经内镜胆管引流术治疗急性胰腺炎

为达到最佳治疗效果，而又减少损伤，７６例急性胰腺炎（ＡＰ）其中３例为重症急性胰腺炎（ＳＡＰ）患者接受了经内镜胆管引流术（ＥＢＤ），引流成功６９例。ＡＰ顺利治愈６７例，治愈率９７．１％，平均治愈时间８．５天。而ＥＢＤ术不成功改为其它治疗的７例，平均治愈时间长达１４．５天。结果表明ＥＢＤ具有简便、安全、疗效好、对患者打击小的优点     

垂体微腺瘤的诊断与治疗

对37例垂体微腺瘤患者行经单鼻孔蝶窦入路垂体微腺瘤切除术。对肿瘤的诊断、手术入路、肿瘤切除程度、术后症状和内分泌变化及术后并发症进行了探讨。结果37例均能经MRI检查得到初步诊断。肿瘤均全部切除。术后各种症状均有不同程度改善。26例激素水平恢复到正常（93%）。9例术后发生轻微脑脊液鼻漏,12例术后发生尿崩,均经保守治疗后痊愈。无大出血和感染病例。认为垂体微腺瘤应首选经单鼻孔蝶窦入路垂体瘤切除术。术前准确的诊断和熟练的显微外科操作是提高肿瘤切除率和防止术后并发症的关键。     

脑脊液囊虫抗体检测与细胞学检查对比分析诊断脑囊虫病的价值

应用ＡＢＣ－ＥＬＩＳＡ、ＳＰＡ－ＥＬＩＳＡ和细胞学检查４１例脑囊虫病患脑脊液抗囊虫抗体及细胞学异常进行对比观察分析。结果显示，ＡＢＣ－ＥＬＩＳＡ法阳性３７例（９０．２％），ＳＰＡ－ＥＬＩＳＡ法阳性３４例（８０．５％），细胞学异常２９例（７０．７％）。３７例脑脊液抗囊虫抗体阳性嗜酸性粒细胞、激活淋巴细胞、浆细胞、嗜碱性粒细胞的检出率分别为７８．３％、７３．０％、７５．７％和２４．３％；抗体滴     

睡眠呼吸暂停低通气综合征患者经鼻持续气道正压通气治疗的家庭调压

经鼻持续气道正压通气（ＣＰＡＰ）是目前治疗睡眠呼吸暂停低通气综合征（ＳＡＨＳ）最有效的方法。最适ＣＰＡＰ压力调定的传统方法是在多导生理记录仪睡眠呼吸监测（ＰＳＧ）的指导下,由人工在睡眠室调定,我们探讨在家庭中这一压力的调定。对象与方法１３４例ＳＡＨＳ患者均按国际标准方法［１］经ＰＳＧ确诊。均已婚,配偶健在。男１１９例,女１５例,平均体重７９．８ｋｇ（５０－１１５ｋｇ）,平均年龄５１．７岁（２７－７８岁）,睡眠呼吸紊乱指数（ＡＨＩ）为（４８．３±２６．６）次／小时（５－１０５次／小时）。实施家庭调…     

射频导管消融治疗儿童室上性心动过速100例体会

经射频导管消融（ＲＦＣＡ）治疗３．５～１４岁儿童阵发性室上性心动过速（ＰＳＶＴ）１００例，探讨ＲＦＣＡ治疗儿童ＰＳＶＴ的安全性及疗效。１００例中房室折返性心动过速（ＡＶＲＴ）７９例，慢－快型房室结折返性心动过速（ＡＶＮＲＴ）２１例。首次消融成功９６例（９６％）。失败４例均为ＡＶＲＴ。平均Ｘ线曝光时间１９ｍｉｎ。除２例ＡＶＮＲＴ放置导管过程中发生一过性ＩＩ度房室阻滞（ＡＶＢ）外，余术中和术后均无并发症发生。术后随访１个月～４．５年，ＡＶＲＴ复发１例，ＡＶＮＲＴ复发４例（占２１例的１９％），总复发率５％。结论：①ＲＦＣＡ治疗儿童ＰＳＶＴ安全、有效。②因儿童的ＡＶＮＲＴ消融慢径易出现ＡＶＢ且复发率高，应严格掌握手术适应证。③术中Ｘ线曝光时间应＜４０ｍｉｎ。     

