硬膜外切除前床突改善鞍区显露的定量研究

目的:探讨翼点入路开颅术中改善鞍区结构显露的有效方法。方法:10例经甲醛固定的成人头颅湿性 标本均采用右侧翼点入路开颅。硬膜外切除前床突前后分别测量视神经、颈内动脉、视神经-颈内动脉三角的长度以及该三角的最大宽度。结果:以上指标在前床突切除前和切除后的测量结果分别是:视神经长度为(10.28±2.30)mm和(22.83±2.54)mm;颈内动脉长度为(10.48±2.39)mm和(14.78±3.02)mm;视神经-颈内动脉三角长度为(10.38±2.84)mm和(23.55±2.79)mm,宽度为(3.93±1.16)mm和(12.95±2.61)mm。结论:鞍区病变手术治疗的过程中,前床突切除可使视神经和视神经-颈内动脉三角长度的显露增加1倍;视神经颈内动脉三角宽度的显露增加2～3倍。硬膜外切除前床突对改善鞍区手术中重要结构的显露有十分重要的意义。     

经蝶入路的显微解剖和解剖变异及其临床意义(一) ·鼻道与蝶窦·

０　引　　言所谓鞍区是以蝶鞍为中心,鞍内藏垂体。垂体前上方紧邻视神经和视交叉;两侧为海绵窦及位于其中的颈内动脉、动眼神经、滑车神经、三叉神经第Ⅰ、Ⅱ支（即眼神经、上颌神经）及外展神经;下方为蝶窦;后方借鞍背和斜坡,与脑干相隔。对蝶鞍及其周围结构,在显微镜放大和某种特殊的条件下,常发现有解剖变异,这对神经外科经额和经蝶入路都是十分重要、十分有价值的。从目前掌握的文献和作者的临床工作体会,鞍区的解剖变异对经蝶入路不利,概括起来有以下几个方面：①大的前海绵间窦向前可伸展至垂体,其中有１０％可延伸到垂体…     

经鼻蝶垂体瘤切除术致鞍隔破裂术中钛夹修补1例报告

患者,男,62岁,因视力下降半年入院,查体发现患者双颞侧视野缺损,激素水平检测未发现异常,CT检查发现垂体病变,进一步MRI检查明确为垂体肿瘤约2cm×2cm大小,肿瘤向上凸入鞍隔但未穿破鞍隔,呈典型的雪人征,视神经被向上推挤,肿瘤向两侧紧邻颈内动脉。安排行经鼻蝶入路垂体肿瘤切除术。     

经单鼻孔-蝶窦入路手术显微解剖与临床应用

目的：为经鼻蝶入路切除垂体瘤提供手术解剖学资料。方法：对15例成人福尔马林固定的头颅标本进行经鼻蝶入路的解剖观察及相关数据的测量。结果：蝶窦口-视神经距离为10．6±1．8mm，蝶窦口-颈内动脉距离为12．7±1．8mm，垂体窝前后径为10．2±1．5mm，垂体窝左右径为14．0±2．4mm，垂体窝上下径为6．5±1．4mm。结论：熟悉蝶鞍区解剖结构，注意蝶窦口、蝶窦外侧壁蝶鞍底壁与周围结构关系，有助于开展经鼻孔-喋窦入路切除鞍区肿瘤手术的准确定位及术中安全操作，避免损伤重要的血管神经。     

视交叉及其周围结构的测量

目的 :为视交叉及其周围区病损机制和手术治疗提供解剖学依据。方法 :在 37例成人颅脑视交叉及其周围区 ,对具有临床意义的数据进行解剖学测量。结果 :视神经颅内段长度为 :左 ( 9.5± 0 .2 )mm ,右 ( 9.6± 0 .3)mm ;垂直径 :左 ( 3.5± 0 .1 )mm ,右 ( 3.6± 0 .1 )mm ;横径 :左 ( 5 .3± 0 .2 )mm ,右 ( 5 .5± 0 .3)mm。视交叉后缘至鞍背的距离 :前置位 ( 3.5± 1 .1 )mm ;后置位 ( 3.0± 1 .5 )mm。视交叉的前后径、垂直径、横径分别为 ( 8.5± 0 .9)mm ,( 3.2± 0 .1 2 )mm ,( 1 1 .9± 0 .5 )mm。视神经管间距为 ( 1 1± 1 .2 )mm。视交叉的前角角度为 ( 65 .5± 5 .6)度。结论 :①视交叉与垂体的位置关系的不同 ,垂体瘤压迫视交叉的部位就不同。②视交叉前角的角度一般小于直角 ,其大小与视神经管间距及视神经颅内段长度有关。③视交叉并不与鞍隔接连 ,故垂体肿瘤增大向上穿破鞍隔后 ,在一定时间内 ,尚不致压迫视交叉。④鞍隔的厚度 ,鞍隔孔的类型和大小与肿瘤扩散的难易和扩展方向有重要关系。     

