吻合腓肠浅动脉游离小腿后侧皮瓣修复全手掌软组织缺损

目的：研究修复全手掌软组织缺损的方法。方法：利用吻合腓肠浅动脉的小腿后侧皮瓣移植修复全手掌软组织缺损10例。结果：临床应用10例成活，其中1例于术后72h因动脉过长而栓塞，经取出血栓，再次吻合动脉，皮瓣成活，术后10～15个月随访，皮瓣外形近似正常手掌，两点辨别觉为5cm，感觉为S4。结论：利用吻合腓肠浅动脉皮瓣修复全手掌软组织缺损是一种可选的方法。     

Detection of Gene Alteration for Color Vision Defects by Polymerase Chain Reaction

According to the fact that the abnormalities of visual pigment genes were always involved in the changing of the exon 5, two oligonucleotide primers were designed to amplify the exon 5 of red pigment gene and green pigment gene. After electrophoresis of the PCR products digested with Rsal or Sau3A, the DNA fragments from the exon 5 of red pigment gene (RPG) and green pigment gene (GPG) were separated since there are different restriction endonuclease sites. On the other hand, we analyzed the exon 5 related fragment by Southern blot hybridization with probe out of the 3'end of the fourth in-tron of green pigment gene. The results of PCR are consistent with nucleic acid hybridization. PCR technique will be of value in prenatal evaluation and genetic counselling.     

儿童出生缺陷发生危险因素的病例对照研究

目的探讨儿童出生缺陷发生的危险因素 ,以期控制儿童出生缺陷的发生。方法随机选取 5 71例出生缺陷儿童 ,按照 1:1配对的原则选取 5 71例健康儿童做对照 ,调查两组儿童父母可能对出生缺陷有影响的 19个因素 ,进行单因素与多因素条件Logistic回归分析。 结果产妇文化程度低、妊娠期剧烈呕吐、父亲吸烟与母亲被动吸烟、月人均收入低、孕早期患感染性疾病、孕早期蛋白质摄入不足等与儿童出生缺陷发生有关。结论提高产妇文化程度、劝阻父母吸烟、加强孕早期营养摄入与控制孕早期感染能够减少儿童出生缺陷的发生     

成人阴茎段尿道缺损的修复

目的 总结成人阴茎段尿道缺损的于术修复方法及阴囊中缝区皮瓣的临床应用。方法 2000年1月～2005年11月，对不同原因的阴茎段尿道缺损患者26例，年龄18～40岁。应用局部阴茎皮瓣再造缺损尿道，其中先天性阴茎型尿道下裂16例；外伤性阴茎中段尿道缺损6例。远段尿道缺损4例。外伤1～4年，曾行尿道造瘘术，反复尿道外口开大。应用以阴囊前、后动脉为蒂的阴囊中隔岛状皮瓣进行刚茎腹侧再造尿道表面创面的覆盖，皮瓣范围在阴囊中缝区宽2．5cm，长5．5cm内。结果 术后除4例患者并发感染而漏尿，术后2～4周内自行愈合外，其余患者伤口均Ⅰ期愈合。术后随访7个月～4年，阴茎无弯曲，排尿无异常。结论 应用阴茎局部皮瓣再造尿道及阴囊中缝区带蒂岛状皮瓣覆盖创面，是修复青春期后阴茎段尿道缺损一种良好的方法，下术操作简便，皮瓣血运可靠，修复后阴茎外形及功能均良好。     

成人房间隔缺损外科治疗146例

[目的]总结成年人继发孔型房间隔缺损的手术治疗经验。[方法]146例18岁以上继发孔型房间隔缺损病人,年龄(18～59)岁,平均(29.7±9.4)岁;合并部分型肺静脉异位引流5例;合并动脉导管未闭1例;合并三尖瓣关闭不全105例,中度以上关闭不全21例;合并二尖瓣关闭不全48例,二尖瓣狭窄4例;心房纤颤6例,心房扑动4例;术前B型超声检测肺动脉压(2.67～17.73)kPa,平均(6.70±2.47)kPa;房缺修补采用直接连续缝合或补片修补,3例行补片活瓣法;同期行三尖瓣成形术21例,均行De Vega成形术;二尖瓣成形术25例,行二尖瓣置换术4例。[结果]术后早期死亡5例;随访115例,随访率78.8％,随访4个月至10年8个月,2例死亡,其余患者心功能有明显改善,与术前相比差异有统计学意义(P< 0.001),生活质量明显提高。[结论]成人房间隔缺损应采取积极的手术治疗,围术期肺动脉高压及合并症的正确处理是手术成功的关键。     

