经Dolenc入路治疗颅内复杂部位动脉瘤17例临床分析

目的 探讨采用Dolenc入路开颅手术治疗颅内复杂部位动脉瘤的临床效果。方法 回顾性分析2014年11月—2016年1月,首都医科大学附属北京天坛医院神经外科经Dolenc入路开颅手术夹闭治疗的17例颅内复杂部位动脉瘤患者的临床资料,其中男7例、女10例,年龄41～72岁,包括颈内动脉床突段动脉瘤4例、眼动脉段动脉瘤8例、基底动脉顶端动脉瘤1例、大脑后动脉动脉瘤2例、前循环合并后循环多发动脉瘤2例(均一次手术夹闭)。结果 17例患者完全夹闭动脉瘤;除2例患者术后出现同侧动眼神经麻痹,其中1例患者出现同侧额叶梗死灶外,其他患者术后均未出现并发症。所有患者术后6个月门诊复诊,均未见动脉瘤复发,未见手术后遗症,格拉斯哥预后评分平均为4.8分。结论 对于颅内一些特殊部位动脉瘤的开颅手术夹闭治疗,相对于传统的入路方式,Dolenc入路具有明显的优势,手术的安全性高。     

直接前侧入路微创全髋关节置换术中股外侧皮神经损伤的研究进展

目的 探讨直接前侧入路微创全髋关节置换术中的股外侧皮神经损伤发生的原因及预防方法。方法 分别以“直接前侧入路”、“股外侧皮神经”为关键词在PubMed及CNKI的中国期刊全文数据库检索2005年1月—2016年5月关于直接前侧入路微创全髋关节置换术中股外侧皮神经损伤的原因及损伤方法和相关文献,对最终筛选出的28篇相关文献进行分析总结。分析直接前侧入路、Heuter间隙、股外侧皮神经的的解剖学特点,以及术中预防股外侧皮神经损伤的方法。结果 股外侧皮神经损伤是直接前侧入路微创全髋关节置换术常见术中并发症之一,发生率为0.9%~3.4%。通过Heuter间隙所行的全髋关节置换术最符合微创手术的标准,作直接前侧入路皮肤切口分离皮下软组织时常常损伤股外侧皮神经,可以通过改良手术切口位置、精细化手术操作、纵向牵引拉钩及肌间隔穿支动脉这一定位股外侧皮神经的解剖学标志,来降低股外侧皮神经的损伤概率。结论 直接前侧入路微创全髋关节置换术与传统全髋关节置换术相比,理论上有较小的软组织损伤,虽然仍会在术中造成股外侧皮神经的损伤,但是存在降低损伤率的方式。     

上颌对称性多生前磨牙1例

患者,男,29岁,2006年12月24日因上颌腭部多生牙影响舌在口腔内活动度,要求治疗。检查:右侧上颌第一前磨牙与第二前磨牙间腭侧有一多生牙,左侧第一磨牙与第二磨牙间颊侧有一多生牙,双侧多生牙牙冠形态与第一前磨牙完全相同,并影响功能,在麻醉下拔除双侧上颌多生牙。     

改良左胸入路在Siewert Ⅰ、Ⅱ型胃食管连接部腺癌手术中的应用

目的 探讨改良左胸入路在Siewert Ⅰ、Ⅱ型胃食管连接部腺癌(EGJA)手术中的应用价值。方法 采用回顾性病例对照研究方法。收集2010年1月—2012年12月蚌埠医学院第一附属医院肿瘤外科手术治疗的83例Siewert Ⅰ、Ⅱ型EGJA 患者临床资料,其中男63例、女20例,年龄37~79岁。按手术入路的不同分组:65例为改良组,选择左胸第8、9肋间进胸,切口前方位于胸肋关节处,后方至正对肩胛骨下角处;18例为经腹组,取上腹正中切口,经腹入路手术。比较两组的手术时间、清扫淋巴结数量、纵隔淋巴结清扫比例和术后并发症等指标。结果 改良组和经腹组手术时间分别为(186.40±19.45)min和(172.67±21.73)min,清扫淋巴结分别为(16.55±2.42)枚和(12.06±2.88)枚,差异均有统计学意义(t=2.585、7.553,P值均＜0.05)。改良组和经腹组患者的纵隔淋巴结清扫率分别为100.00%(65/65)和1/18,差异有统计学意义(χ²=71.511,P＜0.01)。两组输血率、住院时间和并发症发生率比较,差异均无统计学意义(P值均＞0.05)。结论 改良左胸入路适用于Siewert Ⅰ、Ⅱ型EGJA的手术治疗,具有术野清晰、手术过程相对简便的优点,能满足胃周及下纵隔淋巴结清扫的需要。     

