目的：探討N-乙酰半胱氨酸對燙傷大鼠炎癥反應的影響。方法：48只Wistar大鼠隨機分為實驗組和對照組，制作燙傷休克模型，傷后1小時腹腔注射生理鹽水40ml/kg抗休克，實驗組于抗休克鹽水中加入N-乙酰半胱氨酸160mg/kg，其后足量飲水。分別于燙傷前、燙傷后8小時、16小時及24小時，處死每組各6只大鼠并立即心臟取血，采用ELISA法檢測大鼠血清中TNF-a含量，于創周近頭側 0.5cm處取皮膚全層組織，在顯微鏡下進行中性粒細胞計數。 結果：兩組大鼠血清TNF-a含量傷后顯著升高，8小時達到高峰，其后逐漸下降，兩組各時點比較有顯著差異（P＜0.05）；創周組織中性粒細胞計數于傷后隨時間延長逐漸增多，兩組比較有顯著性差異（P＜0.05）。 結論：N-乙酰半胱氨酸有助于降低燙傷大鼠血漿中TNF-a含量及創周組織中的中性粒細胞計數量，減輕燙傷大鼠的全身及局部炎癥反應。
目的:回顧性分析臀會陰及下肢大面積皮膚軟組織撕脫傷的治療體會。方法:2005年1月至2007年6月,對8例臀會陰及下肢大面積皮膚軟組織撕脫傷患者進行綜合治療。男4例,女4例,年齡4～48歲,平均26歲,病程1天～1月,平均2周。皮膚撕脫達體表總面積8%～20%。致傷原因:車禍傷7例,高墜傷1例。其中7例成人均上翻身床治療,1例小孩床上自行翻身,6例由于創面距肛門較近或脊髓損傷不能控制大便而行結腸造瘺,通過造瘺口排便,創面愈合3月后行造瘺還納術。所有患者均通過積極創面處理、肉芽新鮮后行刃厚植皮術而痊愈。結果:8例患者經過我們的綜合治療后傷口均愈合,隨訪6月后皮膚愈合良好。6例行結腸造瘺的患者中3例因骨盆骨折穩定于出院后3月左右行結腸造瘺還納術,恢復肛門排便,3例伴有脊髓損傷患者而不能自行控制排便的患者在隨訪期間未行結腸造瘺還納術。結論:臀會陰及下肢大面積皮膚軟組織撕脫傷患者通過上翻身床,必要時行結腸造瘺,積極的創面處理及對癥支持治療能取得較好效果。
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.
【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.