OBJECTIVE: To probe into the clinical manifestation, diagnosis, as well as treatment of pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester. METHODS: Analysis of 14 p...OBJECTIVE: To probe into the clinical manifestation, diagnosis, as well as treatment of pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester. METHODS: Analysis of 14 patients with pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester was made after conservative treatment by drugs from January 1996 to December 1999. RESULTS: The 14 patients with a pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester were painless, had slight vaginal bleeding, and concurrently had increased serum beta-subunit human chorionic gonadotropin (beta-HCG). Doppler ultrasonic examination revealed an obvious enlargement of the previous cesarean section cicatrix in the uterine isthmus, and found a gestational sac or mixed mass attached to the cicatrice, with a very thin myometrium between the gestational sac and bladder walls. Among the 14 patients, 12 patients had crystalline trichosanthes injected into the cervix, mifepristone taken orally, or methotrexate in the form of intramuscular injection. Following this procedure, their serum beta-HCG dropped to normal. The other 2 patients had a total hysterectomy. CONCLUSIONS: Pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester is a complication of cesarean section. Early diagnosis and effective conservative treatment by drugs are instrumental in decreasing the potential occurrence of uterine rupture, which is also conducive to preserving the patient's future fertility.展开更多
目的探讨在四肢关节周围急性皮肤软组织裂伤修复中,基于倒刺缝线的深部定向减张缝合联合表皮美容缝合技术的应用效果。方法采用回顾性队列研究,纳入2021年6月至2025年6月我院急诊科收治的88例四肢关节周围急性皮肤软组织裂伤患者。根据...目的探讨在四肢关节周围急性皮肤软组织裂伤修复中,基于倒刺缝线的深部定向减张缝合联合表皮美容缝合技术的应用效果。方法采用回顾性队列研究,纳入2021年6月至2025年6月我院急诊科收治的88例四肢关节周围急性皮肤软组织裂伤患者。根据伤口缝合方式分为改良组(44例,采用倒刺缝线深部定向减张联合美容缝合)与传统组(44例,采用传统间断减张联合常规缝合)。通过倾向评分匹配控制基线差异。主要结局指标为术后1、3、6个月的温哥华瘢痕量表(Vancouver scar scale,VSS)和患者与观察者瘢痕评价量表(patient and observer scar assessment scale,POSAS)评分。次要指标包括并发症发生率、关节活动度恢复率、患者满意度及肢体特异性功能评分,其中上肢采用上肢功能障碍评分量表(disabilities of the arm,shoulder and hand,DASH)缩略版(QuickDASH)评分,下肢采用膝关节协会评分(Knee Society score,KSS)或美国足踝外科学会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足功能评分。采用重复测量方差分析进行动态比较;采用单因素及多元线性回归分析探讨影响瘢痕质量的独立因素。结果改良组术后各时间点VSS及POSAS评分均显著低于传统组(P<0.001)。多元回归分析显示,采用改良技术是获得优良瘢痕的独立预测因素(β=-3.85,P<0.001)。改良组的总体并发症发生率(6.8%)显著低于传统组(29.5%),术后2周关节活动度恢复>75%患者的占比、肢体功能评分及患者满意度均显著增高(P<0.05)。亚组分析表明,该技术对高张力部位(如关节伸侧)的瘢痕改善效果尤为显著。结论对于四肢关节周围外伤,采用深部定向减张缝合联合美容缝合的改良技术,能有效改善瘢痕质量,降低并发症风险,促进早期功能恢复,提高患者满意度,尤其适用于高张力伤口,是一种更具优势的修复策略。展开更多
缝合是外科的基本操作,随着公众对于瘢痕的认识不断加深,临床中对美容缝合技术的需求日益增加,而减张缝合是实现美容缝合的重要途径之一。本文系统综述了减张缝合技术的原理,常用方法及各方法的适应症,重点探讨了LBD减张缝合(looped,bro...缝合是外科的基本操作,随着公众对于瘢痕的认识不断加深,临床中对美容缝合技术的需求日益增加,而减张缝合是实现美容缝合的重要途径之一。本文系统综述了减张缝合技术的原理,常用方法及各方法的适应症,重点探讨了LBD减张缝合(looped,broad,and deep buried suturing technique)、合肥缝合法、章氏超减张缝合、皮下心形缝合等技术的操作要点、优势及应用范围。同时,还介绍了超减张缝合在面部外伤修复、体表肿物切除及瘢痕修复等整形美容手术中的应用,旨在为整形美容外科医生提供相应的技术参考,推动超减张缝合技术在整形美容领域的更广泛应用和进一步发展。通过系统检索PubMed、Web of Science、IEEE Xplore及CNKI数据库(2015-2025年),采用复合关键词(“suture”or“suture method”)联合功能化术语(“scar”),限定文献类型为临床研究、临床试验、Meta分析、多中心研究或观察性研究。初筛共获得2262篇文献,经去重及标题/摘要筛选后,根据纳入与排除标准①纳入前瞻性、回顾性临床研究、多中心临床研究,Meta分析以及与缝合方法密切相关的基础研究;②研究主题聚焦整形外科缝合技术;③中、英文全文可获取,最终纳入246篇核心文献进行综述。结果表明,在选择伤口缝合材料和缝合技术时,必须考虑许多因素,包括伤口张力、伤口边缘外翻的期望、所需的止血、修复类型、患者护理伤口和返回拆线的能力、皮肤完整性和伤口位置。仔细考虑这些因素并正确执行缝合技术是获得理想美容效果的重要保障。展开更多
文摘OBJECTIVE: To probe into the clinical manifestation, diagnosis, as well as treatment of pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester. METHODS: Analysis of 14 patients with pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester was made after conservative treatment by drugs from January 1996 to December 1999. RESULTS: The 14 patients with a pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester were painless, had slight vaginal bleeding, and concurrently had increased serum beta-subunit human chorionic gonadotropin (beta-HCG). Doppler ultrasonic examination revealed an obvious enlargement of the previous cesarean section cicatrix in the uterine isthmus, and found a gestational sac or mixed mass attached to the cicatrice, with a very thin myometrium between the gestational sac and bladder walls. Among the 14 patients, 12 patients had crystalline trichosanthes injected into the cervix, mifepristone taken orally, or methotrexate in the form of intramuscular injection. Following this procedure, their serum beta-HCG dropped to normal. The other 2 patients had a total hysterectomy. CONCLUSIONS: Pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester is a complication of cesarean section. Early diagnosis and effective conservative treatment by drugs are instrumental in decreasing the potential occurrence of uterine rupture, which is also conducive to preserving the patient's future fertility.
