ObjectiveTo introduce the surgical method and effectiveness of repairing skin and soft tissue defect in the palm or dorsum of the hand and forearm with epigastric bilobed flap. MethodsBetween October 2010 and December 2013, 4 male patients with skin and soft tissue defect in the palm or dorsum of the hand and forearm were treated, aged from 36 to 62 years. Of them, 3 cases had degloving injury caused by machines and 1 case had necrosis of fingers and skin after surgery of crush injury. The time from injury to hospitalization was from 3 hours to 15 days. Among the 4 cases, the size of palmar defect was 7 cm×4 cm to 16 cm×6 cm, and the size of dorsal defect was 10 cm×7 cm to 20 cm×10 cm. The epigastric bilobed flap was designed based on the axial vessel which was formed by inferior epigastric artery, superior epigastric artery, and intercostals arteries. The size of flap ranged from 12 cm×4 cm to 18 cm×6 cm in the vertical direction, 15 cm×8 cm to 22 cm×11 cm in the oblique direction. The donor site was directly closed. The pedicles were cut at 22 to 24 days after repairing operation. ResultsAll the flaps survived well with the wound healing by first intention. Four patients were followed up 3 months to 1 year and 2 months. The other flaps had good appearance and texture except 1 bulky flap. The flap sensation basically restored to S2-S3. The function of the hands recovered well. ConclusionSkin and soft tissue defect in the palm or dorsum of the hand and forearm can be repaired with the epigastric bilobed flap, because it has such advantages as big dermatomic area and adequate blood supply. Besides, the operation is practical, safe, and simple.
ObjectiveTo investigate the effect and incidence of residual leakage after surgical repair of large ventricular septal defects with moderate to severe pulmonary hypertension using cross-linkage mattress suture, a suture method invented by us, as compared with interrupted mattress suture. MethodsWe retrospectively analyzed the clinical data of 41 patients of large ventricular septal defect with moderate to severe pulmonary hypertension underwent surgery using cross-linkage mattress suture in Beijing Anzhen Hospital from February 2011 through April 2013. The 41 patients were as a cross-linkage group (average age 18.7±12.3 years, the ratio of male to female 31:10). Another 41 patients, who were repaired using interrupted mattress suture, were retrospectively chosen by matching age, size and location of the defects, pulmonary artery pressure and vascular resistance with members from the cross-linkage group, and were assigned as a control group (average age 17.4±11.8 years, the ratio of male to female 31:10). ResultsThere was no operative mortality and no new perioperative atrioventricular conduction block. Postoperative echocardiography revealed the incidence of residual leakage was 31.7% (13/41) in the control group, 0% (0/41) in the cross-linkage group with a statistical difference (χ2=13.164, P=0.000). With a follow-up of 18.2±6.1 months, no late death and no new atrioventricular conduction block occurred. There was no statistical difference in New York Heart Association functional class or pulmonary artery pressure measured through echocardiography between the two groups. While there was a statistical difference in incidence of residual leakage between the the cross-linkage group and the control group (0% (0/41) versus 26.8% (11/41), χ2=10.499, P=0.001). ConclusionThere is a high incidence of residual leakage after the surgical repair of large ventricular septal defect complicated with moderate to severe pulmonary hypertension using interrupted mattress suture, while the use of cross-linkage mattress suture can effectively reduce the incidence of residual leakage.
目的总结左胸骨旁小切口微创封堵分流方向偏向流出道的室间隔缺损（VSD）的初步经验。 方法2014年2～8月广州医科大学附属第一医院对15例分流方向偏向流出道的VSD患者施行左胸骨旁小切口微创封堵手术，其中男7例，女8例；年龄10个月～19岁（4.5±4.6）岁；体重5.5～54.0（14.6±14.1）kg；其中干下型6例，嵴内型6例，膜周部型3例；缺损直径2.5～6.5（4.0±1.2）mm，距主动脉瓣环距离≤1 mm 9例，≤2 mm4例，>2 mm 2例；合并主动脉瓣右冠瓣轻度脱垂5例；采用左胸骨旁第2或第3肋间1.5～2.5 cm切口，在经食管超声心动图（TEE）监视下在右心室流出道表面选择适当的穿刺点，建立VSD输送轨道并置入封堵器，观察有无残余分流、主动脉瓣反流；术后3个月复查经胸超声心动图。 结果15例均成功封堵，无中转开胸，无残余分流和心律失常，新发主动脉瓣轻微反流2例，围手术期输血1例；手术时间30～120（58±28）min，术中出血量5～200（26±50）ml；术后住院时间3～13（4.3±2.6）d，无二次开胸止血、Ⅲ°房室传导阻滞、主动脉瓣反流加重、溶血、切口感染等并发症；术后3个月返院复查经胸超声心动图13例，无新发主动脉瓣反流和封堵器脱落；2例术中新发主动脉瓣反流加重，其中1例出现残余分流。 结论左胸骨旁小切口封堵分流方向偏向流出道VSD 手术安全、切口小、操作简单，近期效果尚满意；对合并主动脉瓣轻度脱垂VSD 需慎重施行外科微创封堵手术。
Objective To systematically evaluate the clinical effectiveness of platelet-rich plasma (PRP) combined with grafting material for the treatment of periodontal intrabony defects. Methods The following databases such as PubMed, The Cochrane Library, EMbase, CNKI, CBM and WanFang Data were searched on computer from inception to August, 2012 to collect the relevant randomized controlled trials (RCTs) on PRP combined with grafting material versus grafting material alone for periodontal intrabony defects. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of the included studies. RevMan 5.2 software was applied for meta-analysis. Results A total of 11 RCTs involving 342 patients were included. The pooled analysis on 7 RCTs showed that there was a significant difference in lower increase of clinical attachment loss (WMD=0.70, 95%CI 0.51 to 0.90, Plt;0.000 01) between the PRP combined with grafting material group and the grafting material alone group. But there was no significant difference in the gingival recession (WMD= −0.01, 95%CI −0.15 to 0.13, P=0.86). The pooled analysis on 9 RCTs showed that there was no significant difference in the reduction of plaque index (WMD= −0.04, 95%CI −0.09 to 0.02, P=0.20) between the two groups. Conclusion PRP combined with grafting material is superior to grafting material alone in the clinical attachment loss. But, there are no significant differences in gingival recession and plaque index. However, given the limited sample size and incomplete measure indexes of included studies, this conclusion still needs to be further proved by conducting more high-quality and large-scale RCTs.
