衰老所致泪槽和睑颊沟出现的断层解剖学研究

目的 研究老年泪槽及睑颊沟形成出现的机制.方法 采用4具60岁以上泪槽及睑颊沟明显显现的尸体标本(男2具,女2具,平均年龄67.2岁),及4具30岁以下无明显泪槽及睑颊沟出现的尸体标本(男2具,女2具,平均年龄23.5岁).对他(她)们的下睑及眶周区域做逐层解剖及断层解剖学检查,通过大体标本及组织切片观察结果,比较两组间差异.结果 老年标本的皮肤、眼轮匝肌均较年轻标本萎缩、松弛,在眼睑较薄皮肤与颧颊部较厚皮肤的交界部位形成泪槽与睑颊沟畸形;年轻人颧部脂肪上缘高于眼轮匝肌睑部与眶部的结合部,老年人颧部脂肪上缘处于眼轮匝肌睑部与眶部的结合部,与泪槽及睑颊沟出现的位置相对应;眼轮匝肌限制韧带起于眶下缘并止于眼轮匝肌睑部与眶部的结合部及眶部眼轮匝肌,老年人较年轻人松弛.结论 泪槽和睑颊沟的形成是衰老的进程所致各层组织松弛、萎缩和下移等综合因素共同作用的自然生理变化的结果,尤其是颧部脂肪上部的萎缩与下移;眶隔及眼轮匝肌限制韧带限制组织下移的作用可能是眶下缘凹陷更加凸显的原因.     

Radial nerve injury during double plating of a displaced intercondylar fracture

Double-plate fixation is a popular treatment method for intercondylar humeral fractures. Ulnar nerve complications are emphasized, but radial nerve complications are rarely mentioned. We present a case of iatrogenic radial nerve palsy following open reduction and double plating of a supracondylar/intercondylar fracture of the humerus. Before surgery, only a sensory deficit in the radial nerve territory was present, but after surgery, there was a complete motor deficit of the wrist and finger extensors. On exploration, a segment of nerve was found crushed within the reduced lateral condyle fracture site, with a screw from the posteroradial plate going through the nerve. Although rare, radial nerve injury can occur with posteriorly displaced supracondylar/intercondylar humerus fractures. When preoperative signs of radial nerve injury are present, we recommend that the radial nerve be identified and protected during double-plate fixation.     

Association of metabolic syndrome, atherosclerosis risk factors, sex hormones in ED in aboriginal Taiwanese

The overall prevalence of metabolic syndrome (MS) in aboriginal male Taiwanese is very high. Many studies have found that those with cardiovascular disease and MS have a significantly higher risk of ED. In this study, we attempted to find the correlation among MS risk factor, atherosclerosis risk factors and low serum testosterone in relation to the development of ED. This was a cross-sectional study of 238 cases, and collected data included demographic data, lifestyle questionnaires, sexual desire scale, sexual satisfaction scale and International Index of Erectile Function (IIEF) questionnaire. Among our 238 subjects, 146 had MS (61.3%) and 114 subjects with MS had ED (85.7%). Using age-adjusted multivariate logistic regressive analysis, this study showed that aboriginal males with ED had a significantly higher prevalence of MS (OR=12.02, 95% confidence intervals (CI): 6.33-22.83, P<0.001). Among the MS components, abnormal fasting blood sugar was the most significantly independent factor for ED in aboriginal males (OR=8.94, 95% CI: 4.71-16.97, P<0.001). The presence of MS had a significant correlation with lower IIEF-5 scores, lower sexual desire scores, lower testosterone serum level (P<0.01) and abnormal interleukin-6 (IL-6) and high sensitivity C-reactive protein (HsCRP). The results of this study support the idea that MS, low serum testosterone and HsCRP may predict ED in aboriginal Taiwanese males. Further studies with population-based and longitudinal design should be conducted to confirm this finding and design to compare rates of ED in aboriginal men with MS.     

管状胃在食管癌切除术颈部吻合中的应用

目的探讨管状胃在食管癌切除术食管胃颈部吻合中的临床应用,总结其经验。方法将苏北人民医院2007年1月至2009年1月经"颈、胸、腹"三切口手术治疗食管癌患者850例,按手术先后分成A、B两组。A组行管状胃代食管手术,共425例,男287例,女138例;年龄(58.2±11.5)岁,其中食管上段癌27例,食管中段癌346例,食管下段癌52例。B组行全胃代食管手术,共425例,男298例,女127例;年龄(58.5±12.8)岁,其中食管上段癌33例,食管中段癌338例,食管下段癌54例。观察两组患者手术时间、住院时间以及术后吻合口瘘、吻合口狭窄、胸胃综合征、反流性食管炎等术后并发症的发生情况。结果全组患者均顺利完成手术,无死亡患者,A、B两组手术时间[(175.0±12.8)min vs.(171.0±10.5)min,t=1.702,P>0.05]和术后住院时间[(16.0±8.5)dvs.(16.3±8.8)d,t=1.773,P>0.05]差异均无统计学意义。术后随访6个月,无失访,A组吻合口瘘(χ2=5.550,P<0.05),反流性食管炎(χ2=9.150,P<0.05),胸胃综合征(χ2=10.500,P<0.05)等并发症发生率比B组低,且差异有统计学意义。两组吻合口狭窄发生率差异无统计学意义(χ2=0.120,P>0.05)。结论在经"颈、胸、腹"三切口治疗食管癌手术中,管状胃代食管更符合生理解剖要求,降低吻合口瘘、胸胃综合征及反流性食管炎等并发症发生率,改善患者术后生活质量。     

