A Comparison between Supra-Scarpa’s Fascia Abdominoplasty and Traditional Abdominoplasty: Effect of Caesarian Section

Background: Abdominoplasty is still among the most popular surgeries in the world of cosmetic surgery, as many modifications have been implemented on this surgery to improve aesthetics and reduce the ratio of complication, especially seroma. Also, the duration to drain removal increases the risk of infection, and this can be avoided by preserving the Scarpa’s fascia. Methods: The study was performed from January 2018 to December 2020. The patients were divided into two groups: group A with patients who were performed in Supra-Scarpa’s fascia abdominoplasty, and group B who were performed in traditional abdominoplasty;then group A was divided into two subgroups (A1 with caesarean history and A2 with no caesarean history) that differ in caesarean history or not, while a comparison was done between the groups regarding early outcomes. Results: A total of 40 full abdominoplasties were preformed (group A, 19 patients;group B, 21 patients);then group A was divided into two subgroups (group A1, 13 patients;A2, 6 patients);we found that the time until drain removal and its drain output in group A is less with a statistical significance, and the seroma was less to happen in group A with no statistical significance. However, the operative time in group A is higher with statistical significance. In the subgroups A1 and A2, there was no statistically significant difference in the results. Conclusion: Preservation of the Scarpa’s fascia reduces the time until drain removal, total drain output and the occurrence of seroma and the caesarean scar doesn’t affect the efficacy of preserving the Scarpa’s fascia.

Gerota筋膜内后腹腔镜应用于肥胖患者的体会

目的探讨Gerota筋膜内后腹腔镜的临床应用价值。方法36例肥胖患者采用12肋下腋后线孔气囊扩张建立Gerota筋膜内后腹腔间隙,进行腹腔镜肾切除4例,肾囊肿去顶12例,肾盂输尿管上段切开取石17例,离断性肾盂成形1例,肾上腺肿瘤切除2例。结果35例手术顺利完成,仅1例输尿管结石因术中气腹机故障改开放手术。手术时间20～160min(平均63.1min)。术中出血量10～240mL(平均55mL)。肾盂输尿管上段切开取石患者,6例术后少许漏尿2～6d(平均3.5d)。住院时间4～26d。术后随访35例,2～13个月(平均5.1个月),未见严重并发症。结论为减少脂肪组织的干扰,肥胖症患者可在Gerota筋膜内建立后腹腔间隙行腹腔镜手术,简便易行,路径直接,组织分离少,手术时间缩短。

用毗邻肌、筋膜瓣预防Frey′s综合征

目的 探讨在腮腺切除手术的同时 ,用残余的腮腺咬肌筋膜和胸锁乳突肌瓣修复与重建腮腺咬肌筋膜屏障 ,是否能够有效预防味觉出汗综合征的发生。方法 通过对 2 1例在腮腺切除术中保留、重建腮腺咬肌筋膜的患者进行术后随访 ,并采用咀嚼维生素C片诱导及碘———淀粉试验检测 ,观察术后味觉出汗综合征的发病率。结果 在调查的 2 1例患者中 ,仅有 2例病人发现有潮红和出汗现象 ,较传统腮腺切除术的发病率明显降低。结论 切除腮腺时 ,用毗邻肌筋膜瓣预防Frey′s综合征不仅有显著效果 ,而且还能纠正面侧部的凹陷畸形。

Rare Case of Spontaneous Perinephric Hematoma with Two-Year Follow-Up

Background: Spontaneous perinephric hematoma with no associated pathology or provocation is a rare clinical phenomenon. The hematoma requires a two-year interval for a favorable hematoma resolution, and no associated hypertension or renal scarring. Aims: Evidence of the efficacy of conservative management for spontaneous perinephric hematoma with a 2-year follow up. Case Presentation: A previously healthy 38-year-old woman, presented with a sudden onset of left flank pain, associated with fatigue and pallor. The patient remained hemodynamically stable with no significant history or associated provocations identified. Conclusion: The acute management strategy is favorable in such condition, as the hematoma remains under tamponade in the retroperitoneal space, regardless of the size and organ displacement. Closed observation, serial blood investigation and repeated CT scans are vital to assist in the decision to intervene.

