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1.
保留迷走神经主干门奇断流术治疗门静脉高压症 总被引:8,自引:0,他引:8
目的 探讨保留迷走神经主干门奇断流术(VTPPD)的手术方法及疗效。方法 根据食管下段迷走神经前后主干走行,设计出该术式的游离曲线,在临床上应用22例,并与同期施行的门奇断流术(PD)32例,PD+幽门成形术(PD+PP)16例进行比较。结果 手术死亡率和术后再出血率VTPPD组均为4.5%,PD组分别为6.3%和9.4%,PD+PP组均为6.3%,3组无明显差异(P〉0.05)。胃肠功能恢复时间 相似文献
2.
断流加分流联合术的门静脉血流动力学变化与临床疗效 总被引:3,自引:0,他引:3
目的:前瞻性分析门奇静脉断流加脾肾静脉分流术(联合手术)和断流术后的门静脉血流动力学变化与临床疗效。方 法:彩色多普勒超声监测各手术组门静脉系统血流动力学变化,随访临床疗效。结果:联合手术组PVD术后平均下降0.20 cm(15.87%)、PVF平均下降288.29ml/min(41.15%),FPP平均F降0.66kPa(17.41%);断流组PVD平均下降0.13cm(9.29%), PVF平均下降200.70ml/min(30.35%),FPP平均下降0.38kPa(10.56%);联合手术组与断流组比较PVD有明显差异(P< 0.01)。再出血率分别为2.9%和13.8%(P<0.05),肝性脑病率分别为5.7%和3.5%(P<0.05)。结论:联合手术组的门静脉血 流动力学变化及临床疗效优于断流组。 相似文献
3.
彩超观察门静脉高压血流动力学变化简便易行,有良好临床应用价值。为进一步评价远端脾肾分流术(DSRS)的疗效,作者应用彩色多普勒超声(彩超)观察DSRS手术前后血流动力学变化,将8例DSRS和14例断流术与对照组比较,结果:DSRS术后3周,门静脉血流(PVF)较术前降低50%。随访2年,部分患者PVF继续下降。DSRS与断流比较,PVF降低更明显(P<0.001)。结论:DSRS术后早期PVF下降,部分病例有持续下降趋势。DSRS选择性分流作用不完全。断流术维持PVF作用优于DSRS。 相似文献
4.
统计分析120例门脉高压症外科手术治疗的效果,包括脾肾静脉分流术(SRS)37例,门奇静脉断流术(PAD)57例,SRS+PAD26例。其中择期手术97例(80.0%)。病死率7.2%,急症手术23例(19.1%)病死率17.3%.,总病死率9.1%。各术式病死卒为SRS16.2%,PAD7%.SRS+PAD11.5%。SRSfoPAD各有优缺点,但以PAD止血效果佳,对肝功能影响较小,病死率低。文中对术式改进和术式选择作了描述和讨论 相似文献
5.
肺动脉瓣下室间隔缺损的外科治疗 总被引:1,自引:0,他引:1
我院自1974年5月~1998年4月共施行室间隔缺损(VSD)修补手术1070例,其中肺动脉瓣下室间隔缺损(SPVSD)193例,占18%(不包括法洛四联症的SPVSD)。由于SPVSD部位特殊,且常合并主动脉瓣脱垂及主动脉瓣关闭不全(AI),因此,此型VSD与常见的膜部室间隔缺损(MVSD)的外科治疗有所不同。现对本组病例的临床特点和手术治疗加以分析和讨论。1 临床资料与方法本组193例中,男112例,女81例。年龄2~35岁,平均9.4±5.5岁。体重10~59kg,平均25.2±12.1k… 相似文献
6.
目的:评价主动脉瓣替换(AVR)术后左心功能的近期及其远期效果。方法:对1978年12月至1996年12月期间连续129例单纯行AVR的病人进行分析。结果:术前B超示左心室舒张末期内径(LVEDD)、收缩末期内径(LVESD)分别为(64.5±9.3)mm、(44.7±9.9)mm,术后14天至3个月分别为(51.9±7.2)mm、(31.5±4.5)mm(P<0.01);术后1~2年分别为(47.6±6.1)mm、(29.5±5.4)mm(P<0.01)。手术死亡率3.9%。术后随访6个月至16年,平均4.4年,累计随访501病人·年。晚期死亡6例(1.2%病人·年),5年及10年生存率分别为89.3%、77.3%。血栓栓塞及与抗凝有关的出血率分别为0.8%病人·年、1.0%病人·年。结论:AVR术后95%病人的心功能恢复至I或I级,长期效果满意。故主动脉瓣病变、LVEDD扩大并出现症状的病人,应行主动脉瓣替换术。 相似文献
7.
