腭裂手术治疗及并发症的预防

目的探讨腭裂手术治疗及并发症的预防措施。方法回顾分析我科自2007年2月至2009年12月收治先天性腭裂95例患者的临床资料。结果术后并发症：术后出血1例;复裂穿孔2例;术后瘘孔3例;术后咽喉部水肿1例发生在术后24h以内,经静脉滴注地塞米松后消除。结论腭裂为口腔颌面部常见的先天性发育畸形,手术医师精细的操作对预防术后并发症尤为重要,同时术后病情观察及护理是患者康复的关键。     

腭裂100例术后并发症的分析与预防

先天性腭裂是儿童常见的先天性畸形,以往手术治疗术后并发症难以避免,时有发生,影响术后患者的发音质量及生活质量。本科室通过腭裂术式的改进、麻醉水平的提高、术后护理水平的提高,使腭裂患者术后并发症大为降低,现报道如下。     

先天性腭裂修复术的护理体会

腭裂是口腔颌面部常见的先天性畸形疾病之一，常与唇裂相并而造成口鼻相通，使吮吸进食、发音发生一定的障碍，先天性腭裂早期修复，有利于患儿获得良好的腭咽闭合和发音功能恢复，现将12例腭裂修复术后的护理体会介绍如下。     

低体重婴幼儿先天性心脏病的术后护理

目的探讨低体重婴儿先天性心脏病的术后护理。方法通过对30例心内术后婴儿的临床观察，采取的护理措施：加强呼吸道管理，恢复和维护肺功能，防止肺高压危象，预防和减少肺部并发症；加强心功能支持，减轻心脏负荷，加强营养支持，预防呼吸机依赖和进行呼吸肌功能锻炼等护理；严格执行各项操作规程以预防感染的发生。结果通过30例婴儿先天性心脏病术后的护理，大大降低术后并发症，减少病死率，提高了手术成功率。结论合理到位的术后护理是提高手术成功率、降低术后并发症的关键。     

小儿唇腭裂何时手术好

如果有人问：“你觉得最常见的先天畸形是什么？”很可能会答：“免唇”。对了，“兔唇”在医学上称为唇裂。常常和口腔内的腭裂合并，共同称为唇腭裂。唇裂和腭裂是人体面部最常见的先天性缺陷（畸形）。唇裂又称“豁嘴”，是婴儿刚出生时就可以被发现的畸形之一。它也可以和口腔中上腭部裂隙同时存在。但如果只有部分上腭裂开，则在婴儿出生时未能发觉，直到吮吸母亲乳汁时，才发现乳汁从鼻孔中漏溢出来，而且出现呛咳症状，再经医师或家属仔细观察检查，才发现婴儿存在口腔内上腭口盖的先天性裂隙——腭裂，俗称“狼咽”。严重者上腭全部一分为二，从齿槽开始，直到悬雍垂（俗称“小舌头”）。     

医用明胶海绵在腭裂修复术中的临床应用

<正>腭裂是口腔颌面部常见的先天性发育畸形,患病率高达0.182%[1]。手术封闭裂隙,重建腭咽闭合是治疗先天性腭裂的有效方法。在腭裂修复术中,用来填塞两侧松驰切口及覆盖创面的传统材料是碘仿纱条。临床中我们发现,采用传统方法处理的患者,术后常出现食欲不振、口内异物感、发热、继发性出血等并发症。为避免或减少腭裂患者术后出现以上并发症,我科自2010年来采用医用明胶海绵填塞双侧松弛切口的方法,取得了较好的临床效果。本文就医用明胶海绵     

腭裂术后纱布滞留鼻咽部误诊为肿瘤1例

腭裂术后纱布滞留鼻咽部误诊为肿瘤１例（山东省临沂市１４６医院２７６００３）吴玉堂，温献洲，胡宝琪，李翠兰，魏顶富，刘加成刘某，男，１４岁。因鼻塞伴呼气恶臭味２年。患者原有先天性腭裂，无鼻塞及臭昧感。２年前曾在他院行腭裂修补术（腭咽环扎法），术后一直有...     

腭裂语音及其治疗现状概述

<正>腭裂语音是腭裂主要症状之一,它产生于先天性腭裂畸形。腭裂语音患者,并不是随着腭裂畸形的修复而治愈的完全消失,5%～10%患者术后仍有腭裂语音[1]。导致术后腭裂语音的因素很多,如手术时间晚或手术方式不当,腭裂畸形严     

28例婴幼儿先天性腭裂修补的麻醉总结

本院近6年来共实施婴幼儿先天性腭裂修补术28例，术后均痊愈出院，现将麻醉有关问题总结如下。     

婴儿先天性舌根囊肿的麻醉处理

先天性舌根囊肿是造成婴儿时期呼吸窘迫的重要原因之一。由于先天性舌根囊肿患儿一般年龄小,全身状态差,手术耐受能力降低,口腔内空间狭小,手术操作困难[1],给麻醉诱导、气管插管及术中、术后麻醉管理均造成极大困难。我院收治先天性舌根囊肿患儿35例,均于全麻气管插管下行急症手术,术后效果良好,围术期麻醉报告如下。     

