难治性癫痫显微外科治疗的疗效分析

目的 报道应用显微外科治疗难治性癫痫的临床效果。方法应用三维痫灶定位诊疗计划对163例顽固性癫痫患者进行术前、术中致痫灶三维精确定位，然后在显微镜下采用几种术式结合的方法手术处理致痫灶、致痫网。术后随访1～2年，回顾性分析显微外科手术治疗的临床效果。结果结果发现术后癫痫发作完全消失52例（31．90％），发作显著改善83例（50．92％），改善较好10例（6．13％），改善较差15例（9．20％），发作无改善3例（1．84％），手术总有效率为88．96％，无效率为11.04％，术后88．96％以上的患者生活质量均有一定程度的提高。结论应用显微外科技术切除癫痫病灶可以明显减少术后并发症，提高临床疗效。     

颞叶癫痫的术前评估与手术治疗

目的对行手术治疗的顽固性颞叶癫痫患者术前进行综合评估,明确致痫灶部位,实施个体化手术方案。方法对26例颞叶癫痫患者术前进行视频脑电图(V-EEG)、磁共振成像(MRI)检查,综合分析检查结果,制定相应手术方案。术中行皮层脑电描记,术后对切除组织进行病理检查,并对患者进行手术后随访。结果V-EEG、MRI两种检查定位结果完全一致的有21例。24例患者(92.3%)术后癫痫发作完全或部分缓解,2例患者(7.6%)无明显缓解。结论对顽固性颞叶癫痫患者术前进行综合评估,对制定合理的手术方案,提高治愈率有重要指导意义。     

小儿症状性癫痫的外科治疗

目的探讨小儿症状性癫痫的病因、临床特点及手术方法。方法对1994年1月至2003年8月手术治疗的27例小儿症状性癫痫病例进行回顾性分析。结果全组无手术死亡及严重并发症。随访26例,时间为6个月～8年,18例(66.7%)癫痫发作消失,6例(22.2%)发作减少75%以上,3例(11.1%)发作减少50%～75%。结论术前综合评估对症状性癫痫患儿致痫灶的定位有较大应用价值,皮层脑电图监测下多种手术方法结合治疗小儿症状性癫痫安全有效。     

基于立体脑电图技术治疗难治性颞叶癫痫的研究进展

颞叶癫痫在所有局灶性癫痫中发病率最高, 具有病因学、症状学及电生理特征多样, 进展为难治性癫痫率高的特点。手术是治疗难治性颞叶癫痫的有效手段, 但传统方法通常难以对致痫区进行准确定位, 立体脑电图技术为致痫区的准确定位提供了有效手段。基于立体脑电图的射频热凝和MRI引导的激光间质热疗, 为手术风险高、难度大的难治性癫痫患者的外科治疗提供了精准、微创的新选择。     

多模态磁共振评估颞叶癫痫手术疗效

目前对颞叶癫痫(TLE)大多采取手术治疗,需要在术前、术后进行全面评估。目前多模态磁共振技术已用于评估术后癫痫疗效及术前、术后的语言、记忆功能。本文就多模态MR技术在TLE手术癫痫缓解评估以及认知功能评估中的研究进展进行综述。     

