目的：探讨N-乙酰半胱氨酸对烫伤大鼠炎症反应的影响。方法：48只Wistar大鼠随机分为实验组和对照组，制作烫伤休克模型，伤后1小时腹腔注射生理盐水40ml/kg抗休克，实验组于抗休克盐水中加入N-乙酰半胱氨酸160mg/kg，其后足量饮水。分别于烫伤前、烫伤后8小时、16小时及24小时，处死每组各6只大鼠并立即心脏取血，采用ELISA法检测大鼠血清中TNF-a含量，于创周近头侧 0.5cm处取皮肤全层组织，在显微镜下进行中性粒细胞计数。 结果：两组大鼠血清TNF-a含量伤后显著升高，8小时达到高峰，其后逐渐下降，两组各时点比较有显著差异（P＜0.05）；创周组织中性粒细胞计数于伤后随时间延长逐渐增多，两组比较有显著性差异（P＜0.05）。 结论：N-乙酰半胱氨酸有助于降低烫伤大鼠血浆中TNF-a含量及创周组织中的中性粒细胞计数量，减轻烫伤大鼠的全身及局部炎症反应。
目的：探讨电击伤的临床特征，手术治疗及疗效。方法：对78例电击伤患者的临床资料进行分析。结果：电击伤多为工伤，病情重，常常多次手术，住院时间长，致残率高。结论：早期积极、延迟的手术，功能可得到最大的恢复，截肢率降低，预后较好；电击伤创面修复以皮瓣、肌皮瓣转移的手术方式效果为佳。
Objective To summarize the treatment of chronic osteomyel itis of the skull and its effectiveness. Methods Between January 2004 and February 2009, 24 patients with chronic osteomyel itis of skull were diagnosed and treated, including 16 males and 8 females with an average age of 45.6 years (range, 18-56 years). The mean disease duration was 5.8 years (range, 3-11 years). The causes included infection after craniotomy in 3 cases, burn in 15 cases, and electrical injury in 6 cases, and the leision was located at the frontal and parietal of the skull in 10 cases, at the temporal and parietal of skull in 8 cases, and at the occipital of the skull in 6 cases. The soft tissue defects ranged from 7 cm × 6 cm to 19 cm × 12 cm, and the skull defects ranged from 5 cm × 4 cm to 10 cm × 7 cm. After wide thorough debridement of necrotic tissue, soft tissue defects were repaired with adjacent scalp flap in 12 cases, trapezius myocutaneous flap in 6 cases, and free anterolateral thigh flap in 6 cases; the flap size ranged from 8 cm × 7cm to 20 cm × 13 cm. The donor sites were sutured directly or covered with spl itthickness skin. Results All pathological examinations showed pyogenic osteomyel itis of the skull, and local ized squamous carcinoma was found in 1 case. One patient had sub-flap infection at 2 weeks after operation, and heal ing was achieved after surgical removal of residual tissue; the remaining flaps survived, and incision healed by first intention. All patients were followed up 10 months to 4 years with an average of 2 years after operation. The color and texture of the flaps were good. No recurrence of osteomyel itis happened during follow-up. The patient diagnosed as having local ized squamous carcinoma was followed up 4 years without recurrence. At 3 to 6 months after operation, 8 patients had headache or felt dizzy, and the skull was reconstructed by the titanium meshes. Conclusion In patients with chronic osteomyel itis of skull, the infected foci should be cleaned out thoroughly as early as possible, and the skin flap or myocutaneous flap is used to repair the wounds, thus the good results can be achieved.
