Search

STUDY ON REPAIR APPROACH OF BILATERAL CLEFT LIPS AND NOSE DEFORMITY

Objective To detect the operative technique and aesthetic problem of reconstruction to deformity of bilateral cleft lip． Methods From March 2003 to December 2004, 26 patients with bilateral cleft lip were treated, aged 10 months to 11 years. Of 26 patients, there were 13 bilateral complete cleft lip and palate, 9 bilateral incomplete cleft lip and 4 mixed cleft lip with unilateral complete cleft palate. The chief design principle was keeping the length of prolabium. During operation, sufficient dissociation was made in the base of the ala base and orbicularis oris muscle to reconstruct these structures．The circle suture was made for the bilateral orbicularis oris muscle. The shape of vermilion was achieved by lateral red lip muscle flap and simultaneous simple rhinoplasty was performed. Results Primary healing of the incisions was achieved in all cases. After the 10 days-3 months follow-up, the results were satisfactory in thewidth and chubbiness of the nose bottom,the shapes of nostril and Cupid’s bow were good without whistle deformity. Theapperance of upper lip was good in either dynamic or static state． Conclusion Excellent shapes and function of the nose and lip， and opportunity for twostage repair could be obtained with this method，which being believed important methods for the primary repair of bilateral cleft lip．

双侧颞叶癫痫的外科治疗策略

单侧颞叶癫痫(Unilateral temporal lobe epilepsy，UTLE)是最适合外科手术的对象之一，手术疗效已得到肯定。但是仍有部分颞叶癫痫患者术后发作控制不理想，可能与致痫灶为双侧颞叶起源或颞叶附加癫痫综合征等因素相关。其中双侧颞叶癫痫(Bilateral temporal lobe epilepsy，BTLE)是临床治疗的难题，常常药物疗效差，而又不被建议外科治疗。然而，目前BTLE的诊断标准、发病率、以及外科治疗策略等方面仍不明确。文章对BTLE的临床概念、发生率、形成机制、临床特点、诊断依据、神经心理学检查及外科手术策略进行分析、探讨。结果显示，基于头皮发作间期、发作期脑电图(EEG)判定BTLE并不可靠，经过颅内电极发作期EEG记录后，部分患者可以诊断为UTLE，接受手术切除后，效果满意；部分患者的颅内EEG记录显示癫痫发作具有明显的偏侧倾向，也可以考虑切除性手术。高频(EEG)监测、神经影像学检查及神经心理学检查对BTLE的诊断和治疗策略也有重要意义。

同期双侧单孔胸腔镜切除肺多发磨玻璃影的单中心经验

目的总结双肺多发磨玻璃影（ground-glass opacity，GGO）患者同期行双侧单孔胸腔镜手术切除的经验。方法回顾性分析 2015 年 5 月至 2019 年 10 月同期行双侧单孔胸腔镜肺 GGO 切除 34 例患者的临床资料，其中男 6 例、女 28 例，平均年龄 41～69（57.9±6.7）岁。结果术中平均出血量（120.9±67.7）mL，平均手术时间（140.0±74.8）min，术后平均胸腔引流时间（4.8±3.1）d，术后平均住院时间（7.2±4.3）d。术后并发症包括肺部感染 2 例，心房颤动 3 例，肺持续漏气>3 d 5 例，经治疗后均好转，无围手术期严重并发症及死亡病例。共切除 GGO 病灶 76 个，总恶性率为 81.6%，其中纯 GGO 40 个，恶性 28 个（70.0%），平均直径（9.6±3.8）mm；混合 GGO 36 个，恶性 34 个（94.4%），平均直径（15.6±6.6）mm。平均随访时间 38.4 个月，未发现术后转移及复发。结论双肺多发 GGO 患者的病灶为恶性可能性大，在肺功能允许时可考虑同期双侧单孔胸腔镜多病灶切除，根据病灶位置、大小及术中快速病理结果可灵活采取亚肺叶或肺叶切除方法。双侧同期手术安全可行，不会增加术后并发症风险，短期预后良好。

Effectiveness comparison between unilateral and bilateral percutaneous kyphoplasty for Kümmell disease

