腔内修复手术治疗急性stanfo rd B型主动脉夹层对照研究

目的：探讨腔内修复手术与药物保守治疗急性 stanford B型主动脉夹层患者的临床疗效和安全性。方法将82例急性stanford B型主动脉夹层患者按随机数字表法分为观察组与对照组，每组41例。观察组采用腔内修复手术治疗，对照组予以药物保守治疗，治疗后随访12个月。比较两组CT血管造影复查结果，生存率，并发症及不良反应发生率。结果治疗后CT血管造影复查发现，观察组假腔血栓化及假腔消失率显著高于对照组（P＜0．01），假腔增大、假腔无变化率均显著低于对照组（P＜0．01）。随访各时点两组生存率比较差异均无显著性（P＞0．05）。两组各种并发症及不良反应发生率比较差异无显著性（P＞0．05）。结论腔内修复手术与药物治疗急性stanford B型主动脉夹层均有一定疗效，两者生存率基本相当，但手术干预可提高假腔血栓化及假腔消失率，有更高的临床价值。

Isolated segmental,sectoral and right hepatic bile duct injuries

The treatment of isolated segmental, sectoral and right hepatic bile duct injuries is controversial. Nineteen patients were treated over a 26-year period. Group one was comprised of 4 patients in whom the injury was primarily repaired during the original surgery; 3 over a T-tube, 1 with a Roux-en-Y. These patients had an uneventful recovery. The second group consisted of 5 patients in whom the duct was ligated; 4 developed infection, 3 of which required drainage and biliary repair. Two patients had good long-term outcomes; the third developed a late anastomotic stricture requiring further surgery. The fourth patient developed a small bile leak and pain which resolved spontaneously. The fifth patient developed complications from which he died. The third group was comprised of 4 patients referred with biliary peritonitis; all underwent drainage and lavage, and developed biliary fistulae, 3 of which resolved spontaneously, 1 required Roux-en-γ repair, with favorable outcomes. The fourth group consisted of 6 patients with biliary fistulae. Two patients, both with an 8-wk history of a fistula, underwent Roux-en-γ repair. Two others also underwent a Roux-en-γ repair, as their fistulae showed no signs of closure. The remaining 2 patients had spontaneous closure of their biliary fistulae. A primary repair is a reasonable alternative to ligature of injured duct. Patients with ligated ducts may develop complications. Infected ducts require further surgery. Patients with biliary peritonitis must be treated with drainage and lavage. There is a 50% chance that a biliary fistula will close spontaneously. In cases where the biliary fistula does not close within 6 to 8 wk, a Roux-en-γ anastomosis should be considered.

Clinical Research of a Modified Midfacial Degloving in a Maxillectomy (with a Report of a Typical Case)

OBJECTIVE To investigate the feasibility of employing a modified midfacial degloving in maxillectomy. METHODS Eight patients with carcinoma of the maxillary sinus underwent a modified midfacial degloving operation. The tumors were classified according to the 2002 AJCC system. The TNM staging of the cases was as follows： 1 T4aN0M0, 2 T3N0M0 and 5 T2N0M0. Of the 8 cases, 1 patient underwent extended maxillectomy; exenteration of the orbit; tumorectomy of the sphenomaxillary and infratemporal fossae. Two patients received a total maxillectomy, and 5 a partial resection of the maxilla. Postoperative pathological report： 4 well-differentiated squamous carcinoma, 2 moderately-differentiated squamous carcinoma, 1 mucoepidermoid carcinoma and 1 adenoid cystic carcinoma.RESULTS A modified midfacial degloving operation can sufficiently expose a field of operation, resect the tumor within a safe margin, and leave no facial cicatricles. One patient died of intracranial metastasis 8 months after operation. We observed no recurrences or metastasis in other patients during the period of follow-up.CONCLUSION The major advantages of employing the modified midfacial degloving in maxillectomy is that a facial incision can be avoided. It has an advantage of minimal invasive surgery

3D打印在下颌骨缺损中的修复应用

对比不同质量方案研究对象在下颌骨缺损修复手术治疗中的临床数据,辨析3D打印技术在人体外形修复中的优势效果。方法 选取2021年到2022年为期1年时间内我院收治的下颌骨缺损患者,记录作为研究对象的40例患者修复手术治疗的数据,其中随机数字选取观察组(N=20)与对照组(N=20),保证观察组和对照组人数相等,为对照组患者采用常规术式治疗方案,而观察组患者采用3D打印人工骨修复下颌骨治疗技术,需在研究中采集两组患者的手术相关数据,包括手术时长、术中出血量、治疗优良率和治疗满意度(满意度包含发音、外观、咬合能力等)。结果 观察组的手术总时长和手术过程中出血量显著低于对照组;观察组患者的治疗优良率显著高于对照组;观察组患者治疗后的发音、外观和咬合咀嚼力满意度均优于对照组,差异具有统计学意义(P<0.05)。结论 3D打印在下颌骨缺损修复治疗中具有良好的应用成效,可以根据患者的实际情况,精准定制符合下颌骨假体,进行修复重建手术。并有效缩短手术时长,保证患者安全,且能够加快术后恢复效率,有效减少患者痛苦,增强患者在术后修复的满意程度,具有极大的临床推广价值。