微创手术并脑室灌洗治疗脑出血脑室铸型的疗效观察

目的　探讨重型高血压脑出血并脑室铸型的有效治疗方法 ,评价其治疗效果。方法　对 36例高血压脑出血患者采用双侧侧脑室灌洗、引流 ,腰椎穿刺脑脊液置换 ,配合微创小骨窗开颅手术治疗。结果　半年后随访结果 :治愈 8例 ,中残 14例 ,重残 9例 ,植物状态 2例 ,死亡 4例。结论　小骨窗微创手术加用双侧侧脑室灌洗、腰椎穿刺脑脊液置换是救治重症高血压脑出血脑室铸型的有效方法     

双侧脑室引流联合脑脊液置换治疗重型脑室出血的临床研究

目的探讨治疗重型脑室出血的有效治疗方法。方法将52例重型脑室出血患者作为治疗组,行双侧脑室外引流术联合脑脊液置换,每天2次向脑室内注入尿激酶2～4万U,夹管2h后开放引流血性脑脊液。术后每2～3d复查头部CT,脑室内积血基本清除后拔管。将以往单侧脑室引流的45例作为对照组。结果术后72h,治疗组意识转清率升高;术后第7天,治疗组血肿清除率提高,血肿引流时间缩短。4周后根据GOS评分,治疗组优良16例,轻残26例,重残6例,死亡4例;对照组优良7例,轻残18例,重残11例,死亡9例,以优良和轻残视为有效,治疗组有效率80.8%,对照组有效率55.6%,两组比较差异有统计学意义。结论该方法是一种治疗脑室出血的有效方法,可提高脑室出血患者的生存质量和生存率。     

脑室出血时脑脊液中尿激酶型纤溶酶原激活物受体的动态变化及意义

目的 探讨脑室出血后脑室系统是否存在纤溶系统活性物质基础,应用外源性尿激酶(UK)是否有助于增强纤溶的活性.方法 34例脑室出血经侧脑室穿刺外引流治疗的患者随机分为UK组和non-UK组.UK组均行侧脑室穿刺+脑室内UK灌注治疗;而non-UK组单纯行侧脑室穿刺外引流治疗.留取穿刺后0、2、4、6、12 h脑室外引流脑脊液标本2 mL,采用ELISA法测量每组各时间点脑脊液标本中尿激酶型纤溶酶原激活物受体(UPAR)水平.结果 non-UK组脑室出血后6～24 h、24～48 h、48～72 h三个时间段脑脊液中UPAR水平比较差异无统计学意义.UK组经脑室穿刺注入UK 2 h后脑室外引流脑脊液中UPAR水平增高.结论 脑室出血后脑室系统中存在纤溶系统活性物质基础,在脑室出血后的脑室系统内应用UK是可行的.     

Endoscopic ear surgery: A case series and first United Kingdom experience

AIM: To present the United Kingdom's first case series of 70 otological cases of endoscopic and non-endoscopic ear surgeries.METHODS: Prospective case series incorporating a range of endoscopic procedures performed using a 4 mm, 18 cm rigid endoscope, performed by a single surgeon at a single centre. Primary outcome measures included mean average pre and post-operative air-bone gap hearing thresholds and duration of surgery.RESULTS: Thirty-eight patients underwent endoscopic assisted ear surgery and 32 underwent non-endoscopic assisted ear surgery. In both surgical groups, there was a significant difference between pre and post-operative mean air-bone gaps(P = 0.02). Mean operating time was comparable between both groups. Eight patients developed post-operative complications.CONCLUSION: Endoscopic ear surgery can be performed safely in a range of otological procedures. This has the potential to become a well-established surgical option for middle ear surgery in the near future. Advantages and limitations are discussed.     

