头痛 呕吐伴意识不清

<正>病历摘要患者男性,48岁。主因突发头痛、呕吐伴意识不清18 h,于2013年4月21日入院。入院前18 h无明显诱因突发头痛,呈全脑爆发性剧痛,伴非喷射状呕吐,呕吐物为胃内容物和暗红色血性液体。发病后意识状态呈渐进性下降,至入院前2 h处于昏迷状态,呼之不应,刺激四肢无反应。病程中无双眼凝视、口角歪斜、肢体抽搐等症状。     

小脑后下动脉动脉瘤治疗体会

目的探讨小脑后下动脉动脉瘤的治疗方法。方法分别采用动脉瘤栓塞术、动脉瘤夹闭术和血管吻合术联合动脉瘤栓塞术治疗80例小脑后下动脉动脉瘤患者,总结3种手术方式适应证和技术特点。结果 80例患者中行动脉瘤栓塞术49例,手术成功率约为95.92%(47/49);行动脉瘤夹闭术19例,手术成功率为16/19;行枕动脉-小脑后下动脉吻合术联合动脉瘤栓塞术12例,手术成功率为11/12。2例术后死亡,21例出现神经功能缺损症状,其余57例均好转。术后平均随访3.65年,复查CTA或DSA显示7例动脉瘤复发。结论小脑后下动脉动脉瘤栓塞术手术创伤较小、手术时间较短;对于后循环血管迂曲、动脉瘤较小、瘤颈较宽者,动脉瘤夹闭术相对安全且简单易行;对于动脉瘤栓塞术和夹闭术均较困难者,血管吻合术联合动脉瘤栓塞术为最后选择。     

血流重建方法治疗复杂前循环动脉瘤的疗效分析

目的探讨应用血流重建方法治疗复杂前循环动脉瘤的疗效。 方法回顾性分析2011年8月至2017年4月天津市环湖医院神经外科收治的24例复杂前循环动脉瘤患者（共29个动脉瘤）的临床资料。根据动脉瘤的位置选择不同的血流重建方式,其中行颈内动脉闭塞＋颞浅动脉－大脑中动脉吻合术8例,颈内动脉缩窄＋颞浅动脉－大脑中动脉吻合术2例,颈外动脉－桡动脉－大脑中动脉吻合术8例,大脑中动脉动脉瘤切除＋桡动脉原位吻合术4例,颌内动脉－桡动脉－大脑中动脉吻合术＋动脉瘤孤立术2例。观察吻合血管通畅情况及术后并发症,采用改良Rankin量表评分（mRS）评估患者的预后。 结果24例患者均顺利完成血流重建,术中吻合血管通畅。6例术后出现脑梗死,其中1例死亡。23例患者术后随访3～68个月,随访期间未见动脉瘤复发或破裂出血。所有患者吻合血管均通畅,动脉瘤均缩小或消失。mRS评分为0分18例（78.3%）,1分3例（13.1%）,3分1例（4.3%）,6分1例（4.3%）。 结论对于复杂前循环动脉瘤,根据动脉瘤的位置和侧支循环代偿情况,选择合适的血流重建方式为有效的治疗方法。     

儿童第四脑室肿瘤所致脑积水治疗探讨

目的 探讨第四脑室肿瘤相关性脑积水的治疗.方法 总结天津市环湖医院自2008年5月至2010年5月间收治的31例第四脑室周围肿瘤患儿脑积水的处理结果.患者分为3组:A组(5例):肿瘤切除术前行脑室-腹腔分流术;B组(15例):肿瘤切除术后处理组,又分为B1组(7例),即术后仍有脑积水实施脑室分流术;B2组(8例):第三脑室底造瘘术;C组(11例),肿瘤切除术后脑积水自行缓解.患儿长期随访中出现的脑积水症状以及各方法的并发症出现情况对比;影像学以MRI脑室相关径线的改变为评价指标.结果 A组术前2 d行脑室-腹腔分流者,术后未再出现脑积水症状,1例有裂隙脑室;B1组7例脑室-腹腔分流术,1例裂隙脑室,1例分流管梗阻更换分流管;B2组8例行第三脑室底造瘘术,2例头皮缝合口漏,1例硬膜下积液.组间对比分析表明,A组和B组间,B1和B2组问并发症的发生率差异无统计学意义(P>0.05);MRI脑室各相关径线值改变差异无统计学意义(P>0.05).结论 脑室-腹腔分流或第三脑室底造瘘方法均能解决第四脑室肿瘤相关性脑积水.

