New hydronephrosis and/or vesicoureteral reflux after bladder outlet surgery without augmentation in 75 children with neurogenic bladder

ObjectiveWe report new upper tract changes in children after bladder neck (BN) surgery without augmentation for neurogenic incontinence.Materials and methodsConsecutive children with neurogenic sphincteric incompetency had BN surgery without augmentation. Postoperative renal sonography and fluoroscopic urodynamics were done at 6 months, 12 months, and then annually.ResultsThere were 75 patients with mean follow-up of 48 months. Of these, 17 (23%) developed new hydronephrosis (HN) or vesicoureteral reflux (VUR). All HN resolved with medical management, as did 25% of VUR cases. Persistent VUR was treated by dextranomer/hyaluronic acid injection, or re-implantation in two patients undergoing re-operative BN surgery. There was no association between these upper tract changes and end filling pressures (<40 cm vs. >40 cm) or continence status (dry vs. wet).ConclusionsUpper tract changes developed in 25% of patients with neurogenic bladders after BN surgery without augmentation during a follow-up of 48 months. All new HN and most new VUR resolved with medical management or minimally invasive intervention. No patient developed upper tract changes requiring augmentation.     

静脉镇静镇痛技术在隆乳术中的临床应用

目的介绍静脉镇静镇痛技术在局部麻醉隆乳术中的应用效果和体会。方法将606例ASAⅠ、Ⅱ级隆乳术患者分为四组,分别采用负荷剂量后持续输注异丙酚-芬太尼(P-F组,n=56)、咪唑安定-芬太尼(M-F组,n=130)、异丙酚-芬太尼-氯胺酮(P-F-K组,n=68)或咪唑安定-芬太尼-氯胺酮(M-F-K组,n=352)复合液的给药方法,调整注速维持镇静深度在改良的警觉/镇静评分2或3分。结果四组患者术中的镇静镇痛效果均满意,呼吸循环功能基本稳定,均在停药3~10min后清醒,但P-F-K组和M-F-K组患者的术中疼痛发生率及程度显著低于P-F组和M-F组。术后随访所有患者均对麻醉效果满意,仅P-F组和P-F-K组分别有11例和5例患者有模糊术中记忆。结论镇静镇痛技术是适用于隆乳局部麻醉手术简单、安全有效的理想麻醉方法,复合使用小剂量氯胺酮能明显减少术中疼痛的发生率,其中以咪-芬-氯复合镇静镇痛的术中疼痛和记忆发生率最低,程度最轻,是适于该手术的最佳镇静镇痛方法。     

MRI三维重建在聚丙烯酰胺水凝胶注射隆乳术后诊断中的应用

目的 探讨聚丙烯酰胺水凝胶注射隆乳术后分布的有效诊断方法.方法 对聚丙烯酰胺水凝胶注射隆乳术后的患者进行双侧乳房MRI薄层扫描(层厚1 mm,t2_ps3d_cor序列),在计算机上运用Amira电脑软件模块对扫描信息分别进行体积重建和表面重建,观察水凝胶的分布范围和部位,并计算其体积.结果 自2007年3月以来,于临床应用23例(46只乳房),其中5例(10只)水凝胶位于乳房后间隙,包膜完整,分布均匀,无移位;6例(12只)注射的水凝胶包膜不完整,形态不规则,边缘不整,呈多处散在的团块分布;11例(22只)水凝胶浸及胸大肌内、胸大肌后方、乳腺组织内和皮下,1例(2只)外院双侧取除水凝胶术后复查发现仍有少量残留,散在分布于乳腺及变性肌肉组织中.初次就诊的22例(44只)注射水凝胶的总体积为220.309～372.371 ml,平均306.328ml.结论 MRI三维重建能清晰显示注射物的体积和分布范围,可以有效地指导水凝胶的手术取除.     

聚丙烯酰胺水凝胶注射隆乳取出前行MRI检查的意义

目的 分析聚丙烯酰胺水凝胶(polyamide hydrogel, PAMHG)注射隆乳后取出术前行磁共振成像(MRI)检查的意义.方法 采用Philips 3.0T磁共振仪及4通道乳腺相控阵线圈,对20例共40只乳房曾注射PAMHG隆乳后取出术前的行双侧横轴位T1WI、T2WI-脂肪抑制(fat satura-tion,FS)及矢状位T2WI-FS平扫,其中8例用磁显葡胺(Gd-DTPA,0.1 mmol/kg,2.0 ml/s静脉团注)行THRIVE动态增强.对MRI表现与手术、病理结果 对照分析.结果 PAMHG于T1WI表现为与腺体相等信号,T2WI表现为明显高信号.PAMHG内见不同程度低信号间隔100%(40/40),与周围组织相间分布,无光滑囊壁90%(36/40),见T1WI及T2WI低信号、光滑均匀囊壁10%(4/40).MRI发现PAMHG皮下硬结70%(28/40),腺体内硬结20%(8/40),胸大肌下条带状弥散硬结100%(40/40),乳腺肋间肌肌间隙出现PAMHG游走10 0A(4/40).所有PAMHG隆乳材料均无对比增强,1例于乳腺腺体内发现不规则结节状增强.T2WI上所见PAMHG范围、表现与手术所见一致.结论 PAMHG取出术前T2WI-FS可以准确评价其分布范围及并发症,MRI平扫同时进行动态增强扫描可以鉴别腺体内的硬结并及时发现伴发的乳腺癌,对临床取出PAMHG具有重要的指导意义.     

