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1.
Background  Atypical meningioma is one of the rare subtypes of meningioma, which is lacking of optimal consensus on treatment strategies. This study aimed to investigate the radical treatment strategies to improve the long-term outcome of recurrent atypical meningiomas.
Methods  The prognostic factors including the age and gender of patients; the location, histology, recurrence pattern and mitotic cell rate of the tumors; and the resection extents, surgical strategies and adjuvant therapies of 15 cases of recurrent atypical meningiomas were analyzed retrospectively.
Results  The age and gender of patients were not associated with tumor recurrence. However, high recurrence rates and poor prognosis for atypical meningiomas were associated with the high mitotic cell rate, failure to achieve Simpson grade I-II resection, and without the dura and bone flap replacement intraoperatively. Post-operative radiotherapy improved the outcomes of tumors in patients after the second surgery.
Conclusion  Radical treatment strategies such as dura and bone flap replacements and radiotherapy should be considered in patients diagnosed with atypical meningiomas.
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2.
Background  Recently, there has been a surge of interest in minimally invasive techniques with endoscope in thyroid surgery. The aim of this study was to investigate the possibility of a scarless neck surgery under endoscopy for the treatment of thyroid tumor and to observe the results of this procedure.
Methods  A total of 68 patients (64 women and 4 men) underwent the surgery. Their ages ranged from 18 to 65 years, with a mean age of (34±3) years. There were 64 cases of thyroid adenoma, and 4 cases of nodular goiter. An incision was made on the surface of the chest bone. The operation cavity was made by dragging the skin. Sixty-four patients underwent partial thyroid lobectomy, four patients underwent thyroid lobectomy.
Results  All 68 cases showed healing in one stage. None of the cases showed paralysis of the recurrent laryngeal nerve or tumor recurrence within the next 2 to 60 months of follow-up. The patients experienced slight pain after the operation. The patients were satisfied with the cosmetic results of the surgery.
Conclusion  The gasless endoscopic surgery through the upper chest, which was performed to treat thyroid tumor, did not leave any scar, and was easy to handle, and gave good cosmetic results.
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3.
Background  Recurrence or metastasis of myxomas is not rare and can lead to malignancy. We aimed to analyze the risk factors for postoperative cardiac myxoma recurrence and to summarize its clinical characteristics, treatments and classification.
Methods  The clinical data of 5 patients with recurrent cardiac myxoma were retrospectively analyzed and our clinical experience was summarized. Moreover, the relevant literatures were reviewed.
Results  All the five cases of primary myxomas were derived from atypical positions. One patient had early distant metastasis, one had family history, and two suffered malignant recurrence. The recurrence interval was (2.30±2.16) years and the recurrent tumors were all found in different chambers from those of the corresponding primary tumors. Re-operation was performed after recurrence. One patient died of heart failure after malignant recurrence, and the other 4 cases had satisfactory therapeutic outcomes after re-operations. Our experience advocated a clinical classification of “typical” and “atypical” cardiac myxoma, the typical myxomas referred to the tumors locating at the left atria, with single pedicle, rooted at or around the fossa ovalis, involving no genetic causes, and the atypical myxomas included the familial tumors, tumors stemming from multiple chambers, rooted in abnormal positions of the left atrium, with evident genetic mutation, or with malignant tendency.

Conclusions  Postoperative follow-up is of vital importance for patients with myxomas characterized by multi-chamber distribution, early distant metastasis, atypical origin, and family history. Once recurs, re-operation is necessary and should be performed immediately.

