颅底及近颅底肿瘤手术入路(附126例报告)

目的探讨颅底及近颅底肿瘤切除的最佳手术入路.方法颅底及近颅底肿瘤患者126例,手术采用上、下颌外旋入路分别为13、17例耳后C型切口、经颈、颅面联合入路分别为16、48、6例;上颌骨截除术5例;鼻侧切开术5例;经腮、口、颈额、额眶入路分别为5、6、4、1例.结果89例良性肿瘤,2例复发经再次手术治愈;37例恶性肿瘤中,术后存活不足1年者4例,1年、2年、3年、5年以上者分别为6、12、10、5例.结论上颌外旋适用于切除前、中颅底肿瘤;下颌外旋适用于切除咽旁间隙良性肿瘤;耳后C型切口入路适用于颞骨肿瘤;额眶入路适用于切除眶顶、蝶骨肿瘤.     

RADIATION HORMESIS A NEW CONCEPT IN RADIOLOGICAL SCIENCE

Low-dose ionizing radiation caused definite stimulation of immune reactions both in humans and mice. The PFC reaction in response to SRBC immunization and the NK activity of the splenocytes were significantly enhanced after low-dose whole body irradiation. Activation of the T lymphocytes, especially the TH, with increased production of IL-2, might be a critical step in the whole process of immunoenhancement. A single dose of 75 mGy X-rays caused significant lowering of hypothalamic M-Enk content as well as serum corticosterone level. The increased serum testosterone level would exert an inhibitory influence on the CRF-ACTH-CS system to keep the blood corticosterone at a lower than normal level which might facilitate the immune reactions in the SRBC-immunized animals. The increased catecholamines in the spleen would probably reinforce this effect resulting in immunoenhancement. Low-dose ionizing radiation caused increased repair of the genetic material at both the molecular and subcellular levels. The UDS of human and murine lymphocytes was augmented by single or continuous low-dose irradiation. The stimulation of DNA polymerase activity might be responsible for such effects. Exposure to very small doses of low LET radiation could induce in different tissues an adaptive response which alleviated chromosome damage caused by subsequent larger dose radiation. Such an adaptive response could be induced both in vivo and in vitro in different animal species. The induced adaptive response faded away after 3 cell cycles could be re-induced by a second exposure to low-dose radiation. The mechanism of the inductive process needs further study.(ABSTRACT TRUNCATED AT 250 WORDS)     

锁孔显微神经外科手术治疗颅底和脑深部肿瘤

目的　探讨锁孔显微神经外科手术治疗颅底及脑深部肿瘤的手术技巧和适应证。方法　对 2 5例颅底及脑深部病变行锁孔开颅显微神经外科切除术 ,其中部分使用内窥镜及术中超声辅助技术。结果　 2 2例实体瘤全切除 (或等体积切除 ) 1 9例 ,次全切除 3例 ,无手术死亡、致残及开颅术相关的并发症。结论　锁孔神经外科显微手术是治疗颅底和脑深部病变的微创治疗技术 ,恰当选择适应证、个体化设计手术方案尤其重要 ,神经内窥镜、术中超声的应用可提高手术疗效。     

中颅窝孔道的CT研究及临床评价

目的：探讨成人中颅窝各孔道的ＣＴ 形态和大小。方法：以５０ 例正常成人颅底为研究对象,采用薄层高分辨力ＣＴ 扫描和图像放大重建方法,对中颅窝孔道（包括视神经孔,眶上裂、圆孔、翼管、卵圆孔、棘孔、破裂孔、颈动脉管）的大小和形态进行研究,并对测量值进行统计学处理。结果：各孔道显示良好,与解剖测量值吻合。结论：为临床医师诊治颅底疾病提供了重要参考依据     

颅底卵圆孔、棘孔和破裂孔形态的X线研究

颅底卵圆孔、棘孔和破裂孔是X线照片观察颅骨肿瘤转移,特别是鼻咽癌转移的重要骨性标志。X线检查方法最为简便。作者对200具正常干颅骨的听眶位和听眦位颅底片作了三孔形状、位置、大小和清晰度的分析,结果表明影响其X线表现的因素很多。作者讨论了这些因素,认为听眦位显示卵圆孔最清晰,而破裂孔的解剖外口极不规则,听眶位能很好显示内口,后者作为观察标志是适宜的。此外,作者认为不能仅仅以大小的轻微改变(不大于0.5mm)作为癌肿破坏的依据。     

