少见型脑胶质肉瘤1例

病例 女,25岁,1周前无明显诱因出现头痛、头晕症状,无恶心、无胸闷气急,无呼吸困难,无四肢抽搐.外院就诊检查头颅CT示颅内占位病变,为进一步诊治来我院门诊复查.颅脑MRI检查示右额叶巨大肿块,呈T1FLAIR像等低信号、T2FLAIR等高信号及DWI像高信号影,内见畸形血管流空信号影,边界欠清,周围脑实质水肿,增强后显著不均匀强化,部分坏死灶,邻近脑膜增厚、强化,脑膜尾征可见,提示血管瘤型脑膜瘤可能(图1,2).入院后行颅脑CT增强示右额叶片状高低不均密度影,边界欠清,增强后病灶显著不均匀强化,CTA示混杂血管团,提示“颅内动静脉畸形”可能(图3).术前行DSA检查,并行脑膜中动脉栓塞术(图4).术中见肿瘤质地软,呈现鱼肉状,血供极其丰富,出血量约600 mL;术后病理结果为胶质肉瘤(WHOⅣ级).     

普通腔镜器械行结直肠癌根治术42例

微创外科是近年来外科发展的趋势。腹腔镜结直肠手术相对腹腔镜其它手术发展缓慢,该手术在适应证、手术复杂性、术后肿瘤复发和卫生经济学等等方面的问题制约该手术的广泛普及。我科自2006年2月成功开展了第一例腹腔镜下直肠癌根治术以来．应用电凝钩、钛夹钳相结合,无超声刀及一次性切割缝合器吻合器条件共完成各类结直肠手术42例。分析报告如下．     

腹腔镜辅助胃癌根治术16例分析

1994年日本学者Kitano等[1]首次报道腹腔镜胃癌根治术治疗早期胃癌,此后应用逐渐广泛。由于腹腔镜胃癌根治手术难度高、风险大、操作复杂、技术要求高,国内至今仍限于大型医院开展。我院2007年3月—2009年12月完成腹腔镜下胃癌D2根治术16例,总结报道如下。     

腹腔镜脾脏切除术23例

我院2005年3月—2010年2月在无切割闭合器的条件下施行腹腔镜脾切除术（1aparoscopic splenectomy,LS）23例,总结报道如下。     

肠-腔-房转流术治疗混合型布加综合征的疗效分析

Objective To investigate the therapeutic effect of the meso-cavo-atrial shunt (MCAS) in the treatment of combined Budd-Chiari syndrome (BCS). Methods The clinical data of 17 cases of combined BCS with all or bilateral hepatic vein occlusion and long range occlusion or obstruction of inferior vena cava (IVC) were admitted to the Qilu Hospital from February 2000 to May 2004. All patients were treated by MCAS with artificial blood vessels. The pre- and postoperative clinical symptoms, the IVC and portal venous (PV) pressures, the incidence of postoperative complications and the patency rate of the artificial vessels were analyzed. The survival of patients was analyzed using the Kaplan-Meier analysis, and the data were analyzed using the chi-square test and t test. Results No patient died during the perioperative period, and the symptoms of 15 patients disappeared or were relieved after operation, with a significant difference compared with those before operation (χ2 =9.78, P <0. 05 ). Three patients had complications after the operation. The postoperative PV and IVC pressures were decreased by 1.2 cm H2O (1 cm H2O =0.098 kPa) and 18.5 cm H2O, respectively. There were significant differences in the decrease of IVC and PV pressures ( t = 2.38, 3.06, P < 0.05 ). The 1-, 3-, 5-year survival rates were 16/17, 15/17 and 14/17, respectively, and the 5-year patency rate of the artificial vessels was 14/17.Conclusions MCAS can simultaneously relieve IVC and PV hypertension for patients with combined BCS. The postoperative complication rate was decreased, the 5-year survival rate and the patency rate of the artificial vessels were improved after the treatment, so MCAS is an optional surgical method for treating combined BCS.     

腹腔镜下甲状腺腺瘤切除术26例体会

甲状腺疾病是普外科常见病、多发病。治疗措施主要是手术切除。传统手术颈部留有明显的手术瘢痕。虽然小切口开放甲状腺切除术使切口缩小至5cm,但其美容效果仍难令人满意。腹腔镜甲状腺手术强调美容效果,入路选择在隐蔽的部位,颈部不留瘢痕,美容效果好,更符合患者的心理要求,已成为甲状腺外科研究的发展趋势和重要方向。     

下肢深静脉血栓并发肺栓塞的治疗

下肢深静脉血栓形成是常见病。此病可后遗下肢水肿、继发性静脉曲张、皮炎、色素沉着、淤滞性溃疡等,其急性期可因血栓脱落而发生致命性的并发症——肺栓塞。及时、准确诊断及合理、有效的治疗是防止因肺栓塞导致预后不良的主要手段。本研究选取我科收治的下肢深静脉血栓形成合并肺动脉栓塞5例,对其临床资料进行回顾性分析,现报告如下：     

腹腔镜复杂性胆囊切除术治疗体会(附647例报道)

腹腔镜胆囊切除手术已在各级医院广泛开展。但面对复杂性胆囊疾病的腹腔镜切除手术。即使是熟练的肝胆外科腔镜医生。也颇感头痛。因而总结复杂、疑难胆囊腹腔镜下切除的经验．对降低术中中转率和术后并发症发生率具有现实意义。回顾性分析行复杂、疑难胆囊腹腔镜切除术的647例患者病例资料。总结报道如下。     

鼻内镜脑脊液鼻漏修补术7例体会

我院自1997年～2002年开展了7例鼻内镜脑脊液鼻漏修补术,取得了一定的经验,报告如下。1 资料与方法1.1 临床资料。本组7例中,男5例,女2例,年龄为23～57岁,平均41.3岁。7例均有脑脊液鼻漏,时间最短者1月,最长者3年。6例为单纯性脑脊液鼻漏,5例位于筛窦,1例位于蝶窦;1例伴有脑膜脑膨出,位于筛窦,筛窦内面积为2.0mm×1.1mm。7例脑脊液鼻漏均经内镜、影像学、鼻流出液葡萄糖定量测定证实。     

鼻内镜脑脊液鼻漏修补术7例体会

我院自1997年～2002年开展了7例鼻内镜脑脊液鼻漏修补术，取得了一定的经验，报告如下。