摘要:目的: 評估手術、栓塞及γ刀綜合治療腦動靜脈畸形的療效。 方法 :回顧性分析了我科自2002年3月至2009年7月期間綜合治療的43例腦AVM患者,分析評估這43例腦AVM的臨床特點及治療效果,隨訪患者并對其進行GOS評分。 結果 :本組病例采取栓塞＋手術治療3例、栓塞＋γ刀治療26例、手術＋γ刀治療11例、栓塞+手術＋γ刀治療3例。術后隨訪28例,隨訪時間4月至7年6月,GOS評分5分者25例,患者均能重新回到工作或學校;GOS評分4分者2例,患者生活能夠自理;GOS評分1分者1例,患者死亡。 結論 :對大型、功能區、有深部靜脈引流的腦AVM綜合治療有一定的優越性,它不僅使腦AVM治愈率明顯提高,而且與治療相關的各種并發癥和病死率也明顯降低。Abstract: Objective: To evaluate the efficacy of multimodality treatment of cerebral arteriovenous malformations(AVMs) with surgery, embolization and γknife radiation. Methods : A retrospective analysis of 43 cases of cerebral AVMs applied with multimodality treatment in our department From March 2002 to July 2009 has been made, meanwhile we have analyzed and assessed the clinical characteristics and treatment outcome of these 43 patients with cerebral AVMs. Results : Patients received multimodality treatment with embolization followed by surgery(n=3), embolization followed by γknife radiation(n=26), surgery followed by γknife radiation(n=11), or embolization, surgery, and γknife radiation(n=3). Postoperative followup of 28 cases, the followup time is 4 months to 7 years and 6 months. GOS score 5 in 25 cases, who can be able to return to work or school. GOS score 4 in 2 cases, who can be able to live independently. GOS score 1 in 1 case, who is dead. Conclusion : In the cerebral AVMs which are large, or located within or immediately adjacent to eloquent regions of the brain, or have deep venous drainage, multimodality treatment has some superiority. It can not only improve the cure rate of cerebral AVMs significantly, but also reduce the treatmentrelated complications and mortality.
As a new discipline, the cardiac surgery has a great development in the modern age, but still faces many problems and disputes. The emergence of the evidence-based medicine(EBM),which emphasizes the best evidence, and combines the doctor’s clinical experience to make the best judgment, gives the development of the cardiac surgery a new thinking . Four systematic reviews published in The Cochrane Library (Issue 3, 2004) have interprated the importance of EBM on how to resolve the actual problems in different field of the cardiac surgery.
OBJECTIVE: To investigate the clinical effects of the microsurgical treatment for the skin-degloving injury of the whole hand or foot. METHODS: From March 1984 to October 2001, we treated 6 cases of skin-degloving injury of the whole hand and foot. In 2 cases of skin-degloving hands, one was treated with free great omentum transplantation plus skin graft, the other with pedical abdominal S-shaped skin flap as well as mid-thick skin graft. In 4 cases of skin-degloving injury of the foot, 2 cases was repaired with free latissimus dosi musculocutaneous flap, 1 case with distall-based lateral skin flap of the leg and 1 case with free tensor fasciae latae muscle flap. The flap size ranged from 7 cm x 9 cm to 22 cm x 15 cm. One case was operated on the emergency stage, the other 5 cases on the delayed stage. The delayed time ranged from 2 to 14 days with an average of 6.6 days. RESULTS: All the flaps survived. After 1-2 year follow-up, the appearance and function of the hand and the foot were good. CONCLUSION: Microsurgery technique in repairing skin-degloving injury of the whole hand and foot can achieve good results. The keys to success are thorough debridement of the recipient area, appropriate selection of the donor site, good vascular anastomosis and active postoperative rehabilitation.
摘要:目的:探討神經內鏡經單鼻腔蝶竇入路在切除垂體腺瘤中的臨床應用。 方法:對58例垂體腺瘤患者進行手術切除。應用神經內鏡直接自單鼻腔進入,暴露雙側蝶竇開口,打開蝶竇前壁進入蝶竇腔切除腫瘤。 結果: 腫瘤全部切除42例,約占 72%;次全切除16例,約占28%,無嚴重并發癥。結論:神經內鏡經單鼻腔蝶竇入路切除垂體腺瘤是一種更微創、暴露更好、并發癥少的手術方式。Abstract: Objective: To investigate the clinic application of endoscopic end nasal transsphenoidal surgery for pituitary tumors. Methods: 58 patients were treated. A endoscope was used to open the anterior wall of the sphenoid sinus and resected tumors. Results: 42 cases (72%) underwent total resection, 16 cases (28%) underwent subtotal resection. No severe complications was found. Conclusion: Endoscopic end nasal transsphenoidal surgery for pituitary tumors can reduce the tissue trauma, improved visualization, more complete tumor removal, and reduce complications.
Objective To investigate the effect of lung volume reduction surgery （LVRS） on messenger RNA expression levels of cytoskeletal proteins in diaphragmatic muscle tissues of emphysematous rabbits. Methods A total of 40 rabbits were randomly divided into 4 groups （10 rabbits in each group） ：normal control group, emphysema group, sham operation group and LVRS group. Rabbits in control group were intratracheally administered with 0.9% normal sodium, but those in other groups were intratracheally administered with 0.4% papain at the dose of 0.5 ml/kg and inhaled cigarette smoke to induce emphysema model. Then, rabbits in emphysema group were fed routinely, however, after median sternotomy , bilateral LVRS was performed in LVRS group but not in sham operation group. The mRNA expression levels of titin and nebulin in the diaphragmatic muscles of rabbits in each group were detected by reverse transcription-polymerase chain reaction（RT-PCR）. Results Compared with control group, the mRNA expression levels of titin and nebulin in the rabbit diaphragm of emphysema groups and sham operation group decreased significantly （P〈0.01 ）, so did those in LVRS group （P〈0.05）. But it increased significantly in LVRS group compared with emphysema group and sham operation group （P〈0.05）. Conclusion LVRS can increase the mRNA expression levels of titin and nebulin in diaphragmatic muscle tissues of emphysematous rabbits, which may be the associated mechanisms at the molecular level in restoring the functions of the emphysematous diaphragm by LVRS.