Complete mesocolic excision: Lessons from anatomy translating to better oncologic outcome

Since the introduction of complete mesocolic excision(CME) for colon cancer, the oncologic outcome of patients has been greatly improved, which has led to a longer survival and a lower recurrence, just like the total mesorectum excision for rectal cancer. Despite the fact that the exact anatomy of the organ is one of the most vital things for surgeons to conduct surgery, no team has really studied the exact structure of the mesocolon and related attachments for CME, until the mesocolonic anatomy was first formally characterized in 2012. Therefore, this article mainly focuses on the anatomy development of the mesocolon and the achievement in this field. Meanwhile, we introduce the latest progress in laparoscopic surgery for colon cancer achieved by our team.

Assessment of palmar subcutaneous tissue vascularization in patients with Dupuytren's contracture

AIM To investigate the structural and functional characte-ristics of palmar hypodermal tissue vascularization in Dupuytren's contracture patients of different agegroups.METHODS Eighty-seven Dupuytren's contracture patients underwent partial fasciectomy. Twenty-two of them were less than 55 years old(Y-group, n = 22); the others were 55 and older(O-group, n = 65). In surgically excised representative tissue samples, a histomorphometric analysis of the perforating arteries of the palmar aponeurosis and stereologic analysis of hypodermis vascularity were performed. The method of laser flowmetry estimated the microcirculation of the skin of the palm.RESULTS Frequency of cases with rapid development of contracture(less than 5 years) was 13.6% in the Y-group and 40% in the O-group, P < 0.05. The external and luminal diameters of perforating arteries in palmar fascia were decreased more severely in Y. The thickness of intima increased three times compared with healthy control, and the intima/media relation also increased, especially in O. Increased numerical and volumetric micro-vessel densities in hypodermis, percentage of large vessels(more than 12 μm in diameter), and percentage of vessels with signs of periadventitial inflammatory infiltration were noted in Y. The percentage of vessels with adventitial fibrosis was greater in O than in Y. Base capillary flow in Y was increased compared to healthy control subjects and to O, and peak capillary flow was increased in comparison with control.CONCLUSION Compared to the O-group, Y-group patients exhibited more severe constrictive remodeling of palmar fascia perforating arteries supplying hypodermis but more expressed compensatory changes of its capillarization.

从“毒伏筋膜”理论辨证论治克罗恩病

克罗恩病(Crohn′s disease,CD)是一种反复发作的慢性炎症性肠病,文中从“毒伏筋膜”理论分析克罗恩病的辨证论治,认为筋膜是克罗恩病发病的重要病位,其病因源于先天禀赋虚弱和后天劳伤精耗,两者共同促成肾精亏虚、毒伏少阴的始动因素,继而伏毒渐张、外发少阳导致筋膜受损是克罗恩病发病的核心病机。根据疾病不同分期特点,采取分期辨治、清透伏毒的治疗原则,潜伏期温肾藏精、养膜固本以充养膜筋,活动期治在少阳、清透伏毒以安其筋膜,迁延期扶正祛邪、标本兼顾以修复筋膜,并提出柔挛解急、护溃保膜、破缴伏巢的特色治疗方法,以期为中医治疗克罗恩病提供新思路。

大腿阔筋膜在Chiari畸形伴脊髓空洞术中的应用

目的探讨自体大腿阔筋膜治疗Chiari畸形伴脊髓空洞症手术中的应用方法。方法回顾性总结了2001年-2007年该手术模式治疗的12例病人的临床资料。采取后颅窝减压,硬膜切开,显微镜下松解小脑扁桃体粘连,切除下疝的小脑扁桃体,用大腿阔筋膜行后颅窝重建术,空洞不处理。结果12例病人除1例病情稳定症状与手术前无明显改善,其余11例病人临床症状均较手术前明显好转。手术4月后复查MRI,4例空洞消失,6例空洞较手术前缩小,2例空洞无明显变化。12例病人枕大池均重现。结论用自体大腿阔筋膜行后颅窝重建,恢复枕大池的结构和功能,是治疗Chiari畸形伴脊髓空洞症的有效方法,对提高疗效有明显的作用。

