内镜辅助显微镜经鼻蝶入路垂体腺瘤切除术应用解剖及临床研究

目的：探讨内镜辅助显微镜经鼻蝶入路的解剖与临床应用价值。方法：在6例成人尸头标本上模拟经鼻蝶入路手术。采用内镜辅助显微镜经鼻蝶入路手术治疗垂体瘤患者32例。结果：（1）采用经鼻蝶入路,内镜下在蝶窦内可观察到更多的周围结构,利于确定鞍底、海绵窦与鞍结节位置,在显露硬膜下结构时,内镜下侧方可显露海绵窦外侧壁,前方可显露双侧嗅神经和直回。（2）32例患者中,肿瘤全切29例,次全切除2例,大部切除1例;无手术死亡病例,无严重并发症发生。结论：内镜辅助显微镜经鼻蝶入路对鞍区显露良好、肿瘤全切率高、手术创伤小、术后并发症少,是切除垂体瘤的理想术式。     

神经内镜下经鼻蝶入路治疗垂体腺瘤25例疗效观察

目的：探讨神经内镜下经鼻蝶入路治疗垂体腺瘤的手术疗效。方法：2012年1月至2012年12月,应用神经内镜经鼻蝶入路治疗垂体腺瘤25例,其中巨大腺瘤7例,大腺瘤18例;无功能腺瘤14例,垂体泌乳素（ PRL）腺瘤6例,生长激素（ GH）腺瘤3例, PRL＋GH腺瘤2例。术前均行头颅三维CT、MRI扫描及内分泌学检查。结果：本组25例,肿瘤全切除20例（80．0％）,近全切除3例（12％）,部分切除2例（8％）。术后尿崩3例,鼻出血1例。所有患者在术后第5～12天出院。术后随访1～10个月,患者临床症状和内分泌学指标均有所改善,未见肿瘤复发,无一例患者死亡。结论：神经内镜下经鼻蝶切除垂体腺瘤具有创伤小,术野清晰,手术操作简单、安全,术后并发症少,恢复快,住院时间短等优点,是治疗垂体腺瘤安全有效的手术方法。     

经鼻蝶人路神经内镜下垂体腺瘤切除术进展

目的：探讨神经内镜下经鼻蝶人路在垂体腺瘤切除术中的应用。方法：在Pubmed、中国知网等数据库查阅有关经鼻蝶入路神经内镜下垂体腺瘤切除术研究的文献,汇总分析。结果：经鼻蝶入路神经内镜下垂体腺瘤切除术分为标准入路和扩大入路。通过扩大入路,可以切除侵犯海绵窦、鞍上和斜坡的垂体腺瘤。经鼻蝶入路神经内镜垂体腺瘤切除术的并发症主要有脑脊液鼻漏、尿崩和出血等。结论：经鼻蝶入路神经内镜下垂体腺瘤切除术具有损伤小、暴露充分、肿瘤全切率高及术后并发症少等优点,是垂体腺瘤切除的理想术式。     

单鼻孔经蝶入路垂体腺瘤切除手术配合

显微镜下单鼻孔经蝶入路垂体腺瘤切除是近年来随着显微外科及影像学发展起来的又一新技术,其手术入路更加简单、手术损伤小、患者痛苦小、无需剃头、无头面部切口、符合美容要求、术后恢复快等特点及其适应证不断扩大,已在临床上广泛推广。我院于2006年在显微镜下单鼻孔经蝶入路切除垂体瘤36例,均取得满意效果,现报告如下。1临床资料1.1一般资料本组36例,男13例,女23例,年龄18～70岁,平均46岁,术前均行CT、MRI检查,临床诊断为垂体腺瘤,临床表现为视力改变、多饮多尿、嗜睡、内分泌功能障碍,面容改变,额头变大,下颌突出,鼻大唇厚、手指变粗…     

