经动脉与静脉采血行血液稀释式自体血回输的对比观察

目的比较经动脉与静脉采血行血液稀释式自体血回输的效果。方法将行血液稀释式自体血回输的择期手术患者189例按时间先后分为对照组(97例)和观察组(92例)。对照组行静脉采血,观察组经动脉采血,监测两组患者采血前后血压、心率、SpO2变化;比较两组采血时间、一次穿刺采血成功率。结果两组患者采血前、采血后15min、30min平均动脉压、心率、SpO2变化比较,差异无统计学意义(均P>0.05);观察组一次穿刺采血成功率显著高于对照组,采血时间显著短于对照组(P<0.05,P<0.01)。结论经动脉采血可在保证安全的前提下,缩短采血时间,提高一次采血成功率。     

三种不同植骨方式在胸、腰椎结核手术治疗中的观察

目的:对比观察块状植骨、颗粒植骨和钛网植骨三种不同植骨方式在后路胸腰椎结核手术中的临床应用效果.方法:选取我院93例胸、腰椎结核患者,分为三组,彻底结核病灶清除后,分别采用块状植骨(32例)、颗粒植骨(35例)、钛网植骨(26例)三种不同植骨方式,对三组术中植骨所需时间,术中出血量,术后后凸畸形角纠正状况,末次随访后凸畸形角丢失状况,植骨融合时间进行对比.结果:患者均得到12～36个月随访,植骨所需手术时间A组为23.4±4.3min,B组为5.2±2.4min,C组为25.6±3.6min,B组植骨所需时间明显短于A组、C组(P＜0.05),A组、C组比较差异无统计意义(P＞0.05);术中出血量A组为553±53ml,B组为352±48ml,C组为564±47ml,B组明显少于A组、C组(P＜0.05),A组、C组比较差异无统计意义(P＞0.05);术前Cobb角A组为36.5°±5.9°,B组为36.2°±4.7°,C组为36.8°±5.1°,三组差异无统计学意义(P＞0.05),术后Cobb角A、B、C三组分别为15.3°±3.6°、15.6°±3.1°及15.1°±2.9°,三组间差异无统计学意义(P＞0.05);末次随访时Cobb角A组为16.9°±3.6°,平均丢失1.6°,B组为17.5°±3.1°,平均丢失1.9°,C组为16.8°±2.9°,平均丢失1.7°,三组差异无统计学意义(P＞0.05);植骨融合时间A组为5.9±0.4个月,B组为4.1±0.3个月,C组为6.2±0.5个月,B组明显短于A组、C组(P＜0.05),A组、C组比较差异无统计意义(P＞0.05).结论:颗粒骨植骨较传统块状植骨和钛网植骨植入方便易行,植入时间短,出血量少,植骨融合时间短,是后路胸椎结核病灶清除术后理想的植骨方式.     

术前门静脉血栓对活体肝移植预后的影响

目的 探讨术前门静脉血栓对活体肝移植的影响.方法 回顾性分析天津市第一中心医院2007至2011年完成的99例成人间活体肝移植患者,根据术前是否有门静脉血栓分为2组,血栓组26例,无血栓组73例.比较2组的术前危险因素及门静脉血栓对活体肝移植手术和术后患者预后的影响.结果 26例门静脉血栓患者Ⅰ级血栓23例,Ⅱ级血栓3例.肝移植术前的脾切除是发生门静脉血栓的独立危险因素(x2 =10.211,P=0.001).术前门静脉血栓会延长手术的无肝期(Z=-2.430,P=0.015),但2组患者术后并发症发生率(x2=0.326,P=0.568)及死亡率均无统计学差异,而且对患者的1年生存率和3年生存率均无影响(x2=0.505,P =0.477).结论 对于活体肝移植合并Ⅰ级或Ⅱ级门静脉血栓的患者,通过合理的术中处理及术后预防,门静脉血栓不会影响患者的预后.但门静脉血栓增加了一定的手术难度,需要详尽的术前评估和仔细的术中操作.     

