层析征在预测脑出血血肿稳定性及预后中的应用价值

目的:探讨计算机断层扫描（CT）所示的层析征在预测高血压性脑出血患者血肿稳定性及预后中的应用价值。方法:选择潍坊市人民医院神经外科自2016年1月至2019年7月收治的221例高血压性脑出血患者,其中男100例,女121例;平均年龄60岁。动态观察患者入院时和入院后复查CT所示的亚高密度区的变化,亚高密度区逐渐明显增大...     

软通道清除脑内血肿手术方式的临床研究

目的:探讨软通道清除脑内血肿的手术方式、注意要点及其并发症的预防。方法:采取锥颅置管尿激酶溶凝术治疗98例患者,根据术前CT检查结果,对不同部位的血肿采用不同的手术方法。对手术操作细节、留置引流管时间、尿激酶用量及手术并发症进行分析总结。结果:根据术前的CT影像学特点,可将脑内血肿分为:髓质大型、髓质小型、破入脑室大型、破入脑室小型,对不同类型的脑内血肿采用不同的手术方式。结论:对不同部位的出血应采用不同的术式,注意手术细节操作,对其疗效有着重要意义。     

手术治疗伴有髓内出血水肿的创伤性颈脊髓损伤的疗效及预后预测因素

目的:分析伴有髓内出血水肿的创伤性颈脊髓损伤(CSCI)的手术疗效,探讨其预后预测因素.方法:回顾性分析2014年1月～2019年12月在我院接受手术治疗的伴髓内出血水肿的创伤性CSCI患者83例.术前和术后6个月依据美国脊髓损伤协会残障等级[American Spinal Injuries Association(A...     

乳突型先天性胆脂瘤伴外伤后巨大血肿1例

目的 提高临床医生对乳突型先天性胆脂瘤并外伤后巨大血肿病人的认识及诊断、治疗水平。方法 因“左耳后撞伤肿胀疼痛9个月，加重4天”1例于2021年2月9日入贵州医科大学附属医院，其临床表现及影像学资料缺乏特异性，极易误诊，病人于2021年2月10日全麻显微镜下行左侧完壁式乳突根治术+乳突占位切除术。结果 彻底切除肿物并清除血肿，术后病理及免疫组化证实乳突占位中央为纤维素及炎细胞渗出凝块，乳突占位边缘为炎性肉芽组织伴异物肉芽肿形成，符合胆脂瘤改变。术后6个月随访，病人无耳痛、耳流脓、耳后肿胀、听力下降、眩晕等症状，复查耳内镜、颞骨CT未见复发及进展征象，复查纯音听阈示左耳听力基本恢复正常。结论 该病人有外伤史，术中证实颞骨胆脂瘤并巨大血肿形成，较为罕见，诊断依靠病理学检查，治疗以手术彻底切除为主，术后需密切随访。     

迟发性外伤性颅内血肿临床分析

目的:探讨迟发性外伤性颅内血肿的临床特点、诊断及治疗。方法:收集我院1999年1月至2010年10月收治的迟发性外伤性颅内血肿病例193例进行回顾性分析。其中男性134例、女性59例,年龄4-71岁。结果:经治疗后,痊愈102例,轻残26例,重残22例,死亡43例,残亡占22%。结论:迟发性血肿多见于外伤的急性期,以枕部着力的对冲伤多见,意识变化是最重要的临床特点,致残率死亡率高,早期诊断及时处理是改善预后的关键。     

食物烫伤致食管全段巨大血肿 1例

目的 分析1例因食物烫伤致食管全段巨大血肿病例,为临床提供参考.方法 分析解放军陆军第八十一集团军医院消化内科2019年7月10日急诊收治的一位因食物烫伤导致食管全段巨大血肿病人病情演变、诊断治疗经过及相关文献复习.结果 经过电子胃镜及影像学检查综合分析诊断为食管血肿,经消化内科保守治疗病人痊愈出院.结论 食物烫伤导致食管全段巨大血肿临床罕见,胃镜下组织损害可达烫伤Ⅱ度,经过内科保守治疗预后良好.发病初期需结合多种检查手段确诊,病情允许应尽早胃镜检查以明确病因,但需谨慎操作.     

