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find Author "李文" 24 results
  • 联合应用UW液与乳酸林格氏液供肝灌注保存(附6例报告)

    Release date:2016-08-28 05:30 Export PDF Favorites Scan
  • MODIFIED TRANSCRANIAL APPROACH TO RESECT TUMOR AROUND THE ANTERIOR SKULL BASE AND DOUBLE TISSUE FLAP TO RECONSTRUCT THE ANTERIOR SKULL BASE

    Objective To explore better approach of resecting tumoraround the anterior skull base and reconstructing the anterior skull base.Methods In November 2004, a 49-years-old male patient with intracranial recrudescent adenoid cystic carcinoma in the anterior cranial fossa was treated using modified transcranial approach. Neurosurgeon and rhinolaryngologist cooperated to excise the tumour completely, and to reconstruct anterior skull base using the pedicle periosteum temproal musculofascial flap(15 cm×10 cm) andthe pedicle flap of aponeurosis of occipitofron talis muscle and muscular fasciae(10 cm×6 cm).Results After operation, the wound healed by first intention. Complication, such as infection and cerebrospinal rhinorrhea, did not occur. The patient was discharged 10 days after operation, and was followed up for 8 months, no local recurrence were investigated and no scar formed over the face.Conclusion The modified transcranial approachis a relatively novel exposure that enables the skilled cranial base surgeon tosafely resect many malignant lesions previously and to reconstruct the defect of anterior skull base together. 

    Release date:2016-09-01 09:26 Export PDF Favorites Scan
  • 颈清扫术后乳糜瘘治疗方法的比较

    目的 比较颈清扫术后乳糜瘘治疗方法的临床效果。 方法 回顾分析1993年7月-2009年8月,就诊的21例根治性颈清扫术后乳糜瘘的治疗方法及其临床效果。 结果 加压包扎法5例,加压包扎辅以胃肠外营养6例,手术探查结扎2例,结扎后辅以生物胶覆盖结扎创面2例,行负压吸引加胃肠外营养6例,均治愈。5例单纯加压包扎法用时4~8 d,其中1例辅以拆线引流碘仿纱条填塞加压后愈合,4例手术止瘘者均Ⅰ期愈合。其余外加压2 d无效,行外加压辅以胃肠外营养或负压吸引辅以胃肠外营养后愈合。 结论 多种乳糜瘘的治疗方法均有明显临床效果,应该根据患者的具体情况采用。其中胃肠外营养在治疗中占有重要的地位。

    Release date:2016-09-08 09:49 Export PDF Favorites Scan
  • 腮腺区Kimura病1例

    Release date:2016-09-08 10:02 Export PDF Favorites Scan
  • Reconstruction of Tissue Defects Resulting from Buccal or Oropharyngeal Carcinoma Ablation with Regional Pedicular Flaps in 65 Cases

    目的:组织瓣修复缺损是头颈部肿瘤切除术中的重要手段和必要环节。本研究总结65例颊癌和口咽癌不同范围组织缺损用局部带蒂组织瓣的修复方法。方法: 回顾2001~2009年我科65例口腔颊癌及口咽癌切除术后选择腭瓣、颏下瓣、面动脉逆行皮瓣、颊脂垫颊肌复合瓣修复颊部及口咽部组织缺损,病变范围和治疗结果。结果: 65例皮瓣中,17例腭瓣全部成活,29例颏下瓣26例全部成活,2例部分坏死,1例表层皮肤坏死, 7例面动脉逆行皮瓣6例全部成活,1例坏死,12例颊脂垫或颊脂垫颊肌复合瓣全部成活11例,1例部分坏死,总成活率96.9%。31例患者术后有不同程度的张口受限,咀嚼和吞咽功能基本正常。结论: 根据颊癌和口咽癌的病变范围决定采用不同的临近带蒂组织瓣修复缺损,修复效果确切,可以明显减少手术创伤和术后并发症,尤其适用于年老及较多基础疾病患者,仍应作为头颈部肿瘤术后缺损修复的重要方法。