全视网膜光凝联合睫状体光凝治疗视网膜中央静脉阻塞引起的新生血管性青光眼

目的观察全视网膜光凝术联合经巩膜睫状体光凝术治疗视网膜中央静脉阻塞引起的新生血管性青光眼的临床效果。方法选取因视网膜中央静脉阻塞引起的新生血管性青光眼,分A组和B组。A组,白内障轻度,能行全视网膜光凝术;B组,白内障较重,不能行全视网膜光凝术。A组7例患者行全视网膜光凝联合睫状体光凝术。B组,7例患者仅行睫状体光凝术。结果 A组患者眼压下降,新生血管消失或部分消失,视力提高或保持视力;B组部分患者眼压下降,前房见积血或新生血管部分消退,部分患者眼压仍高,需二次睫状体光凝,视力光感或无视力。结论全视网膜光凝联合睫状体光凝能有效治疗视网膜中央静脉阻塞引起的新生血管性青光眼。     

湿性脂肪干细胞辅助自体颗粒脂肪移植五年临床回顾总结

目的:回顾总结2008～2013年笔者行湿性脂肪干细胞辅助自体颗粒脂肪注射填充移植术五年的临床经验。方法:549例均采用湿性脂肪干细胞辅助自体颗粒脂肪移植术,单次注射填充移植完成532例(96.91%),17例(3.09%)脂肪存活率较低(30%～40%)需二次注射填充移植完成。结果:本组仅2例(0.36%)出现轻微并发症,成活率和远期效果明显提高,取得预期临床效果。结论:随访1～5,采用规范的湿性肿胀技术和注射器吸脂法抽吸颗粒脂肪及湿性新鲜原代血管基质细胞和脂肪干细胞辅助自体颗粒脂肪移植注射填充移植技术效果明显持久,遵循其正确的临床操作原则和技术指南及标准操作流程,能明显提高移植脂肪成活率和良好远期效果,是一种切实、可行、有效的临床方法。     

Penile reconstruction

During the most recent years, a variety of new techniques of penile reconstruction have been described in the literature. This paper focuses on the most recent advances in male genital reconstruction after trauma, excision of benign and malignant disease, in gender reassignment surgery and aphallia with emphasis on surgical technique, cosmetic and functional outcome.     

腹腔镜胆囊切除术中合并门静脉海绵样变性的处理体会(附10例报告)

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术中合并门静脉海绵样变性(cavernous transfor-mation of the portal vein,CTPV)的处理方法。方法:回顾分析2009年7月至2012年6月为10例胆囊良性疾病合并CTPV患者行LC的临床资料。9例患者于术前经彩色多谱勒超声、CT及DSA检查明确合并CTPV;1例患者术中发生大量出血,中转开腹证实合并CTPV并门静脉右支纵行劈裂损伤。结果:7例患者顺利完成手术,3例中转开腹。手术时间45～130 min,平均(60±15)min;术中出血量5～100 ml,平均(65±25)ml。术后1例发生毛细胆管漏,余者均无胆漏、出血等并发症发生。患者均顺利出院,术后平均住院(3.2±1.0)d。结论:术前明确诊断,术中仔细辨别变性迂曲血管,必要时行预防性缝扎止血,解剖困难时及时中转开腹,为合并门静脉海绵样变性的患者行LC是可行的。     

Synthetic hydrogel scaffold is an effective vehicle for delivery of INFUSE (rhBMP2) to critical‐sized calvaria bone defects in rats

Medtronic's INFUSE Bone Graft provides surgeons with a potent tool for stimulating bone formation. Current delivery vehicles that rely on Absorbable Collagen Sponges (ACS) require excessive quantities of the active ingredient in INFUSE, recombinant human Bone Morphogenic Protein‐2 (rhBMP2), to achieve physiologically relevant concentrations of the growth factor, driving up the cost of the product and increasing the likelihood of undesirable side effects in neighboring tissues. We demonstrate that a simple light‐mediated, thiol‐ene chemistry can be used to create an effective polymer delivery vehicle for rhBMP2, eliminating the use of xenographic materials and reducing the dose of rhBMP2 required to achieve therapeutic effects. Comprised entirely of synthetic components, this system entraps rhBMP2 within a biocompatible hydrogel scaffold that is degraded by naturally occurring remodeling enzymes, clearing the way for new tissue formation. When tested side‐by‐side with ACS in a critical‐sized bone defect model in rats, this polymeric delivery system significantly increased bone formation over ACS controls. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 401–406, 2013     

Rabbit Model for Evaluation of a Long Small-Caliber Vascular Graft

We developed an experimental method for evaluating the properties and healing process of a long, small-caliber vascular graft in a small animal. Eight rabbits were used. A left thoracotomy was performed and the thoracic aorta was isolated. The aorta was clamped and excised in the middle without a temporary shunt. A 15-cm-long by 4.0-mm-ID segment of a vascular graft was implanted end to end. After the blood flow of the aorta was restarted, the long graft remained in a big loop shape in the thoracic cavity and showed no tension. The major advantage of this technique is that, although it is simple, we are still able to evaluate a long, small-caliber vascular graft in a small animal.