显微切除痫灶治疗颞叶顽固性癫痫的疗效分析

目的总结显微切除痫灶治疗颞叶顽固性癫痫的临床疗效。方法颞叶顽固性癫痫24例,手术采用改良翼点入路切口,运用良好的显微外科技术,将癫痫灶切除。结果术后随访半年至3年,16例癫痫发作完全消失,4例术后较术前显著改善,2例术后效果良好,手术总有效率91.7%(22/26)。结论根据脑电监测范围显微切除痫灶治疗颞叶顽固性癫痫是安全、有效的手术方式,辅以综合治疗术后并发症少,疗效满意。     

32例小儿癫痫病灶切除麻醉处理体会

目的：探讨小儿顽固性癫痫病灶切除术麻醉方式的选择及术中EEG监测的有效麻醉配合。方法：对我院实施的32例小儿顽固性癫痫病灶切除术手术麻醉进行回顾性分析。结果：32例手术麻醉及术中EEG监测均顺利完成，无严重麻醉相关并发症。结论：小儿顽固性癫痫病灶切除术手术选择静吸复合全麻为宜，七氟醚丙泊酚复合为理想选择，术前术中尽量避免使用镇静药。     

顽固性癫痫发作间期PET/CT的显像研究

目的探讨顽固性癫痫患者在发作间期PET／CT显像对癫痫灶定位的诊断价值,以指导手术治疗。资料与方法对28例顽固性癫痫患者,行发作间期的^18F—FDG PET／CT显像。对其中的21例癫痫灶较局限的患者行癫痫灶或颞前叶切除,术中行皮层脑电图（ECoG）或深部脑电图（DEEG）描记,以检测其特异性,术后进行随访。结果28例顽固性癫痫患者中,经PET／CT显像有25例显示出低代谢灶,敏感性为89．3％（25／28）。21例手术患者经随访1年以上,癫痫发作消失者18例。结论PET／CT脑显像对癫痫患者的术前定位具有重要价值。     

外科治疗顽固性癫痫10例报告

外科治疗顽固性癫痫１０例报告武警江苏总队医院神经外科乔振才，谭金涛，许钟（扬州２２５００３）我院于１９９０年５月～１９９３年１０月对药物治疗无效的１０例顽固性癫痫患者分别采用不同手术方式进行治疗，效果良好，报告如下。１　临床资料１．１一般资料男７例，...     

手术治疗顽固性癫痫86例

目的　探讨手术治疗顽固性癫痫的适应证和手术方法的选择。方法　应用多导联头皮电极脑电图和术中使用皮质电极和深部电极脑电图明确痫性放电的部位及范围。手术方式有病灶切除、胼胝体切开、MST(多处软膜下横切 )以及脑立体定向术。结果　疗效按 Penfied的标准评定 :术后无癫痫发作 2 8例 (3 2 .6% ) ,其中 2 2例仍服用少量抗癫痫药 ;发作减少 >75 %者 3 5例 (4 7.7% ) ;发作减少 5 0 %～ 75 %者 1 7例 (1 9.8% ) ;效差或无效 6例 (7% )。结论　严格筛选病例 ,把握好手术适应证及合理选用手术方法 ,对提高手术治疗顽固性癫痫的疗效是至关重要的     

癫痫磁共振脑功能成像研究进展

癫痫是神经科仅次于脑血管病的第二高发疾病．其中约70％的病例可用药物治愈或控制．其余为难治性癫痫。手术治疗是控制顽固性癫痫的重要手段。目前,手术能使80％的患者癫痫发作得到有效控制,其治疗效果有赖于癫痫灶和脑功能区的准确定位。近年来磁共振功能成像(functional magnetic resonance imaging．fMRI)技术飞速发展,对癫痫患者认知功能及手术治疗评价能发挥重要作用。     

胼胝体前部潜行切开微创治疗顽固性癫癎122例

胼胝体前部2／3切开是治疗顽固性癫痫的手术方式之一，疗效较为肯定。但其手术操作范围大，易损伤桥静脉而导致术后严重并发症。2000年以来，我们采用胼胝体前部潜行切开微创治疗顽固性癫癎122例，疗效满意。     