鼻内镜手术治疗慢性鼻窦炎临床分析

目的探讨功能性鼻内镜手术治疗慢性鼻窦炎的疗效并分析其并发症发生的原因。方法对2002～2007年完成随访的124例内镜鼻窦手术进行临床分析。124例中，Ⅰ型1期11例，Ⅰ型2期30例，Ⅰ型3期7例；Ⅱ型1期8例，Ⅱ型2期27例，Ⅱ型3期11例；Ⅲ型30例。实行鼻内镜手术，术后定期内镜下随访，术后随访3～15个月，平均6个月。结果Ⅰ型治愈率为91．7％，Ⅱ型治愈率为82.6％，Ⅲ型治愈率为56．7％，Ⅰ型和Ⅲ型，Ⅱ型和Ⅲ型比较有统计学差异，Ⅰ型和Ⅱ型比较疗效差异无显著性；坚持定期随访组治愈率为85.2％，未能坚持定期随访组治愈率66.7％，差异有统计学意义；变应性体质组和非变应性体质组治愈率分别为58．3％，88．6％，疗效有统计学差异。全身麻醉平均出血量220ml，局部麻醉185ml，并发症发生率7．26％。结论鼻内镜手术是治疗慢性鼻窦炎的有效方法，正确处理中鼻甲及鼻中隔偏曲，加强术中出血控制，重视术腔的清洗是提高治愈率的关键。     

Endoscopic thyroidectomy by a modified anterior chest approach: A single institution`s 5-year experience

Endoscopic thyroidectomy embodies the features of both minimally invasive surgery and aesthetic surgery. However, none of the established approaches is minimally invasive and meanwhile maximally cosmetic. Here we applied a modified anterior chest approach to achieve excellent cosmesis with reduced physical invasion. Fifty-six patients with benign thyroid diseases accepted this procedure. A 10mm longitudinal incision was made about one-fourth of the distance from the xiphoid to the sternal notch. Bilateral transversal incisions (5mm and 10mm) were performed about one-third of the distance from the nipple to the sternoclavicular joint. The subfascial space was maintained with CO₂ insufflation. Endoscopic lobectomy or subtotal thyroidectomy was performed according to the diseases. Fifty-four of the 56 procedures were successfully performed endoscopically, including 41 unilateral lobectomies and 13 subtotal thyroidectomies. The mean operative time for uni- and bilateral procedures was 117.2 min and 184.5 min, respectively. Conversion occurred in two cases due to bleeding and malignant frozen section analysis, respectively. Postoperative complications included one temporary recurrent nerve palsy, one transient hypocalcemia, and one subcutaneous emphysema. 96.2%(50/52) of the patients were extremely satisfied or satisfied with the cosmetic effect. This procedure is more likely to be accepted by patients older than 30 years. Endoscopic thyroidectomy by the modified anterior chest approach is an effective procedure with both excellent aesthetic benefits and reduced physical injury.     

Early outcomes of limb salvage surgery with mega-prosthesis: A single center experience

Objective: To determine the early outcomes of limb salvage surgery with mega prosthesis.Methods: This retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) from 1st January 2017 till 31st January 2020. Data like demographics, histopathology, functional and survival outcomes were retrieved from the Hospital Information System. Musculoskeletal Tumor Society (MSTS) score was used to evaluate the functional outcomes after the surgery. For survival analyses, Kaplan-Meier curve was applied. Prosthesis joint infection, amputation rate, metastasis, mortality rate, and recurrence were also recorded. Results: This study included 43 patients who underwent limb salvage surgery with endoprosthesis reconstruction at SKMCH&RC. The mean age at the time of diagnosis was (26.5±15.8) years. Patients with distal femoral replacement had the highest MSTS scores (81.45±9.70) while those with proximal humerus replacement has the lowest MSTS scores (56.8±11.2). There was a strong association between site of tumor and MSTS (F=3.30, P=0.017). We also found a correlation between surgical site infection and MSTS scores (r=0.484, P=0.001). Patients with recurrence also had significantly lower MSTS scores (P<0.05). The cumulative survival rate at the end of two-year follow-up was (71.4±17.1)％ in proximal femur tumor patients, (88.0±7.8)％ in distal femur tumor patients, and (50.0±3.5)％ in proximal humerus tumor patients. Besides, patients with Ewing sarcoma had the highest survival rate (97.5±11.0)％ while patients with chondrosarcoma had the lowest survival rate (77.8±13.9)％. Conclusions: Limb salvage surgery with mega-prosthesis can be performed with satisfactory functional and survival outcomes, but further studies are needed to compare it with other limb salvage methods. This study can be used as a reference for future studies.     

