颈动脉支架植入术的术中护理干预

目的:探讨颈动脉支架植入术的术中护理干预的疗效及护理。方法:54例患者分为对照组和干预组。对照组(n=21),干预组(n=33),对照组给于常规护理,干预组在常规护理基础上给与认知、心理、行为干预。观察两组的疗效并进行比较。结果:干预组的静脉输液通畅,高压灌注线管理良好,恐惧,意识体征变化,尿潴留均较对照组有明显改善(P<0.01)。结论:在颈动脉支架植入术的术中实行护理干预有重要意义,值得推广应用。     

LigaSure在小切口甲状腺手术中的应用

目的探讨血管闭合器（LigaSure）在小切口甲状腺手术中的应用效果。方法回顾性分析2年间收治的58例良性甲状腺疾病（Ⅱ&#176;）采用颈部小切口及LigaSure下施行甲状腺次全切除术者临床资料。结果手术平均时间45（35～70）min。术中平均出血量15（5～30）mL，术后24h甲均切口引流量20（10～30）mL，术后未出现声嘶及口角麻木等手术并发症。术后平均住院时间3（2～4）d。结论LigaSure在甲状腺手术中的应用较之传统手术能缩短手术时间、减少术中出血量和手术并发症，术后恢复快，手术切口小，不甚影响美观。     

椎体成形时骨水泥泄漏的影像学表现及其临床意义

目的:探讨经皮穿刺椎体成形术聚甲基丙烯酸甲酯混合剂(骨水泥)泄漏的影像表现特点及其对临床疗效的影响.方法:回顾性分析经皮穿刺椎体成形术和经皮脊柱后凸成形术中发生骨水泥泄漏的33个病例.结果:影像学明显可见的骨水泥泄漏共33例,包括静脉泄漏、椎体旁泄漏、椎管泄漏和针道泄漏等形式,因泄漏造成的不良反应有腰背部疼痛加重5例,咯血2例,腹部神经刺激2例.结论:经皮穿刺椎体成形术时发生骨水泥泄漏的原因主要是引流静脉粗大、椎体的结构破损、穿刺途径偏离和注射时机过早等,少许泄漏一般无严重后果,大量泄漏进入椎管和血管可导致神经压迫和肺动脉栓塞等并发症.     

肛门括约肌肌电图监测下双侧L2～S2选择性脊神经后根切断术治疗痉挛性脑瘫

目的为提高手术安全性,在L2～S2选择性脊神经后根切断(SPR)手术时,对肛门括约肌进行肌电图(EMG)监测,并评价其作用。方法在SPR手术监测中,当对S2后根小束进行电刺激时,采用针状电极记录双侧肛门括约肌的反应情况,有明显反应的后根小束予以保留。手术后随访患者踝痉挛改善情况和括约肌功能变化情况。结果所有患者手术后踝痉挛均有明显改善,无大小便功能障碍发生。结论SPR手术包括S2后根时,术中括约肌EMG监测对保证疗效,保护括约肌功能,提高手术安全,具有重要意义。     

Inhibition of warm ischemic injury to rat liver, pancreas, and heart grafts by controlling the nutritional status of both donor and recipient

In this study, we tested the effect of donor fasting with or without the use of an essential fatty acids deficiency (EFAD) diet in the recipient using rat heart, pancreas, and liver transplant models. We then compared the survivals, tumor necrosis factor alpha (TNF-α) response, and white cell accumulation in rats in order to clarify the mechanisms of the beneficial effect of donor fasting and recipient EFAD. It was found that when the grafts were obtained from fasted donors and then transplanted into fed recipients, the survival rate was significantly higher for all three grafts than for those obtained from fed rats and transplanted into fed rats. The best survival was seen for pancreas grafts obtained from fasted donors and then transplanted into EFAD recipients. TNF-α secretion was significantly suppressed in both fasted and EFAD rats, and both the total cell count and neutrophil count were suppressed in EFAD rats. These results clearly indicate that in addition to liver grafts, both heart and pancreas grafts obtained from fasted animals are more tolerant to warm ischemic injury. Furthermore, the combination of donor fasting and recipient EFAD acts synergistically to inhibit the post-transplantation inflammatory reaction (through decreased TNF-α secretion and white cell accumulation), thus resulting in an improved survival.     