小剂量山朝治疗再生障碍性贫血

小剂量山地明治疗再障１７例，其中ＣＡＡ９例，ＳＡＡ－Ⅰ５例，ＳＡＡ－Ⅱ１例，ＰＴＣＡ２例。剂量为２００－３００ｍｇ／ｄ，分两次口服，平均３．５－５ｍｇ／（ｋｇ．ｄ），疗程３－６个月，除２例ＰＲＣＡ外余同时口服康力龙４－６ｍｇ／ｄ，结果：基本治愈３例，缓解１例，明显进步６例，见效７例，总有效率５８．８％     

经单鼻蝶窦入路显微外科手术切除垂体腺瘤(附51例报告)

目的探讨经单鼻孔蝶窦入路显微外科手术切除垂体腺瘤的手术技巧以及并发症的处理方法。方法回顾性分析我院手术治疗的51例垂体腺瘤患者。对比手术前后视力视野变化、垂体内分泌变化,并分析并发症的发生率及相关影响因素。结果经单鼻孔蝶窦入路显微外科手术全切除垂体腺瘤46例、次全切5例,视力症状改善(改善率82.1%),内分泌功能改善,术后出现尿崩症12例(2周后均恢复),术中脑脊液漏9例(经同期手术修补后痊愈)。结论经单鼻孔蝶窦入路切除垂体腺瘤具有安全、简便、微创等优点,是大部分垂体腺瘤的首选手术方式。     

经皮冠状动脉腔内成形术对不稳定型心绞痛患者心率变异的影响

应用长程心电图分析系统对１６例不稳定型心绞痛患者（ＵＡＰ组）入院后第２日、经皮冠状动脉腔内成形术（ＲＴＣＡ）后第１，３，３０日以及１４８例健康中、老年人（对照组）２４ｈ心电图进行心率变异（ＨＲＶ）分析。结果：ＵＡＰ组２４ｈ连续正常ＲＲ间期的标准差（ＳＤＮＮ）、２４ｈ内连续５ｍｉｎ节段平均正常ＲＲ间期的标准差（ＳＤＡＮＮｉ）、相邻ＲＲ间期差的均方根（ｒＭＳＳＤ），相邻两个正常心动周期差值大于５０ｍｓ个数占总搏数的百分比（ＰＮＮ５０）、低频功率（ＬＦ）及高频功率（ＨＦ）均明显低于对照组（分别为９２．７±１４．３ｍｓｖｓ１２８．９±１７．８ｍｓ、７８．８±１０．６ｍｓｖｓ１１８．６±１９．１ｍｓ、１９．３±７．７ｍｓｖｓ２９．８±１２．７ｍｓ、３．６±１．７％ｖｓ６．５±５．５％、３１７．２±１４８．３ｍｓ２ｖｓ４７６．５±２８７．３ｍｓ２，Ｐ均＜０．０５），而ＬＦ／ＨＦ高于对照组（３．５±１．３ｖｓ２．４±１．１，Ｐ＜０．０５）。ＰＴＣＡ术后３０天ＵＡＰ患者ＨＲＶ逐渐恢复正常。结果提示ＵＡＰ患者交感神经和迷走神经张力下降，而以后者更明显；ＰＴＣＡ后ＨＲＶ逐渐恢复，说明ＰＴＣＡ能改善ＵＡＰ患者的ＨＲＶ。     

阻塞性睡眠呼吸暂停综合征与心律失常

阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）对心血管功能的影响越来越引起人们的关注。为探讨ＯＳＡＳ与心律失常的关系，我们对２１２例打鼾者行夜间多导睡眠图监测（ＰＳＧ），呼吸紊乱指数（ＡＨＩ）≥５为ＯＳＡＳ。分析ＰＳＧ心电导联。结果：１４６例病人诊断为ＯＳＡＳ，其中８２例ＯＳＡＳ病人发生心律失常（５６．２％），包括早搏或心动过速、传导阻滞或二者均有。采用经鼻持续气道内正压呼吸（ｎＣ－ＰＡＰ）７小时治疗严重的ＯＳＡＳ合并心律失常１９例，其中治疗后心律失常完全消失者１４例（７３．７％）。ＯＳＡＳ病人的心律失常发生率较非ＯＳＡＳ高（χ２＝１７．２８，Ｐ＜０．０００１）。心律失常发生率与低氧及夜间呼吸暂停严重程度呈正相关。ｎＣＰＡＰ有效治疗呼吸暂停的同时可逆转或改善心律失常。作者认为，低氧血症很可能是ＯＳＡＳ者心律失常的重要原因之一。     

