多只扩张器超量扩张修复大面积瘢痕性秃发

目的 探讨应用多只扩张器超量扩张头皮修复大面积瘢痕性秃发的临床效果.方法 Ⅰ期手术：根据秃发区的形状、面积大小,选择多只扩张器,在肿胀麻醉下,置于头部有发区帽状腱膜下,注射壶外置.超量扩张3～6个月,以获得额外有发头皮.Ⅱ期手术：将扩张器取出,切除瘢痕,将扩张后的有发头皮,采用滑行推进皮瓣、旋转皮瓣与易位皮瓣联合运用的手术方式,修复头皮秃发区.结果 23例患者术后秃发区修复效果良好,外观满意.结论 多只扩张器超量扩张可获得大量额外扩张头皮.合理设计皮瓣转移术,最大限度地提高了扩张皮肤的利用率,可修复大面积瘢痕性秃发,修复效果良好.     

The use of nasal dilator strips as a placebo for trials evaluating continuous positive airway pressure

OBJECTIVES:

The aim of the current study was to compare the objective and subjective effects of continuous positive airway pressure to the use of nasal dilator strips in patients with acromegaly and moderate to severe obstructive sleep apnea.

METHODS:

We studied 12 patients with acromegaly and moderate to severe obstructive sleep apnea (male/females = 8/4, age = 52±8 ys, body mass index = 33.5±4.6 Kg/m², apnea–hypopnea index = 38±14 events/h) who had been included in a randomized, crossover study to receive three months of treatment with continuous positive airway pressure and nasal dilator strips. All patients were evaluated at study entry and at the end of each treatment by polysomnography, and Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index and treatment satisfaction questionnaires. ClinicalTrials.gov: NCT01265121

RESULTS:

The apnea–hypopnea index values decreased significantly with continuous positive airway pressure treatment but did not change with the use of nasal dilator strips. All of the subjective symptoms improved with both treatments, but these improvements were significantly greater with continuous positive airway pressure than with the nasal dilator strips.

CONCLUSION:

The use of nasal dilator strips had a much smaller effect on the severity of obstructive sleep apnea in patients with acromegaly and moderate to severe obstructive sleep apnea in comparison to the use of continuous positive airway pressure. Moreover, the improvement in several subjective parameters without any significant objective improvement in obstructive sleep apnea resulting from the use of nasal dilator strips is compatible with a placebo effect.     

局部胆管内压大小及持续时间对犬胆管壁的影响

目的探讨局部肌管内压大小及持续时间对犬胆管壁的影响。方法设计并自制一内置入式胆管扩张器,体外测试扩张气囊内压力与注水容积及囊径的关系。将20只杂交犬随机分为5组,A组为假手术组仅在胆总管内放置胆管扩张器;B、C组分别向扩张气囊内注水0.1 ml、0.2 ml(球囊压力分别为0.24 kPa、0.58 kPa)扩张胆总管,10 min后抽空气囊并留置胆管扩张器作胆汁引流;D、E组分别向扩张气囊内注水0.1 ml、0.2 ml扩张胆总管后,不抽空气囊并留置作胆汁引流。各组分别于术后7 d再次剖腹。观察各组扩张前后血清总胆红素(TB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)值及胆管直径(BD)变化、胆管壁及肝组织学改变。结果与A组比较,C组扩张后BD增宽(P<0.05),D组扩张后BD显著增宽(P<0.01).E组扩张后TB、ALT、AST均增高(P<0.01);A、B组胆管壁组织学无明显变化,C组胆管壁黏膜充血水肿,部分黏膜脱落,D组胆管直径增粗及胆管壁增厚。E组胆管壁部分坏死,与网膜或十二指肠粘连。结论局部胆管内压大小及持续时间对犬胆管壁的影响存在双向互变关系,正常胆管壁在一定的时间内可承受一定的局部胆管内压而不致发生胆管壁的病理变化,适宜的局部胆管内压可引起局部胆管及其上游胆管壁扩张,反之,胆管壁可出现破坏性改变。     

Evaluation of dilators for central venous catheterization using an experimental model

Purpose Skin incision before percutaneous central venous catheterization may cause serious hemorrhage and/or skin cicatrization. To minimize these adverse effects, we improved the shape of a dilator and coated it with lubricant to reduce insertion load.Methods We selected three types of dilators from different manufacturers. Each brand was widely available on the market in Japan. We redesigned one model with modified multitapering angles. Six types of dilators in total (three manufactured dilators, one manufactured dilator with lubricant, and the newly modified dilator +/– lubricant) were examined regarding load of insertion using pork muscle covered with porcine skin. Among these dilators, two manufactured dilators and the newly modified one with lubricant were also investigated regarding insertion load with or without skin incision.Results The minimum load of insertion was observed in the newly modified dilator with lubricant. The modified dilator attenuated the insertion load by up to 50% of the manufactured dilator, and the lubricant also reduced load by up to 16%. The insertion load of the modified dilator coated with lubricant was comparable to that of the manufactured dilators inserted with a 2-mm skin incision.Conclusion The lubricant-coated dilator with multitapering angles was associated with decreased insertion load and thus facilitated its insertion without skin incision.     