神经内镜手术与软通道穿刺引流术治疗高血压性脑出血的随机对照研究*

目的比较神经内镜颅内血肿清除术(NEIHE)与软通道血肿穿刺引流术(SCPD)治疗高血压性脑出血(HICH)的临床疗效与预后。方法将2015年1月-2016年12月收治的106例HICH病例按照随机数字法分为神经内镜组(51例,NEIHE方案)与穿刺引流组(55例,SCPD方案),记录手术及并发症指标,比较外周血炎性因子与神经功能缺损评分变化,对比两组术后疗效。结果神经内镜组手术时间和术中失血量高于穿刺引流组[(108.5±33.8)vs(85.8±25.4)min、(54.2±17.7)vs(42.6±14.5)ml,P0.05],但术后48 h血肿清除率和术后总体并发症发生率均明显优于穿刺引流组[(85.8±7.8)%vs(74.7±9.2)%、13.7%vs 29.1%,P0.05]。术后14 d,神经内镜组外周血肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和超敏C反应蛋白(hs-CRP)下降数值均明显高于穿刺引流组[(129.5±33.7)vs(107.8±29.5)pg/ml、(74.3±22.8)vs(56.7±18.2)pg/ml、(32.6±7.5)vs(27.2±6.6)mg/L,P0.05]。术后14 d,神经内镜组美国国立卫生院脑卒中量表评分(NIHSS)下降数值较穿刺引流组更为明显[(13.0±3.8)vs(10.3±3.5),P0.05]。术后6个月,神经内镜组存活病例Barthel指数提高数值明显高于穿刺引流组[(44.8±9.7)vs(39.5±11.2),P0.05]。结论 NEIHE较SCPD治疗HICH虽然手术操作相对复杂,但血肿清除率更彻底,并发症更少,近期疗效及预后均具备明显优势。     

脑脊液置换治疗蛛网膜下腔出血随机抽样研究

对42例蛛网膜下腔出血患者采用脑脊液置换疗法,并与对照组40例比较。结果治疗组无一例死亡,对照组死亡6例(15％),迟发性脑血管痉挛的发生率分别为7.1％和22.5％。治疗组的疗效明显优于对照组。     

Individualized minimally invasive treatment for adult testicular hydrocele: A pilot study

BACKGROUND Hydrocelectomy is the gold standard for the treatment of hydrocele,but it often causes complications after surgery,including hematoma,infection,persistent swelling,hydrocele recurrence,and chronic pain. In recent years,several methods for minimally invasive treatment of hydrocele have been introduced,but they all have limitations. Herein,we introduce a new method of individualized minimally invasive treatment for hydrocele.AIM To present a new method for the treatment of adult testicular hydrocele.METHODS Fifty-two adult patients with idiopathic testicular hydrocele were included. The key point of this procedure was that the scope of the resection of the sheath of the tunica vaginalis was determined according to the maximum diameter(d) of the effusion measured by ultrasound and the maximum diameter of the portion of the sheath pulled out of the scrotum was approximately πd/2. The surgical procedure consisted of a 2-cm incision in the anterior wall of the scrotum,drainage of the effusion,and dissection of part of the sheath of the tunica vaginalis. After the sheath was peeled away to the predetermined target extent,the pulled-out sheath was removed. The intraoperative findings and postoperative complications were analyzed.RESULTS All patients were successfully treated with a median operation time of 18 min.The median maximum diameter of the effusion on ultrasound was 3.5 cm,and the median maximum diameter of the resected sheath was 5.5 cm. Complications occurred in four(7.7%) patients: two(3.8%) cases of mild scrotal edema,one(1.9%) case of scrotal hematoma,and one(1.9%) case of wound infection. All of the complications were grade I-II. Recurrent hydrocele,chronic scrotal pain,and testicular atrophy were not observed during a median follow-up of 12 mo.CONCLUSION We report a new technique for individualized treatment of testicular hydrocele,which is quantitative and minimally invasive and yields good outcomes. Further study is warranted to verify its potential value in clinical practice.     