上腹部手术对肺功能的影响 总被引:22,自引:1,他引:22
为探讨手术与麻醉对肺功能的影响,对25例上腹部手术(UAS)患者术后肺功能的掼害和恢复进行了连续观察。手术前后分别用肺功能测定仪测量肺通气功能和血气,并于不同体位(坐位和仰卧位)测量功能余气量(FRC)。结果显示:UAS后呼吸频率(R)增加,潮气量(VT)减少,分钟通气量(VE)无明显改变。术后肺活量(VC)和用力肺活量(FVC)等明显下降,手术当天FVC为术前的27.1%,至术后第7天恢复至术前69.6%。PaO2术前为10.57±1.46kPa,术后第J、3天分别为9.61±1.45和9.69±1.38kPa,同期肺泡一动脉血氧分区差[P(A-a)DO2]梯度增加。硬膜外阻滞术后坐位时FRC无明显改变,仰卧位时在术后第1、7天分别为术前的75.4%和95.8%。麻醉和手术时间越长,肺功能损害越重。本文证实UAS后肺功能严重受损,气体交换障碍,术后坐位时FRC无明显改变,仰卧位时减少。 相似文献
8.
9.
230例婴幼儿室间隔缺损的外科治疗 总被引:1,自引:0,他引:1
目的 探讨外科手术治疗婴幼儿室间隔缺损(VSD)的结果和经验。方法 对1990年2月至1997年12月的230例婴幼儿VSD修补术进行总结。年龄3 ̄36个月,体重3.2 ̄15.5kg。膜周部VSD192例,干下型VSD36便,膜周部并肌部VSD2例,术前中度以上肺动脉高压150例(65.2%)。结果 全组手术死亡13例,手术病死率为5.65%。手术死亡的主要原因为肺动脉高压危象和严重心律失常。术后 相似文献
10.
心脏瓣膜病巨大左室的外科治疗经验 总被引:29,自引:3,他引:26
1987年1月至1992年3月,我们为65例心脏瓣膜病巨大左室(EDD>70mm)病人施行了瓣膜替换术。术前平均EDD78.8mm,ESD57.3mm,FS0.26。心功能III级16例,IV级49例。手术方式:MVR16例,MVR+TVP10例,AVR11例,MVR+AVR21例,MVR+AVR+TVP7例。术后早期发生心、肺、肾、肝等重要器官并发症27例,死亡9例(13.8%)。AVR组(18 相似文献
11.
目的:评估微电极引导苍白球腹后核毁损术治疗帕金森病的效果。方法:应用微电极导向苍白球腹后核毁损术治疗帕金森病48例(单侧毁损47例,双侧1例)。术前及术后每间隔6个月采用统一帕金森病等级量表(unified Parkinson′s disease rating scale,UPDRS)进行1次疗效评估。结果:术后对患者随访6-34个月,平均24个月。经靶点毁损患者手术对侧肢体症状明显改善,“开“或“关“状态均有改进。UPDRS积分显示“开“状态平均改善率为28.7%,“关“状态改善率为47.6%。本组4例患者(占8.3%)术后遗留对侧肢体肌张力下降,无手术死亡和视野缺损发生。结论:微电极技术可行内囊和视束通道的定位,结合射频电极刺激更有利于上述结构的鉴别和苍白球腹后核的靶点定位。 相似文献
12.
OBJECTIVE: To introduce the methods and effects of microelectrode-guided posteroventral pallidotomy (PVP) for Parkinson's disease. METHODS: 109 patients underwent PVP by microelectrode electrophysiological recording for intraoperative target localization. 45 patients underwent unilateral PVP, 21 patients simultaneous bilateral PVP, 43 patients combined thalamotomy and PVP. Modified Webster Scale was used for objective assessments before and after operation. Postoperative CT scan or MRI was performed to localise lesions. RESULTS: Microelectrode recording usually led to a final pallidotomy lesion position that deviated from the CT stereotactically defined target point. The change rate of targets was 84.7%. PVP significantly and immediately improved all Parkinsonian motor signs and reduced drug-induced motor fluctuations and dyskinesia. The mean Webster Scale was improved by (72.7 +/- 11.3)% in the "on" state, and (89.3 +/- 8.1)% in the "off" state. No patient showed permanent complications. CONCLUSIONS: Microelectrode-guided PVP was proved to be safe and effective. Bilateral PVP and combined PVP can significantly and immediately abolish all Parkinsonian motor signs. Physiological methods of microelectrode recording can significantly improve the safety and efficacy of PVP, and decrease the rate of complication. 相似文献
13.
