喉返神经解剖在甲状腺手术中的应用研究

目的探讨解剖喉返神经在甲状腺手术中的应用。方法回顾分析因甲状腺疾病行手术治疗的236例患者的临床资料,共施行甲状腺手术335侧次;甲组101例行甲状腺手术158侧次,术中均未解剖喉返神经,其中57例行双侧甲状腺手术。乙组135例行甲状腺手术同时解剖喉返神经177侧次,其中42例因双侧甲状腺手术而行双侧喉返神经解剖。结果喉返神经损伤均发生在切除甲状腺范围包含背侧腺体时。甲组暂时性损伤2例,永久性损伤1例,损伤率为1.9%;乙组暂时性损伤1例,无永久性损伤病例,损伤率为0.56%;两组差异有统计学意义(χ2=0.382,P<0.01)。结论甲状腺手术中解剖喉返神经能减少喉返神经的损伤,切除背侧腺体时应常规解剖喉返神经。     

改良犬原位背驮式肝移植的解剖学观察

目的观察犬肝脏解剖学特点,探索建立改良的犬同种异体原位背驮式肝移植模型。方法对15只杂交犬的肝脏进行活体和尸体标本的解剖观察。结果犬肝共分7叶,门静脉分左右支进入肝脏,门静脉左支供应约70%肝组织(Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ叶),门静脉右支供应约30%肝组织(Ⅵ、Ⅶ叶),分别阻断门静脉左、右支后5 min左右门静脉压力达到峰值,并迅速回复至门静脉正常压力值上限范围内;肝动脉和胆管与门静脉分支伴行进入各肝叶;左肝静脉粗大,可以作为肝静脉重建的流出道,其余3~6支肝静脉可以分别结扎,肝后下腔静脉易于与肝脏分离。结论犬肝的解剖学特点适宜于建立改良的原位背驮式肝移植模型。     

Computer-assisted LISS plate osteosynthesis of proximal tibia fractures: feasibility study and first clinical results.

Fluoroscopy is the most common tool for the intraoperative control of long-bone fracture reduction. Limitations of this technology include high radiation exposure for the patient and the surgical team, limited visual field, distorted images, and cumbersome verification of image updating. Fluoroscopy-based navigation systems partially address these limitations by allowing fluoroscopic images to be used for real-time surgical localization and instrument tracking. Existing fluoroscopy-based navigation systems are still limited as far as the virtual representation of true surgical reality is concerned. This article, for the first time, presents a reality-enhanced virtual fluoroscopy with radiation-free updates of in situ surgical fluoroscopic images to control metaphyseal fracture reduction. A virtual fluoroscopy is created using the projection properties of the fluoroscope; it allows the display of detailed three-dimensional (3D) geometric models of surgical tools and implants superimposed on the X-ray images. Starting from multiple registered fluoroscopy images, a virtual 3D cylinder model for each principal bone fragment is constructed. This spatial cylinder model not only supplies a 3D image of the fracture, but also allows effective fragment projection recovery from the fluoroscopic images and enables radiation-free updates of in situ surgical fluoroscopic images by non-linear interpolation and warping algorithms. Initial clinical experience was gained during four tibia fracture fixations that were treated by LISS (Less Invasive Stabilization System) osteosynthesis. In the cases operated on, after primary image acquisition, the image intensifier was replaced by the virtual reality system. In all cases, the procedure including fracture reduction and LISS osteosynthesis was performed entirely in virtual reality. A significant disadvantage was the unfamiliar operation of this prototype software and the need for an additional operator for the navigation system.     

腹腔镜在体表未触及隐睾诊治中的应用(附1例报告并文献复习)

目的探讨腹腔镜在体表未触及隐睾诊治中的应用。方法通过对1例术前双侧均未触及睾丸的隐睾患者行腹腔镜检查和治疗并结合文献复习。结果对于在体表未触及的隐睾均可以通过腹腔镜达到明确诊断和治疗。结论腹腔镜诊治腹腔型隐睾是一种临床适用性较强的手术方法,在很大程度可以代替开放的剖腹探查术,具有较高的临床推广应用价值。     

间隙连接蛋白家族新成员Cx36

Cx36是哺乳动物间隙连接蛋白(connexin,Cx)家族γ亚类的第一个成员,它参与形成间隙连接,介导相邻细胞间的物质和信息的直接交换。间隙连接是神经系统构成电突触的结构基础,参与调控神经冲动信息的传递和复杂神经网络的整合,而Cx36是唯一一个在神经系统中优先表达的Cx,因此成为电生理研究领域的热点。就Cx36的发现过程、结构和定位进行了总结,并着重介绍它在神经系统中的功能和调节机制。     

