可吸收胶原蛋白止血海绵在腔镜甲状腺手术中的止血疗效

目的：总结可吸收胶原蛋白止血海绵在腔镜甲状腺手术中止血疗效的临床经验。方法2011年2月~2013年2月,对128例接受腔镜甲状腺手术的患者,随机分成观察组和对照组,观察组于术后用可吸收胶原蛋白止血海绵,对照组于术后不用任何止血材料,分别于术后12、24、48h观察甲状腺残腔引流管的引流量。结果观察组术后12、24、48h的引流量均少于对照组（P＜0.05）。结论可吸收胶原蛋白止血海绵在腔镜甲状腺手术中具有安全、有效的止血效果。     

泰绫联合胶原蛋白海绵在肝切除术中的临床应用

目的 探讨泰绫联合胶原蛋白海绵在肝切除断面的止血、防漏效果。方法 随机将51例择期行肝部分切除术的患者分为治疗组和对照组,治疗组肝断面处理中使用泰绫联合胶原蛋白海绵,对照组不使用任何止血材料,比较两组术后24、48、72 h腹腔引流量、引流管放置时间及创面发生渗血、胆漏的几率。结果 治疗组术后腹腔引流量明显少于对照组,拔管时间缩短,创面渗血、胆漏发生率低于对照组,两组间差异有统计学意义（P＜0.05）。结论 泰绫联合胶原蛋白海绵在肝切除术中具有安全、可靠的止血、防胆漏效果,能显著减少术后腹腔引流量,缩短腹腔引流时间。     

医用生物蛋白胶在皮肤扩张器植入术中的应用

目的：回顾总结生物蛋白胶在皮肤扩张器植入术中应用的临床经验。方法：皮肤扩张器植入术中应用生物蛋白胶18例，共41只扩张器。在拟植入扩张器部位常规剥离腔隙，手术创面均匀涂抹生物蛋白胶，短暂压迫后植入扩张器。观察术后24h和48h引流物的质、量，及有无血肿、感染和扩张器外露。结果：无一例发生并发症；负压引流物在术后的前24h多为淡红色，24h后转为淡黄色液体；引流量在术后的前24h为8-15mL，后24h为5-8mL；1例（耳部扩张器植入）术后24h出现过敏症状。结论：在扩张器植入术中应用生物蛋白胶具有以下优点：（1）止血效果肯定，明显缩短手术时间；（2）术后引流量明显减少；（3）促进组织愈合，减少并发症的发生率。     

皮肤软组织扩张术的应用探讨

目的：为了提高皮肤扩张手术的修复质量和临床效果,根据病损的程度、形态、部位等特点,对皮肤扩张器埋植和扩张后皮瓣的设计进行探讨研究。方法：通过对87例皮肤扩张术病例分析：（1）瘢痕畸形的程度、形态、部位与扩张器类型选择的关系;（2）Ⅰ期手术与预扩张皮瓣的关系;（3）Ⅱ期手术皮瓣设计原则;（4）纤维囊壁与皮瓣设计的关系。结果：（1）皮肤缺损的形状适合选择同种形态的扩张器,功能部位适合长柱形成或肾形扩张器;（2）扩张器应埋植在皮肤缺损邻近有足够正常皮肤或有知名血管的部位;（3）皮下的充分剥离和可靠的止血是减少并发症和提高手术质量的有效措施;（4）皮瓣蒂应选择在距缺损近,易转移,无“猫耳”的部位;（5）纤维囊壁应尽量剥除,可明显减少皮瓣回缩,增加皮瓣修复面积。结论：皮瓣设计贯穿皮肤扩张术全过程,理想的皮瓣设计可以提高修复效果,是治疗的最终目的。     