Pallidotomy: a comparison of responders and nonresponders 总被引:3,自引:0,他引:3
Van Horn G Hassenbusch SJ Zouridakis G Mullani NA Wilde MC Papanicolaou AC 《Neurosurgery》2001,48(2):263-71; discussion 271-3
OBJECTIVE: We reviewed a prospective series of 32 unilateral, large-volume, microelectrode-guided posteroventral pallidotomies to determine the differences between responsive and nonresponsive patients. METHODS: Our patients underwent extensive pre- and postoperative evaluations. One year postoperatively, we correlated the outcomes of 25 patients with their histories, physical findings, neuropsychological assessments, and lesion characteristics to further understand the indications, limitations, and pitfalls of unilateral pallidotomy. Our group judged responsiveness by comparing the preoperative total Unified Parkinson's Disease Rating Scale off-state scores with those obtained 1 year postoperatively. A score indicating greater than 20% improvement at 1-year follow-up was rated a good outcome; improvement of greater than 40% was rated an excellent outcome. RESULTS: Although most patients sustained long-term benefits, some demonstrated little or no improvement. Patient and lesion factors influenced outcome. Younger age (<60 yr), tremor, unilateral predominance, L-dopa responsiveness, motor fluctuations with dyskinesia, and good lesion placement predicted a good response to unilateral pallidotomy. Advanced age (>70 yr), absence of tremor, increased duration of disease, reduced responsiveness to L-dopa, frontal behavioral changes, prominent apraxic phenomena, and improper lesion placement predicted a poor response. CONCLUSION: Unilateral, large-volume pallidotomy with precise lesion control provides long-lasting benefits for carefully selected patients. 相似文献
14.
Herrera EJ Viano JC Cáceres M Costello G Suárez M Suárez JC 《Acta neurochirurgica》2000,142(2):169-175
Summary ? Objective. We analyse the clinical aspects, results and reliability of posteroventral pallidotomy (PVP) carried out as treatment for
the principal symptoms and treatment induced complications in patients with Parkinson's disease (PD).
Patients and Methods. Between August 1995–January 1998, 17 patients with PD were treated surgically, 13 patients with PVP. A pre- and post-surgical
clinical evaluation was carried out. Riechert's Stereotactic System (MHT, Freiburg, Germany) was used. Ventriculography under
stereotactic conditions was used in the PVP procedures, Laitinen's co-ordinates as anatomical target, and electrical stimulation
for physiological determination. 3–4 radiofrequency lesions were made at 83°C for 20″. The mean age was 60±10.8 years, ages ranging from 45–79 years. 8 (60.5%) of the patients were male. The cardinal symptoms
of the series were bradykinesia and rigidity. The duration of the illness ranged from 8.6±3.7 years with a range of 4–15 years.
7 (53.8%) presented with a duration of 10 years or more. 6 (46,2%) of the patients underwent left PVP, the remaining 7 (53.8%)
right PVP. Only one patient received treatment with right PVP and ipsilateral thalamotomy in the same surgical procedure.
The mean post-surgical follow up was 16±7 months, with a range of 2 to 26 months.
Results. An up to date evaluation was carried out on all patients showing significant changes after PVP in UPDRS motor (P<0.005),
complete rigidity relief (P<0.005), bradykinesia relief (P<0.005) and complete tremor relief (P<0.005). An important improvement
in contralateral dyskinesia was noted after PVP. A subjective evaluation of the results showed excellent results in 4 (30.8%)
patients, good in 6 (46.2%) and fair in 3 (23%). No significant correlation was found between age and duration of illness
(P=0.7). Two patients suffered slight side effects, one patient with worsening of hypophonia whilst the other suffered subjective
visual impairment controlled by normal post operative ophthalmological examinations. There was no peri-operative mortality.
Conclusion. PVP is considered a safe and effective surgical method for the treatment of both the principal symptoms of PD and the complications
of DOPA medication. 相似文献
15.