    Release date:2016-09-08 10:12 Export PDF Favorites Scan
  • 腮腺肿瘤术中保留耳大神经分支的临床分析

    目的分析腮腺肿瘤手术中保留耳大神经分支的临床效果。 方法回顾2011年7月-2013年6月63例腮腺肿瘤手术中耳大神经保留及术后术区皮肤感觉随访情况。63例患者中行耳大神经分支保留手术55例,其中保留耳大神经耳后支7例,保留耳后及耳垂支41例,保留耳前、耳垂及耳后三大主要分支7例;8例未保留耳大神经。 结果未保留耳大神经患者术后耳垂及耳垂周围皮肤长期麻木。保留耳大神经分支的55例患者中49例出现暂时性术区皮肤感觉减退,1~3个月恢复正常,6例术后耳后乳突区、耳垂几乎无明显麻木。 结论腮腺肿瘤术中保留耳大神经分支,可避免或减轻患者术区麻木、提高患者术后生活质量。保留耳垂及耳后分支具有手术操作可行性,疗效确切。

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  • “Z”成形术在喉全切除术气管造瘘中的应用

    目的探讨“Z”成形术在喉全切除术后气管造瘘中的应用。 方法2009年12月-2011年12月对78例行喉全切除术患者术中同期采用“Z”成形术行气管造瘘术,术后随访测量造瘘口直径大小。 结果78例气管造瘘术患者气管造瘘口直径在术后第1天为(3.26±0.14)cm,术后3个月为(2.72±0.18)cm,术后6个月为(2.23±0.17)cm,术后1年为(2.04±0.14)cm;随访2年,1年后造瘘口直径趋于稳定,未再继续缩窄;所有患者全部脱管,脱管时间为6个月,无患者出现造瘘口狭窄、呼吸困难。 结论“Z”成形术操作方便,应用于喉全切除术后气管造瘘可以很好地预防气管造瘘口狭窄。

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  • Repairing partial suprahyoid epiglottis-preserved circumferential defect in near total laryngectomy with anterior medial thigh flap in advanced laryngeal cancer

    ObjectiveTo explore the feasibility to restore pronunciation function by repairing partial suprahyoid epiglottis-preserved circumferential defect in near total laryngectomy with anterior medial thigh flap in advanced laryngeal cancer. Methods A retrospective study of 5 male patients with advanced laryngeal cancer between August 2019 and October 2022, aged 56-73 years, with an average age of 65 years were reviewed. The disease duration ranged from 3 to 24 months, with an average of 8 months. Tumor classification by location: 2 cases of glottic type, 2 cases of supraglottic type, and 1 case of subglottic type; TNM staging: 3 cases of T4N0M0 stage, 1 case of T4N1M0 stage, and 1 case of T4N2M0 stage; American Joint Committee on Cancer (AJCC) staging (2017): stage Ⅳ. Near total laryngectomy with partial suprahyoid epiglottis-preserved and selective bilateral neck dissection were performed before the anterior medial thigh flap was used to repair the circumferential defects. The flap size ranged from 6 cm×5 cm to 8 cm×6 cm. Four patients underwent adjuvant radiotherapy and chemotherapy after operation, while 1 patient did not receive any other adjuvant treatment such as radiochemotherapy. Results The flaps of all 5 patients survived without obvious neck infection. One patient developed a slight pharyngeal fistula after oral feeding at 1 month after operation, which healed after another week of gastric feeding. Primary healing also achieved in the thigh donor area. One patient had bilateral cervical lymph node metastasis, and 1 patient had lymph node metastasis on one side. The remaining 3 patients had no cervical nodes metastasis on both sides. All 5 patients were followed up 12-36 months, with an average of 27.6 months. Four patients had clear, audible, and hoarse voice while 1 patient (case 3) had pronunciation similar to whispering. Laryngoscopy showed that the reconstructed laryngeal inlet was fissure-shape and the reconstructed laryngo-trachea canal below the laryngeal inlet was gradually enlarged. At 1 month after operation, the gastric tube was withdrawn and the food was taken orally. There was no obvious aspiration pneumonia. The tracheostomy tube could be blocked in 4 patients for from 30 seconds to 3 minutes. Among them, 3 patients were able to make a noticeable pronunciation even when the tube was not blocked, and they were able to engage in barrier-free language communication; the tracheostomy tube could not be blocked in 1 patient who had a pronunciation similar to whispering. Preliminary voice analysis showed that the patients have a relaxed and natural pronunciation, without obvious breath-holding or air-swallowing movement, compared to patients with esophageal pronunciation. Decannulation did not achieved until the last follow-up in all 5 patients. ConclusionThe anterior medial thigh flap can repair circumferential defects after near total laryngectomy in advanced laryngeal cancer patients and achieve satisfactory pronunciation, thus can serve as an effective pronunciation rehabilitation method. The preserved part of epiglottis may play a role to prevent postoperative aspiration.

