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经翼点入路显微手术治疗颅内动脉瘤54例 总被引:1,自引:1,他引:1
目的 探讨经翼点入路显微手术治疗颅内动脉瘤的方法。方法 应用显微神经外科技术,对54例颅内动脉瘤患者进行直视手术。经翼点入路,以Mayfied三头钉头架固定头部,取自耳屏前方、颧弓上缘至中线发际内作弧形切口。根据需要充分显露载瘤动脉后,再解剖瘤颈。结果 54例颅内动脉瘤手术夹闭成功,以格拉斯哥术后评分量表对患者神经功能评分,评分为好的患者48例,差者3例,死亡3例。结论 经翼点入路,应用显微外科技术,手术路径最短,视野角度最大,是手术治疗大脑动脉环动脉瘤的经典入路。 相似文献
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颅内动脉瘤是自发性蛛网膜下腔出血(SAH)最常见的病因之一,致残率、病死率均高,手术夹闭动脉瘤难度大.Yasargil翼点入路开颅,面神经额支的保护率为70%,术后颞肌萎缩时有发生。作者对常规翼点入路进行了改良,使面神经的损伤概率降低,术后颞肌不萎缩现将颅内动脉瘤改良翼点入路的手术方法及临床疗效报道如下。 相似文献
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2001年1月-2005年12月,我们为70例患者行显微镜下颅内动脉瘤夹闭术,效果满意。现将手术配合体会总结如下。 相似文献
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颅内动脉瘤应选用显微手术夹闭还是血管内栓塞术? 总被引:2,自引:0,他引:2
刘承基 《中国脑血管病杂志》2004,1(12):530-532
自从1938年Walter Dandy首次经开颅用银夹成功地夹闭动脉瘤颈治疗颅内动脉瘤以来,该术式一直被认为是治疗颅内动脉瘤的标准方法。以后随着手术显微镜的应用以及动脉瘤夹、麻醉、手术中监护和手术后护理的改进,使动脉瘤夹闭术达到完美水平,以致至今仍被誉为治疗颅内动脉瘤的“金标准”。但是自从1991年发明经皮动脉腔内Guglielmi可脱性弹簧圈(Guglielmi detachable coil,GDC)栓塞动脉瘤以来, 相似文献
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目的探讨颅内前循环动脉瘤的影像学诊断方法、手术时机、改良翼点入路的显微手术方法,术中和术后脑血管痉挛(CVS)的防治以及可能影响手术预后的因素。方法回顾性分析62例颅内前循环动脉瘤患者的临床资料。结果62例患者均经DSA和(或)CTA检查后明确其诊断。61例行改良翼点入路开颅手术;1例行纵裂入路开颅手术。直接夹闭动脉瘤63个,包裹梭形动脉瘤1个,术中所见与影像学检查结果一致。术后随访51例,随访时间为1个月~2年。按照格拉斯哥预后评分(GOS),良好的有45例(88.2%),轻度残疾的有2例(3.9%),重度残疾的有1例(1.9%),死亡的有3例(5.9%)。随访的患者均未出现颞肌萎缩及面神经颞支损伤等情况。术后有1例患者因CVS死亡,术中应用罂粟碱处理的22例患者,术后均无明确的CVS发生。有15例患者术中行终板造瘘,术后配合腰大池引流术,在6个月至2年的随访中只有2例发生慢性脑积水。结论①术前应行高质量的全脑血管造影,有利于手术的进行。②颅内前循环动脉瘤一旦被确诊应早期治疗。③改良翼点入路可以减少颞肌萎缩的发生,术后面神经损伤减少。④CVS是影响手术预后的重要因素,术中终板造瘘和术后腰大池引流术等综合措施有利于减少CVS和慢性脑积水的发生。 相似文献
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Masaya Yamamoto Hisao Hara Hideo Shinji Tsuyoshi Ono Itaru Yokouchi Shingo Ito Hidehiko Hara Takuro Takagi Kaoru Sugi Masato Nakamura 《Cardiovascular Revascularization Medicine》2010,11(2):105-109
Endovascular treatment (stenting) has evolved as an effective and safe treatment modality for symptomatic subclavian and innominate artery disease. Most of these patients have comorbid conditions associated with atherosclerotic vascular disease, which is responsible for the access site and increased difficulty of procedure. We report a case of symptomatic innominate artery stenosis with concomitant atherosclerotic disease of the abdominal aorta successfully treated with using coronary devices and the pull-through technique via the bilateral brachial approach. 相似文献
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Robertson DJ Greenberg ER Beach M Sandler RS Ahnen D Haile RW Burke CA Snover DC Bresalier RS McKeown-Eyssen G Mandel JS Bond JH Van Stolk RU Summers RW Rothstein R Church TR Cole BF Byers T Mott L Baron JA 《Gastroenterology》2005,129(1):34-41
BACKGROUND & AIMS: Colonoscopic polypectomy is considered effective for preventing colorectal cancer (CRC), but the incidence of cancer in patients under colonoscopic surveillance has rarely been investigated. We determined the incidence of CRC in patients under colonoscopic surveillance and examined the circumstances and risk factors for CRC and adenoma with high-grade dysplasia. METHODS: Patients were drawn from 3 adenoma chemoprevention trials. All underwent baseline colonoscopy with removal of at least one adenoma and were deemed free of remaining lesions. We identified patients subsequently diagnosed with invasive cancer or adenoma with high-grade dysplasia. The timing, location, and outcome of all cases of cancer and high-grade dysplasia identified are described and risks associated with their development explored. RESULTS: CRC was diagnosed in 19 of the 2915 patients over a mean follow-up of 3.7 years (incidence, 1.74 cancers/1000 person-years). The cancers were located