游离皮瓣修复头颈部肿瘤术后组织缺损△

目的 探讨不同游离皮瓣在头颈部肿瘤术后组织缺损修复应用中的优缺点。方法 回顾分析46例经游离皮瓣修复的头颈部恶性肿瘤病例临床资料,其中扁桃体癌11例、下咽癌17例、舌根会厌癌4例、鼻腔鼻窦癌术后放疗后复发14例。根据肿瘤切除术后缺损部位和大小,分别采用前臂桡侧皮瓣、股前外侧瓣和背阔肌皮瓣修复术后组织缺损。结果 46例恶性肿瘤患者,应用前臂皮瓣修复20例,应用股前外侧瓣修复20例,采用背阔肌修复6例。46例游离皮瓣成活42例(91.3%)。修复扁桃体癌术后缺损的11例患者,综合治疗后3年总生存率为72.7%(8/11);修复下咽缺损的17例患者,综合治疗后3年总生存率为64.7%(11/17);全舌加全喉切除术后缺损修复的4例患者,综合治疗后3年总生存率为50%(2/4);14例复发性鼻腔鼻窦癌患者,再次手术后总生存率为21.4%(随访2~5年)。结论 游离前臂皮瓣和股前外侧瓣能满足头颈部肿瘤术后不同大小缺损修复的需求。     

龋病防治的临床难度评估

龋病是发生于牙体硬组织的慢性感染性疾病,具有发病率高、治疗率低等特点,严重危害口腔和全身健康。加强和完善龋病的规范化治疗是全人群、全生命周期龋病管理面临的关键问题。因此,在龋病诊断和分类的基础上,建立龋病防治临床难度评估系统,主要包括龋病风险评估和龋病治疗难度评估,可为龋病管理提供有效的依据。本文围绕龋病防治难度评估系统,从龋病的诊断和分类、龋病风险评估和龋病治疗难度评估等龋病防治临床管理的重要组成部分进行归纳与阐述。     

急性阑尾炎开放阑尾切除术后再次手术46例临床分析

目的对急性阑尾炎开放阑尾切除术后再次手术的原因和防治措施进行探讨。方法收集2013-01—2019-01间息县人民医院收治的46例急性阑尾炎开放阑尾切除术后再次手术患者的临床资料,进行回顾性分析。结果 46例患者中,粘连性肠梗阻18例(39.1%),分别行粘连松解术10例、粘连松解术+小肠扭转复位术6例、粘连松解术+小肠减压+部分小肠切除术2例。切口疝15例(32.6%)。其中,开放Sublay修补术9例,行腹腔镜Sublay修补术6例。炎症性并发症13例(28.3%)。其中,切口窦道形成扩创术6例,阑尾残株炎残株切除4例,粪瘘3例行回盲部切除术。再次术后发生切口感染4例,切口裂开2例,炎性肠梗阻1例。均经对症处理后痊愈。46例患者再次手术后均获6～13个月随访,其间均恢复良好,无因为术后并发症再次住院治疗或手术的病例。结论急性阑尾炎开放阑尾切除术后再次手术的主要原因为粘连性肠梗阻、腹壁切口疝及炎症性并发症。规范手术操作、彻底腹腔冲洗、规范缝合切口、采取腹腔镜阑尾切除术等,均为降低阑尾切除术后再次手术率的有效措施。     

口腔精准医学：现状与挑战

精准医学是人类基因组计划的延续,是医学发展的必然产物,是一种考虑人群基因、环境及生活方式个体差异的促进健康和治疗疾病的新兴医学模式。本文首次提出口腔精准医学的概念,以口腔典型疾病为例,结合近期的研究成果与学者观点,阐述口腔精准医学对口腔学科发展的指导意义及实现口腔精准医学将面对的机遇与挑战。     