The main treatment methods of macular edema (ME) are intravitreal injection of anti-vacular endothelial growth factor drugs, corticosteroids, retinal laser photocoagulation and pars plana vitrectomy (PPV). However, recurrent ME, epiretinal membrane formation and drug resistance have occurred to a part of patients, which is called refractory ME (RME). PPV with internal limiting membrane peeling (ILMP) has the potential of treating and relieving RME. PPV combined with ILMP can treat and relieve RME by removing the posterior vitreous cortex, or removing the epiretinal membrane or internal limiting membrane at the same time during surgery to relieve the traction between the vitreous body and the retina. However, due to the complex pathogenesis of ME, the therapeutic effects of PPV combined with ILMP on ME caused by different etiologies still need clinical studies to explore the best surgical methods for ME caused by different etiologies.
Objective To explore the arterial origin and the distribution of the extracranial branches of the facial nerve. Methods Red latex or red chlorinated polyvinyl chloride was injected into the arteries of 15 fresh adult head specimens by both common carotid artery catheterization. The arterial origin and distribution of the extracranial branches of the facial nerve were observed. Results The nutrient arteries of the extracranial branches of the facial nerve originated from stylomastoid artery of the posterior auricular artery, the facial nervous branch of superficial temporal artery, transverse facial artery, superior and inferior facial nervous branches of external carotid artery and the posteriorand anterior facial nervous branches of external carotid artery. The outer diameters of them were (0.8±0.2) mm, (0.9±0.4) mm, (1.9±0.3) mm, (1.0±0.2) mm, (1.1±0.4) mm, (1.0±0.2) mm and (1.1±0.6) mm respectively. The sub-branches ofthe attendant artery of the facial nerve anastomosed each other in addition to supplying their own nerve, and a rich vascular network was formed between the facial nerve and adjacent tissue. Conclusion The study on blood supply of the extracranial segment of the facial nerve can provide anatomic basis for avoiding injury of the nutrient arteries of the facial nerve during operation of the parotidean and masseteric region clinically.
In recent years, day surgery has developed rapidly in China. It is very important to ensure the medical quality and safety of day surgery patients post-discharge. However, there are no regulations, guidelines or policy on the quality and safety of medical care post-discharge in China yet. As one of the medical institutions which are the earliest to carry out day surgery in a standardized way in China, West China Hospital of Sichuan University has summarized the nearly 10 years’ experiences in day surgery, and formulated management norms after discharge of day surgery, including discharge evaluation, discharge guidance, follow-up after discharge, and emergency plan. This paper introduces the management norms for day surgery post-discharge from West China Hospital ofSichuan University, in order to provide reference for the management of the day surgery patients post-discharge medical care in China.
Objective To determine the safety and efficacy of surgical biliary bypass on the elderly patients with unresectable pancreatic head cancer. Methods The clinical data of 55 cases with unresectable pancreatic head cancer treated with palliation methods from July 2002 to June 2009 in our hospital were retrospectively analyzed. The patients were divided into three groups according to different age and therapeutic program: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (group A), 19 patients under 65 years of age were treated by surgical biliary bypass (group B) and 17 patients with the age of 65 years or older received percutaneous transhepatic biliary drainage (group C). Then the therapeutic results were compared.Results With respect to the postoperative level of serum bilirubin, the incidence of early complications, postoperative hospitalization and mean survival time, no statistically significant difference was found between group A and B (Pgt;0.05). There was one case of recurrent jaundice and one case of gastric output obstruction in group B, while no one suffered postoperative complication in group A, and the difference was statistically significant (Plt;0.01). Compared with group A, the postoperative level of serum bilirubin, the number of patient readmitted, the rate of recurrent jaundice and gastric output obstruction were higher in group C (Plt;0.05 or Plt;0.01). The mean postoperative hospitalization and overall survival time were significantly shorter in group C than group A (Plt;0.05 or Plt;0.01, respectively). Conclusion Surgical palliation does not increase the morbidity rate, but it does improve the quality of life in elderly patients with unresectable pancreatic head cancer.
ObjectiveTo systematically review the safety of propofol versus sevoflurane for pediatric surgery. MethodsEMbase, PubMed, The Cochrane Library, CSCD, CNKI, WanFang Data were searched to collect randomized controlled trials (RCTs) about propofol versus sevoflurane for pediatric surgery from inception to January 2015. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then metaanalysis was performed by using RevMan 5.3 software. ResultsFifteen RCTs involving 1 065 children were included finally. Meta-analysis results showed that, compared with the sevoflurane group, the propofol group could reduce the incidence of emergence agitation (OR=0.23, 95%CI 0.16 to 0.34, P<0.000 01) and the incidence of postoperative vomiting (OR=0.32, 95%CI 0.20 to 0.51, P<0.000 01). There were no significant differences between the two groups in extubation time (MD=0.98, 95%CI -0.26 to 2.21, P=0.12), eye-opening time (MD=3.32, 95%CI -2.65 to 9.29, P=0.28) and postoperative analgesic requirements (OR=0.60, 95%CI 0.30 to 1.23, P=0.16). ConclusionIn reducing the incidence of emergence agitation and postoperative vomiting, propofol is superior to sevoflurane, so propofol is safer than sevoflurane for children's surgery.