Different forms of free radial collateral artery perforator flaps for reconstruction after removal of oral tumors北大核心CSCD

Objective To investigate the efficacies of different forms of free radial collateral artery perforator flaps in repairing the defects after oral tumor surgeries. Methods From May 2016 to March 2021, 28 patients (22 males, 6 females, aged 35 ⁃ 62 years) with oral tumors admitted by Hunan Cancer Hospital received the reconstructive surgeries with the free radial collateral artery perforator flaps after removal of oral tumors, including 24 cases of tongue cancer (11 cases of tongue marginal cancer, 9 cases of tongue belly cancer and 4 cases of tongue cancer involved in the floor of the mouth) and 4 cases of buccal and oral cancer. Four forms of radial collateral artery perforator flaps were used: single perforator flaps for 6 cases, double perforators flaps for 7 cases, flaps without perforator visualization for 10 cases and chimeric perforator myocutaneous flaps for 5 cases. The recipient vessels were the superior thyroid artery and superior thyroid vein, and if second concomitant vein available, it was anastomosed with internal jugular vein in end‑to‑side fashion. SPSS 20.0 statistical software was used to analyze the data. Results The mean length of flaps was (9.7±0.4) cm, mean width (4.4±0.3) cm and mean thickness (1.1±0.4) cm. The mean length of the vascular pedicles was (7.1±0.6)cm (6.0-8.0 cm), the mean diameter of the radial accessory arteries was (1.1±0.3)mm (0.8-1.3 mm). Eleven cases(39.3%) had respectively one accompanying vein and 17 cases(60.7%) had respectively two accompanying veins, with the mean diameter of (1.1±0.3) mm (0.8-1.3 mm). All the 28 flaps survived, the donor and recipient wounds healed in one stage, the appearances of the flaps were satisfactory, only linear scars remained in the donor sites, and the upper arm functions were not significantly affected. Follow up for 12‑43 months showed that the flaps were soft with partially mucosalization, the reconstructed tongue and buccal cavity were in good shape, and the swallowing and language functions were satisfactory. The swallowing and language functions were retained to the greatest extent in 3 cases with near total tongue resection, although the functions were still significantly affected. There was no local recurrence of the tumor during follow‑up. One case had regional lymph node metastasis, and further lymph node dissection and comprehensive treatment were performed, with satisfactory outcomes. Conclusions The vascular pedicle of the radial collateral artery perforator flap has a constant anatomy, which can be prepared in different forms to improve the safety of the operation and minimize the donor site damage. It is an ideal choice for the repair of small and medium‑sized defects after oral tumor surgery. © 2023 Authors. All rights reserved.     

儿童与成人慢性分泌性中耳炎细菌学特点的分析

目的对比研究中耳炎差异球菌、肺炎链球菌、流感嗜血杆菌、卡他莫拉菌、金黄色葡萄球菌、草绿色链球菌在慢性分泌性中耳炎(secretory otitis media,SOM)儿童及成人患者的中耳积液(middle ear fluid,MEF)及鼻咽部分泌物(nasopharynx,Nph)中的检出率。方法运用PCR技术，观察并比较6种细菌在慢性分泌物中耳炎儿童组与成人组患者的MEF及Nph中的阳性率。结果①本研究中SOM儿童组与成人组患者MEF的主要细菌分布相似。PCR检测阳性率分别为91.30%（63/69）和 88.25%（30/34），差异无统计学意义（χ2=0.244，P>0.05）；②儿童组及成人组患者的MEF中，常可检测出2种或2种以上的细菌，但儿童组较成人组更为常见，差异具有统计学意义（P<0.05）；③儿童组患者MEF中阳性率最高的细菌为肺炎链球菌及金黄色葡萄球菌，成人组患者MEF中阳性率最高的细菌为金黄色葡萄球菌；④儿童组患者的MEF中，肺炎链球菌的阳性率高于成人组，差异具有统计学意义（χ2=5.526，P<0.05），其余5种细菌差异无统计学意义（P>0.05）；⑤儿童组MEF与Nph细菌阳性率比较，NPh中草绿色链球菌、流感嗜血杆菌、卡他莫拉菌的阳性率均高于MEF（χ2=21.852，P<0.05；χ2=21.369，P<0.05；χ2=4.309，P<0.05），差异具有统计学意义（P<0.05）；而金黄色葡萄球菌、肺炎链球菌及耳炎差异球菌在MEF与Nph中阳性率相似，差异均无统计学意义（P>0.05）；⑥成人组MEF与Nph细菌检出率比较，除草绿色链球菌在Nph中阳性率高于MEF（χ2=15.281，P<0.05）外，其余5种细菌差异均无统计学意义（P>0.05）。结论SOM儿童患者较成人更易发生中耳腔多种细菌混合性感染。     

腰椎后路减压融合术结合加速康复外科理念在高龄腰椎退行性疾病中的应用

目的 探讨后路减压植骨融合术结合加速康复外科理念对高龄腰椎退行性病变患者的治疗安全性和有效性。方法 回顾性观察自2018年1月～2019年12月行后路减压+椎间或横突间植骨融合+椎弓根螺钉固定术治疗的37例高龄患者(≥75岁),均有至少1种以上的合并症，采取加速康复外科(enhancedrecoveryaftersurgery, ERAS)理念指导下的围手术期治疗。采集术后3个月及末次随访时的ODI指数及VAS评分，观察其临床疗效及并发症情况。结果 所有手术由相同医生完成，平均涉及节段(2.03±0.79)个，未出现重大并发症。患者术后3个月VAS评分有显著缓解(P<0.05),末次随访时的ODI指数和VAS评分均较术前明显缓解，差异有统计学意义(P<0.05)。结论 应用腰椎后路减压融合术结合ERAS措施治疗高龄腰椎退行性疾病，可有效缓解术后疼痛，利于早期康复，明显改善近期生活质量。