Westerberg BD Roberson JB Stach BA Silverberg GD Heit G 《Stereotactic and functional neurosurgery》2002,79(2):75-87
Parkinson's disease is a chronic, progressive neurodegenerative disorder resulting from dopaminergic cell loss in the pars compacta of the substantia nigra. Conventional treatment of Parkinson's disease consists of pharmacological replacement of dopamine. A treatment alternative, posteroventral pallidotomy (PVP), has been used for medically intractable stages of the disease. The purpose of this study was to evaluate the effects of PVP on balance function, as measured by dynamic posturography, in patients with medically intractable Parkinson's disease. Five subjects were studied within 2 days prior to and within 6 months following PVP. Pretreatment abnormalities were found in vestibular, visual, and somatosensory processing in balance function. Posteroventral pallidotomy resulted in improvement in vestibular compensation of posture in some patients, which may be at least partially due to an improvement in latencies to respond to changes in stance. Dynamic posturography is an effective tool in the evaluation of balance and posture in patients with advanced Parkinson's disease. 相似文献
16.
Defebvre L Krystkowiak P Blond S Destée A 《Presse medicale (Paris, France : 1983)》2000,29(27):1525-1531
PATHOPHYSIOLOGY: In Parkinson's disease, the neurodegenerative process of the nigrostriatal dopaminergic pathways induces an increase in activity of the subthalamic nucleus and the medial globus pallidus, which cause inhibition of thalamo-cortical outputs explaining parkinsonism. HIGH-FREQUENCY DEEP BRAIN STIMULATION: The adverse effects induced by lesions of subcortical structures (thalamotomy, pallidotomy) have increased interest in chronic electrical stimulation proposed as a new therapy in Parkinson's disease. This technique is reversible and can be modulated with less adverse effects. TWO TARGETS: Two targets may be proposed in case of severe motor fluctuations: the medial globus pallidus and the subthalamic nucleus. Pallidial stimulation improves dramatically levodopa-induced dyskinesia and, with a variable degree, the parkinsonian triad. Subthalamic stimulation rapidly reverses akinesia, rigidity and tremor and also dyskinesias which progressively tend to diminish after decreasing L-dopa dosage. LONG-TERM EFFICACY: A follow-up period of a few years has confirmed that the beneficial effect is maintained. However, stimulation dose not prevent the development of certain symptoms (postural impairment, cognitive decline). LIMITED INDICATIONS: Chronic electrical stimulation of medial globus pallidus and subthalamic nucleus may be proposed for parkinsonian patients with severe motor fluctuations associated with abnormal involuntary movements which are not controlled by different medical therapies. Parkinsonian symptoms must still be levodopa responsive and cause severe clinical disability severely limiting daily living activities. Cognitive impairment and other severe pathologies are contraindications. 相似文献
17.
Results of chronic subthalamic nucleus stimulation for Parkinson's disease: a 1-year follow-up study 总被引:4,自引:0,他引:4
Vesper J Klostermann F Stockhammer F Funk T Brock M 《Surgical neurology》2002,57(5):306-11; discussion 311-3
BACKGROUND: Deep brain stimulation (DBS) has been established as an alternative approach for the treatment of advanced Parkinson's disease (PD). Recently, the subthalamic nucleus (STN) has been identified as the optimal target for DBS. METHODS: Thirty-eight patients have undergone surgery for advanced PD since 1996. They include 12 females and 26 males with a mean age of 55.6 years. The mean stage on the Hoehn and Yahr Scale was 3.5 (off condition). Electrodes (Medtronic DBS 31389) were stereotactically implanted into the STN bilaterally. Targeting was performed using computerized tomography (CT) scans and ventriculography (VG). After 4 days of external stimulation, permanent neurostimulators were implanted. Patients were evaluated preoperatively and 1, 6, and 12 months postoperatively. Evaluations were performed in defined on and off states using the Unified Parkinson's Disease Rating Scale (UPDRS) as well as the Hoehn and Yahr Scale, the dyskinesia scale, and the Activities of Daily Living (ADL) Scale. RESULTS: Significant improvement of all motor symptoms was found in all patients (UPDRS motor score 32/48 preoperatively versus 15/30 at 12-month follow-up, p < 0.001). Daily off-times were reduced by 35%. Dyskinesias also improved markedly (UPDRS IV: 3.2/3.1 [on/off] vs. 0.9/1.3 at 12 months follow-up). Postoperative L-dopa medication was adjusted (mean reduction: 53%). Complications occurred in two patients (5%) who developed infections, leading to system removal. Systems were replaced after 6 months. Two patients (5%) had a permanent worsening of a previously known depressive state and developed progressive dementia. CONCLUSIONS: TN stimulation is a relatively safe procedure for treating advanced PD. The possibility of readjusting the stimulation parameters postoperatively improves the therapeutic outcome and reduces side effects in comparison to ablative methods. 相似文献
18.