保留腮腺咬肌筋膜联合口腔修复膜植入预防味觉出汗综合征

目的探讨保留腮腺咬肌筋膜联合口腔修复膜植入在预防腮腺肿瘤切除术后味觉出汗综合征的临床效果。方法将我院2006-2011年收治的68例良性腮腺肿瘤患者随机分为2组各34例。试验组保留腮腺咬肌筋膜联合口腔修复膜植入;对照组常规手术切除腮腺咬肌筋膜。术后一年采用问卷调查和碘—淀粉试验检测味觉出汗综合征阳性率。结果试验组有2例患者,对照组有4例患者不能按时到院复查。问卷调查味觉出汗综合征阳性率:实验组为3.1%(1/32),对照组为46.7%(14/30);碘-淀粉试验阳性率:实验组0%(0/32),对照组33.3%(10/30)。实验组与对照组相比较差异有统计学意义(P<0.05)。结论保留腮腺咬肌筋膜联合口腔修复膜植入能显著降低腮腺肿瘤切除术后味觉出汗综合征发生率。

保留腮腺咬肌筋膜加胸锁乳突肌肌瓣在腮腺手术中的应用

目的：探讨保留腮腺咬肌筋膜加胸锁乳突肌肌瓣对预防面部凹陷畸形及味觉出汗综合征的临床效果。方法选择腮腺良性肿瘤的患者110例，随机分为治疗组56例和对照组54例，治疗组保留腮腺咬肌筋膜并即刻行胸锁乳突肌肌瓣充填，对照组常规方法行腮腺肿瘤切除术，术后随访观察疗效。结果经术后3-24个月随访，所有手术均获得成功，保留腮腺咬肌筋膜加胸锁乳突肌肌瓣的手术方法在面部凹陷畸形的改善效果及味觉出汗综合征发生率均优于对照组（P〈0.01）。结论保留腮腺咬肌筋膜加胸锁乳突肌肌瓣可作为修复腮腺术后畸形及预防味觉出汗综合征的优先选择。

大鼠阔筋膜襻神经的免疫组织化学研究

目的 :证明Wistar鼠模型人工阔筋膜襻有神经分布。方法 :采用SP免疫组织化学染色方法 ,标记人工阔筋膜襻的S 1 0 0蛋白受体。结果 :术后一个月时 ,大鼠的阔筋膜襻有S 1 0 0蛋白表达 ,表明该人工阔筋膜襻有神经支配。结论 :人工阔筋膜襻是有神经支配的人工装置。

乳腺纤维结构改变对乳腺恶性肿瘤诊断价值

目的:探讨乳腺内纤维结构改变对判断乳腺恶性肿瘤的价值。方法:乳腺肿瘤64例(良性21例,恶性43例),术前或活检前高频超声检查,记录肿物周围纤维结构的声像图改变,初步判断肿物良、恶性质并按有无浸润和浸润深度分级,共两类各4级,术后将病理结果与术前的超声分级做对比分析。结果:恶性肿瘤中浅、深筋膜和cooper韧带发生改变的几率明显高于良性肿瘤,分别为64%,26%(P<0.01),诊断价值的大小依次为:浅、深膜受侵>cooper韧带。结论:高频超声对观察乳腺内纤维结构改变对恶性肿瘤诊断有重要提示价值。

冯氏筋膜点缓解脑卒中后手痉挛的临床疗效初步观察

目的观察针刺冯氏筋膜点缓解脑卒中后手痉挛的临床疗效。方法对16例脑卒中后手痉挛患者行冯氏筋膜点针刺治疗。疗程为4周,观察治疗前、首次治疗后和疗程结束时改良Ashworth量表评分的变化情况。结果患者改良Ashworth量表评分在首次治疗后和疗程结束时均较治疗前降低(P<0.05),且疗程结束时降低更为显著(P<0.05)。结论针刺冯氏筋膜点能有效即时缓解脑卒中后手痉挛,且随着干预时间的延长,效果更加明显。

