口腔颌面部肿瘤患者术后缺损的外侧皮瓣修复术与前臂皮瓣修复术对比研究

摘要 目的：探讨口腔颌面部肿瘤患者术后缺损的外侧皮瓣修复术与前臂皮瓣修复术对比。方法：选取遂宁市中心医院（我院）2015年8月到2020年8月共收治的120例口腔颌面部肿瘤患者,所有患者通过肿瘤切除术后均出现组织缺损现象,对所有组织缺损的患者依照不同的皮瓣修复方式分为两组,其中应用外侧皮瓣修复术的68例患者分为外侧皮瓣修复组,应用前臂皮瓣修复术的52例患者分为前臂皮瓣修复组,对比两组的皮瓣修复效果,治疗后的口腔功能恢复情况,瓣成活率、术后皮瓣危象率以及血管吻合时间,并发症情况。结果：外侧皮瓣修复组的总有效率为95.59 %,前臂皮瓣修复组的总有效率为84.62 %,外侧皮瓣修复组明显高于前臂皮瓣修复组（P＜0.05）;外侧皮瓣修复组患者的外形修复、语言功能、咀嚼功能、吞咽功能以及口腔闭合评分明显高于前臂皮瓣修复组（P＜0.05）;两组的皮瓣成功率均比较高对比无明显差异（P＞0.05）,两组的术后皮瓣危象率比较低,对比无明显差异（P＞0.05）,血管吻合时间对比无明显差异（P＞0.05）;对比两组并发症发生情况发现,外侧皮瓣修复组的总并发症发生率为2.94 %,前臂皮瓣修复组并发症发生率为17.31 %,外侧皮瓣修复组明显低于前臂皮瓣修复组（P＜0.05）。结论：对口腔颌面部肿瘤患者术后缺损患者应用外侧皮瓣修复术能够提升患者的皮瓣修复效果,提升患者的口腔功能恢复情况,减少并发症的发生,安全性好,值得临床应用推广。     

Churg-Strauss syndrome: a diagnosis not to be forgotten

Churg-Strauss syndrome (CSS) is a peculiar form of vasculitis with involvement of small- and medium-size arteries, histologically characterized by necrotizing granulomas in vessel walls and in perivascular tissues. The Authors report a case of CSS occurred in a young man being treated with corticosteroids for a diagnosis of asthma. The patient was hospitalized because of fever, diarrhoea and abdominal pain; the first assessment showed leucocytosis and eosinophilia,increase in flogosis indexes and anti-pANCA antibodies positive. A few days later an acute peritonitis with multiple intestinal perforations occurred and a partial resection of small bowel was performed,followed by another resection of an ileal segment because of a new double perforation close to the previous intestinal anastomosis. In the bowel resection pieces necrotizing vasculitis and granulomatous infiltrates involving lymphocytes and eosino- phils were observed. Although the severe intestinal involvement and especially the symptoms necessitating iterative surgery were significant factors of poor prognosis the patient was successfully treated firstly with metylprednisolone only and then with monthly administration of immunosuppressive drugs combined with lower daily dose of steroids. The CSS diagnosis is not to be forgotten althoughits early clinical features can be frequently mistaken for an allergic disease; an early diagnosis can allow to perform the best treatment, to reach the disease remission and to improve the quality of life of the patients.     

Intrathoracic versus Cervical Anastomosis after Resection of Esophageal Cancer: A matched pair analysis of 72 patients in a single center study

ABSTRACT: BACKGROUND: The aim of this study was to analyze the early postoperative outcome of esophageal cancer treated by subtotal esophageal resection, gastric interposition and either intrathoracic or cervical anastomosis in a single center study. METHODS: 72 patients who received either a cervical or intrathoracic anastomosis after esophageal resection for esophageal cancer were matched by age and tumor stage. Collected data from these patients were analyzed retrospectively regarding morbidity and mortality rates. RESULTS: Anastomotic leakage rate was significantly lower in the intrathoracic anastomosis group than in the cervical anastomosis group (4 of 36 patients (11 %) vs. 11 of 36 patients (31 %); p = 0.040). The hospital stay was significantly shorter in the intrathoracic anastomosis group compared to the cervical anastomosis group (14 (range 10-110) vs. 26 days (range 12 - 105); p = 0.012). Wound infection and temporary paresis of the recurrent laryngeal nerve occurred significantly more often in the cervical anastomosis group compared to the intrathoracic anastomosis group (28 % vs. 0 %; p = 0.002 and 11 % vs. 0 %; p = 0.046). The overall Inhospital mortality rate was 6 % (4 of 72 patients) without any differences between the study groups. CONCLUSIONS: The present data support the assumption that the transthoracic approach with an intrathoracic anastomosis compared to a cervical esophagogastrostomy is the safer and more beneficial procedure in patients with carcinoma of the lower and middle third of the esophagus due to a significant reduction of anastomotic leakage, wound infection, paresis of the recurrent laryngeal nerve and shorter hospital stay.     