难治性癫痫162例的外科治疗

目的总结难治性癫痫外科治疗过程中对痫灶群的定侧与定位、术前评估、术中痫灶定位和多种手术方式的组合选择。方法回顾性分析162例难治性癫痫患者的术后随访结果。临床表现单纯部分性发作18例,单纯部分性发作继发全身强直阵挛性发作25例,全身强直阵挛性发作36例,复杂部分性发作34例,复杂部分性发作伴全身强直阵挛性发作32例,失神发作伴全身强直阵挛性发作17例。患者术前均经神经电生理检查如脑电图（EEG）、视频脑电监护系统（V-EEG）和影像学检查（CT、MRI）,其中有16例还行发作间期单光子发射型计算机断层显像仪（SPECT）检查,5例行正电子发射计算机断层显像（PET）检查。所有病例均在皮层脑电监护系统（EcoG）及深部电极监测下进行手术。手术方式包括局部癫痫灶切除64例,前颞叶切除术32例,颞叶加杏仁核和大部分海马切除27例,额叶切除25例,额叶加颞叶前部切除7例,功能性大脑半球切除4例,致痫灶部分切除加胼胝体切开3例。结果46例患者术后癫痫发作完全消失,73例发作显著改善,22例改善较好,15例改善较差,6例发作无改善,手术总有效率为87．7％,大部分患者生活质量较术前提高,人际关系改善,恢复工作和学习。结论外科手术是治疗难治性癫痫的一种有效方法,但手术前应准确定位致痫灶,并选择适当的手术方式,以取得最佳的治疗效果。     

药物难治性癫痫外科治疗的临床研究

目的本研究旨在探讨并完善对药物难治性癫痫的外科手术治疗方法，并对影响疗效的因素进行统计学分析，期望确定影响预后的相关因素和各种癫痫发作的最佳治疗方案。方法采用脑电图、CT、MRI等影像学技术，对53例不同发作类型需要手术治疗的难治性癫痫患者进行术前致痫灶定位，分别对患者行不同方法的手术治疗。结果经过1～6年的随访，总有效率达90％。术后疗效与手术方式、癫痫的发作类型、起病年龄、发作次数、脑电图背景及智商等因素之间显著相关。结论手术是解除或减轻药物难治性癫痫患者痫性发作的有效方法之一。     

儿童脑神经节细胞瘤伴癫的显微外科治疗

目的：探讨神经节细胞瘤（Ganglioglioma,GG)伴癫痫的临床表现及外科治疗方法。方法：回顾性分析9例GG伴癫痫的病例,肿瘤位于颞叶6例,额叶2例,枕叶1例,均进行术前脑电图及影像学检查,并在脑电图监测下行肿瘤加致痫灶切除术。结果;在获随访8例中,完全不发作6例,好转2例。结论：GG伴癫痫应尽早手术治疗,脑电图监测行致痫灶加肿瘤切除效果良好。     

MR评估颞叶癫痫治疗效果研究进展

颞叶癫痫（TLE）是临床最常见的癫痫类型,一般可予以药物治疗;当发展为难治性癫痫时,需考虑手术治疗。目前主要通过观察治疗后一定时期内癫痫发作的频率来评估治疗效果,无法实现实时、客观评价。随着MRI技术及图像分析方法的不断进步,多模态MRI已广泛应用于评估TLE治疗效果。本文就多模态MRI及其技术评估TLE患者癫痫缓解情况及认知功能的研究进展进行综述。     

异丙酚复合麻醉在致痫灶精确定位手术中的应用

近年来功能神经外科在ECoG(皮层脑电图)监测下行顽固性癫痫致痫灶切除术取得了较大进展,使难治性癫痫得到了完全控制或显著改善。此类手术对麻醉有特殊要求,我们试用了不同的药物组合,减少全麻药物对ECoG致痫灶定位的影响,提高了ECoG确定大脑皮质切除范围的精确程度,现报告如下。     

An incremental step in patient safety: reducing the risks of retained foreign bodies by the use of an integrated laparotomy pad/retractor

Retained foreign body is a recognized complication of abdominal, pelvic, and thoracic surgery and a cause of medical malpractice. Efforts to reduce its incidence include safe exposure and the use of fewer laparotomy pads. The EZ DASH is an absorbent 12-thickness laparotomy pad covering a malleable stainless steel mesh, providing both the needed retraction and a reduction in the use of individual pads. EZ DASH has been introduced into clinical use in 183 consecutive cases by specialty surgeons (colorectal, gynecology, and gynecologic oncology services) at multiple medical centers. The retractor may be shaped to the individual needs of an operating field, eg, the pelvis, and the small bowel secured behind the retractor, held in place by the tension of its mesh and the security of the abdominal wall. Positioning has been intuitive and secure, and the intraoperative use of sponges and of operating time have both been noticeably reduced. Among 183 cases, 91% of uses were felt to reduce OR time by or=10 minutes. Ninety-three percent of EZ DASH cases used fewer individual laparotomy pads for small bowel retraction. Ninety-five percent of uses suggested a value added to the case by the operating surgeon with an expressed desire to use the product repeatedly. The EZ DASH is a simple method of obtaining small bowel retraction and laparotomy pad absorption with a reduction in the need for individual pads, providing excellent exposure for the operative field and reducing the risk of retained foreign body.     

