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find Keyword "颈部" 67 results
  • 消化道吻合器在颈部胃食管吻合中的应用

    目的 总结食管癌切除后采用消化道吻合器行颈部胃食管吻合术治疗食管癌患者的临床经验,以降低术后吻合口瘘和吻合口狭窄的发生率,提高手术疗效。 方法 125例食管癌患者,根据采用的手术术式不同分为两组,器械吻合组:行食管癌切除后采用国产常州WGWB-26型吻合器进行颈部胃食管吻合;手工吻合组,行食管癌切除后采用手工方法进行颈部胃食管吻合。 比较两种手术术式的胃食管吻合时间、术后吻合口瘘和吻合口狭窄的发生率。 结果 全组无手术死亡。器械吻合组吻合时间少于手工吻合组(30±5min vs. 55±5 min, Plt;0.05),近期吻合口瘘和吻合口狭窄发生率明显低于手工吻合组(0% vs. 4.8%, 0% vs. 9.5%,Plt;0.05);器械吻合组随访1~15个月食管X线钡餐检查证实无吻合口狭窄。 结论 使用吻合器行胃食管器械吻合,能增加吻合的可靠性,减少术后并发症,包括吻合口瘘和吻合口狭窄的发生。

    Release date:2016-08-30 06:08 Export PDF Favorites Scan
  • 食管癌切除胃食管颈部吻合与胸腔内吻合的对比分析

    目的 比较食管癌切除胃食管颈部吻合与胸腔内吻合的手术疗效。方法 中下段食管癌患者165例,根据手术方式不同,将其分为两组,胃食管颈部吻合组:73例,经左颈、右胸、上腹正中三切口手术40例,经左胸、左颈二切口手术33例。胸腔内吻合组:92例,经左胸或右胸径路行主动脉弓上吻合47例,弓下吻合45例。比较两组术后并发症的发生率和生存率。结果 术后食管胃颈部吻合组残端癌、手术死亡率和吻合口瘘死亡率均低于胸腔内吻合组(Plt;0.05);两组患者间5年生存率差别无统计学意义(Plt;0.05);但淋巴结转移阴性和阳性患者5年生存率两组间比较差别均有统计学意义(Plt;0.05)。结论 食管癌切除胃食管颈部吻合术治疗中下段食管癌符合肿瘤根治原则,肿瘤切除彻底,残端癌的发生率和死亡率低。

    Release date:2016-08-30 06:26 Export PDF Favorites Scan
  • SUBCUTANEOUS PEDICLE SCAR-BAND ROTATION FLAP FOR REPAIRING CERVICAL POSTBURN SCAR CONTRACTURE

      Objective To investigate the operative method and efficacy of subcutaneous pedicle scar-band rotation flap in the treatment of cervical postburn scar contracture. Methods Between August 2008 and May 2010, 15 patients with cervical postburn scar contracture were treated with subcutaneous pedicle scar-band rotation flaps, including 9 males and 6 females with an average age of 17.3 years (range, 7-35 years). The disease duration was 1-8 years (mean, 3 years). The locations were the left cervical region in 6 cases, the right cervical region in 8 cases, and mental cervical angle region in 1 case. According to LI Ao’s classification standard for cicartrical contracture, there were 12 cases of grade I and 3 cases of grade II. The area of scar ranged from 8 cm × 5 cm to 25 cm × 12 cm. After scar relaxation, wounds were repaired with the subcutaneous pedicle scar-band rotation flaps of 7 cm × 5 cm to 15 cm × 10 cm at size. In 3 cases of grade II, free split thickness skin grafts (7 cm × 4 cm to 12 cm × 7 cm at size) were used simultaneously. Results After 2 weeks of operation, 2 scar-band flaps had distal partial necrosis and healing was achieved after dressing change with formation of hypertrophic scar; the others survived with healing of incisions by first intention. After 6-12 months of follow-up, all patients possessed good cervical contours, sufficient release of scar contractures, and normal cervico-mandicular or mental cervical angles. The skin’s color and texture were satisfactory. There was no recurrence of cervical scar contracture and other complications. All patients acquired normal cervical movement at last follow-up. Conclusion Subcutaneous pedicle scar-band rotation flap is a simple, efficient, and versatile technique in release of cervical postburn scar contracture. It is an effective method to make use of the lateral excess scar flap to resurface defects caused by scar release.

