甲状旁腺全切联合自体前臂移植术对肾性甲状旁腺功能亢进的疗效观察与护理

目的探讨甲状旁腺全切联合自体前臂移植术对肾性甲状旁腺功能亢进患者的疗效。方法回顾性分析2018年2～8月我科收治的34例肾性甲状旁腺功能亢进全麻下行甲状旁腺全切联合自体前臂移植术患者,观察其围手术期收缩压、舒张压、甲状旁腺素水平变化情况对比其术前术后脚后跟、膝关节疼痛情况,对其护理进行梳理。结果 34例患者手术后的收缩压(124.97±20.43)mmHg、舒张压(76.44±12.75)mmHg、甲状旁腺素水平(76.30±20.43)pg/mL均显著低于手术前(P0.05)。脚后跟、膝关节疼痛评估术后疼痛评分明显低于术前(P0.05)。结论甲状旁腺全切联合自体前臂移植术对肾性甲状旁腺功能亢进患者的疗效显著,能显著改善患者生活质量,而积极有效的临床护理,能保证手术的成功,减少并发症的发生。     

超声刀在前臂皮瓣制备术中的应用研究

目的探讨超声刀在前臂皮瓣制备术中的应用及疗效评价。方法 2014年8月至2015年12月在南京医科大学附属口腔医院行前臂皮瓣修复口腔组织缺损的患者26例,随机分为两组,每组13例,试验组运用超声刀制备,对照组运用普通手术刀制备,分析两组患者手术时间、术中出血量及术中术后并发症发生情况。结果术后前臂皮瓣全部存活,试验组手术时间少于对照组(P<0.05),试验组术中出血少于对照组(P<0.05)。两组均未出现并发症。结论运用超声刀行前臂皮瓣制备术可以缩短手术时间、减少手术中出血量,可在临床推广应用。     

“Chain-link” combined tissue transfer for the reconstruction of the mandible

We describe a procedure for “chain-link” combined tissue transfer connecting the vascular pedicle of a deep circumflex iliac flap with that of a forearm flap after wide resection of the mandible. Combination of these flaps facilitated the reconstruction of the defect in both intra- and extraoral soft tissue and the mandibular bone. This method is useful when cervical recipient blood vessels are limited due to the wide resection of the primary tumor and radical neck dissection.     

颏下岛状皮瓣与前臂皮瓣修复口腔鳞癌术后缺损的比较

目的：比较颏下岛状皮瓣与游离前臂皮瓣修复口腔鳞癌术后缺损的结果。方法：2009年5月~2011年8月,69例口腔鳞癌术后缺损采用颏下岛状皮瓣或游离前臂皮瓣修复,比较2种修复方法的皮瓣大小、手术时间、住院时间、并发症、口腔功能恢复及复发情况。结果：69例患者中,采用颏下岛状皮瓣修复32例,游离前臂皮瓣修复37例。颏下岛状皮瓣组与游离前臂皮瓣组在平均皮瓣大小（32.78cm2 VS 48.27cm2）、平均手术时间（351min VS 508min）、平均住院日（13.06dVS 17.48d）等均有统计学差异（P〈0.001）;两组患者总的并发症发生相似,但颏下岛状皮瓣组发生颌下区积液的比例较高（P〈0.05）;两组患者在术后口腔功能恢复及肿瘤复发方面无差异。结论：颏下岛状皮瓣修复可明显缩短手术时间及患者住院时间,可作为口腔鳞癌术后中小型缺损修复的首选。     

Long‐term outcomes of microsurgical reconstruction for large tracheal defects

BACKGROUND:

Reconstruction of large tracheal defects has been largely unsuccessful. The purpose of this study was to review the authors' experience with microsurgical reconstruction of these defects.

METHODS:

Seven cases of microsurgical tracheal reconstruction were performed between May 2002 and April 2008. All but 1 patient had recurrent thyroid cancer; the other patient had primary adenocystic carcinoma of the trachea. The radial forearm free flap was used for lining in all cases. Rigid support was provided with a variety of prosthetic materials.

RESULTS:

All defects involved the cervical trachea, with an average length of 5.8 cm ± 1.0 cm (range, 5 cm‐7.5 cm). The width of defects ranged from half of the tracheal circumference to the entire circumference. Major complications included air leak in 4 patients, exposure and removal of prosthesis in 2 patients, and cardiopulmonary complications in 2 patients. One patient with postoperative retroperitoneal hematoma, abdominal compartment syndrome, and multiple organ failure died 2 months after surgery. Two patients died of other causes 1 year and 4 years, respectively, after surgery. The other 4 patients were alive and disease free, with follow‐up ranging from 1 to 4.5 years. Four patients are asymptomatic, with normal speech and swallowing functions. Two patients remained tracheostomy dependent, but vocal ability was intact. All patients tolerated a regular diet.

