滑车上动脉的影像学研究及在鼻再造术中的应用

目的通过颈内、外动脉造影对滑车上动脉分支血管进行影像学研究,并设计改良额部皮瓣行鼻再造术。方法选用30例成人颈内、外动脉造影资料进行血管三维成像,对滑车上动脉分支(肌支和皮支)进行研究,探讨滑车上动脉分支走行、层次以及与眶上动脉的交通情况。根据影像学检测结果临床应用滑车上动脉分支设计额部皮瓣对11例鼻缺损患者行鼻再造术。其中男7例,女4例;年龄15～48岁,平均23岁。鼻缺损范围3.0 cm×2.5 cm～5.0 cm×3.5 cm。结果颈内动脉造影和三维成像显示,30例滑车上动脉恒定出现,直径(0.9±0.6)mm;其中浅层皮支恒定出现,直径(0.7±0.3)mm;深层肌支4例缺失,直径(0.5±0.5)mm,走行于额肌间,长(32.0±6.2)mm,分支间互有交通并与眶上动脉亦有吻合。临床应用皮瓣均成活,无软骨外露,外形良好。术后经4个月～3年随访,鼻尖、鼻翼及鼻小柱外形接近正常,鼻高度和坡度适中,再造鼻质地弹性良好,鼻孔无狭窄,通气功能正常。结论影像学检测结果佐证了滑车上动脉存在恒定皮支,以其分支为血管蒂设计的额部皮瓣提高了鼻再造疗效。     

陈旧性鼻骨骨折的治疗

目的：讨论陈旧性鼻骨骨折的诊疗方案。方法：对76例患者鼻骨骨折在2周左右及大于2周行鼻骨骨折手法复位或切开鼻骨成形术。结果：35例患者鼻部外观无塌陷无歪鼻畸形,鼻道通畅,鼻功能恢复良好,无并发症。结论：鼻骨骨折手法复位及鼻骨成形术治疗陈旧性鼻骨骨折效果满意。     

自体鼻中隔软骨游离移植亚洲人鼻延长术

目的 探讨自体中隔软骨移植,改变鼻短小鼻尖圆钝的外形、延长鼻长度、改善鼻尖外形及鼻唇角.方法 松解与塑造鼻翼软骨形后,切取自体鼻中隔软骨行L状移植及帽状移植,并辅以埋线塑形等手段.结果 共完成此类手术345例,经6个月至4年术后随访,均获得满意效果.结论 采用在鼻中隔下端与鼻翼软骨穹窿部行鼻中隔软骨移植的方法加长鼻长度,疗效可靠,且自体鼻中隔软骨取材方便、损伤小、不易发生感染及排异等并发症,值得推广.     

鼻内镜下低温等离子射频治疗隐蔽性鼻出血

目的探讨鼻内镜下低温等离子射频治疗隐蔽性鼻出血的疗效。方法2009年1月-2011年2月对67例隐蔽性鼻出血行鼻内镜检查,明确出血部位后,低温等离子射频电凝出血部位。结果67例均明确出血部位,下鼻道穹隆部、嗅裂区、中鼻道和中鼻甲最常见,分别有18、16和14例。所有病例经1—3次低温等离子射频电凝止血或联合前后鼻孔填塞后均彻底止血。结论鼻内镜下低温等离子射频治疗隐蔽性鼻出血效果确切,安全可靠。     

Serrated polyp detection rate during screening colonoscopy

Aim The adenoma detection rate is an important quality indicator for colonoscopy, but recently, serrated polyps of the large bowel have been recognized as important premalignant lesions. As they are often more difficult to see than adenomas, the detection rate of serrated polyps is set to become a more stringent indicator of quality in colonoscopy than adenoma detection rate. Here we aim to provide preliminary data on serrated polyp detection. Method This is a retrospective review of prospectively collected data. Colonoscopies were stratified by one of six colorectal surgeons, each of whom had performed more than 1000 colonoscopies. Exams were separated by indication and the number of patients with at least one adenoma or one serrated polyp recorded. Time of withdrawal in normal examinations was noted. Results Eighteen thousand and three colonoscopies were included. Average completion rate was 96.3 ± 1.2%. Mean serrated detection rate for all examinations was 20.6 ± 4.8% and for screening examinations only was 13.9 ± 5.0%. Corresponding means for adenoma detection were 31.5 ± 6.7% and 20.7 ± 4.1%, respectively. Simple regression of overall adenoma detection rate versus overall serrated detection rate was not significant (R = 0.571, P = 0.237), but was significant for screening exams (R = 0.854, P = 0.031). There was a strong relationship between time of withdrawal and serrated detection rate (screening, R = 0.908, P = 0.012; overall, R = 0.956, P = 0.003). Conclusion Taking time to withdraw the colonoscope is essential for maximum detection of serrated polyps. The ability to find adenomas does not necessarily correlate with an ability to find serrated polyps.     

