足月新生儿颅内出血的CT诊断

经CT扫描诊断的足月新生儿颅内出血8例,就其病因、CT表现特点及CT与超声检查的比较进行讨论。提出新生儿颅内出血与孕期、胎次、分娩方式均有一定的关系,同时还应注意新生儿因脑发育不成熟在CT扫描图像上有其特殊表现。     

老年脑出血的CT扫描与预后

本组老年脑出血发病率５７％，明显高于中、青年组脑出血。首要病因是高血压病，社会环境变迁是老年脑出血的重要因素。ＣＴ扫描特点为①型别：壳核出血最多（３５．４％）、其次为丘脑（２９％）、脑叶（２１．４％）、其它型别均低于５％；②血肿量：小量出血最多（６８．８％）。预后特点是存活率较高８７．２％、死亡率仅１２．８％。     

Selective vessel ligation in the pelvis: an invaluable tool in certain surgical procedures

While developing the technique of abdominal radical trachelectomy for conservative cervical cancer management, the vascular supply of the uterus was thoroughly examined. The question of how many vessels the uterus requires to ensure its viability arose. Following an abdominal radical trachelectomy for stage IB cervical carcinoma, blood supply of the body of the uterus is successfully maintained by only the two infundibulopelvic vessels (n= 34). Pregnancy has resulted following this technique (n= 2). Selective ligation of the pelvic vasculature has been utilized in the abdominal radical trachelectomy procedure. The objectives of this study were to investigate the vasculature of the infundibulopelvic and broad ligaments, to assess the contribution of the ovarian and uterine vessels to overall uterine perfusion, and to consider the clinical applications of selective pelvic vessel ligation. Ten fresh dissections of the infundibulopelvic vessels, broad ligaments of benign total abdominal hysterectomy, and bilateral salpingo-oophorectomy specimens were performed. Perfusion index (PI) and oxygen saturation (O(2)Sat) measurements using a modified probe were taken at specified intervals at the uterine cornu during ten routine benign abdominal hysterectomies to assess the contribution of the ovarian and uterine vessels to overall uterine perfusion and the concepts studied were utilized in certain gynecological procedures. The ovarian/infundibulopelvic vessels course medially through the broad ligament toward the uterine cornu and consistently give off a branch to the ovary on its lateral border. In addition, further vessels were noted to run laterally from the uterine cornu along the ovarian ligament to the medial aspect of the ovary. PI and O(2)Sat measurements imply that the uterine and ovarian vessels contribute almost equally to uterine perfusion. Clinical application by selective ligation of the pelvic vasculature has been utilized in certain gynecological procedures often prone to torrential life-threatening uterine hemorrhage. Selective temporary ligation of the uterine and ovarian vessels has proven useful in the surgical management of chemoresistant gestational trophoblastic disease, in the Strassman procedure, fertility-sparing surgery in ruptured cornual ectopic pregnancies, and unrelenting postpartum hemorrhage. Of the six supplying vessels (ovarian, uterine, and vaginal) to the uterus only two (ovarian or uterine or a combination thereof) are required for uterine viability.     

降低高血压脑出血术后死亡的几点体会

目的 :总结降低高血压脑出血病人术后病死率的方法。方法 :分析 36例高血压脑出血病人救治经过。结果 :36例中死于肺部感染 9例 ,再出血 7例 ,消化道出血 6例 ,术后颅高压未解除 5例 ,肾功能衰竭 5例 ,其他 4例。结论 :严格掌握高血压脑出血手术指征 ,选择正确手术方法 ,术后合理用药及护理能降低高血压脑出血手术后病死率 ,改善预后。     