Autotransplantation of human carotid body cell aggregates for treatment of Parkinson's disease 总被引:11,自引:0,他引:11
Arjona V Mínguez-Castellanos A Montoro RJ Ortega A Escamilla F Toledo-Aral JJ Pardal R Méndez-Ferrer S Martín JM Pérez M Katati MJ Valencia E García T López-Barneo J 《Neurosurgery》2003,53(2):321-8; discussion 328-30
OBJECTIVE: In this study, we assessed the feasibility of autotransplantation of carotid body (CB) cell aggregates into the striatum for the treatment of patients with Parkinson's disease (PD). METHODS: Six patients with advanced PD underwent bilateral autotransplantation of CB cell aggregates into the striatum. They were evaluated clinically preoperatively and for 18 months after surgery according to the recommendations of the Core Assessment Program for Intracerebral Transplantation. RESULTS: No major complications or adverse events resulted from the cell implantation or surgical procedures. During the course of the study, there was no significant aggravation of dyskinesia or decline in cognitive function in any of the patients. Five of the six patients who underwent transplantation manifested a measurable degree of clinical improvement evidenced by standardized clinical rating scales for PD. A decrease in the blinded Unified Parkinson's Disease Rating Scale Part III in the "off" state, the main measure of transplant efficacy in our study, was found to be maximal (between 26 and 74%) at 6 months after surgery. At 1 year, clear reductions in the blinded Unified Parkinson's Disease Rating Scale Part III were maintained in three patients (24, 38, and 52%, respectively). Modest improvement was seen in two patients (13 and 17%), and the sole patient who showed no improvement had the most fibrosis in the CB. The age of the patient and the state of the CB tissue were adversely correlated with clinical improvement after CB autotransplantation. CONCLUSION: This pilot study indicates that CB autograft transplantation is a relatively simple, safe, and viable therapeutical approach for the treatment of patients with advanced PD. More studies are needed to optimize the procedure and to assess its general applicability for the treatment of patients with PD. 相似文献
19.
Lévesque MF Taylor S Rogers R Le MT Swope D 《Stereotactic and functional neurosurgery》1999,72(2-4):170-173
OBJECTIVES: We wanted to evaluate chronic subthalamic nucleus (STN) stimulation as an alternative to pallidotomy for severe Parkinson's disease symptomatology. METHODS: Nine patients met clinical criteria for unilateral standard pallidotomy. All had severe medically refractory drug-induced dyskinesia and had reached maximal daily levodopa therapy. Pre- and postoperative videos, neuropsychometric testings and clinical stagings were administered. Three patients were selected to undergo stereotactic implantation of a deep brain stimulator (DBS) after Institutional Review Board approval and informed consent. These were performed using digitized microrecordings. The other group received unilateral pallidotomy. RESULTS: At a mean follow-up of 6 months, our results support recent findings of significant major improvement in motor scores, activity of daily living and decrease in amount of daily levodopa intake by close to 50% after 3 months of stimulation. CONCLUSIONS: Chronic stimulation of the STN appears to provide significant motor improvement in patients with severe Parkinson's disease and is more beneficial than pallidotomy. 相似文献
20.
OBJECT: The aim of this study was to examine neuropsychological outcome from unilateral posteroventral pallidotomy (PVP) in Parkinson disease while controlling for confounding factors such as test practice and disease progression. METHODS: Participants underwent baseline and 2-month follow-up assessments of cognition, quality of life, mood, and motor functioning. The surgery group (22 patients) underwent PVP (15 left, seven right) after baseline assessment. The waitlist group (14 patients) underwent PVP after follow up. At follow up, the left PVP group exhibited a decline on verbal measures of learning, fluency, working memory, and speeded color naming. The incidence of significant decline on these measures after left PVP ranged from 50 to 86%. The right PVP group did not exhibit a significant cognitive decline, but fluency did decline in 71% of patients who underwent right PVP. Participants who underwent PVP reported better bodily pain and social functioning at follow up than participants in the waitlist group. Improved bodily pain was evident for 62% of the surgery group, and social functioning improved for 19%. Surgery did not alter reported physical functioning or mood. Dyskinesia improved after surgery, but there were no improvements in "on-state" manual dexterity or handwriting. CONCLUSIONS: Most patients who underwent left PVP exhibited declines in learning, fluency, working memory, and speeded color naming. Accounting for retesting effects altered the magnitude of these declines by up to one quarter of a standard deviation, but did not increase the breadth of postsurgical neuropsychological decline beyond that typically reported in the literature. It was found that PVP improved dyskinesia, bodily pain, and social functioning, but did not lead to improvement on other objective and self-reported measures of motor functioning. 相似文献