BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(...BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(≥3 cm)SMTs is scarce and limited.AIM To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large(≥3 cm)SMTs.METHODS We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University.The operative,postoperative,and follow-up conditions of the patients were evaluated.RESULTS All tumors were completely resected using EFTR.36(42.35%)patients had tumors located in the fundus of the stomach,and 49(57.65%)had tumors located in the body of the stomach.All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment.Postoperative fever and stomach pain were reported in 13(15.29%)and 14(16.47%)patients,respectively.No serious adverse events occurred during the intraoperative or postoperative periods.A postoperative review of all patients revealed no residual or recurrent lesions.CONCLUSION Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture,especially for large(≥3 cm)EFTR wounds in SMTs.展开更多
AIM:To observe the clinical outcomes of 30-gauge(G)needle-guided 10-0 prolene suture purse-string pupilloplasty for atonic pupil management.METHODS:Eight patients with atonic pupils who underwent suture purse-string p...AIM:To observe the clinical outcomes of 30-gauge(G)needle-guided 10-0 prolene suture purse-string pupilloplasty for atonic pupil management.METHODS:Eight patients with atonic pupils who underwent suture purse-string pupilloplasty were retrospectively analyzed.Preoperative data and at least 6mo of postoperative data were collected from all the patients.RESULTS:The corrected distance visual acuity(CDVA)before and after surgery was 0.58±0.22 and 0.20±0.10 logMAR,respectively(P=0.002).The pre-and postoperative pupil size was 7.38±0.88 and 3.09±0.71 mm(P=0.000),respectively.The corneal endothelial cell count was 2841±176/mm^(2) before and 2692±143/mm^(2) after surgery(P=0.000).No intraoperative or postoperative complications were reported.During the follow-up period of at least 6mo,all treated pupils were centered and generally or nearly round.Furthermore,the patients did not exhibit photophobia,glare,or diplopia.CONCLUSION:This technique is a simple and effective method for pupil reduction.展开更多
AIM:To evaluate trans-anal reinforcing sutures in low anterior resection using the double-stapled anastomosis technique for primary rectal cancers performed at a single institution.METHODS:The data of patients who rec...AIM:To evaluate trans-anal reinforcing sutures in low anterior resection using the double-stapled anastomosis technique for primary rectal cancers performed at a single institution.METHODS:The data of patients who received transanal reinforcing sutures were compared with those of patients who did not receive them after low anterior resection.Patients who underwent laparoscopic low anterior resection and the double-stapled anastomosis technique for primary rectal cancer between January2008 and December 2011 were included in this study.Patients with no anastomosis,a hand-sewn anastomosis,high anterior resection,or preoperative chemoradiation were excluded.The primary outcomes measured were the incidence of postoperative anastomotic complications and placement of a diverting ileostomy.RESULTS:Among 110 patients,the rate of placement of a diverting ileostomy was significantly lower in the suture group(SG)compared with the non-suture control group(CG)[SG,n=6(12.8%);CG,n=19(30.2%),P=0.031].No significant difference was observed in the rate of anastomotic leakage[SG,n=3(6.4%);CG,n=5(7.9%)].CONCLUSION:Trans-anal reinforcing sutures may reduce the need for diverting ileostomy.A randomized prospective study with a larger population should be performed in the future to demonstrate the efficacy of trans-anal reinforcing sutures.展开更多