27颊侧罕见多生牙尖的CBCT诊断与鉴别诊断

目的　利用锥形束CT（Cone Beam Computer Tomography,CBCT）确诊27颊侧多生牙尖1例,并对其鉴别诊断、发生机制及CBCT的临床应用特点进行分析。 方法　本文根据口腔临床一般检查、口腔局部X线片并结合CBCT对患牙进行确诊;对多生牙尖、融合牙、双生牙、结合牙各自的特点及鉴别要点分析讨论。 结果　根据口腔临床一般检查、口腔局部X线片, 特别是应用CBCT确诊了1例左上第2磨牙颊侧多生牙尖。 结论　口腔辅助检查是临床上确诊口腔颌面部疾病的必要手段。CBCT具有扫描时间短、辐射剂量小、扫描灵活、分辨率高等优点,提高了各类口腔疾病的诊疗水平。     

翼腭窝及其毗邻区域肿瘤的手术入路及临床研究

目的　探讨如何选择最佳手术入路切除翼腭窝及其毗邻区域肿瘤,以提高疗效,减少并发症和后遗症。 方法　回顾性分析108例翼腭窝及其毗邻区域肿瘤患者的临床表现、组织学诊断、影像学检查及各种手术入路。 结果　85例良性肿瘤患者随访0.5～5年,无一例复发;23例恶性肿瘤患者术后均行放化疗,随访0.5～5年,生存期不足1年6例,0.5～4年8例,5年及以上11例。 结论　⑴鼻侧切开术行上颌骨部分切除术适合于原发于筛上颌窦侵及翼腭窝及其毗邻区域病变;⑵扩大上颌骨切除术适合于原发上颌窦恶性肿瘤累及翼腭窝及其毗邻区域;⑶面正中揭翻术或鼻内镜辅助下面正中揭翻术适合于鼻腔、鼻窦、鼻咽、翼腭窝的良性肿瘤及生长缓慢的恶性肿瘤侵犯翼腭窝及其毗邻区域;⑷颞-颧-颌联合入路适合于翼腭窝及其毗邻区域肿瘤累及颞下窝及蝶鞍旁;⑸颈颌入路适合于咽旁间隙良、恶性肿瘤侵犯翼腭窝及其毗邻区域;⑹正中下颌骨裂开入路适合于翼腭窝及其毗邻区域肿瘤累及颞下窝、椎前间隙及颅底;⑺经口腔腭部入路适合于鼻咽、翼腭窝的良性肿瘤及生长缓慢的恶性肿瘤侵犯翼腭窝及其毗邻区域。⑻鼻内镜下入路适合于鼻咽、翼腭窝的良性肿瘤及生长缓慢的恶性肿瘤侵犯翼腭窝及其毗邻区域。     