A Rapid Method of Obtaining Epidermal Peels in Plants by Treatment with Cupric Sulphate and Hydrochloric Acid

In a microsurgical study currently in progress, the need arose to prepare accurately oriented longitudinal sections of artery 1 mm in external diameter. The specimens were rats' common femoral arteries which had been subjected to division and microsuture anastomosis. We wanted to see the extent of any narrowing at the site of the microsurgical repair or histological changes on either side of the repair, and to relate such changes to possible causes of surgical trauma.     

A Method for Accurately Orienting Microsurgical Blood Vessel Specimens for Longitudinal Sectioning

In a microsurgical study currently in progress, the need arose to prepare accurately oriented longitudinal sections of artery 1 mm in external diameter. The specimens were rats' common femoral arteries which had been subjected to division and microsuture anastomosis. We wanted to see the extent of any narrowing at the site of the microsurgical repair or histological changes on either side of the repair, and to relate such changes to possible causes of surgical trauma.     

Diagnosis and treatment of carotid body paraganglioma: 21 years of experience at a clinical center of Serbia

BACKGROUND: The carotid body paraganglioma (chemodectoma) is a relatively rare neoplasm of obscure origin. These are usually benign and commonly present as asymptomatic cervical mass. PATIENTS AND METHODS: Records of 12 patients (9 female and 3 male) with carotid body tumors treated between 1982 and 2003, treated at our center were retrospectively reviewed. Data on classification, clinical presentation, and surgical treatment were extracted from the case records. Surgical complications and treatment outcome were noted and survival was calculated by actuarial method. The literature on carotid body paraganglioma was reviewed. RESULTS: The average age of the patients was 52 years (range 30-78 years). Eight of these cases presented as a large asymptomatic non-tender neck mass, and two each presented with dysphagia, and hoarseness of voice. As per Shamblin classification seven of tumors were type II and 5 were types III. In 7 cases subadventitial tumor excision was performed, while in 5 associated resection of both external and internal carotid arteries was carried out. The artery was repaired by end-to-end anastomosis in one case, with Dacron graft in one case, and with saphenous vein graft in 3 cases. There was no operative mortality. After a mean follow-up of 6.2 years (range 6 months to 20 years), there were no signs of tumor recurrence in any of the cases. CONCLUSIONS: Surgical excision is the treatment of choice for carotid body paragangliomas although radiation therapy is an option for patients who are not ideal candidates for surgery. For the tumors that are in intimate contact with carotid arteries, the treatment by vascular surgeon is recommended.     

Hemodynamic analysis of Hyrtl anastomosis in human placenta

The Hyrtl anastomosis is a common connection between the umbilical arteries near the cord insertion in most human placentas. It has been speculated that it equalizes the blood pressure between the territories supplied by the umbilical arteries. However, its functional role in the regulation and distribution of fetal blood flow to the placenta has not yet been explored. A computational model has been developed for quantitative analysis of hemodynamic characteristic of the Hyrtl anastomosis in cases of discordant blood flow in the umbilical arteries. Simulations were performed for cases of either increased placental resistance at the downstream end or reduced arterial blood flow due to some pathologies upstream of one of the arteries. The results indicate that when placental territories of one artery impose increased resistance to fetal blood flow, the Hyrtl anastomosis redistributes the blood flow into the second artery to reduce the large pressure gradients that are developed in the affected artery. When one of the arteries conducts a smaller blood flow into the placenta and a relatively smaller pressure gradient is developed, the Hyrtl anastomosis rebuilds the pressure gradients in the affected artery and redistributes blood flow from the unaffected artery to the affected one to improve placental perfusion. In conclusion, the Hyrtl anastomosis plays the role of either a safety valve or a pressure stabilizer between the umbilical arteries at the placental insertion.     

