悄然兴起的新型手术刀——激光刀

随着激光技术的发展,激光在临床医学领域的应用也日益增多.本文概述了激光手术刀的特点及应用领域,阐明了工程技术对医学的发展起着日益广泛而更加深刻的推动作用.     

Realistic Cosmetic Plastic Surgery Simulation Based on the Golden Ratio

Facial cosmetology is usually operated by surgeons on the basis of clinical experiences and is full of risks because of the lack of objective criteria and auxiliary tools.The available plastic simulation systems are not easy to manipulate.This paper presents a realistic cosmetic plastic surgery simulation framework guided automatically by golden ratio data,which is suitable for personalized realistic facial models from 3D laser scan.A golden ratio facial mask is made based on the ideal golden ratio facial mask data,with reference to the facial ratio of goodlooking groups of eastern people.The plastic design for the region of interest will be driven automatically by Laplacian coordinates deformation,based on the matched characteristic points and lines of the golden ratio facial mask to set the boundary conditions.The evaluation from clinical surgeons shows that the new plastic simulation system is practical and will be widely used in clinical operations.     

激光角膜矫正术中所用激光波长的选择

用分光光度计测定了12例兔角膜和1例人角膜的吸收光谱,结果表明波长小于300nm的准分子激光和波长在1.88μm～2.64μm,2.36μm～40μm的激光,均可对角膜进行切割并可望用于激光角膜矫正术。     

关节镜手术治疗踝关节痛风性关节炎的临床研究

目的探讨关节镜手术治疗踝关节痛风性关节炎的临床疗效。方法 2011年11月至2013年4月,选择55例(99踝)在我院就诊的痛风性关节炎患者,分为治疗组(n=28)和对照组(n=27)。于我院在西药治疗的基础上,治疗组给予踝关节镜手术,对照组给予痛风定胶囊治疗。治疗后随访10个月,治疗后疗效评定根据血尿酸、ESR(红细胞沉降率)、CRP(C反应蛋白)、健康相关问题评分、AOFAS(美国足踝协会)与后足功能评分评价所有患者。结果治疗后两组ESR、CRP、血尿酸、健康相关问题评分较前明显降低,AOFAS踝与后足功能评分较前明显提高,差异有统计学意义(P0.05)。治疗后治疗组的健康相关问题评分明显低于对照组(P0.05),AOFAS踝与后足功能评分明显高于对照组(P0.05)。治疗组的显效率(84%)明显高于对照组的显效率(68%,P0.05)。治疗组不良反应发生率为16%,对照组为8%,差异无统计学意义(P0.05)。结论踝关节镜手术和药物治疗均可有效的治疗踝关节痛风性关节炎,踝关节镜手术在提高患者生活质量和改善踝关节功能方面优于药物治疗。     

抗肥胖药的研究进展

肥胖人群的比例近年逐年上升,并且有年轻化的趋势。肥胖是一种与多种疾病相关的慢性病,危害着人类的健康。抗肥胖药的开发一直是人们关注的热点。本文综述此类药物的研究进展。     

Nd:YAG激光治疗白内障超声乳化术后囊袋皱缩的临床观察

目的观察Nd:YAG激光前囊切开术治疗白内障超声乳化术后囊袋皱缩的临床效果。方法回顾分析2004年3月至2005年3月白内障超声乳化术后囊袋皱缩35例35眼的临床资料,患眼均接受Nd∶YAG激光前囊四象限放射状切开术,术后随访3～9个月(平均5.7±2.5月)。结果术后35眼最佳矫正视力均不低于术前,囊袋皱缩未再继续进展,无严重并发症发生。结论Nd∶YAG激光前囊切开治疗白内障超声乳化术后囊袋皱缩安全有效,早期治疗效果更佳。     

侧颅底手术过程中脑及颅神经功能保护

手术是绝大部分侧颅底病变的首选治疗方式。因侧颅底解剖结构复杂,毗邻脑及重要血管神经,手术容易致死或致残,限制了该部位手术的实施。脑、后组颅神经、面神经、听力功能是该部位手术保护的重点,恰当处理功能保留和切除病变的关系、良好的外科操作技能以及合理使用介入、导航等新的辅助技术是侧颅底手术中实现器官功能保护的关键。     

