36例隆突性皮肤纤维肉瘤临床诊疗分析

目的:分析隆突性皮肤纤维肉瘤误诊率、复发率高的原因,探讨提高治愈率的策略.方法:回顾性分析36例隆突性皮肤纤维肉瘤患者的临床和病理资料.全组病例均行肿瘤局部扩大切除术,切缘距离肿瘤缘2.5～3.0 cm,术中快速冷冻切片病理检查至边缘和基底阴性.创面行皮片或皮瓣移植修复,3例多次复发患者手术切除同时行125I放射性粒子组织间植入治疗.结果:临床首诊误诊率高达63.8%(23/36).36例扩大切除后创面一期愈合率95%.中位随访时间3.4(1～6)年,共4例(11.1%)复发,3例辅以125I粒子植入治疗者,随访1～2年均未复发.全组病例未发现远处转移和死亡.结论:隆突性皮肤纤维肉瘤临床症状不典型是误诊率高的主要原因,病理检查是明确诊断的方法,手术扩大切除是提高治愈率的关键,放射性粒子组织间近距离治疗是较好的辅助疗法.     

特重度烧伤合并腹腔内高压对肾功能影响的相关性研究

目的:观察特重度烧伤患者腹腔压力增高对肾功能的影响?方法:选择16例特重度烧伤患者,根据腹内压(intra-abdominal pressure ,IAP)的测量值分为两组,IAP≥12 mmHg为腹内高压组,IAP < 12 mmHg为对照组,每日1次在固定时间检测患者腹腔压力,记录平均动脉压?尿素氮?肌酐?尿量?出入量等指标的变化?结果:腹内高压组的尿素氮?肌酐的变化与腹内压的改变呈正相关(P < 0.05),而腹内压与平均动脉压和尿量无明显的相关性(P > 0.05)?结论:腹腔压力的上升与肾功能的指标具有相关性?对具有腹内高压危险因素的特重度烧伤患者应常规监测腹内压的变化,采取及时有效的治疗措施,用以预防腹腔内高压及腹腔间隔室综合征的发生与发展?     

负压辅助愈合治疗系统在修复下肢软组织缺损中的应用

下肢软组织损伤和(或)合并开放性骨折,是整形外科的常见疾患.传统的治疗方式多采用常规换药,待肉芽生长后植皮或应用皮瓣或肌皮瓣修复缺损,病程长.常规换药对促进创面肉芽生长的效果较差.我们应用负压辅助愈合治疗系统辅助治疗下肢软组织损伤和(或)合并开放性骨折患者23例,效果良好.现报道如下.     

两种负压创面治疗技术临床疗效比较

Objective To compare the differences of the clinical effects, side effects and treatment-related cost between two kinds of negative-pressure wound therapy (NPWT). Methods Forty-four inpa-tients with acute, subacute, and chronic wounds were divided into simplified NPWT group ( A group) and conventional NPWT group ( B group) according to the random number table. Wounds of patients in A group were treated with gauze + continuous suction with hospital central negative pressure ( -10.64 kPa) for 24 hs; wounds of patients in B group were treated with sponge + interrupted suction with a purpose-designed suction appliance ( -16.63 kPa) for 24 hs. Gross wound condition, treatment time, survival rates of skin graft and flap, changes of bacterial species on wound, treatment cost, and ratio of side effects between two groups were compared. Results There was no significant difference between A and B groups in respect of gross wound condition, treatment time [ A group (29 ± 12) d, B group (26 ± 13) d, P > 0. 05 ], changes of bacterial species, survival rates of skin graft [ A group (98 ± 4 ) % , B group ( 98 ± 4 ) % , P > 0. 05 ] and flap (A group 98% , B group 100% , P >0.05). Treatment cost of A group $ (374 ± 134) was obviously lower than that of B group $ (9825 ± 4956) ( P <0. 01 ), while more side effects were observed in A group (33.3%) than that in B group (5.0%) ( P < 0.05 ). Conclusions Both simplified NPWT and NPWT with purpose-designed appliance ean effectively improve wound healing. The simplified method may cause many side effects and has a potential risk of inciting nosocomial infection, but it can be conveniently employed with a low cost. In contrast, the cost of using purpose-designed appliance should be cut down to meet the aim of generalization.     