BACKGROUND Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close,although complete closure is recommended for better recovery.Endoscopic purse-string assisted suturing...BACKGROUND Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close,although complete closure is recommended for better recovery.Endoscopic purse-string assisted suturing(EPSS)has been used in clinical practice and has proven to be an effective and safe technique for the closure of large mucosal defects.However,details regarding the efficacy of endoscopic pre-purse-string suture(P-EPSS)are unknown,especially that it offers several advantages over conventional EPSS(C-EPSS).AIM To elucidate the outcomes of EPSS-assisted closure in different clinical situations,and evaluate the efficacy of P-EPSS.METHODS This retrospective observational study included a total of 180 patients who underwent closure assisted by P-EPSS(n=63)or C-EPSS(n=117)between July 2014 and June 2020.The P-EPSS and C-EPSS groups were compared and the intergroup differences in aspects such as the lesion size,location,and morphology,incidence of complete closure,intraoperative perforation,and delayed adverse events were evaluated.Data on the features and clinical course of cases with adverse events were collected for further analysis.RESULTS Patients with lesion size larger than 3 cm,lesions located at the fundus of stomach,or submucosal tumors originating from the deep mucosa were more likely to undergo P-EPSS-assisted closure.The P-EPSS group showed a significantly higher proportion of intraoperative perforation(56%vs 17%)and a much shorter procedure time(9.06±6.14 min vs 14.84±7.25 min).Among adverse events,the incidence of delayed perforation(5%vs 4%;P=0.82)and delayed bleeding(3%vs 4%;P=0.96)did not differ significantly between the groups.Multivariate analysis revealed that lesions with incomplete closure[odds ratio(OR)=21.33;95%confidence interval(CI):5.45-83.45;P<0.01]or size greater than 3 cm(OR=3.14;95%CI:1.08-9.18;P=0.039)showed a statistical tendency to result in an increase in delayed adverse events.CONCLUSION The present study revealed that EPSS could achieve secure complete closure of mucosal defect.PEPSS could shorten the procedure and yield complete closure of mucosal defects.Rather than closure-type selection,incomplete closure or lesion size larger than 3 cm were associated with worse outcomes.展开更多
BACKGROUND In rotator cuff repair surgery,the double-row technique is widely performed.Studies have shown that with increased contact area and pressure between tendon and bone interface,better healing is promoted.AIM ...BACKGROUND In rotator cuff repair surgery,the double-row technique is widely performed.Studies have shown that with increased contact area and pressure between tendon and bone interface,better healing is promoted.AIM To assess the different suture configurations with the double-row technique and how this influences the contact area of the rotator cuff tendon to bone.METHODS This was a controlled laboratory study where identical tears were created in 24 fresh porcine shoulders over a 1.5 cm×2.5 cm infraspinatus insertion footprint.Double-row repair techniques,with 3 to 4-suture anchors in different configurations(2 medial,2 lateral vs 2 medial,1 lateral vs 1 medial,2 lateral),were employed for three control groups.Each group consisted of eight shoulders with identical repair configurations.Footprint contact areas of the repaired tendon against the tuberosity were determined using pressure sensitive Fujifilm placed between the tendon and tuberosity.RESULTS The mean contact area between tendon and insertion footprint from the imprinted Fujifilm was obtained using computer software.The contact area measured from a standard 4-suture anchor double row repair was 75.1±9.3 mm2,whereas areas obtained for the 2 lateral-1 medial and 2 medial-1 lateral anchor configurations were 72.9±5.2 mm2 and 75.0±4.9 mm2 respectively.No statistical significance was noted between the three groups.CONCLUSION In the technique of double-row repair,using a 3-suture anchor configuration may offer a non-inferior alternative to the standard 4-anchor construct in terms of efficacy.This may also result in overall cost reduction and shorter surgical time.展开更多
