听神经瘤的显微手术治疗及面听神经保护

[目的]探讨显微外科技术治疗听神经瘤,以提高面听神经的保留率,预防并发症的发生。[方法]对经显微手术治疗的30例听神经瘤进行回顾性分析。[结果]肿瘤全切除28例(93.3%),面神经解剖保留25例(83.3%),有效听力保留4例(13.33%),无手术死亡。[结论]显微外科手术是治疗大中型听神经瘤的有效方法,熟悉肿瘤与面听神经的病理解剖关系,有助于提高手术效果。     

Laryngotracheal trauma

A case of electric burns to the larynx and trachea is reported. The defect in the anterior wall of the trachea has been repaired with the silastic sheet burned into the local skin flap of the neck, to prevent collapse of the anterior wall of the trachea. Nasotracheal tube worked as a stent. It has worked well. The patient does not have any difficulty in breathing nor any stridor, following healing.     

Acoustic Screening for Laryngeal Cancer

An acoustic screening method for indicating the possible presenceof laryngeal cancer was investigated. Three acoustic parameters,comprising perturbations in pitch-period and peak-amplitudesequences, and vocal noise, were measured from a sustained vowel,e, spoken by the subjects taking part in the investigation.Experiments to discriminate between normal and cancer groupswere performed with voice samples taken from 64 normal controlsubjects and 57 patients with laryngeal cancer. Experimentswere also carried out to test the perceptual significance ofthe three parameters. From the results, we have been able toconclude that their combined use will enable us to build anacoustic screening system for laryngeal cancer.     

显微手术切除大型听神经瘤术后听力的保留

背景与目的：大型听神经瘤在全切除肿瘤的同时保留患者的面、听神经功能是神经外科医生的难题,本研究探讨在面、听神经功能监护下,显微手术切除大型听神经瘤术后听力保留的可能性。方法：对2002年1月至2008年4月湘雅医院神经外科同一术者（袁贤瑞教授）在面肌肌电图和耳蜗神经监测下,经乙状窦后入路显微手术切除的127例大型听神经瘤手术中有完整听力随访资料的41例病例进行回顾性研究。听功能采用北京市耳鼻咽喉科研究所研制的普通话言语测试材料（mandarin speech test materials,MSTMs）句表进行言语识别率测试和纯音听阈测定（PTA）,并使用New Hannover Classification听力分级法进行术后听力分级。结果：127例患者中,术中10例获得明确的听神经解剖学保留,其余117例术中未能找到确切的听神经。对随访到的41例听神经瘤患者进行术后听功能评价,听力保留率为26.8%。结论：对于有相当经验的神经外科医生来说,在面、听神经监护下,经乙状窦后-内听道入路显微手术全切除大型听神经瘤的同时可以保留部分患者的听神经功能。     

大型听神经瘤的显微手术治疗：附45例分析

背景与目的:听神经瘤为常见颅内良性肿瘤之一,治疗以手术为主,本文探讨经枕下-乙状窦后(Suboccipital retrosigmoid approach,SO)入路显微手术治疗大型听神经瘤的操作技巧及治疗效果。方法:回顾性分析经枕下-乙状窦后入路显微手术治疗的45例大型听神经瘤。结果:本组肿瘤全切40例(88.9%),次全切除5例(11.1%)。面神经解剖学保留率为86.7%(39例)。对40例进行1年以上的随访评估,面神经功能获得满意恢复者为32例(71.1%)。结论:经枕下-乙状窦后入路显微手术切除大型听神经瘤,面神经可获得解剖学与功能的保护,能明显降低并发症与病死率。     

Audiovestibular derangement in head trauma

Head trauma may result in varying degrees of derangement of inner ear functions either due to simple concussion or as a result of fracture temporal bone or both. 50 cases of Head Injury studied for cochlear and vestibular functions are being reported.     

听神经瘤218例分析

本文报告经枕下入路切除的218例听神经瘤,其中大型占99%,全部经手术和病理证实。听神经瘤是一种常见的颅内良性肿瘤,早期手术可全切并易保留面神经,部分甚至可能保留听神经。其早期症状不典型,诊断较困难,但脑干听觉诱发电位(BAEP)检查多有异常,故对疑有听神经瘤的病人,可首先行 BAEP 筛选检查。BAEP 波型不受麻醉的影响,能常规地、可靠地进行术中监护,推广使用对降低死亡率、致残率有一定的帮助。本文还对听神经瘤的手术方法、死亡原因等问题进行了探讨。     

Auricular trauma and its management

Forty cases of external ear trauma have been studied during a period of three years from Jan ’2001 to December 2004. It was observed that accidental trauma to the auricle may result in laceration, partial or complete loss of auricle. Injury of the tympanic membrane, temporal bone or facio maxillary region may be associated with auricular trauma. All wounds of auricle carry a risk of infection leading to perichondritis. Principles of successful treatment are conservation of tissue and prevention of infection.     

Lap belt abdominal aortic trauma

A case of vehicle accident trauma to the abdominal aorta in a patient wearing a lap-type seat belt is presented, together with its diagnosis and management. The role of the radiologist is emphasized.     

