甲状腺手术显露喉返神经的临床研究

目的探讨甲状腺手术时显露喉返神经(RLN)对预防RLN损伤的作用。方法分析810例甲状腺手术中252例甲状腺手术中显露RLN(甲组)和558例术中未显露RLN(乙组)患者的临床资料。结果虽然甲组甲状腺手术切除范围大于乙组;但甲组RLN损伤发生率(1.19%)明显低于乙组(3.05%)(P<0.01)。结论甲状腺手术时有选择地显露喉返神经,可明显降低喉返神经损伤发生率。     

喉返神经解剖在甲状腺手术中的应用研究

目的探讨解剖喉返神经在甲状腺手术中的应用。方法回顾分析因甲状腺疾病行手术治疗的236例患者的临床资料,共施行甲状腺手术335侧次;甲组101例行甲状腺手术158侧次,术中均未解剖喉返神经,其中57例行双侧甲状腺手术。乙组135例行甲状腺手术同时解剖喉返神经177侧次,其中42例因双侧甲状腺手术而行双侧喉返神经解剖。结果喉返神经损伤均发生在切除甲状腺范围包含背侧腺体时。甲组暂时性损伤2例,永久性损伤1例,损伤率为1.9%;乙组暂时性损伤1例,无永久性损伤病例,损伤率为0.56%;两组差异有统计学意义(χ2=0.382,P<0.01)。结论甲状腺手术中解剖喉返神经能减少喉返神经的损伤,切除背侧腺体时应常规解剖喉返神经。     

微囊化猪视网膜色素上皮细胞移植治疗帕金森病的实验研究(英文)

目的研究微囊化后的猪视网膜色素上皮细胞(retinal pigment epithelial,RPE)对帕金森病大鼠模型的移植疗效。方法原代培养RPE 并传代,高效液相色谱法测定培养液上清中多巴胺(dopamine, DA)和高香草酸(homovanillic acid, HVA)的含量,ELISA法检测脑源性神经营养因子(brain-derived neurotrophic factor, BDNF)和胶质细胞源性神经营养因子(glial-derived neurotrophic factor, GDNF)的含量。用高压静电成囊装置制备海藻酸钠-多聚赖氨酸-海藻酸钠微囊化细胞。6-羟基多巴胺(6-hydroxydopamine, 6-OHDA)毁损内侧前脑束 (medial fore-brain bundle,MFB)建立 SD 大鼠帕金森病模型。立体定向移植 RPE+ 微囊,检验旋转实验、免疫组化和脑内生化的变化。结果 RPE 培养上清液中DA、HVA、BDNF、GDNF 的含量稳定,微囊化后细胞长期存活,活性没有明显变化。6-OHDA毁损MFB建立大鼠帕金森病模型的成模率为83%。移植微囊化的RPE后有效率为33%。结论猪 RPE 体外培养生长旺盛,持续分泌 DA、BDNF 和 GNDF,微囊化不影响其分泌功能。RPE 移植对帕金森病大鼠有一定的治疗作用。     

复发性脑膜瘤术前评估与术中处理

目的探讨脑膜瘤复发手术方法。方法1998年10月以来我院收治复发性脑膜瘤12例,对术前组织病理、CT、MRI及术中所见进行回顾性分析,总结。结果12例病人均行手术治疗,术后随访,无再次复发。结论手术是治疗复发性脑膜瘤的重要手段,完整切除肿瘤、术中化疗是减少复发的关键。     

复发性胶质瘤再手术治疗的探讨

目的 探讨复发性胶质瘤患者再手术的效果。方法 对22例复发性胶质瘤患者再手术前的功能状态、两次手术间隔时间及手术切除的程度与术后存活期等资料进行临床和统计学分析。结果 第二次手术前生活能自理或半自理的病人（Kamofsky计分≥60）平均生存期约16月，生活不能自理的病人（Kamofsky计分〈60）平均生存期约6月（P〈0．01）。两次手术间隔时间大于1年者平均生存期约17月，间隔时间小于半年者平均生存期约6月（P〈0．01）。手术肿瘤全切除者平均生存期约15月，次全切除者平均生存期约10月（P〈0．05）。结论 术前功能情况好，手术间隔时间大于1年及术中全切肿瘤者再手术治疗可获得较好效果。     

