额颞部良性肿物切除手术切口的选择

颌面部软硬组织良性肿物为常见病。以往，额颞部良性肿物手术治疗多采用肿物表面顺皮纹方向的切口，随着人们对美学要求的提高，此类切口术后遗留面部瘢痕的缺点，日益不为患者接受。近年来，我们采用发际内和眉弓上缘切口手术治疗，此类切口位置隐蔽，术后瘢痕不易被发现，取得了满意的治疗效果。     

平行切断法处理额肌的内镜额部除皱术

目的探讨一种新的内镜额部除皱方法并总结其临床效果。方法2010年1月至2017年1月,北京大学第三医院成形外科119例患者行内镜额部除皱术。该术式在额肌上做平行切断以改善额部皱纹。部分降眉肌、皱眉肌用微创钳钝性咬除。术中不使用固定装置,也不行缝扎固定。术后对患者发放相关FACE-Q量表评估满意度,并测量手术前后眉部位置。结果术后1周,119例患者肿胀基本消除,眉间纹、额横纹明显减轻或消失。眉部测量显示,患者眉毛有明显抬高。FACE-Q量表结果显示,患者对术后额部皱纹、眉间皱纹改善满意度高,对手术结果满意度高;患者自觉年轻7岁。该术式常见的早期并发症是额部暂时性皮肤麻木,其次是发际线后退。结论内镜额部除皱术式可有效改善额部、眉间皱纹,满足患者需求。     

内镜在额颞部除皱术及术后再次修复中的应用

目的探讨内镜在额颞部除皱术及术后再次修复中的应用及临床效果。方法对67例受术者内镜下行额颞部除皱术,其中22例为额颢部除皱术后再次内镜下修复者。随访时间1个月至2年,受术者和医师对术后满意率作为评价标准,同时记录各种术后并发症。结果67例受术者术后完全康复,无严重并发症发生。受术者的满意率为85％（57／67）,医师的满意率为89％（60／67）。80％左右受术者术后早期出现轻微并发症,如挂线处小坑、轻度不对称、过度矫正、短期皮肤麻木、术后肿胀、较明显瘢痕和脱发等。4例受术者术后在额部皮下出现皮下淤青和较小血肿,早期穿刺抽吸后加压包扎,后期经过局部热敷,术后2周左右血肿逐渐吸收,恢复正常。2例受术者术后3个月左右颞部切口出现反复红肿,头皮表皮出现破溃后自愈,半年后经原切口取出钛钉和周围悬挂缝线,切除切口边缘瘢痕组织后缝合,切VII期愈合。2例由于术中电凝误伤,出现额部小范围皮肤坏死,局部换药,愈合后出现小坑样凹陷性瘢痕,半年后逐渐变平,小坑不明显。所有上述并发症经过处理后均愈合良好。结论内镜在额颞部除皱及术后再次修复中很有价值,尤其对于50岁以内的受术者应用内镜额颞部除皱及术后再次修复效果良好。     

内镜下电切额部除皱术

内镜技术已广泛应用于普外、泌尿、胸外、骨科、妇科等临床科室，而在整形外科方面的应用却较晚。直至1992年美国Vasconez才第一次放映了面部内镜除皱术的录像。此后，国内陆续开展了此项技术。艾玉峰等在1996年首先报道了应用内镜除皱。随后，宋业光等也相继采用内镜进行面部除皱。但目前所使用的器械及方法并无重大改进。国内开展此项手术的单位较少，有创新者鲜有报道,效果难以肯定。     

内窥镜下手术治疗额颞部良性肿瘤

目的 :介绍运用内窥镜手术治疗额、颞部良性肿瘤的手术方法。方法 :额、颞部良性肿瘤共 13例 ,均采用发际内切口 ,手术经骨膜下或帽状腱膜下进路 ,在 3 0 °角或 4 5 °角内窥镜图像的指引下摘除肿瘤。结果 :13例均无神经血管损伤及血肿、感染等并发症 ,患者均自觉满意。结论 :在内窥镜图像的指引下摘除肿瘤 ,疗效与常规开放式手术完全相同 ;其过程符合微创和美学整形的原则 ,是患者乐于接受的治疗方法     

内镜额颞部上提与面中下部多层次剥离除皱术

自１９９５年８月以来,我们对１８例面部老化明显者,采用内窥镜技术额颞部上提与面中部行广泛多层次剥离悬吊术,取得良好效果。１手术方法１．１麻醉及切口设计 均在全麻下,于额部发际后２～２．５ ｃｍ,在正中及左右颞线上各设计长２ｃｍ纵向小切口,耳前切口紧邻耳轮上脚、耳屏及耳垂。１．２额颞部（面上部）剥离 额颞部切口深至帽状腱膜下层,盲视下钝性剥离顶枕部,直到枕骨粗隆;前方剥离额部至眶缘上３ ｃｍ,向左右侧掀起颞部头皮,到达颧弓上２ ｃｍ处。将内窥镜从其中１个切口放至眶缘上,用内窥镜剥离子在内窥镜监视下充分…     