婴儿唇腭裂同期修复术临床评价

目的：探讨婴儿唇腭裂同期修复术的临床疗效。方法：对年龄5～12月的128例唇腭裂患儿进行同期修复术,观察术中、术后患儿的反应和恢复情况,评价临床疗效。结果：128例患儿均能耐受手术,术中出血量少,无严重并发症发生,语音恢复好。结论：在麻醉、术后护理及手术技术条件具备的情况下,婴儿唇腭裂同期修复术是安全可行的。     

2010～2012年普兰店市人群为基础的出生缺陷监测结果分析

目的了解普兰店市人群出生缺陷的发生情况,为今后监测工作的管理重点和制订出生缺陷预防措施提供依据。方法按照全国妇幼卫生监测办公室制订的以人群为基础的出生缺陷监测方案,对普兰店市2010年10月1日～2012年9月30日所有孕28周～生后42d的监测对象进行逐一筛查,首次发现的所有出生缺陷病例均应报告。结果2010～2012年普兰店市以人群为基础的出生缺陷率呈缓慢下降趋势,人群出生缺陷发生率顺位从高到低依次为先天性心脏病、多指（趾）、总唇裂、并指（趾）、总腭裂。结论降低出生缺陷,预防至关重要,重点应推广一级预防。加强二级预防,积极处理三级预防,降低因出生缺陷导致的儿童死亡。     

Induction of cell-cycle arrest by all-trans retinoic acid in mouse embryonic palatal mesenchymal (MEPM) cells.

all-trans retinoic acid (atRA), the oxidative metabolite of vitamin A, is essential for normal embryonic development. Also, high levels of atRA are teratogenic in many species and can effectively induce cleft palate in the mouse. Most cleft palate resulted from the failed fusion of secondary palate shelves, and maintenance of the normal cell proliferation is important in this process of shelf growth. To clarify the mechanism by which atRA causes cleft palate, we investigated the effect of atRA on proliferation activity and cell cycle distribution in mouse embryonic palatal mesenchymal (MEPM) cells. atRA inhibited the growth of MEPM cells by inducing apoptosis in a dose-dependent manner. atRA also caused a G1 block in the cell cycle with an increase in the proportion of cells in G0/G1 and a decrease in the proportion of cells in S phase, as determined by flow cytometry. We next investigated the effects of atRA on molecules that regulate the G1 to S phase transition. These studies demonstrated that atRA inhibited expression of cyclins D and E at the protein level. Furthermore, atRA treatment reduced phosphorylated Rb and decreased cdk2 and cdk4 kinase activity. These data suggest that atRA had antiproliferative activity by modulating G1/S cell cycle regulators and by inhibition of Rb phosphorylation in MEPM cells, which might account for the pathogenesis of cleft palate induced by retinoic acid.     

505例唇腭裂患儿血常规检测结果分析

目的通过对唇腭裂患儿血象进行回顾性分析,探讨其血常规检测参数的变化,为选择麻醉方法和手术时机提供依据。方法对2011年5月～2012年8月住院治疗的505例唇腭裂患儿血常规检测结果进行调查统计分析,按畸形和治疗程度不同分为唇裂（A组）、腭裂组（B组）和唇腭裂组（C组）;以1岁以内正常婴儿（D组）、1～5岁正常儿童组（E组）共计180名作为对照。检测白细胞（WBC）、红细胞（RBC）、血红蛋白（HGB）、血小板（PLT）和淋巴细胞百分率（L%）。同时跟踪调查36例唇腭裂患儿唇裂修复前后的血象变化。结果与同一年龄段正常儿童比较,A、B、C3组的WBC和L%均显著高于正常儿,A、C组的RBC显著低于正常儿,A、1岁以内单纯腭裂未经修复（B1组）、C组的HGB显著低于正常儿,A、B1、1岁以内唇腭裂已进行唇裂修复但未经腭裂修复的患儿（B2组）、C组的PLT高于正常儿。36例跟踪调查的唇腭裂患者在唇裂修复后WBC、PLT有显著性降低,RBC、HGB有显著性提高,淋巴细胞百分率无显著性变化。结论唇腭裂患儿更易发生病毒感染或急慢性炎症,表现为某些血象指标的异常,对麻醉和手术可能有一定影响,应该慎重选择手术适应证。唇裂合并腭裂患儿在唇裂修复后,血象指标可能趋于正常。     