上前牙区种植相关解剖因素CBCT研究

目的 通过对400例成人上前牙区CBCT图像进行测量统计，了解上前牙区种植相关解剖因素，为美学区种植提供参考。方法 筛选纳入400例患者CBCT图像，测量唇、腭侧不同位点的骨量并探索上前牙根和牙槽骨的位置关系。结果 唇侧骨壁厚度在根尖处较厚，在唇侧牙槽嵴顶下2 mm处较薄，在根中1/2处最薄,唇侧牙槽嵴顶下2 mm和根中1/2处骨壁厚度>1 mm所占比率在中切牙至尖牙分别为37%、30%;31%、27%;56%、34%。腭侧骨壁厚度自牙槽嵴顶向根方递增，根方骨量>5 mm所占比率在中切牙至尖牙分别为94%、82%、97%。中切牙至尖牙相对于牙槽骨的位置关系分型Ⅰ、Ⅱ、Ⅲ、Ⅳ型分别为79.5%、10.5%、1.0%、2.0%;72.0%、14.5%、3.0%、5.0%;83.0%、5.5%、0.0%、0.5%。Ⅰ亚类（根尖区唇侧骨板厚度图像精度上难以分辨）各牙位占比分别为7.0%、5.5%、11.0%。结论 上前牙区唇侧嵴顶及根中处骨板厚度普遍很薄，绝大多数位点骨厚度<1 mm，根中1/2厚度最小；腭侧骨壁厚度自嵴顶向根方递增。上前牙根和牙槽骨多数属于Ⅰ类位置关系，为美...     

神经内镜与显微镜经远外侧锁孔入路在颅颈交界区手术中应用的解剖学对比研究

目的 探讨神经内镜与显微镜经远外侧锁孔入路行颅颈交界区手术中,枕髁磨除前后的解剖观察范围,并分析枕髁磨除的意义。方法 纳入10%甲醛固定的5例（10侧）成年国人尸头标本,动静脉分别以红、蓝乳胶灌注,其中男3具、女2具,年龄58~70岁、平均61岁。模拟远外侧手术入路：取乳突后“S”形切口、枕髁后微骨窗开颅,分别在显微镜和神经内镜下操作,观察磨除枕髁前后镜下术野显露的解剖结构,测量并计算延髓腹外侧的显露面积,对比2种手术入路的观察范围。结果 显微镜经远外侧锁孔入路可显露成人尸头标本后组颅神经、椎动脉、基底动脉、小脑前下动脉和小脑后下动脉,枕髁磨除后扩大了对椎动脉、舌下神经、延髓侧方及腹侧的显露。神经内镜经远外侧锁孔入路通过面听-舌咽神经间隙、舌咽-迷走神经间隙、迷走-副神经颅根间隙和副神经脊髓根腹侧间隙,可观察后组颅神经、椎动脉、基底动脉、小脑前下动脉、小脑后下动脉、脑干侧面及腹侧面;磨除枕髁前、后内镜下延髓腹外侧显露面积分别为（331.0±6.6）mm²和（464.7±10.6）mm²,差异有统计学意义（t=52.99, P<0.001）;磨除枕髁前、后显微镜下延髓腹外侧显露面积分别为（205.8±9.6）mm²和（329.1±6.7）mm²,差异有统计学意义（t=75.07, P<0.001）;磨除枕髁前、后内镜下延髓腹外侧显露面积均大于显微镜下,差异均有统计学意义（t=62.18、64.62, P值均<0.001）;内镜磨除枕髁前与显微镜磨除枕髁后的显露面积差异无统计学意义（t=1.63, P=0.137）。结论 远外侧锁孔入路磨除枕髁后神经内镜与显微镜2种手术方式均能增加延髓腹外侧的显露面积;神经内镜远外侧锁孔入路不磨除枕髁即可获得良好的、与显微镜远外侧锁孔入路磨除枕髁后相似的显露范围,对脑干腹侧面、椎动脉、基底动脉等深部结构的显露更具优势,临床手术中可免于磨除枕髁。     