AIM： To compare the results of the anoscope of the PPH kit and a modified anoscope during stapled haemorrhoidopexy. METHODS： The hospital records of 37 patients who underwent stapled haemorrhoidopexy between 2001 an...AIM： To compare the results of the anoscope of the PPH kit and a modified anoscope during stapled haemorrhoidopexy. METHODS： The hospital records of 37 patients who underwent stapled haemorrhoidopexy between 2001 and 2006 were reviewed. The purse-string suture anoscope in the PPH kit was used on 15 patients （Group 1）, and the modified anoscope was used on 22 patients （Group 2）. Demographic characteristics of the patients, operation time, surgeon＇s performance, analgesic requirement, and complications were compared. RESULTS： Operation time was significantly longer in Group 1 （42.0 4- 8.4 min vs 27.7 4- 8.0 min, P = 0.039）. The surgeons reported their operative performance as significantly better in Group 2 （the results of the assessments were poor in ten, medium in four and good in one in Group 1, while good in all patients in Group 2, P 〈 0.001）. The need for haemostatic sutures was significantly higher in Group 1 （six cases） and was needed in two cases in Group 2 （P = 0.034）. CONCLUSION： Operation time decreased and the surgeon＇s satisfaction increased with use of the modified anoscope, and fewer haemostatic sutures were required if the surgeon waited longer before and after firing the stapler.展开更多
目的:探讨子宫肌层3层缝合对剖宫产术后憩室大小的影响及子宫切口憩室(CSD)形成的相关因素。方法:回顾性分析2022年4~11月于华东师范大学附属芜湖医院行剖宫产术的240例产妇的临床资料,根据子宫肌层缝合方式的不同分为3层缝合组(124例)...目的:探讨子宫肌层3层缝合对剖宫产术后憩室大小的影响及子宫切口憩室(CSD)形成的相关因素。方法:回顾性分析2022年4~11月于华东师范大学附属芜湖医院行剖宫产术的240例产妇的临床资料,根据子宫肌层缝合方式的不同分为3层缝合组(124例)和双层缝合组(116例);另根据术后是否形成CSD将产妇分为CSD组(23例)和非CSD组(217例)。对比3层缝合组与双层缝合组产妇的临床特点,采用多因素Logistic回归分析CSD形成的独立影响因素并构建人工神经网络模型;采用受试者工作特征(ROC)曲线、校准曲线和临床决策曲线进行模型验证。结果:①3层缝合组产妇的子宫肌层瘢痕厚度显著高于双层缝合组(7.06±2.09 mm vs.5.68±1.97 mm);而CSD形成情况(4.03%vs.15.52%)和憩室大小(0.36±0.09 ml vs.0.47±0.12 ml)则显著低于双层缝合组,差异均有统计学意义(P<0.05);②多因素分析示,子宫后屈、剖宫产次数≥2次、胎膜早破、围产期感染、剖宫产时机(择期)是影响CSD形成的独立危险因素(OR>1,P<0.05),而子宫肌层3层缝合是保护性因素(OR<1,P<0.05);③人工神经网络预测模型显示剖宫产次数、胎膜早破以及是否进行3层缝合所占权重均较高,经ROC曲线、校准曲线和临床决策曲线验证表明该模型预测能力良好。结论:CSD的形成与子宫后屈、剖宫产次数、胎膜早破、围产期感染、剖宫产时机等指标有关,临床应重点关注,此外,子宫肌层3层缝合可降低CSD的形成概率,在临床上值得推广应用。展开更多
目的:探究双层软组织缝合封闭技术在单纯应用抗骨吸收药物引起的发生在下颌骨的中早期药物相关性颌骨骨坏死(medication-related osteonecrosis of the jaw,MRONJ)患者手术治疗中的临床应用效果。方法:选择2021年10月至2022年9月于北京...目的:探究双层软组织缝合封闭技术在单纯应用抗骨吸收药物引起的发生在下颌骨的中早期药物相关性颌骨骨坏死(medication-related osteonecrosis of the jaw,MRONJ)患者手术治疗中的临床应用效果。方法:选择2021年10月至2022年9月于北京大学口腔医院四病区经手术治疗的中早期下颌骨MRONJ患者的病历资料进行回顾性分析,收集患者术前基线临床资料,包括原发疾病、伴发疾病、用药方案(药物种类、用药时长)、MRONJ分期、临床症状、影像学表现等,所有患者在手术中行下颌骨边缘切除术去除坏死骨,运用双层软组织缝合封闭技术关闭伤口,术后定期复查随访,评价双层软组织缝合封闭技术的治疗效果及并发症,并对患者进行疼痛评分和功能状态评价。结果:研究共纳入13例患者(女12例,男1例),年龄(66.69±13.14)岁。原发疾病包括骨质疏松7例,肺癌2例,乳腺癌3例,前列腺癌1例;2例伴发糖尿病,2例伴发心血管疾病,1例伴发干燥综合征。9例患者静脉注射唑来膦酸,平均用药时间(37.7±20.0)个月,7例患者同时服用了来曲唑片等其他药物;3例患者应用地舒单抗注射液,平均用药时间(10.3±11.9)个月;5例患者服用阿仑膦酸钠片,平均用药时间(55.20±27.20)个月,2例患者不同程度地服用醋酸泼尼松片或阿卡波糖片。MRONJ 1期4例,2期9例。13例患者均采用双层软组织缝合封闭技术关闭伤口,术后平均随访11.9个月(9~17个月),13例患者皆治愈,无溢脓等并发症发生。患者术前Karnofsky功能状态评分量表(Karnofsky performance status,KPS)评分为(68.46±14.05)分,术后评分为(82.31±15.36)分,差异有统计学意义(P<0.05)。患者术前疼痛评估视觉模拟评分量表(visual analogue scale,VAS)评分为(5.77±0.73)分,术后评分为(0.38±0.51)分,差异有统计学意义(P<0.001)。结论:双层软组织缝合封闭技术在中早期单纯使用抗骨吸收类药物的下颌骨MRONJ患者中可以取得良好的临床治疗效果,可为用药情况更加复杂的MRONJ患者提供临床治疗思路。展开更多
基金This observational study was approved by the Ethics Committee of Renmin Hospital of Wuhan University.