异种骨衍生材料修复节段性骨缺损的实验研究

目的 :评价三种异种骨衍生材料修复节段性骨缺损的成骨作用 .方法 :分别用复合型完全脱蛋白骨 (CFDB)、部分脱蛋白骨 (PDPB)、部分脱钙骨 (PDCB)修复兔桡骨节段性缺损 ,以自体髂骨和空白缺损作为对照 ,术后 4 ,8,12 ,2 4周取材 ,通过X线摄片和不脱钙硬组织切片检测 ,评价三种材料的成骨作用 .结果 :X线摄片可见 4周时材料密度较高 ;8周时材料与宿主骨交界处模糊 ;12周时材料边缘部分区域密度接近宿主骨 ;2 4周时PDPB组髓腔再通 ,PDCB组缺损区域密度大部分接近宿主骨 ,有一些高密度影 ,CFDB组缺损区域有更多高密度影 .X线片评分表明 4周和 8周时各材料组无显著差异 ;12周时PDPB组和PDCB组评分高于CFDB组 ;2 4周时评分为PDPB组 >PDCB组 >CFDB组 .经组织形态观察可见 4周和 8周新骨贴附材料生长 ,以后新骨增多 ,材料随时间推移逐渐降解吸收 ,2 4周时成骨量PDPB组 >PDCB组 >CFDB组 .结论 :PDPB修复节段性骨缺损的效果好 ,PDCB的修复效果较好 ,CFDB修复效果欠佳     

动脉转位术的临床应用

目的 总结动脉转位术(arterial switch operation，ASO)治疗完全型大动脉转位(transposition of the great arteries，TGA)和右心室双出口伴肺动脉瓣下室间隔缺损(VSD)的临床经验。方法 采用ASO治疗小儿先天性心脏病32例，其中TGA22例，伴室间隔完整型(intact ventricular septum，IVS)9例，伴VSDl3例；右心室双出口伴肺动脉瓣下VSD(Taussig—Bing)10例。结果TGA／IVS9例中死亡1例，TGA／VSD13例中死亡4例，Taussig-Bing10例死亡3例，总手术死亡率25％(8／32)。术后随访3个月～2年，所有患者紫绀消失，活动能力明显增强。1例Taussig—Bing术前二尖瓣轻-中度反流，术后仍为中度反流；2例TGA主动脉和肺动脉瓣上狭窄，压差40mmHg(1kPa=7．5mmHg)，1例肺动脉瓣下狭窄和残余VSD，3个月后再次手术治愈。结论 ASO已广泛应用于TGA的纠治，手术效果满意；应用于右心室双出口肺动脉瓣下VSD的早期纠治，不但可防止发生肺血管阻塞性病变，而且避免了心内修补左心室流出道梗阻的远期并发症。     

软组织缺损断指再植的皮瓣移植

为解决伴有软组织缺损的断指进行再植，自１９８９年１月－１９９３年１２月，应用１２处１０５块带蒡及游离皮瓣移植修复软组织缺损进行再植８６例，共１１２指。再植成活率９６．４％，皮瓣成活率９８．１％。随访６－２４个月，按中野与玉井断指再植的功能评价：优良率达８５．９％。结果表明：利用不同皮瓣一期修复断指再植时皮肤、神经、血管、肌腱能最大限度恢复再术后的外形及功能。     

Hypoplastic left heart syndrome: Anesthetic care prior to transplantation or surgical palliation

Hypoplastic left heart syndrome is the most common lethal cardiac defect in neonates. Options for treatment include cardiac transplantation and surgical palliation. When cardiac transplantation is chosen as the preferred option, a considerable delay may occur until a suitable donor is available. During this time, anesthetic care may be required for various surgical procedures. Associated anomalies seen in these infants and the anesthetic implications imposed by the abnormal cardiac anatomy are discussed.     

Clumsiness: kinaesthetic perception and translation

Summary Earlier findings have suggested that abnormal clumsiness in children is associated with a perceptual defect in the kinaesthetic modality, and with a defect of the translation between stimulus and response. In this experiment, perception was investigated by manipulating the requirement to discriminate between kinaesthetic stimuli, and the translation process by manipulating stimulus-response compatibility. Consistent with earlier findings, the kinaesthetic reaction time of clumsy children was found to be longer than that of controls; but, although the requirement to discriminate between stimuli and incompatibility both lengthened reaction times, the increases were similar for clumsy and control groups. It is suggested that these negative findings may be attributable to a practice effect in the former, and to inadequate loading on the translation process in the latter. However, it is also suggested that the findings may indicate that clumsiness is associated with a defect in the cross-modal translation of information.