口腭咽入路的解剖基础及手术中应用

目的　探讨口腭咽入路相应的解剖学结构和临床应用效果。 方法　在15具动脉灌注乳胶的成人尸头上模拟口腭咽入路,在显微镜下观察腭大孔、切牙孔的位置,骨嵴的比例,腭大动脉的走行,硬腭部软组织的结构特点并测量颅底重要解剖结构间的距离;对2006年3月至2010年6月经口腭咽入路行显微手术治疗的18例颅底中线区肿瘤患者的资料进行回顾性分析。 结果　切牙孔距牙槽嵴前端的距离为(5.18±2.44)mm,骨嵴的比例为93.3%,54支腭大动脉走行于硬腭半宽的中内2/3侧,术式的暴露范围主要受限于双侧的视神经、颈内动脉、舌下神经管内口等结构;本组18例中12例全切除,6例次全切除,并发症包括1例脑脊液鼻漏,1例构音不良,无死亡、偏瘫等严重并发症。 结论　口腭咽入路切除颅底中线区肿瘤具有暴露充分、手术创伤小、并发症少的优点。该入路是切除颅底中线区肿瘤的较佳入路。     

锁骨后方软组织侵袭性肿瘤的手术治疗分析

目的 探讨锁骨切开入路手术治疗锁骨后方侵袭性肿瘤的可行性、安全性及其临床应用价值。方法 回顾性分析2014年1月—2017年1月复旦大学附属肿瘤医院骨软组织外科收治的12例锁骨后方软组织侵袭性肿瘤患者的临床资料,其中男5例、女7例,年龄18~74岁;黏液纤维肉瘤4例,侵袭性纤维瘤4例,肌纤维母细胞瘤2例,骨外骨肉瘤1例,高级别梭形细胞肉瘤1例。肿瘤长径为4~12 cm(中位数为8 cm)。均行锁骨切开+软组织肿瘤切除+锁骨复位钢板螺钉内固定术治疗,术中锁骨劈开位置均位于锁骨中1/3段,术后三角巾制动4~6周。手术并发症按T94分级系统评价,手术前后患肢功能以肌骨肿瘤学会(MSTS)评分标准进行评价。结果 本组12例患者肿瘤均得以完整切除,切缘R0为10例、R1为2例,未见手术相关并发症发生。术后均获随访,随访时间12~38(中位数为24)个月。术前患肢功能MSTS评分中位数为28分,术后6个月时评分中位数为28分。局部复发2例(分别为术后2个月和3个月复发),其中1例骨外骨肉瘤患者复发同时发现了脑转移,术后20个月死亡。结论 锁骨切开入路可安全应用于锁骨后方软组织侵袭性肿瘤的切除,术后患侧肢体功能良好,肿瘤控制满意。     

Assessment of angiogenic markers in oral hemangiomas and pyogenic granulomas

The purpose of this research was to evaluate the immunohistochemical expression of the vascular endothelial growth factor (VEGF-C1) and measuring the angiogenic activity by the staining for von Willebrand factor (vWF) and CD31 in oral pyogenic granulomas and hemangiomas. The results showed that there was no statistically significant difference in the angiogenesis index between the lesions evaluated. The average microvessel density determined for MVC (microvessel count) using CD31 was 60.64 for hemangiomas and 59.64 for pyogenic granulomas, while angiogenic index determined using vWF was 64.24 and 62.20 in these lesions. The results showed that the cells highlighted by staining for vWF were more uniform than in those stained for CD31. There was no statistically significant difference between the lesions for the number of cells highlighted by staining for VEGF-C1. However, the mean number of cells highlighted in pyogenic granuloma specimens was higher (153.23) when compared to oral hemangioma specimens (115.17). The VEGF-positive cells were endothelial cells and fibroblasts in hemangiomas and macrophages and fibroblasts in pyogenic granulomas. These results effort the role of the angiogenic factors in the etiopathogenesis of the hemangiomas and pyogenic granulomas, however, it showed that microvessel quantification is not useful in the differential diagnosis of these lesions.     

