Surgical versus medical treatment of spontaneous posterior fossa haematomas: A cooperative study on 205 cases

22 Italian centres have joined together in a cooperative study aiming to define the ideal management of spontaneous posterior fossa haematomas. 205 cases have been evaluated: 155 cerebellar haematomas and 50 brainstem haematomas. Out of these, 190 cases, all studied by CT scan, are the subject of the present study.

Cerebellar haematomas have been divided, according to a tomographic classification, into 3 groups: group 1 (4th ventricle not shifted), group 2 (4th ventricle shifted or obliterated) and group 3 (intraventricular blood). Each group has been subdivided into: A (no hydrocephalus),. and B (hydrocephalus). Regardless of therapeutical modalities, mortality rate was 38% for cerebellar haematomas; level of consciousness a few hours after haemorrhage and size of the lesion appeared to be significant prognostic factors. As a whole, medical treatment gave better results than surgical treatment. Considering each tomographical group in detail, surgery should be limited to patients in group 2B and 3B, especially when exhibiting neurological deterioration.

For brainstem haematomas, overall mortality was 57%. The possibility of survival was linked to the presence or absence of initial loss of consciousness and to the size of the lesion; while hydrocephalus did not influence the final outcome, ventricular blood was a risk factor. Surgical evacuation showed some value in chronic cases. However, medical treatment appears to be the best policy for brainstem haematomas of limited size; for larger lesions, the outcome appears to be uniformly fatal, regardless of the treatment employed.     

巨大垂体腺瘤二次经蝶手术30例分析

目的探讨巨大垂体腺瘤二次经蝶手术策略、技巧及术后并发症处理方法。方法回顾性分析30例巨大垂体腺瘤二次经蝶手术病人的临床资料,对手术切除程度、术后症状、激素水平变化及并发症处理等进行总结和分析。结果术后病理结果显示：无功能性腺瘤22例,其中无功能性促肾上腺皮质激素腺瘤1例;生长激素腺瘤8例。功能性垂体腺瘤病人术后激素水平均不同程度下降。术后并发一过性尿崩症9例,脑脊液鼻漏4例,无死亡或严重并发症病例。术后3个月行MRI复查17例,肿瘤全切除4例,次全切除7例。部分切除6例。结论对单纯经蝶或经颅入路均无法一期全切除或术后随访肿瘤复发的巨大垂体腺瘤病例．二次经蝶手术应作为首选治疗方法。     

控制性减压术治疗重型、特重型颅脑损伤

目的探讨控制性减压术治疗重型、特重型颅脑损伤的临床疗效。方法将80例重型、特重型颅脑损伤病人按半随机原则等分为两组,治疗组行术中控制性减压术,对照组行常规骨瓣开颅术。术后随访6个月,GOS预后评分4-5为预后良好,1-3分为预后不良。结果治疗组发生术中急性脑膨出3例,迟发性颅内血肿4例,脑梗死2例。对照组发生术中急性脑膨出10例,迟发性颅内血肿12例,脑梗死3例。两组急性脑膨出和迟发性颅内血肿发生率差异均有统计学意义（P〈0．05）,而脑梗死发生率差异无统计学意义（P〉0．05）。随访6个月,治疗组GOS4。5分23例,1.3分17例;对照组GOS4-5分13例,1-3分27例;两组预后良好率差异有统计学意义（P〈0．05）,预后不良率差异无统计学意义（P〉O．05）。结论控制性减压术能有效降低重型、特重型颅脑损伤病人并发症的发生率,改善病人预后。     

Surgical pathology of epilepsy‐associated non‐neoplastic cerebral lesions: A brief introduction with special reference to hippocampal sclerosis and focal cortical dysplasia