Circumnipple-Incision, Longitudinal-Breast Dissection Augmentation Mammaplasty

A modification of circumnipple breast augmentation is described, which confines the minimal scar to the base of the nipple. Furthermore, a longitudinal breast parenchyma dissection is performed for breast pocket dissection that limits the injury of the lactiferous ducts and nerves to a minimum, and makes dissection and exposure of the pocket easier, even in patients whose nipples are small. This technique is especially useful in small breasts. We have performed this procedure in 57 patients, and the few complications to date are discussed in this paper.     

乳房假体隆乳术后并发症12例分析

目的 减少隆乳术并发症的发生，提高隆乳术的远期效果。方法 对１２例乳房假体隆乳术后１～１３年间出现并发症患者的临床表现及包膜病理变化进行分析讨论。结果 １２例１５侧乳房中，单侧９例并发１种并发症者４例，并发２种者４例，并发３种者１例；双侧３例，并发同一种并发症者２例，并发３种并发症者１例。各种并发症有其特有的包膜病理及临床特点。结论 严格执行无菌操作、熟练掌握该术技能、造反优质假体、首选胸大肌下置     

聚丙烯酰胺水凝胶在乳房纤维包膜挛缩病例中的应用

乳房纤维包膜挛缩是隆乳术后最棘手的问题，尽管预防和治疗的方法颇多，但收效仍不理想，复发率很高，目前尚无可靠治疗方法。本组从１９９７ 年１０ 月至今应用聚丙烯酰胺水凝胶替代５０ 例因硅胶囊乳房假体隆乳引起的纤维包膜挛缩。根据挛缩程度，包膜腔内有无被污染和包膜腔在乳房的位置等因素分Ⅰ期替换或Ⅱ期替换两种方式。本组５０ 例替换结果显示，原僵硬的乳房变为柔软，Ｂ超证实挛缩的囊壁在３ ～６ 个月后有变薄现象。本组资料结果证实，用聚丙烯酰胺水凝胶替代硅胶囊乳房包膜挛缩的假体隆乳，对原已形成的纤维包膜挛缩有良好的近期（半年）治疗效果。     

Anterior cruciate ligament repair with internal brace augmentation: A systematic review

BackgroundPrimary repair of anterior cruciate ligament (ACL) ruptures has re-emerged as a treatment option for proximal tears, with internal brace augmentation often utilised. The aim of this study is to provide an overview of the current evidence presenting outcomes of ACL repair with internal bracing to assess the safety and efficacy of this technique.MethodsAll studies reporting outcomes of arthroscopic primary repair of proximal ACL tears, augmented with internal bracing from 2014-2021 were included. Primary outcome was failure rate and secondary outcomes were subjective patient reported outcome measures (PROMs) and objective assessment of anteroposterior knee laxity.ResultsNine studies were included, consisting of 347 patients, mean age 32.5 years, mean minimum follow up 2 years. There were 36 failures (10.4%, CI 7.4% - 14.1%). PROMs reporting was variable across studies. KOOS, Lysholm and IKDC scores were most frequently used with mean scores > 87%. The mean Tegner and Marx scores at follow-up were 6.1 and 7.8 respectively. The mean side to side difference measured for anteroposterior knee laxity was 1.2mm.ConclusionsThis systematic review with meta-analysis shows that ACL repair with internal bracing is a safe technique for treatment of proximal ruptures, with a failure rate of 10.4%. Subjective scores and clinical laxity testing also revealed satisfactory results. This suggests that ACL repair with internal bracing should be considered as an alternative to ACL reconstruction for acute proximal tears, with the potential benefits of retained native tissue and proprioception, as well as negating the need for graft harvest.     

静脉自控镇痛在隆乳术中的应用与护理

目的 探讨静脉自控镇痛(PCIA)在隆乳术中的临床应用与护理。方法 将206例隆乳术病人随机分成两组。实验组采用静脉自控镇痛法术后镇痛;对照组采用传统镇痛法术后镇痛。结果 实验组术后镇痛效果优于对照组,病人入睡情况明显优于对照组(P<0.01),但恶心呕吐发生率高于对照组(P<0.01)。结论 实施PCIA能有效改善术后疼痛,同时要加强临床观察和护理。