CT立体定位引导微创穿刺颅内血肿清除术与开颅手术治疗高血压脑出血的疗效观察

目的：探讨采用CT立体定位引导微创穿刺颅内血肿清除术与开颅血肿清除术治疗高血压脑出血（HICH）患者的疗效。方法：选取住院治疗的182例高血压脑出血患者,随机分为CT立体定位引导微创穿刺颅内血肿清除术组（微创穿刺组）与开颅手术组,每组91例,分别采用CT立体定位引导微创穿刺颅内血肿清除术和开颅手术治疗,对两组术后神经功能恢复情况、有效率、平均住院日及平均住院费用进行比较。结果：CT立体定位引导微创穿刺颅内血肿清除术术后格拉斯哥昏迷评分（GCS）、神经功能缺损评分、治疗总有效率及神经功能缺损恢复时间优于开颅手术组,差异有统计学意义（P〈0．05）,CT立体定位引导微创穿刺颅内血肿清除术平均住院日较开颅手术组短（P〈0．05）,平均住院费用少于开颅手术组（P〈0．05）。结论：CT立体定位引导微创穿刺颅内血肿清除术治疗高血压脑出血安全有效。     

对动脉瘤性蛛网膜下隙出血行夹闭术患者实施学科融合管理模式的对照研究

目的 探讨对动脉瘤性蛛网膜下隙出血行夹闭术的患者实施科学融合管理模式的效果.方法 2005年4月至2007年3月收治入院的符合纳入排除标准的患者123例,实施传统管理模式,其中62例由神经内科转入神经外科行手术治疗的患者作为转科组,61例直接收入神经外科行手术治疗的患者作为外科组;将2007年4月至2009年3月收治入神经疾病综合病房的101例符合纳入排除标准的患者作为实验组,实施学科融合管理模式.对3组患者的检查时间、待手术时间、平均住院时间及神经功能评分、术后并发症发生情况进行比较.结果实验组与转科组和外科组分别比较,患者待检查、待手术及平均住院时间显著缩短,住院费用显著降低;3组患者神经功能评分、术后并发症发生率比较无显著差异;术后病死率实验组与转科组比较无显著差异,实验组术后病死率显著低于外科组.结论学科融合管理模式可以缩短术前不适当住院日,为患者尽早手术赢得时间;在保证治疗效果的同时缩短平均住院日、降低住院费用,有利于减轻家庭和社会负担.

Abstract：

Objective To explore the effect of multi-disciplinary management for aneurysmal subarachnoid hemorrhage treated with clipping surgery. Methods 123 subjects admitted to hospital in April 2005 to March 2007 and received traditional management were named as the control group.62 subjects in the control group who admitted to neurology department first and then transferred to neurosurgery when diagnosed as aSAH by DSA were named as the transfer group. 61 subjects who admitted to neurosurgery directly and diagnosed as aSAH by DSA were named as the surgery group. 101 subjects who received multidisciplinary management from April 2007 to March 2009 were named as the experimental group. The waiting time before DSA, waiting time before surgery, hospital stay and hospitalization costs were compared between the three groups. Results Compared with the transfer group and the surgery group, the experimental group was lower in waiting time before DSA, waiting time before surgery, hospital stay and hospitalization costs, but there is no significant difference between the three groups in postoperative neurological function score and incidence rate of complications. The mortality rate was not significantly higher in the experimental group than the transfer group, but was significantly lower than the surgery group. Conclusions Multi-disciplinary management can reduce the "inappropriate hospital stay" of aSAH patients for early surgery. It can reduce the average hospital stay, hospital cost, in order to reduce the burden on families and society.     

宫腔镜与诊断性刮宫对异常子宫出血的临床诊断价值的对比观察

目的对比观察宫腔镜检查与诊断性刮宫在异常子宫出血患者中的诊断价值。方法 2009年1月至2012年1月门诊184例异常子宫出血患者,随机分成两组。宫腔镜组92例,应用宫腔镜检查,直视下对宫内病变准确定位后取活体组织或定位诊断性刮宫送病理检查。对照组92例,行传统诊断性刮宫术送病理检查。结果宫腔镜组92例患者,宫腔镜下有异常发现87例,检出率为94.6%,余5例宫腔镜下未发现异常。对照组92例患者中,有异常发现54例,检出率为58.7%;无异常38例。宫腔镜的检出率明显高于对照组(P<0.05)。结论门诊宫腔镜检查异常子宫出血,与传统诊断性刮宫相比,可提高对子宫内膜息肉、子宫黏膜下肌瘤及慢性子宫内膜炎的检出及诊断准确率,是诊断异常子宫出血可靠和理想的手段。     