Forel-H区立体定向毁损术治疗癫痫134例疗效观察

本文报告Forel-H区脑立体定向毁损术治疗顽固性癫痫134例的平均4.8年随访结果。手术效果优秀者29例,良好25例,总有效率63.4%。术后并发症27例,死亡1例。对手术效果及评价标准、导致并发症的可能因素、手术适应症进行讨论。     

软膜下横切术的麻醉管理

目前治疗顽固性癫痫较有效的方法有癫痫灶切除术,但由于该手术无法处理功能区癫痫灶,手术效果受到一定影响.我院自1991年4月开展多软膜下横切术,治疗功能区癫痫有特殊功效.该手术的麻醉管理难度较大,即要保持生命体征平稳,又不能麻醉过深以免影响术中皮层电极脑电图检测癫痫灶的结果.现将20例麻醉管理经验报告如下:     

软膜下横切术的麻醉管理

目前治疗顽固性癫痫较有效的方法有癫痫灶切除术,但由于该手术无法处理功能区癫痫灶,手术效果受到一定影响.我院自1991年4月开展多软膜下横切术,治疗功能区癫痫有特殊功效.该手术的麻醉管理难度较大,即要保持生命体征平稳,又不能麻醉过深以免影响术中皮层电极脑电图检测癫痫灶的结果.现将20例麻醉管理经验报告如下:     

Articular cartilage regeneration of the knee joint after proximal tibial valgus osteotomy: a prospective study of different intra- and extra-articular operative techniques

In this prospective study high tibial osteotomy for medial gonarthrosis was performed in 95 patients (105 knee joints). The patients underwent simultaneously diagnostic and operative arthroscopic surgery of the knee joint. A follow-up arthroscopic examination could be performed in 75 patients (85 knee joints) at the time of implant removal. In group 1 (20 knee joints), the osteotomy was performed after diagnostic arthroscopy without arthroscopic operation of the knee joint. The fixation of the osteotomy was accomplished by staples, postoperative plaster fixation and physiotherapy. In group 2 (20 knee joints), osteotomy was performed without additional operative arthroscopy after diagnostic arthroscopy, internal fixation by AOT-plate, no external fixation postoperatively and physiotherapy. In group 3 (22 knee joints), osteotomy was performed with additional operative arthroscopy (Pridie drilling), internal fixation by AOT-plate no external fixation postoperatively no external fixation, physiotherapy and continuous passive motion. In group 4 (23 knee joints), osteotomy was performed with additional operative arthroscopy (abrasio-arthroplasty), internal fixation by AOT-plate, no external fixation postoperatively, physiotherapy and continuous passive motion. All patients underwent arthroscopic examination of the knee with cartilage biopsies taken from three different regions of the femoral condyle during the same operative session as the osteotomy. At follow-up arthroscopy cartilage biopsies were taken from the same regions. There was no great difference in clinical outcome after 1 year between all groups. Arthroscopy as well as routine and electron microscopy showed better cartilage regeneration in groups 3 and 4. Groups 1 and 2 showed only regeneration isles, sometimes not well fixed to the underlying bone, while in groups 3 and 4 cartilage regeneration was thicker and more stable, sometimes covering all of the pre-existing erosions. Therefore, we recommend osteotomy of the tibia for osteoarthritis together with operative arthroscopy in the same operative session. Received: 8 October 1997 Accepted: 5 April 1998     

Pre‐operative factors predicting good outcome in terms of health‐related quality of life after ACL reconstruction

The life situation of many patients changes after an anterior cruciate ligament (ACL) rupture and subsequent reconstruction, and this may affect their health‐related quality of life in many ways. It is well known that the overall clinical results after ACL reconstruction are considered good, but pre‐operative predictive factors for a good post‐operative clinical outcome after ACL reconstruction have not been studied in as much detail. The purpose of this study was to identify pre‐operative factors that predict a good post‐operative outcome as measured by the Short Form 36 (SF‐36) and Knee Osteoarthritis Outcome Score (KOOS) 3–6 years after ACL reconstruction. Seventy‐three patients scheduled for ACL reconstruction were clinically examined pre‐operatively. The SF‐36 and KOOS questionnaires were sent by mail to these patients 3–6 years after reconstruction. Predictive factors for health‐related quality of life were investigated using a stepwise regression analysis. In conclusion, pre‐operative factors, such as pivot shift, knee function, and range of motion, may predict a good post‐operative outcome and explain up to 25% in terms of health‐related quality of life after ACL reconstruction. Furthermore, it appears that the patients’ pre‐injury and pre‐operative Tegner activity levels are important predictors of post‐operative health‐related quality of life.     