三维超声后处理技术在产前诊断中的应用进展

目的三维超声在产前筛查和诊断某些胎儿畸形中有重要作用。后处理技术是获取ROI的三维容积数据后,根据诊断需要对图像做进一步处理,可依据不同断面对组织结构进行全面分析,增加组织对比度,准确测量胎儿不规则结构的体积和心脏容积,对血管的分布和连接情况进行分析,数据存储后可进行脱机分析。三维超声成像的后处理技术已广泛应用于临床。本文对三维超声成像的后处理技术模式和应用现状进行综述。     

Operative indications and options in intestinal Crohn's disease

Multidisciplinary management of Crohn's disease is mandated by the complexity of the clinical scenarios and interfaces between medical treatment, nutritional support, and surgical interventions. Surgery is a critical component of the treatment algorithm intended to improve patient symptoms and quality of life, resolve disease-associated complications, and maximize efficacy of medical therapy.The most common procedure performed for intestinal Crohn's disease is resection of the affected segment of bowel with primary anastomosis when feasible and indicated. Different surgical techniques have been proposed with the goals of limiting postoperative complications and preventing surgical recurrences. Selected patients affected by intestinal Crohn's disease are at especially increased risk for repeated surgical intervention and bowel sparing techniques have been developed to reduce the risk of short bowel syndrome in this population.The clinical scenarios of intestinal Crohn's disease vary as to when surgery is indicated and what techniques should be employed. Multiple surgical options might be used in a single patient with multifocal disease with an intent to provide a longer remission time. The important role of preoperative optimization and postoperative treatment reinforces the notion that timing and coordination of medical and surgical treatments is crucial in this debilitating and complex disease.     

能谱CT在冠状动脉成像中的应用进展

后处理技术如多元成像方法、单能级重建、有效原子序数成像及虚拟平扫等使能谱CT在冠状动脉图像质量优化、狭窄程度判断、斑块成分分析及降低辐射剂量等方面均取得了一定进展。本文对能谱CT成像原理、技术特点及其在冠状动脉成像中的应用进展进行综述。     

图像分割技术在血管图像中的应用

图像分割是一种重要的图像技术,是进一步图像分析和处理的基础。血管系统成像在临床医疗过程中发挥着重要的作用。临床医生了解一些常用的医学图像分割方法,有利于其在临床工作中根据图像特征和分割要求来选择适合的方法,提高图像质量,做出正确的诊断。本文综述图像分割技术在血管图像方面的应用。     

16层螺旋CT后处理技术在气管异物检查中的应用

目的探讨16层螺旋CT后处理技术在气管及支气管异物检查中的方法,评价应用价值。方法对32例临床疑为气管、支气管异物的患者进行检查。首先进行常规成像,然后进行二维重建技术:多平面重建(MPR)、曲面重建(CMPR);三维重建技术:最小密度投影(MinIp)、容积再现(VR)及三维显示技术:CT仿真内窥镜(CTVE)等技术方法成像。结果 6例未发现异常,26例误吸异物存在于气管、支气管中。其中位于主气管4例,左主支气管8例,右侧主支气管13例;左、右主气管内均有异物的1例,均获得满意的后重建图像。后重建图像实现单独或联合显示气管、支气管树等结构,并任意切割、旋转及三维解剖测量,较常规图像清楚、直观,显示解剖、异物位置全面、准确。以上病例均行纤维支气管镜检查或临床证实。结论 16层螺旋CT扫描及多种后处理技术的运用是气管、支气管异物准确诊断的方法,无创伤、定位准、简便易行。后重建图像处理技术能很好显示气管、支气管树结构及异物的位置关系,为影像诊断及临床制定科学的方案提供可靠的解剖依据。     