鞍底开窗对显微镜下经蝶入路垂体腺瘤切除术的影响

目的　探讨鞍底开窗对显微镜下经蝶入路垂体腺瘤切除术的影响。 方法　收集本院2014年3月至2015年3月收治的经鼻蝶入路手术患者51例的临床资料,进行回顾性研究。其中男性22例,女性29例,年龄19~75岁。手术前后均行CT、MRI检查,通过Mimics15.0软件进行影像融合重建,测算鞍底骨窗的大小、最高点到蝶骨平台的垂直距离,分析其与肿瘤切除程度、术中脑脊液漏及术后尿崩症发生的关系。 结果　肿瘤全切除组的鞍底骨窗面积小于残留组,其骨窗面积与肿瘤最大面积的比值大于残留组;术中脑脊液漏组其骨窗最高点到蝶骨平台的垂直距离小于无脑脊液漏组。差异均具有统计学意义（P<0.05）。多因素Logistic回归分析显示,鞍底骨窗与肿瘤面积的比值、肿瘤的侵袭性,是影响垂体腺瘤切除程度的独立预测因素。有尿崩症组与无尿崩症组,其鞍底骨窗面积无统计学差异（P>0.05）。 结论　鞍底开窗相对不足,是导致肿瘤残留的原因之一;骨窗的位置越高,术中越易出现脑脊液漏;鞍底开窗面积对术后尿崩症的发生无明显影响。     

经口鼻蝶入路垂体瘤切除术的护理

目的加强经口鼻蝶入路垂体瘤切除术病人的全面护理，提高手术成功率。方法对30例经口鼻蝶入路垂体瘤切除术病人术前做好心理疏导，术后重点观察尿量、鼻腔渗血渗液情况，及时发现并处理并发症。结果全部病人术前精神状态良好．如期进行手术，术后效果理想，无一例病情恶化，均满意出院。结论有针对性地做好经口鼻蝶入路垂体瘤切除术的护理．对患者的恢复至关重要。     

经单鼻孔蝶窦入路垂体微腺瘤切除术（附68例报告）

目的探讨经单鼻孔蝶窦入路垂体微腺瘤切除术的疗效,总结手术技巧及术后并发症的防治经验。方法对68例垂体微腺瘤病人行经单鼻孔蝶窦入路垂体微腺瘤切除术。对手术入路,肿瘤切除程度,术后内分泌变化及术后的并发症进行了探讨。结果所有68例病人均得到肿瘤全切。术后各种症状均有不同程度改善。22例病人激素水平恢复到正常（78%）。有5例病人术后发生轻微的脑脊液鼻漏（21%）,9例病人发生术后尿崩（32%）,均经保守治疗后痊愈。无死亡和感染病例。结论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。     

内镜辅助下经鼻蝶入路摘除垂体腺瘤

目的：探讨内镜辅助下经鼻蝶入路摘除垂体腺瘤的疗效。方法应用内镜辅助找到蝶窦开口,导入鼻窥镜,用传统显微镜技术切除肿瘤,然后内镜观察有无肿瘤残存,继而将残存肿瘤切除。结果全切22例,次全切3例;术前视力障碍8例中,术后全部改善。术中发现脑脊液漏4例,修补后未发生脑脊液漏及颅内感染;一过性尿崩2例,迟发性低钠血症1例,经过处理后治愈。结论内镜辅助显微镜经碟入路切除垂体腺瘤彻底,避免了单纯内镜止血困难的问题。     

单鼻孔经蝶入路垂体瘤切除术32例围手术期护理

目的探讨单鼻孔经蝶入路垂体瘤切除术的护理方法。方法回顾分析2005年1月-2007年4月收治的32例垂体瘤病人的临床资料。结果垂体瘤32例采用单鼻孔经蝶入路切除术，配合药物治疗及精心围手术期护理，尿崩症及脑脊液漏等并发症均得到有效控制，所有病人均痊愈出院。结论经单鼻孔经蝶入路手术治疗垂体瘤创伤小、并发症少、术后不留皮肤疤痕。加强围手术期护理，对促进病人早日康复至关重要。     