CONCLUSIONS:

Microsurgical reconstruction is a viable option in selected patients with large cervical tracheal defects that are beyond primary repair. Cancer 2011. © 2010 American Cancer Society.     

长春瑞宾颈外静脉与前臂静脉给药静脉炎发生率比较

目的:对比通过颈外静脉留置针与前臂静脉穿刺在长春瑞宾应用中静脉炎发生情况。方法:对108例滴注长春瑞宾的乳腺癌、肺癌患者随机分为两组,68例为颈外静脉留置组(A组),40例前臂静脉组(B组)。观察静脉炎发生情况。结果:A组发生率为3%,B组发生率为57.5%,两组患者静脉炎发生有明显差异。结论:颈外静脉留置滴注长春瑞宾能减少静脉炎的发生。     

22例导管扩张下动静脉内瘘术的临床效果评价

目的探讨动脉取栓导管扩张下血液净化用前臂动静脉内瘘术的手术方法以及临床效果。方法总结东莞市人民医院肾内科2006年1月至2008年1月收治的22例诊断明确的尿毒症患者因需要长期透析以及血管条件差而行动脉取栓导管辅助下前臂动静脉内瘘术。手术选择患者的非主力手,分别游离头静脉和桡动脉,结扎头静脉和桡动脉的远端向头静脉和桡动脉的近端分别插入动脉取栓导管并用2ml注射器向导管内注入适量肝素生理盐水,充起球囊,根据需要持续均匀的扩张头静脉和桡动脉的狭窄段,再以7-0的血管逢线端侧吻合血管。结果术后即时、1h、2h、3h、术后连续7 d均能听到血管杂音以及扪及到血管震颤平均随访8个月手术的成功率为95.5%以上。已有20例患者内瘘成熟并已使用,内瘘的血流量大于200ml/min,完全能满足各种血液净化治疗。结论动脉取栓导管辅助下前臂动静脉内瘘手术成功率高,可以纠正血管条件差伴有部分狭窄的患者,内瘘成熟快,血流量大,临床效果好。     

个体化前臂皮瓣Ⅰ期修复口腔颌面部软组织缺损

 目的探讨个体化前臂皮瓣修复口腔颌面部软组织缺损的可行性,并评价其疗效。方法对32例口腔颌面部软组织缺损的病例根据缺损的部位及形态设计前臂皮瓣,分析皮瓣成活情况及术后皮瓣修复效果。结果32例皮瓣全部成活,成功率100%。本组随访6~36个月,口腔颌面部功能及外形恢复好。结论个体化设计的前臂皮瓣对颌面组织缺损Ⅰ期重建,安全可靠,制备简单,是修复口腔颌面软组织缺损的理想方法,可明显提高患者的生存质量。     

前臂皮瓣Ⅰ期修复面及咽部肿瘤术后软组织缺损

目的 :探讨前臂皮瓣在耳鼻咽喉 头颈外科头颈部恶性肿瘤手术中的应用。方法 :对 6例咽喉部肿瘤切除后软组织缺损的病例 ,通常采用前臂皮瓣修复 ,即将皮瓣的桡动脉、头静脉与甲状腺上动脉和面静脉分别端端显微吻合 ,Ⅰ期修复组织缺损。结果 :修复成功 4例 ,失败 2例。结论 :前臂皮瓣具有血管表浅 ,行程稳定 ,口径粗 ,血管长 ,前臂皮肤薄、软、皮下脂肪少 ,具可塑性 ,可折叠等优点。经临床应用证实 ,前臂皮瓣修复是一种灵活多用 ,技术完善的头面、咽部及口底缺损修复的手段     

冬病夏治穴位贴敷加曲肘外旋法治疗肩周炎的临床观察

目的:探讨冬病夏治穴位贴敷加曲肘外旋法治疗肩周炎的疗效结果。方法:对23例(36肩)进行冬病夏治法贴敷于合谷、曲池、缺盆、肩骨禺、肩贞、肩井、天宗、条口等穴。结果:36肩中优28肩,良8肩。其中轻型9型疗效均为优;中型20肩:优18肩,良2肩;重型7肩:优4肩,良3肩。结论:冬病夏治穴位贴敷对轻、中型患者疗效显著;对明显外伤或手术引起的冻结肩疗效不理想;这与操作技术、功能锻炼有直接关系;而病程长短对疗效无明显影响。