    Release date:2016-08-31 05:43 Export PDF Favorites Scan
  • VERTICAL TRAPEZIUS MYOCUTANEOUS FLAP FOR REPAIRING SOFT TISSUE DEFECT AFTER HEAD AND NECK TUMOR RESECTION

    Objective To introduce the experience of the cl inical appl ication of vertical trapezius myocutaneous flap in repairing soft tissue defects after head and neck tumor resection. Methods Between June 2008 and February 2010, 12 cases of soft tissue defect caused by head and neck tumor resection were repaired with vertical trapezius myocutaneous flap.There were 9 males and 3 females with an age range from 32 to 76 years (median, 54 years). Twelve cases including 2 cases of basal cell carcinoma of orbital skin, 2 cases of squamous cell carcinoma of the parotid gland, 2 cases of submandibular gland mal ignant mixed tumor, 2 cases of metastatic lymph nodes of nasopharyngea carcinoma after radiotherapy, 1 case of squamous cell carcinoma of tongue, and 3 cases of squamous cell carcinoma of occipital skin, and all were classified as TNM stages T3 or T4. The area of soft tissue defect ranged from 13 cm × 6 cm to 25 cm × 13 cm. The vertical trapezius myocutaneous flap ranged from 14 cm × 7 cm to 26 cm × 14 cm and was transfered to repair defect tissue in the homolateral wounds after tumor resection and neck dissection homochronously. The donor sites were sutured directly. Results All incisions healed primarily without infection. Eleven flaps survived except 1 flap with edge necrosis, which was cured after dressing change. Subcutaneous hematocele and effusion occurred in 2 cases on the back after tube was removed at 7 days postoperatively, and they were cured by sucted and pressured dressing. Eleven patients were followed up 1-3 years (mean, 2 years). Nine cases had no tumor recurrence and the flaps had statisfactory appearance; the abduction function of shoulder joint were normal. One case of orbit basal cell carcinoma occurred 3 months after operation and 1 case of nasopharyngeal carcinoma died of brain metastasis 12 months after operation. Conclusion It is an easy and simple therapy to repair head and neck soft tissue defect using the vertical trapezius myocutaneous flap, which can meet the needs of repairing tissue defect of head and neck.

    Release date:2016-08-31 05:44 Export PDF Favorites Scan
  • FACIAL AND CERVICAL RECONSTRACTIONS USING EXPANDED FLAP FROM MEDIAL UPPER ARM

    【Abstract】 Objective To investigate the blood supply of the expanded skin flap from the medial upper arm andits appl ication for the repair of facial and cervical scar. Methods From May 2000 to February 2007, 20 cases (12 males and 8 females; aging from 7 to 42 years) of facial and cervical scar were treated with the expender flap from medial upper arm. The disease course was 9 months to 20 years. The size of the scar was 8 cm × 6 cm - 22 cm × 18 cm. The operation was carried out for three steps: ① The expander was embed under the superior proper fascia. ② The scar in the face and cervix was loosed and dissected. Combined the expanded skin flap from the medial upper arm(the size of the flap was 9 cm × 7 cm - 24 cm × 18 cm) in which the blood supply to the flap was the superior collateral artery and the attributive branches of the basil ica with auxil iary veins for blood collection with partial scar flap (3.5 cm × 2.5 cm - 8.0 cm × 6.0 cm) was harvested and transferred onto the facial and cervical defect. ③ After being cut off the pedicle, the scar was dissected. The expanded flap was employed to coverthe defect. Results After 3-24 months follow-up with 16 cases, all the grafted skin flaps survived at least with nearly normal skin color, texture and contour. The scars at the donor sites were acceptable. The function and appearance of the face and cervix was improved significantly. No surgery-related significant compl ications were observed. Conclusion Repair of facial and cervical scar with the medial upper arm expanded skin flap is a plausible reconstructive option for head and face reconstructions. However, a longer surgery time and some restrictive motion of the harvested upper l imbs might be a disadvantage.