扩大经鼻蝶海绵窦下壁手术入路的显微外科解剖

目的:为经鼻蝶海绵窦下壁手术入路提供解剖基础。方法:对10例成人头颅湿标本,采用扩大经鼻蝶手术入路,在手术显微镜下观测相关解剖结构。结果:⑴通过扩大入路可建立直视海绵窦下壁的通路。⑵可视的海绵窦下壁范围为不规则四边形,前界长(11.95±2.01)mm(8.66~15.15mm),内侧界长(14.02±1.68)mm(11.47~17.66mm)。⑶可完整显示海绵窦的前下腔和内侧腔及外侧腔和海绵窦外侧壁的大部。结论:切除中、上鼻甲及后组筛窦的扩大手术入路,可以较好的显露海绵窦的下壁,具有直视、微创的优点。     

儿童肠系膜淋巴结炎的病原体分析

目的分析儿童肠系膜淋巴结炎的病原体,为该病的临床诊断和治疗提供实验室依据。方法对2010年1月至2012年12月期间．湖北省黄冈地区门诊和住院已经确诊为儿童肠系膜淋巴结炎的1225例标本进行免疫学检验和细菌培养。结果从1225例送检标本中检出病毒1097例,其中柯萨奇病毒976例,埃可病毒121例。细菌培养检出细菌118例,阳性率为9．6％;其中溶血性链球菌73例,占61．9％;金黄色葡萄球菌31例,占26．2％;其他14例,占11．9％。结论病毒感染和溶血性链球菌、金黄色葡萄球菌等是造成儿童肠系膜淋巴结炎的主要病原体。     

The role of bactericidal/permeability-increasing protein in the treatment of primate bacteremia and septic shock

Human neutrophil azurophilic granules contain an 55-kDa protein, known as bactericidal/permeabilityincreasing protein (BPI), which possesses a high-affinity binding domain for the lipid A component of lipopolysaccharide (LPS). Thein vivo LPS neutralizing activity of exogenous BPI was studied in a model of lethalEscherichia coli bacteremia. Five baboons were treated with BPI (5 mg/kg bolus injection followed by a 95 g/kg/min BPI infusion over 4 hr), while four additional animals received a genetically engineered variant of BPI (NCY103). Five animals received a placebo treatment and served as controls. Both wild-type rhBPI and NCY103 significantly (P<0.05) decreased blood levels of LPS throughout an 8-hr evaluation period following live bacterial challenge. Two hours followingE. coli administration, LPS levels peaked in the controls, at 6.86±3.22 ng/ml, whereas LPS levels were 3.39±2.1 ng/ml in the BPI group and 2.04±1.18 ng/ml in the NCY103 group. Tumor necrosis factor-alpha (TNF-) and interleukin-6 levels likewise were attenuated in the treatment groups, whereas circulating sTNFR I was significantly (P<0.05) reduced only in the BPI group. Leukocytopenia and granulocytopenia were significantly (P<0.02) lessened in the BPI group, by an average of 59% leukocytopenia and 65% granulocytopenia, respectively. This study supports the concept ofE. coli LPS neutralization by BPIin vivo and demonstrates that a moderate (70%) reduction in peak LPS-LAL activity is sufficient to alter some hematologic and cytokine manifestations of bacteremia.     

Comparison of efficacy of cefoperazone/sulbactam and imipenem/cilastatin for treatment of Acinetobacter bacteremia

Multiple antibiotic resistance threatens successful treatment of Acinetobacter baumannii infections worldwide. Increasing interest in the well-known activity of sulbactam against the genus Acinetobacter has been aroused. The purpose of this study was to compare the outcomes for patients with Acinetobacter bacteremia treated with cefoperazone/sulbactam versus imipenem/cilastatin. Forty-seven patients with Acinetobacter baumannii bacteremia were analyzed through a retrospective review of their medical records for antibiotic therapy and clinical outcome. Thirty-five patients were treated with cefoperazone/sulbactam, and twelve patients with imipenem/cilastatin. The percentage of favorable response after 72 hours was not statistically different between cefoperazone/sulbactam group and imipenem/cilastatin group. The mortality rate was not statistically different, too. Cefoperazone/sulbactam was found to be as useful as imipenem/cilastatin for treating patients with Acinetobacter bacteremia.     

