在口腔修复临床上,对固定修复制取的印模在模型灌注过程中使用"切龈术",使牙体预备的肩台在灌制的石膏模型上直接暴露,可使技师在石膏代型颈缘修整时更直观、容易操作,从而提高固定修复体龈下颈缘密合度,增加固定修复一次修复成功率。

Intheprocessofmakingsubgingivalcervicalmarginalmatrix,gingivalexcisiononthematrixesmadethebutmentbareatcervi-cal and could help technician trim matrix more easily and directly.By this way subgingival marginal adaptation of the fixed crown can be pro-moted,concurrently increase the success rate of finishing the fixed prosthesis one-off.

目的为颈椎前路减压手术在有限显露术野中达到安全、有效减压提供更科学的减压标志。方法在15具成人尸体标本上,解剖观测C3~7节段相关解剖数据,以所测量的数据为基础,计算:(1)椎体钩前脚至颈长肌内侧缘的距离/颈长肌内侧缘至正中矢状面的距离(AULD/MLPD);(2)椎体钩前脚至横突孔内侧缘的距离/椎体钩前脚至颈长肌内侧缘的距离(AUTD/AULD);(3)椎体钩前脚至硬膜囊外侧缘的垂直距离/椎体钩后脚至硬膜囊外侧缘的距离(AUDD/PUDD)和(4)椎体钩与神经根最近点和椎体钩前脚的垂直距离/椎体钩前后脚的垂直距离(UNAD/APUD)。结果 AULD/MLPD在C3的平均值为0.83,在C4的平均值为0.55,在C5的平均值为0.20,在C6的平均值为0.34,在C7的平均值为0.27;AUTD/AULD的平均值为2.71;AUDD/PUDD的平均值为0.28;UNAD/APUD的平均值为0.34。结论椎体钩前脚是颈椎体前部恒定的解剖标志,可作为颈椎前路手术的稳定、可靠的骨性减压标志,依据AUDD/PUDD、UNAD/APUD和AUTD/AULD的比值,有助于术中判断硬膜囊、颈神经根和椎动脉的位置。

Objective The primary purpose of the current study is to provide more scientific landmarks for safe and efficient decompression within limited operating field in cervical anterior decompression. Methods Relative data were observed and measured at C3~7 of 15 adult cadaveric specimens and some data were calculated basing on above data:the ratio of anterior crus of uncinate process-medial border of longus colli muscle distance and medial border of longus colli muscle-median sagittal plane distance(AULD/MLPD), the ratio of anterior crus of uncinate process- medial border of foramen transversarium distance and anterior crus of uncinate process-medial border of longus colli muscle distance (AUTD/AULD), the ratio of anterior crus of uncinate process-lateral border of dural sac perpendicular distance and posterior crus of uncinate process-lateral border of dural sac distance(AUDD/PUDD), and the ratio of the nearest point of uncinate process and nerve root-anterior crus of uncinate pr

目的 探讨胰颈切缘阳性的胰头腺癌行全胰十二指肠切除术的临床疗效.方法 回顾性分析2009年8月至2014年5月福建医科大学附属协和医院收治的15例胰颈切缘阳性的胰头腺癌患者的临床资料.15例患者均先行标准的胰十二指肠切除术,胰颈切缘及胰腺远端1 cm切缘术中病理学检查为阳性,则行全胰十二指肠切除术.通过门诊或电话随访,随访时间截至2014年8月.结果 15例患者均成功施行全胰十二指肠切除术,手术时间为4.0～10.0 h,平均手术时间为6.5h,出血量为300～2 000 mL,平均出血量为800 mL,术后住院时间为13.0 ～35.0 d,平均术后住院时间为22.3 d.术后并发肺部感染3例、腹腔感染2例、低血糖2例,无围手术期死亡,无胆汁漏、胃肠吻合口瘘等.术后予胰岛素、胰酶替代治疗,大部分患者血糖控制良好,无腹痛、脂肪泻等不适,无营养不良.术后平均随访时间21个月（3个月至5年）.生存时间＜1年3例、1～2年2例、＞2年5例、＞5年1例,4例随访＜6个月仍生存至随访截止时间.其中5例术后6个月内发生肝转移.结论 全胰十二指肠切除术是胰颈切缘阳性的胰头腺癌达到R0切除的必要术式.