Noninvasive adrenal imaging in hyperaldosteronism

Proper management of primary aldosteronism requires localization of excess aldosterone production. Partial or radical adrenalectomy may cure cases of aldosterone-producing adenomas; however, pharmacologic management is indicated in cases of bilateral adrenal hyperplasia. Differentiating among the causes of primary aldosteronism can be a diagnostic challenge. Adrenal vein sampling, the gold standard for diagnosing subtypes of primary aldosteronism, is an invasive and often difficult procedure. Advancements in CT and MRI have improved their adrenal-imaging capabilities, but accuracy in identifying aldosterone-producing adenomas remains inferior to adrenal vein sampling. Radionuclide scintigraphy has been used for many years and can also provide functional information for diagnosis. No diagnostic test, however, distinguishes with complete accuracy aldosterone-producing adenomas from bilateral adrenal hyperplasia in primary aldosteronism. Therefore, a combination of diagnostic techniques may most effectively guide medical management.     

Parametric response mapping of CT images provides early detection of local bone loss in a rat model of osteoporosis

Loss of bone mass due to disease, such as osteoporosis and metastatic cancer to the bone, is a leading cause of orthopedic complications and hospitalization. Onset of bone loss resulting from disease increases the risk of incurring fractures and subsequent pain, increasing medical expenses while reducing quality of life. Although current standard CT-based protocols provide adequate prognostic information for assessing bone loss, many of the techniques for evaluating CT scans rely on measures based on whole-bone summary statistics. This reduces the sensitivity at identifying local regions of bone resorption, as well as formation. In this study, we evaluate the effectiveness of a voxel-based image post-processing technique, called the Parametric Response Map (PRM), for identifying local changes in bone mass in weight-bearing bones on CT scans using an established animal model of osteoporosis. Serial CT scans were evaluated weekly using PRM subsequent to ovariectomy or sham surgeries over the period of one month. For comparison, bone volume fraction and mineral density measurements were acquired and found to significantly differ between groups starting 3 weeks post-surgery. High resolution ex vivo measurements acquired four weeks post-surgery validated the extent of bone loss in the surgical groups. In contrast to standard methodologies for assessing bone loss, PRM results were capable of identifying local decreases in bone mineral by week 2, which were found to be significant between groups. This study concludes that PRM is able to detect changes in bone mineral with higher sensitivity and spatial differentiation than conventional techniques for evaluating CT scans, which may aid in clinical decision making for patients suffering from bone loss.     

非增强和增强核磁共振定位股前外侧皮瓣穿支的临床对照研究

目的:探讨非增强核磁共振(non-enhanced magnetic resonance angiography,NE-MRA)在股前外侧穿支皮瓣穿支定位中的临床应用价值。方法:自2018年5月至2019年10月,我们对19例拟行股前外侧皮瓣移植术的患者,术前均进行NE-MRA和增强核磁共振(contrast-enha...     

The perioperative care of Jehovah's Witnesses

Jehovah's Witnesses are a Christian denomination with around 8 million members worldwide. They belief the teachings of the Bible prohibit the transfusion of blood and blood components. Some blood products may be deemed acceptable as part of their beliefs and they may be accepting of intraoperative techniques such as cell salvage. Jehovah's Witnesses have the right to accept or refuse treatment without providing a reason for doing therefore medical practitioners must respect these even if this would pose threat to the patient's life. Care of the Jehovah's Witness should employ a multidisciplinary team approach with senior clinicians. Goals of management include to optimize oxygen delivery and haemoglobin synthesis, reduce blood loss, and correct any coagulopathy.