Objective To investigate a method of repairing hypospadias by combining buccal mucosal graft with scrotal flap and its therapeutic effect. Methods From March 2002 to December 2007, 42 patients with hypospadias underwent primary urethral reconstruction using buccal mucosal graft and scrotal flap. The patients ranged in age from 18 months to 18 years. There were 21 cases of penoscrotal type, 12 cases of scrotal type and 9 cases of perineal type. Among them,8 cases were at initial operation, and 34 cases suffered from the failure of hypospadias repair 6-19 months (average 10 months) after initial operation. During operation, the defect of urethra was 3-7 cm (average 4.2 cm) when the penis was straightened; the buccal mucosa (3.0 cm × 1.2 cm-7.0 cm × 1.5 cm) was transplanted to the tunica albuginea in the ventral aspect of the penis, and was paired with the scrotal flap (3.0 cm × 1.5 cm-7.0 cm × 1.5 cm) to repair urethra. Results The incision of 38 cases healed by first intention, and no compl ication occurred. At 7 days after operation, 4 cases had urinary fistula at either coronary sulcus or anastomotic stoma, one of which spontaneously closed 2 months after operation and the rest 3 recovered by repairing urinary fistula 6 months after operation. All patients were followed for 3-48 months (average 18 months). Urination was smooth, the reconstructed urethral opening was at the tip of glans peins without retraction and with apperance similar to the normal urethral opening. The appearance of penis and scrotum was satisfying, and the penis was straightened completely. Conclusion Combined buccal mucosal graft and scrotal flap, with considerable tissue for uretha tract reconstruction and low incidence rate of urethral stricture, is one of the effective methods to repair hypospadias.
ObjectivesTo systematically review the efficacy and safety of palifermin on oral mucositis (OM) and acute graft versus host disease (aGVHD) for hematological malignancy patients undergoing hematopoietic stem cell transplantation (HSCT).MethodsPubMed, The Cochrane Library, Web of Science, EMbase, Clinicaltrials.gov, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) of the efficacy of palifermin on OM and aGVHD for hematological malignancy patients undergoing HSCT from inception to September 30th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 7 RCTs involving 904 patients were included. The results of meta-analysis showed that: palifermin could reduce the duration of OM grade 2 to 4 (MD=−4.21, 95%CI −7.83 to −0.58, P=0.02), OM grade 3 to 4 (MD=−2.54, 95%CI −4.61 to −0.46, P=0.02) significantly for hematological malignancy patients undergoing HSCT. However, no significant difference was found in the prevalence of aGVHD grade 2 to 4 (RR=1.29, 95%CI 0.95 to 1.75, P=0.11), aGVHD grade 3 to 4 (RR=0.99, 95%CI 0.55 to 1.77, P=0.97), OM grade 2 to 4 (RR=0.86, 95%CI 0.72 to 1.03, P=0.11) and OM grade 3 to 4 (RR=0.82, 95%CI 0.65 to 1.03, P=0.08) between palifermin group and placebo group. The prevalence of paresthesia (RR=4.24, 95%CI 1.24 to 14.56, P=0.02) and erythema (RR=1.49, 95%CI 1.06 to 2.09, P=0.02) were significantly higher in palifermin group.ConclusionsThe durations of OM grade 2 to 4, 3 to 4 are significantly reduce in patients receiving palifermin compared with those receiving a placebo, however, no statistically significant difference are found in the incidence of aGVHD grade 2 to 4, 3 to 4, OM grade 2 to 4, 3 to 4. Parethesia and erythema are more prevalent among patients using palifermin. Therefore, advantages and disadvantages of palifermin should be considered when used in clinical.
【摘要】目的探讨颌下腺移位术对预防急性放射性口腔黏膜反应及口干燥症的临床效果。方法2007年7月2009年6月间选择40例患者进行前瞻性临床对照研究。治疗组20例,在放疗前将颌下腺移位至颊下区。对照组20例不行颌下腺移位术。观察放疗中两组急性口腔黏膜反应,测定放疗前后唾液分泌量的变化,放疗后3个月进行口干燥程度问卷调查。结果治疗组急性口腔黏膜反应明显轻于对照组(Plt;0.05)。治疗组放疗后3个月移位术侧颌下腺摄取、排泌功能均明显较对照好,两组比较有统计学意义(Plt;0.05)。结论颌下腺移位术预防鼻咽癌放疗后口干燥症的临床近期疗效较好,可改善鼻咽癌患者放疗后的生活质量。
Objective To explore the feasibility of one-stage repair of hypospadias using the meatalbased flap overlapping with buccal mucosal graft. Methods From March 2002 to May 2004, 21 patients with hypospadias were treated with the meatal-based flap overlapping with buccal mucosal graft. Their ages ranged from 14 months to 8 years. The procedure were as follows:urethralplate at proximal corona was cut to correct glandular tilt and chordee; the buccal mucosa taking from inner cheek was then fixed on tunica albuginea of ventral shaft with suture; and the meatalbased flap was rotated distally and overlaid with buccal mucosal graft to repair urethra.Results All patients were followed up 318 months (7 months on average). A cosmetic glans and a vertically oriented, normal appearing slit meatus were achieved. Two patients had fistulas on lateral corona. Fistula spontaneously healed in 1 case and the other one was repaired after 6months. Conclusion The technique of meatal-based flap overlapping with buccal mucosal graft can completely correct glandular tilt and chordee, prove good cosmetic and functional glans and meatus.