自制丁字绷带预防混合痔术后出血325例效果观察

为观察自制弹力丁字绷带对混合痔术后患者止血的效果,我们将620例混合痔患者按照住院号单双号分为治疗组（325例）和对照组（295例）,术后分别用弹力丁字绷带固定和常规普通纱布覆盖创面。观察术后伤口敷料渗血情况,记录渗血量、渗血时间等。结果显示,治疗组无1例出现术后大出血,对照组有2例大出血。术后6h对照组渗血量评分（2．21±1．85）明显高于治疗组（1．10±0．34）,术后24h对照组渗血量评分（3．31±0．61）亦明显高于治疗组（2．34±0．53）,差异均有统计学意义,P〈0．05。结果表明,混合痔术后患者应用弹力丁字绷带固定能有效地压迫止血,减少术后创面渗血。     

聚桂醇对皮肤扩张术中止血效果的应用研究

目的:探讨聚桂醇在皮肤软组织扩张器埋植术中的止血效果,为防止术后血肿的发生提供安全有效的方法.方法:以40个患者为实验对象,随机分成两组,每组20人,在实验组分离的腔隙内涂以聚桂醇注射液,对照组涂以生理盐水作为对照,观察止血和扩张效果.结果:实验组的出血量和血肿发生率都小于对照组,并且没有出现皮瓣血运障碍,扩张速率与对照组基本一样.结论:聚桂醇用于扩张器埋植术中能发挥较好的止血效果,并且不会影响后期扩张.     

几丁糖对扩张后皮瓣纤维包膜中胶原含量影响的研究

目的：在临床实践中应用几丁糖干预扩张后皮瓣纤维包膜的形成过程,观察应用前后纤维包膜中胶原含量及扩张后皮瓣回缩率的变化规律,从而分析几丁糖对纤维包膜中胶原含量的影响。方法：2006年以来,对每位患者同时应用二个扩张器修复病变部位,共对24例患者行皮肤软组织扩张术,每个患者均在病变周围两侧（选取行皮肤软组织扩张术时,同一区域适于同时应用二个100lm扩张器修复病变的患者24例）,两侧各埋置100ml皮肤软组织扩张器一枚;均将其中一侧设为治疗组,另一侧设为对照组（并做标记）,取材进行Masson染色后,随机选取光镜100倍Masson染色切片治疗组与对照组各15个视野,应用捷达病理图像彩色分析系统测量平均灰度。对两组间平均灰度进行比较。了解两组之间有无统计学意义。结果：治疗组和对照组24例,全部取材成功。治疗组纤维包膜组织平均灰度值显著高于对照组：169.935±16.015,156.945±13.546,P〈0.05。结论：应用几丁糖干预扩张器置入后纤维薄膜形成的过程中,几丁糖可以使扩张后皮瓣纤维包膜中的胶原纤维含量降低,从而降低扩张后皮瓣的收缩率。     

应用多个扩张器扩张皮肤软组织修复颈部挛缩瘢痕的护理

目的 探讨应用多个扩张器皮肤软组织扩张术修复颈部挛缩瘢痕的护理体会。方法 1998年1月～2003年6月应用多个扩张器置入颈部正常皮肤下，扩张皮瓣修复颈部瘢痕切除后创面15例，手术前后制定护理细则，保证病情观察的规范化。结果 13例患者扩张皮瓣转移后无继发畸形，1例皮瓣部分血运障碍，1例扩张器外露、切口感染，经换药后均痊愈。结论 皮肤软组织扩张术是修复较大颈部瘢痕切除后创面的首选方法，规范化的护理，能有效预防术后并发症，提高手术效果。     

医用生物蛋白胶在面颈部扩张器埋置术中的应用

目的：探讨在面颈部扩张器埋置术中,应用生物蛋白胶辅助创面止血以降低血肿发生率的可行性。方法：选取我科2006～2007年的40名面颈部软组织扩张术患者,随机分为对照组和用药组,用药组术中应用生物蛋白胶对创面辅助止血。观察分析两组术后引流液量等指标。结果：用药组术后扩张皮瓣下引流液量和血肿的发生率均明显低于对照组且对扩张器后期扩张无影响,无任何副作用发生。结论：应用生物蛋白胶对创面辅助止血可明显减少面颈部扩张器置入后血肿的发生。     

