Microsurgical treatment of medium and large supratentoriai arteriovenous malformations

Objective The present article aims at summarizing our operative experiences and exploring the management strategies and some key operative techniques of the medium and large supratentorial arteriovenous malformations （AVM）. Methods 72 patients with medium and large supratentorial AVM which were operated on were retrospectively analyzed. The size, location and pattern of venous drainage of the AVM were determined by angiograplay. According to the Spetzler-Martin grading system, there were 30 cases with grade Ⅱ,     

Diagnosis and treatment of cavernous sinus neurinoma

Objective To study the diagnosis and microneuro-smgical treatment of cavernous sinus neurinoma. Methods Twenty-two patients with cavernous sinus neurinoma which had diagnosed by MRI were operated on by microsurgery. Fourteen patients received excision of tumor through frontotemporal approach with zygomatic osteotomy and, 8 patients via subtemporal and suboccipital transtentorial approaches. Results Total resection was achieved in 21 patients (95.5%),and subtotal resection in 1.There was no operative death. The all operative samples were confirmed neurinoma pathohistologically. The symptoms postoperation such as headache and exophthalmos were reduced. Three months after operation, the function of the 6th nerve was improved in 12 of 19 patients with paresis of the 6th nerve. One patient with hemiplegia recovered well. The function of the 3th nerve recovered in 4 of 6 patients with recurrent paresis of the 3th nerve. Those patients with hydrocephalus were improved after operation. The patients were follow     

AN EVALUATION OF THE EFFECT OF THE ACCESSORY PREOPERATIVE ARTERIAL EMBOLIZATION FOR MAXILLOFACIAL VASCULAR MALFORMATION

Eleven patients with maxillofacial vascular malformations were reported and their treatment was discussed. Our results demonstrated that the accessory preoperative transcatheter arterial embolization with gelfoam for vascular malformations could effectively decrease blood loss and blood transfusion, keep the operative feild clear, shorten operative time, Facilitate radical resection of the lesion and improve the successful rate of operation. The ligation of afferent vessels and external carotid artery was in futility and even deleterious effects.     

Reconstruction of esophagus with whole stomach through esophageal bed after resection of the upper esophageal carcinoma. A report of 160 cases.

From September 1985 to December 1992, 160 cases of reconstruction of the esophagus with the whole stomach through the esophageal bed after resection of the upper esophageal carcinoma were performed with neither operative mortality nor intrathoracic complications. The leakage rate of the cervical anastomosis with Gambee's single layer methodwas 1.2%. The main steps of the operative procedure consisted of: (1) making a right thoracotomy for dissecting and removing the entire thoracic esophagus; (2) laparotomy for mobilizing the whole stomach, constricting it to tube shape and doing a pyloroplasty; and (3) pulling up the mobilized tube-like stomach through the posterior mediastinal space(i.e, the esophageal bed) out of the left neck incision and then the esophagogastrostomy with Gambee's single layer anastomosis was performed.     

The Surgical Treatments for the Long Saphenous Varicose Vein

Objective To summarize the experiences of the surgical treatments for the long saphenous varicose vein. Methods 545 cases （667 legs） were treated with smaller incisions and stripping of the long saphenous vein. Results 500 cases （91.7%） were followed-up on an average of 3.7 years. The result shows that this technique could decrease the operative injures and the complications. The recurrent rate is very low （1.2%）. Conclusion This easy and reasonable operative technique is worth recommending due to their ideal effects.     

弥漫性脑肿胀去骨瓣减压手术的疗效评价

Objective　To evaluate the therapeutic effect of decompressive craniectomies in acute traumatic patients with diffuse brain swelling. Methods　23 patients with acute posttraumatic diffuse brain swelling admitted and confirmed by X-CT were randomly treated by surgical decompressive craniectomies (operative group). Their treated results were compared with those of another 11 patients treated conservatively (non-operative group) at the same period. Results　The mortality rate was similar in both operative and nonoperative groups. Conclusion　The decompressive craniectomy operation has no value and not valid for treatment of acute posttraumatic diffuse brain swelling.     

TRAITEMENT DES FRACTURES DE L''''OLECRANE PAR SUTURE PERCUTANEE

The authors devised a method of percutaneous suture for treating fracture of olecranon. There are two operative technics for percutaneous suture: one is the suture through two skin holes and another the suture through four skin holes. 40 cases of fracture of olecranon were resorted to the method of percutaneous suture. Suture with steel wire through two skin holes was used in 3 cases and suture with steel wire through four skin holes in 37 cases. Most of the fractures had satisfactory reduction and all the fractures healed well. 33 cases had been followed for more than one year, the late results were excellent in 20, good in 8, fair in 4 and poor in 1. The operative technic of the percutaneous suture is simple and less traumatic to the local tissues. The late functional recovery is not inferior to that of open reduction with internal fixation.     

Spiral CT and three-dimensional reconstruction imaging in developmental dysplasia of hip

Objective To study the role of three-dimensional computed tomography and reconstruction (3 - DCT) in the operative treatment of developmental dysplasia of the hip. Methods Twenty cases of developmental dysplasia of hip were examined preoperatively with X-ray and 3 -DCT. The 3 - EXIT data were compared with the operative findings. Results In 9 out of 16 cases, X-ray and 3 - EXIT results were consistent with each other. For the remaining 7 cases, 3 - EXIT revealed deformities not shown on X-ray and the operative plans were modified according to the findings. Conclusion 3 - DCT provides a better image of hip dislocation and is helpful to decide the surgical approach and degree of correction. 5 refs.     

Laparoscopic splenectomy by secondary pedicle division strategy: a highly cost-effective method

Background Laparoscopic splenectomy （LS） shows many advantages compared with open surgery except for the high cost. This study was aimed to recommend secondary pedicle division strategy as a method with high cost-effectiveness. Methods From January 2003 to June 2005, 14 consecutive patients underwent laparoscopic splenectomy. The splenic pedicle was controlled by secondary pedicle division strategy in 8 cases and by Endo-GIA in the other 6 cases. A retrospective study was carried out to evaluate the operative time, blood loss, time to diet, operative morbidity, postoperative stay, and operative cost.
Results LS was performed successfully in a total of 14 cases. There was no significant difference between the two strategies in operative time, blood loss, time to diet, operative morbidity and postoperative stay. The operative cost of secondary pedicle division strategy group （RMB 8354.38±752,10） was significantly lower than that of Endo-GIA group （RMB 11053.33±602.27） （P〈0.01）.
Conclusions Laparoscopic splenectomy by secondary pedicle division strategy is a safe, effective and economical procedure with the value of popularization in developing countries.     

Development of allograft spleen heteroptopic transplantation model in cervical region in rats

To develop a simple allograft spleen het-eroptopic transplantation model in the cervical region in rats. Methods Under microscope, the spleen was incised with parts of the portal vein and left abdominal aorta. Donor＇s portal vein and recipients external jugular vein was attached with cuff and then abdominal aorta and the common carotid artery was attached by the same method. This method was also compared with conventional suture method. Results Recipient operative duration in the new model was （31 ±5. 8 ）rain and the success rate was 75.6%. However, recipient operative duration in conventional model was （110±9.8）rain and success rate was 69.2 %. Concision This model can be established easily and the operative duration can be reduced. Biopsy can be perormed at any number of times safely and easily. The recipient can＇ t be contaminated and injured seriously. This kind of model enables us to perform secondary organ grafting into the abdominal cavity, It holds good to study the spleen transplantation and combined transplantation.refs,1 tab.