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4.
《中华医学杂志(英文版)》2012,125(24):4328-4333
Background  Intraoperative magnetic resonance imaging (iMRI) dates back to the 1990s and has been successfully applied in neurosurgery but they were low-field iMRI (<1.0T). This paper reports the clinical experience with a 3T iMRI-integrated neurosurgical suite in Huashan Hospital, Shanghai, China.
Methods    From September 2010 through March 2012, 373 consecutive patients underwent neurological surgery under guidance with 3T iMRI. A retrospective analysis was conducted regarding clinical efficiency.
Results  All surgery in the 373 patients was safe. The ratio of gross total resection for cerebral gliomas (n=161) was increased from 55.90% to 87.58%. The ratio of benefit in extent of resection was 39.13%. One hundred and fifty eight of the 161 glioma patients accomplished follow-up at 3 months postoperatively. Twenty of 161 patients (12.42%) suffered from early motor deficit after surgery. Late motor deficit was however observed in five of 158 patients (3.16%). Twenty-one of 161 patients (13.04%) had early speech deficit and late speech deficit was only observed in six of 158 patients (3.80%). The ratio of gross total resection for pituitary adenomas (n=49) was increased from 77.55% to 85.71%. The ratio of benefit in extent of resection was 10.2%. There were no iMRI-related adverse events even for patients who underwent awake craniotomy.
Conclusion  The 3T iMRI integrated neurosurgical suite provides high-quality intraoperative structural and functional imaging for real-time tumor resection control and accurate functional preservation, resulting in an improvement in maximal safe brain surgery.
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5.
Background  As the third-generation tension-free tape for female stress urinary incontinence (SUI), tension-free vaginal tape (TVT)-Secur has decreased the common complications associated with TVT and tension-free vaginal tape-transobturator (TVT-O), such as bladder perforation and obstruction of the bladder outlet; but its efficacy and persistence were still controversial. The aim of this study was to prospectively evaluate and compare the postoperative efficacy and complication at different follow-up time.
Methods  Patients with SUI, who underwent TVT-Secur treatment in two hospitals from October 2008 to October 2009, were selected. By analyzing preoperative and intraoperative data and postoperative complications, the therapeutic effect and satisfaction at different follow-up stages were evaluated.
Results  A total of 30 female patients participated in this study. Patients were scheduled for follow-up at the 1st month, 3rd month, 6th month and 12th month, while the cure rate was 83.3% (25 patients), 66.7% (20 patients), 63.3% (19 patients) and 60.0% (18 patients) respectively and the overactive bladder (OAB) symptoms appeared in 11 patients (36.7%), 10 patients (33.3%), 6 patients (20%) and 7 patients (23.3%) respectively.
Conclusion  With the follow-up time becoming longer, TVT-Secur has a high recurrence rate of SUI, the therapeutic effect from the 3rd month to the 12th month is relatively persistent.
  相似文献   

6.
髂静脉受压综合征的腔内治疗   总被引:3,自引:0,他引:3  
Background  Iliac vein compression syndrome (IVCS), the symptomatic compression of the left common iliac vein between the right common iliac artery and the vertebrae, is not an uncommon condition. The aim of this research was to retrospectively evaluate long-term outcome and the significance of endovascular treatment in patients with left IVCS. 
Methods  Between January 1997 and September 2008, 296 patients received interventional therapy in the left common iliac vein. In the second stage, 170 cases underwent saphenous vein high ligation and stripping. Two hundred and thirty-one cases were followed up over a period of 6 to 120 months (average 46 months) and evaluated for symptom improvement with color ultrasound and ascending venography.
Results  The stenotic or occlusive segments of the left iliac vein were successfully dilated in 285 cases, of whom 272 received stent implantation therapy. Most of the patients achieved satisfactory results on discharge. During the follow-up period, varicose veins were alleviated in 98.7% of the patients, and leg swelling disappeared or was obviously relieved in 84% of cases. About 85% of leg ulcers completely healed. The total patency rate was 91.7% as evaluated with color ultrasound and 91.5% with ascending venography.
Conclusions  Endovascular treatment of IVCS provides effective symptomatic improvement and good long-term patency in most patients.
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7.
Background  Bleb-associated endophthalmitis (BAE) is a rare but severe complication of trabeculectomy with poor outcome. Various surgical methods were explored to treat such patients. However, there is no defined protocol. The aim of this study was to describe a new combined operation, and to demonstrate the outcome of the treatment.
Methods  Nine patients with BAE were enrolled in our study. The combined operation including pars plana vitrectomy (PPV), sclera patch graft (SPG) and endoscopic cyclophotocoagulation (ECP) was used to treat these patients.
Results  In the follow-up of 18–24 months, all patients with the endophthalmitis were cured, the useful visual acuity was preserved in 7 patients, and the intraocular pressure (IOP) of 8 patients was controlled just after first operation, only one needed another trans-scleral cyclophotocoagulation.
Conclusion  This combined operation is a useful method for treating the patients with BAE, with SPG and vitrectomy to control the endophthalmitis and ECP to balance the postoperative IOP.
  相似文献   

8.
Background  Osteoclast-associated receptor (OSCAR) is a member of the newly identified leukocyte receptor complex, and has recently been described as a key molecule in osteoclastogenesis. In this study, we measured the levels of soluble osteoclast-associated receptor (sOSCAR) in the serum of rheumatoid arthritis (RA) patients and healthy controls to examine whether sOSCAR may play a role in the process of inflammatory arthritis.
Methods  Enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of sOSCAR in the serum of 40 healthy controls and 40 RA patients.
Results  The serum levels of sOSCAR were significantly lower in RA patients than in healthy controls, and were inversely associated with inflammatory activity.
Conclusion  sOSCAR is decreased in patients with RA and reduced levels of the protein are associated with increased inflammatory response.
  相似文献   