Acoustic analysis of subjects with vocal cord paralysis

Theoretically, there should be a close relationship between the vibratory pattern and acoustic output. The study aims at differentiating unilateral vocal cord paralysis (VCP) from normal subjects and also between right VCP and left VCP based on the acoustic analysis of the subjects voice. The study also aims at comprehensively investigating the phonatory disturbance resulting from VCP on the Indian population. Results indicate that statistically significant differences were found among the following acoustic parameters: fluctuation per sec, in fimdamental frequency (fo), fluctuation per sec, in amplitude, extent of fluctuation in fo, extent of fluctuation in amplitude, jitter ratio, jitter factor, shimmer. Psigma and maximum phonation duration in differentiating unilateral VCP from normal subjects. Also the acoustic parameters: fluctuation per sec, info, extent of fluctuation in fo and Psigma could statistically differentiate between right VCP and left VCP. It can be concluded that the above parameters can be successfully used for diagnosing VCP and also the type of VCP. This is of particular significance in difficult to visualize patients and to monitor the therapeutic outcomes of vocal rehabilitation, following unilateral vocal cord paralysis. These results need to be further clinically validated by using a larger number of subjects.     

胸部钝伤后的心血管损害

简介：胸部钝伤后的心血管损害，发病率随诊断方法的不同而有很大变化。大多数已发表的文献仅探讨了独立的病例。进行此项研究总结了我们在处理胸部外伤引起的心血管损害患者方面的经验。方法：从1989年～1999年在我们医院里进行了一项回顾性研究。搜集的参数包括年龄、性别、受伤原因、临床治愈情况、采用的诊断试验以及治疗措施。结果：10例患者(均为男性)因继发于胸部钝伤的心脏损害而被收入ICU。5例患者(平均年龄30岁)患急性冠状动脉疾病；其中4例外侧区受到了重击，1例为多发伤。这5例都表现出急性心肌梗死症状，3例出现心前区疼痛，另2例则以其他的器官功能障碍为主要表现。所有这些患者都接受了冠状动脉造影检查，其中4例显示前降支堵塞，而事先接受了溶栓治疗的1例患者则显示正常。有3例患者(平均年龄37岁)出现了严重的急性瓣膜返流：1例患者因直接的心前区撞击导致乳头肌断裂而引起二尖瓣返流；1例患者因胸部的钝挫伤导致二尖瓣修补物破裂；另1例是因多发伤引起的三尖瓣撕脱和房间隔缺损造成了严重的三尖瓣返流和右向左分流。他们均成功地接受了手术。有2例患者因车祸受伤，1例出现主动脉夹层，成功植入了修补膜，另1例经紧急手术抢救无效，死于主动脉峡部破裂引起的大出血。结论：胸部钝伤能够引起严重的心脏损害，但常被忽略，尤其是在由车祸造成的多发伤时。临床上的疑点是诊断的基础，因为心血管的症状常被其他器官的损害所掩盖。在我们的研究中，最为常见的明显的心血管损害是急性心肌梗死和房室瓣破裂导致的急性返流。     

Popliteal artery pseudo-aneurysm following penetrating trauma

Popliteal artery pseudo-aneurysm due to accidental penetrating trauma, once common during world wars, is now rare. It may require amputation due to ischaemic complication. One such case is detailed here. The angiographic findings, complications, management and literature review are provided.     

不同手术方式对子宫肌瘤的机体创伤及安全性分析

目的探讨不同手术方式对子宫肌瘤的机体创伤及安全性。方法选取126例子宫肌瘤患者,按照手术方式的不同分为对照组和治疗组,各63例。对照组患者采用传统开腹手术,治疗组患者采用腹腔镜下子宫肌瘤切除术。观察两组患者的术后恢复、疼痛和不良反应情况,并观察术后瘤体体积变化情况。结果两组患者治疗后一般状况良好,但治疗组患者术后住院时间为(3.4±1.6)d,下床时间为(1.3±0.6)h,阴道出血时间为(3.1±0.9)d,均显著短于对照组的(7.3±1.7)d,(46.8±11.2)h,(11.7±5.3)d,差异均有统计学意义(均P<0.05);治疗组患者术后6 h和24 h疼痛评分均显著优于对照组,差异均有统计学意义(均P<0.05);但术后72 h疼痛评分在各组间差异均无统计学意义(均P>0.05);治疗组术后的不良反应发生率为23.8%,显著少于对照组的49.2%,差异有统计学意义(P<0.05);术后随访6个月发现,治疗组的瘤体体积显著缩小,但对照组部分患者仍发现瘤体的增长。结论尽管腹腔镜下子宫肌瘤切除术未完全切除瘤体,但整体上改变了瘤体的大小,且术后患者恢复快,创伤小,安全性高,值得临床进一步推广。     

大型听神经瘤的微骨窗手术切除技巧

背景与目的：大型听神经瘤的全切和功能保留对神经外科来说仍旧是一个挑战。本研究探讨大型听神经瘤的微骨窗手术显露、内听道磨开及囊性肿瘤切除等技巧。方法：总结41例大型听神经瘤经乙状窦后入路微骨窗（切口长6cm,骨窗直径约3cm）手术切除的临床资料,并对手术中的技巧操作进行分析。结果：肿瘤全切除39例（95%）,次全切除2例（5%）;面神经解剖保留36例（88%）,最后一次随访时神经功能（HB分级）Ⅰ级7例（17%）,Ⅱ级15例（37%）,Ⅲ级5例（12%）,Ⅳ～Ⅴ级9例（22%）,Ⅵ级5例（12%）;耳蜗神经解剖保留9例（22%）,保留有效听力7例（17%）。结论：经枕下乙状窦后入路微骨窗手术切除大型听神经瘤是一种理想的微创手术方法。