微创技术在皮肤扩张器埋置术中的应用评价

目的：利用微创切口埋置扩张器进行皮肤扩张，控制皮肤切口裂开和扩张器外露并发症。方法：选用导管外置式扩张器和传统扩张器，在局部肿胀麻醉下经微创切口置入皮下间隙，注水导管全部外置，对213例皮肤扩张病例进行观察。结果：经病变内垂直小切口埋置扩张器均获成功，局部肿胀麻醉和术中注水扩张可控制出血，无一例患者接受输血。术后进行快速扩张顺利，总并发症发生率为7.4％。结论：经微创切口埋置扩张器损伤小，并发症少，适合快速皮肤扩张术。     

人重组骨形态发生蛋白-2修复全层关节软骨缺损的实验研究

目的 :研究人重组骨形态发生蛋白 2 (rhBMP 2 )对全层关节软骨缺损的修复 ,观察修复效果。方法 :家犬 8只 (16膝 ) ,每个膝内外髁均做全层软骨缺损 ,内外髁共 3 2个缺损。随机分为 4组 ,每组 2只。每只犬一侧关节行胶原海绵吸附rh BMP填充内外髁缺损 ,另一侧以单纯胶原海绵填充作对照 ,不处理组为空白对照。术后 2、4、 8、 12周取材作大体、光镜、透射电镜观察。结果 :rh BMP组为类软骨细胞修复 ,而单纯胶原海绵组和空白组均为纤维性修复。结论 :rhBMP 2有效地促进关节软骨缺损的修复 ,可以作为临床上治疗关节软骨缺损的方法     

胶原海绵为载体构建大鼠羊膜上皮细胞复合体的实验研究

目的：大鼠羊膜上皮细胞（AECs）体外培养并种植于胶原海绵形成细胞支架复合体后,探讨细胞在支架上分别于体内及体外时的生长情况。方法：取第三代AECs细胞种植于胶原海绵支架。光镜下及用荧光标记法观察细胞种植前后的增殖情况;ELISA法检测细胞支架上清液中VEGF、bFGF、TGFβ的含量。并通过荧光标记示踪法观察细胞支架植于体内后细胞的存活情况。结果：AECs在胶原海绵支架上生长情况良好,细胞支架上清液中VEGF、bFGF、TGFβ的含量随时间增长呈不断上升趋势,将细胞支架移植于体内后经过观察发现细胞仍存活良好。结论：AECs在胶原海绵支架上及体内移植后生长情况良好,这为利用AECs胶原海绵支架复合体进行细胞治疗奠定了实验基础。     

Collagen sponge repair of small cerebrospinal fluid leaks obviates tissue grafts and cerebrospinal fluid diversion after pituitary surgery

OBJECTIVE: Repair of a cerebrospinal fluid (CSF) leak created at the time of transsphenoidal surgery typically involves placement of a fat, fascial, or muscle graft and sellar floor reconstruction. In this report, a simplified repair for small, "weeping" CSF leaks using collagen sponge is described. METHODS: All patients underwent an endonasal transsphenoidal procedure using the operating microscope. At the completion of tumor removal, if a small CSF leak was noted but no obvious large arachnoidal defect was present, a piece of collagen sponge was fashioned to cover the exposed diaphragma sellae. Titanium mesh was then wedged into the intrasellar, extradural space and a larger piece of collagen was placed over the reconstructed sellar floor. Nasal packing was removed within 24 hours. RESULTS: During an 18-month period, 62 consecutive transsphenoidal procedures were performed for tumor removal. Of 20 patients with a small CSF leak (18 pituitary adenomas, 1 Rathke's cleft cyst, and 1 chordoma), all had successful repair with collagen sponge. At follow-up examinations at 1 to 18 months, no patient had required a lumbar drain or had developed meningitis. One other patient had a large intraoperative arachnoidal defect that was unsuccessfully repaired with the collagen sponge technique; in this patient, a second operation was required with a fat graft, sellar floor reconstruction, and lumbar drainage. CONCLUSION: A simplified repair of small CSF leaks after transsphenoidal surgery using a two-layered collagen sponge technique with sellar floor reinforcement is thought to be safe and effective and obviates the need for tissue grafts, fibrin glue, or lumbar drain placement.     

