主动脉瓣成形术治疗室间隔缺损并中重度主动脉瓣关闭不全

目的探讨室间隔缺损(VSD)并中重度主动脉瓣关闭不全(AI)患儿行主动脉瓣成形术的疗效。方法分析13例14岁以下VSD并中重度AI患儿行主动脉瓣成形术的临床资料。其中VSD为干下型9例,膜周部型4例;中度AI 4例,重度AI 9例。结果全组均无手术死亡。出院查体脉压差均恢复正常。术后彩色多普勒超声心动图检查平均左心室舒张末径与术前比较明显缩小(P<0.05),未发现有室间隔残余漏,2例有轻度AI。随访无手术死亡,患儿心功能均为纽约心脏协会(NYHA)Ⅰ或Ⅱ级。结论儿童主动脉瓣成形术效果良好,对于VSD并中重度AI患儿应首选主动脉瓣成形术。     

室间隔缺损介入封堵术中及术后发生传导阻滞高危因素探讨

目的探讨经导管介入封堵术治疗室间隔缺损(VSD)术中及术后传导阻滞的类型及高危因素。方法选择我院施行室间隔缺损介入封堵术患者45例,术中4例及术后11例出现传导阻滞,对引发传导阻滞的高危因素进行分析。结果45例VSD患者43例封堵成功,成功率95.56%;其中2例术中反复出现完全性房室传导阻滞(CAVB),被迫中止手术;术后11例发生传导阻滞,除Ⅱ°房室传导阻滞及完全性右束支传导阻滞各1例,因出现时间较晚未恢复外,其余传导阻滞均在14d内恢复。年龄(<4岁)、VSD上缘距主动脉右冠瓣距离(<3mm)、VSD直径(≥10mm)、穿刺成功后A-V轨道建立时间(≥60min)与传导阻滞的发生密切相关(P<0.05)。结论传导阻滞是膜周部室间隔缺损封堵术的常见并发症,了解VSD的特殊解剖结构、严格选择手术适应症缩短手术操作时间、减少传导束及其周围组织水肿是减少室间隔缺损介入封堵术后传导阻滞发生率的有效措施。     

前臂骨间背侧动脉逆行岛状皮瓣在手外科中的应用

目的：探讨前臂骨间背侧动脉逆行岛状皮瓣在修复手部软组织缺损中的应用价值。方法：选择手部软组织损伤患者30例作为研究对象,采用前臂骨间背侧动脉逆行岛状皮瓣修复术治疗,随访6～8个月,观察手部功能、外形和感觉的恢复情况。结果：术后随访观察皮瓣全部成活,手部外形及功能恢复满意,感觉部分恢复。结论：骨间背侧动脉逆行岛状皮瓣手术操作简单,易于成活,可加以推广用于治疗手部软组织缺损。     

Repair of Rabbit Segmental Defects with the Hybrid RP Scaffolds

Objective The objective of this experiment is to observe the effects of hybrid RP scaffolds on repairing segmental bony defects. Methods BMSCs were seeded into the hybrid and original RP scaffolds in order to repairing 15 mm segmental defect in the radius of rabbits. Radiograph, Micro CT and histology were used to evaluate the scaffolds degrading rate and new bone formation. Results The results suggested that the apatite/collagen sponge composite coating could improve the RP scaffolds degrading rate and new bone forming in vivo. Bony union was observed in the hybrid scaffolds group after 1 year post-operation. Conclusion The PLGA/β-TCP scaffolds With apatite/collagen sponge composite coating is promising as a candidate 3D substrate for bone tissue engineering.     

载药羟基磷灰石人工骨修复骨缺损的实验研究

用载药羟基磷灰石陶瓷人工骨（Ｃ－ＰＨＡ）进行家兔骨缺损修复。实验表明,蜂蜡包裹的Ｃ－ＰＨＡ在家兔体内具有明显的药物缓释作用,２７周局部组织仍含有效药物浓度。新生骨可顺利长入Ｃ－ＰＨＡ材料,术后１８周,材料表面全部被板层骨覆盖。蜂蜡不影响植入区的新骨长入和骨缺损的修复,亦不影响ＰＨＡ发生生物降解。     

Large skull defect in a headbanger

A mentally retarded self-mutilating child developed a large skull defect at the site of repeated trauma. The bony defect involved only the outer table and had smooth bony margins.     

侵犯胸壁的原发性肺癌的外科治疗

目的　探讨侵犯胸壁的原发性肺癌的外科治疗经验。方法　对35例侵犯胸壁的原发性肺癌患者,按照肿瘤外侵程度及采取的手术方式不同分组,肺叶及壁层胸膜切除16例为1组,肺胸壁整块切除19例为2组。结果　全组无手术死亡。1组3和5年生存率分别为38.5%和18.2%,2组3和5年生存率分别为41.2%和35.7%。全组N0患者3、5年生存率分别为63.2%(12/19)和42.9%(6/14),N12患者中仅1例生存5年以上。结论　手术切除范围和淋巴结转移是影响侵犯胸壁肺癌预后的重要因素。行术后胸壁缺损的重建时,采取20Prolene线网状固定,胸背部肌肉覆盖,效果良好     

Primary reconstruction by modified cervical island skin flap following resection of oral and pharyngeal cancer

Summary Reconstruction of the intraoral defect following cancer surgery often causes formation of fistula, impairment of lingual movement, and prolonged hospitalization by secondary reconstruction. To reduce such complications, the modified cervical island skin flap method as a one-stage intraoral reconstruction was used in 18 patients. Lateral cervical island flap was used in 15 cases and the median flap in three. This method proved to be successful for 17 patients. One patient who received a preoperative full dose of irradiation developed a fistula. There were two types of healing of the skin flap. The postoperative external appearance and function of the tongue were commendable.     

Reconstruction of critical-size mandibular defects in immunoincompetent rats with human adipose-derived stromal cells

In patients with bony defects, autologous bone grafts are the “gold standard” for reconstruction. In children, autologous bone harvesting is limited but tissue engineering offers an alternative. Next to bone marrow, adipose tissue is a source of mesenchymal stromal cells, and adipose-derived stromal cells (ADSC) can differentiate into osteocytes.The aim of this study was to evaluate the efficacy of bioactive implants (ADSC in fibrin glue) for repair of critical-size mandibular defects in athymic rats.Human adult ADSC embedded in fibrin glue were implanted into a critical-size defect in the rat mandible and their efficacy was compared to those of protected bone healing (pbh), autologous bone graft, and an empty defect. The newly formed bone was quantified using high-resolution flat-panel volumetric CT (fpvCT) during different observation times. After eight weeks, the specimens were assessed histologically and by micro-computed tomography (μ-CT).The radiographic examination demonstrated a significantly higher level of ossified defect area in the ADSC side compared with the pbh side. The autologous bone graft side showed significantly enhanced bone formation compared to the empty defect. The histological findings in the specimens with ADSC showed bony bridging of the defect. ADSC were capable of defect reconstruction under our experimental conditions.