心包横窦的范围、通连及其变异

目的：明确正常心包横窦的范围、通连及变异,为临床影像学及心脏外科疾病的诊断及治疗提供依据。方法：选用正常成人胸部连续断层标本４０例及心包完整的离体心脏１０例。对横窦的形态、通连关系、毗邻关系及变异进行观察。结果：５０例标本中,２例可见前垂中与主动脉上窦后部直接延续,未见中间水平部;４８例可见中间水平部或／及后垂直部,其中２４％（１２例）中间水平部延续到右肺动脉前下方,３０％（１５例）延续到右肺动脉     

心包窦的观察及其临床意义

原位解剖观察了６０具成人尸体的心包窦。心包横窦长轴呈由右后上向左前下略倾斜位，横窦长４５．３±０．７ｍｍ，右口较左口大，因此在做心血管外科手术时从右口进入横窦较易，心包斜窦深４１．２±０．７ｍｍ，入口宽４２．９±０．７ｍｍ，心包前下窦的长轴与心脏下缘方向一致，为从右向左逐渐增宽的细长形，最宽处８５％尸体位于心尖附近，前下窦中部宽度平均为１３．６±０．５ｍｍ。     

心包横窦的解剖及临床影像学意义

横窦是心包窦中位置最深的一个窦,是指位于升主动脉、肺动脉干的后方与上腔静脉、左、右心房及左、右上肺静脉之间,由壁层心包与脏层心包返折形成.     

心包窦及其相邻结构横断层解剖学研究

目的：阐明心包窦、心包隐窝横断层解剖学特征，为ＣＴ、ＭＲＩ提供形态学基础。方法：按ＣＴ、ＭＲＩ扫描要求，冰冻、锯切３０具经防腐固定的男性成年躯干，制成连续横断层标本。对每一断层下断面进行拍照，结合标本和照片对断层面的结构进行追踪观察、记录、分析处理。结果：对心包横窦及其隐窝的断层解剖学特征进行了详细描述，并阐明其在ＣＴ、ＭＲＩ中的应用意义；横窦体位于主动脉窦口稍上方，向右经右心耳和右心室壁之间通入固有心包腔，向左经左心耳与右心室壁之间通入固有心包腔，主动脉上隐窝在此平面开口于窦体；８０％的主动脉上隐窝位于主动脉弓头臂干起始处，主动脉弓、胸腺、上腔静脉之间；上腔静脉后隐窝，出现率为２０％；主动脉下隐窝位于主动脉无冠状动脉窦（右后窦）、左冠状动脉窦（左后窦）和左心房之间，出现率为１００％。结论：掌握心包窦、心包隐窝及其相邻结构的横断层解剖学特征对影像诊断具有重要意义     

主动脉窦瘤破裂手术体会

目的 探讨主动脉窦瘤破裂手术，总结分析手术效果和手术经验。方法 回顾性分析1997年1月至2003年6月收治43例主动脉窦瘤破裂病人的临床资料。结果 全组无死亡病例，术后切口感染1例、轻度主动脉瓣关闭不全1例、传导阻滞1例、感染性心内膜炎合并主动脉瓣关闭不全1例。结论 主动脉窦瘤破裂手术风险小且远期效果好，早期手术可以避免疾病恶化和引起并发症。     

横窦引流小脑桥静脉的形态特点及其临床意义

目的:通过显微解剖和铸型方法观察横窦引流小脑桥静脉的形态特点,为小脑幕下手术入路的选择提供形态学依据.方法:分别观测30例(60侧)静脉内灌注蓝色乳胶的成人头颅湿标本和观察12例胎儿和幼儿的脑静脉血管铸型.结果:横窦引流小脑桥静脉按其注入小脑幕处所在位置的不同,分为窦汇组(28%)、小脑幕组(36%)和岩部组(36%)3组,3组桥静脉的数目差异无统计学意义,各组桥静脉的直径分别为(1.6±0.7)mm, (1.9±0.7)mm, (1.9±0.7)mm.7%的病例缺乏窦汇组桥静脉,13%的病例缺乏小脑幕组桥静脉,每侧显微解剖标本至少存在一根岩部组桥静脉.结论:小脑幕下手术中,旁正中入路损伤桥静脉的机会最小,术前建议进行影像学检查以选择合适的手术入路.     