Among epilepsy‐associated non‐neoplastic lesions, mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE‐HS) and malformation of cortical development (MCD), including focal cortical dysplasia (FCD), are the two most frequent causes of drug‐resistant focal epilepsies, constituting about 50% of all surgical pathology of epilepsy. Several distinct histological patterns have been historically recognized in both HS and FCD, and several studies have tried to perform clinicopathological correlations. However, results have been controversial, particularly in terms of post‐surgical seizure outcome. Recently, the International League Against Epilepsy constituted a Task Forces of Neuropathology and FCD within the Commission on Diagnostic Methods, to establish an international consensus of histological classification of HS and FCD, respectively, based on agreement with the recognition of the importance of defining a histopathological classification system that reliably has some clinicopathological correlation. Such consensus classifications are likely to facilitate future clinicopathological studies. Meanwhile, we reviewed the neuropathology of 41 surgical cases of mTLE, and confirmed three type/patterns of HS along with no HS, based on the qualitative evaluation of the distribution and severity of neuronal loss and gliosis within hippocampal formation, that is, HS type 1 (61%) equivalent to “classical” Ammon's horn sclerosis, HS type 2 (2%) representing CA1 sclerosis, HS type 3 (17%) equivalent to end folium sclerosis, and no HS (19%). Furthermore, we performed a neuropathological comparative study on mTLE‐HS and dementia‐associated HS (d‐HS) in the elderly, and confirmed that neuropathological features differ between mTLE‐HS and d‐HS in the distribution of hippocampal neuronal loss and gliosis, morphology of reactive astrocytes and their protein expression, and presence of concomitant neurodegenerative changes, particularly Alzheimer type and TDP‐43 pathologies. These differences may account, at least in part, for the difference in pathogenesis and epileptogenicity of HS in mTLE and senile dementia. However, the etiology and pathogenesis of most epileptogenic lesions are yet to be elucidated.     

内镜潜水技术在垂体外科手术中的应用

目的 探讨内镜潜水技术在垂体外科手术中的应用方法、适应证、疗效和并发症.方法 回顾性分析99例内镜下经鼻垂体手术病人的临床资料,均计划采用内镜潜水技术.其中垂体腺瘤91例,垂体Rathke囊肿8例.结果 术中实际应用内镜潜水技术84例,随访3～6个月,其中肿瘤全切除60例,次全切除19例,部分切除5例.术中出现脑脊液漏1例,修补后无脑脊液漏.术后视力损害加重1例,治疗后恢复至术前水平.术后出现一过性尿崩症23例.15例因解剖和操作等原因未能实施潜水技术.结论 内镜潜水技术安全实用,可提高病变切除程度,相关并发症少,器械的水中操作技术仍需改进.     

Quantitative comparison of the expression of antimicrobial peptides in the oral mucosa and extraoral skin

Antimicrobial peptides (AMP) defend epithelial surfaces against pathological micro-organisms. We know of no comparison of their expression between the oral mucosa and extraoral epithelium, but knowledge of differences in their quantities is of interest, possibly as a starting point for new treatments. Expression of AMP human beta-defensin (hBD)-1/-2/-3 and psoriasin in the oral mucosa and extraoral epithelium of the head and neck were measured by real-time polymerase chain reaction (RT-PCR) (n=14), immunohistochemistry (n=6), and western blot (n=8). RT-PCR showed that all the genes investigated were expressed significantly more in the oral mucosa than in the skin (hBD-1: p=0.002; hBD-2: p=0.006; hBD-3: p=0.035; psoriasin: p=0.02). Immunohistochemistry and western blot showed differential concentrations of proteins: hBD-2 (p=0.021) and hBD-3 (p=0.043) were pronounced in the oral mucosa, whereas psoriasin was raised in the extraoral skin (p=0.021). There was no difference in protein concentrations for hBD-1 (p=0.08). The observed differences in the expression of AMP may be important for new treatments such as topical application of AMP derivatives.     

采用组织瓣修复上颌骨缺损36例临床分析

目的 总结采用组织瓣进行上颌骨缺损重建的临床效果。方法 回顾 2012年 8月—2018年 12月于我院行上颌骨切除并即刻行缺损重建的 36例患者,分析上颌骨缺损类型与重建方法的关系。结果 按照 Brown分类,上颌骨Ⅱb类缺损 22例,Ⅱc类缺损 3例,Ⅱd类缺损 8例,Ⅲb类缺损 3例。33例（91.7%）Ⅱ类缺损中,采用腓骨瓣修复 2例,颏下岛状瓣修复 17例,前臂皮瓣修复 14例。3例（8.3%）Ⅲb类缺损均采用组织瓣联合预成型的个性化钛网修复。所有患者皮瓣制备时间（64±15）min。手术时间（420.6±75.5）min,术中出血（650.5±172.3）mL,皮瓣最大 12 cm×5 cm,最小 8 cm×4 cm。术后所有组织瓣均完全成活,无一例发生局部坏死或完全坏死。术后平均随访（24.5±13.6）个月,随访期间,3 例死亡（鳞癌 T2N0M0 和 T3N0M0 各 1 例,腺样囊性癌 T3N0M0 1 例）,2 例复发（均为腺样囊性癌T3N0M0）,其余 31 例均无瘤生存;无一例发生口腔上颌窦瘘,外形满意率 88.9%（32/36）,发音清晰率为 91.7%（33/36）。结论 采用血管化组织瓣重建上颌骨Ⅱ类缺损能获得较为满意的外形、发音和口鼻腔封闭,组织瓣联合个性化钛网是修复上颌骨Ⅲ类缺损的适宜方法。     