深在性囊性胃炎内镜下的特征性表现及治疗策略：基于单中心的回顾性研究

目的：基于单中心数据探讨深在性囊性胃炎（gastritis cystica profunda,GCP）内镜下的特征性表现及诊疗策略。方法：回顾性分析复旦大学附属中山医院内镜中心2011年10月至2016年10月内镜治疗后经病理确诊的40例GCP患者的临床资料,总结其内镜下特征性表现,并对其中GCP合并早期胃癌的患者进行单独分析。结果：GCP内镜下表现以黏膜下隆起型为主（18/40, 45%）,术前超声胃镜对黏膜下隆起型的GCP有较高的诊断价值。术前诊断为GCP而接受治疗的比例为20%,内镜治疗后随访均无复发。5例（12.5%）GCP患者合并有早期胃癌,主要表现为黏膜病变型（Ⅱa+Ⅱc型）,接受内镜下治疗后随访均无复发。结论：GCP患者内镜下主要表现为黏膜下隆起型;GCP患者常合并早期胃癌,老年男性、既往远端胃切除史、病灶位于贲门、内镜表现为Ⅱa+Ⅱc型可能是GCP合并早期胃癌的高危因素;无论是否合并早期胃癌,内镜黏膜下剥离术（ESD）治疗都是一种安全、有效的微创治疗方式。     

Predictive factors for stem cell mobilization failure in multiple myeloma patients: A single center experience

Background and aimHigh-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has been considered the standard of treatment care for patients with multiple myeloma (MM). Insufficient mobilization and harvest of peripheral stem cells can be a major obstacle for performing ASCT. This is resulting in a lacking opportunity of cure in patients with MM. The aim of this study was to evaluate the factors which influence mobilization failure in patients with MM.Materials and methodsThis study has been performed in a retrospective manner. Two hundred and thirty-four patients with diagnosed MM who underwent stem cell mobilization after induction chemotherapy at Hacettepe University Hospital between the years of 2003 and 2018 were evaluated.ResultsA total of 234 patients were included in this study. The median age was 54 (32–76) years at the time of diagnosis. In 209 of 234 patients (89.3%) first mobilization trial was successful. At univariate analysis, among parameters identifiable before mobilization, male gender (p = 0.03), number of chemotherapy cycle before stem cell mobilization (p < 0.001), second ASCT (p < 0.001) and immunomodulatory treatment before stem cell mobilization (p < 0.001) predicted mobilization failure. At multivariate analysis, number of chemotherapy cycle before stem cell mobilization (p = 0.03), second ASCT (p < 0.001) and immunomodulatory treatment before stem cell mobilization (p = 0.02) retained independent predictive power.ConclusionDetectable different clinical characteristics of MM patients before initiating mobilization may be predictors of poor mobilization. Therefore, the mobilization protocol should be evaluated on a patient basis. Minimization of exposure to chemotheraputic agents in MM patients, especially immunomodulatory agents, may increase CD34+ cell harvest yields.     

The effect of introducing endoscopic therapy on surgery and mortality rates for peptic ulcer hemorrhage. A single center analysis of 1,125 cases

The introduction of early endoscopic diagnosis has not been associated with a reduction in either surgical intervention or overall mortality for peptic ulcer hemorrhage. Recent studies have suggested that endoscopic therapy can reduce rebleeding rates from peptic ulceration. We report a 2-year experience of the influence of endoscopic heater probe (HP) (Olympus CD 10Z) therapy on the outcome of patients admitted with peptic ulcer hemorrhage. Eight hundred and sixty-two patients admitted with peptic ulcer hemorrhage over a 5-year period (1978/9 and 1983/5) before endoscopic therapy (PRE-HP), and 263 patients admitted with peptic ulcer hemorrhage after introduction of endoscopic therapy (POST-HP: 1986-1988) were assessed. All 1,125 patients were managed by a joint physician/surgeon team. The introduction of HP therapy was associated with a reduction in surgical intervention and overall mortality rates for gastric ulceration from 16% and 8.9% PRE-HP to 7% and 2.6% POST-HP respectively (p less than 0.05). A similar but non-significant trend was noted for duodenal ulceration. The beneficial effects of HP therapy appear to be due to a reduction in the need for surgical hemostasis in patients with an ulcer base visible vessel. Our results suggest that a more widespread use of endoscopic therapy may result in an improved outcome from peptic ulcer hemorrhage.     