经蝶手术治疗大型及巨型垂体腺瘤140例临床观察

目的观察经蝶手术治疗大型、巨型垂体腺瘤的临床疗效。方法大型、巨型垂体腺瘤患者140例。采用（左）鼻中隔切口,切开鼻前庭小柱,经鼻中隔—蝶窦中线处凿开鞍底,切除肿瘤。结果 140例肿瘤行包膜内全切除48例,其余行次全切除或大部分切除。术后症状立即改善者122例,并发暂时性尿崩症20例、脑脊液（CSF）鼻漏18例、颅内感染5例、垂体功能低下1例。结论对于大型和巨型垂体腺瘤,经蝶手术治疗可获良好效果。     

老年垂体腺瘤的经蝶显微手术治疗

目的：对22例老年人垂体腺瘤的经蝶显微手术治疗,探讨老年性垂体腺瘤的临床特点及治疗原则,方法：本组老年人垂体腺瘤均经血清激素检查,CT或MRI扫描确诊,采用经蝶显微手术治疗,术后治疗特别注意水和电解质的平衡,结果：无分泌功能腺瘤17例,肿瘤全切12例,次全切7例,大部分切除3例,无手术死亡,无并发症死亡。在平均3．1年随访中,20例恢复良好,2例症状复发,结论：老年性垂体腺瘤绝大部分为无功能性,经蝶入路显微手术切除是一种安全,有效的方法,但要注意手术适应症的选择和术后体液,电解质平衡。     

老年人垂体腺瘤49例术后临床分析

目的 探讨老年人垂体腺瘤的临床特点和治疗效果。方法 回顾分析49例手术及病理证实的老年人垂体腺瘤资料。结果 49例患者平均病程4．4年。视力视野障碍46例（93．8％）,头痛20例（40．8％）,内分泌障碍16例（32．7％）。肿瘤大于3cm25例（51．0％）,大部及部分切除11例（22．4％）,以经碾人路效果为好。术后常规放疗28例,肿瘤控制率93．0％,其中50％发生垂体功能低下。随访7－127个月（平均50．5个月）,视力改善27例（58．7％）,生活理43例（87＝8％）;40例术后3个月－5年复查CT或MRI提示肿瘤消失30例（61．2％）,残瘤静止5例（10．2％）,复发5例（10．2％）。结论 老年人垂体腺瘤以大腺瘤和无功能腺瘤为多;临床以视力视野改变为主;经碟人路显微手术是首选治疗方法;术后辅以放疗可控制或延缓肿瘤复发,但需注意视力损害及垂体功能低下的严重并发症。     

神经导航系统引导单鼻孔蝶窦入路垂体瘤切除术的应用

目的观察神经导航系统引导单鼻孔蝶窦入路垂体瘤切除术的应用效果。方法32例垂体瘤患者,术前行MRI或CT薄层扫描,将图像资料输入Brain LAB Vector Vision神经导航系统中进行三维重建,据此设计最佳手术入路,并对肿瘤及重要结构作标记;术中在神经导航系统的引导下寻找蝶窦前壁、鞍底、颈内动脉、海绵窦和斜坡等结构,切除肿瘤。结果32例均在神经导航引导下经鼻蝶入路顺利到达肿瘤部位,注册误差0．3～2．5mm;肿瘤全切除24例,次全切除6例,大部切除2例;术后26例症状有不同程度的改善,6例无变化,无严重并发症出现。结论神经导航引导单鼻孔蝶窦入路垂体瘤切除术定位准确、肿瘤全切除率高、并发症少。     

巨大垂体腺瘤的显微手术治疗

为提高巨大垂体腺瘤显微手术的疗效 ,回顾性分析 5 6例巨大垂体腺瘤患者的临床资料及治疗方法。依据肿瘤的生长方向及部位将 5 6例分为四型 ,据此分别采用经蝶、经额下、额下经蝶、扩大经蝶、扩大额下硬膜外、额下 -翼点等 10种入路进行显微手术。5 6例巨大垂体腺瘤全切 2 9例 ,近全切 2 0例 ,大部切除 7例。无死亡者。提示依据巨大垂体腺瘤的不同位置及生长方向选择适当的手术入路是提高全切率、降低死亡率及复发率的重要手段     