侧颅底及颅后窝手术入路应用解剖

研究侧颅底手术入路和乙状窦后进路相关的应用解剖。方法：通过测量40例颅骨,确定茎突根部至侧颅底、星点至颅后窝各孔裂间连线的长度和各连线与正中矢状面所成角度。结果：茎突根部至圆孔、棘孔、颈动脉管外口、颈静脉窝、舌下神经管外口的距离和夹角分别为(24.2±2.5)mm〔(149.8±5.2)°〕、(18.9 ±2.6)mm〔(154.6±5.0)°〕、(9.1±1.9)mm〔(120.4±8.1)°〕、(3.8±1.6)mm〔(85.9±5.4)°〕、(16.6±2.1)mm〔(85.5±5.2)°〕。星点至三叉神经压迹、内耳门、颈静脉孔、舌下神经管内口的距离和夹角分别为(58.3±3.3)mm 〔(139.4±5.6)°〕、(44.6±7.9)mm〔(134.5±7.0)°〕、(42.9±3.5)mm〔(128.3±8.0)°〕、(55.7±3.7)mm〔(116.7±7.8)°〕。结论：围绕两种手术入路测量所得结果,有助于设计手术入路并为手术准确定位有关结构提供依据。     

加速康复外科理念在腹腔镜直肠癌根治术护理中应用

目的探讨加速康复外科理念在腹腔镜直肠癌根治术围手术期护理中的应用。方法将60例行腹腔镜直肠癌根治术病人随机分为两组,对照组采用传统围手术期护理方法;观察组给予加速康复外科护理措施。观察并比较两组术后排气、排便、进食、首次活动时间和住院时间。结果与对照组比较,观察组术后排气、排便、进食、首次活动时间均提前,住院时间缩短,差异有显著性(P<0.05)。结论加速康复外科能促进病人康复,具有良好的社会效益和经济效益。     

A NEW CONCEPT ON CHIASMAL ARCHITECTURE AND ITS PROJECTION ON THE RETINA

A study of several hundred visual fields of patients with pathologic lesions at the chiasmal region in some temporal fields demonstrates a kind of paracentral hemicircular (PCHC) bundle scotoma which was not connected with the blind spot. The particular pattern of these scotomas prompts the authors to advance a new concept on the chiasmal architecture and its projection on the retina. That is each paracentral fiber bundle on the retina divides into different districts, the fibers from the corresponding dis- tricts of each bundle weave compactly into the exact lamella in the chiasma, and with this pre- sumed fiber arrangement, there is the result.ant appearance of PCHC bundle scotoma.     

A NEW CONCEPT ON THE NATURAL COURSE OF HEPATOCELLUL.AR CARCINOMA

Based upon mass screening of hepatocellu- lar carcinoma (HCC) using alpha fetoprotein (AFP) as tumor marker and long term follow- up study, a new concept concerning the natural cours.e of HCC has been developed. Adverse to the previous concept of relat.ive short survival, HCC exist.s and develops for a. relatively long period before symptoms occur. A group o.f pa- thologically proven HCC cases receiving non- res.ect.ional treatment revea.led that the median survival of subclinicaI HCC was 14 months ver- sus 3 months in clinical HCC. 10 more months should be added from the first, appearance of low but gradually increasing AFP of subclinicaJ HCC, so the natural course of HCC is about 24 months. This relatively long period provides much more opportunity for s.uccessful treat- ment of this grave malignancy if it is detected Early.     