    Release date:2024-02-20 04:11 Export PDF Favorites Scan
  • A Preliminary Study of CO2 Laser Surgery and Open Partial Laryngectomy in Treating T3 Glottic Laryngeal Carcinoma

    目的 探讨T3期喉癌采用支撑喉镜下CO2激光切除术和部分喉切除术两种手术治疗方式的临床治疗效果。 方法 将2003年8月-2010年7月收治的31例患者按所接受手术方式分为A、B两组(非随机分组),A组16例中男15例,女1例,年龄38~72岁,中位年龄51岁;B组15例,均为男性,年龄46~68岁,中位年龄58岁。病变均累及前联合,A组10例和B组11例累及对侧声带约1/3。A组选择支撑喉镜下CO2激光切除术,B组选择气管切开+部分喉切除术。两组患者首次术后均未接受放射(放疗)或化学治疗(化疗)。术后第1、3、6、12、24个月门诊纤维喉镜复查。随访时间14~78个月。 结果 A组5例复发或颈部淋巴结转移,复发率31.3%;5例患者均行再次手术、颈清扫及放、化疗。B组4例复发,复发率26.7%;4例均行全喉切除双侧选择性颈清扫术,其中3例术后辅以放、化疗。两组复发率比较差异无统计学意义(P>0.05)。 结论 采用支撑喉镜下CO2激光切除治疗T3期喉癌,有望得到类似部分喉切除的临床治疗效果。

    Release date:2021-06-23 07:35 Export PDF Favorites Scan
  • Protection of the Vascular Pedicles during Re-operation after Free Jejunal TransplantationProtection of the Vascular Pedicles during Re-operation after Free Jejunal Transplantation

    【摘要】 目的 观察全喉全下咽切除术后空肠游离移植术二次手术时同时保留动静脉血管蒂或仅保留动脉血管蒂时对移植组织的影响。  方法 回顾分析2002年1月-2009年12月4例下咽癌行全喉全下咽切除术空肠游离移植术术后8~18个月因颈部转移灶出现而需再行手术患者的临床资料,其中3例行根治性颈清扫,1例行局部包块扩大切除术。2例同时保留动静脉蒂,2例仅保留动脉蒂。 结果 4例术后临床Ⅰ期愈合。保留动静脉蒂者吞咽功能与术前无异。仅保留动脉蒂者术后1个月仍有颈中份的明显隐痛,胃肠造影移植空肠段的蠕动明显减弱,吞咽固体食物时自觉较术前缓慢。 结论 再次手术时保留血管蒂对于保持空肠移植段的活力具有重要的意义。【Abstract】 Objective To observe the effect of keeping arteriovenous or venous pedicles during the second free jejunal transplantation after total laryngopharyngectomy on the transplanted tissues. Methods From January 2002 to December 2009,four patients underwent total laryngopharyngectomy and free jejunal. But 8-18 months later, the patients underwent another operation because of recurrent metastatic mass in the ipsilateral neck side of anastomosis; in whom three underwent radical neck dissection and one underwent local enlarged mass resection. In the four patients, two had arteriovenous pedicles remained and another two kept only venous pedicles. Results All of the four patients experienced first-stage healing. The deglutitive function in the two patients who had received the arteriovenous pedicles preservation didn’t differ much from that before the operation. While vague anguish in the anterior region of the neck, weak peristalsis of the transplanted jejunum, a little discomfort and slow swallowing were found in another two patients. Conclusion Keeping vascular pedicles during re-operation helps make the activity of the transplanted jejunum.

    Release date:2016-09-08 09:24 Export PDF Favorites Scan
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