腭裂修复术对婴幼儿听力和中耳功能的短期影响

目的　探讨单纯腭裂修复术对腭裂婴幼儿听力和中耳功能的短期影响。方法　2013年1月至2014年11月在北京协和医院行手术治疗的先天性腭裂婴幼儿33例，其中男22例，女11例，在腭裂修复术前、术后1~24个月对患儿进行畸变产物耳声发射（distortion product otoacoustic emission, DPOAE）、听性脑干反应（auditory brainstem response，ABR）和226 Hz鼓室声导抗图检测，观察腭裂修复术后患儿听力和中耳功能的短期变化。结果　33例（66耳）腭裂婴幼儿手术时平均年龄为17个月（8.5 ~25个月）。64耳接受术前DPOAE测试，7耳（10.9%）通过；56耳接受术后DPOAE测试，19耳（33.9%）通过，手术前后通过率比较差异具有统计学意义（P＜0.01）；术前术后均接受DPOAE测试的54耳中，16耳（29.6%）听力改善。63耳接受术前ABR检查，其中Ⅴ波反应阈平均值为（43.73±13.65）dB nHL；62耳接受术后ABR检查，其中Ⅴ波反应阈平均值为（35.65±13.75）dB nHL，手术前后反应阈值比较差异具有统计学意义（P＜0.01）；术前术后均接受ABR检测的53耳中，29耳（54.7%）术后V波反应阈降低，听力改善。手术前后226 Hz鼓室声导抗图分型比较差异无统计学意义（P＞0.05）。结论　单纯腭裂修复术术后患儿短期听力得到改善，但中耳功能改善不明显。     

Validation of a Cleanroom Compliant Sonication-Based Decellularization Technique: A New Concept in Nerve Allograft Production

Defects of the peripheral nervous system are extremely frequent in trauma and surgeries and have high socioeconomic costs. If the direct suture of a lesion is not possible, i.e., nerve gap > 2 cm, it is necessary to use grafts. While the gold standard is the autograft, it has disadvantages related to its harvesting, with an inevitable functional deficit and further morbidity. An alternative to autografting is represented by the acellular nerve allograft (ANA), which avoids disadvantages of autograft harvesting and fresh allograft rejection. In this research, the authors intend to transfer to human nerves a novel technique, previously implemented in animal models, to decellularize nerves. The new method is based on soaking the nerve tissues in decellularizing solutions while associating ultrasounds and freeze–thaw cycles. It is performed without interrupting the sterility chain, so that the new graft may not require post-production γ-ray irradiation, which is suspected to affect the structural and functional quality of tissues. The new method is rapid, safe, and inexpensive if compared with available commercial ANAs. Histology and immunohistochemistry have been adopted to evaluate the new decellularized nerves. The study shows that the new method can be applied to human nerve samples, obtaining similar, and, sometimes better, results compared with the chosen control method, the Hudson technique.     

EGFR Mutations in Surgically Resected Fresh Specimens from 697 Consecutive Chinese Patients with Non-Small Cell Lung Cancer and Their Relationships with Clinical Features

We aimed to reveal the true status of epidermal growth factor receptor (EGFR) mutations in Chinese patients with non-small cell lung cancer (NSCLC) after lung resections. EGFR mutations of surgically resected fresh tumor samples from 697 Chinese NSCLC patients were analyzed by Amplification Refractory Mutation System (ARMS). Correlations between EGFR mutation hotspots and clinical features were also explored. Of the 697 NSCLC patients, 235 (33.7%) patients had tyrosine kinase inhibitor (TKIs) sensitive EGFR mutations in 41 (14.5%) of the 282 squamous carcinomas, 155 (52.9%) of the 293 adenocarcinomas, 34 (39.5%) of the 86 adenosquamous carcinomas, one (9.1%) of the 11 large-cell carcinomas, 2 (11.1%) of the 18 sarcomatoid carcinomas, and 2 (28.6%) of the 7 mucoepidermoid carcinomas. TKIs sensitive EGFR mutations were more frequently found in female patients (p < 0.001), non-smokers (p = 0.047) and adenocarcinomas (p < 0.001). The rates of exon 19 deletion mutation (19-del), exon 21 L858R point mutation (L858R), exon 21 L861Q point mutation (L861Q), exon 18 G719X point mutations (G719X, including G719C, G719S, G719A) were 43.4%, 48.1%, 1.7% and 6.8%, respectively. Exon 20 T790M point mutation (T790M) was detected in 3 squamous carcinomas and 3 adenocarcinomas and exon 20 insertion mutation (20-ins) was detected in 2 patients with adenocarcinoma. Our results show the rates of EGFR mutations are higher in all types of NSCLC in Chinese patients. 19-del and L858R are two of the more frequent mutations. EGFR mutation detection should be performed as a routine postoperative examination in Chinese NSCLC patients.