内镜下额颞部除皱术的改进

目的探讨将内镜技术应用于除皱术中以来,通过技术的改良,以获得创伤小,避免神经、血管损伤,彻底止血,固定确实的效果。方法颞部采用两个间断的小切口,避开颞浅血管的分支,在内镜辅助下于颞浅筋膜下进行剥离及止血、悬吊固定。额部在发际后做3个横行切口,在内镜辅助下操作,将额部剥离后的皮瓣向上悬吊固定于切口下方颅骨外板上。结果采用内镜额颞部除皱58例,术后肿胀程度轻,无明显瘀青,术后1周均能恢复社交活动。术后1年随访有56例（96．55％）明显改善;2年随访35例中有33例（94．29％）明显改善。未出现面神经损伤病例。结论通过内镜辅助下除皱术可充分认识到术中明视下操作,能减少术中血管、神经的误伤,便于分离、止血、缝合及悬提固定,通过技术改良能达到创伤更小,康复更快,效果更满意的目的,因此扩大了手术适应人群。     

内镜下额颞部除皱术的改进

目的 探讨将内镜技术应用于除皱术中以来,通过技术的改良,以获得创伤小,避免神经、血管损伤,彻底止血,固定确实的效果.方法 颞部采用两个间断的小切口,避开颞浅血管的分支,在内镜辅助下于颞浅筋膜下进行剥离及止血、悬吊固定.额部在发际后做3个横行切口,在内镜辅助下操作,将额部剥离后的皮瓣向上悬吊固定于切口下方颅骨外板上.结果 采用内镜额颞部除皱58例,术后肿胀程度轻,无明显瘀青,术后1周均能恢复社交活动.术后1年随访有56例(96.55%)明显改善;2年随访35例中有33例(94.29%)明显改善.未出现面神经损伤病例.结论 通过内镜辅助下除皱术可充分认识到术中明视下操作,能减少术中血管、神经的误伤,便于分离、止血、缝合及悬提固定,通过技术改良能达到创伤更小,康复更快,效果更满意的目的,因此扩大了手术适应人群.     

额部扩张皮瓣的手术设计

目的探讨额部扩张皮瓣的手术设计.方法对121例额、颞部瘢痕、斑痣、血管瘤等皮肤病变切除后的患者采用额部扩张皮瓣进行修复,并比较滑行皮瓣、易位皮瓣及旋转皮瓣的手术效果.结果 115例患者取得良好的手术效果,修复后皮肤弹性良好、颜色较理想、瘢痕较细小;4例患者扩张皮瓣的远端有0.5～1.0cm的坏死,行Ⅱ期瘢痕切除缝合术;2例患者有单侧眉上提,半年后好转.结论易位皮瓣术后瘢痕明显,尽量少用或不用;旋转皮瓣可以充分利用扩张后"过剩"的皮肤,是一种值得推广的额部皮瓣设计方法.对皮瓣的周密设计并了解不同皮瓣的优缺点,对手术效果及术后并发症的预防非常重要.     

额部扩张皮瓣的手术设计

目的 探讨额部扩张皮瓣的手术设计。方法 对121例额、颞部瘢痕、斑痣、血管瘤等皮肤病变切除后的患者采用额部扩张皮瓣进行修复，并比较滑行皮瓣、易位皮瓣及旋转皮瓣的手术效果。结果 115例患者取得良好的手术效果，修复后皮肤弹性良好、颜色较理想、瘢痕较细小；4例患者扩张皮瓣的远端有0．5～1．0cm的坏死，行Ⅱ期瘢痕切除缝合术；2例患者有单侧眉上提，半年后好转。结论 易位皮瓣术后瘢痕明显，尽量少用或不用；旋转皮瓣可以充分利用扩张后“过剩”的皮肤。是一种值得推广的额部皮瓣设计方法。对皮瓣的周密设计并了解不同皮瓣的优缺点。对手术效果及术后并发症的预防非常重要。     

Endoscopic resection of benign breast tumors: retromammary space approach

Endoscopic surgery is characterized by the creation of a working space. At our department, we have obtained good results with a retromammary space approach in which the tumor is resected after creation of a working space in the retromammary space. The special instruments used for this purpose comprise an endoscopic vein harvesting system to dissect the retromammary space, a dissecting balloon to compress the space to achieve hemostasis, and laparosonic coagulating shears to incise the tumor. This surgical technique provides a superior cosmetic result, and the level of patient satisfaction has been high.     

Laparoscopic resection for benign tumors of the stomach.

