开颅手术治疗慢性硬膜下血肿26例

住临床上首选单孔钻孔冲洗引流术治疗慢性硬膜下血肿(CSDH)[1].但根据血肿具有形态及性状多样性的特点,有针对性地选择开颅手术治疗CSDH,以减少术后复发、提高患者的治愈率尤为关键.我院2001-2006年应用外颅手术治疗26例CSDH患者,取得满意疗效.现报告如下.     

单孔钻颅引流术治疗老年慢性硬膜下血肿86例分析

单孔钻颅引流术治疗86例老年慢性硬膜下血肿患者,其中83例治愈,治愈率96.9%.该方法简单、操作容易,是治疗老年慢性硬膜下血肿的有效方法。     

单孔钻颅引流治疗老年慢性硬膜下血肿96例分析

单孔钻颅引流术治疗96例老年慢性硬膜下血肿患者,其中93例治愈,治愈率96.9%.该方法简单、操作容易,是治疗老年慢性硬膜下血肿的有效方法.     

内镜辅助下钻孔引流治疗慢性硬膜下血肿

对慢性硬膜下血肿(chronic subdural hematoma,CSDH)的治疗,传统方法为钻孔冲洗引流术,虽然简单方便快捷,疗效亦较满意,但存在血肿清除不尽彻底、术后颅内积气发生率较高、术后血肿复发和硬膜下积液等并发症[1].近年来,随着神经内镜技术的发展,神经内镜技术越来越多地用来治疗CSDH.笔者应用软性神经内镜辅助下钻孔引流治疗CSDH患者,并将其疗效与同期单纯采用钻孔引流术的患者进行比较.现报告如下. 1 临床资料 1.1 一般资料 选择2010年3月-2012年12月收治的CSDH患者60例.根据治疗方法分为应用STORZ神经内窥镜操作系统治疗组(内镜组)和采用单纯钻孔引流治疗组(对照组).内镜组男25例,女5例;年龄41～83岁,平均50.3岁.     

单孔腹腔镜治疗良性卵巢肿瘤临床疗效

目的探讨单孔腹腔镜治疗良性卵巢肿瘤的临床效果及预后。方法选取自2017年8月至2018年8月收治的90例良性卵巢肿瘤患者为研究对象,按照随机数字表法将所有患者分为A、B两组,每组各45例。A组采用多孔腹腔镜治疗,B组采用单孔腹腔镜治疗。比较两组患者手术情况(手术时间、出血量、通气时间、住院时间)、术后疼痛情况、美观满意评分及不良反应发生情况。结果 B组通气时间以及住院时间均显著低于A组,两组比较,差异均有统计学意义(P<0.05)。两组患者手术时间、出血量比较,差异均无统计学意义(P>0.05)。两组患者术后2 h疼痛评分比较,差异无统计学意义(P>0.05)。B组术后24 h、术后72 h疼痛评分显低于A组,美观满意评分高于A组,两组比较,差异有统计学意义(P<0.05)。两组不良反应发生情况比较,差异无统计学意义(P>0.05)。结论采用单孔腹腔镜手术治疗良性卵巢肿瘤可有效降低患者术后疼痛情况,促进患者术后恢复,提高美观度评分,且安全性较高。     

锥颅治疗慢性硬膜下血肿47例分析

目的探讨锥颅治疗慢性硬膜下血肿的疗效。方法对47例慢性硬膜下血肿患者均根据颅脑CT定位,采用经头皮直接锥颅置管冲洗引流术治疗。结果47例病人中,意识障碍、偏瘫均在1~2 d内明显好转,2周后患者生活基本能自理,记忆力恢复正常,术后全部痊愈出院,随访半年无一例复发。结论经头皮行锥颅慢性硬膜下血肿冲洗引流术操作简单、手术时间短、创伤小、并发症少、疗效高。     

血肿清除加侧脑室外引流治疗高血压病脑出血并破入脑室

目的：总结高血压病脑出血并破入脑室的病人做小骨窗侧裂入路血肿清除加钻颅侧脑室外引流综合治疗的技术和经验。方法：按顺序行小骨窗侧裂入路血肿清除术、钻颅侧脑室引流术。如果有血块梗阻者,在活动性出血停止24h后,灌注尿激酶5000～10000u至脑室内,关闭6～8h后开放引流。结果：本组成活74例,成活率89%,按日常生活能力（ADC）评分：ADCI级11例、ADCII级34例、ADCIII级21例、ADCIV级5例、ADCV级3例,死亡9例。结论：小骨窗侧裂入路血肿清除加钻颅侧脑室外引流综合治疗可以尽早清除血管外积血,在可视下电凝活动出血,止血牢靠,从而减少脑实质内出血灶进一步压迫损害脑神经,减少血性成分对室管膜损害,减少颅内容量及引起颅压升高的重要因素,从而维护血肿周围脑血流、脑灌注压和血肿部位支配的神经系统功能,减轻脑水肿的发生,缩短了恢复时间,减少了并发症的发生。     

锥颅引流和开颅血肿清除术治疗高血压脑出血的临床疗效对照

目的：探究锥颅引流术和开颅血肿清除术治疗高血压脑出血的效果。方法资料随机选取诊治高血压脑出血的患者87例,随机分为研究组44例,对照组43例。对照组予以开颅血肿清除术,研究组予以锥颅引流术,分析比较两组治疗效果、持续疗效和后遗症。结果研究组一周内意识恢复率高于对照组;研究组住院期间病死率低于对照组;研究组持续疗效优于对照组;研究组后遗症发生率低于对照组（ P＜0.05）。结论锥颅引流术治疗高血压脑出血疗效显著。     

CT导引下超早期引流与开颅治疗高血压脑出血的对比研究

目的:回顾性分析CT导引下超早期细孔钻颅引流术和开颅术2种不同术式治疗高血压脑出血的疗效。方法:收集2007年4月²012年8月在我院分别接受CT导引下血肿细孔钻颅引流尿激酶溶解术67例和开颅血肿清除术64例的高血压脑出血患者资料(出血量在102012年8月在我院分别接受CT导引下血肿细孔钻颅引流尿激酶溶解术67例和开颅血肿清除术64例的高血压脑出血患者资料(出血量在10¹60ml),对2组的年龄、出血量、死亡率、肢体瘫痪、语言障碍、植物状态进行比较。结果:2组年龄、脑出血量差异无统计学意义(P>0.05),肢体瘫痪、语言障碍、死亡率、植物状态有明显差异。结论:高血压脑出血CT导引下钻孔引流尿激酶溶解术的疗效明显优于开颅术。     

钻孔冲洗引流术对慢性硬脑膜下血肿患者神经功能及炎性指标的影响

目的探讨钻孔冲洗引流术对慢性硬脑膜下血肿(CSDH)患者神经功能及炎性指标的影响。方法选择2017年1月-2018年9月收治的CSDH患者90例,采用随机数字表法分为两组(n均=45)。对照组采用钻孔不冲洗引流术,观察组采用钻孔冲洗引流术,比较两组患者神经功能及炎性指标。结果术后2个月,观察组中国卒中量表(CSS)评分低于对照组,差异有统计学意义(P<0.05);观察组术后1d时白细胞介素-6(IL-6)、白细胞介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)、血清超敏C反应蛋白(hs-CRP)低于对照组,差异有统计学意义(P<0.05)。结论钻孔冲洗引流术可有效挽救CSDH患者神经功能损伤,降低炎性指标水平。     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.