目的:探讨高血压脑干出血的显微外科治疗的手术指征、手术技巧、效果和预后。方法: 回顾性分析21例高血压脑干出血患者的临床资料、手术方式、治疗效果及随访资料。结果:21例患者均于显微镜下清除血肿,无手术死亡,术中运用神经电生理监测。11例患者术后神经功能障碍得到改善,5例症状加重持续昏迷。5例术后死亡,术后随访6～18个月,9例生活基本能够自理,7例长期卧床。结论: 采用显微外科技术治疗高血压脑干出血,效果良好。
From 1984 to 1994, 236 different types of traumatic defects of foot were repaired by microsurgical tissue grafting. They included simple cutaneous flap in 187 and composite flap in 49. Among the 236 different tissue flaps, vascularized flap was used in 97 and pedicled flap in 139. The 4 fore-foot and 6 heel defects were repaired by composite skeleted cutaneous grafts with scapula and vascularized febula respectively. After the follow-up from 1 to 10 years, all the grafted tissues were survived and healed well. The functions were satisfactory, and 186 patients had resumed their original works. The key to good function following repair was to maintaion the integrity of foot structures and the sensation of the sole and heel.
Reconstruction and repair of atresia or defect of the upper portion of esophagus is difficult. From November 1980 to December 1997, forth-five cases, consisting 35 males and 10 females, were treated with microsurgical technique. The 45 patients fell into the following groups as esophageal atresia of various causes in 21 cases, anastomotic fistula or stenosis following reconstruction of esophagus in 7 cases and late carcinoma of esophagus in 17 cases. The types of reconstruction consisted of transfer of free jejunum with its lower portion carrying a vascular pedicle in 24 cases, free transfer of jejunal graft in 15 cases, free vascularized jejunal graft in 2 cases and free vascularized tubular skin graft in 4 cases. After a follow-up of 6-19 months besides eight cases died from late esophageal carcinoma, thirty-seven cases were survived and could take food by mouth. All of the benign cases could return to work. In patients having late esophageal carcinoma, the operative procedure could improve the life quality and facilitate chemotherapy and radiotherapy.
Seventeen cases involving 18 fingers of acute rupture of flexor tendon within the Zone Ⅱ were repaired by microsurgical technique for reconstructing the digital sheath with biological membrane since 1989. The excellent/good rate based on Eaton grading was 89%. The main procedure of the operation. the early postoperative rehabilitation and active excercises were described.
【摘要】 目的 探讨高血压基底节出血的显微外科治疗技巧、效果和预后。 方法 回顾分析2007年3月-2009年10月52例高血压所致基底节出血患者的临床表现、影像学资料、手术方式、治疗效果及随访资料。 结果 52例患者均于显微镜下清除血肿，无手术死亡。39例患者术后神经功能障碍得到改善，8例症状加重持续昏迷，5例术后1周死亡。术后随访6~18个月，35例生活基本能够自理[日常生活能力量表（ADL）Ⅰ~Ⅲ级]，12例长期卧床（ADL Ⅳ级）。 结论 采用显微外科技术治疗高血压基底节出血效果良好。【Abstract】 Objective To investigate the technique, effectiveness, and prognosis of microsurgical treatment of hypertensive basal ganglia hemorrhage. Methods A retrospective study was carried out on 52 patients with hypertensive basal ganglia hemorrhage from March 2007 to October 2009. The clinical presentation, neuroradiological data, surgical approach, therapeutic efficacy and follow-up data were reviewed. Results All of the hematoma were removed under microscope without surgery-related death. After operation, the functional disorders of nervous system were improved in 39 patients. Eight patients deteriorated with persistent coma after operation, five patients died. The survivors were followed-up for six to 18 months. Thirty-five patients were able to self-care with some efforts (ADL Ⅰ-Ⅲ), and 12 patients had hemiparalysis or coma (ADL Ⅳ). Conclusion Microsurgery is an effective treatment for hypertensive basal ganglia hemorrhage with microsurgical technique.
ObjectiveTo study the effectiveness of Keystone flap in the repair of soft tissue defect of lower extremity.MethodsThe clinical data of 27 cases with soft tissue defects of lower extremity treated by Keystone flap between January 2018 and June 2020 were retrospectively analyzed. There were 18 males and 9 females, with an average age of 43.9 years (range, 8-63 years). The cause of soft tissue defects included skin tumor in 3 cases, ulcer in 2 cases, soft-tissue infection in 8 cases, trauma in 7 cases, and donor site defect after free or pedicled flap transplantation in 7 cases. Defect size ranged from 2.0 cm×1.5 cm to 15.0 cm×9.5 cm. The types of Keystone flaps included type Ⅰ in 2 cases, type Ⅱa in 16 cases, type Ⅱb in 1 case, type Ⅲ in 6 cases, and Moncrieff modified type in 2 cases. The area of flap ranged from 3.0 cm×1.5 cm to 20.0 cm×10.0 cm. The donor site was directly sutured (26 cases) or repaired with skin grafting (1 case).ResultsThe operation time was 45-100 minutes, with an average of 67.5 minutes; the hospitalization stay was 3-12 days, with an average of 8.5 days. Postoperative incision dehiscence occurred in 1 case, and flap marginal necrosis occurred in 2 cases, all of which were completely healed after dressing change; 1 case of incision was swollen and congested with tension blisters, which resolved spontaneously at 7 days after operation. The other flaps and the skin grafting survived and healed successfully, the wounds of recipient and donor sites healed by first intention. The healing time was 2-3 weeks (mean, 2.2 weeks). No pain occurred in all patients. All 27 cases were followed up 3-26 months (mean, 11.5 months). No obvious scar contracture and bloated skin flap were found. The texture and color of the skin in the recipient area were similar to those of the surrounding tissues and feel existed.ConclusionThe Keystone flap is a feasible and efficient way to repair soft tissue defect of lower extremity. Furthermore, the skin color and texture is similar to the surrounding tissue after healing.
ObjectiveTo explore the technique of hepatic artery reconstruction in complicated hilar cholangiocarcinoma surgery. MethodThe clinicopathologic data of 3 patients with complicated hilar cholangiocarcinoma with arterial invasion underwent hepatic artery reconstruction in the Department of Hepatopancreatobiliary Center of Beijing Tsinghua Changgung Hospital from March to July 2022 were retrospectively analyzed. ResultsAll 3 patients (case 1–3) were the males, aged 53, 68, and 56 years, respectively, and with hypertension or diabetes; the longitudinal diameters of the tumor were 3.5 cm, 3.0 cm, and 3.2 cm, respectively. All patients had the right hepatic artery invasion. Case 2 and 3 had the arterial stratification. The arterial defects after radical resection were 4.5 cm, 3 cm, and 3 cm, respectively. The right or right posterior hepatic artery was reconstructed by the autotransplantation of right gastroomental artery, the left hepatic artery, and the anterior superior pancreaticoduodenal artery, respectively. After operation, the reconstructed hepatic arteries were unobstructed and free of stenosis, and there were no complications such as bleeding, infection, and thrombosis by Doppler ultrasound and CT angiography. The results of postoperative pathological diagnosis were the hilar cholangiocarcinoma with arterial invasion, and all the incisal edges were negative. ConclusionFrom the preliminary results of 3 cases, it is safe, feasible, and effective to select proper autologous artery (matched in length and caliber) for reconstruction the defective invaded hepatic artery which resected together with hilar cholangiocarcinoma, but the technical difficulty is still relatively high.