SURGERY IN THYROTOXICOSIS

Long term results of surgical treatment of 271 cases of thyrotoxicosis treated in the P'eo- pIe's HosDital of Beijing Medical College from 1960 through 1976 are evaluated. There were 206 female.s and 65 males with ages ranging from 15 t0 66 years. 218 (80.4%) were primary hyperthyroidism and 53 (19.6%) toxic nodula.r goiter. There was no operat.ive mortality. Post- operative respiratory distres.s requiring tracheo- stomy occurred in 8, all recovered without se- quelae after decanalizat.ion. Thyroid crisis was encountered in 3 and all were curetl. 247 .(91.9%) wcre followed up to December 1979, an average 9 year follow up period. Of 247, per- manent vocal paralysis developed in 3 (1.1'10) and permanent tetany in 3 (1.1'10) others. Dur- ing follow up the recurrence rate of hyper- thyroidism was 2.1% and the inc;idence of hy- pothyroidism 0.8%, giving a cure rate of 97.170. In correlating the final re,sults of surgical treat- ment with the amount of thyroid gland preserv- ccl after resection, it was found that a preserva- t.ion of 3-5 gm in all of the thyroid tissue, or 3-6170 0f its original weight, gave the best results. From this analysis, it is concluded that surgical treatment is the method of choice for thyrotoxicosis.     

微创股骨头内植骨手术新概念（股骨头内蘑菇状植骨手术的可行性研究）

目的 探讨广泛清除股骨头内坏死病灶的微创手术方法,使植骨区形态呈蘑菇状,扩大股骨头软骨下植骨的范围,加强对骨关节面的支撑.方法 设计制造股骨头内切骨器械、骨碎屑清除器械及碎骨块植入器械.用切骨器械在股骨头兴趣区内(坏死区)将骨质切碎形成空腔,用碎屑清除器将空腔内骨碎屑清空,用植骨器械将3mm3骨水泥颗粒植入空腔内.结果 在平小转子下方3 cm处,开6 mm微孔骨隧道,可在股骨头软骨下兴趣区挖出蘑菇状空腔,并植入骨水泥颗粒,完成模拟植骨过程.结论 应用特制器械可将股骨头坏死病灶广泛清除,扩大股骨头内的植骨范围,使植骨形态呈蘑菇状,实现股骨头坏死的微创手术治疗.     

前中颅底沟通瘤的手术入路和显微切除

目的：探讨前中颅底沟通瘤的手术入路和颅底重建的方法。方法：采用经额鼻筛眶入路、经额颞眶颧入和经额颞联合耳前颞下入路暴露肿瘤,予于显微手术切除。结果：１７例该部位肿瘤施一微手术治疗,肿瘤全切除１１例,次全切除３例,大部分切除３例。手术结果良好,无手术死亡及严重并发症。结论：前中颅底内外沟通瘤应根据肿瘤位置、侵犯范围选择适当手术入路,充分暴露病灶,有利于广泛切除肿瘤。颅底重建是避免脑脊液漏及颅内感染的     

胸腔镜辅助小切口食管癌根治术31例

目的探讨胸腔镜辅助小切口能否选到常规开胸食管癌根治术的要求，观察1年存活率和1年复发率厦手术创伤程度。方法同期进行胸腔镜辅助小切口食管癌切除31例设为观察组，常规开胸食管癌切除34倒设为对照组，比较二组围手术期情况、淋巴结清扫个数厦1年生存率和复发率。结果二组在淋巴结清扫个数、阳性率、1年生存率和1年复发率方面比较差异均无统计学意义（P〉0．05），而手术时间、术中失血量、术后引流量比较差异均有统计学意义（P〈0．05）。结论胸腔镜辅助小切口在食管癌根治术中能选到常规开胸的治疗效果，且有胸部创伤小、术中失血量少、术后引流量少的优点。     

COMBINED SPINAL AND EPIDURAL ANAESTHESIA FOR ABDOMINAL SURGERY: A NEW TECHNIQUE

Combined spinal and epidural anaesthesia was used in 50 patients undergoing abdominal surgery. A fixed dose of 1.0 mL of 5 per cent lignocaine was injected intrathecally in all cases followed by 10 mL of 0.5 per cent bupivacaine epidurally, using “needle through needle” technique in the same lumbar intervertebral space. Subsequently epidural catheter was passed for top-up doses and postoperative analgesia. The advantages of this technique observed were immediate onset of intense block of prolonged, controllable duration and no incidence of post-spinal headache. Five cases developed intraoperative hypotension which required correction. No patient developed any complications of spinal and epidural anaesthesia.KEY WORDS: Anaesthesia epidural, Anaesthesia spinal