Complications of endoscopic surgery of the pituitary adenomas: analysis of 570 patients and review of the literature

Endoscopic transsphenoidal surgery is emerging as a minimally invasive and maximally effective procedure for pituitary adenomas. In this report we analyzed the complications in 624 procedures of endonasal transsphenoidal endoscopic surgery in the treatment of 570 patients with pituitary adenomas. The leading author (MB) operated pituitary adenomas via pure endoscopic endonasal transsphenoidal surgery between January 2006 and August 2011 at the Hacettepe University, Department of Neurosurgery in Ankara. Complications were assessed in 624 surgical procedures under five groups; rhinological, CSF leaks, infection, vascular and endocrinologic complications. We observed a total of 76 complications (12.1%). Rhinological complications occurred in 8 patients (1.3%): 4 epistaxis (0.6%) and 4 hyposmia (0.6%). Postoperative CSF leaks occurred in 8 patients (1.3%), and infectious complications occurred in 8 patients: 3 cases of sphenoidal sinusitis (0.4%), 5 cases of meningitis (0.8%). Only 1 case of internal carotid aneurysm rupture during the opening of sellar floor (0.16%) was observed. Endocrinologic complications occurred in 51 (8.1%) patients: Anterior pituitary deficiency in 12 (1.9%), transient diabetes insipidus (DI) in 29 (4.6%), permanent DI in 3 (0.4%) and inappropriate antidiuretic hormone secretion syndrome occurred in 7 (1.1%). There was no mortality directly related to the surgical procedure. The complication rates observed in our study suggests that the endoscopic pituitary surgery is at least as safe as microscopic transphenoidal surgery. These rates were obtained with due experience and well-coordinated teamwork. To further improve these rates, new technological developments will be helpful.     

Long term outcome following repeat transsphenoidal surgery for recurrent endocrine-inactive pituitary adenomas

It is widely accepted that the standard first-line treatment for most endocrine inactive pituitary macroadenomas (EIA) is surgery, usually via a transsphenoidal approach. What is less clear is what approach to take when these tumors recur, especially when this recurrence involves areas which are difficult to surgically remove tumor from, such as the suprasellar region or cavernous sinuses. We present long term follow-up for a series of 81 patients who underwent repeat surgery for recurrent non-secreting pituitary adenomas. We analyzed data collected from all adult patients undergoing their second microsurgical transsphenoidal resection of a histologically proven endocrine-inactive pituitary adenoma at the University of California at San Francisco between January 1970 and March 2001. Data for these patients were collected by review of medical records, mail, and/or telephone interviews. Visual function, anterior pituitary function, and tumor control rates were analyzed for the series. Records were available for a total of 81 recurrent EIA patients. The median time between their initial and repeat operations was 4.1 years. The mean tumor size was 2.2 ± 0.2 cm. A total of 35/81 patients had greater than 5 years of follow-up. A total of 24/81 patients had greater than 10 years of follow-up. Over one half of these patients presented with visual disturbance, and we found that 39% of these patients experienced improved vision with a second surgery. More importantly, no one with normal vision suffered any appreciable decline in vision. Approximately, 35% of patients with pre-operative anterior pituitary dysfunction recovered function after surgery in our series; and no patient’s function worsened. A total of 4/52 (8%) patients with greater than 2 years of post-op follow-up experienced a clinically meaningful tumor recurrence requiring additional treatment. Our data suggest that when performed by experienced transsphenoidal surgeons, durable tumor control can be obtained in these frequently locally aggressive tumors with acceptable rates of post-operative morbidity.     

垂体肿瘤239例临床特征分析

目的 探讨垂体瘤的临床特征及治疗方案.方法 回顾性分析福建省立医院自1994年1月至2007年6月间收住的239例垂体瘤患者的临床资料.结果 239例垂体腺瘤中,男性93例(38.9%),女性146例(61.1%).诊断时的平均年龄为(43.8±14.9)岁(范围为3.9～77岁).依据临床表现、影像学及内分泌检查、免疫组织化学染色所示,催乳素瘤为最常见的肿瘤(26.8%).手术治疗179例(74.9%),其中经蝶入路108例(60.3%),经额入路71例(39.7%),非手术治疗及随访者60例(25.1%).结论 垂体瘤可表现为内分泌异常、神经系统症状或其他原因行MRI意外发现;催乳素瘤为最常见的肿瘤.     