9.
Background  Massive presacral venous plexus hemorrhage during radical resection of rectal carcinoma is rare, but when it occurs, bleeding can be uncontrollable, leading to death in some cases. Medical adhesive gauze sticking and packing and thumbtack compressive fixation are often used for hemostasis, but these methods are not effective in cases of uncontrollable massive hemorrhage. Therefore, identifying a practical, accurate, and reliable method of hemostasis in these cases is essential.
Methods  Between January 2004 and December 2009, we treated 3 patients with massive presacral venous plexus hemorrhage during resection of rectal carcinoma by placing small, trimmed thin steel plates at the bleeding sites. The plates were fixed with a saddle-type application of thumbtacks.
Results  Bleeding was successfully controlled in all 3 patients, and intestinal anastomosis was carried out after hemostasis. No complications were observed.
Conclusions  Application of a small, thin steel plate to the bleeding site with thumbtack fixation is a simple and effective method of hemostasis in patients with massive presacral venous plexus hemorrhage during resection of rectal carcinoma.
  相似文献   

10.
ackground  Percutaneous transluminal renal angioplasty with stent is an effective procedure for atherosclerotic renal artery stenosis. However, the decision to perform this procedure has recently raised considerable debate. The aim of this study was to assess the effects of percutaneous transluminal renal angioplasty with stent in atherosclerotic renal artery stenosis patients, especially as it relates to blood pressure control and renal function improvement.
Methods  A retrospective analysis was made of the clinical data from 125 atherosclerotic renal artery stenosis patients who underwent percutaneous transluminal renal angioplasty from July 2004 to June 2008 in the Department of Vascular Surgery of Beijing Chaoyang Hospital. We compared blood pressure, number of oral antihypertensive medications, and renal function changes pre and post-procedure at 24 months follow-up.
Results  A total of 125 atherosclerotic renal artery stenosis patients underwent percutaneous transluminal renal angioplasty and 143 stents were placed. At 24 months follow-up, both systolic and diastolic blood pressure and the number of oral antihypertensive medications were significantly reduced (P <0.05). Overall, the estimated glomerular filtration rate did not change significantly (P >0.05); however, a significant increase in estimated glomerular filtration rate was observed in the subgroup of patients with a lower baseline estimated glomerular filtration rate and in the subgroup of patients with bilateral renal artery stenosis (P <0.05).
Conclusion  Percutaneous transluminal renal angioplasty is a safe procedure for atherosclerotic renal artery stenosis patients, providing a significant improvement in blood pressure control and reduction in the number of oral antihypertensive medications.
  相似文献   

11.
背景: 非典型性脑膜瘤(Atypical meningioma)数量较少,治疗方案仍缺乏共识。 方法:对15例复发并经第二次手术后病理诊断证实为非典型性脑膜瘤的病人进行了回顾性研究。分析了病人年龄、性别、肿瘤位置、肿瘤病理特性、分裂细胞数量、复发的方式、第一次和第二次手术切除程度、手术策略以及手术后辅助放化疗对病人复发和生存期的影响。 结果:病人年龄、性别与肿瘤对复发无明确影响,但是肿瘤位于颅底、高度分裂、切除不彻底、术中未能对硬脑膜及骨瓣进行置换等均是导致非典型性脑膜瘤易复发,预后不良的因素。术后放疗能提高再次手术病人肿瘤的控制效果,放、化疗联合应用与单独放射治疗效果无明显差异。 结论: 手术切除程度、对相应硬脑膜及骨瓣的处理、术后的综合治疗能明显影响病人的预后,一旦诊断为非典型性脑膜瘤,无论是第一次手术还是复发后手术,均应下定决心采用诸如替换硬脑膜、骨瓣、放射治疗等更积极的进行处理。  相似文献   