Choices of Surgical Approaches for Gastrointestinal Stromal Tumors of the Stomach: Laparoscopic versus Open Resection

Aims: The aim of this study is to explore the optimal surgical approach for gastrointestinal stromal tumors (GISTs) of the stomach in terms of the perioperative outcomes and long-term relapse-free survival. Methods: From January 2004 to July 2011, 156 patients who underwent either laparoscopic (LAP group, n = 68) or open surgery (OPEN group, n = 88) were included in the final analysis following the eligibility criteria. Results: Clinicopathological characteristics of the selected patients were similar between the two groups. The LAP group was associated with less blood loss (50 vs. 180 ml, p < 0.001), shorter operating time (90 vs. 125 min, p < 0.001), earlier oral intake (3 vs. 5 days, p < 0.001), shorter postoperative hospital stay (8 vs. 10 days, p < 0.001), and low risk of postoperative complications (5.9 vs. 22.7%, p = 0.004) compared with the OPEN group. No significant difference was observed in 5-year relapse-free survival between the LAP and OPEN groups (94.2 vs. 94.0%, p = 0.807). The subgroup analysis of patients who underwent wedge resection showed similar results with the original comparison except that difference in complication rate between the two groups lost significance. Conclusions: Laparoscopic wedge resection for gastric GISTs ≤7 cm could get preferable short-term postoperative outcomes and similar long-term relapse-free survival compared with open surgery.     

颈椎闭合性创伤继发椎动脉损伤的研究进展

近年来国内外有关颈椎闭合性创伤合并椎动脉损伤的报道逐渐增多。献报道其发生率从19.7％～46％不等，并发现椎动脉损伤与单侧小关节移位、横突孔内有骨折片(即横突孔粉碎性骨折)之间有显相关性，旋转暴力可能是引起椎动脉阻塞的重要因素。椎动脉损伤在临床上可表现为视物模糊、晕厥、吞咽困难以及Wallenberg综合征等。磁共振血管成像(MRA)是一种诊断椎动脉损伤的无创检查，且易于在患行磁共振检查时同时进行，对闭合性颈椎创伤患，应常规行颅外血循环MRA检查，只有当患出现脑缺血症状时才考虑传统的血管造影。溶栓治疗对减低神经并发症及促进预后有待进一步研究，只有当患出现严重活动性出血或动脉介入影像学失败时才行手术治疗，外科暴露复杂并需对局部解剖知识非常了解。     

预防性肌瓣在小腿开放性骨折中的应用

目的探讨预防性肌瓣在治疗小腿Ⅱ、Ⅲ度开放性骨折中的应用效果。方法急诊一期彻底清创,选择髓内钉、外固定支架及钢板固定骨折,应用各种不同肌瓣覆盖骨折断端及缺损创面。结果临床应用15例,所有病例伤口均Ⅰ期愈合,无感染发生。随访1～3年,患者肢体功能恢复满意。结论预防性肌瓣一期应用对小腿Ⅱ、Ⅲ度开放性骨折及合并严重软组织缺损的治疗可取得良好疗效。     

慢传输型便秘患者粪菌移植治疗的护理

目的总结30例慢传输型便秘患者行粪菌移植(FMT)治疗的护理方法。方法对30例慢传输型便秘患者行粪菌移植治疗。治疗前做好入院宣教、供体护理、受者肠道准备,配制移植菌液,经鼻肠管注入菌液,移植后密切观察不良反应并做好饮食指导。结果经粪菌移植治疗后第12周,11例(36.7%)患者获得临床治愈,18例(60.0%)获得临床改善,1例无效。患者自主排便次数从治疗前的平均1.2次/周逐渐增加,至12周达4.2次/周。治疗后不同时间点生活质量评分显著低于治疗前(P0.05,P0.01)。结论粪菌移植治疗慢传输型便秘效果良好。在粪菌移植治疗中,供体筛查的准确性、菌液提取与配制、移植前后患者适应性以及移植后肠康复中饮食、活动指导等是护理的重点。