头颈肿瘤游离皮瓣修复术后皮瓣坏死及皮瓣相关并发症影响因素分析

目的 分析皮瓣坏死及术后出现皮瓣相关并发症的影响因素。方法 回顾性分析因头颈肿瘤行游离皮瓣修复患者的年龄、性别、手术时长、吸烟、酗酒、高血压、糖尿病、术前放疗、血管吻合方式等对皮瓣坏死及皮瓣相关术后并发症的影响作用。结果 年龄、性别、手术时长、吸烟、酗酒、术前放疗、血管吻合方式不是头颈肿瘤患者游离皮瓣修复后皮瓣坏死及发生皮瓣相关术后并发症的危险因素;糖尿病是头颈肿瘤患者游离皮瓣修复后皮瓣坏死的危险因素(P=0.006),高血压(P=0.040)、糖尿病(P=0.024)是出现皮瓣相关术后并发症的独立危险因素。结论 在有游离皮瓣修复指征的头颈肿瘤但伴随有糖尿病、高血压疾病的患者中,经过全身情况评估后个体化选择修复方式。     

消痔灵注射液治疗内痔出血疗效观察

目的 评价消痔灵注射液治疗内痔出血的临床疗效.方法 80例内痔出血患者经口服泻药或者灌肠,排便后自腔缘3、6、9点注入麻醉药,观察应用消痔灵注射液治疗80例内痔出血患者的疗效进行回顾性分析.结果 80例内痔出血患者中76例次日出血停止,4例便后偶有滴血症状,经局部换药、使用痔疮栓及局部熏洗等保守治疗后出血消失,随访6～24个月无复发.结论 消痔灵注射液治疗内痔出血是一种简单、有效、可靠的方法.

Abstract：

Objective To assess the clinical effect and safety of Xiaozhiling injection on bleeding caused by hemorrhoids.Methods A retrospective analysis was performed on 80 hemorrhoid patients treated with Xiaozhiling injection.Results Among 80 patients.76 bleeding stopped after the injection.Four bleeding had interrupted outbreak and was cured after symptomatic treatment.Conclusion Xiaozhiling is an effective medicine for treatment of hemorrhoids bleeding.     

Hospital recovery following Thermachoice ablation is not dependent on setting (outpatient or daycase) or rescue analgesia: unexpected result

BACKGROUND: Thermal balloon endometrial ablation (TBEA) is increasingly being performed in the outpatient setting under local anaesthesia (LA) rather than in a daycase setting under general anaesthesia (GA). Our aim was to compare the post operative rescue analgesia requirements and duration of hospital stay in women undergoing outpatient (LA) and daycase (GA) TBEA. METHODS: Prospective observational study of consecutively recruited women who underwent outpatient (LA) TBEA (n=51) and daycase (GA) TBEA (n=50) over the same time period. Analgesia that was provided additional to the standard administered analgesic regimen was considered rescue analgesia. The main outcome measures were requirement for rescue analgesia and duration of hospital stay in both cohorts. RESULT(S): LA compared to GA cohorts had shorter hospital stays (11h [95% CI 9-13] vs. 17h [95% CI 14-20]) and lower analgesia requirements. However, multivariate regression, correcting for all known confounders, showed that duration of stay was independent of setting for ablation or amount of rescue analgesia. CONCLUSION(S): Duration of hospital stay is not entirely dependent on whether outpatient or daycase endometrial ablation is considered. This unexpected preliminary finding deserves to be validated in future confirmatory trials that compare outpatient and daycase treatments. We also discuss the confounding factors that should be considered when designing such trials.     

动脉化静脉皮瓣成活机制的实验研究

目的 直视下观测动脉化静脉皮瓣的血液循环途径,探讨其成活机制。方法 选用15只中国大白兔30只耳朵,设计动脉化静脉皮瓣模型,应用微循环显微镜在不同时间观察皮瓣微循环的血液途径(1h、2h、4h、8h)。结果 皮瓣全部成活。皮瓣组织内毛细管管网是一个“立体”的网状结构;静脉皮瓣早期可见毛细血管床关闭,动脉血在微静脉间快速流动;随毛细血管逐渐开放,动脉血逆流进入微循环,完成循环重建。结论在引流静脉保持通畅的前提下,静脉皮瓣可借助静脉系统重建有效血液循环并保持成活。     

局部应用生物蛋白胶和加替沙星对手及前臂屈肌腱粘连及感染的预防

目的评价生物蛋白胶和加替沙星对肌腱吻合后预防粘连及局部感染的作用。方法12例肌腱断裂患者肌腱吻合后喷涂生物蛋白胶和加替沙星混合剂,观察患指功能恢复及伤口愈合情况,术后随访2~10个月。结果应用生物蛋白胶和加替沙星混合剂的患指功能恢复优良率为83.33%,较好为16.67%。结论生物蛋白胶和加替沙星对肌腱吻合后功能恢复和伤口愈合有良好疗效。     