Abstract：

Objective To investigate the management of hydrocephalus caused by tumors of the 4th ventricule. Method Thirty - one children with tumors of the 4th ventricule treated in Huanhu hospital in Tianjin,among which 13 patients had medulloblastoma, 13 ependymoma,3 astrocytoma and 2 choroid plexus papilloma. The patients were divided into three groups. Group A (5 cases): all the patients preoperatively accepted ventriculo - peritoneal shunting(V -Ps). Group B(15 cases): postoperative management group, which was divided into two subgroups,group B1 and group B2. V -Ps were performed in group B1(7 cases) for hydrocephalus after resection of tumor and endoscopic third ventriculostomy ( ETV) in group B2 (8 cases). The patients in group C ( 11 cases) did not develope hydrocephalus after tumor resection. Results There was no postoperative hydrocephalic sign in 5 patients treated by V - Ps 2 days before tumor resection. 15 out of 31 patients(48% ) developed hydrocephalus after resection of tumor. 7( group B1) of 15 patients were treated with V - Ps,of them one had slit ventricule and one recepted shunt tube reversion. 8 (group B2)of 15 patients underwent ETV,of them one had subdural hydroma and 2 had leakage of incisioa 11 (group C) out of 31(35% ) had no hydrocephalus. Radiological assessement was performed with 4 ventricule index( Ⅵ),including the maximal width of frontal horns,occipital horns,biparietal and 3th ventricule. There was no significant diference ( P > 0. 05 ) among the three groups in ventricule indexes and postoperative complications. Conclusions The 4th ventricule tumor - related hydrocephalus could be resolved by V - Ps or ETV. It is more rational to deal with the hydrocephalus just after the resection of tumor.     

转基因人抗体的制备及其抗肿瘤研究进展

鼠源抗体及基因工程技术改造的各类人源化小分子抗体在肿瘤的导向治疗中虽然已显示出强大的抗肿瘤活性,但仍有许多不尽人意之外,直接限制了其临床疗效的提高,转基因人抗体制备技术的不断成熟,由仅转移较少部分人Ig发展为可转移大部分人Ig全套胚系基因,以产生高亲和力、高特异性的完全人抗体,应用该技术制备的抗体已进入肿瘤的动物实验阶段,并获得喜的抗肿瘤效果,具有很大的发展潜力。     

转基因人抗体的制备及其抗肿瘤研究进展

鼠源抗体及基因工程技术改造的各类人源化小分子抗体在肿瘤的导向治疗中虽然已显示出强大的抗肿瘤活性,但仍有许多不尽人意之处,直接限制了其临床疗效的提高.转基因人抗体制备技术的不断成熟,由仅转移较少部分人Ig发展为可转移大部分人Ig全套胚系基因,以产生高亲和力、高特异性的完全人抗体.应用该技术制备的抗体已进入肿瘤的动物实验阶段,并获得可喜的抗肿瘤效果,具有很大的发展潜力.     

苯丁酸钠抑制可移植性人脑胶质瘤增殖机制的探讨

目的 探讨苯丁酸钠对可移植性人脑胶质瘤增殖抑制作用机制。方法 通过流式细胞仪、Western blot及测量瘤块体积，观察苯丁酸钠对胶质瘤体积、细胞周期、GFAP、c-myc和MHC－I的影响。结果 苯丁酸钠可显著抑制胶质瘤细胞的生长，使瘤细胞阻滞于G0／G1期，S期瘤细胞百分比下降，同时分化抗原GFAP、免疫相关抗原MHC－I上调，肿瘤抗原c-myc蛋白表达下调。结论 苯丁酸钠显著抑制胶质瘤细胞的体内增殖是通过诱导胶质瘤细胞向良性分化起作用的。     

儿童颅内蛛网膜囊肿分流术后分流管临时结扎

目的 探讨儿童颅内蛛网膜囊肿分流术后分流管结扎并安全拔除的可能性.方法 选择2004年1月至2009年12月在天津市环湖医院进行囊肿-腹腔分流的9例患儿,在分流术后6个月随访囊肿消失或缩小,直至2年囊肿无变化者,于皮下分流管最明显部分进行结扎,然后继续随访(平均2.4年)观察.结果 9例患儿有4例在术后平均6个月时囊肿消失;5例中颅窝囊肿在随访6个月时病变缩小,症状消失;继续随访囊肿未见增大;1例囊肿在12个月时消失;结扎分流管后平均随访2.4年没有任何异常表现,影像学未见囊肿复发或原有囊肿增大.结论 囊肿-腹腔分流管在囊肿消失或稳定后平均2年可以试行临时结扎,再继续随访,如长时间无变化可以考虑拔除分流管.

Abstract：

Objective In the past decade, thousands of the pediatric patients with intracranial arachnoid cysts ( ACs) undertook the operation of the cyst - peritoneal shunt ( C - Ps). More and more complications caused by the insertion and long time staying in the body of the shunt device were reported in recent years. Therefore,it is just the aim of this article to make clear how to removal the shunt device timely and safely. Method 9 pediatric patients hospitalized in Tianjin Huanhu Hospital from January 2004 to December 2009 were taken into the study. We investigated the clinical symptoms and neuroimaging findings just at the time of 6 months after C - Ps. If the cyst disappear or reduce in size were found, follow - up would be continue for 2 years. When the change of the cyst in size could not be found, ligating of the shunt tube would be performed at an appropriate position subcutaneously, and a long time follow - up would be performed. Results The cysts disappeared in 4 out of 9 patients in an average 6 months of follow - up. At the same period the cysts reduced in size in 5 patients. No symptom or sign were found during the following up of 2.4 years after the shunt tube ligation. Conclusions Ligating of the shunt tube can be tried after 2 years of C-P shunt without any change in cyst size and clinical symptoms. The removal of the shunt device will be carried out finally.