RESUMO
Objective To compare the clinical efficacy of the flaps of modified Limberg and direct incision followed by suture in the treatment of sacrococcygeal pilonidal sinus,aiming to provide the academic guide for its clinical surgery.Methods A total of 76 patients suffered from sacrococcygeal pilonidal sinus were treated with two surgical methods in Department of General Surgery and Department of Burn and Plastic Surgery in Sixth Medical Center of PLA General Hospital from 2013 to 2017.Among these patients,37 cases were resected and reconstructed using the flaps of modified Limberg,the other 39 cases were sutured after beingresected.These patients were followed up during the next 1 or 2 years.Five indexes including surgery period,length of hospital stay,postoperative infection,recurrence and complication,were investigated to statistically compare two different surgery methods' efficacy,using independent t test or chi-square test respectively.Results There were 76 patients in the Limberg flap group and the direct suture group,the operation time was about one and a half hours,and the hospitalization time was about 15 days (P＞0.05);there was no statistical difference between them.There were no complications in 35 of the 37 patients in the Limberg flap group,but skin cracking and infection in 2 patients.In the direct suture group,there were 39 patients,16without complications and 23 with complications,(x2=1133.2393,P=0.0000);there were statistical differences.Among the 37 patients in the Limberg flap group,only one recurred;among the 39patients in the direct suture group,9 recurred (x2=1192.9211,P=0.0000);there were statistical differences.Conclusions Limberg flap incision shows good healing and fewer complications.Within the group of Limberg flap incision healing,only few cases of recurrences occur after the surgery.It not only effectively reduce the complication rate in patients,but also release the pain from long-term,reduplicated medication.The author proposes that this operation should be promoted in the future clinical practice.
RESUMO
Objective To explore the influence of excessive PTEN expression to fibroblast cycle and collagen secretion induced by LPS.Methods Normal skin fibroblast in the patient with hyperplastic scar were cultured in vitro.When the primary culture was close to 80% fusion,the digestive passage was performed,cultured to the third generation.LPS(0.5 μg/mL) was adopted to stimulate the third generation of normal skin fibroblasts.Defective adenovirus carrying PTEN gene was transfected to the third passage fibroblasts after LPS stimulation.Flow cytometer was adopted to detect the cell cycle.ELISA method was adopted to detect the secreted collagen amont.Results Excessive PTEN expression could inhibit the increase of G2M cell cycle induced by LPS.LPS stimulation could increase the secretion of collagen in skin fibroblasts,yet excessive PTEN expression could inhibit the secretion of collagen induced by LPS.Conclusion LPS could increase the amont of fibroblasts on G2M cell cycle and secretion of collagen,yet excessive PTEN expression can inhibit the effect.
RESUMO
Objective To explore the effects on image quality and dose reduction to the lens when using bismuth shielding in head and neck MSCT.Methods The standard phantom and the cadaveric head with none,1,2 and 3 layers of bismuth shielding were scanned with protocols of brain,temporal bone and paranasal sinuses using a 16-MDCT scanner.The organ dose to the lens in each scanning was measured with thermoluminescence dosimeters(TLD).The above scanning with sinus protocol was repeated with a sponge with thickness of 5,10,15 and 20 mm placed between the shielding and phantom/head.The CT attenuation of phantom with the distance of 2,4,6 and 8 cm to shielding were measured.The image quality was subjectively evaluated by 2 physicians.Results The organ doses of the lens with protocols of brain,temporal bone and sinuses were 24.31,27.60 and 20.01 mGy,respectively.The doses were decreased significantly when using bismuth shielding.With the increase of the shield gap,the degree of dose reduction was reduced,but the increasing degree of CT attenuation significantly reduced.Using 2-layer and 3-layer bismuth shield in brain and temporal bone CT scan,the radiation doses were reduced by 47.1％ and 59.1％,respectively while maintaining the diagnostic image quality.Using 1-layer shield without gap and 2-layer shield with 1.5 cm gap in sinus CT,the radiation doses were reduced by 31.5％ and 34.5％,respectively.Conclusions Reasonable usage of bismuth shielding can effectively reduce the radiation dose to the lens of eye in head and neck MSCT.