A simplified method for the routine culture of normal oral epithelial (NOE) cells from upper aerodigestive tract mucosa

A method has been established for the routine culture for normal oral epithelial (NOE) cells based on simple methodology and commercially available materials. Normal mucosa was obtained from surgical resections of cancer patients, oropharyngeal mucosa, or pediatric tonsillectomies, anterior tonsillar pillar. NOE cells were allowed to outgrow using explant outgrowth techniques on whole mucosa or the dispased epithelial component. Outgrowth in AmnioMax-C100 medium (Gibco) followed by cell passaging in KGM (Clonetics) using Primaria (Falcon) tissue culture dishes produced reproducible growth, a reflection of a high rate of cell proliferation. Using this technique, cells maintain log phase growth for 2 cell passages, a minimum of 10–20 population doublings, and over 10⁸ cells can be easily obtained from most specimens, if desired. The growth potential of NOE cells from individual clinical specimens can be predicted by cell size on a particle counter. If the mean population diameter is approximately 15 m or less, cells exhibit good log phase growth whereas if the diameter is greater than 16 um, growth is poor. NOE cells cultured by this method show typical epithelial morphology, have desmosomal junctions, rest on an extracellular matrix, are positive for cytokeratin expression and are growth inhibited by TGF-, a normal inhibitory growth regulator. In summary, using this technique, epithelial cells from human oral mucosa can be easily generated in sufficient quantity and quality for cell biological, biochemical and molecular studies.Abbreviations NOE normal oral epithelia - CE cornified envelopes - IHC immunohistochemistry - TGF- transforming growth factor beta     

甘草油口腔干预护理预防危重患者口腔感染的效果观察

目的 探讨甘草油口腔干预护理预防危重患者口腔感染的效果。方法 选取2015年1月~2017年12月在我院住院的危重患者96例,随机分为甘草油护理组和常规护理组,各48例。常规护理组采用生理盐水擦拭、漱口;甘草油护理组采用甘草油涂于口腔内。比较两组患者口腔异味、真菌感染、退苔例数及牙周健康状况,观察两组患者干预前后口腔pH值、口腔评分。结果 甘草油护理组发生异味、真菌感染例数少于常规护理组,退苔例数多于常规护理组,差异有统计学意义（P＜0.05）;甘草油护理组菌斑指数、牙龈指数为（1.27±0.34）、（1.14±0.21）,低于常规护理组的（2.93±0.42）、（2.26±0.37）,差异有统计学意义（P＜0.05）;甘草油护理组口腔pH值、口腔评分为（7.01±0.43）、（10.02±2.01）分,高于于常规护理组的（6.37±0.36）、（6.85±2.61）分,差异有统计学意义（P＜0.05）。结论 应用甘草油对危重患者进行口腔护理,可有效维护患者口腔健康,降低口腔感染、异味发生率,改善患者牙周健康状况,值得临床应用。     

Characterization of three novel human papillomavirus types isolated from oral rinse samples of healthy individuals

BackgroundDespite the strong evidence of HPV infection as the etiological agent in a subset of oral cancer, oral α-HPV detection is rare in healthy individuals, and little is known of the existing of novel HPV types in oral cavity.ObjectiveWe determined whether novel HPV types can be isolated from oral rinse samples collected from healthy individuals.Study designWe performed rolling circle amplification (RCA) coupled with degenerated PCR assay on 48 oral rinse samples to amplify novel HPV types. Full length HPV DNA was cloned using long range PCR. Quantitative type specific Taqman assays were used to determine the prevalence of novel HPV types in 158 archived oral tissue samples.ResultsWe were able to isolate four novel human papillomavirus types. Full length HPV DNA was cloned for three of the four novel HPV types. All four HPV types belong to the genus Gammapapillomavirus (γ-PV), where HPV 171 is most closely related to HPV 169, showing 88% similarity; HPV 172 is most closely related to HPV 156, showing 70% similarity; HPV 173 is most closely related to HPV 4, showing 73% similarity; oral sample lavage (OSL) 37 is most closely related to HPV 144, showing 69% similarity. Finally, we showed that HPV 173 was rarely present in oral tissues (2/158), HPV 172 was only detected in normal oral tissues (25/76), and HPV 171 was more prevalent in malignant oral tissues (17/82 vs. 10/76, p = 0.21).ConclusionsNovel γ-HPV types are present in oral cavity of healthy individuals.     