目的：了解大鼠脑出血后血肿周围组织细胞凋亡与神经元特异性烯醇化酶（NSE）的表达及大鼠神经功能缺损程度的关系。方法：用胶原酶注入到大鼠尾状核的方法制作脑出血模型。将大鼠分为脑出血、假手术组、正常组3组。采用苏木素伊红(HE) 染色、NSE免疫组织化学染色及TUNEL分别观察各组在脑出血后第6 h、12 h、24 h、48 h、72 h、5 d、7 d时血肿周围NSE及TUNEL的表达。用Longa评分法评价大鼠神经功能缺损程度。结果：大鼠在胶原酶注入6 h后形成稳定的血肿，在造模24～48 h神经功能缺损程度最重；6 h即见到TUNEL阳性细胞的表达，在48 h最明显；NSE从神经元中漏出弥散到细胞间隙也在48 h达高峰。结论：脑出血血肿周围凋亡与神经功能缺损及NSE的变化有关，凋亡可能在脑出血的神经损伤中起重要的作用。
ObjectiveTo summarize the method and experience in surgical treatment for mesh infection after prosthetic patch repair of ventral hernia. MethodsThe clinical data of 16 patients with mesh infection after ventral hernia repair accepted surgical treatment in our department from June 2007 to May 2010 were analyzed retrospectively. There were 10 males and 6 females, the age range from 24 to 73 years with an average 45.2 years. The patients with mesh infection included 11 cases of infection after incisional hernia repair, 4 cases of infection after abdominal wall defects repair caused by abdominal wall tumor resection, 1 mesh infection combine with urinary fistula caused by parastomal hernia of ileal neobladder repaired by using prosthetic patch. Clinical manifestation included mesh exposion, abscess, chronic sinus, and enterocutaneous fistula. All patients accepted local treatment of change dressing by primary operative surgeon, but the wounds didn’t heal about 3 to 24 months. Then the patients performed radical removal of infected mesh and abdominal wall reconstruction. ResultsAll patients accepted affected mesh removal successfully. Five patients performed abdominal wall reconstruction by using components separation technique. Four cases accepted abdominal wall repair by using polypropylene mesh. Five patients performed abdominal wall repair by using human acelluar dermal matrix. One case accepted change dressing and vacuum aspiration on the infected wound surface without reconstruction. And one case closed the wound immediately after infected mesh removal. The postoperative hospitalization time was 9 to 25 d (average 14 d). Thirteen patients recovered with primary wound healing. The other 3 cases recovered with second healing by local change dressing. All patients were followed up from 6 to 34 months (average 22 months), no abdominal wall hernia recurrence occurred. ConclusionsIt is very difficult to deal with mesh infection after prosthetic patch repair of abdominal wall hernia or defect. The surgical treatment should be done according to specific condition of each individual so as to acquire satisfied results.
目的 探讨对Mirizzi综合征实施临床合理有效的手术方法。方法 自1990年1月至2003年12月期间，我院采用经肝放置胆道支撑引流管治疗Ⅱ、Ⅲ型Mirizzi综合征21例,胆道支撑引流管放置6个月以上，并行胆道造影检查。结果 所有患者恢复良好,胆道造影检查见胆道通畅后拔除支撑引流管，随访2～10年,无并发症发生。结论 经肝放置胆道支撑引流管治疗Ⅱ、Ⅲ型Mirizzi综合征,是保持胆道生理功能完整的有效方法。
目的总结陈旧性会阴肛管缺损肛门不全失禁临床处理经验。方法回顾性分析我院1994年1月至2000年1月收治的7例陈旧性会阴肛管缺损肛门不全失禁患者的临床资料。结果7例患者均行手术治疗，术后全部随访，无一例复发。结论对于陈旧性会阴肛管缺损肛门不全失禁患者，明确找到断裂的外括约肌断端是手术成败的关键。