TiO_2纳米管阵列负载盐酸米诺环素前后抗牙周致病菌性能的研究

目的:探讨二氧化钛(TiO_2)纳米管阵列负载盐酸米诺环素(MN)前后对牙龈卟啉单胞菌(Pg)、福塞坦氏菌(Tf)和伴放线放线杆菌(Aa)早期黏附行为的影响。方法:阳极氧化法制备TiO_2纳米管阵列并负载MN。微生物实验分成3组:单纯抛光钛片(Ti)组、TiO_2纳米管钛片(TiO_2)组和负载MN(120μg)TiO_2纳米管钛片(MN TiO_2)组;通过抑菌圈实验评估各组钛片的抗菌性能。结果:Ti组基本没有抗菌作用;TiO_2组的抗Aa、Pg及Tf活性较差,4 h后的抗菌率仅20%左右;负载MN后其抗菌性能增强,4 h后的抗菌率高达77%以上。结论:Ti组没有抗菌作用,若在其表面形成TiO_2纳米管阵列且负载MN则可形成较强的抗牙周致病菌作用。     

Fusobacterium nucleatum: a rare cause of bacteremia in neutropenic patients with leukemia and lymphoma

Although anaerobic bacteremias are uncommon in oncohematologic patients, nevertheless they have been considered an emergent problem in the last few years. Fusobacterium nucleatum is an anaerobic Gram-negative bacillus commonly present in the oral cavity and in the respiratory and genito-urinary tracts. Over a 10-year period 18 episodes of F. nucleatum bacteremia in patients with hematological malignances (15 leukemias and 3 lymphomas) have been observed in our Department of Hematology. Predisposing factors included oropharyngeal mucositis and severe neutropenia owing to intensive chemotherapy. In our experience no septic shock occurred and the outcome of bacteremias caused by F. nucleatum was favorable.     

3820例呼吸道感染患儿病原体的检测结果及流行病学特点分析

目的:了解垫江地区儿童呼吸道病原体流行情况,为疾病的预防和诊治提供实验室依据.方法:回顾性分析2018年1月至2020年10月本院收治的3820例呼吸道感染患儿入院时检测的血常规、血清淀粉样蛋白A(Serum amyloid A,SAA)、C反应蛋白(C-reactive protein,CRP)结果及采用间接免疫荧光...     

Comparison of three chromogenic agar plates for isolation and identification of urinary tract pathogens

Objective   To comparatively assess the performance of three chromogenic agar plates, CPS ID2, Chromogenic UTI, and USA, for the detection and enumeration of all urinary tract pathogens and the direct identification of Escherichia coli , Proteus mirabilis and Enterococcus spp.
Methods   Two hundred and forty-three urine specimens prospectively collected from hospitalized patients were randomly inoculated in parallel on the three media.
Results   Of the 243 urine specimens, 235 yielded positive cultures, of which 151 were pure cultures and 84 were mixed cultures. CPS ID2, Chromogenic UTI and USA agar gave detection rates of 99.1%, 97.1% and 96.6%, respectively. The main difference in non-detection between CPS ID2 agar and the two new media concerned Staphylococcus spp. strains. Based on the total number of strains detected ( n  = 348), the total identification rates of E. coli , P. mirabilis and Enterococcus spp. on CPS ID2 agar, Chromogenic UTI agar and USA agar were 60.3%, 61.2% and 59.2%, respectively.
Conclusion   The detection rates and identification rates of the three media were very close and only minor differences were noted. The lower detection rates for Chromogenic UTI and USA were mainly due to their lesser ability to support growth of Staphylococcus spp.