Comparison of mast cells count in oral reactive lesions

The purposes of this study were a comparison of mast cells (MCs) count in oral soft-tissue reactive lesions showing different degrees of fibrosis, and also an evaluation of the correlation of mast cells counting with the score of inflammation.     

Continuous Low-Dose Oral Chemotherapy in Recurrent and Persistent Carcinoma of Cervix Following Chemoradiation: A Comparative Study Between Prolonged Oral Cyclophosphamide and Oral Etoposide

Aim:

To compare the efficacy and toxicities of low-dose oral cyclophosphamide and oral etoposide in patients with persistent and recurrent cervical cancer with gross pelvic disease following full course of chemoradiation therapy.

Materials and Methods:

30 patients with recurrent and persistent cervical cancer with gross pelvic disease were enrolled in this trial. The patients were randomly divided into two groups of 15 patients each with one group receiving low dose oral cyclophosphamide (100 mg/day) and the other group receiving low-dose oral etoposide (50 mg/day). Results were statistically analysed by IBM SPSS Statistics 19.

Results:

Oral etoposide was not well tolerated with grade 2 neutropenia occurring in 33.3% and grade 3 neutropenia in 6.6% and thrombocytopenia occurring in 13.3%. Oral cyclophosphamide group on the other hand was better tolerated with none of the patients having thrombocytopenia and 6.6% patients having grade 2 neutropenia. There were two complete response (15.38%) and one partial response at the end of study (7.6%) in the cyclophosphamide group whereas there was no complete response and two partial response (16.6%) in the oral etoposide group.

Conclusion:

Long-term, low-dose oral etoposide was found to be less tolerated without any significant effect with patients with persistent and recurrent cervical cancer with gross pelvic disease following full course of chemoradiation therapy in contrast to oral cyclophosphamide which was found to be effective and well-tolerated by the patients.     

Multiple hepatocellular tumours in a patient treated with oral contraceptives

Summary A case of multiple hepatic tumours in a patient treated for four years with high doses of oral contraceptives is described. Solitary hepatocellular lesions associated with conventional doses of oral contraceptives have been reported previously in twenty nine cases. Haemorrhage has been a common mode of presentation and is attributed to the marked vascularity of the lesions, an appearance referred to as peliosis hepatis. Radiographic studies show this term to be inappropriate as the vessels are of arterial origin. Another finding not previously reported is the presence of diffuse hyperplasia in the non-tumourous parts of the liver.     

Evaluation of tissue engineered models of the oral mucosa to investigate oral candidiasis

Candida albicans is a commensal organism that can be isolated from the majority of healthy individuals. However, in certain susceptible individuals C. albicans can become pathogenic leading to the mucocutaneous infection; oral candidiasis. Murine models and in vitro monolayer cultures have generated some data on the likely virulence and host factors that contribute to oral candidiasis but these models have limitations. Recently, tissue engineered oral mucosal models have been developed to mimic the normal oral mucosa but little information is available on their true representation. In this study, we assessed the histological features of three different tissue engineered oral mucosal models compared to the normal oral mucosa and analysed both cell damage and cytokine release following infection with C. albicans. Models comprised of normal oral keratinocytes and a fibroblast-containing matrix displayed more similar immunohistological and proliferation characteristics to normal mucosa, compared to models composed of an oral carcinoma cell line. Although all models were invaded and damaged by C. albicans in a similar manner, the cytokine response was much more pronounced in models containing normal keratinocytes. These data suggest that models based on normal keratinocytes atop a fibroblast-containing connective tissue will significantly aid in dissecting the molecular pathogenesis of oral candidiasis.     

Oral Complications of HIV Disease

Oral lesions are among the early signs of HIV infection and can predict its progression to acquired immunodeficiency syndrome (AIDS). A better understanding of the oral manifestations of AIDS in both adults and children has implications for all health care professionals. The knowledge of such alterations would allow for early recognition of HIV-infected patients. The present paper reviews epidemiology, relevant aspects of HIV infection related to the mouth in both adults and children, as well as current trends in antiretroviral therapy and its connection with orofacial manifestations related to AIDS.