Nonoperative management of malignant biliary obstruction: a radiologic alternative

Twelve patients with advanced malignant biliary obstruction were managed with a combination of sonography, percutaneous fine-needle aspiration biopsy, transhepatic cholangiography, and percutaneous biliary drainage. Excellent palliation of biliary obstruction was obtained in nine patients, four of whom are still living. Surgery was avoided in all cases, and a single episode of sepsis was the only complication. The literature indicates that surgical bypass procedures for malignant bile duct obstruction incur an average 20% operative mortality and provide only a 6 month mean survival. A combined radiologic approach offers an alternative to standard operative management of malignant biliary obstruction. When the cost-benefit ratios of operative vs. nonoperative management are considered, perhaps more patients should undergo radiologic management.     

Nonoperative treatment of acute rupture of the achilles tendon: results of a new protocol and comparison with operative treatment

BACKGROUND: Excellent results are reported from both nonoperative and operative treatment of Achilles tendon rupture. PURPOSE: To describe a new nonoperative treatment protocol for Achilles tendon ruptures and compare outcomes with operative treatment. STUDY DESIGN: Retrospective cohort study. METHODS: We treated 23 patients nonoperatively with an equinus ankle cast and boot and compared their outcome with that of a group of 24 patients previously treated operatively. Muscle strengthening and walking with full weightbearing were started as soon as tolerated in both groups. Follow-up examinations were performed for 18 nonoperatively treated patients after 23 months and for 15 operatively treated patients after 49 months. RESULTS: Subsidence of pain, return to unaided walking, and return to work was faster in the nonoperatively treated group. Patient satisfaction, return to sports, and ultimate strength was the same for both groups. The complication rate was similar, except for reruptures: four early in the nonoperative group and one late in the operative group. Two types of reruptures occurred in the nonoperative group: 1). normally healing tendon subjected to new trauma, rerupturing in the healing zone, and achieving a good result with continued nonoperative treatment; and 2). tendon failing proximal to the initial rupture at the muscle-tendon junction, without trauma, requiring operative repair and augmentation. CONCLUSIONS: Results of operative and nonoperative treatment were equivalent.     

Hemorrhage in pituitary adenoma: correlation of MR imaging with operative findings

The aim of this study was to correlate MR imaging and operative findings of hemorrhage in pituitary macroadenomas. We retrospectively reviewed MR images of 113 surgically proven pituitary adenomas. All patients were examined on a 1.5-T MR system. The intensity of intratumoral cystic cavities was correlated with operative findings. In 15 patients with pituitary apoplexy, we determined relationship between interval of MR examination after apoplectic event and MR signal intensity. In 8 patients with repeated preoperative MR examination, we evaluated sequential changes of intratumoral hemorrhage. There were 54 cavities at surgery: 52 were hemorrhagic and 2 were nonhemorrhagic. Twenty-nine of 52 hemorrhagic cysts demonstrated high/low signal (H/L) fluid–fluid levels on T2-weighted image (T2WI). In 19 of them, two components could be separately seen at operation: the supernatant high-intensity area represented xanthochromic fluid, and the dependent low-intensity area represented liquefied hematoma. The H/L fluid–fluid level was observed predominantly in hematomas on MR images obtained after longer intervals. In patients with repeated MR examination, follow-up MR imaging revealed additional hemorrhage or new formation of fluid–fluid levels. It was surprising that 12 of 14 cysts preoperatively judged as nonhemorrhagic in fact contained hemorrhagic components. The preoperative MR images are well correlated to the operative findings in hemorrhagic pituitary macroadenomas. It proved that 52 of 54 cystic cavities had hemorrhagic component. Received 1 July 1997; Revision received 12 November 1997; Accepted 9 December 1997     