游离皮瓣在晚期颅底肿瘤术后组织缺损中应用效果分析

目的:探讨使用游离皮瓣修复晚期颅底肿瘤术后缺损组织的效果及适应症。方法:选择2009年1月至2013年9月在我院行晚期颅底肿瘤术并且需要进行组织修复的病患74例作为研究对象。根据病患选择的修复方式分为观察组和对照组各37例。观察组采用游离皮瓣,而对照组使用钛网修复。观察两组相应指标,比较不同修复材料的修复效果。结果:观察组手术效果显效率和总有效率为40.54%(15/37)、97.30%(36/37),显著高于对照组,差异有统计学意义(P0.05)。观察组在术中出血量、手术时间以及术后愈合时间等方面均优于对照组,差异有统计学意义(P0.05)。观察组术后出现颅内感染、脑脊液漏和皮瓣坏死比率为8.11%(3/37)、0(0/37)和2.70%(1/37)都少于对照组,差异有统计学意义(P0.05)。结论:采用前臂皮瓣进行晚期颅底肿瘤术后缺损组织修复效果更好,皮瓣存活率更高。比传统钛网修复引起的并发症更少,值得临床推荐使用。     

Macroscopic and microscopic intermesenteric communications

The aim of this study was to describe all levels of the intermesenteric communications because of their importance in vascular diseases of the colon. The connections of superior and inferior mesenteric networks are very important in cases of acute or chronic obstruction to prevent ischemia and necrosis. Angiograms of mesenteric arteries were studied (40), cadaverous large intestine samples with mesentery and feeding vessels were dissected (36) or injected with India ink solution (24) or methylmetacrylate Mercox (41). In 7.9 % of cases an intermesenteric connection was described, named anastomosis intermesenterica accessoria and classified according to Pikkieff's(1) proposal. The marginal artery in the left colic flexure forms an arch called Riolan's arcade(2) or Haller's anastomosis(3) and is present in 95 % of cases. Infrequent anastomosis between straight vessels and mighty plexuses in the intestinal wall were registered. There are no regional differences when compared to the rest of colon.     

Management of colonic and rectal injuries.

In managing a colonic or rectal injury the surgeon must decide whether it is acceptable to have feces passing over a suture line or anastomosis. If it is, resection and anastomosis or simple oversewing of the bowel can be done. If it is not, there are four choices: (a) closure of the wound, drainage and proximal diversion; (b) primary closure or resection and anastomosis of the wound with exteriorization; (c) formation of a double-barrelled colostomy; and (d) resection of the injured colon with formation of an end-colostomy and a mucosal fistula or a Hartmann procedure. The surgeon''s choice should be dictated by the severity of the injury, the degree of fecal contamination and the general condition of the patient.     

CARCINOMA OF THE RECTUM—Low Abdominal Tranverse Incision for Resection with End-to-End Anastomosis

On the basis of published studies of the lymphatic spread of carcinoma of the rectum, tumors lying as low as the anterior peritoneal reflection may be treated by segmental resection with end-to-end anastomosis. Statistics of five-year survivals in these published studies indicate that for tumors in such locations, a segmental resection offers the same chance for cure as an abdominoperineal resection.The transverse low abdominal incision previously described by the author permits better exposure, facilitates the performance of anastomosis which can be made at a greater depth, and thus enables the surgeon to resect a wider margin distal to the tumor.     

Carcinoma of the rectum; low abdominal transverse incision for resection with end-to-end anastomosis

On the basis of published studies of the lymphatic spread of carcinoma of the rectum, tumors lying as low as the anterior peritoneal reflection may be treated by segmental resection with end-to-end anastomosis. Statistics of five-year survivals in these published studies indicate that for tumors in such locations, a segmental resection offers the same chance for cure as an abdominoperineal resection. The transverse low abdominal incision previously described by the author permits better exposure, facilitates the performance of anastomosis which can be made at a greater depth, and thus enables the surgeon to resect a wider margin distal to the tumor.     

Anterior spinal arteries. Origin and distribution in man

This study was designed to extend our present knowledge of the origin and distribution of anterior spinal arteries and was carried our using 31 human cadavers with arterial injections of natural latex. The conclusions reached are that there are always one or two anterior spinal arteries (right or left), which proceed from the intracranial segment of the vertebral arteries. These arteries have a descending course, with distribution into the ventral face of the medulla oblongata and the first cervical segments of the medulla spinalis. In cases where there are two anterior spinal arteries, they anastomose with each other to form the common, unpaired and median anterior spinal artery. The different observed locations of the origins of anterior spinal arteries may be systematised into three types. Each of these types has differential characteristics: bilateral origin (type I; 77.4%), unilateral origin (type II; 9.7%) and origin in an intervertebral transversal anastomosis (type III; 12.9%). We do however subdivide the bilateral origin group, according to the calibre of the arteries, into the subtypes 'balanced' (type Ia; 22.6%), 'right dominated' (type Ib; 32.2%) and 'left dominated' (type Ic; 22.6%). The collaterals of the anterior spinal arteries which distribute into the ventral face of the medulla oblongata are described.     