Complications of revision surgery in case of bleeding after thyroid surgery: A systematic review

ObjectivesThe aim of this review is to evaluate complications in patients undergoing surgical control of bleeding after thyroid surgery. Secondly, we have analyzed the rate of the main complications.MethodsThe databases PubMed and EMBASE were searched for articles regarding complications after revision thyroid surgery for bleeding. A Systematic review methodology based on Preferred Reporting Items for Systematic Reviews and Meta-analysis was performed.ResultsNine studies met the inclusion criteria, six are retrospectives and three retrospectives controlled. The overall rate of bleeding after thyroid surgery was 1.38%. In these patients, the most common complication after revision surgery for bleeding is hypoparathyroidism 24.9% (95% CI: 20.7–29.5) followed by recurrent laryngeal nerve injury 8.1% (95% CI: 6.4–10.1) and wound infection 4.5% (95% CI: 2.5–7.6). Tracheostomy and other lethal complications are rarely described.ConclusionAlthough rare, complications after surgical control of bleeding in patients undergoing thyroid surgery can be serious. Therefore, in order to optimize the surgical outcomes, standardized protocol providing early detection and precise hemostasis procedure, is needed. Specific patient-informed consent for this condition should be created.     

Three cases of organized hematoma of the maxillary sinus in patients who underwent preoperative arterial embolization

Organized hematoma (OH) is benign tumor in the maxillary sinus. The standard treatment for OH is complete surgical resection, however massive bleeding can occur during the procedure, albeit rarely. Some reports have suggested preoperative embolization is useful for reducing the volume of intraoperative bleeding. We report 3 cases of OH in the maxillary performed preoperative embolization. We identified the feeding arteries by angiography or IVR-CT, and we embolized them using Gelatin sponge particles. The embolized artery was the maxillary artery or both the maxillary and the facial artery. There were no major complications as a result of embolization. The mean fluoroscopy time was 35.8 minutes, and the mean fluoroscopy dose was 329.3 mGy. Tumor resection was performed the next day after arterial embolization. The mean bleeding volume for surgery was 383.3 ml, and the mean operative time was 194 minutes. No recurrence was observed in any of the cases over a 4-year follow-up period. We considered that it is possible that preoperative artery embolization is useful for decreasing intraoperative bleeding volume. Although the methods and usefulness of embolization await future reports, it is a technique that should be considered preoperatively because of its potential to prevent massive bleeding.     

Clinical application of 3DSlicer and Sina in minimally invasive puncture drainage of elderly patients with spontaneous intracerebral hemorrhage under local anesthesia

BackgroundDecreased organ function and poor physical compensatory capacity in elderly patients diagnosed with spontaneous intracerebral hemorrhage (ICH) can make surgical treatment procedures challenging and risky. Minimally invasive puncture drainage (MIPD) combined with urokinase infusion therapy is a safe and feasible method of treating ICH. This study aimed to compare the treatment efficacy of MIPD conducted under local anesthesia using either 3DSlicer + Sina application or computer tomography (CT)–guided stereotactic localization of hematomas in elderly patients diagnosed with ICH.MethodsThe study sample included 78 elderly patients (≥ 65 years of age) diagnosed with ICH for the first time. All patients exhibited stable vital signs and underwent surgical treatment. The study sample was randomly divided into two groups, either receiving 3DSlicer+Sina or CT-guided stereotactic assistance. The preoperative preparation time; hematoma localization accuracy rate; satisfactory hematoma puncture rate; hematoma clearance rate; postoperative rebleeding rate; Glasgow Coma Scale (GCS) score after 7 days; and modified Rankin scale (mRS) score 6 months after surgery were compared between the two groups.ResultsNo significant differences in gender, age, preoperative GCS score, preoperative hematoma volume (HV), and surgical duration were observed between the two groups (all p-values > 0.05). However, the preoperative preparation time was shorter in the group receiving 3DSlicer + Sina assistance compared to that receiving CT-guided stereotactic assistance (p-value < 0.001). Both groups exhibited significant improvement in GCS scores and reduction in HV after surgery (all p-values < 0.001). The accuracy of hematoma localization and puncture was 100% in both groups. There were no significant differences in surgical duration, postoperative hematoma clearance rate, rebleeding rate, postoperative GCS and mRS scores between the two groups (all p-values > 0.05).ConclusionsA combination of 3DSlicer and Sina is effective in accurately identifying hematomas in elderly patients with ICH exhibiting stable vital signs, thus simplifying MIPD surgeries conducted under local anesthesia. This procedure may also be preferred over CT-guided stereotactic localization in clinical practice due to its ease of use and accuracy in hematoma localization.