Objective To compare the effectiveness between unilateral and bilateral percutaneous kyphoplasty (PKP) in the treatment of Kümmell disease. Methods The clinical data of 45 patients with Kümmell disease that met the criteria between January 2014 and February 2016 were analyzed retrospectively. Among them, 26 cases were treated by unilateral PKP (unilateral group), 19 cases were treated by bilateral PKP (bilateral group). There was no significant difference in gender, age, disease duration, injured vertebral segment, bone mineral density (T value), and the preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI), anterior vertebral height, and kyphosis Cobb angle between 2 groups (P>0.05). The operation time, intraoperative fluoroscopy times, amount of injected bone cement, and hospitalization time were recorded, and the situation of bone cement leakage was observed. The VAS score, ODI, anterior vertebral height, and kyphosis Cobb angle were evaluated before operation, at 1 day after operation, and at last follow-up. Results Bone cement leakage during the operation were found in 4 cases (15.38%) of unilateral group and 3 cases (15.79%) of bilateral group without obvious neurological symptoms; there was no significant difference in the incidence of bone cement leakage between 2 groups (χ2=0.000, P=1.000). The operation time, intraoperative fluoroscopy times, and amount of injected bone cement in the unilateral group were significantly lower than those in the bilateral group (P<0.05); but there was no significant difference in the hospitalization time between 2 groups (P>0.05). The X-ray film examination showed that there was no pulmonary embolism in all patients at 1 day after operation. All the patients were followed up 12-24 months, with an average of 16.4 months. There was no complication such as vertebral re-fracture or cement block displacement in the injured vertebra. The VAS score, ODI, anterior vertebral height, and kyphosis Cobb angle at 1 day after operation and at last follow-up were significantly improved when compared with preoperative values in 2 groups (P<0.05); the VAS score and ODI in 2 groups were further reduced at last follow-up when compared with the value at 1 day after operation (P<0.05), but the anterior vertebral height and kyphosis Cobb angle in 2 groups at last follow-up did not change significantly (P>0.05). There was no significant difference in above indexes at 1 day after operation and at last follow-up between 2 groups (P>0.05). Conclusion Both unilateral and bilateral PKP can achieve good effectiveness in treatment of Kümmell disease. But the unilateral puncture technique possesses advantages such as shorter operation time, less radiation dose, and less amount of injected bone cement.

双侧肩关节脱位一例

Analysis on clinicopathological features and prognosis of bilateral primary breast cancer between young patients and middle-old patients

Objective To explore the clinicopathological features of bilateral primary breast cancer (BPBC) at different ages. Methods Clinical data of 105 BPBC patients admitted to the Department of Breast Surgery in The First Affiliated Hospital of Zhengzhou University from January 2017 to January 2020 were collected and divided into young group (≤40 years old) and middle-old group (>40 years old) according to age. The characteristics and differences of bilateral tumor lesions in pathological type, molecular type, tumor diameter, histological grade, clinical stage, lymph node metastasis, recurrence or distant metastasis, immunohistochemical indexes expression characteristics, consistency and difference, and overall prognosis between the two groups were retrospectively analyzed. Results There were statistically significant differences between the two groups in the size of the first primary cancer, lymph node metastasis, the high expression rate of Ki-67 in the second primary cancer, clinical stage of double primary cancer and recurrence or distant metastasis (P<0.05). In the young group, the proportion of the first primary cancer with T3–T4 stage was higher, the incidence of lymph node metastasis was higher, the proportion of high expression of Ki-67 in the second primary cancer was higher, and the proportion of patients with double primary cancer at first diagnosed as stage Ⅳ were higher than those in the middle-old group, and were prone to recurrence or distant metastasis. The expression of immunohistochemical indexes in bilateral cancer foci was consistent between the two groups (P<0.05). The expression consistency of ER and Ki-67 in the young group was better, and the expression consistency of PR and HER-2 in the middle-old group was better. The histological grade of the first primary cancer, TNM stage of bilateral primary cancer and recurrence or metastasis were independent factors affecting the prognosis of patients (P<0.05). Conclusions The BPBC patients of different ages have different clinicopathological features, and the expression of immunohistochemical indexes in bilateral cancer foci is consistent. Tumor histological grade of the first primary cancer may affect the prognosis of patients with BPBC, and the prognosis of patients with early bilateral TNM stage is better.

