显微外科手术治疗颅咽管瘤46例分析

目的探讨颅咽管瘤显微手术切除的方法和效果。方法采用显微外科手术治疗颅咽管瘤46例。术前对临床表现、影像检查进行分析,经额下或翼点入路进行手术。结果全切除18例,次全切除28例,无手术死亡。术后临床症状和体征均有不同程度的恢复。结论采用显微手术治疗颅咽管瘤,可以提高肿瘤本身和肿瘤壁的全切除率,达到保护视力,改善内分泌功能,减少各种并发症的目的。首次手术应尽量全切。     

颅咽管瘤显微手术治疗及疗效分析

 目的 探讨颅咽管瘤的显微手术方法及疗效。方法 回顾性分析武警总医院2010-01至2014-12收治的136例颅咽管瘤患者的临床资料。手术均在显微镜下进行,其中采用额底纵裂入路42例,额下入路28例,胼胝体穹窿间入路27例,翼点入路36例,经蝶窦入路3例。结果 本组肿瘤全切除118例,次全切除14例,大部分切除4例。术后出现尿崩症63例(暂时性尿崩症42例),视力下降或失明28例,电解质紊乱65例。其他并发症:中枢性高热8例,动眼神经损伤3例,脑梗死1例,颅内感染2例。术后1个月内出现死亡3例,死因均为下丘脑综合征。因病情危重或经济原因放弃治疗办理自动出院3例。结论 根据肿瘤的生长部位、比邻关系和生长方式,合理地选择手术入路是颅咽管瘤手术成功的关键。     

复发性颅咽管瘤的原因分析和治疗进展

颅咽管瘤是一种常见的先天性良性肿瘤,其治疗效果欠满意,复发率较高,是神经外科的难题之一。颅咽管瘤的复发原因很多,与手术前症状、肿瘤病理类型、手术全切和术后放疗有关。复发性颅咽管瘤的治疗方法包括外科切除、立体定向放射治疗和立体定向内化疗,它们各有优缺点,若能联合应用、取长补短,则对某些复发颅咽管瘤可以进行有效的治疗,提高肿瘤控制率和生存率,减少治疗相关致残率、病死率。     

儿童期颅咽管瘤:放疗后存活,局部控制,内分泌和神经功能

颅咽管瘤约占颅内肿瘤的9%,50%发生在儿童及青少年。治疗方法有全切除,次全切除紧密观察,次全切除术后放疗,针吸和/或活检而后放疗。日趋增多的是以显微外科全部切除肿瘤。然而全切除的可能性幅度为8—74%,全切术后的复发幅度高达0—50%。另有些作者提倡较为局限的切除而后放疗。长期的随访表明本疗法在存活与复发率上均可与全切除疗法相媲美。     

立体定向^32P内放疗联合伽玛刀治疗囊实性颅咽管瘤62例临床总结

目的介绍立体定向治疗囊实性颅咽管瘤的手术流程,总结手术经验。方法对2008年4月-2009年4月我科收治的62例颅咽管瘤患者行立体定向^32P内放射治疗后联合伽玛刀治疗,观察其视力、内分泌变化、临床症状改善情况及有无并发症。结果经治疗后62例患者各项检查指标均取得不同程度的改善,出现术后并发症9例（术后出血2例、术后发热6例、尿崩1例）,无死亡病例。术后60例患者视力均较术前明显提高,术前有精神障碍3例患者术后6个月复查精神障碍明显改善。术后肿瘤复发2例。结论立体定向^32P内放疗联合伽玛刀治疗囊实性颅咽管瘤是一种安全有效的治疗方法。     

颅咽管瘤13例显微外科治疗体会

我科自1986年以来收治颅咽管瘤13例，均采用显微外科技术行手术切除．现结合献报告如下。     

原发性肝癌破裂出血手术切除治疗的预后分析

目的:分析原发性肝细胞肝癌破裂出血手术治疗的临床特点以及影响其预后的相关因素。方法:回顾性分析新疆医科大学第一附属医院自2000年1月至2010年12月诊断肝细胞性肝癌破裂出血并行手术切除治疗的26例患者临床资料特点及随访结果。结果:肝癌破裂出血急诊手术止血并切除肿瘤26例,术后1、3、5年生存率分别为80.0%、34.0%、13.0%。平均生存时间22.63±18.73月。结论:术前精确评估、避免输血和术后给予化疗栓塞是改善原发性肝癌破裂出血手术切除治疗后预后的有效措施。     

关于颅咽管瘤手术原则的临床病理研究

长期以来,认为手术切除是颅咽管瘤较理想的治疗措施。然而,“全部”切除肿瘤会引起严重的神经内分泌并发症,而且手术后易于复发,都是神经外科医生感到棘手的问题。为此,本文根据7例尸检材料的病理学研究与15例经手术广泛切除的临床分析,探讨颅咽管瘤手术切除的可能性,以及影响预后的一些有关问题。根据7例尸检与15例手术所见,发现颅咽管瘤的瘤体可为囊性(10例)、实质性(6例)、及混合型(6例)。肿瘤的容积2～55毫升不等。瘤体较大者(容积大于30毫升),可向第三脑室发展,并可侵及丘脑。组织学检查发现:囊性颅咽管瘤的     

CT立体定向术在内放射治疗囊性颅咽管瘤的应用

目的：探讨治疗囊性颅咽管瘤最佳方法。方法：对20例囊性颅咽管瘤行CT立体定向囊内置管同位素（胶体磷酸铬）放射治疗。结果：全部病例经排除囊液后临床症状迅速改善,经囊内放射治疗后,2－5年随访,CT扫描显示,肿瘤均较治疗前明显缩小。结论：CT立体定向囊腔内放射治疗囊性颅因咽管瘤十分安全、有效,应作为治疗囊性颅咽管瘤首选的方法。     

喉咽癌12例诊治体会

目的:探讨喉咽癌早期诊断与治疗方法.方法:12例确诊为喉咽癌的患者均行以手术为主的综合治疗,其中部分喉咽或梨状窝切除5例,部分喉咽半喉切除1例,部分喉咽全喉切除3例,喉咽、喉食管上端切除3例,均行组织修补,对颈部淋巴结采用根治性颈淋巴清扫术或选择性颈淋巴清扫术.结果:1例术后1年内肺部转移行化疗,存活2年以内3例,存活3年3例,存活5年1例,其它失访.结论:有咽喉非特异性症状应加强查体做到早发现、早诊断、早治疗.喉咽肿瘤应根据肿瘤的特征及患者情况采取综合性,个体化的治疗原则.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.