庆大霉素胶原海绵减少术后手术部位感染的临床应用

目的探讨庆大霉素胶原海绵在脊柱手术术后减少手术部位感染的临床应用。方法回顾性分析2012年3月—2015年3月在安康市中医院骨科行脊柱手术的232例患者的临床资料,其中110例(A组)使用了庆大霉素胶原海绵,122例(B组)未使用。采用Pearsonχ~2检验或Fisher精确概率检验分析庆大霉素胶原海绵使用、年龄、性别、糖尿病史、吸烟史、手术区域、手术等级、手术时间、内固定使用是否为患者手术部位感染相关因素。结果 10例(4.3%)患者手术部位感染,其中3例感染表皮葡萄球菌(S.epidermidis),3例感染耐甲氧西林金黄色葡萄球菌(MRSA),2例感染屎肠球菌(E.faecium),2例未检出病原菌。1例感染者术后使用庆大霉素胶原海绵,9例未使用。手术感染与庆大霉素胶原海绵使用有相关性,而与年龄、性别、糖尿病史、吸烟史、手术区域、手术等级、手术时间、内固定使用无相关性。庆大霉素胶原海绵使用组手术部位感染率(0.9%,1/110)低于非庆大霉素胶原海绵使用组(7.4%,9/122),两组患者的年龄、性别、糖尿病、吸烟史、手术区域、手术等级、手术时间、内固定使用差异无统计学意义(P0.05)。使用庆大霉素胶原海绵患者无不良反应发生。结论庆大霉素胶原海绵的使用能降低术后手术部位感染风险,有助于患者康复。     

胶原海绵止血功能的实验研究

目的 验证国产胶原海绵的止血性能。方法 选用健康成年SD大鼠20只,随机分为二组,行肝脏和切口,分别用胶原及明胶少绵止血,观察止血情况;切除肝左前叶造成标准肝创伤模型,分别用二种海绵止血,观察止血情况,并记录即时止血时间及出血量。术后7、14及20天剖腹观察腹腔内粘连、腹腔内感染及肝脏愈合情况,并切除部分再生肝组织进行组织学检查。结果 胶原海绵下肝创面粘附良好,即时止因时间及出血量均明显优于对照组（P＜0.05）。组织切片显示胶原海绵吸收、降解快,可诱导肝细胞再生。结论 胶原海绵止血性能良好,能有效导肝再生,吸收降解快,使用方便,有应用、推广价值。     

Healing of a deep skin wound using a collagen sponge as dressing in the animal experiment]

The high number of available wound dressing materials as well as the scientific reports about the topic indicates that the problem of an ideal wound dressing is not jet solved. In the last thirty years lot of scientific reports about collagen as wound covering has been published. The positive effect of collagen by his application on a wound ist well known. We investigated the effect of a collagen sponge on healing of full thickness skin wound in guinea pig. The animals were divided in two control groups and two experimental groups. In the control group there were air exposed wounds and another wounds covered with paraffin gauze. In the experimental groups were such wounds covered with natural reconstituted collagen sponge as well as wounds covered with chemically prepared collagen sponge with hexamethyldiisocyanat. The results were compared. The air exposed wounds healed in 50 days, the wounds covered with paraffin gauze healed in 48 days. By covering the wounds with collagen sponge the healing was shortened in 24 or 27 days respectively. Not only the healing time was shortened but also the quality of the wound repair by dressing the wounds with collagen sponge was enhanced.     