以肾上腺意外瘤为首诊原因的亚临床库欣综合征一例

Effect of unilateral rotator cuff repair on the contralateral shoulder in patients with bilateral rotator cuff tears

ObjectiveTo investigate the effect of unilateral rotator cuff repair on the contralateral shoulder in patients with bilateral rotator cuff tears.MethodsA clinical data of 46 patients with bilateral rotator cuff tears met the criteria between May 2016 and May 2019 was retrospectively analyzed. Of 46 patients, 23 patients underwent bilateral conservative treatment (conservation group), 23 patients underwent unilateral arthroscopic rotator cuff repair, and conservative treatment on the contralateral side (operation group). There was no significant difference in gender, age, disease duration, degree of rotator cuff tear, and comorbidities between 2 groups (P>0.05). Before operation and at 6 and 12 months after operation, the degree of the rotator cuff tear was measured by MRI, and the shoulder function was evaluated by the visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM) (forward flexion, external rotation, external rotation at 90° of abduction, and internal rotation). The evaluation results of the non-surgical side of shoulders in the operation group were compared with one side of shoulders in the conservation group.ResultsAll incisions healed by first intention without any complication after operation. All patients were followed up 12 months. MRI reexamination showed that the degree of rotator cuff tear of the contralateral shoulder in the operation group increased significantly after operation (P<0.05). There was no significant difference between the operation group and the conservation group before operation (P>0.05), but the rotator cuff tear of the contralateral shoulder in the operation group was more serious than that of the conservation group at 6 and 12 months after operation (P<0.05). At 6 and 12 months after operation, the VAS score, UCLA score, and ASES score significantly improved when compared with the preoperative scores in 2 groups (P<0.05). There was no significant difference in the VAS score, UCLA score, and ASES score between 2 groups before operation (P>0.05). The function scores in the conservation group were better than those in the operation group at 6 and 12 months after operation (P<0.05). There were significant differences in the ROM of shoulder between pre- and post-operation in 2 groups (P<0.05). And there was no significant difference between 2 groups at pre- and post-operation (P>0.05).ConclusionFor patients with bilateral rotator cuff tears, the unilateral rotator cuff repair can aggravate the rotator cuff tear of contralateral shoulder.

双侧颞叶癫痫

颞叶癫痫（Temporal lobe epilepsy，TLE）是最常见的限局性癫痫，药物治疗效果差，因此是癫痫外科治疗的主要类型。但标准前颞切除后 1～2 年无发作率仅为 65%，其原因之一是双侧颞叶癫痫（Bilateral temporal lobe epilepsy，BTLE）。BTLE 的定义尚无统一标准，在临床及头皮脑电图可发现有 BTLE 的可能，颅内电极尤其是立体定向脑电图在确定 BTLE 方面起决定性作用。BTLE 的确切发生率尚不了解，在 TLE 大约 30%～40% 为 BTLE。双侧颞叶间有功能性相互密切联系，一侧颞叶病变或功能异常很容易影响对侧颞叶，逐渐形成 BTLE。BTLE 几乎均为药物难治的，在精准定位定侧的情况下，如能证实发作的 50%～80% 以上起于一侧，神经心理检查对侧颞叶功能适当，无颞外症状，行一侧颞叶切除 30% 预后好。对 BTLE 尚有很多需深入研究的问题，尤其是外科治疗的适应证及预后。今后应深入开展多中心大样本前瞻性研究。

Prospective Randomised Neurocognitive Study of Unilateral and Bilateral Antegrade Selective Cerebral Perfusion for Total Aortic Arch Replacement

ObjectiveTo compare the cerebral protective effect of unilateral and bilateral antegrade selective cerebral perfusion during total aortic arch replacement, particularly with respect to neuropsychological outcome.MethodsFrom June 2003 to March 2004, 16 patients who underwent total aortic arch replacement were randomly allocated to one of two methods of brain protection: unilateral antegrade selective cerebral perfusion (unilateral group, n =8) or bilateral antegrade cerebral perfusion (bilateral group, n =8). Preoperative and postoperative neurological examination, brain computed tomography(CT) scan, and cognitive function tests were performed.ResultsAll patients survived the operations and were discharged from hospital. No new brain infarction occurred. Transient neurologic dysfunction occurred in 1 patient of each group. There were no intergroup differences in the scores of preoperative and post operative cognitive function ( P gt;0.05).ConclusionBoth methods of brain protection for patients undergoing total aortic arch replacement result in favorable and similar effect of brain protection in term of cognitive function provided the circle of Willis is patent and collateral flow is adequate.