不同手术方式对糖尿病足溃疡创面疗效的观察

目的探讨不同手术方式修复糖尿病足溃疡创面的疗效。方法选取2006年1月~2010年12月在我科住院手术治疗的糖尿病足患者72例,根据手术方法的不同,将清创后同种异体皮覆盖创面,待二期修复创面36例设为试验组,彻底清创一期植皮或皮瓣修复创面36例设为对照组,比较两组患者的住院时间、住院费用、截肢率、肢体保留比。结果对照组的住院时间、住院费用、截肢率均高于试验组,肢体保留比低于试验组,差异均有明显的统计学意义（P〈0.05）。结论对合并有下肢血管病变的糖尿病足溃疡创面采取简单清创,二期手术行自体皮片移植封闭创面治疗方式,能够降低患者的截肢率、最大程度地保留患者的肢体长度,从而减轻个人、家庭、社会的负担,是一种安全有效的手术方式。     

Volume-rendered 3D display of MR angiograms in the diagnosis of cerebral arteriovenous malformations

PURPOSE: To determine whether application of a volume-rendered display of 3D time-of-flight (TOF) MR angiography could assist the diagnosis of cerebral arteriovenous malformations (AVMs). MATERIAL AND METHODS: Volume-rendered 3D images of postcontrast 3D time-of-flight MR angiography were compared with conventional angiograms in 12 patients. The correlation between the 3D images and the operative findings was also analyzed in 5 patients. RESULTS: The 3D-displayed images showed all of the feeders and drainers in 10 and 9 patients, respectively. In all patients, the nidus was three-dimensionally visualized. In 3 patients with hematomas, the relationship between the hematoma and the AVM was well demonstrated. The 3D images corresponded well with the operative findings in the 5 patients. CONCLUSION: This method is of help in assessing the relationship between the components of an AVM as well as that between an AVM and an associated hematoma.     

Subarachnoid hemorrhage due to isolated spinal artery aneurysm in four patients

Spinal artery aneurysms are usually found with arteriovenous malformations or other entities that increase hemodynamic stress. Isolated spinal artery aneurysms are rare. Four patients who presented with the acute onset of lower back pain underwent MR imaging, which revealed spinal subarachnoid hemorrhage. In all patients, work-up yielded a diagnosis of isolated spinal aneurysm, and operative treatment was successful. In the appropriate clinical setting, spinal aneurysm should be considered as a possible cause of spinal subarachnoid hemorrhage.     

铥激光气化切除术与双极等离子电切术治疗良性前列腺增生的疗效比较

目的比较经尿道双极等离子前列腺电切术（transurethral plasmakinetic resection of prostate,PKRP）与经尿道铥激光前列腺气化切除术（thulium laser vaporesection of prostate,TmLRP）治疗前列腺增生症的疗效。方法分别用PKRP及TmLRP治疗前列腺增生症（benign prostatic hyperplasia,BPH）患者86例和43例。比较两种术式的手术时间、手术费用、手术前后血红蛋白改变、膀胱冲洗时间、并发症及近期疗效等指标。结果 129例患者均安全渡过围手术期,未出现严重并发症。TmLRP组患者的术后膀胱冲洗时间、手术前后血红蛋白改变均明显少于PKRP组（P〈0.05）。TmLRP组患者的平均手术时间,手术费用均明显高于PKRP组（P〈0.05）。两组术后国际前列腺症状评分、生活质量评分、残余尿量和最大尿流率均明显改善（P﹤0.05）,但两组间差异无显著意义（P﹥0.05）。结论 PKRP与TmLRP治疗BPH均有效,TmLRP的手术安全性优于PKRP,但手术时间及费用无优势。     

Postoperative chylothorax in children with congenital heart disease. Clinical and roentgenographic features.

The clinical and roentgenographic findings in 11 children were reviewed following development of a chylothorax after surgery for the management of congenital heart disease. The operative site in most cases was in proximity to the aortic isthmus. The pleural effusion was delayed in onset, reaccumulated rapidly after initial thoracentesis, and frequently recurred after apparent resolution. In most patients, widening of the mediastinum was noted prior to the appearance of the pleural effusion. Anatomical features of the thoracic duct and pathophysiologic concepts operative in chylothorax are reviewed and related to the clinical and roentgenographic characteristics of this entity.