IGF-I和IGF-IR在子宫内膜息肉中的表达及临床意义

目的:检测子宫内膜息肉胰岛素样生长因子-I(IGF-I)及其受体(IGF-IR)的表达,探讨子宫内膜息肉的发生机制。方法:前瞻性研究子宫内膜息肉患者40例,全部患者均接受宫腔镜下子宫内膜息肉切除术,切除息肉及周围正常内膜组织,采用免疫组化方法测定息肉组织和周围正常内膜组织中IGF-I、IGF-IR的表达水平。结果:IGF-I在息肉组的表达高于内膜组,差异有统计学意义(P<0.05),IGF-IR在息肉组及内膜组中的表达差异无统计学意义(P>0.05),息肉组IGF-I阳性细胞与IGF-IR阳性细胞表达无相关(P>0.05)。结论:子宫内膜息肉中IGF-I的高表达可能参与了子宫内膜息肉形成的病理过程。     

Medpor植入术治疗萎缩性鼻炎的疗效分析

目的:探讨Medpor外科种植体鼻腔植入治疗萎缩性鼻炎(AR)的疗效分析。方法:选取38例萎缩性鼻炎的患者,行Medpor外科种植体经唇龈切口鼻底黏膜下填充术,对远期疗效进行观察。结果:38例经3-10年随访观察,治愈21例(55.3%),显效11例(28.9%),改善4例(10.5%),无效2例(5.3%)。本组病例总有效率94.7%。结论:Medpor外科种植体是治疗萎缩性鼻炎的理想材料。     

鼻窦冲洗法在鼻腔手术后的应用

目的探讨鼻窦冲洗在鼻腔手术后的应用。方法 126例鼻腔手术后患者随机分为治疗组与对照组。治疗组61例鼻腔术后行鼻窦冲洗和输液抗炎治疗。对照组65例仅行输液抗炎治疗,随后2个月比较两组疗效。结果治疗组缩短了临床疗程,提高了1级治愈率。结论鼻腔手术后进行鼻窦冲洗有利于术腔内的清洁,减少了术腔结痂,缩短了临床疗程,提高了1级治愈率。     

Metabolism of chlorobenzene in the mucosa of the murine respiratory tract

The metabolism and binding of the volatile halogenated hydrocarbon chlorobenzene-¹⁴C (CB) in the respiratory tract of mice was studied. As shown by whole-body autoradiography with heated tissue-sections, a selective localization of nonvolatile metabolites occurred in the mucosa of the entire respiratory system. Microautoradiography showed that tissue-bound metabolites were present in the epithelium of the nasal and tracheo-bronchial mucosa and in subepithelial glands in the olfactory nasal mucosa. In vitro experiments with slices from the nasal mucosa, lung and liver indicated transformation of CB to metabolites which could not be extracted from the tissues; the binding was most pronounced in the nasal mucosa. The formation of nonextractable metabolites by the nasal mucosa and lung in vitro was decreased by metyrapone, piperonylbutoxide and SKF 525, indicating a cytochrome P-450 dependent metabolism of CB in the respiratory tissues. Autoradiography of lung slices incubated with CB revealed that a preferential localization of metabolites in the bronchial mucosa also occurred in vitro. The results indicate that in situ metabolism of chlorobenzene in the mucosa of the respiratory tract may play a role in the pathogenesis of chlorobenzene induced bronchiolar necrosis in mice. The high binding of metabolites in the nasal mucosa suggest that this tissue may also be a site of toxic action of chlorobenzene.