文摘BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(≥3 cm)SMTs is scarce and limited.AIM To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large(≥3 cm)SMTs.METHODS We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University.The operative,postoperative,and follow-up conditions of the patients were evaluated.RESULTS All tumors were completely resected using EFTR.36(42.35%)patients had tumors located in the fundus of the stomach,and 49(57.65%)had tumors located in the body of the stomach.All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment.Postoperative fever and stomach pain were reported in 13(15.29%)and 14(16.47%)patients,respectively.No serious adverse events occurred during the intraoperative or postoperative periods.A postoperative review of all patients revealed no residual or recurrent lesions.CONCLUSION Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture,especially for large(≥3 cm)EFTR wounds in SMTs.
基金Supported by the Changzhou Science and Technology Bureau(No.CJ20239004).
文摘AIM:To observe the clinical outcomes of 30-gauge(G)needle-guided 10-0 prolene suture purse-string pupilloplasty for atonic pupil management.METHODS:Eight patients with atonic pupils who underwent suture purse-string pupilloplasty were retrospectively analyzed.Preoperative data and at least 6mo of postoperative data were collected from all the patients.RESULTS:The corrected distance visual acuity(CDVA)before and after surgery was 0.58±0.22 and 0.20±0.10 logMAR,respectively(P=0.002).The pre-and postoperative pupil size was 7.38±0.88 and 3.09±0.71 mm(P=0.000),respectively.The corneal endothelial cell count was 2841±176/mm^(2) before and 2692±143/mm^(2) after surgery(P=0.000).No intraoperative or postoperative complications were reported.During the follow-up period of at least 6mo,all treated pupils were centered and generally or nearly round.Furthermore,the patients did not exhibit photophobia,glare,or diplopia.CONCLUSION:This technique is a simple and effective method for pupil reduction.
文摘AIM:To evaluate trans-anal reinforcing sutures in low anterior resection using the double-stapled anastomosis technique for primary rectal cancers performed at a single institution.METHODS:The data of patients who received transanal reinforcing sutures were compared with those of patients who did not receive them after low anterior resection.Patients who underwent laparoscopic low anterior resection and the double-stapled anastomosis technique for primary rectal cancer between January2008 and December 2011 were included in this study.Patients with no anastomosis,a hand-sewn anastomosis,high anterior resection,or preoperative chemoradiation were excluded.The primary outcomes measured were the incidence of postoperative anastomotic complications and placement of a diverting ileostomy.RESULTS:Among 110 patients,the rate of placement of a diverting ileostomy was significantly lower in the suture group(SG)compared with the non-suture control group(CG)[SG,n=6(12.8%);CG,n=19(30.2%),P=0.031].No significant difference was observed in the rate of anastomotic leakage[SG,n=3(6.4%);CG,n=5(7.9%)].CONCLUSION:Trans-anal reinforcing sutures may reduce the need for diverting ileostomy.A randomized prospective study with a larger population should be performed in the future to demonstrate the efficacy of trans-anal reinforcing sutures.