    Release date:2016-09-01 09:10 Export PDF Favorites Scan
  • 早期应用肌皮瓣修复颈部深度电烧伤

    目的 总结颈部深度电烧伤早期扩创后应用肌皮瓣修复的临床经验。 方法 2002 年1 月- 2007 年5 月,对7 例男性颈部严重电烧伤患者行早期清创修复;年龄11 ~ 53 岁。6 ~ 10 kV 电压烧伤6 例,380 V 电压烧伤1 例。伤后4 h ~ 2 d 入院。烧伤总面积2% ~ 31%,其中颈部Ⅲ度以上烧伤范围10 cm × 8 cm ~ 35 cm × 18 cm。合并枕骨外露2 例,下颌骨外露1 例,右肩关节、锁骨外露1 例,甲状软骨和气管外露1 例,气管、食管外露并瘘口1 例。采用下斜方肌皮瓣修复2 例,背阔肌皮瓣3 例,胸大肌皮瓣2 例,切取皮瓣范围12 cm × 8 cm ~ 30 cm × 15 cm。 结 果 6 例肌皮瓣完全成活,1 例远端边缘(1.5 cm)坏死,二期修复。术后均获随访,随访时间2 ~ 14 个月。术后皮瓣质地柔软,外观稍显臃肿2 例,经再次手术削薄后外形满意。6 例食管、气管、骨、大血管等外露组织均得到修复。未出现局部慢性窦道,术后无颈部血管破裂大出血、垂肩和上肢外展受限等并发症发生。颈部外形良好,部分轻度瘢痕增生,但无挛缩、斜颈及颈颌粘连等畸形;颈部活动度恢复良好,头可平视、后伸及前屈,颈左右旋转20 ~ 45°。 结 论 颈部深度电烧伤早期应用肌皮瓣修复效果良好。

    Release date:2016-09-01 09:16 Export PDF Favorites Scan
  • 组织瓣移植修复头颈癌术后缺损

    目的 探讨游离组织瓣和带蒂组织瓣移植一期修复局部晚期头颈癌术后缺损的适应证和技巧。方法 2005年3月~12月采用自体组织移植一期修复头颈癌术后缺损25例,年龄14~78岁;其中舌癌7例(T3N1M0、T3N2M0、T3N0M0各2例,T4N2M0 1例);颊黏膜癌4例(T3N2M0 1例,T4N0M0 2例,放疗后未控1例);下牙龈癌3例(T4N1M0 2例,术后复发侵犯皮肤1例);口底癌2例(T4N3M0,T4N0M0各1例);硬腭癌1例(T4N0M0);硬腭癌术后复发1例;软腭癌放疗后未控1例;下咽放疗后未控2例;鼻咽癌放疗后颈淋巴结复发侵犯皮肤2例;颞部皮肤癌1例;喉癌术后复发1例。采用游离组织瓣12例,其中桡侧前臂皮瓣8例,空肠瓣2例,髂骨瓣1例,股前外侧皮瓣1例;带蒂组织瓣13例,其中胸大肌肌皮瓣4例,斜方肌肌皮瓣2例,舌骨下肌肌皮瓣7例。术后观察组织瓣成活率、并发症和近期疗效。 结果 术后1例空肠瓣坏死,1例舌骨下肌肌皮瓣部分坏死,其余组织瓣全部成活,伤口Ⅰ期愈合。全部患者随访2~10个月,原发灶未控或复发5例,其中3例死亡;2例带瘤生存,颈淋巴结复发1例,挽救手术后生存至今;无瘤生存20例。外形满意20例,基本满意4例,不满意1例。吞咽功能满意22例,基本满意2例,不能吞咽1。22例术后发音满意,3例喉全切术不能发音。 结论 组织瓣移植扩大手术适应证,为局部晚期或者放疗后复发/未控的头颈癌患者治疗提供机会;游离组织瓣和带蒂组织瓣移植具有较高成功率,应根据患者一般情况和缺损类型选择合适的修复方法;保证血供和静脉回流是组织移植成功的关键。

    Release date:2016-09-01 09:22 Export PDF Favorites Scan
  • DONOR SITE CHOICE FOR FREE FLAPS IN HEAD AND NECK RECONSTRUCTION AFTER TUMOR SURGRY