303例下咽癌的外科治疗及组织移植修复重建术的临床分析

目的探讨下咽癌的外科治疗及术后下咽食管缺损不同组织移植Ⅰ期重建方法在下咽癌治疗中的远期疗效.方法回顾性分析1965～1998年外科治疗下咽癌患者303例,其中130例经不同组织移植重建下咽食管手术治疗(1997年UICC分期Ⅱ期5例;Ⅲ期16例;Ⅳ期109例),其中梨状窝区94例,咽后壁区18例,环后区18例.游离空肠15例,胃代下咽食管81例,结肠代下咽食管10例,胸大肌肌皮瓣修复20例,其他方法4例.173例下咽癌患者不需要重建(Ⅰ期7例,Ⅱ期12例,Ⅲ期51例,Ⅳ期103例),其中梨状窝160例,咽后壁8例,环后5例.结果 Kaplan-Meire法统计生存率,130例组织移植重建患者3年生存率为43.2%,5年生存率为36.4%;173例不需要组织重建患者3年生存率为59.2%,5年生存率为47.7%.各组吞咽功能良好率均在80%以上.胃代下咽食管手术死亡率为8.6%(7/81例);胸大肌肌皮瓣修复手术死亡率15.0%(3/209例);游离空肠及结肠代食管下咽无手术死亡.总手术并发症20世纪90年代之前为44.3%(35/79例),90年代手术并发症为13.7%(7/51例),χ2=13.457,P=0.004,差异有显著性;其中90年代胸大肌肌皮瓣修复并发症最高为18.2%(2/11例).结论游离空肠、胃代下咽食管、胸大肌肌皮瓣修复在下咽癌的生存率、吞咽功能的恢复及手术并发症等方面均取得较好的治疗效果,是值得提倡的重建方法.     

Harvey Cushing's postoperative sketches of pediatric brain tumors

Harvey Cushing was a man of many talents. Not only was he a premier surgeon and scientist, but a prolific author and artist as well. In this paper, we present two postoperative sketches of pediatric brain tumors drawn by Dr. Cushing. These sketches are representative of drawings which accompany many of his operative notes at the Peter Bent Brigham Hospital. About 25% of Cushing's surgical sketches depict operations performed on children. The most commonly drawn childhood tumors were craniopharyngiomas and gliomas of the brain stem and cerebellum. These drawings reveal how Cushing maintained detailed records of his surgical experience. It is clearly evident from these records that Dr. Cushing gained substantial experience in the treatment of pediatric brain tumors.     

Local thermal sensation and finger vasoconstriction in the locally heated hand

Summary The effects of local heating on finger blood flow (BF) and local thermal sensation (Sens _w ) were studied. Finger BFs in both hands were measured simultaneously; one hand was immersed in water the temperature (T _w ) of which was raised from 35° C to 43°C by steps of 2° C every 10 min, while the other hand was kept atT _w 35°C. FingerBF in the locally heated hand decreased atT _w 37 to 41°C, while fingerBF in the control hand did not alter. Sens_w, in the heated hand showed a dynamic response, initially increasing concomitantly with an increase inT _w , then gradually returning and adapting to a new level of Sens_w. The dynamic response of Sens_w, was not perceived during mental calculation even whenT _w was raised to 40°C, and the reduction in finger blood flow was not observed. These results suggest that finger vasoconstriction caused by local heating closely relates to the dynamic response characteristic of local thermal sensation atT _w above core temperature, and that the perception of local thermal sensation in the central nervous system is involved in the mechanism of this vasoconstrictor response.     

脑干听觉诱发电位在后颅凹肿瘤诊断及术中监护的应用

目的：了解脑干听觉诱发电位技术在后颅凹肿瘤诊断及术中监护的意义。方法：对８例后颅凹肿瘤患者进行术前检查，其中２例进行术中监护，对ＢＡＥＰ各波波形、潜伏期、波间期的变化进行分析。结果：Ⅰ、Ⅲ、Ⅴ波潜伏期延长４例；ⅠⅢ、ⅢⅤ或ⅠⅤ波波间期延长５例；波形分化不良，重复性差６例；由于手术操作引起的颅内压变化、脑干出血、缺血、受压均可引起ＢＡＥＰ的变化。结论：ＢＡＥＰ对后颅凹病变的早期诊断、术中重要结构的保护及术后功能的评估有重要意义     

胃癌术中动脉区域灌注化疗与全身静脉化疗的临床疗效比较

目的　评价胃癌术中动脉区域灌注化疗药物的临床疗效。方法　对 40例经病理确诊的胃癌患者 (治疗组 )于术中经供应肿瘤的区域动脉行插管化疗 ,同时进行手术治疗 ,并与同期术中行全身静脉化疗的 2 4例胃癌患者 (对照组 )进行临床疗效比较。结果　术后病理检查显示 ,治疗组原发灶中的癌细胞均有不同程度地变性坏死 ,其近期有效率为 95 % ,对照组有效率为 41.6 7% ,两组比较差异显著 (P<0 .0 5 )。结论　胃癌患者术中经动脉灌注化疗 ,其近期抗癌效果好 ,毒副反应轻 ,对减少或防止术中癌细胞的医源性扩散与种植以及术后复发 ,均有重要的临床意义