横窦的形态及其临床意义

解剖观测50例(男28,女22)成人硬脑膜标本,结果如下:1.按横窦截面积,将其分为三种类型:①右侧偏大型,占58％;②左侧偏大型,占36％;③左右均衡型,占6％。2.中段横窦壁脑面平均厚度:男性为0.27±0.03mm,女性为0.23±0,02mm;骨面平均厚度:男性为0.35±0.04mm,女性为0.27±0.02mm。3.本文还对横窦与硬脑膜动静脉瘘等与临床有关的内容进行了讨论。     

主动脉窦瘤破裂外科治疗21例

目的：探讨先天性心脏病主动脉窦瘤破裂后手术方法和疗效。方法：回顾性分析21例主动脉窦瘤破裂病人的临床资料。全组均在全麻低温体外循环下经右室切口和/或主肺动脉横切口行修补术，并同时纠治心内合并畸形。结果：本组无手术死亡病例，术后出现肺水肿1例、心衰2例、二度房室传导阻滞1例，均治愈。随访3个月～5a,疗效优者20例，良者1例术后残留主动脉瓣关闭不全。结论：主动脉窦瘤破裂病势凶险，一旦确诊，尽早手术治疗，不要为改善心功能而延误手术时机；手术治疗远期效果满意。     

纵隔原发性内胚窦瘤3例临床病例分析与文献复习

目的：分析原发纵隔内胚窦瘤的临床影像学表现及病理特征。方法：回顾性分析3例经手术和病理证实的原发纵隔内胚窦瘤的临床、影像及病理资料。结果：3例肿块均位于前纵隔,肿瘤横断面最大长径及短径的平均值分别为(13.0±4.2)、(8.2±1.3) cm。两例血清AFP检测浓度均明显高于正常。CT和MRI扫描示巨大不规则囊实性肿块,密度/信号不均匀,增强后分隔及实性部分轻度至中度强化。3例均取得手术病理结果,免疫组织化学表达AFP(+),PLAP部分(+),CK-pan(+),CK-L(+), Ki-67约70%~95%(+)。结论：原发纵隔内胚窦瘤的术前综合分析和评估很重要,影像学检查对其诊断具有重要意义,病理学特征可以指导其进一步的治疗和监测预后。     

成人CT血管成像横窦体表定位研究及其意义

目的　利于64排螺旋CT确定横窦和乙状窦的体表定位,评价采用上项线和颧弓-枕外隆突连线作为横窦标志的准确性,为横窦区入路相关手术的骨窗定位提供解剖学基础。 方法　回顾性重建100例进行过64排螺旋CT头部CTA检查患者的横窦和乙状窦影像,对比观察体表骨性标志与静脉窦的位置关系,确定横窦的体表定位。 结果 星点主要位于横窦和乙状窦连接部的横窦侧;星点位于横窦和乙状窦连接部前上方占4%,星点恰好位于连接部占81%,星点位于连接部后下方占15%。颧弓-枕外隆突连线和上项线走行不完全一致,它们与横窦的关系多样;上项线与横窦走行不一致;颧弓-枕外隆突连线可作近段横窦的定位标志,但是随着它们向外移行,颧弓-枕外隆突连线则主要位于横窦下方,并且它们的距离越来越远。 结论 上项线不能代表颧弓-枕外隆突连线的走行,同时它们都不是定位横窦的可靠标志,64排螺旋CT的头部减影CTA检查可作为常规术前检查来明确个体解剖资料从而定位横窦和乙状窦,以便指导横窦区相关手术入路设计。     

Sinus surgery

Functional endoscopic sinus surgery (FESS) is a recent addition to the treatment armamentarium of sinus disease. Performed through the nasal cavity using endoscopes and inciting no external scars, these advantages have renewed an interest in the surgical intervention of various sinus diseases. With minimal risk and complications associated with FESS, the temptation exists to lower the threshold and expand the indications for sinus surgery. However, regardless of the reduced risk, FESS should be pursued only when the goals are attainable and the limitations of surgery are understood for each specific disease. Chronic rhinosinusitis (CRS), affecting more than 31 million people a year, represents a treatment challenge. The challenge stems from evidence that CRS can result from different etiologies including bacteria, virus, fungi, superantigens, and unfavorable anatomy. With an unclear pathogenesis, success of medical therapy is often limited. Individuals failing medical therapy are candidates for surgical intervention. The controversy, indications, and goals of surgery in CRS are reviewed. Other indications for FESS are less controversial. Nasal polyps, which can interfere with medical therapy and obstruct airflow, often require surgical intervention. In addition, recent data has suggested a link between surgery and a reduction in inflammatory markers. Repair of skull base defects, and resection of benign and limited malignant nasal masses are also indications for FESS. This article reviews the indications of sinus surgery. In addition, it addresses some of the controversies, limitations, and advances in FESS.     