髋关节囊周围神经阻滞和髂筋膜间隙阻滞在老年髋部骨折患者早期镇痛中的应用

目的比较髋关节囊周围神经阻滞(pericapsular nerve group block,PNGB)和腹股沟韧带上髂筋膜间隙阻滞(supra-in-guinal fascia iliaca compartment block,S-FICB)在老年髋部骨折患者早期镇痛中的效果。方法按随机数字表法将2021年10月至2022年5月急诊科就诊的老年髋部骨折患者分为两组:PNGB组和S-FICB组,每组25例。记录两组患者一般情况,记录神经阻滞前(T0)、阻滞后15 min(T1)、阻滞后30 min(T2)、阻滞后2 h(T3)、阻滞后6 h(T4)、阻滞后12 h(T5)和阻滞后24 h(T6)的静息和抬髋15度时相应的数字评定量表(numerifal rating scale,NRS)评分,记录两组起效时间、超声成像时间、穿刺操作时间和患者镇痛满意度及不良反应发生情况。结果与T0比较,两组静息和抬髋15度时T1~T6的NRS评分明显降低(均P<0.05);与S-FICB组比较,PNGB组静息和抬髋15度时T1~T6的NRS评分明显降低(均P<0.05)。与S-FICB组比较,PNGB组起效时间、超声成像时间和穿刺操作时间明显缩短,镇痛满意度评分明显提高(均P<0.05)。两组均未发生神经阻滞相关并发症。结论PNGB和S-FICB对老年髋部骨折患者均有良好的镇痛效果,PNGB操作所需时间更少,起效更快,患者满意度更高。

Historical development of mesenteric anatomy provides a universally applicable anatomic paradigm for complete/total mesocolic excision

Although total mesorectal excision has now become the‘gold standard’for the surgical management of rectal cancer,this is not so for colon cancer.Recent data,provided by Hohenberger and West et al.and others,have demonstrated excellent oncological outcomes when mesenterectomy is extensive(as is implicit in the concept of a‘high tie’)and the mesenteric package not violated.Such studies highlight the importance of understanding the basics of the mesenteric organ(including the small intestinal mesentery,mesocolon,mesosigmoid and mesorectum)and of abiding to principles of planar surgery.In this review,we first offer classic descriptions of the mesocolon and then detail contemporary thinking.In so doing,we provide an anatomical basis for safe and effective complete mesocolic excision(CME)in the management of colon cancer.Finally we list opportunities associated with the new anatomical paradigm,demonstrating benefits across multiple disciplines.Perhaps most importantly,we feel that a crystallized view of mesenteric anatomy will overcome factors that have hindered the general uptake of CME.

乳腺间质内纤维结构改变对乳腺肿瘤诊断的价值

目的探讨乳腺内纤维结构(深、浅筋膜和Cooper韧带)的改变对判断乳腺肿瘤性质的价值.方法乳腺肿瘤84例(良性31例,恶性53例),术前或活检前高频超声扫查,记录肿物周围纤维结构的声像图改变,初步判断肿物良、恶性质并按有无浸润和浸润深度分级,共两类各4级.术后将病理结果与术前的超声分级做对比分析.采用receiver operating characteristic统计法分析深、浅筋膜和Cooper韧带多变量中最有意义的参数,计算ROC曲线下面积作为精确度比较的定量指标.结果恶性肿瘤中浅、深筋膜和Cooper韧带发生改变的几率明显高于良性肿瘤,分别为64%、26%,(P<0.01).筋膜改变对判断肿物性质的准确率均高于Cooper韧带, 95%可信限范围分别为 86.3%～97.6% 和 63.9%～84.5%.诊断价值的大小依次为:浅、深筋膜受侵>Cooper韧带.结论高频超声观察乳腺内纤维结构的改变对判断肿瘤性质有重要的提示诊断价值.

完整保留腮腺筋膜的临床研究

目的:探讨腮腺良性肿瘤切除术中完整保留腮腺筋膜的适应证和手术技巧,减少术后Frey′s综合征的发生。方法:对35例腮腺良性肿物患者实施保留腮腺筋膜手术,术后随访6～24个月。结果:35例患者全部得到了随访,26例完整保留了腮腺筋膜患者中无一例发生Frey′s综合征,9例未能完整保留腮腺筋膜患者中有2例发生了Frey′s综合征,完整保留和未能完整保留腮腺筋膜者在预防Frey′s综合征方面差异有统计学意义(P<0.05)。结论:腮腺良性肿瘤切除术患者选择得当能完整保留腮腺筋膜,从而避免术后Frey′s综合征的发生。