基金the National Natural Science Foundation of China,No.82172737 and 82003277Shanghai Municipal Education Commission,No.16411950403 and 19411951605。
文摘BACKGROUND Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close,although complete closure is recommended for better recovery.Endoscopic purse-string assisted suturing(EPSS)has been used in clinical practice and has proven to be an effective and safe technique for the closure of large mucosal defects.However,details regarding the efficacy of endoscopic pre-purse-string suture(P-EPSS)are unknown,especially that it offers several advantages over conventional EPSS(C-EPSS).AIM To elucidate the outcomes of EPSS-assisted closure in different clinical situations,and evaluate the efficacy of P-EPSS.METHODS This retrospective observational study included a total of 180 patients who underwent closure assisted by P-EPSS(n=63)or C-EPSS(n=117)between July 2014 and June 2020.The P-EPSS and C-EPSS groups were compared and the intergroup differences in aspects such as the lesion size,location,and morphology,incidence of complete closure,intraoperative perforation,and delayed adverse events were evaluated.Data on the features and clinical course of cases with adverse events were collected for further analysis.RESULTS Patients with lesion size larger than 3 cm,lesions located at the fundus of stomach,or submucosal tumors originating from the deep mucosa were more likely to undergo P-EPSS-assisted closure.The P-EPSS group showed a significantly higher proportion of intraoperative perforation(56%vs 17%)and a much shorter procedure time(9.06±6.14 min vs 14.84±7.25 min).Among adverse events,the incidence of delayed perforation(5%vs 4%;P=0.82)and delayed bleeding(3%vs 4%;P=0.96)did not differ significantly between the groups.Multivariate analysis revealed that lesions with incomplete closure[odds ratio(OR)=21.33;95%confidence interval(CI):5.45-83.45;P<0.01]or size greater than 3 cm(OR=3.14;95%CI:1.08-9.18;P=0.039)showed a statistical tendency to result in an increase in delayed adverse events.CONCLUSION The present study revealed that EPSS could achieve secure complete closure of mucosal defect.PEPSS could shorten the procedure and yield complete closure of mucosal defects.Rather than closure-type selection,incomplete closure or lesion size larger than 3 cm were associated with worse outcomes.
文摘BACKGROUND In rotator cuff repair surgery,the double-row technique is widely performed.Studies have shown that with increased contact area and pressure between tendon and bone interface,better healing is promoted.AIM To assess the different suture configurations with the double-row technique and how this influences the contact area of the rotator cuff tendon to bone.METHODS This was a controlled laboratory study where identical tears were created in 24 fresh porcine shoulders over a 1.5 cm×2.5 cm infraspinatus insertion footprint.Double-row repair techniques,with 3 to 4-suture anchors in different configurations(2 medial,2 lateral vs 2 medial,1 lateral vs 1 medial,2 lateral),were employed for three control groups.Each group consisted of eight shoulders with identical repair configurations.Footprint contact areas of the repaired tendon against the tuberosity were determined using pressure sensitive Fujifilm placed between the tendon and tuberosity.RESULTS The mean contact area between tendon and insertion footprint from the imprinted Fujifilm was obtained using computer software.The contact area measured from a standard 4-suture anchor double row repair was 75.1±9.3 mm2,whereas areas obtained for the 2 lateral-1 medial and 2 medial-1 lateral anchor configurations were 72.9±5.2 mm2 and 75.0±4.9 mm2 respectively.No statistical significance was noted between the three groups.CONCLUSION In the technique of double-row repair,using a 3-suture anchor configuration may offer a non-inferior alternative to the standard 4-anchor construct in terms of efficacy.This may also result in overall cost reduction and shorter surgical time.
文摘AIM： To compare the results of the anoscope of the PPH kit and a modified anoscope during stapled haemorrhoidopexy. METHODS： The hospital records of 37 patients who underwent stapled haemorrhoidopexy between 2001 and 2006 were reviewed. The purse-string suture anoscope in the PPH kit was used on 15 patients （Group 1）, and the modified anoscope was used on 22 patients （Group 2）. Demographic characteristics of the patients, operation time, surgeon＇s performance, analgesic requirement, and complications were compared. RESULTS： Operation time was significantly longer in Group 1 （42.0 4- 8.4 min vs 27.7 4- 8.0 min, P = 0.039）. The surgeons reported their operative performance as significantly better in Group 2 （the results of the assessments were poor in ten, medium in four and good in one in Group 1, while good in all patients in Group 2, P 〈 0.001）. The need for haemostatic sutures was significantly higher in Group 1 （six cases） and was needed in two cases in Group 2 （P = 0.034）. CONCLUSION： Operation time decreased and the surgeon＇s satisfaction increased with use of the modified anoscope, and fewer haemostatic sutures were required if the surgeon waited longer before and after firing the stapler.