    Objective To choose suitable free flaps for reconstructing headand neck defects caused by tumor resection. Methods A retrospective analyses was made in 86 cases of head and neck defects treated with four kinds of free flaps between January 1999 and January 2002. The head and neck defects were caused by tumor resection. The locations were oral cavity (n=32), hypopharynx (n=27), mandible (n=12), skull base (n=5), scalp and skin (n=6) andmidface(n=4). The donor sites of free flaps included the rectus abdominis (n=32), anterolateral thigh (n=10),jejunum (n=25), fibula (n=11), latissimus dorsi (n=4), forearm (n=3) and scapula (n=1). The sizesof the cutaneous/musculocutaneous flaps ranged from 4 cm×5 cm to 14 cm×24 cm. The lengths of the fibula were 4-16 cm,of jejunum 9-20 cm. Results The overall free flap success rate was 92% (79/86). Of 32 oral cavity defects, 22 were reconstructed by rectus abdominis (69%) and 10 by anterolateral thigh flaps (31%). Of 27 hypopharyngeal defects, 25 were restored by jejunum flaps (93%). Eleven of 12 mandibular defects were reconstructed by fibula flaps(92%). Four of 5 defects of skull base were reconstructed by rectus abodominis flaps (80%). The free flaps of rectus abodominis, anterolateral thigh, jejunum and fibula were most frequently used, accounting for 91%(78/86) of all flaps in head and neck defect reconstruction. Conclusion Although head and neck defects represent a complicated spectrum of subsites and loss, these four freeflaps can manage most reconstruction problems.

    Release date:2016-09-01 09:28 Export PDF Favorites Scan
  • COMBINED SCAPULAR/PARASCAPULAR BILOBAR FLAPS FOR RECONSTRUCTION OF SEVERE NECK CONTRACTURE

    Objective To discuss the reconstruction of severe neck contracture by transplanting combined scapular/parascapular bilobar flaps, and the probability to reestablish three-dimensional movement of the neck. Methods From January 2003 to November 2004, 9 cases of sustained severeneck contractures were treated (aged 9-32 years). The combined scapular/parascapular bilobar flaps, pedicled on the circumflex scapular vascular bundle, were microsurgically used to cover the soft tissue defect after excision of hypertrophic scar and release of contracture. The maximum size of the combined bilobar flap was 20 cm×8 cm to 20 cm×11 cm,while the minimum one was 15 cm×4 cm to 15 cm×6 cm. Results The combined scapular/parascapular flapswere successfully used to treat 9 cases of severe neck contracture. All patients were satisfied with the final functional and aesthetic results. There was no recurrence during 3-9 months follow-up for 8 patients. The cervicomental angle was 90-105°.Conclusion The combined bilobar scapular/parscapular flap, providing a large area of tissue for coverage in three dimensions with a reliable blood supply by only one pedicle anastomosis during operation, is agood option for reconstruction of the severe neck contracture.

    Release date:2016-09-01 09:26 Export PDF Favorites Scan
  • EXPANDED CLAVIPECTORAL SKIN FLAP COMBINED WITH REVERSE AXIS SKIN FLAPIN REPAIRING CERVICAL SCAR CONTRACTURE DEFORMITY AFTER BURN

    Objective To evaluate the effect of a combined cervicalexpanded skin flap in repairing cervical scar contracture deformity after burn injury. Methods From April 2001 to May 2003, 16 cases (10 males and 6 females)of scar contracture deformity in the cervix were treated withexpanded clavipectoral axis skin flap combined with reverse axis skin flap.The tissue expanders were embedded under the part containing cutaneous branches of transverse cervical artery in cervical segments and the second and/or the third perforating branch of internal thoracic artery for the first operation. Normal saline was injected regularly. The expanded clavipectoral skin flap and reverse axis skin flap with perforating branch of internal thoracic artery were designed,the scar in the cevix was loosed or dissected according to the size of the skinflaps, the skin flaps were transferred to cover the wound, and the contracture deformity in the cervix was corrected. The size of the flaps were 9 cm×5 cm-15 cm×7 cm. Results All skin flap survived. The function and appearance of the cervix was improved significantly after 6-30 months follow-up. However, venous return dysfunction in reverse perforating branch of internal thoracic artery occurred in 1 case, andblood circulation was improved after treatment. Conclusion Expanded clavipectoral axis skin flap combined with reverse axis skin flap can be used to repair scar contracture deformity in cervix, which lessen scar and abatethe chance to contract again. 

    Release date:2016-09-01 09:26 Export PDF Favorites Scan
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