术中使用缓释型5-FU对于进展期结肠癌的疗效研究

随着生活水平的提高,恶性肿瘤的发病率也逐年增高,最新资料统计表明,目前全球结肠直肠癌病人每年有100万之多[1]。在我国其发病率近年来也呈明显上升趋势,到目前为止,结肠直肠癌病人的术后5年生存率也一直徘徊在50%左右[2]。因而如何有效地进行结肠肿瘤治疗,无论是在手术还是在其他辅助治疗方面都值得我们深入地探讨和研究。     

群集钙化对鉴别乳腺良恶性病变的意义

目的评价乳腺钼靶片群集钙化对鉴别乳腺良恶性病变的意义。方法分析76例乳腺X线钼靶片群集钙化病例,全部经手术病理证实,其中,乳腺恶性病变52例,良性病变24例。采用下列4项指标分析上述76例群集钙化的特征并进行良恶性对照研究:a)病灶钙化总数;b)每平方厘米钙化数目(N/S);c)钙化灶的大小、形态;d)钙化灶合并肿块。结果76例群集钙化病例中钙化总数大于30个、N/S大于等于10个、钙化灶大小形态不一致、钙化合并肿块,这4项指标诊断恶性钙化的特异性和敏感性分别为83.3%和69.2%,79.2%和76.9%,62.5%和92.3%,62.5%和53.8%。结论N/S大于等于10个、钙化总数大于30个及钙化灶大小、形态不一致这3个特征对恶性钙化最具有诊断价值。     

硬化注射治疗直肠前突的临床研究

目的：探讨硬化注射法治疗直肠前突的有效性。方法：将80例中度及中度以上的直肠前突患者随机分成两组，各40例。试验组行硬化注射法治疗，对照组行经阴道切开修补，并观察两组的治疗效果及并发症。结果：治疗后患者症状评分较治疗前降低，两组治疗效果相比无统计学差异。但治疗组在术中出血、术后疼痛等并发症方面则优于对照组。结论：硬化注射法是一种简便有效的治疗直肠前突的方法。     

Treatment of severe subglottic laryngotracheal stenosis using hyoid graft with sternohyoid muscle flap]

OBJECTIVE: To evaluate the possibility and reliability of the hyoid-sternohyoid graft transfer in the correction of server subglottic laryngotracheal stenosis, and delineate the operation skills and clinical results. METHODS: Seven patients with severe subglottic stenosis underwent laryngotracheal reconstruction using the hyoid grafts with sternohyoid muscle flaps (HG-SHMF). Five of these patients had traumatic subglottic stenosis, one with scar tissue of unknown etiology arising in the subglottic region, another with tracheal narrowing caused by inhalation of hydrochloric acid. RESULTS: All seven patients were successfully decannulated with moderate good voice. The average time from reconstruction to decannulation was 15.4 months. The stent was endoscopically removed with a range of 3 to 22 months; the mean time required for stenting was 9.6 months. Two patients who received additional salvage reconstruction procedures because of graft or stent displacement were extubated with improved voices and satisfactory airway. CONCLUSIONS: The HG-SHMF transfer was a single-stage reconstruction, relatively simple procedure that can restore an adequate airway and a good voice. Patients undergoing laryngotracheal reconstruction with HG-SHMF must have regular, long-term follow-up since graft displacement and recurrent granulation tissue or scar reformation can cause restenosis after an initially successful surgery. This procedure should be used in a large number of patients to further test its reliability.     

内镜活检对胃癌组织学分类术前诊断的价值

目的 探讨内镜活检对胃癌组织学分类术前诊断的价值。方法 术前对141例胃癌患的内镜活检标本分别根据Lauren分类和世界卫生组织（WHO）分类判断组织学分类，并与手术标本结果对照。结果 内镜活检对胃癌Lauren分类术前诊断的准确率为76.6%。对肠型胃癌诊断的敏感性和特异性分别为85.4%和80.6%。而对弥漫型胃癌则分别为82.7%和80.3%，在59例术前诊断为肠型胃癌的病例中，18例（30.5%)在手术标本中呈弥漫性行生长，而在75例术前诊断为弥漫型胃癌的病例中，仅6例（8.0%)术后诊断为肠型胃癌，内镜活检对胃癌WHO分类术前诊断的准确率为87.2%，其中对乳头状/管状腺癌，黏液腺癌和印戒细胞癌的敏感性分别为91.9%。33.3%和66.7%。结论 内镜活检对胃癌组织学分类的术前诊断具有较高的临床应用价值。