【Abstract】 Objective To investigate the effects of different surgical methods in treating scalp mal ignanttumors. Methods From January 1995 to September 2004, 70 patients with scalp mal ignant tumor were treated with different surgical methods. There were 41 males and 29 females with an average age of 50.3 years (30-85 years). The course of disease ranged from 2 weeks to 3 years(mean 3.5 months). There were 31 cases of basal cell carcinoma, 24 cases of squamous carcinoma, 8 cases of melanocarcinoma, 4 cases of fibrous sarcoma, 2 cases of l iposarcoma, and 1 case of vasculosarcoma. Leision size ranged from 1.0 cm × 0.5 cm to 10.0 cm × 8.0 cm. Scalp defect ranged from 3 cm × 3 cm to 12 cm × 11 cm after clearing up the tumors. Defect was repaired with free skin transplantation in 51 cases, scalp flap in 12 cases, cervico-shoulder flap in 2 cases, trapizius myocutaneous flap in 3 cases, and radial artery retro-island flap in 2 cases. The flap sizes ranged from 5 cm × 4 cm to 18 cm × 12 cm. Results Of 70 cases, 67 skin flaps survived and incision healed by first intention; 2 flaps necrosed at distal part(lt; 1 cm) and healed by second intention after dressing change; 1 flap infected and was treated with symptomatic medication.All the donor sites healed by first intention. Fifty-five patients were followed up for 1 to 5 years and 5 cases had tumor recurrence. In patients receiving skin transplantation, 1 case of squamous carcinoma and 1 case of fibrous sarcoma relapsed after 1 year and 2.5 years respectively and were given radical resection and skin flap grafting; in patients receiving skin flap grafting, 1 case of vasculosarcoma and 1 case of squamous carcinoma relapsed after 6 months and 3 months respectively, and gave up treatment; 1 case of fibrous sarcoma relapsed after 2 years and was given radical resection and skin flap grafting. The other cases survived and had no tumor recurrence. Conclusion Scalp mal ignant tumors should be diagnosised and treated as early as possible. Clearing up completely by surgery is an effective method.
Objective To summarize the prevention and treatment of postoperative complications after the skin soft tissue expansion for scar alopecia. Methods From January 1995 to June 2005, 57 patients with scar alopecia were admitted to our department for treatment. Of the patients, 25 were males and 32 were females with their ages ranging from 5 to 55 years. The causes were burn in 33 patients, trauma in 14, alopecia after head surgery in 8, and other causes in 2. Their disease courses ranged from 6 months to 15 years. Fortreatment, 89 therapeutic expanders were utilized in 57 patients. The retrospective analysis on the complications and their prevention and treatment were performed. Results The follow-up for 3-12 months averaged 6 monthsrevealed that 81 areas undergoing the expander insertion healed well and the hair grew well, too. Eight areas undergoing the expander insertions had complications, including expander exposure in 2 patients, infection in 2, hematoma in 1, expander rupture in 1, necrosis of the flap tip in 1, and scar necrosis at the injection port in 1. The results also revealed that there was a significantly increased rate of complications in the patients aged 5-10 years and the patients older than 50 years （Plt;0.05）. The complication rate in the patients who received 2 expanders at one time was significantly higher than that in the patients whoreceived only 1 expander（Plt;0.05）. However, there was no significant difference in the complication rate in the other kinds of patients. All the complicationswere effectively treated with a satisfactory therapeutic result. Conclusion The skin soft tissue expansion for scar alopecia can effectively prevent and treat postoperative complications. If the complications are identified early and treated properly, the therapeutic results will be satisfactory.
目的:回顾性分析臀会阴及下肢大面积皮肤软组织撕脱伤的治疗体会。方法:2005年1月至2007年6月,对8例臀会阴及下肢大面积皮肤软组织撕脱伤患者进行综合治疗。男4例,女4例,年龄4～48岁,平均26岁,病程1天～1月,平均2周。皮肤撕脱达体表总面积8%～20%。致伤原因:车祸伤7例,高坠伤1例。其中7例成人均上翻身床治疗,1例小孩床上自行翻身,6例由于创面距肛门较近或脊髓损伤不能控制大便而行结肠造瘘,通过造瘘口排便,创面愈合3月后行造瘘还纳术。所有患者均通过积极创面处理、肉芽新鲜后行刃厚植皮术而痊愈。结果:8例患者经过我们的综合治疗后伤口均愈合,随访6月后皮肤愈合良好。6例行结肠造瘘的患者中3例因骨盆骨折稳定于出院后3月左右行结肠造瘘还纳术,恢复肛门排便,3例伴有脊髓损伤患者而不能自行控制排便的患者在随访期间未行结肠造瘘还纳术。结论:臀会阴及下肢大面积皮肤软组织撕脱伤患者通过上翻身床,必要时行结肠造瘘,积极的创面处理及对症支持治疗能取得较好效果。