【摘要】 目的 观察应用不同手术方法矫正麻风麻痹性下睑外翻的疗效。 方法 2006年10月-2009年11月，共收治麻风麻痹性下睑外翻68例115眼，根据患者下睑外翻程度和局部专科情况，分别采用颞肌移位+阔筋膜移位悬吊固定术（Johnson法），改良颞肌移位术，下睑板缩短外眦韧带悬吊固定术，眼轮匝肌岛状皮瓣，眼轮匝肌悬吊固定术以及丝线悬吊固定术矫正眼睑外翻。 结果 68例115眼成功率98.9%，手术后由于下睑外翻导致的各种合并症明显好转。随访观察4～11个月所有患者术后效果良好，无复发。 结论 麻风麻痹性下睑外翻的手术治疗应根据患者的不同情况选择合适的手术方法，才能达到最佳的矫正效果。【Abstract】Objective To evaluate the clinical effect of different surgical methods to correct lower eyelid paralytic ectropion. Methods From October 2006 to November 2009, 68 cases (115 eyes) with lower eyelid paralytic ectropion induced by leprosy were treated in this department.According to the degree and local circumstance of different patients, some patients underwent temporalis muscle transfer (TMT) with the Johnson’s procedure, some patients underwent modified temporalis muscle transfer, and some patients underwent orbicularis oculi muscle island flap or uplifting the lower eyelids with orbicularis oculi muscle, silk, lateral canthal tendon. Results The achievement rate of 68 cases (115 eyes) was 98.9%.The complications resulted from lower eyelid ectropion were obviously improved.All the patients got good results followed up for 4 months to 11 months after operation and no recurrence was found. Conclusion To achieve the best effect of correcting lower eyelid paralytic ectropion, it is the key point to choose the suitable method according to the level and local circumstance.
Objective To investigate the influencing factors in the service volume of primary health care institutions in Chengdu, and provide references for promoting the hierarchical diagnosis and treatment. Methods A self-administered questionnaire was used to investigate the service volume of a total of 390 primary health care institutions (including community health service centers and township hospitals) across 22 districts and counties of Chengdu from October to November 2016. Rank sum test, rank correlation analysis and multiple linear regression model were used to analyze the influencing factors of outpatient visits in the institutions. Results The median annual amount of outpatient visits was 60 493 in community health service centers and 31 374 in township hospitals. Between community health service centers and township hospitals, the difference in median daily visits per doctor was not significant (14.41 vs. 13.29), but the median daily visits per doctor in general practitioners (12.22 vs. 8.16), rehabilitation physicians (10.10 vs. 6.34) and traditional Chinese medical doctors (4.82 vs. 6.17) varied considerably. Multiple linear regression analysis showed that the amount of outpatient visits in community health service centers was related to the amount of intermediate physicians, while the amount of outpatient visits in township hospitals was related to the setup of dental clinics, the amount of primary physicians, the amount of beds and population to be served (P<0.05). Conclusions Differences exist in the service volume among primary health care institutions in Chengdu. It’s necessary to make proper plans for the management of administrative offices and the allocation of personnel, so as to improve medical services of primary health care institutions.
ObjectiveTo summarize the experience of surgical treatment of asphyxiating thoracic dysplasia (Jeune syndrome).MethodsA total of 15 patients with asphyxiating thoracic dysplasia from August 2018 to April 2020 in our hospital were retrospectively included. There were 7 males and 8 females, aged 1-25 (8.87±6.71) years. Special steel bars were used to correct the growth direction of the rib and costal cartilage. Meanwhile, the concave and convex deformities of the chest wall on both sides were corrected to increase the chest volume and correct the thoracic deformity.ResultsThe contour appearance of the chest wall of all patients changed after the operation. The shape was close to normal, and the symptoms of hypoxia were improved. The operation time was 147.73±59.78 min, intraoperative bleeding volume was 105.67±91.90 mL, ICU stay time was 14.20±13.54 d and hospital stay time was 26.00±17.87 d. Eleven patients were directly extubated after the operation, 4 patients underwent tracheotomy and received assisted respiration, and the assisted respiration time was 19, 13, 22 and 12 days, respectively. The postoperative chest circumference was significantly increased, and the blood oxygen saturation was significantly improved. There were 5 patients with cardiac insufficiency, and 3 of them were improved by cardiotonic therapy, 2 of them died of heart failure on the 2nd and 31st day after the operation, respectively. Abdominal distention occurred in 10 patients after operation, and 5 of them were obstinate and eliminated by comprehensive treatment. All patients were followed up. The appearance of thorax was improved obviously and there was no sign of compression in lungs. One 13-year-old patient developed respiratory discomfort 3 months after the operation, and the symptoms were relieved after self-administration of oxygen. A 25-year-old patient developed cardiac insufficiency half a month after the discharge, and the symptoms disappeared after cardiotonic treatment. Four patients took out the steel bars in 13, 13, 15 and 17 months after the operation, respectively. The appearance of thorax remained well after the operation. The imaging examination showed that the position of bone structure was normal, the lung field was clear, and there was no sign of chronic inflammation.ConclusionThis technique is a safe and simple operation method. It can not only eliminate the deformity of chest wall, but also increase the volume of chest obviously. However, the long-term effect needs to be further evaluated.