Mechanical anastomosis of small arteries and veins with the unilink apparatus: a histologic and scanning electron microscopic study

A new method for mechanical anastomosis of small vessels--the Unilink device--has been tested in 23 rabbits. A total of 81 arterial and venous anastomoses were performed. One of the arterial anastomoses were thrombotized, while the remaining 80 anastomoses were fully patent at 2 or 16 weeks. The repair process at the anastomotic site was very rapid both in arteries and veins. The endothelialization was complete at 2 weeks, but a marked atrophy of the media was noted in the arterial anastomoses. The same phenomenon was observed in the venous anastomosis, but to a much lesser degree. Thrombus formation was extremely rare, and the atrophy of the media did not seem to affect the patency rate. The experiment has confirmed that the Unilink method provides a very safe, fast, and simple way to perform microvascular anastomoses.     

Arterial adaptations to altered blood flow

Arterial remodeling in response to altered blood flow is believed to be critical to vascular adaptations to developmental, physiological, pathological, and therapeutically induced changes in blood flow. To assess this remodeling, we used left-to-right carotid anastomosis to increase blood flow in the right common carotid arteries of adult rabbits by 60%. After 2 months, these vessels exhibited no compensatory enlargement. In contrast, the same procedure performed in 5- to 6-week-old weanling rabbits resulted in accelerated growth of the vessels: diameters exceeded those of control arteries by 19% after 2 months. Common carotid arteries in adult rabbits remodeled to produce a diameter reduced by 23% when blood flow was reduced by 63% by external carotid ligation. This adaptation restored shear stress exerted on the vessel wall to control levels. The reduced diameter was not reversed when the vessels were maximally dilated with nitroprusside, adenosine, and forskolin; however, normal diameters were restored within 1 week when normal blood flows were reestablished. Thus, the adult arteries did not respond to increased blood flow produced by the anastomosis, but this procedure did reverse adaptations to decreased flow. In contrast, immature arteries were responsive to this increase in blood flow, even in the absence of prior flow modulation.     

The effects of tapering and artery wall stiffness on treatments for Coarctation of the Aorta

Coarctation of the Aorta is a congenital narrowing of the aorta. Two commonly used treatments are resection and end-to-end anastomosis, and stent placements. We simulate blood flow through one-dimensional models of aortas. Different artery stiffnesses, due to treatments, are included in our model, and used to compare blood flow properties in the treated aortas. We expand our previously published model to include the natural tapering of aortas. We look at change in aorta wall radius, blood pressure and blood flow velocity, and find that, of the two treatments, the resection and end-to-end anastomosis treatment more closely matches healthy aortas.     

Correction of the unilateral cleft lip nose

The cleft lip nasal deformity is best repaired secondarily in teenagers. Some more severe cases may be repaired during childhood. Optimal repair requires adequate exposure, best obtained with transcolumellar flying-bird incisions. The major anatomic defect, the misplaced lateral crus, needs to be advanced to a normal position. The vestibular lining of the lateral crus should remain attached to add circulation and support, especially when scoring of the cartilage is needed. The lateral defect left after advancement of the lateral crus should be closed with sutures. Accessory procedures, including septoplasty, augmentation or reshifting of the alar base attachment, and occasionally, cartilage grafts, are critical to achieving an aesthetic result. Fifty-three patients operated on using the technique described are reviewed.     