Objective To investigate the clinical efficacy of total pancreaticoduodenectomy for the pancreatic head adenocarcinoma with positive neck margin.Methods The clinical data of 15 patients with pancreatic head adenocarcinoma and had positive neck margin who received total pancreaticoduodenectomy at the Union Hospital of Fujian Medical University from August 2009 to May 2014 were retrospectively analyzed.Patients were followed up by out-patient examination or telephone interview till August 2014.Results Total pancreaticoduodenectomy was successfully carried out on the 15 patients.The operation time was 4.0-10.0 hours (mean,6.5 hours),and the volume of blood loss was 300-2 000 mL (mean,800 mL).The duration of postoperative hospital stay was 13.0-35.0 days (mean,22.3 days).The main postoperative complications included pulmonary infection (3 cases),abdominal infection (2 cases)and low blood glucose (2 cases).No interoperative death,bile leakage or gastrointestinal anastomotic fistul

目的应用CT三维重建测量技术对寰椎侧块螺钉置入的相关参数进行测量,研究影响置钉的解剖结构因素。方法从我院行头颈CT血管造影扫描的患者中选取头颈部未见异常者305例,利用其CT影像数据进行寰椎三维数字化重建,测量与寰椎侧块置钉相关的解剖学数据,并分析颈内动脉对寰椎侧块置钉的影响。结果寰椎后弓下缘侧块高度为（4.53±0.90）mm,其中小于3.5mm的占11.5%。后弓下缘侧块宽度为（9.38±1.21）mm,钉道最大内倾角为（26.69±3.31）°,钉道最大长度为（22.56±2.10）mm,内倾角为0°的钉道长度为（15.75±1.77）mm。颈内动脉与寰椎侧块的最短距离为（3.52±1.36）mm,钉道与颈内动脉内缘相切时钉道内倾角为（-9.62±7.26）°,其中有6.7%大于0°,最大值为8.3°。结论寰椎后弓下缘侧块高度为侧块螺钉固定的主要解剖限制性因素,在一定范围内采用适当的内倾角度可增加寰椎侧块的钉道长度,采用10°的内偏钉道有利于避免侧块螺钉对颈内动脉的损伤。

Objective To measure the relevant parameters of atlantal lateral mass screw fixation using CT three-dimen-sional reconstruction measurement technology, and to study the anatomical structure factors which can influence the screw placement.Methods A total of three hundred and five cases who were performed computed tomography angiography in head and neck without any pathology of craniocervical junction were selected.Their axial images were used to reconstruct 3D model of atlas and to measure the anatomical structure data of the atlantal lateral mass screw fixation,and to analyze the effect of loca-tion of the internal carotid artery on the lateral mass screw insertion.Results The height of the lateral mass at the inferior mar-gin of the posterior arch was (4.53±0.90)mm,11.5% of which were less than 3.5 mm.The width of the lateral mass at the inferior margin of the posterior arch was (9.38±1.21)mm,the largest leaning angle of the screw trajectory was (26.69± 3.31)°,the larges

目的：探讨LEEP术后切缘阳性的高级别子宫颈上皮内瘤变（CIN）绝经前患者病灶残留的相关因素，为进一步诊疗提供依据。方法收集初次LEEP术切缘阳性并行二次手术的51例高级别CIN、绝经前患者的临床资料，并对其病灶残留及相关因素进行分析。结果二次手术患者术后病理提示CIN共19例，其病灶残留率为37.2%。年龄≤35岁者病灶残留率为17.6%，年龄＞35岁为47.1%，两者之间差异明显（P＜0.05）。术前子宫颈脱落细胞(LBC)检测提示高度上皮内病变的病灶残留率明显高于低度上皮内病变组（P＜0.05）。颈管搔刮物中提示病变存在者病灶残余率约72.7%，高于颈管搔刮物阴性者（P=0.006）。多因素logistic回归分析发现，LBC提示高度上皮内病变及颈管搔刮物阳性是与初次锥切切缘阳性病灶残留高度相关因素，其危险度分别为3.258、7.064。对51例二次手术患者随访至2013年6月，共2例复发，占3.92%。结论患者年龄、LBC结果及颈管搔刮物阳性与初次手术病灶残留有相关性，对于此类患者应予以高度重视。

Objective To investigate the risk factors of residual lesions in patients with high- grade cervical intraepithelial neoplasia (CIN) of positive resection margins after loop electrosurgical excision procedure(LEEP). Methods The clinical data of 51 premenopausal patients with high- grade CIN undergoing LEEP from January 2007 to June 2012 at Affiliated Shaoxing Hospi-tal were retrospectively analyzed. Al patients had positive resection margins in initial conization and underwent second surgery. The risk factors of residual lesions were analyzed. Results Histopathological results of the second operation showed that 19 cases out 51 patients (37.2%) had residual disease. The residual disease rate in patients aged≤35 year was 17.6% , while in those>35y was 47.1%(P 35 years, LBC showing ASC- H and HSIL and endocervical curettage suggesting CIN are risk factors associat-ed with residual lesions in patients with high- grade CIN of positive margins after LEEP.