12.
目的 系统评价非典型性脑膜瘤患者术后复发的总体情况。方法 计算机检索中国知网、万方数据库、中国生物医学文献数据库、维普数据库、PubMed、Embase、Web of Science和Cochrane Library数据库,搜集关于非典型性脑膜瘤肿瘤复发的相关文献,检索时限均为建库至2021年7月。由两位研究者独立筛选文献,提取数据并评估纳入研究的偏倚风险后,采用R 5.0进行Meta分析。结果 共纳入29个研究,包括3122例患者。Meta分析结果显示,非典型性脑膜瘤患者术后肿瘤总体复发率为38%。亚组分析结果显示,≥60岁患者肿瘤复发率为51%,<60岁患者肿瘤复发率为40%,差异无统计学意义。男性和女性患者肿瘤复发率分别为42%和44%,差异无统计学意义。矢状窦旁脑膜瘤复发率高达52%,患者出现脑组织浸润后肿瘤复发率为47%,Ki-67>8%的患者复发率为63%,有丝分裂数≥6/10高倍视野的患者肿瘤复发率为53%,存在组织坏死的患者肿瘤复发率为69%。肿瘤次全切的复发率高达58%,接受放疗较未接受放疗的患者肿瘤复发率高,分别为38%、29%(P=0.007)。结论 非典型性脑膜瘤患者术后肿瘤复发率较高,需予以一定的重视并采取相应的干预措施,以提高患者无瘤生存率。  相似文献   

13.
 目的   分析治疗上颌窦内翻性乳头状瘤(inverted papilloma,IP)的相关因素和获得更佳疗效的手术方法。方法    回顾性分析2003—2015年在复旦大学附属眼耳鼻喉科医院行鼻内镜下IP切除术的病例资料,手术均由同一位医师完成,分别对肿瘤分期、手术方式、影响因素及预后进行比较分析。结果    共纳入88例上颌窦乳头状瘤的患者,其中男性58例(65.9%),女性30例(34.1%),男女比例为1.9∶1。平均年龄52 岁,平均随访时间约98.6个月。主要症状依次为单侧鼻塞伴或不伴流涕56例(63.6%),鼻出血8例(9.1%),体检发现鼻腔新生物5例(5.7%),头面部胀痛5例(5.7%),嗅觉减退3例(3.4%)。88例患者中,49例(55.7%)行鼻窦开放术,39例(44.3%)采用另一种类型的手术方式,其中15例(38.5%)行上颌窦内侧壁切除术,24例(61.5%)行上颌窦前、内侧壁切除术。88例病例中有2例(2.3%)切除鼻泪管并在术中行鼻腔泪囊造口术,4例(4.5%)因涉及额窦同时行Draft Ⅱ型手术。行鼻窦开放术的患者中复发13例,术后鼻塞5例,偶有鼻出血3例,无癌变患者;行上颌窦内侧壁切除术的患者中复发2例,行上颌窦前、内侧壁切除术的患者中复发1例。39例行另一术式的患者中,术后鼻塞4例,溢泪1例,癌变2例,癌变患者术后行放化疗,其中1位患者因放疗后肉瘤死亡。癌变患者嘱其放化疗并定期随访。88例患者总复发率为18%,总恶变率为2%。结论    对不同分期的肿瘤可以用不同的内镜手术,具体术式的选择应根据患者具体的病情、肿瘤侵及的范围和术者的经验等因素综合决定。彻底切除肿瘤及其侵及的黏膜是手术成功的关键,联合术后定期随访和进行综合治疗,是治疗上颌窦IP最合理的方式。  相似文献   

14.
肖军   《中国医学工程》2009,(4):296-298
目的评价标准外伤大骨瓣开颅术救治急性硬膜下血肿的疗效。方法采用标准外伤大骨瓣开颅术救治58例急性硬膜下血肿患者,对其临床资料进行回顾性分析、总结。结果全组58例中,恢复良好26例,中残14例,重残8例,死亡10例。术后并发症:迟发性血肿5例,外伤性脑梗塞2例,硬膜下积液5例,皮片坏死2例,颅内感染2例,外伤性癫痫3例。结论标准外伤大骨瓣开颅术暴露良好、止血彻底,有利于清除血肿、脑疝复位和缓解颅压,是救治急性硬膜下血肿的有效手段。  相似文献   

15.
Surgical strategies for petroclival meningioma in 57 patients   总被引:2,自引:0,他引:2  
Background Resection of petroclival meningioma (PCM) is difficult for neurosurgeons and usually brings poor performance status. In this study, we evaluated the possible risk factors for unfavorable clinical outcomes of surgical treatment of PCM, and tried to explore the optimal surgical strategies for better postoperative quality of life.Methods We recruited 57 patients (14 male, 43 female, mean age, 50.5 years) who underwent surgical resection of PCM in Huashan Hospital during 2002-2006. The primary outcomes including postoperative neurological deficits,modified Rankin scale (mRS) score and recurrence rate were evaluated, and all potential risk factors were assessed by the X2 test. Odds ratio and 95% confidence interval were calculated by univariate Logistic regression. The mean follow-up time was 34 months.Results Gross total resection was achieved in 58% of patients. One patient died during the perioperative period because of intracranial hemorrhage. Sixty-seven percent of patients experienced new postoperative neurological deficits and 26% had a higher mRS score at follow-up assessment. Postoperative complications were observed in 24 patients.Within the follow-up period, radiographic recurrence occurred in 12.3% of patients at a mean follow-up of 42 months.Postoperative radiosurgery was administered to 19 patients who had residual tumors or recurrence and no furtherprogression was found. Tumor adhesion, hypervascularity and engulfment of neurovascular structures were three risk factors for increased mRS score (P=0.0002; P=0.0051; P=0.0009). Tumor adherence to adjacent structures clearly affected the extent of resection (P=0.0029). The risk of postoperative cranial nerve deficits increased with tumor engulfment of neurovascular structures (P=0.0004).Conclusions Intraoperatively defined tumor characteristics played a critical role in identifying postoperative functional status. An individual treatment strategy after careful preoperative evaluation could help improve quality of life.  相似文献   

