【摘要】 目的 觀察綜合治療體表血管瘤及脈管畸形的臨床療效。 方法 2008年1月-2010年9月，收治體表血管瘤和脈管畸形患者共205例。手術治療156例，其中單純手術治療103例，合并介入治療9例，硬化劑治療44例；非手術治療49例，其中介入治療1例，硬化劑治療38例，介入合并硬化劑治療10例。術后隨訪6個月～3年。 結果 15例手術治療患者于術后6個月～2年復發，其中單純手術治療患者10例（復發率9.71%），合并介入治療患者2例（復發率22.22%），合并硬化劑治療患者3例（復發率6.82%），均再次手術治療后痊愈。9例非手術治療患者于治療后3個月～2年復發，其中8例硬化劑治療患者，1例介入合并硬化劑治療患者，均經手術治療后痊愈。余患者未見復發。 結論 以手術治療為主的綜合治療，是體表血管瘤和脈管畸形治療的良好方法。【Abstract】 Objective To observe the clinical therapeutic efficacy of comprehensive treatment on body surface hemangioma and vascular malformations. Methods Between January 2008 and September 2010, 205 pateints with surface hemangioma and vascular malformation were treated. A total of 156 patients received surgical treatment, in whom 103 received surgery alone, 9 underwent combined interventional treatment, and 44 received combined sclerotherapy. There were 49 patients underwent non-surgical treatment, including intervention in 1, sclerotherapy in 38 involving 10 had combined sclerotherapy. The patients were followed up for 6 months to 3 years. Results A total of 15 patients who had received surgical treatment recurred 6 months to 2 years after the treatment, including 10 who had been treated with surgery alone (with the recurrence rate of 9.71%), 2 combined with interventional treatment (with the recurrence rate of 22.22%), and 3 combined with sclerotherapy (with the recurrence rate of 6.82%). They were all cured after reoperation. Nine cases of non-surgical treatment recurred 3 months to 2 years after the treatment, including 8 who had received sclerotherapy, and 1 combined with interventional treatment and sclerotherapy. Patients were all cured after surgery. The other patients had no recurrence. Conclusion Applying mainly on surgical treatment, the combined therapy is a good way for body surface hemangioma and vascular malformations.
改革教學模式，激發學習興趣，提高教學質量是教師的責任，也是教師孜孜不倦的追求。針對醫學免疫學教學中存在的問題，交替采用比喻法、探究法、討論法、設問引導法、案例法等多種教學方法和形式，改進教學效果，增強學生的學習興趣和學習積極性，使教學質量顯著提高，并受到廣大學生的一致肯定和好評。
Objective To investigate the effectiveness of free anterolateral thigh flap (ALTF) with fascia lata in repairing diabetic foot ulcers (DFUs) with bone exposure. Methods Between January 2019 and January 2021, 20 patients with DFUs with bone exposure were admitted. There were 17 males and 3 females with a median age of 57.5 years (range, 48-76 years). There were 10 cases of Wagner grade 3 and 10 cases of grade 4. The DFUs formed 1 to 14 months, with a median time of 3 months. The patients underwent CT angiography, which showed extensive atherosclerosis in both lower limbs; 6 of them were severely narrowed or occluded and underwent percutaneous transluminal angioplasty. The size of wound ranged from 7 cm×6 cm to 27 cm×10 cm after applied first-stage debridement combined with vacuum sealing drainage treatment. In the second-stage, free ALTF with fascia lata was used to repair wounds and partial defects of tendons. The size of flap ranged from 8 cm×5 cm to 28 cm×11 cm. The wound of the donor site was sutured directly. The survival of the flap, the healing time of the wound, and the complications were recorded. The laser speckle blood flow imaging system was used to detect the blood perfusion of the flap and the skin around the flap at 2 weeks and 6 months after operation. The foot function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score at 6 months after operation. Results After operation, effusion under the flap happened in 6 cases, which cured after symptomatic treatment. Flaps survived completely in 14 cases. The tissue necrosis at the edges of the flaps occurred in 3 cases and healed after dressing changes. Venous crisis of flaps occurred in 3 cases, of which 1 case was completely necrotic after exploration, and the other 2 cases were partially alive. The wounds of 3 cases were repaired with skin grafts after debridement and dressing. The flap survival rate was 95.0%, and the limb salvage rate was 100%. The wound healing time after flap transplantation was 14-30 days, with an average of 19.1 days. Two patients had recurrence of peripheral skin ulcers of the flaps within 1 month after healing, which healed after conservative dressing changes. Eighteen cases of incisions at donor site healed by first intention, 2 cases had local skin necrosis and healed by debridement and suture. All patients were followed up 6-30 months, with a median time of 11 months. The texture, appearance, and elasticity of the flaps were good. All patients could walk alone without pain. At 6 months after operation, the AOFAS score was 75.9±11.9, which was significantly different from that (44.7±18.4) before operation (t=?7.025, P=0.000). The blood perfusion value increased from (38.1±7.8) PU at 2 weeks to (42.7±10.3) PU, and the difference was significant (t=?4.680, P=0.001). Conclusion Free ALTF with fascia lata has a rich blood supply and a high survival rate. It can be used to repair DFUs with bone exposure. After the free skin flap healed, it can promote revascularization of the affected foot, reduce the probability of ulcer recurrence, and avoid amputation.