文摘目的:探讨子宫肌层3层缝合对剖宫产术后憩室大小的影响及子宫切口憩室(CSD)形成的相关因素。方法:回顾性分析2022年4~11月于华东师范大学附属芜湖医院行剖宫产术的240例产妇的临床资料,根据子宫肌层缝合方式的不同分为3层缝合组(124例)和双层缝合组(116例);另根据术后是否形成CSD将产妇分为CSD组(23例)和非CSD组(217例)。对比3层缝合组与双层缝合组产妇的临床特点,采用多因素Logistic回归分析CSD形成的独立影响因素并构建人工神经网络模型;采用受试者工作特征(ROC)曲线、校准曲线和临床决策曲线进行模型验证。结果:①3层缝合组产妇的子宫肌层瘢痕厚度显著高于双层缝合组(7.06±2.09 mm vs.5.68±1.97 mm);而CSD形成情况(4.03%vs.15.52%)和憩室大小(0.36±0.09 ml vs.0.47±0.12 ml)则显著低于双层缝合组,差异均有统计学意义(P<0.05);②多因素分析示,子宫后屈、剖宫产次数≥2次、胎膜早破、围产期感染、剖宫产时机(择期)是影响CSD形成的独立危险因素(OR>1,P<0.05),而子宫肌层3层缝合是保护性因素(OR<1,P<0.05);③人工神经网络预测模型显示剖宫产次数、胎膜早破以及是否进行3层缝合所占权重均较高,经ROC曲线、校准曲线和临床决策曲线验证表明该模型预测能力良好。结论:CSD的形成与子宫后屈、剖宫产次数、胎膜早破、围产期感染、剖宫产时机等指标有关,临床应重点关注,此外,子宫肌层3层缝合可降低CSD的形成概率,在临床上值得推广应用。
文摘目的:探究双层软组织缝合封闭技术在单纯应用抗骨吸收药物引起的发生在下颌骨的中早期药物相关性颌骨骨坏死(medication-related osteonecrosis of the jaw,MRONJ)患者手术治疗中的临床应用效果。方法:选择2021年10月至2022年9月于北京大学口腔医院四病区经手术治疗的中早期下颌骨MRONJ患者的病历资料进行回顾性分析,收集患者术前基线临床资料,包括原发疾病、伴发疾病、用药方案(药物种类、用药时长)、MRONJ分期、临床症状、影像学表现等,所有患者在手术中行下颌骨边缘切除术去除坏死骨,运用双层软组织缝合封闭技术关闭伤口,术后定期复查随访,评价双层软组织缝合封闭技术的治疗效果及并发症,并对患者进行疼痛评分和功能状态评价。结果:研究共纳入13例患者(女12例,男1例),年龄(66.69±13.14)岁。原发疾病包括骨质疏松7例,肺癌2例,乳腺癌3例,前列腺癌1例;2例伴发糖尿病,2例伴发心血管疾病,1例伴发干燥综合征。9例患者静脉注射唑来膦酸,平均用药时间(37.7±20.0)个月,7例患者同时服用了来曲唑片等其他药物;3例患者应用地舒单抗注射液,平均用药时间(10.3±11.9)个月;5例患者服用阿仑膦酸钠片,平均用药时间(55.20±27.20)个月,2例患者不同程度地服用醋酸泼尼松片或阿卡波糖片。MRONJ 1期4例,2期9例。13例患者均采用双层软组织缝合封闭技术关闭伤口,术后平均随访11.9个月(9~17个月),13例患者皆治愈,无溢脓等并发症发生。患者术前Karnofsky功能状态评分量表(Karnofsky performance status,KPS)评分为(68.46±14.05)分,术后评分为(82.31±15.36)分,差异有统计学意义(P<0.05)。患者术前疼痛评估视觉模拟评分量表(visual analogue scale,VAS)评分为(5.77±0.73)分,术后评分为(0.38±0.51)分,差异有统计学意义(P<0.001)。结论:双层软组织缝合封闭技术在中早期单纯使用抗骨吸收类药物的下颌骨MRONJ患者中可以取得良好的临床治疗效果,可为用药情况更加复杂的MRONJ患者提供临床治疗思路。
