会厌瓣在声门癌术后喉呼吸功能不良整复中的应用

目的 探讨会厌瓣在声门癌行喉部分切除术所致喉呼吸功能不良再手术中的应用。方法 对19例因声门癌行喉部分切除术所致术后喉呼吸功能不良的患者,采 用会厌瓣进行再手术,将临床资料进行回顾性分析。结果 18例（94.7%）采用会厌瓣重建后17～194d成功拔出气管套管,1例因瘢痕形成而失败。结论 在因声门癌行喉部分切除术所致喉呼吸功能不良的再手术中应用会厌瓣,具有方法便捷、效果可靠的优点。     

经尿道内括约肌切除术在神经源性膀胱患者中的应用及长期随访研究

目的:治疗神经源性膀胱的首要两大目的即保护上尿路功能,获得或保持最恰当的尿控能力,但目前缺乏完美的治疗方法.为评价经尿道内括约肌切除术在神经源性膀胱患者中的应用及长期效果,行本研究.方法:回顾性分析2010年6月-2019年6月在我院接受经尿道内括约肌切除术治疗的17例神经源性膀胱患者的临床资料,其中男9例,女8例,年...     

腭咽环扎术后阻塞性睡眠呼吸暂停低通气综合征上气道形态的研究

目的：探讨腭咽环扎术（VRLP）后阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的上气道形态特征.方法：应用纤维鼻咽镜和头影测量技术检查了6例VRLP后并发OSAHS患者、6例VRLP后未发生OSAHS和6例未手术腭裂患者的上气道形态,测量了鼻咽腔直径、腭咽环扎处咽腔直径、口咽腔直径、舌根后咽腔直径、下咽腔直径、舌骨至下颌骨的距离等6个相关参数,并应用单因素方差分析进行组间比较.结果：未手术腭裂患者上气道形态光滑,VRLP后上气道在软腭后区和舌根后区出现2处狭窄,VRLP后OSAHS患者上气道鼻咽部明显狭窄变形,为腺样体肥大所致.结论：X线头影测量技术是一种简单实用的评估VRLP后OSAHS的方法,建议VRLP术前行此检查以排除腺样体严重增生患者.     

Radiographic Analysis of Graft Dimensional Changes in Transcrestal Maxillary Sinus Augmentation: A Retrospective Study

Background. The maxillary sinus lift is a popular and predictable technique associated with implant-supported rehabilitation of the severely atrophic maxilla. The aim of the present retrospective study was to investigate the effectiveness of transcrestal maxillary sinus augmentation and the graft resorption pattern using different heterologous bone substitutes. Methods. A total of 75 sinus-grafting procedures were performed and 89 implants were placed in 66 patients, 24 males and 42 females, with mean age 67.9 ± 10.64 years (range 43–84 years). Nineteen subjects were smokers. The mean follow-up period was 93.33 ± 54.71 months (range 14–240 months). Clinical and radiographical evaluations were performed. Graft height and width were measured at baseline and at the latest follow-up. Results. Mesiodistal and vertical resorption averaged 9.3 ± 20.7% (standard deviation), and 5.04 ± 9.9% of the postoperative size, respectively, considering the graft as the unit. Linear regression analysis showed that graft resorption in both the vertical and the mesiodistal dimension is independent of the follow-up time. Conversely, there was a trend for greater resorption when increasing the postoperative graft size, in both vertical (p = 0.001) and horizontal (p = 0.007) dimensions. When grouping the dimensional changes by graft particle size (only small (<300 μm) particles, combination of small and medium (>500 μm)/large (>1000 μm) particles, and only medium/large particles), there was a trend for greater resorption associated with smaller particles, but it was not significant; neither in the mesiodistal nor in the vertical dimension (p = 0.17 and p = 0.25, respectively). No implant was lost during the observation period. In conclusion, the transcrestal technique for maxillary sinus augmentation documented a high level of predictability. The low clinical morbidity and the contextual dental implant positioning is clinically useful in relation to a significant reduction of the time required for implant restoration, a consistent decrease of the number of surgical phases, and a cost-effectiveness approach for the rehabilitation. The graft resorption pattern in all cases was compatible with persistent implant protection and support.     

膝关节手术后功能锻炼时机的实验研究

目的:探讨膝关节手术后最佳的功能锻炼时机。方法:采用新西兰兔制成膝关节创伤模型,然后按功能锻炼时机不同分为术后不固定组(A组);术后固定24 h组(B组);术后固定72 h组(C组)3组,30 d后测量膝关节活动度,观察滑膜上皮细胞以及细胞增生、胶原纤维增生情况。结果:A组膝关节活动范围更大,滑膜上皮细胞光滑细胞增生和胶原纤维增生均不明显,较B、C组有统计学差异(P<0.05)。结论:通过动物实验,我们发现:在膝关节手术后,麻醉消退后即刻开始功能锻炼,确能较术后24 h和72 h才开始锻炼在减轻膝关节的粘连,减少关节内瘢痕组织增生,最大限度地恢复膝关节的功能等方面有着明显的优点。     

一种新的手术方式:声带外展下移术治疗双侧神经麻痹

目的探讨一种新的手术方式:声带外展下移术治疗双侧神经麻痹临床优势及特点。方法回顾性分析15例使用声带外展下移术治疗双侧神经麻痹的临床效果。结果所有患者术后伤口一期愈合。9例患者术后10天拔管,6例患者术后半月至1月时拔管。复查时间1年至2年不等,患者正常生活,均未见呼吸不畅情况发生。结论声带外展下移术疗效确切,具有能同时照顾到呼吸通畅度、发声及避免呛咳的作用。     

从护理收费过低现象看我国综合医疗服务项目价格调整的必要性

我国护理服务价格一直处于较低水平,难以真正体现护理人员的劳务价值.同样,其他综合医疗服务项目的价格也不尽合理,不利于医疗机构的经济运行和发展.文章基于对上述现象的分析提出调整综合服务项目收费价格的一些建议.     

Balloon dilation of intrahepatic biliary strictures for percutaneous extraction of residual intrahepatic stones

Intrahepatic ductal strictures in cholangiohepatitis present an obstacle to successful removal of retained ductal stones via T-tube tracts. We studied the effectiveness of stricture dilatation for stone removal. Fifteen patients with intrahepatic gallstones retained behind strictures underwent balloon dilatation of their strictures to allow stone extraction. All had prior surgical T-tube placement allowing percutaneous access. Balloon dilatation was successful in reducing or eliminating strictures in 86.7% (13 of 15 patients), and complete stone extraction after the successful dilatation was possible in 76.9% (10 of 13 patients). The reasons for failure were impacted stones and acute ductal angulation which prevented passage of catheters. It is concluded that balloon dilatation of intrahepatic biliary strictures is an effective adjunct for extraction of intrahepatic biliary calculi associated with recurrent pyogenic cholangiohepatitis.