细胞凋亡与胃癌

胃癌是我国最常见的恶性肿瘤之一 ,死亡率占恶性肿瘤的第一位。胃癌的发生与胃粘膜上皮细胞和胃癌细胞凋亡、增殖调控失衡有关。现综述细胞凋亡及凋亡相关基因在胃癌的发生、发展、转归和治疗中的地位及其应用前景     

老年非心脏手术患者术前高敏C反应蛋白与术后心脏不良事件相关性的研究

Objective To investigate the relevance between level of preoperative high-sensitivity C-reactive protein(hsCRP) and the occurrence of postoperative adverse cardiac events in elderly patients underwent noncardiac surgery. Methods 49 patients of more than 65 years that had undergone elective noncardiac surgery were enrolled in the study. And all patients were conformed to the standards of "classification of risk factors for clinical history", content of "Guidelines on Preoperative Cardiovascular Evaluation for Noncardiac Surgery" established by the ACC/AHA .The patients were divided into two groups based on the preoperative hsCRP level:A group:hsCRP ≤ 3mg/L group (n=21) and B group: hsCRP>3mg/L group (n=28). General clinical characteristics of patients were recorded before operation, and 24 hours dynamic ECG was monitored a week prior to and after the operation. All patients taken measures of analgesia after surgery. The incidence of postoperative adverse cardiac events and the hospitalized days was recorded. The distinctions between two groups were analyzed regarding the occurrence of adverse cardiac events and hospitalized days after operation. Results 19 patients had postoperative myocardial ischemia; 4 cases in A group and 15 cases in B group. 7 patients suffered other postoperative adverse cardiac events, including 1 case in A group and the others in B group. There was statistically significant difference considering morbidity of myocardial ischemia in postoperation between the two groups, but there was no statistically significant difference about incidence of other adverse cardiac events and the length of stay in postoperation. Indexes about serious degree of myocardial ischemia:total depression time is(43.5±5.82 )min in A group, is( 135.0±81.2)min in B group. The depression times is(5.2±2.5 )in A group, is( 8.8±3.0)in B group.The longest depression time is( 23.7±9.2)min in A group, is( 84.3±54.1 )min in B group.Total ischemia burden is( 170.1 ±88.8 )mm· min-1 ·24h-1 in A group, is (311.3± 118.8 )mm· min-1 ·24h-1 in B group.There was statistically significant difference between the two groups. Conclusion Level of preoperative hsCRP>3 mg/L was relevant to the incidence of the most common postoperative adverse cardiac events--myocardial ischemia in elderly patients and level of preoperative hsCRP >3 mg/L was one of the risk factors of postoperative myocardial ischemia;Determination of preoperative hsCRP level may improve cardiovascular risk scoring system.     

螺旋CT和MMP-3联合诊断胃癌的浸润和转移

目的 探讨联合应用螺旋CT及患者胃癌组织中MMP-3的表达水平以提高胃癌的浸润和转移的诊断率.方法 应用螺旋CT对患者进行术前诊断;应用免疫组织化学法对胃癌患者MMP-3的表达进行检测.结果 SCT与MMP-3联合诊断胃癌的检出率为(92.31%),明显高于SCT(71.79%)及MMP-3(74.36%)单个指标的检出率.结论 应用SCT与MMP-3联合诊断,诊出率较高,可用于临床判断胃癌的浸润和转移的重要参考指标.     

螺旋CT和MMP-3联合诊断胃癌的浸润和转移

目的探讨联合应用螺旋CT及患者胃癌组织中MMP-3的表达水平以提高胃癌的浸润和转移的诊断率。方法应用螺旋CT对患者进行术前诊断;应用免疫组织化学法对胃癌患者MMP-3的表达进行检测。结果 SCT与MMP-3联合诊断胃癌的检出率为（92.31%）,明显高于SCT（71.79%）及MMP-3（74.36%）单个指标的检出率。结论应用SCT与MMP-3联合诊断,诊出率较高,可用于临床判断胃癌的浸润和转移的重要参考指标。