目的 總結(jié)應(yīng)用人工補片胸壁重建治療胸壁巨大缺損的療效。 方法 2002 年1 月－ 2008 年10 月，收治14 例胸壁腫瘤患者。男10 例，女4 例；年齡28 ～ 67 歲，平均45 歲。原發(fā)性腫瘤11 例，轉(zhuǎn)移性腫瘤3 例。腫瘤位于前胸壁5 例，后胸壁3 例，側(cè)胸壁6 例。病程20 ～ 270 d?；颊呔袛U大根治切除術(shù)，切除2 ～ 5 根肋骨，胸壁缺損范圍9 cm × 7 cm ～ 17 cm × 12 cm，采用單層或雙層Marlex 網(wǎng)片結(jié)合自體肌肉瓣覆蓋重建胸壁。 結(jié)果 患者均順利完成手術(shù)。術(shù)后切口均Ⅰ期愈合。胸壁無明顯反常呼吸。14 例均獲隨訪，隨訪時間13 ～ 26 個月，平均21 個月。隨訪期間未出現(xiàn)與材料有關(guān)的宿主反應(yīng)。患者胸壁無明顯畸形，外觀良好，呼吸運動時胸壁重建處無不適。1 例因腫瘤復(fù)發(fā)伴肝臟轉(zhuǎn)移死亡。 結(jié)論 人工補片胸壁重建治療胸壁巨大缺損安全、有效。
【摘要】 目的 觀察激素加霉酚酸酯（mycophenolate mofetil，MMF）和他克莫司（tacrolimus，F(xiàn)K506）的多靶點方案治療難治性腎小球疾病的療效及安全性。 方法 2008年5月-2010年3月收治的15例狼瘡性腎炎（lupus nephritis，LN）、3例膜增生性腎小球腎炎（membranoproliferative glomerulonephritis，MPGN）及3例膜性腎?。╩embranous nephropathy，MN）患者，因多種免疫抑制劑治療無效或復(fù)發(fā)而改用多靶點療法。潑尼松以30~40 mg/d起始，逐漸減量。MMF 和FK506起始劑量分別為0.5 g/d或1 mg/d，目標血藥濃度分別為20~40 mg/（h·L）或5~8 ng/mL。定期隨訪觀察肝腎功能、尿蛋白定量、不良反應(yīng)等指標?！〗Y(jié)果 治療6個月時15例LN中7例（46.7%）完全緩解（complete remission，CR），5例（33.3%）部分緩解（partial remission，PR），3例（20%）無效（no response，NR）。3例MPGN均表現(xiàn)為NR。3例MN中2例（66.7%）PR，1例（33.3%）NR。治療過程中呼吸道感染及脫發(fā)各1例，胃腸不適2例，肌酐逐步升高3例，無死亡或退出者?！〗Y(jié)論 多靶點療法對難治性LN安全、有效，可作為其他免疫抑制劑治療無效或復(fù)發(fā)時的選擇方案，但對MPGN和MN療效欠佳，需進一步研究?！続bstract】 Objective To investigate the efficacy and safety of multitarget therapy with steroid, mycophenolate mofetil (MMF) and tacrolimus (FK506) in the treatment of refractory glomerular diseases. Methods Fifteen patients with lupus nephritis (LN), 3 patients with membranoproliferative glomerulonephritis (MPGN) and 3 patients with membranous nephropathy (MN) who failed the previous immunosuppressive therapy from May 2008 to March 2010 in our hospital were treated with multitarget therapy. The initial dose of prednisone was 30-40 mg/d and then tapered gradually. MMF and FK506 were started at 0.5 g/d or 1 mg/d, and the target blood concentration of the two drugs was 20-40 mg/(h·L) and 5-8 ng/mL respectively. Clinical parameters such as liver and renal function, urine protein, and side effects were recorded and analyzed in the regular follow-up. Results After 6 months of treatment, 7 (46.7%) of the 15 LN patients achieved complete remission (CR), 5 (33.3%) achieved partial remission (PR), while 3 (20%) failed this treatment and had no response (NR). All of the three MPGN patents had NR to this combined therapy. Two (66.7%) of the 3 MN patents achieved PR while 1 (33.3%) had NR. No patient withdrew or died because of side effects. One patient developed upper respiratory infection, one experienced alopecia, two developed gastrointestinal syndrome and three experienced gradual increasing in the serum creatinine. Conclusion Multitarget therapy with FK506, MMF and steroid is an effective and safe therapy for refractory lupus nephritis and it can be used in patients who are resistant to the conventional immunosuppressive therapy. However, this combined therapy does not meet a satisfactory result in patients with MN and MPGN, which entails further study.