Risk factors for delayed intracranial hemorrhage secondary to ventriculoperitoneal shunt: A retrospective study

BACKGROUNDDelayed intracranial hemorrhage (DICH), a potential complication of ventriculoperitoneal (VP) shunts, has been associated with high mortality, but its risk factors are still unclear.AIMTo investigate the risk factors of DICH after VP shunts.METHODSWe compared the demographic and clinical characteristics of DICH and non-DICH adult patients with VP shunts between January 2016 and December 2020. RESULTSThe 159 adult VP shunt patients were divided into 2 groups according to the development of DICH: the DICH group (n = 26) and the non-DICH group (n = 133). No statistically significant difference was found in age, sex, laboratory examination characteristics or preoperative modified Rankin Scale (mRS) score between the DICH and non-DICH groups (P > 0.05); however, a history of an external ventricular drain (EVD) [P = 0.045; odds ratio (OR): 2.814; 95%CI: 1.024-7.730] and postoperative brain edema around the catheter (P < 0.01; OR: 8.397; 95%CI: 3.043-23.171) were associated with a high risk of DICH. A comparison of preoperative mRS scores between the DICH group and the non-DICH group showed no significant difference (P = 0.553), while a significant difference was found in the postoperative mRS scores at the 3-mo follow-up visit (P = 0.024).CONCLUSIONA history of EVD and postoperative brain edema around the catheter are independent risk factors for DICH in VP shunt patients. DICH patients with a high mRS score are vulnerable to poor clinical outcomes.     

Application of digital positioning guide plates for the surgical extraction of multiple impacted supernumerary teeth: A case report and review of literature

BACKGROUNDAn extra tooth in the normal tooth sequence in any region of the dental arch is regarded as a supernumerary tooth (SNT). Due to the large variation in location and morphology, the extraction of impacted SNTs is an extensive and complex procedure with high risks of several complications. This report presents a rare case of seven impacted SNTs in the bilateral upper and lower arch that were successfully extracted with the use of digital positioning guide plates.CASE SUMMARYIn January 2022, a 21-year-old male was referred to our department with a chief complaint of pain in relation to tooth #36. Clinical examination showed a deep carious lesion with pulpal involvement in tooth #36 and lingual swelling of the bilateral mandibular posterior area. Radiographic examination revealed seven deeply impacted SNTs in the bilateral posterior area and bilateral impacted mandibular third molars. Based on these findings, the patient was diagnosed with bilateral, multiple impacted SNTs and tooth #36 chronic pulpitis. A root canal treatment and an all-ceramic crown restoration for tooth #36 were performed. An individualized digital positioning guide plate was designed by computer-aided design/computer-aided manufacturing technology and cone-beam computed tomography for extraction of the impacted SNTs. During the operation, the digital positioning guide plate allowed rapid positioning and exposure of the SNTs while avoiding adjacent important anatomical structures. At 3-month follow-up, regeneration of bone and soft tissues was visible.CONCLUSIONThe application of digital positioning guide plates is useful for the individualized and minimalized extraction of impacted supernumerary teeth.     

慢性鼻窦炎鼻息肉经鼻内镜鼻窦手术并发症及其防范

目的探讨慢性鼻窦炎鼻息肉经鼻内镜鼻窦手术并发症发生的原因及其防范补救措施。方法采用回顾性分析111例住院病例围术期观察和出院后随访观察,并对并发症防范及补救措施进行评价。结果本组手术并发症总的为10例（9％）。其中术中出血1例（1％）,眶纸板及眶筋膜损发生2例（1．8％）,内直肌损伤导致复视发生1例（1％）,术腔粘连闭塞发生3例（2．7％）,鼻中隔穿孔发生2例（1．8％）,泪道损伤发生1例（1％）;本组没有其他严重手术并发症的发生。结论鼻内镜鼻窦手术（FSS）并发症在临床上并不少见,应高度重视;严格筛选手术适应证,规范化的围术期用药和处理,术前仔细检查患者和阅读CT片,术后定期随访,适时采取补救措施,对降低手术并发症的发生和保障医疗安全十分重要。