深部埋置环形褥式缝合联合浅层X射线放射治疗胸背部瘢痕疙瘩的疗效分析

目的探讨深部埋置环形褥式缝合联合浅层X射线放射治疗胸背部瘢痕疙瘩的临床疗效。方法选取102例胸背部瘢痕疙瘩患者,采用深部埋置环形褥式缝合技术进行治疗,术后进行病理HE染色分析,于术后24 h内行第1次浅层X射线放射治疗,每隔5 d 1次,共4次。于术后1个月、3个月、6个月及1年观察患者的临床疗效,记录患者术后并发症发生率及满意率。结果瘢痕组织HE染色可见表皮萎缩变薄,真皮中上部成纤维细胞及胶原增生,增生的毛细血管周围可见稀疏的炎细胞浸润。术后1个月、3个月、6个月及1年,患者治疗有效率分别为100%、99.02%、96.08%及89.22%;术后总体并发症发生率为16.67%,总体满意率为97.06%。结论胸背部瘢痕疙瘩手术切除后采取深部埋置环形褥式缝合技术联合浅层X射线放射治疗,患者可取得较好的临床疗效,且具有复发率低、无严重并发症等优点。     

Penile aseptic abscess in the cavernous body at the base of the penis:a case report

We report a case of aseptic abscess in the cavernous body at the base of the penis.In our clinical observation,the patient underwent puncture and drainage of the corpus cavernosum abscess,followed by surgical resection of the abscess wall,with the incisions closed layer by layer with primary suture.In addition,we paid attention to strengthening the postoperative management by using elastic bandages to wrap the penis intermittently to prevent edema;the incision would not be covered with dressings from the third day after the operation,so as to keep the incision site dry in an open way.During the period of indwelling of the catheter after the operation,we noticed the care of the external orifice of the urethra to reduce the occurrence of catheter-related infections.Finally,the patient was diagnosed with a penile aseptic abscess in the cavernous body at the base of the penis.The patient recovered well after surgery and was discharged 1 week later.At 1.5 years after the operation,the shape of the penis returned to normal,and the erectile function was normal.It was seen that good nursing concept is of great help for prognosis,which could avoid infection and edema,and is conducive to wound healing.     

尼龙绳结扎装置在内镜下荷包缝合过程中的常见问题分析及应对策略

目的 总结尼龙绳结扎装置在内镜下荷包缝合过程中出现的问题事件并分析其原因,从而改进和探索尼龙绳结扎装置使用过程中的技巧及策略。方法 回顾性分析2017年4月－2020年12月该院消化内镜中心99例行上消化道内镜下荷包缝合患者的手术过程,总结尼龙绳结扎装置在使用过程中出现的问题事件及其原因。结果 共总结出问题事件21次,包括外鞘管前端褶皱10次、结扎环脱钩5次、结扎环无法释放2次、结扎环断开2次、结扎环塞向前移动2次。结果显示,内镜类型和缝合镜式是问题事件发生的影响因素,且单腔镜操作、倒镜缝合比双腔镜、正镜缝合更容易发生问题事件,病变的位置不是问题事件发生的影响因素,差异无统计学意义（P > 0.05）。结论 通过分析人为因素、创面位置因素、装置质量因素等问题事件的原因,提出相应的对策,从而减少和避免不必要的问题事件,提高手术效率。     

Evaluation of In Vivo Properties of Velosorb™ Fast Versus Vicryl™ Rapide in a Functional Rabbit Model of Intradermic Suture and Episiotomy

Objective: Fast-absorbing polyglactin 910 is commonly used to suture skin and vaginal incisions. In vitro studies have shown similar tensile strength properties between Velosorb? Fast and Vicryl? Rapide (Al-Qattan MM. J Hand Surg Br Eur. 2005;30(1):90–91). This randomized study compared Velosorb? Fast (Covidien) with Vicryl? Rapide (Ethicon) in a rabbit model of intradermic suture and episiotomy. Materials and Methods: This randomized prospective study was performed on 20 New Zealand rabbits, in which we realized a mediolateral perineo-vaginal incision and two vertical skin incisions of about 8 cm on the abdominal wall. The sutures were randomized between Velosorb? Fast (Covidien) and Vicryl? Rapide (Ethicon), and each rabbit was treated with the same suture on both vaginal incision and left abdominal incision, while the right abdominal incision was closed with an alternate suture. A macroscopic examination was performed on days 5 and 11. On day 11, animals were sacrificed for histological (Badylak quantitative score) and electron microscopic examinations. Differences were considered significant at p < .05. Results: All of the rabbits survived and were included in the final results. Fifty-one sutures were visible by histologic analysis (27 in the Velosorb? Fast group and 24 in the Vicryl? Rapide group). The power of the study was ≥80%. There was no significant difference between the two groups based on the total histologic Badylak score analysis or the Badylak sub-score analysis. Conclusions: Velosorb? Fast seems to be as efficient as Vicryl? Rapide for use in perineal and skin closure.     

Influence of differences in the hardness and calcium content of diets on the growth of craniofacial bone in rats

Objective:To examine the effects of a soft diet and a low-calcium diet on the craniofacial growth and bone architectures of the maxilla and mandible.Materials and Methods:Male rats (n  =  20, 3 weeks old) were divided into four groups. Ten rats were given a normal-calcium diet, and the other rats were given a low-calcium diet. Each group was then divided into two subgroups, which were fed a hard or a soft diet. After 4 weeks, craniofacial growth and architecture in maxillary and mandibular bone were analyzed using cephalometry, micro-computed tomography, and histopathology.Results:The low-calcium diet had no effect on serum calcium levels. The low-calcium diet had the greatest effect on craniofacial bone growth, while the soft diet affected the growth of several bone sites that are attached to the masseter muscle. A low-calcium diet resulted in the deterioration of the connectivity of the trabeculae in the furcation region of the maxillary and mandibular first molar, while a soft diet resulted in the diffuse disappearance of trabeculae in the central part of the furcation regions. In the midpalatal suture, a low-calcium diet resulted in inhibition of cartilaginous ossification, although the midpalatal suture had a normal cartilaginous structure. A soft diet resulted in narrower cartilage cell layers in the midpalatal suture.Conclusions:We demonstrated that a low-calcium diet and a soft diet resulted in a deterioration of bone structures in both the maxilla and in the mandible; however, the mechanisms underlying these effects differed between diets.