文摘目的探讨在四肢关节周围急性皮肤软组织裂伤修复中,基于倒刺缝线的深部定向减张缝合联合表皮美容缝合技术的应用效果。方法采用回顾性队列研究,纳入2021年6月至2025年6月我院急诊科收治的88例四肢关节周围急性皮肤软组织裂伤患者。根据伤口缝合方式分为改良组(44例,采用倒刺缝线深部定向减张联合美容缝合)与传统组(44例,采用传统间断减张联合常规缝合)。通过倾向评分匹配控制基线差异。主要结局指标为术后1、3、6个月的温哥华瘢痕量表(Vancouver scar scale,VSS)和患者与观察者瘢痕评价量表(patient and observer scar assessment scale,POSAS)评分。次要指标包括并发症发生率、关节活动度恢复率、患者满意度及肢体特异性功能评分,其中上肢采用上肢功能障碍评分量表(disabilities of the arm,shoulder and hand,DASH)缩略版(QuickDASH)评分,下肢采用膝关节协会评分(Knee Society score,KSS)或美国足踝外科学会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足功能评分。采用重复测量方差分析进行动态比较;采用单因素及多元线性回归分析探讨影响瘢痕质量的独立因素。结果改良组术后各时间点VSS及POSAS评分均显著低于传统组(P<0.001)。多元回归分析显示,采用改良技术是获得优良瘢痕的独立预测因素(β=-3.85,P<0.001)。改良组的总体并发症发生率(6.8%)显著低于传统组(29.5%),术后2周关节活动度恢复>75%患者的占比、肢体功能评分及患者满意度均显著增高(P<0.05)。亚组分析表明,该技术对高张力部位(如关节伸侧)的瘢痕改善效果尤为显著。结论对于四肢关节周围外伤,采用深部定向减张缝合联合美容缝合的改良技术,能有效改善瘢痕质量,降低并发症风险,促进早期功能恢复,提高患者满意度,尤其适用于高张力伤口,是一种更具优势的修复策略。
文摘缝合是外科的基本操作,随着公众对于瘢痕的认识不断加深,临床中对美容缝合技术的需求日益增加,而减张缝合是实现美容缝合的重要途径之一。本文系统综述了减张缝合技术的原理,常用方法及各方法的适应症,重点探讨了LBD减张缝合(looped,broad,and deep buried suturing technique)、合肥缝合法、章氏超减张缝合、皮下心形缝合等技术的操作要点、优势及应用范围。同时,还介绍了超减张缝合在面部外伤修复、体表肿物切除及瘢痕修复等整形美容手术中的应用,旨在为整形美容外科医生提供相应的技术参考,推动超减张缝合技术在整形美容领域的更广泛应用和进一步发展。通过系统检索PubMed、Web of Science、IEEE Xplore及CNKI数据库(2015-2025年),采用复合关键词(“suture”or“suture method”)联合功能化术语(“scar”),限定文献类型为临床研究、临床试验、Meta分析、多中心研究或观察性研究。初筛共获得2262篇文献,经去重及标题/摘要筛选后,根据纳入与排除标准①纳入前瞻性、回顾性临床研究、多中心临床研究,Meta分析以及与缝合方法密切相关的基础研究;②研究主题聚焦整形外科缝合技术;③中、英文全文可获取,最终纳入246篇核心文献进行综述。结果表明,在选择伤口缝合材料和缝合技术时,必须考虑许多因素,包括伤口张力、伤口边缘外翻的期望、所需的止血、修复类型、患者护理伤口和返回拆线的能力、皮肤完整性和伤口位置。仔细考虑这些因素并正确执行缝合技术是获得理想美容效果的重要保障。