16.
目的 探讨内侧型蝶骨嵴脑膜瘤的显微手术技巧。方法 回顾性分析19例显微外科手术治疗的内侧型蝶骨嵴脑膜瘤的临床资料,所有病例均经翼点入路或扩大的翼点入路进行肿瘤切除,其中肿瘤全切除16例,次全切除2例,部分切除1例。观察术后疗效。结果 19例术后随访4个月~70月,预后优良16例,一般2例,差1例,无复发病例。结论 术前完善的神经影像学评估,认真的分析影像学资料,术中准确的判断肿瘤包裹的动脉和穿支血管的走行,良好的显微外科技术和手术分离技巧,是提高手术全切率,减少术后并发症的关键。  相似文献   

17.
王文超  盛晓梅 《现代医学》2012,40(4):444-446
目的:探讨如何提高胃底贲门癌尤其是累及食管下段1~2 cm以内的贲门及胃上部癌经腹手术切除成功率,减轻手术创伤,辅以综合治疗,以提高疗效.方法:对61例贲门及胃上部癌中的29例采用术前高选择动脉插管化疗( HSAPC)及术中低渗温盐水灌洗加腹腔化疗等综合治疗.结果:治疗组29例中经腹手术28例(姑息仅3例),经胸手术1例(食道下段受累>2 cm),1、3、5、10年生存率分别为93.1%、62.1%、48.2%、20.7%;而对照组32例中经腹手术19例(姑息达7例),经胸手术达13例.1、3、5、10年生存率分别为81.2%、40.6%、25%、9.4%.结论:胃上部及贲门癌部分累及食管下段,经术前HSAPC可以明显提高经腹手术切除成功率及术后生存期,综合治疗可减少复发.  相似文献   

18.
脑膜瘤手术后复发因素   总被引:1,自引:0,他引:1       下载免费PDF全文
 目的探讨脑膜瘤手术切除后的复发因素。方法回顾分析沈阳军区总医院和上海长征医院神经外科162 例手术显微
镜下切除的位于静脉窦旁、镰旁、以及一些颅底脑膜瘤患者临床资料,排除凸面脑膜瘤,随访3耀5 年,应用单因素、多因素分析
Cox 模型统计学方法,分析脑膜瘤的临床特征(性别、年龄、肿瘤大小、形状)、病理分级、免疫组化指标[包括肿瘤增殖标志物Ki-
67,雄激素受体(AR)、雌激素受体(ER)、孕激素受体(PR)]的表达与复发的关系。结果53 例脑膜瘤复发(复发率32.7%)。免
疫组化染色结果提示AR、ER、PR、Ki-67 抗体在部分脑膜瘤标本细胞核中呈阳性表达。Cox 模型显示肿瘤大小、形状、病理级别
和Ki67 的表达与复发相关( P<0.05)。结论脑膜瘤显微镜下切除后5年内复发率较高。体积较大、不规则形态、病理域级和
芋级、Ki67表达阳性是复发的危险因素,随访时间延长复发率有增高趋势。  相似文献   

19.
目的 探讨显微手术治疗侧脑室三区脑膜瘤的疗效。方法 总结8例经显微手术治疗侧脑室三角区脑膜瘤的临床资料。结果 全组7例获得全切,肿瘤全切除率为87.5%,术后并发同向偏盲4例,偏瘫1例,精神症状3例,经非手术治疗均恢复正常,无手术死亡。1例次全切除,术后3a复发,经再次手术而痊愈。结论 显微手术技术是治疗关键。侧脑室三角区脑膜瘤手术难度大,合理的手术入路、精细的手术操作与良好的术后引流是全切肿瘤、提高疗效的重要因素。  相似文献   

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