灯盏细辛黄酮类成分对压力诱导的视网膜神经节细胞凋亡的影响

目的考察灯盏细辛中黄酮类成分(总黄酮、灯盏花素)对体外高压诱导的视网膜神经节细胞(retinal gan-glion cells,RGCs)凋亡的影响,探讨其视神经保护作用的物质基础。方法采用胰酶消化法将24只出生2~3d的SD(Sprague-Dawley)乳鼠视网膜制成细胞悬液,接种于经多聚鸟氨酸(HA)和层粘连蛋白(LN)包被的盖玻片中。培养72h后,将覆有细胞的血盖片转入加压装置中,加入黄酮类成分,继续培养48h,采用Fas蛋白免疫组化染色法及原位末端脱氧核苷酸转移酶标记(Tunel-POD)法进行检测,每天观察细胞形态,同时对部分细胞行NSE染色检查。结果细胞生长良好,NSE染色表明,85%以上的细胞为RGCs。给药组的Fas蛋白阳性表达指数和凋亡指数均明显低于模型组(P<0.05~0.01)。结论黄酮类成分均能对抗压力诱导的RGCs凋亡,为灯盏细辛视神经保护的有效组分。     

普南扑灵滴眼剂在视网膜脱离手术中的应用

目的　探讨普南扑灵滴眼剂在减轻玻璃体视网膜术 (VRS)和巩膜扣带术 (SBS)后炎症反应的作用。方法　将 82例 (82只眼 )随机分为研究组和对照组 ,研究组 41例 (41只眼 ) ,选用 0 .1%普南扑灵滴眼剂点眼 ,对照组 41例 (41只眼 ) ,选用 0 .0 2 5 %地塞米松滴眼剂点眼。观察指标为眼部疼痛、充血、前房闪辉、角膜炎症、虹膜后粘连。结果　选用 0 .1%普南扑灵滴眼剂的研究组在缓解术后眼部疼痛方面及减轻玻璃体切割术后前房闪辉、虹膜后粘连方面优于对照组 ,差异有显著性 (P <0 .0 5～ 0 .0 1)。结论　普南扑灵能显著的减轻 VRS及 SBS后炎症反应。     

Distribution and spatial geometry of dopamine interplexiform cells in the retina. II. External arborizations in the adult rat and monkey

The morphology and distribution of dopaminergic interplexiform cells in adult rat and monkey retinas were analyzed to determine any correlation with the function of dopamine in the outer retinal layers. The retinas were processed as whole mounts for tyrosine hydroxylase immunohistochemistry. There was a network formed by the sclerally directed processes of interplexiform cells in the inner nuclear, outer plexiform, and outer nuclear layers running throughout the retina. Their density was higher in the superior retina than in the inferior retina of the rat and was especially high in the superior temporal quadrant. The external network in this quadrant was significantly less dense in the monkey than in the rat, as are the interplexiform cells. The somata of interplexiform and other dopaminergic cells were about the same size in both rats and monkeys. Computer-assisted reconstruction of external arborizations of individual cells showed that external processes lay very close to horizontal and photoreceptor cells and also to blood capillaries. Because they were long, thin, and highly varicose; branched at right angles; and often arose from an axon hillock, the external processes were identified as axons. Therefore, we define the dopaminergic interplexiform cells as multiaxonal neurons, with at least one outwardly directed axon that reaches the outer plexiform layer. The function of the network of external processes from the interplexiform dopaminergic cells is discussed in terms of modulating the release of dopamine to external layers.     

Pattern-reversal electroretinograms and visual evoked potentials in branch retinal vein occlusion

We recorded pattern electroretinograms and visual evoked potentials in a group of selected patients with unilateral uncomplicated branch retinal vein occlusion. To document the effects of preexisting risk factors, patients were divided into three groups: diabetes mellitus, hypertension with hyperlipidemia and no systemic disease. The transient and steady-state pattern electroretinogram and visual evoked potential amplitudes were significantly reduced and visual evoked potential peak times were delayed relative to the fellow eyes and agematched normal subjects. There was a second amplitude reduction relative to the other patient groups in both the affected and fellow eyes of the diabetes mellitus group, which was indicative of an additive effect of diabetes mellitus.Abbreviations BRVO branch retinal vein occlusion     

甲状腺手术中避免喉返神经损伤的实用解剖研究

对２０例单发良性甲状腺瘤手术进行了动态解剖学观察，主要针对侧叶切除术中喉返神经的有关解剖学关系进行测量分析，对术中处理甲状腺下动脉的方法提出与传统观念不同的意见认为术中游离并托起患侧叶，紧贴腺体切断甲状腺下动脉各分支，保留甲状腺下动脉主干的方式是避免喉返神经损伤的有益方式