Ganz入路与S-P入路治疗PipkinⅠ和Ⅱ型股骨头骨折的对比分析

目的比较Ganz入路与S-P入路治疗PipkinⅠ和Ⅱ型股骨头骨折的临床疗效。方法回顾性分析2013年1月—2017年4月惠州市中心人民医院、惠州市博罗县杨桥卫生院以及惠州市第一人民医院收治的PipkinⅠ或Ⅱ型股骨头骨折患者29例,其中采用Ganz入路12例,男性10例,女性2例,年龄15~70岁,平均36.83岁;致伤原因:道路交通伤9例,高空坠落伤3例。S-P入路17例,男性15例,女性2例;年龄17~73岁,平均37.53岁;致伤原因:道路交通伤13例,高空坠落伤4例。比较两组患者手术时间、术中出血量、术前术后血红蛋白的差值ΔHGB、末次随访时Thompson-epstein评分的差异,统计分析两组患者术后下肢深静脉血栓、股骨头坏死、异位骨化及截骨片延迟愈合发病率。结果两组患者手术时间及手术出血量差异无统计学意义(P>0.05),Ganz组与S-P组ΔHGB分别为(17.01±4.18)、(11.35±4.32)g/L,差异有统计学意义(P<0.05)。Ganz组随访(17.75±3.49)个月,S-P组随访(18.71±4.04)个月,两组末次随访Thompson-epstein评分优良率差异无统计学意义。术后两组患者下肢深静脉血栓、股骨头坏死、异位骨化的发病率相似,差异无统计学意义,Ganz组发生1例截骨片延迟愈合。结论S-P入路和Ganz入路均能充分暴露术野,有效治疗PipkinⅠ、Ⅱ型骨折,术后疗效及并发症发生率相似;Ganz入路隐性失血较多,且存在截骨片延迟愈合的风险。     

机器人与腹腔镜手术治疗造口旁疝18例临床分析

目的探讨达芬奇机器人和腹腔镜微创手术在造口旁疝治疗中的应用。 方法回顾性分析2018年4月至2022年4月在福建医科大学附属协和医院使用达芬奇机器人系统和腹腔镜行微创造口旁疝无张力修补术的18例患者资料。记录并比较两组手术时间、术中出血量、恢复进食时间、术后切口感染、麻痹性肠梗阻、引流管拔除时间、住院天数等,远期随访指标包括复发、补片感染、慢性疼痛。 结果18例均顺利完成造口旁疝无张力修补术,合并行造口重建术4例（22.2%）。Sugarbaker法修补13例（72.2%）,其中使用达芬奇机器人系统2例,使用腹腔镜11例;Keyhole法修补5例（27.7%）,其中使用达芬奇机器人系统1例,使用腹腔镜4例。手术时间191~406 min,平均（276.8±71.3）min。术中出血量20~100 ml,平均（29.3±22.2）ml。术后第2天恢复流质饮食,第3天进食半流质;放置引流管病例,术后5~7 d拔除引流管;常规腹带束缚3~6个月。术后住院时间3~19 d,平均（8.2±4.7）d。术后复发1例（5.6%）,切口感染1例（5.6%）,麻痹性肠梗阻3例（16.7%）,肺部感染6例（33.3%）,切口感染及麻痹性肠梗阻病例均经过非手术治疗后痊愈出院。随访期间均未出现复发、补片感染、慢性疼痛。 结论使用达芬奇机器人系统和腹腔镜进行微创造口旁疝无张力修补术均安全可行,围手术期并发症少,术后恢复快,疗效确切。