垂体脓肿的诊断与治疗(附6例报告)

目的探讨垂体脓肿（PA）的临床特点、早期诊断和治疗方法。方法对6例PA患者的临床表现、影像学特征、诊断和治疗情况进行回顾性分析。结果6例患者术前均行CT及MRI检查,术前确诊2例。6例患者均行手术治疗,3例经鼻蝶入路,2例经翼点入路,1例经额下入路。术后头痛、泌乳、月经紊乱等症状逐渐消失,随访3个月～2a PA无复发。结论PA早期诊断困难,手术治疗效果肯定,最佳选择为经鼻蝶入路。     

Management of Cushing disease

Cushing disease is caused by a corticotroph tumor of the pituitary gland. Patients with Cushing disease are usually treated with transsphenoidal surgery, as this approach leads to remission in 70-90% of cases and is associated with low morbidity when performed by experienced pituitary gland surgeons. Nonetheless, among patients in postoperative remission, the risk of recurrence of Cushing disease could reach 20-25% at 10 years after surgery. Patients with persistent or recurrent Cushing disease might, therefore, benefit from a second pituitary operation (which leads to remission in 50-70% of cases), radiation therapy to the pituitary gland or bilateral adrenalectomy. Remission after radiation therapy occurs in ～85% of patients with Cushing disease after a considerable latency period. Interim medical therapy is generally advisable after patients receive radiation therapy because of the long latency period. Bilateral adrenalectomy might be considered in patients who do not improve following transsphenoidal surgery, particularly patients who are very ill and require rapid control of hypercortisolism, or those wishing to avoid the risk of hypopituitarism associated with radiation therapy. Adrenalectomized patients require lifelong adrenal hormone replacement and are at risk of Nelson syndrome. The development of medical therapies with improved efficacy might influence the management of this challenging condition.     

Endoscopic endonasal transsphenoidal surgery: surgical results of 228 pituitary adenomas treated in a pituitary center

Pituitary tumors are challenging tumors in the sellar region. Surgical approaches to the pituitary have undergone numerous refinements over the last 100 years. The introduction of the endoscope have revolutionized pituitary surgery. The aim of this study is to report the results of a consecutive series of patients undergoing pituitary surgery using a pure endoscopic endonasal approach and to evaluate the efficacy and safety of this procedure. We reviewed the data of 228 consecutive patients who underwent endonasal transsphenoidal adenoma removal over an 10-year period. Pre- and post-operative hormonal status (at least 3 months after surgery) were analyzed and compared with clinical parameters presented by the patients. Tumor removal rate, endocrinological outcomes, and complications were retrospectively assessed in 228 patients with pituitary adenomas who underwent 251 procedures between December 1998 and December 2007. There were 93 nonfunctioning adenomas, 58 growth hormone-secreting, 41 prolactin-secreting, 28 adrenocorticotropin hormone secreting, 7 FSH-LH secreting and 1 thyroid-stimulating hormone-secreting adenomas. Gross total removal was achieved in 79.3% of the cases after a median follow-up of 61.5 months. The remission results for patients with nonfunctioning adenomas was 83% and for functioning adenomas were 76.3% (70.6% for GH hormone-secreting, 85.3% for prolactin hormone-secreting, 71.4% for ACTH hormone-secreting, 85.7% for FSH-LH hormone-secreting and 100% for TSH hormone-secreting), with no recurrence at the time of the last follow-up. Post-operative complications were present in 35 (13.9%) cases. The most frequent complications were temporary and permanent diabetes insipidus (six and two cases, respectively), syndrome of inappropriate antidiuretic hormone secretion (two cases) and CSF leaks (eight cases). There was no death related to the procedure in this series. The endoscopic endonasal approach for resection of pituitary adenomas, provides acceptable results representing a safe alternative procedure to the microscopic approach. This less invasive method, associated with a small number of complications, provides excellent tumor removal rates and represents an important tool for the achievement of good results in the pituitary surgery, mainly for the complete removal of large adenomas.