Chemotherapy-induced mucositis, one of the most common complications of chemotherapy, can be subdivided in oral and gastrointestinal mucositis. The patients always suffer from oral pain and ulcers, nausea, vomiting, abdominal pain and diarrhea. 5-Fluorouracil- and irinotecan-based regimens are frequently associated with a higher risk and more severe grade of mucositis. The onset of mucositis is also influenced by the patient’s characteristics including age, sex, genetic polymorphisms, systemic comorbidities. At present, the diagnosis of chemotherapy-induced mucositis is mainly based on medical history, physical examination and gastroenteroscopy, lack of reliable biomarkers for early diagnosis. The principles of diagnosis and treatment mainly refer to the clinical practice guidelines issued. Therefore, this article will review the mechanism, diagnosis, latest preventive and treatment strategies of chemotherapy-induced mucositis for helping clinicians to further correctly understand and deal with the adverse reactions.
Objective To investigate the effect of vaginal reconstruction with autologous buccal micro-mucosa graft. Methods From March 2007 and April 2008, 10 patients with absence of vagina were treated, aged 18-31 years (mean 26 years). Nine of them were congenital absence of vagina, and the remaining one was vaginal stenosis after vaginal reconstruction.They all exhibited normal secondary sexual characteristics, normal hormonal levels and 46, XX karyotype. Their abdominal ultrasounography revealed the normal ovaries and tubes but absence of the uterus or small rudimentary horns. However the one with vaginal stenosis had normal uterus. The buccal mucosa graft was minced into 0.5 mm in size and was transplanted to the cavity which was dissected between the bladder and the rectum. Results The operation was performed successfully in all cases. The operative time was about 1-2 hours and operative blood loss was 80-100 mL. Postoperative compl ication occurred in only one case for vaginal bleeding. The patient recovered and the wound healed well after immediate management. The others healed primarily without any compl ications. All cases were followed up for 4-16 months. The depth of neovagina which was formed was 6-10 cm and the width was about two fingers. The l ining was pink-colored and smooth, and was confirmed as nonkeratizing squamous stratified mucosa by histopathological examination. The donor sites healed uneventfully with no change in mouth opening. The perineal area was not disturbed. Four patients were married and satisfied with their sexual l ife without pain and bleeding. Conclusion Vaginal reconstruction with autologous buccal micro-mucosa graft is an easy, minimally invasive and useful method.
Objective To investigate the growth of the tissue engineered mucosa after its heterotransplantation. Methods The epithelial cells and fibroblasts were isolated from a postoperative tissue of the 3month patient with labialcleft. The epithelial cells and fibroblasts were separately seeded on the polylactic／glycolic acid copolymer membrane, and then they were exposed to the air-liquid interface. Seven volunteer patients, whose traumatic beds were repaired with the tissue engineered oral mucosa. The biopsy tissue from one of the seven patients was observed under light icroscope 18 and 30 days after transplantation, respectively. Results The tissue engineered oral mucosa having 5-6 layers anticytoeratin staining positively cells in the epithelial layer and 3-7 layers anti-Cytoeratin staining negatively cells in the subepithelial layer grew well after the he terotransplantation. No differ ence could be found between the transplanting and normal areas. At 18 days, the epithelial layer and lamina propria grew well and the fibroblasts were found; at 30 days, collagen was obviously observed. The structures in both the transplanting and the normal areas were similar. Conclusion The tissue engineered oral mucosa can grow well after the heterotransplantation.
Objective To present method and experiences in using the buccal mucosa with the Snodgrass procedure for repair of hypospadias. Methods Between August 2012 and April 2015, 55 boys with hypospadias were treated with Snodgrass procedure combined with buccal mucosa. The age ranged from 1 to 7 years (mean, 4 years). There were 32 cases of distal penile type, 14 cases of proximal penile type, and 9 cases of coronal sulcus type. The buccal mucosa taking from inner cheek was fixed into the incised urethral plate. The urethral plate was tubularized over a catheter. Results All the patients were followed up 3-25 months (mean, 11 months). After operation, 1 patient had urethral stricture and fistula after repaired urethra was infected, and 5 patients had fistula. For the others, the urination was smooth, the appearance of penis was satisfying, the urethral stricture did not occur, and the penis was straightened completely. Conclusion Compared with traditional Snodgrass procedure, the application of buccal mucosa can increase the reconstruction material of urethral and reduce the stricture of the repaired urethra after operation.