视神经和视交叉的临床解剖研究

目的：研究视神经和视交叉的局部解剖及其临床意义。方法：在手术显微镜下观测15个尸颅视神经和视交叉的形态特征及毗邻关系。结果：镰状皱壁沿视神经的长度为0.4～4.6mm，厚度为0．1～0．8mm。1／3的视神经因眼动脉或颈内动脉的上凸而隆突，鞍结节均较平坦，多数视交叉后缘位于鞍背后方。视神经主要由垂体上前动脉供血，半数有分支沿视神经前行。视交叉的上面多由前交通动脉复合体供血，下面的内侧部多为垂体上动脉供血，外侧部多为颈内动脉和后交通动脉的分支供血。视神经上面覆有一层视神经上膜，再上面为直回下面软膜，二膜问多数分开。结论：眼动脉和颈内动脉可凸入视神经，致视力、视野改变。由于国人鞍结节边界不易确定，按传统方法将视交叉分型有困难，所以宜接蝶棱与视交叉前缘问距判断前置或后置。手术中若损伤沿视神经行走的小动脉，电凝须特别小心。贴视神经上抬直回时，实际上是沿视神经与视神经上膜间或沿上膜与直回下面软膜间粘着较少的界面分离，有半数需切断界面间的纤维小梁。     

垂体柄的显微外科解剖

目的 :探讨垂体柄的显微外科解剖特点和显露垂体柄的显微外科技术。方法 :在 1 5例 (30侧 )经颈内动脉灌注红色乳胶的成人尸体头颅上模拟翼点入路 ,借助手术显微镜在 6～ 2 5倍下通过鞍区手术间隙对下垂体柄显微解剖。结果 :经翼点入路 ,通过鞍区的手术间隙可对垂体柄进行良好的显露。垂体柄的主要血管为垂体上动脉 ,平均每侧有 1 .8支 ,平均直径为 (0 .33±0 .0 2 ) mm ,它分为烛台型和单支型。结论 :经翼点入路对鞍区病变 ,特别是颅咽管瘤显微手术时 ,可利用垂体柄的解剖特点 ,尤其是垂体上动脉的标志对其进行辨识和保护     

鼻颅联合入路治疗鞍区疾病的内镜解剖学研究

目的 :研究眶上锁孔入路及经鼻 -蝶窦入路的内镜局部解剖学并测量有关解剖数据 ,探讨二者联合应用治疗巨大鞍区占位性病变的可行性 ,为颅底外科手术提供相关形态学参考数据。方法 :利用 2 5具成人尸头 ,模拟内镜眶上锁孔入路 ,观察所能达到的解剖部位 ,并测量相关的解剖数据。结果 :眶上锁孔入路可以从前方和上方达到鞍区及斜坡上段 ,清晰显露垂体、垂体柄、视交叉、颈内动脉、基底动脉等结构 ;经鼻 -蝶窦入路可从下方显露垂体及鞍隔等鞍区结构。结论 :内镜眶上锁孔与经鼻 -蝶窦联合入路是一种微创外科技术 ,二者联合应用可治疗巨大鞍区占位性病变     

经额下显微手术切除大型、巨大型垂体腺瘤36例

垂体腺留是神经外科常见的鞍区良性肿瘤。主要治疗手段是手术切除。一般采用经蝶和经额两种入路。而对于大型垂体腺瘤、巨大型垂体腺瘤向鞍上生长者、以及质地坚韧的大垂体腺瘤[5] 等经蝶入路全切难度和危险性都很大。本科 1 995年 1月～ 2 0 0 1年 1 2月收治大型、巨大型垂体腺瘤67例。 31例经额下部分切除肿瘤 ,单纯视神经减压。 36例经额下显微手术切除 ,取得满意效果 ,报道如下。1　临床资料1 .1　一般资料　 67例患者分为肿瘤全切组和部分切除组。肿瘤全切组 36例。男 1 7例 ,女 1 9例 ;年龄 1 9～ 59岁 , ｘ±ｓ(31 .2± 1 0 .6)岁 ;…     

垂体腺瘤与鞍区脑膜瘤的MRI鉴别诊断

目的提高MRI检查对垂体腺瘤与鞍区脑膜瘤的鉴别诊断,有助于临床采取正确治疗方法。方法经MRI检查和手术证实的垂体腺瘤患者45例,鞍区脑膜瘤5例,分析垂体腺瘤与鞍区脑膜瘤的信号特点、生长范围及生长方式。结果垂体腺瘤组中32例肿瘤突破鞍隔向鞍上生长,其中21例视交叉受累;26例向下破坏鞍底进入蝶窦;17例向一侧或两侧侵犯鞍旁和海绵窦,推压或包裹颈内动脉。鞍区脑膜瘤组中鞍隔脑膜瘤2例,鞍旁脑膜瘤3例。结论MRI能鉴别垂体腺瘤与鞍区脑膜瘤,对临床确定正确的手术入路的选择具有重要意义。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.