小切口皮下修剪法治疗腋臭92例体会

目的:探讨采用小切口皮下修剪法治疗腋臭的疗效。方法:92例双侧腋臭患者在局部肿胀浸润麻醉下行小切口皮下修剪法腋臭根治术,术后加压包扎固定,观察疗效及并发症的发生。结果:92例患者治愈81例,有效11例。结论:小切口皮下修剪法腋臭根治术是目前治疗腋臭的较好方法之一。     

cyclinD1?p16?cyclinA1在瘢痕疙瘩和增生性瘢痕中的表达及意义

目的:观察瘢痕疙瘩和增生性瘢痕中成纤维细胞的cyclinD1、p16和cyclinA1的表达,探讨其表达的差异与两种不同类型瘢痕的形成之间的关联性.方法:实验组分为瘢痕疙瘩和增生性瘢痕两组,以正常皮肤组织作为对照组.通过SP免疫组化检测两实验组中cyclinD1、p16和cyclinA1的表达.结果:cyclinD1在瘢痕疙瘩的阳性表达率为91.7%,显著高于增生性瘢痕组的45.5%以及对照组(P<0.05);P16在增生性瘢痕的阳性表达率为81.8%,显著高于瘢痕疙瘩组的33.3%以及对照组(P<0.05);cyclinA1在瘢痕疙瘩的阳性表达率为75.0%.显著高于增生性瘢痕组的27.3%(P<0.05);cyclinD1和cyclinA1在增生性瘢痕组的表达率以及P16在瘢痕疙瘩组的表达率均高于正常皮肤组,但统计学分析其差异并不明娃.结论:在瘢痕的形成过程中,cyclinD1和p16作为一对细胞周期的正负调控因子和cyclinA1作为正调控因子的表达失衡对瘢痕的不同转归是重要的参与机制.     

中西医结合治疗妊娠合并重症肺炎临床体会

重症肺炎发病凶险,常因病情迅速恶化导致急性呼吸窘迫综合征、多脏器功能衰竭而死亡,病死率高;而妊娠期重症肺炎因其特殊性,更应引起临床的高度重视。本医院重症医学科采用中西医结合疗法救治妊娠期合并重症肺炎收到较好疗效,现结合典型病例介绍如下。     

可逆性后部脑病综合征1例

1 病历摘要 患者,女性,32岁,孕26周,主因头痛2d,视物不清3h,意识不清50min入院.患者孕期未做规律产前检查.于入院前2d无明显诱因出现前额部持续性钝痛,下肢肿胀.入院前1d头痛加重,伴有非喷射性频繁恶心、呕吐.呕吐物为胃内容物.入院前3h诉视物不清,50min前出现意识不清,无抽搐.既往体健,否认高血压、肾脏病、癫病史.体格检查,血压30.7/17.3kPa,呼唤睁眼,不能言语,不能遵嘱活动,双侧瞳孔正圆等大,对光反射灵敏.周身浮肿,颈部抵抗,双侧巴氏征阳性.     

胰岛素对大鼠缺血随意皮瓣成活的影响

目的:观察胰岛素对SD大鼠背部缺血随意皮瓣成活的影响,初步探讨其对皮瓣缺血再灌注损伤的保护作用与提高皮瓣成活率之间的相关性?方法:制备6.0 cm×1.5 cm的大鼠背部任意皮瓣模型,实验组皮瓣下局部注射胰岛素0.1 U(1 ml),对照组注射等量生理盐水?测量注射前?注射后1?2?3 h血糖浓度,测定24 h后皮瓣组织内超氧化物歧化酶(SOD)?谷胱甘肽(GSH)?丙二醛(MDA)含量,测定7天后的皮瓣组织成活率以及免疫组化法测定皮瓣组织微血管的表达?结果:与对照组相比,胰岛素注射组在注射前?注射后1?2?3 h的血糖均无显著性差异(P > 0.05)?术后24 h,胰岛素组的皮瓣组织内的MDA含量显著低于对照组,而GSH?SOD水平显著高于对照组(P < 0.05);术后7天,胰岛素组皮瓣的成活率明显高于对照组,(73.963±8.649)% vs(56.175±4.250)%(P < 0.01);术后7天,胰岛素组的皮瓣微血管密度明显高于对照组,192.88±42.20 vs 101.00±22.99(P < 0.01)?结论:局部使用胰岛素能明显促进SD大鼠背部缺血任意皮瓣的成活;其机制与降低皮瓣的缺血再灌注损伤有关?