纤维蛋白胶联合绷带型角膜接触镜在翼状胬肉切除术中的应用

目的：探讨应用纤维蛋白胶联合绷带型角膜接触镜减轻翼状胬肉切除联合自体角膜缘干细胞移植术后疼痛的效果。 方法：对52例72眼行翼状胬肉切除联合自体角膜缘干细胞移植手术治疗的初发性翼状胬肉患者,随机分为试验组（纤维蛋白胶联合绷带型角膜接触镜组）28例38眼和对照组（缝线组）24例34眼。试验组及对照组给予常规20 g/L利多卡因浸润麻醉后进行翼状胬肉切除联合自体角膜缘干细胞移植术。试验组采用黏合剂将植片与植床进行粘贴,对照组采用10-0缝线缝合植片与植床。术毕,试验组角膜表面放置角膜接触镜,对照组不配戴角膜接触镜。主要术后观察患者的术后1,2,3,5,7 d疼痛评分。术后随访6mo,观察植床与植片的匹配程度及感染、复发、植片愈合不良、结膜下囊肿等并发症情况。 结果：试验组患者疼痛程度评分均较对照组显著降低（均为P=0.000）。观察期内,两组植床与植片均成功固定于巩膜表面,并全部成活,同时两组患者均未发生感染、复发、植片愈合不良、结膜下囊肿等并发症。 结论：联合运用纤维蛋白胶黏合剂粘及角膜接触镜,可明显减轻翼状胬肉术后的疼痛反应。     

Central respiratory neuronal activity after axonal regeneration within blind-ended peripheral nerve grafts: time course of recovery and loss of functional neurons

Autologous segments of peroneal nerve were implanted into the medulla of adult rats to induce axonal regeneration of central neurons axotomised during the grafting procedure. Grafts were inserted in the midline where respiratory axons decussate or laterally, either in the nucleus tractus solitarius or in the nucleus ambiguus, close to respiratory cell bodies. The distal part of each graft was left unconnected (blind-ended graft). Between 2 and 30 months post-implantation, unit recordings from single fibres were made from small strands teased from the grafts to investigate activity of neurons regenerating axons. Spontaneous respiratory and non-respiratory activity was present only in grafts examined between 2 and 6 months post-implantation. Respiratory units had discharge patterns identical to those of normal inspiratory or expiratory neurons; their responses to lung inflation and asphyxia were also similar to those of central respiratory neurons. No spontaneous activity was present in the grafts examined 7–30 months post-implantation. Moreover, asphyxia, which normally enhances the activity of central respiratory neurons, failed to elicit activity. These results were similar in all grafts, regardless of the site of implantation. The presence of spontaneous activity only between 2 and 6 months post-implantation indicates that once axonal growth of respiratory neurons is stopped within blind-ended grafts, those neurons still exhibited normal functional properties for 3 months. The absence of activity 6 months after grafting suggests that loss of functional regenerating respiratory neurons does not occur progressively and follows an all or nothing rule within blind-ended grafts.     

Restoration of fertility to oophorectomized sheep by ovarian autografts stored at-196{degrees}C

Cortical slices were prepared from the right ovaries of sixlambs and either grafted directly to the ovarian pedicles oforigin or cooled slowly to liquid nitrogen temperatures in mediumcontaining dimethylsulphoxide. Three weeks later, the contra-lateralovary was removed and replaced with frozen-thawed slices fromthe same animal. Two of the animals mated during their secondoestrous cycle 3–4 months later and the remainder hadat least one ovulatory cycle. The pregnancies reached full-termdevelopment, one lamb being derived from an ovulation in a freshgraft and the other from a frozen-thawed graft. None of thesheep had peripheral plasma concentrations of follicle stimulatinghormone or luteinizing hormone consistently in the castraterange, and only one graft was devoid of follicles when the animalswere slaughtered 9 months after the operations. Grafts withprimordial follicles always contained developing follicles,which occasionally attained pre-ovulatory sizes of 7 mm in diameter.A corpus albicans was present in five grafts. Since all developingfollicles had degenerated 1 week after grafting in an additionalewe, the large follicles in long-term grafts had presumablycommenced growing after the operation. There were no obviousdifferences between fresh and frozen-thawed grafts in eitherappearance or weight, and all had apparently grown since implantation.Despite substantial depletion of primordial follicle numbers,the results indicated that frozen storage and replacement ofa patient’s own ovarian tissue might be practicable whenfertility potential is threatened by chemotherapy/ra/diotherapy     