Pulmonary Artery Reconstruction Using Autologous Pericardium or Azygos Venae Substitute for Surgical Treatment of Central Non-Small Cell Lung Cancer

We evaluated the clinico-surgical significance of pulmonary artery (PA) reconstruction using a patch of autologous pericardium/azygos venae substitute to treat central non-small cell lung cancer in 62 patients with pulmonary arteries invaded by tumor. According to TNM-classification, four patients were stage IIb, 46 were stage IIIa, and 12 were stage IIIb. Depending on tumor infiltration, surgical procedures included partial PA tangential resections/reconstructions by a patch of autologous azygos venae, a patch of autologous pericardium and complete PA sleeve resection and reconstruction by a custom-made autologous pericardial conduit interposition. 47 patients received postoperative chemotherapy and 19 received radiotherapy. There were 2 (3.2 %) postoperative early deaths due to bronchial anastomotic leakage. Postoperative complications occurred in 17.7 % (11/62) patients and all recovered uneventfully. Mean follow-up time after surgical resection was 49.5 (6–12) months and overall ≤1-, 3-, 5-, and ≥10-year survival rates were 80.2, 44.7, 31.4, and 23.1 %, respectively. It was concluded that autologous pericardial patch and azygos vein patch reconstruction of PA were safe and effective. Regarding extended circumferential defects after sleeve resection in which end-to-end anastomosis is not feasible, autologous pericardial conduit interposition may be useful for reconstruction when a tumor extensively infiltrates full circumference of the PA.     

Reconstruction of through-and-through cheek defects involving the oral commissure, using chimeric flaps from the thigh lateral femoral circumflex system

Repairing full-thickness cheek defects involving the oral commissure in the head and neck regions after tumor resection is a challenge for reconstructive surgeons. First, they are usually relatively large defects. Second, the axes of the cheek and intraoral lining are different from each other. Third, the shape and volume of the defect and the oral sphincter should be considered individually. Lateral femoral circumflex perforator flaps with at least two independent cutaneous perforators are suitable for reconstruction of such a defect in one stage. In this study, between January and December of 1999, a total of nine patients underwent reconstruction with chimeric lateral femoral circumflex perforator flaps immediately after resection of their oral cancers. The average age of the patients was 61 years (range, 42 to 74 years). The oral lining defects were between 5 x 5 cm and 6 x 12 cm in size, whereas the cheek defects were between 5 x 6 and 8 x 12 cm. Fifteen flaps were supplied by one perforator, and three flaps were supplied by two perforators. There were nine single arterial anastomoses, eight single venous anastomoses, and one double venous anastomosis. There were no total flap failures. One case of postoperative venous congestion was successfully treated by a second venous anastomosis. The average duration of hospitalization was 31.8 days (range, 18 to 49 days). The median follow-up time was 8.6 months, and all patients were alive at the time of evaluation. Six of nine patients had satisfactory or good contours of the cheek. Five of nine patients had normal deglutition. Six of nine patients had adequate oral continence. Compared with other free flaps, use of the combined (chimeric) lateral femoral circumflex perforator flaps for the reconstruction of cheek through-and-through defects involving the oral commissure has several advantages: (1) easy three-dimensional insetting, (2) a unique character suitable for the requirements of the oral lining and cheek skin to achieve good aesthetic appearance, (3) functional preservation of the oral sphincter and the resistance of gravity by use of the tensor fasciae latae, (4) minimal donor-site morbidity, (5) economic design, and (6) no need for microsurgical fabrication, because major vascular branches such as the transverse branch, the ascending branch, and the feeding branch to the rectus femoris muscle are not sacrificed in the procedure. The disadvantages of these flaps include (1) the complicated anatomy of the perforators, (2) the learning-curve requirement for their use, and (3) the occasional need for secondary venous drainage and shifts to double flaps. Although there are some difficulties, it was concluded that use of the chimeric lateral femoral circumflex perforator flaps in the selected cases is one of the good options available for the reconstruction of cheek through-and-through defects involving the oral commissure.     

左半结直肠癌并急性肠梗阻经内镜介入治疗后再限期手术 的临床应用探讨

目的:探讨左半结直肠癌并急性肠梗阻经内镜介入治疗后再限期行肿瘤根治切除及一期肠吻合术的临床应用价值.方法:回顾性分析2006年-2011年我院收治的87例左半结直肠癌并急性肠梗阻的临床资料.结果:本组87例中,71例经内镜置入支架或肠梗阻导管介入减压治疗成功并完成了肿瘤根治性切除及一期肠吻合术.16例介入治疗失败行了急诊手术治疗,其中支架或导管置入失败7例,堵塞5例,减压效果差4例,无穿孔、出血并发症,介入治疗有效率81.6％.限期手术后切口感染5例(7.0％);急诊手术后切口感染4例(25.0％);吻合口漏2例(2.8％);无死亡病例发生.结论:左半结直肠癌并急性肠梗阻经内镜介入治疗后,限期行肿瘤根治性切除及一期肠吻合术,可以最大限度降低术后切口感染、吻合口漏机率,值得临床推广应用.