Teratogenic interactions between methylmercury and mitomycin-C in mice

Pregnant mice were given p.o. various nonteratogenic doses (0, 2.5, 5 and 10 mg/kg) of methylmercuric chloride on day 9 of pregnancy, and then injected i. p. with a teratogenic dose (4 mg/kg) of mitomycin-C on day 10. Major malformations produced by mitomycin-C alone were cervical rib and vertebral anomaly, polydactyly of the hindlimb and tail anomaly. Combined treatment significantly increased the incidence of these malformations, showing the dose-effect relationship of methylmercury, whereas methylmercury alone is known not to produce such malformations. When mitomycin-C treatment alone was performed on day 9.5 of pregnancy, only vertebral anomalies increased in incidence. Therefore, mitomycin-C teratogenicity in terms of the manifestation of cervical rib, polydactyly and tail anomaly, but not vertebral anomaly, was suggested to be enhanced by methylmercury. A considerable number of foetuses showed cleft palate involvement following combined treatments, but not by either chemical alone. Cleft palate is known to be a major malformation in mice that is caused by methylmercury, and mitomycin-C also induces cleft palate. Therefore, the two chemicals might have affected foetuses additively and thereby induced cleft palate.     

273例腭裂手术治疗回顾性分析

目的通过分析273例腭裂修复手术的一般情况、疗效、并发症等,探讨手术治疗先天性腭裂的经验与教训。方法收集整理绵阳市中心医院耳鼻咽喉科2002年8月年至2010年1月微笑列车项目中273例腭裂手术患者的术前基本情况,手术方案与术后随访资料及围手术期管理方法等,回顾性分析不同方案的优缺点,腭裂修补术后近期及远期并发症的状况及救治经验等。结果 273例手术均顺利完成,并发症14例,其中围手术期较严重并发症7例,主要为出血,感染为出血主要原因,经压迫,重上牙垫,激光止血及后鼻孔填塞后止血,随访发现腭瓣坏死穿孔5例,半年后Ⅱ期修复,腭缝合口黏液囊肿2例。结论在保证安全的前提下,早期手术可获更好效果,早期抽取碘仿纱条并未见特殊异常,低压麻醉是控制术中出血的关键措施。     

Developmental effects associated with exposure to xylene: a review

Data obtained from rodents indicates that maternal exposure to mixed xylenes or individual xylene isomers can have adverse effects on the conceptus. Fetotoxic effects were reported following maternal inhalation exposure to mixed xylenes; altered enzyme activities were also found in rat pups. Dermal application resulted in apparent changes in fetal enzyme activities, while oral treatment was followed by prenatal mortality, growth inhibition, and malformations, primarily cleft palate. Maternal inhalation of individual isomers was associated with all of the above mentioned effects, with the exception of cleft palate. The o- and p-isomers appeared more hazardous to offspring than did the m-isomer. Malformations (i.e., cleft palate) associated with mixed or individual isomers were primarily reported at maternally toxic doses. Thus, a clear case for a selective teratogenic effect due to exposure to xylene has yet to be presented.     

Lack of evidence of teratogenicity of benzodiazepine drugs in Hungary

In order to investigate possible teratogenic effects of commonly used benzodiazepines (diazepam, chlordiazepoxide, nitrazepam) in Hungary, four approaches were used: 1. A retrospective case-control study of 630 cases with isolated cleft lip +/- cleft palate, 179 cases with isolated cleft palate, 392 cases of multiple congenital anomalies including cleft lip and/or cleft palate, and their matched control cases; 2. The Case-Control Surveillance System of Congenital Anomalies in Hungary, 1980 to 1984, involving 355 cases with isolated cleft palate, 417 cases with multiple congenital anomalies, and 186 cases with Down's syndrome (as positive controls). Benzodiazepines were taken by 14.9% of 11,073 control pregnant women studied; 3. A prospective study of 33 pregnant women attending the Counselling Clinic following ingestion of benzodiazepines during the first trimester of pregnancy; 4. An observational study involving 12 pregnant women who attempted suicide and one with accidental overdosage with benzodiazepines during pregnancy. None of these four approaches gave any indication of an association between facial clefting and in utero exposure to these substances.     

Lack of evidence of teratogenicity of benzodiazepine drugs in Hungary

In order to investigate possible teratogenic effects of commonly used benzodiazepines (diazepam,chlordiazepoxide, nitrazepam) in Hungary, four approaches were used: 1. A retrospective case-control study of 630 cases with isolated cleft lip ± cleft palate, 179 cases with isolated cleft palate, 392 cases of multiple congenital anomalies including cleft lip and/or cleft palate, and their matched control cases; 2. The Case-Control Surveillance System of Congenital Anomalies in Hungary, 1980 to 1984, involving 355 cases with isolated cleft palate, 417 cases with multiple congenital anomalies, and 186 cases with Down's syndrome (as positive controls). Benzodiazepianes were taken by 14.9% of 11,073 control pregnant women studied; 3. A prosepctive study of 33 pregnant women attending the Counselling Clinic following ingestion of benzodiazepines during the first trimester of pregnancy; 4. An observational study involving 12 pregnant women who attempted suicide and one with accidental overdosage with benzodiazepines during pregnancy. None of these four approaches gave any indication of a association between facial clefting and in utero exposure to these substances.