翼状胬肉显微手术切除后角膜干细胞移植

目的:观察各种类型翼状胬肉显微手术切除后角膜干细胞移植的疗效。方法:手术显微镜下根治性切除翼状胬肉后,采用角膜干细胞移植,联合眼表面重建术,共治疗各种类型的翼状胬肉46例(57眼)。结果:术后随访12~24个月,所有患者未出现球结膜明显的纤维血管增生及角膜浸润,无1例复发。结论:显微镜下切除各种翼状胬肉,同时移植角膜干细胞,能取得较好的疗效。     

自体肋软骨移植外耳再造术中超声引导胸椎旁神经阻滞麻醉的应用

 目的 探讨超声引导胸椎旁神经阻滞在自体肋软骨移植外耳再造术中的应用。方法 选取2018-05至2019-11武警山东总队医院择期行肋软骨移植外耳再造Ⅱ期手术的患儿60例,随机分为单纯全身麻醉组(A组)30例,全身麻醉复合椎旁神经阻滞组(B组)30 例。观察两种麻醉方式在外耳再造术中的麻醉效果、术后镇痛、术中全麻药物用量及术后不良反应等方面的差异。结果 B组术中使用1%异丙酚(725.69±145.50)mg,瑞芬太尼(2129.90±536.72)μg, 明显少于A组异丙酚(914.58±242.41)mg,瑞芬太尼(3266.79±770.64)μg,差异有统计学意义(P<0.05);B组在切皮时(H₂)、取软骨时(H₃)及拔除气管导管时(H₄)的心率和血压、术后6 h内VAS评分均明显低于A组,差异有统计学意义(P<0.05);B组术后苏醒时间(T₀)为(11.53±1.43)min,明显短于A组的(15.00±1.46)min,差异有统计学意义(P<0.05);B组发生心血管、恶心呕吐、便秘等不良反应明显少于A组,差异有统计学意义(P<0.05)。结论 超声引导胸椎旁神经阻滞复合全身麻醉应用于自体肋软骨移植外耳再造术,术中麻醉效果显著,血流动力学更加稳定,全麻药物用量少,术后镇痛效果明显,适合临床应用。     

自体角膜缘干细胞联合羊膜移植治疗翼状胬肉的临床分析

目的比较自体角膜缘干细胞移植与联合羊膜移植治疗翼状胬肉的疗效。方法126例132眼翼状胬肉患者随机分成A、B2组,A组63例68眼,行自体角膜缘干细胞移植术;B组63例64眼行自体角膜缘干细胞联合羊膜移植术。结果A组8例8眼复发,复发率11．8％,B组3例3眼复发,复发率4．7％,2组术后复发率在统计学上有显著性差异（P〈0．05）。结论自体角膜缘干细胞联合羊膜移植术可有效治疗翼状胬肉,降低复发率改善视功能。     

自体微粒皮移植术在大面积深度烧伤并发症防治中的作用

目的 探讨自体微粒皮移植术在大面积深度烧伤并发症防治中的作用。方法 比较性研究我院1993-2002收治的大面积深度烧伤患者64例,根据早期创面处理方法的不同分为切痂自体微粒皮移植术组和切痂邮票状植皮术组,两组患者的一般情况具有可比性。自体微粒皮移植术组行一次性大面积切痂自体微粒皮和大张异体皮联合移植术,切痂邮票状植皮术组分次行部分Ⅲ度创面切痂自体邮票状皮片移植术。观察自体微粒皮移植术后的临床过程,并比较两组患者脓毒症和MODS的发生率。结果①5-7 d,异体皮表皮层出现疱状变性;2周左右,异体真皮出现黑色斑点;4-6周,形成痂皮脱落,其下为新生表皮覆盖。②自体微粒皮移植术组脓毒症和MODS的发生率分别为34.4％和18.8％,明显低于切痂邮票状植皮术组的62.5％和43.8％,差异有显著性(P<0.05)。结论 自体微粒皮移植术治疗大面积深度烧伤切实可行、疗效确切,能有效降低MODS的发生率。