不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.     

胆囊鳞癌及腺鳞癌临床病理特征分析及预后预测模型构建

目的 分析胆囊鳞癌和腺鳞癌的预后影响因素并构建预后预测模型。方法 回顾性分析2012年1月至2021年12月东方肝胆外科医院行外科手术切除的114例胆囊鳞癌及腺鳞癌患者的临床资料。通过单因素和多因素Cox回归分析确定胆囊鳞癌和腺鳞癌的预后影响因素,并构建列线图（Nomogram）预测模型。应用C-指数、ROC曲线以及校准曲线对模型进行评估。结果 单因素分析结果提示,T分期、TNM分期、切缘性质、血管侵犯、联合肝切除、淋巴结清扫是胆囊鳞癌和腺鳞癌患者术后生存的影响因素。多因素Cox回归分析提示,只有T分期、联合肝切除是鳞癌和腺鳞癌患者术后生存的重要影响因素,此时赤池信息测量准则（AIC）值最小（720.66）,并据此建立胆囊鳞癌和腺鳞癌Nomogram预测模型。该模型C-指数为0.614(95%Ci 0.585～0.643)。1年、2年、3年ROC曲线下面积分别为0.605、0.598、0.592。校准曲线图可见实际观测值与预测值具有较好的一致性。结论 T分期、联合肝切除是胆囊鳞癌和腺鳞癌患者术后生存的重要影响因素,据此建立的Nomogram具有一定的区分度和准确度,有一定的临床参考价值...     

单侧唇裂继发畸形的美学修复

目的 探讨单侧唇裂继发畸形与I期手术方式选择的关系,以及进行唇裂继发畸形美学修复的策略.方法 选择单侧继发唇裂120例,根据I期采用的不同术式进行分组,对唇裂畸形进行观察和分析,采用个体化设计,进行美学修复.对采用Millard、Tennison、矩形瓣及上三角瓣法的单侧唇裂继发畸形修复后,观察上唇人中窝形念、瘢痕、唇峰形态的恢复.结果 显示原采用Millard方法、上三角瓣方法优于Tennison方法和矩形瓣方法.Ⅱ期修复术后效果满意.结论 单侧唇裂I期采用的手术方式对继发畸形的程度和修复有显著影响.     

乳头乳晕坏死1例治疗报告

患者女性,23岁,未婚.因双侧巨乳伴重度乳房下垂,在我院行巨乳缩小矫正术,手术采用垂直切口、乳头乳晕上方真皮腺体蒂移位的缩小方法.乳头乳晕移位12 cm,单侧腺体组织切除量620 g.术后第2天,一侧乳头乳晕血运良好,另一侧乳头乳晕颜色发紫,静脉淤血,经局部穿刺放血、高渗溶液湿敷等治疗,乳头仍完全坏死,仅残留很少部分乳晕组织.     

腰椎棘突间撑开器的研究进展

腰椎棘突间撑开器作为动态稳定系统的重要内容,通过在棘突间置入撑开装置,除了对病变节段的后伸活动有一定限制外,基本保留了椎间的生理活动,扩大了椎管以及椎间孔的容积,减轻了椎间盘后部的负荷,且对相邻节段的活动和负荷传递并没有明显的影响。从现有的资料来看,多种棘突间撑开器的生物力学和临床研究结果均令人鼓舞,本文就其应用研究现状进行了综述。     

FGFR3在大鼠肝硬化模型中的动态表达研究

目的：观察大鼠肝硬化形成过程中成纤维细胞生长因子受体3（Fibroblast growth factor receptor3,FGFR3）的表达变化。方法：70只雄性SD大鼠,随机取10只作为对照组,其余60只作为肝硬化组。采用剂量频次渐变式四氯化碳（CCL）腹腔内注射建立肝硬化大鼠模型。检测2组大鼠的血清ALT、体重、肝体比,病理组织行包括HE和嗜银染色．并采用荧光定量聚合酶链反应（real—timePCR）和蛋白质印迹（Western blot）检测FGFR3基因和相应蛋白在肝硬化形成过程中的表达变化。结果：肝硬化组大鼠的血清ALT、肝体比和死亡率均显著高于对照组（P均〈0．01）;而体重则显著低于对照组（P〈0．01）;肝硬化组大鼠肝组织大体观察、HE染色及嗜银染色均呈明显肝硬化表现,而对照组则无该表现：real-timePCR及Western-blot结果显示,FGFR3在肝硬化形成过程中总体表达逐渐增强。结论：剂量频次渐变式GEl4腹腔内注射法是一种高效、低成本的大鼠肝硬化建模方法。而肝组织FGFR3在肝硬化发生、发展过程中的动态表达在一定程度上反映了肝纤维化及肝硬化程度。     

慢性胰腺炎胰管结石的内镜介入与手术治疗

目的 探讨内镜介入及外科手术治疗慢性胰腺炎(CP)胰管结石的长期疗效.方法 回顾分析1997年至2006年间在第二军医大学附属长海医院住院期间经内镜介入或外科手术治疗的疼痛性CP胰管结石病人的病历资料,随访疗效.结果 入组119例.成功随访113例(95%),男:女=1.4 : 1,平均年龄37.4岁,平均随访时间41.8个月,内镜介入治疗组84例,外科手术组29例.内镜组与外科手术组中分别有近87%和76%病人的腹痛得到了完全或部分缓解(P>0.05).糖尿病和腹泻发生率在内镜治疗和手术治疗后均无显著减少,体重减轻发生率在治疗后均有好转.结论 内镜介入和外科手术治疗疼痛性CP胰管结石疗效类似.     

蜡油样骨病一例

患者，女性，33岁。因左下肢隐痛16年，左髋，左膝活动逐渐受限并于2个月前左膝屈曲完全受限入院。查体：发育良好，头，颈，胸腹部，脊柱未见明显异常，左下肢较对侧长2cm，无明显肌萎缩；     

自制气管切开外套管固定带的制作与应用

目的探讨自制气管切开外套管固定带的临床应用效果。方法将气管切开术后66例患者随机分为观察组与对照组各33例。观察组用自制的气管切开外套管固定带,对照组按常规使用布衬带为气管外套管固定带,其他护理措施一致。结果两组皮肤损害发生率、发生程度、发生时间和持续时间比较,差异有统计学意义（P〈0．05,P〈0．01）。结论行气管切开术后使用自制的气管外套管固定带有效防止了颈部皮肤的损害．避免了感染,患者感觉舒适,操作简便,耗材低廉。     

不同敷料组合对烧伤患者供皮区创面微环境的影响

Objective To investigate the effect of dressing materials in various combinations on bum wound microenvironment and healing condition. Methods Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skingrafting and admitted to our ward were enrolled in study, and they were divided into A ( with dressing composed of aiginate + cotton pad for donor area), B ( with dressing composed of vaseline gauze + cotton pad for donor area) , C (with dressing composed of algi-nate+ foam dressing for donor area), D ( with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared. Results One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporaton in respectively, among them B group showed optimal effect of keeping humidity (P<0.01). Wound pH value in A, B, C, D groups was 7.22±0.06, 7.41±0.03, 7.05±0.03, 7.34±0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98±0.12), and most serious in B group ( score was 8.14±0.82). The shortest wound healing time was seen in C group (6.7±0.8 d) , and longest in D group (15.6±3.5 d). Conclusions Application of various dressings on similar wounds can pro-duce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.