带蒂颊肌瓣鼻底转移术与硅胶鼻底植入术治疗萎缩性鼻炎的疗效比较

目的：比较带蒂颊肌瓣鼻底转移术与硅胶鼻底植入术治疗萎缩性鼻炎的疗效。方法：将80例萎缩性鼻炎患者分为2组,43例行带蒂颊肌瓣鼻底转移术（A组）,37例行硅胶鼻底植入术（B组）。结果：手术治疗后总有效率A组高于B组（P＜0.05）,术后并发症A组少于B组（P＜0.05）。结论：带蒂颊肌瓣鼻底转移术治疗萎缩性鼻炎具有更好的疗效。     

Role of Perforating Artery Pedicled Neurotrophic Flap in the Treatment of Compound Tissue Defect of Tibia Using the Ilizarov Technique

ObjectiveTo describe our experience with the combined use of pedicled neurotrophic flap and distraction osteogenesis in the management of complex lower extremity injuries with composite bone and soft tissue defects and assess the functional and cosmetic results of this method.MethodsA pedicled flap with a marked perforator artery was applied for soft tissue coverage after radical debridement and temporary external fixation. In the second stage, the Ilizarov external fixator was used in place of the temporary external fixator for reconstruction of the segmental bone defect by distraction osteogenesis. Twenty‐five patients (16 men and nine women; mean age, 39.2 years) were treated by using this combined technique between 2008 and 2016. All cases were graded initially as Gustilo–Anderson grade IIIB open fractures. The soft tissue defect after radical debridement ranged from 9 cm × 5 cm to 14 cm × 11 cm, and the average size of segmental defect was 5.2 (Range, 2.5–8.5) cm. Seventeen of these patients had a history of local infection. The bone structure and function were evaluated by two independent evaluators using Paley''s criteria.ResultsTwenty‐five patients were followed up for an average of 28.96 (Range, 15–48) months. The distally based sural neurovascular flap was applied in 13 patients, and the greater saphenous neurocutaneous perforator flap in 12 patients. The flap area ranged from 10 cm × 5 cm to 14 cm × 12 cm. Sufficient coverage of soft tissue defect was achieved in all cases. All flaps survived completely without complications. The bone defects were corrected by a mean lengthening of 6.94 (Range, 4.5–9.5) cm. The residual discrepancy was <1 cm in all cases, which was not clinically significant. The function was evaluated as excellent in 12 patients and good in 13 patients. Bone results were graded as excellent in 18 patients and good in seven patients. Complications during treatment included pain, pin tract infections, ankle midfoot joint stiffness, and docking site nonunion. No recurrence of infection was observed in infected patients. All cases achieved successful limb salvage and satisfactory function recovery without recurrence of infection.ConclusionsThe combined technique of a perforator artery pedicled neurotrophic flap and distraction osteogenesis is an effective alternative approach in the salvage treatment of massively traumatized and chronically infected lower extremities.     

耳穴贴压复合表面麻醉用于鼻内镜手术的效果观察

目的：评价耳穴贴压复合表面麻醉用于鼻内镜手术的麻醉效果。方法选择80例表面麻醉下择期鼻内镜手术患者,随机数字法分为两组：耳穴贴压复合表面麻醉组（A组,n=40）和单纯表面麻醉组（B组,n=40）。 A组患者取耳神门（TF4）、交感（AH6a）和外鼻（TG1.2i）3处穴位粘贴王不留行籽,于术前30分钟进行按压治疗,B组仅穴位处粘贴胶布作为对照且不行按压治疗。患者均采用1%的丁卡因进行表面麻醉,术中根据患者情况给予小剂量的艾司洛尔、硝酸异山梨酯或芬太尼。术中观察麻醉优良率;艾司洛尔、硝酸异山梨酯与芬太尼使用率及不良反应。结果与B组比较,A组麻醉优良率明显升高（P〈0.01）,艾司洛尔、硝酸异山梨酯与芬太尼使用率降低（P均〈0.01）,两组均未出现不良反应。结论耳穴贴压复合表面麻醉用于鼻内镜手术具有良好的麻醉效果。     

延长垂直下斜方肌岛状肌皮瓣修复巨大口咽缺损

【目的】探讨下斜方肌肌皮瓣在晚期口咽根治术后巨大口咽部缺损中的应用。【方法】11例晚期口咽部鳞状细胞癌根治术治疗后用颈横动脉供血的延长垂直下斜方肌岛状肌皮瓣修复巨大口咽部缺损。【结果】全部病例无大块皮瓣坏死，无明显肩部功能影响，供区直接拉拢缝合，吞咽和语言功能满意。经4至15个月（平均7．2个月）追踪复查，有4例肿瘤复发。其中1例带瘤生存和3例死亡。[结论]延长垂直下斜方肌肌皮瓣操作较简单可靠，瓣足够大，可作为晚期口咽部鳞状细胞癌手术治疗后巨大口咽部缺损修复的带蒂皮瓣。     

组织瓣修复口腔颌面部缺损的护理研究

口腔颌面部的外伤及恶性肿瘤等疾病会导致面部组织的缺损,对患者的美观度及功能等产生一定 的影响。组织瓣修复在改善患者口腔颌面部缺损以及外观上具有积极的临床效果,但其手术治疗效果与术 后护理具有密切的联系。本文对组织瓣移植进行概述,并对组织瓣修复口腔颌面部缺损的护理作一综述。