in all regions of the colon; 10 were at or proximal to the hepatic flexure. Although most of the cancers (84%) were of early stage, 2 participants died of CRC. Seven patients were diagnosed with adenoma with high-grade dysplasia during follow-up. Older patients and those with a history of more adenomas were at higher risk of being diagnosed with invasive cancer or adenoma with high-grade dysplasia. CONCLUSIONS: CRC is diagnosed in a clinically important proportion of patients following complete colonoscopy and polypectomy. More precise and representative estimates of CRC incidence and death among patients undergoing surveillance examinations are needed. 相似文献
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前颞叶内侧切除术治疗颞叶内侧型癫痫 总被引:1,自引:0,他引:1
目的探讨前颞叶内侧切除术治疗颞叶内侧型癫痫的治疗效果。方法21例顽固性颞叶癫痫患者,采用无框架神经导航辅助,经颞中回行前颞叶内侧切除术,切除前颞叶、杏仁核及海马。采用分级量表进行针对癫痫发作控制效果的评价。结果21例术后随访6~29个月,神经功能均改善,无严重手术并发症。16例(76%)癫痫发作完全消失(EngelⅠ级),3例(16%)癫痫发作极少(EngelⅡ级),2例(8%)癫痫发作减少(EngelⅢ级)。结论前颞叶内侧切除术是治疗颞叶癫痫的有效方法。神经导航辅助下手术彻底切除杏仁核及海马,避免了语言区和视放射的损伤。 相似文献
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Delayed pulmonary thrombectomy via a peripheral approach in the treatment of pulmonary embolism and sequelae 总被引:1,自引:0,他引:1
V Dor J Jourdan R Schmitt M Sabatier J J Arnulf P Kreitmann 《The Thoracic and cardiovascular surgeon》1981,29(4):227-232
Delayed unilateral pulmonary embolectomy via the peripheral approach has been performed in 12 patients suffering from chronic pulmonary vascular obstruction after a single or repeated embolisms. Arterial hypoxemia and pulmonary hypertension were present in all cases. Embolectomy was performed several months or years after the initial event. There were 2 early and one late death. The surviving patients are doing well clinically and show definite hemodynamic and angiographic improvement. 相似文献
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经面静脉入路栓塞治疗海绵窦区硬脑膜动静脉瘘 总被引:2,自引:0,他引:2
目的探讨经面静脉途径治疗海绵窦区硬脑膜动静脉瘘(arteriovenous fistula,AVF)的方法和疗效。方法回顾性分析经面静脉途径(导管置入股静脉-面静脉-角静脉-眼上静脉-海绵窦)治疗7例海绵窦区硬脑膜AVF的病例资料,其中5例患者岩下窦闭塞;1例患者岩下窦开放,但其AVF所在的海绵窦和岩下窦之间无交通;1例患者的瘘与岩下窦相通。对该患者先行经岩下窦栓塞海绵窦后部,然后再经面静脉途径栓塞海绵窦前部。其他6例患者只经面静脉途径行栓塞治疗。结果血管造影显示,7例患者的角静脉和眼上静脉的走行清晰,其中有1例眼上静脉闭塞的患者,由于导管无法置入闭塞的眼上静脉,导致经静脉途径治疗终止。其余6例患者经面静脉入路用弹簧圈栓塞海绵窦治疗后,4例达到完全栓塞,2例临床症状明显好转。结论相对其他静脉途径而言,经股静脉-面静脉入路是血管内治疗海绵窦区硬脑膜AVF的一种很有价值的方法,即使该入路对术者手术技能要求较高,但仍然不失为一种安全和有效的血管内治疗方法。 相似文献
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Ott DA Gillette PC Cooley DA 《Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital》1982,9(2):149-152
A new method is described whereby atrial epicardial pacing is accomplished with a newly designed lead and a modification of the standard subxyphoid approach. This technique has not been previously reported. 相似文献
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目的总结26例经口内镜下食管环形肌切开术(POEM)治疗贲门失弛缓症的手术配合体会。
方法手术室护士做好充分的术前准备、耐心的心理疏导、默契的术中配合是保证手术成功的关键点。
结果本组26例贲门失弛缓症患者POEM 手术均顺利完成,其中4例患者出现并发症经过对症治疗后都痊愈出院,术后随访9~24个月,所有患者治疗后进食困难明显好转,无严重并发症发生。
结论POEM手术不仅具有手术时间短、创伤小、恢复快、并发症少等微创优势,而且经由人体自然腔道进行手术,充分体现了“无疤痕外科”的优越性,为贲门失弛缓症的手术治疗提供了一种新的选择;本组26例患者在医护团队共同协作下均安全平稳地度过了手术期。 相似文献
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The paper presents the results of clinical and parasitological studies in 22 patients with hymenolepiasis after treatment with ecdisten. The drug was used in a dose of 5 ml thrice a day during two weeks. It normalized all clinical symptoms in 8 patients and improved most of them in other patients. The results of helminthoovoscopy were interpreted in terms of clinical data. The parasitological efficacy of ecdisten is 36.4%. Its good tolerance, no contraindications, and easiness-to-use permit the drug to be recommended as a supplementary health-improving medication. 相似文献