Persistent Urogenital Sinus

Persistent urogenital sinus is a developmental cloacal anomaly, which presents as a single common passage for urethra and vagina in female neonates. Neonates with urogenital sinus frequently have ambiguous genitalia, rarely the vulva maybe normal. Incidence is 0.6in 10000 female births. This anomaly is associated with a wide variety of syndromes. Accurate prenatal diagnosis is possible by ultrasound. Treatment is surgical corrective repair. Molecular factors have been implicated as a possible cause by various workers.     

Conversion of Atrial Flutter to Sinus Rhythm by Carotid Sinus Pressure

Conversion of atrial flutter to normal sinus rhythm via carotid sinus stimulation by manual pressure is not a well-known phenomenon. Two cases of atrial flutter in which carotid sinus pressure restored the sinus rhythm are presented. Since this procedure is usually benign, it is recommended that it be tried on patients having atrial flutter with fast ventricular rate accompanied by hemodynamic decompensation. This may be particularly useful if the patient has been receiving digoxin, that is, when cardioversion may become potentially problematic. Electrophysiological mechanisms of conversion of atrial flutter to sinus rhythm are discussed.     

鼻内窥镜下经上颌窦开口切除上颌窦囊肿

目的：探讨鼻内窥镜下切除上颌窦囊肿的方法。方法：鼻内窥镜下经上颌窦开口单纯上颌窦囊肿摘除术36例，其中单侧囊肿30例，双侧囊肿6例。顶壁囊肿4侧，前壁囊肿6侧，后壁囊肿6侧，底壁囊肿9侧，内侧壁囊肿11侧，自然开口处囊肿2侧。同一侧同时有底壁和后壁囊肿的2侧，同时有内侧壁和底壁囊肿的有2侧。单纯使用粘膜钳切除18侧，对24侧底壁囊肿和内侧壁囊肿同时结合使用电动切割器切除囊肿。结果：所有囊肿均在鼻内窥镜下经上颌窦开口完全切除。术后无明显并发症。随访0．5～2a，无复发。结论：应用鼻内窥镜经上颌窦开口切除上颌窦囊肿创伤小，操作简便，治疗效果确切，是治疗上颌窦囊肿的有效方法。     

Sinus caroticus und Epilepsie

Zusammenfassung Verfasser bringen neue Stützpunkte zu ihrer, in vorangegangenen Arbeiten aufgestellten Behauptung, da? der Sinus caroticus im physiopathologischen Mechanismus des epileptischen Anfalls eine Rolle spielt. In einem Falle von sehr h?ufigenJackson-artigen Anf?llen wurde der Verlauf dieser Anf?lle durch Substanzen, die die Erregbarkeit des Sinus caroticus beeinflussen, abge?ndert. Strychinin, Calcium und Pilocarpin, die die Erregbarkeit des Sinus caroticus erh?hen, verursachten in diesem Falle eine Abschw?chung der Krampfbereitschaft der motorischen Hirnrindenregion, Morphium und Ergotamin, die diese Erregbarkeit im entgegengesetzten Sinne beeinflussen, verursachten eine Zunahme der Krampfbereitschaft. In einem Falle von chronischer Tetanie, dem sich sp?ter epileptische Anf?lle hinzugesellten, fehlten die vasomotorischen Reflexe des Sinus caroticus. Die spontanen epileptischen Anf?lle in einem Falle von vollkommener Obstruktion beider Arteriae carotidae sowohl als auch diejenigen, die in diesem Falle durch eine itraven?se Adrenalineinspritzung haben ausgel?st werden k?nnen, werden durch Fehlen der ‘Schutzreflexe” des Sinus caroticus auf den Sch?delinhalt erkl?rt. Mit 6 Textabbildungen     

Eine Raumforderung im Sinus maxillaris

During the preoperative diagnostics of an 80-year-old male patient prior to a planned endarterectomy, an unclear space-occupying lesion was detected in the right nasopharyngeal cavity. It proved to be a dense soft tissue space-occupying lesion of the right maxillary sinus. The histological investigations revealed a partially necrotically decomposed malignant tumor below normal respiratory mucosa free from dysplasia. This case demonstrates the difficulties in differential diagnostics, particularly involving (aberrant) expression of cytokeratin.     

Sinus disease in cystic fibrosis

Conclusion Sinus abnormalities are prevalent in patients with CF. Symptoms such as nasal obstruction, loss of taste, and chronic headaches are common and often difficult to treat. When evaluating a patient with chronic sinusitis, the findings of noneosinophilic nasal polyps, unusual bacterial organisms, or specific radiographic features suggest the underlying diagnosis of CF. CF should be looked for even in the absence of pulmonary or gastrointestinal symptoms (34). Medical and surgical therapy reduces morbidity in CF patients, although much remains unknown about ideal therapeutic management.