球囊渐进扩张法预防医源性胆管损伤修复后吻合口狭窄

目的探讨应用球囊渐进扩张法治疗医源性胆管损伤及预防术后肝管空肠吻合口狭窄的治疗效果。方法选择28例医源性胆管损伤患者,男15例,女13例,均采用一期肝管空肠吻合手术,术中于吻合口内放置扩张球囊．术后7d开始进行球囊渐进性扩张,根据患者情况每天注气扩张3－4次,逐渐加大注气容量,3个月后拔出球囊导管并随访观察。结果28例患者均完成手术,共使用球囊32支,术后随访6个月。5年,平均2．8年,28例患者术后均未出现腹痛、发热、黄疸、皮肤搔痒等胆管炎及胆管狭窄症状,B超、胆道镜、MRCP检查吻合口无狭窄。结论医源性胆管损伤后．一期手术处理并术中置人扩张球囊、术后渐进扩张的方法可以有效预防术后吻合口狭窄。     

腔镜技术在男性尿道狭窄治疗中的临床应用

目的:探讨腔镜技术在男性尿道狭窄治疗中的临床应用。方法:回顾性分析2003年1月-2008年6月43例男性尿道狭窄经尿道冷切、电切或筋膜扩张器扩张手术的临床资料。结果:43例尿道狭窄腔镜处理病例中,手术成功41例(95.3%),其中1次手术37例,2次或2次以上手术4例;手术失败2例(4.7%),其中1例改开放手术治疗,1例行耻骨上膀胱穿刺造瘘。40例患者随访3-48个月,排尿通畅。结论:腔内治疗尿道狭窄是一条简单、安全、有效的途径。     

扩张器在头皮巨大神经纤维瘤外科治疗中的应用

目的：探讨头皮大型神经纤维瘤的最佳治疗与整复方法。方法：采用扩张器扩张正常头皮，扩张完成后，彻底切除瘤体，转移扩张皮瓣，一期手术完成缺损的修复治疗。结果：23例患者中，5例瘤体累及范围接近头皮1/2，术后经1—10a随访，头发生长良好，瘤体无复发。结论：在充分做好术前设计及严防手术并发症的前提下，采用扩张器可获得充足的带蒂皮瓣，用以修复大面积头皮缺损。该法既能保证彻底切除瘤体，又能避免头发缺失和供皮区带来的美容缺陷和瘢痕增生。     

扩张器注液的操作及护理

本文介绍了扩张器的结构、注液的操作、并发症的防治及注意事项。说明掌握好此项护理技术对修复皮肤软组织缺损具有重要的作用。     

食管癌术后吻合口狭窄内镜扩张治疗临床探讨

目的观察萨氏扩张器在治疗食管癌术后吻合口狭窄的疗效。方法选择食管癌术后吻合口狭窄的病人48例，通过内镜钳道送入导丝越过狭窄的吻合口，沿导丝置入不同的直径的萨氏扩张器，对狭窄部位进行扩张。结果48例病人共进行62次扩张，其中34例1次扩张有效，12例2次扩张有效，1例扩张3次后行植入金属内支架，1例扩张1次后穿孔，治愈率为58，3％。结论萨氏扩张器治疗食管癌术后吻合口狭窄疗效较好。     

RPH联合扩压硬化剂注射治疗混合痔212例

为探讨自动痔疮套扎术（RPH）联合扩压硬化剂注射治疗混合痔的疗效，将212例混合痔患者分为两组，治疗组107例采用RPH联合扩压硬化剂注射治疗，对照组105例采用单纯扩压硬化剂注射治疗，随访观察并评价其疗效。结果显示，治疗组与对照组治愈率分别为99．1％和94．2％，治疗组疗效明显高于对照组（P〈0．05）。结果表明，RPH联合扩压硬化剂注射治疗混合痔疗效明显高于单纯扩压硬化剂注射治疗。