治疗周围静脉畸形28l例。根据临床观察及磁共振(MRI)检查结果分为局限性非浸润型、局限性浸润型、弥漫性非浸润型及弥漫性浸润型等4型，按不同分类，采用不同的手术方式，如病变切除术、病变手术翻瓣联合Nd：YAG激光治疗术及病变手术切除联合Nd：YAG激光治疗术。结果：经随访3月～7．5年，局限性非浸润型总有效率为98．1％。复发率为1．9％。并发症发生率为1．9％，而弥漫性浸润型总有效率为85．2％，复发率为14．9％，并发症发生率为21．0％。结论：静脉畸形的治疗仍是临床难题之一，根据病变分类采用不同的手术方式是必要的，对于弥漫性病变，手术联合Nd：YAG激光治疗术是一种安全、有效、并发症少的新术式。     

案例分析法在医学伦理学课程中的运用

案例分析是医学伦理学课程教学中常用的方法。但其实效如何,却因人而异。我们认为,切实重视案例分析的选择与设计,深入探求案例分析法在教学中的运用,方能事半功倍,教学相长。     

内膜下血管成形术治疗下肢动脉慢性缺血

Objective To assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.     

彩色多普勒超声在静脉畸形腔内激光治疗中的应用

目的 探讨多普勒超声在静脉畸形(venous malformations,VM)腔内激光治疗中的应用.方法 12例VM患者在腔内激光手术治疗中应用超声辅助定位,观察腔内激光治疗后病灶吸收情况.结果 经过激光作用的病灶内表现为等回声及高回声区域,多普勒模式下见血流信号的充盈范围明显缩小.术后随访发现原病灶内表现为均一的等回声区域,边界不清,无明显血流信号充盈.术后所有患者均无皮肤灼伤、神经功能障碍等.影像学及症状的改善均令人满意.结论 VM腔内激光治疗中应用超声,不仅操作简便,而且定位准确,保障了激光治疗的安全性并能客观的评价治疗效果,临床上具有很好的应用前景.     

DIOMED激光治疗下肢静脉曲张

目的 评价DIOMED激光治疗下肢静脉曲张的应用。方法 42例患者，共49条患肢均行激光或激光结合手术治疗。主要有四种手术治疗方式：(1)单纯激光治疗，共9例11条肢体；(2)激光治疗结合高位大隐静脉结扎术，共14例19条肢体；(3)激光治疗结合股浅静脉瓣膜包窄术和大隐静脉高位结扎术。共14例14条肢体；(4)激光治疗结合大隐静脉高位结扎和交通支结扎术。共5例5条肢体。结果 所有的患者已随访1～20个月，平均5．66个月，都恢复正常的生活自理或工作。也无局部复发的临床表现，均取得满意的疗效。结论 静脉腔内激光治疗一种新的治疗方法。具有安全、有效、微创、疗效好、操作简便和不遗留手术瘢痕等优势，还可联合手术治疗。     

案例分析法在医学伦理学课程中的运用

案例分析是医学伦理学课程教学中常用的方法。我们认为,切实重视案例分析法在教学中的合理运用,方能事半功倍,教学相长。一、案例选择与设计的原则医德案例种类繁多,教学中不可能也不应该随手拈来,一一列举,而必须认真选择,精心设计,核心的问题就是要遵循“新、近、精、难”的原则。1.新——案例应是近几年发生的,市场经济条件下出现的新情况与新问题,应对医学生有现实教育意义。2.近——应尽量选择本地区医疗部门和所在院校附属医疗单位发生的医德案例,让医学生看得见,摸得着,加深感触。3.精——案例应是经过文字和技术处理,颇有条理、颇具…     

内膜下血管成形术治疗下肢动脉慢性缺血

Objective To assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.     

Angiojet机械吸栓治疗在手术相关下肢深静脉血栓患者中的应用及疗效

目的:评价Angiojet机械吸栓治疗手术相关下肢深静脉血栓形成(DVT)患者的早期疗效和安全性。方法:回顾性分析2015年9月—2017年1月91例急性DVT(中央或者混合型)患者临床资料,其中30例为手术相关DVT(观察组),61例为非手术相关DVT(对照组),两组患者均首选Angiojet吸栓治疗,后续辅以导管接触性溶栓(CDT)或支架植入,比较两组患者相关临床指标。结果:两组患者术前一般资料无统计学差异(均P0.05)。两组患者支架植入率、支架直径和长度差异均无统计学意义(均P0.05),对照组平均溶栓时间明显长于观察组(2.31 d vs. 1.50 d,P0.05)。两组均无大出血事件及死亡、心血管事件等严重并发症发生,对照组和观察组分别出现6例和4例穿刺点出血,及新发2例及1例症状性肺动脉栓塞,差异均无统计学意义(均P0.05)。两组术后1年通畅率(对照组:88.52%vs.观察组:90.00%)、VRI评分及Villalta评分差异均无统计学意义(均P0.05)。结论:Angiojet吸栓治疗用于手术相关DVT安全且有效。