内镜经蝶入路治疗海绵窦侵袭性垂体瘤

Background Surgery of pituitary adenomas invading cavernous sinus has always been thought as a challenge due to the complex anatomical structures and high risk of complications. The purpose of this study was to evaluate endoscopic trarssphenoidal approach to pituitary adenomas invading cavernous sinus.Methods The clinical data of 22 patients who admitted to Xuanwu Hospital with pituitary adenomas invading cavernous sinus were analyzed retrospectively. All patients underwent endoscopic transsphenoidal surgery. To expose the surgical field sufficiently, the opening of sellar floor was exceeded the bone overlying the invaded cavernous sinus, and synthetic dura was used to repair and strengthen the sella floor for preventing the leak of cerebrospinal fluid.Results Among 22 patients, total resection was achieved in 14, subtotal resection in 5, and partial resection in 3; no patient underwent insufficient resection. Visual symptoms improved in 7 of 9 patients. In one patient diplopia disappeared.Headache was relieved to various extents in all patients. No serious complications were found. Patient＇s hospital stay ranged from 7 to 20 days.Conclusion These data suggest that the endoscopic transsphenoid approach is a safe, minimally invasive, and efficient surgical technique, which might be an important therapeutic strategy for the pituitary adenoms invading cavernous sinus.     

填塞明胶海绵碎粒在PKP手术治疗骨质疏松性椎体压缩骨折的运用价值

经皮椎体后凸成形术( percutaneous kyphoplasty,PKP)凭借其良好的畸形纠正效果以及即时缓解疼痛症状等优势,在骨 质 疏 松 性 椎 体 压 缩 骨 折( Osteoporotic vertebral compression frac-ture,OVCF)的治疗中运用广泛,近远期疗效得到肯定[1...     

巨大海绵窦海绵状血管瘤的硬膜内入路显微外科治疗

目的探讨巨大海绵窦海绵状血管瘤(cavernous sinus cavernous hemangiomas,CSHs)的临床特征及显微外科治疗方法,为CSHs的治疗提供临床经验。方法回顾性分析2009年1月—2018年12月解放军东部战区总医院神经外科收治的15例CSHs患者的临床及随访资料;分析患者的临床表现、颅神经受累情况、手术方式、术后并发症及随访结果。结果15例CSHs患者占同期收治的颅内海绵状血管瘤(CHs)患者的5.6%。临床表现为头痛者11例、视神经损害者5例、动眼神经损害者6例、面部感觉异常者2例、肢体无力者1例。15例患者通过扩大翼点、翼点或颞前小切口入路经硬膜内切除血管瘤,均完整切除;无死亡病例。10例患者术后出现同侧Ⅲ、Ⅳ、Ⅴ及Ⅵ神经部分麻痹。术后获得随访的患者9例,随访时间5~117个月,平均48.9个月,均无肿瘤复发表现;其中4例患者遗留长期海绵窦颅神经功能障碍。结论CSHs多具备特征性影像学表现,术前多可明确诊断。经硬膜内入路手术切除是治疗巨大CSHs的有效方法,术中应尽量按界限整块切除,以减少出血。海绵窦内神经功能的保留仍是目前巨大CSHs手术治疗的难点。     

竞争性内源RNA调控肝癌及中医药干预机制研究进展

长链非编码RNA(LncRNA)是长度大于200个核苷酸的非蛋白质编码转录物,近几年来的研究表明,LncRNA上具有结合microRNA(miRNA)的部分互补序列,这些互补序列通过竞争性结合miRNA,从而抑制miRNA对靶基因mRNA的表达作用。也就是说,LncRNA能够作为一种竞争性内源RNA(ceRNA),通过海绵吸附的方式与miRNA竞争性结合,从而阻止miRNA同其靶mRNA结合,进而调控蛋白质的表达水平。在临床上,肝细胞癌(HCC,简称肝癌)通常被诊断为最致命的恶性肿瘤之一,其在全球癌症相关死亡中居于前列,肝癌因其发病机制的复杂性以及对化疗药物的耐药性,使得HCC的诊断和治疗以及预后仍然不能令人满意。随着研究的不断进展,人们发现LncRNA除了可以直接参与基因的表达调控外,还能够作为一种竞争性内源RNA(ceRNA)与miRNA相互作用,从而在HCC的进展中参与调控细胞增殖、死亡以及侵袭与转移等过程。该文从LncRNA海绵吸附miRNA发挥生物学功能这个方面,归纳总结相关LncRNA在肝癌发生发展中的作用及其与中医药干预机制的研究进展,以此为肝癌的诊断与治疗提供新思路。     

术前鼻腔局部留置激素-明胶海绵对鼻内镜手术患者出血量的影响

目的探讨术前鼻腔局部留置激素-明胶海绵对鼻内镜手术患者出血量的影响。方法选择鼻内镜手术患者88例,按随机数字表法将患者分为对照组和观察组,每组44例。对照组患者于术前经鼻内镜在鼻腔局部留置生理盐水-明胶海绵,观察组患者于术前经鼻内镜在鼻腔局部留置激素-明胶海绵,比较2组患者术中出血量、术后出血量、填塞材料取出时出血量、鼻腔VAS疼痛评分及鼻腔黏膜肿胀程度。结果观察组患者术中出血量、术后出血量、填塞材料取出时出血量及鼻腔VAS疼痛评分均明显少于对照组[(34.60±7.38)mL比(85.90±10.11)mL、(12.58±1.17)mL比(17.40±2.25)mL、(1.30±0.41)mL比(3.71±0.88)mL、(2.26±0.25)分比(5.48±0.27)分,P<0.05或P<0.001];观察组患者鼻腔黏膜肿胀程度明显轻于对照组(P<0.001)。结论术前鼻腔局部留置激素-明胶海绵能够明显降低鼻内镜手术患者的出血量,减轻鼻腔疼痛,改善鼻腔黏膜肿胀程度。