BACKGROUND: Of all gastric tumors, less than 5% are benign. The traditional treatment of symptomatic and some asymptomatic benign tumors has ranged from mucosal resection to limited gastrectomy. Since the advent of laparoscopy, many different laparoscopic approaches to resection of benign gastric tumors have now been described in the literature. METHODS: We reviewed our experience with laparoscopic approaches to surgical resection of 7 benign gastric tumors. The tumor locations were the body (posterior wall), 3 cases; body (anterior wall), 1 case; lesser curvature, 1 case; fundus, 1 case, and antrum, 1 case. Laparoscopic wedge resection was done in 6 cases. The seventh patient underwent a Billroth I procedure because he had leiomyoma at the antrum. There was no conversion to laparotomy. RESULTS: The mean operative time was 105+/-15 minutes, and mean blood loss was 50+/-15 mL. The mean length of hospital stay was 5 days. There were no complications or mortalities. Tumor size ranged from 2 cm to 6 cm in the greatest diameter. There has been no tumor recurrence with a mean follow-up of 26 months. DISCUSSION: Laparoscopic approach is slowly carving a niche for itself in the treatment of benign tumors of the stomach. The basic principles are obtaining a precise preoperative pathological diagnosis; accurate tumor localization; achievement of tumor-free margins; avoidance of spillage of stomach contents, careful dissection of tumors in the esophagogastric junction, and preventing tumor seeding. CONCLUSION: Based on ours and other studies, laparoscopic resection of benign gastric tumors is safe and feasible.     

Laparoscopic resection of benign tumors of the posterior gastric wall

Laparoscopic wedge excision of benign gastric tumors using stapling instruments alone is not feasible for distal lesions and some tumors arising from the posterior gastric wall. An alternative transgastric approach to distal posterior wall lesions utilizing an anterior gastrotomy for access has been successfully applied in two reported cases.     

两孔法腔镜切除乳腺良性肿瘤(附22例报告)

目的探讨腔镜切除乳腺良性肿瘤的可行性.方法2002年3月～2003年8月经乳房钼靶X线照相筛选为良性的乳腺肿瘤22例,其中乳腺纤维瘤15例、乳腺囊性腺瘤7例,肿块直径2～4 cm,平均2.8 cm.采用两孔法腋窝入路,腔镜下用电刀、超声刀进行切除.结果22例均在腔镜下完成乳腺良性肿瘤切除.手术时间28～68 min,平均42 min.放置引流管1 d,1例出现皮下积液,未发生皮肤坏死等并发症,恢复顺利,术后住院2～4 d,平均3 d,随访3～12个月乳房上不留任何瘢痕.结论乳腺良性肿瘤采用经腋窝腔镜切除安全可行,具有美容、美体的手术效果.     

保留十二指肠的胰头近全切除术治疗胰头部良性肿瘤

目的:探讨保留十二指肠的胰头近全切除术治疗胰头部良性肿瘤的价值。
方法:回顾性分析2004年1月—2009年12月4例施行保留十二指肠的胰头近全切除术患者的临床资料,均保留了胃肠道的完整性、肝外胆道、胆囊和Oddi括约肌的功能,仅在壶腹周围和胆管后方保留有少量胰腺组织。
结果:病理证实1例为导管内乳头状黏液瘤,1例为内分泌肿瘤,2例为实性假乳头状瘤。术后2例发生胰瘘,经过非手术治疗治愈。围手术期无死亡。随访8~20个月,均未发现复发征象。
结论:对于胰头部良性肿瘤,特别是摘除困难的,保留十二指肠的胰头近全切除术是合理的选择。

     

Endoscopic resection of solid intraventricular brain tumors

OBJECT: Endoscopic removal of intraventricular brain tumors is well established for cystic tumors such as colloid cysts. Aspiration followed by removal or ablation of the membranous wall is possible given the constituent features of these tumors. It is generally expected that endoscopic removal of solid brain tumors from the intraventricular compartment would impose additional technical demands. In this paper, the feasibility and safety of endoscopic removal of solid intraventricular brain tumors is evaluated. METHODS: Eighty-one patients who underwent endoscopic management of an intraventricular brain tumor were identified from a prospective database. Of these patients, seven underwent attempted endoscopic surgical removal of a solid primary brain tumor. Patient selection, surgical technique, procedure-related morbidity, and extent of removal were reviewed. Five patients underwent complete resection of a solid intraventricular brain tumor, a treatment option that was based on intraoperative assessment and confirmed by postoperative imaging. No patient experienced any procedure-related morbidity. Of the individuals in whom a total endoscopic resection was successful, there has been no symptomatic or radiological evidence of recurrence (mean follow up 20 months). Maximum tumor diameter ranged from 0.5 to 1.8 cm for patients who underwent complete resection, whereas maximum tumor diameter measured 2.4 and 2.5 cm in the two patients in whom a subtotal excision was performed. CONCLUSIONS: In select patients, complete endoscopic removal of solid intraventricular brain tumors is possible and safe. Factors that influence the ability of a surgeon to perform a complete endoscopic resection include tumor size, composition, and vascularity. The procedure requires careful patient selection, the use of refined endoscopic instrumentation, and a disciplined surgical technique.