【摘要】 目的 探讨结膜恶性黑色素瘤的手术治疗方法。 方法 1997年1月-2007年1月收治结膜恶性黑色素瘤48例，均为单眼。肿瘤范围:lt;1/3眼睑长度及结膜14例，gt;1/3眼睑长度，部分穹隆结膜受累19例，上下眼睑及内外眦大部分结膜受累者15例。采用单纯肿瘤切除术、单纯肿瘤切除联合液氮冷冻治疗、眼眶内容物剜除术3种治疗方法。 结果 所有患者均经病理学证实为结膜恶性黑色素瘤 。术后48例进行9个月～5年随访，15例眶内容物剜除术，3例死于肺及颅脑转移；14例单纯扩大肿瘤切除联合液氮冷冻治疗，2例死于肝转移；19例单纯扩大肿瘤切除术，6例分别死于肝、肺及颅脑转移。 结论 早期诊断并选择积极有效的手术治疗是提高患者生存率，改善生存质量的重要手段。手术切除联合液氮冷冻法可有效降低肿瘤复发，避免影响患者视觉质量和外观，是治疗结膜恶性黑色素瘤的一种有效方法。【Abstract】 Objective To investigate the surgical therapeutics for malignant melanoma of eyelid conjunctiva. Methods A total of 48 patients with monocular malignant melanoma of eyelid conjunctiva from January 1997 to January 2007 were collected. The scope of the melanoma involved lt;1/3 eyelid length and conjunctiva in 14, gt;1/3 eyelid length and part of conjunctival formix in 19, and upper and lower eyelid and most of the conjunctiva of medial and lateral canthus in 15. Eye socket exenteration,tumor resection combine with eyelid reconstruction, tumor resection were used. Results All of the patients were diagnosed as malignant melanoma of eyelid conjunctiva by pathological examination. The follow-up period was 9 months-5 years. Among the 15 patients who had undergone eye socket exenteration,3 died. Among the 14 patients who had undergone expand tumor resection combine with liquid nitrogen frozen, 2 died. Among the 19 patients who had undergone tumor resection combine with eyelid reconstruction, 6 died. Conclusion Tumor resection combine with liquid nitrogen frozen is effective on malignant melanoma of eyelid conjunctiva.
目的:探讨先天性上斜肌麻痹的临床特征以及手术治疗方法。方法:对四川大学华西医院收治的先天性上斜肌麻痹126例患者的临床特征、手术方式和疗效进行回顾分析。结果:我们对126例患者进行了2月至5年的随访,其中治愈50(40.0%)例,改善60(47.6%)例,失败12(9.38%)例。结论:先天性上斜肌麻痹的手术治疗要按减弱直接拮抗剂或配偶肌,加强麻痹肌或间接拮抗肌的原则进行。手术的目的是消除垂直偏斜和代偿头位,避免成年后颜面、颈部和脊柱的畸形,建立双眼单视和恢复正常的眼球功能。
ObjectiveTo compare the effect of bromfenac sodium hydrate ophthalmic solution and fluorometholone following sub-bowmans keratomileusis (SBK) from the aspects of subjective visual perception, ophthalmic signs and intraocular pressure. MethodsFifty myopic patients (94 eyes) who underwent SBK from April to May 2013 were divided into two groups according to the different postoperative drug treatment. Patients in group A were treated with bromfenac sodium hydrate (51 eyes), and patients in group B were treated with fluorometholone (43 eyes). To compare the effects of two kinds of drugs after SBK, results of the routine examination were recorded including uncorrected visual acuity (UCVA), refractive status, visual symptoms and signs, intraocular pressure (IOP) and Haze under Corneal Epithelium (HAZE) on pre-operational and postoperative day 1, 7, and 30. ResultsOn the 30th day, IOP in group A and group B were (9.88±2.34) mm Hg (1 mm Hg=0.133 kPa) and (11.00±2.27) mm Hg, respectively, and the difference between the two groups was statistically significant (P<0.05), but there were no statistically significant differences at other time points. There was no statistically significant difference in UCVA, refractive status, visual symptoms and signs, and corneal epithelial staining between the two groups (on day 1, 7, and 30). ConclusionBromfenac sodium and fluorometholone have the same effect in the control of postoperative visual acuity and ophthalmic inflammation. Bromfenac sodium has greater advantages in IOP control. Therefore, bromfenac sodium can substitute fluorometholone in resisting inflammation after SBK.
Objective To explore the learning curve and evaluate the safety of uniportal complete video-assisted thoracoscopic surgery (VATS) lobectomy. Methods We reviewed retrospectively the clinical data of 133 patients, who underwent uniportal VATS between March 2015 and October 2016 in Sichuan Provincial Cancer Hospital. There were 79 males and 54 females at age of 52.21±10.77 years. Results All the 127 patients completed uniportal VATS, 4.51% (6/133) converted to open surgery. There were 78 patients with lobectomy, 6 patients with segmentectomy, 37 patients with wedge resection, 6 patients with pleural, mediastinal lymph node biopsy or mediastinal tumor resection. In the lobectomy group, mean surgical time was 148.75±34.12 min, mean blood loss was 118.87±59.96 ml, mean number of lymph nodes was 11.25±6.15, the mean duration of chest-tube placement was 2.17±1.35 days, and mean length of stay was 7.58±2.59 days. Conclusion Based on skillful performance of the conventional thoracoscopic lobectomy, the learning curve for single port thoracoscopic lobectomy comprises at least 20 patients. The uniportal VATS lobectomy is a safe and operable method of minimally invasive technique, and it is worthy to be applied in thoracic surgery.
Objection To compare the effects of three mainstream surgical methods on the ocular surface and investigate the optimal corneal myopia correction surgery. Methods We selected 118 patients (236 eyes) undergoing small incision lamellar extraction (SMILE) (40 patients, 80 eyes), femtosecond-laser in situ keratomileusis (FS-LASIK) (36 patients, 72 eyes) or sub-Bowman keratomileusis (SBK) (42 patients, 84 eyes) surgery for corneal myopia correction from March 2015 to January 2016. Before surgery, one week and one month after surgery, tear film rupture time, tear river height and eye red index were measured using ocular surface analyzer. The Schimer Ⅰ test was used to detect tear secretion. Corneal sensory gauge was used to measure corneal sensation. Analysis of variance was used to analyze the measurements of the three surgical methods at various time points. Results The tear film rupture time of the three groups decreased after one week (P<0.05), but the time in the SMILE group [(9.643±4.751) seconds] was longer than those in the other two groups [FS-LASIK (8.172±4.300) seconds, SBK (7.612±3.691) seconds,P<0.05]. The time in the SMILE group at one month after surgery was not different from that before surgery (P>0.05). At one month after surgery, the rupture times of the other two groups were still shortened (P<0.05). The tear river heights in the three groups were decreased at one week and one month after surgery (P<0.05), except FS-LASIK group (P>0.05). In the SBK group, at one week after surgery, the decrease of the height was the most obvious (P<0.05). There was no difference in eye red index among the three groups at the time of observation (P>0.05). Corneal sensation decreased in the three groups at one week and one month after surgery. In the SBK group, that was the most obvious decline (P<0.05). In the three groups, the tear secretion did not change at each observation time point (P>0.05). Conclusion In the three surgical methods, SMILE has the minimal impact on the ocular surface, followed by FS-LASIK, and SBK has the greatest impact.