Outcome of intracerebral hemorrhage: clinical and CT findings in 326 patients

Clinical symptoms and findings in cranial computed tomography (CT) were evaluated in 326 patients with intracerebral hemorrhage (ICH). Localizations of ICH were the lobes (n = 254), the basal ganglia (n = 46), the pons and brain stem (n = 13) and the cerebellum (n = 8). Multiple hematomas were present in nine patients. An initial coma (n = 225) was most frequent in ICH of the pons (n = 7), cerebellum (n = 6), and the frontal (n = 71) and temporal (n = 66) lobes. Epileptic seizures (n = 70) were most common in hematomas of the frontal (n = 24), temporal (n = 19) and parietal (n = 12) lobes and the basal ganglia (n = 6). A history of hypertension was given in 140 patients; 119 of these had an ICH with a size of ≥3 cm. Mortality (n = 162) was high with ICH in the pons and brain stem (10 out of 13), in the frontal (54 out of 98) and parietal (32 out of 58) lobes and the basal ganglia (n = 23). A size of the ICH of 3 cm or more in cranial CT and an associated ventricular hemorrhage were associated with a bad outcome. An initial disturbance of consciousness was the only reliable clinical predictor of outcome (chi-square, p < 0.001). Katamnestic evaluation of 66 of the 164 survivors after 5.2 years revealed seizures in 20 patients and mild neurological deficits in 41. Another 14 patients were partially, and nine totally dependent Nineteen patients had died in between; there was only one death attributable to another ICH.     

不同手术方法对高血压脑出血患者康复的影响

目的：探讨不同手术方法对高血压脑出血患康复影响的临床意义。方法：采用立体定向血肿排空术(34例)和骨瓣开颅术(40例)进行对照研究。结果：2组近期疗效无明显差异，远期疗效立体定向组并发症发生率低，神经功能恢复快，ADL评定优于骨瓣组。结论：微创、减压及超早期手术是高血压脑出血较佳的外科治疗方法。     

脑出血患者血肿周围组织细胞色素C的表达及临床意义

目的 研究高血压脑出血患者血肿周围脑组织细胞色素C的释放规律及其与缺氧诱导因子-1a(HIF-1a)的关系,探讨人脑出血血肿周围组织损伤的分子机制.方法 选择行血肿清除术的脑出血患者32例,选取手术过程中获得的血肿周围脑组织,采用免疫组织化学技术、HE染色及TUNEL染色方法检测细胞色素C、HIF-1a的表达及凋亡细胞的变化.结果 出血4h可见神经元细胞及血管内皮细胞肿胀,出血12h可检测到明显的凋亡细胞,24～48h凋亡细胞明显增多,48～72h达到高峰;出血4h,血肿周围脑组织可见少量细胞色素C表达的神经元,48～72h时达到高峰;出血4h,血肿周围脑组织即可见散在HIF-1a表达的神经元,24～48h时达到高峰,48～72h高表达持续存在;细胞色素C的表达与HIF-1a的表达呈正相关性(r=0.83,t=8.32,P＜0.01).结论脑出血后血肿周围组织脑血流量下降可引起细胞色素C的释放,产生缺血性病理损害.     

微创术治疗高血压脑出血的临床研究

目的 探讨微创清除(微创)颅内血肿治疗高血压脑出血患者的疗效.方法 对32例(微创术组)基底节区高血压脑出血、血肿量大于60ml的患者,采用脑CT片进行穿刺点定位,YL-1型颅内血肿粉碎穿刺针对血肿进行穿刺、液化、引流,评估其病死率、好转率及治疗3周时神经功能评分,并与单纯药物治疗组(对照组32例)进行比较.结果 微创术治疗组死亡8例,病死率25.00%,好转23例,好转率71.88%;单纯药物治疗组死亡16例,病死率50.0%,好转15例,好转率46.88%.微创术组病死率显著低于单纯药物治疗组(P＜0.01),好转率则显著高于单纯药物治疗组(P＜0.01);治疗3周时,微创术组神经功能评分为15.47±3.75分,单纯药物治疗组为21.45±4.46分.两组差异有非常显著意义(P＜0.01),提示微创术治疗组患者神经功能恢复程度好于单纯药物治疗组.结论 微创术治疗高血压脑出血患者效果较好,值得临床应用.     

脑动脉瘤手术麻醉处理体会

我院自2002年2月至2003年10月期间施行脑动脉瘤手术18例。现将麻醉处理体会，并结合文献总结如下。