Rapid release of gentamicin from collagen sponge: In vitro comparison with plastic beads

The gentamicin-containing collagen sponge is a new product intended for local application in bone and soft-tissue infections. The release of gentamicin from the collagen sponges was compared in vitro to that from polymethyl-methacrylate (PMMA) beads. A static and kinetic experimental design was used. In the static model, pieces of collagen sponge or PMMA beads were added to 20 mL of distilled water, and during the following hours the gentamicin concentrations in the water were repeatedly measured. This simple model was extended to the kinetic model as the released gentamicin was removed from the water exponentially by means of an infusion-withdrawal pump. The gentamicin was released from the carrier substances with increasing half lives. During the first 4 hours, the half life increased from 0.2 to 1.5 hours for the collagen sponge and from 3 to 78 hours for the PMMA beads. After 1.5 hours, 95 percent of the gentamicin was released from the sponges, whereas only 8 percent was released from the beads.     

Rapid release of gentamicin from collagen sponge. In vitro comparison with plastic beads

The gentamicin-containing collagen sponge is a new product intended for local application in bone and soft-tissue infections. The release of gentamicin from the collagen sponges was compared in vitro to that from polymethyl-methacrylate (PMMA) beads. A static and kinetic experimental design was used. In the static model, pieces of collagen sponge or PMMA beads were added to 20 mL of distilled water, and during the following hours the gentamicin concentrations in the water were repeatedly measured. This simple model was extended to the kinetic model as the released gentamicin was removed from the water exponentially by means of an infusion-withdrawal pump. The gentamicin was released from the carrier substances with increasing half lives. During the first 4 hours, the half life increased from 0.2 to 1.5 hours for the collagen sponge and from 3 to 78 hours for the PMMA beads. After 1.5 hours, 95 percent of the gentamicin was released from the sponges, whereas only 8 percent was released from the beads.     

表皮生长因子导入治疗在皮肤扩张器中的应用研究

目的:探讨使用导入仪导入重组人表皮生长因子(rhEGF)促进皮肤扩张的临床效果。方法:自2013年1月~2013年5月入选38例患者,共将76个扩张器进行埋置,按照随机原则,分为常规注水对照组(36个扩张器)与导入仪导入治疗组(36个扩张器)。治疗组的扩张器在每次注水扩张的第二天进行导入仪治疗,在被扩张的皮肤表面涂抹rhEGF并使用导入按摩仪进行按摩导入。对照组的扩张器仅进行常规的注水。测量两组扩张器扩张致额定容量所花费的时间、皮肤扩张比率及扩张皮肤即刻回缩比率,采用自身对照的方法进行比较分析。进行胶原含量,I/III型胶原比率(%)的测定和病理HE染色分析。结果:注水后第二天进行rhEGF导入治疗能使扩张器扩张致额定容量所花费的时间明显缩短,皮肤扩张比率则明显增加,扩张皮肤即刻回缩比率减少,有效减小皮辨的即时回缩率。治疗组胶原纤维束粗而密,I/III型胶原比例降低。结论:注水后第二天通过使用导入仪将rhEGF导入扩张皮肤治疗能缩短扩张时程,促进皮肤的面积增加,降低皮瓣回缩的比率,提高皮瓣质量,改善治疗效果。     

纤维蛋白原-胶原海绵片在肝手术创面的止血及组织封闭作用的动物实验研究

目的探讨纤维蛋白原鄄胶原海绵片在手术创面的止血性能、封闭创面的效果及在体内降解吸收的状况。方法将SD大鼠20只随机分成实验组和对照组。实验组用纤维蛋白原鄄胶原海绵片进行止血,对照组用明胶海绵片止血。结果在大鼠肝表面的切口,两种止血材料均能即刻止血。纤维蛋白原鄄胶原海绵片与切口粘附紧;而明胶海绵片较易脱落。在大鼠左肝前叶切除术中,纤维蛋白原鄄胶原海绵片组在止血时间及出血量的指标上均优于明胶海绵片组(P<0.05)。组织学检查:创面炎症消退、止血材料降解和促肝细胞再生,实验组均优于对照组。结论纤维蛋白原鄄胶原海绵片能有效地止血,与创面的粘附力强,吸收降解快,且能诱导肝创面肝细胞再生。因而,纤维蛋白原鄄胶原海绵片是一种安全的局部止血、组织封闭和促进细胞再生的生物材料。