腹腔镜下肝脏海绵状血管瘤的治疗

目的总结腹腔镜下肝脏海绵状血管瘤的治疗经验,探讨其安全性及可行性。方法回顾性分析我院67例腹腔镜下治疗肝脏海绵状血管瘤的临床资料,其中58例行腹腔镜下肝脏海绵状血管瘤的射频消融治疗,9例行腹腔镜下肝血管瘤的切除治疗。结果本组病例均在腹腔镜下完成手术治疗,平均手术时间约100 min,平均出血量约300 ml,术后第2天均能下地活动,并进流质饮食,术后平均住院时间5 d,1例术后出现右肝管狭窄,术后无胆漏出血,随访远期效果良好。结论腹腔镜下肝海绵状血管瘤的治疗是安全可行的,疗效确切,治疗病例应严格选择。     

数字减影血管造影在出血性脑卒中诊治中的应用

目的　探讨数字减影血管造影 (DSA)对早期出血性脑卒中的诊治价值。方法　分析我院2 0 0 1年 9月～ 2 0 0 4年 2月出血性脑卒中 76例患者临床与DSA资料。结果　 76例均经DSA检查 ,5 2例DSA阳性 ,阳性率 6 8.4 %。颅内动脉瘤 30例 ,其中囊性动脉瘤 2 7例 ,假性动脉瘤 3例 ;脑血管畸形 17例 ,其中动静脉畸形 16例 ,海绵状血管瘤 1例 ;Moyamoya病 5例。 2 4例DSA检查无阳性发现。 30例颅内动脉瘤行血管内治疗 10例 ,显微神经外科手术夹闭 13例 ,痊愈好转 2 2例 ,死亡 1例 ,病死率 4 .4 %。未做治疗者 7例 ,好转 1例 ,死亡 6例。 17例脑血管畸形手术血肿清除 +畸形血管切除 13例 ,行血管内NBCA胶栓塞 2例 ,血管内栓塞 +手术 2例 ,均好转出院。 5例Moyamoya病好转出院 4例 ,合并脑积水脑疝死亡 1例。 2 4例DSA阴性均好转出院。 6 8例好转治愈患者随访 3个月无复发。结论　尽早DSA检查及对因治疗出血性脑卒中可以极大改善患者预后。     

节段性脊柱脊髓血管瘤病介入治疗分析

目的　探讨节段性脊柱脊髓血管瘤病诊断和治疗方法的选择 ,提高介入治疗疗效。方法　对 1997年 1月～ 2 0 0 0年 12月的 14例节段性脊柱脊髓血管瘤病诊断和治疗方法进行回顾性分析。结果　 14例随访 4个月～ 3年 ,其中治愈 (症状和体征完全消失 ,复查脊髓血管造影无畸形血管存在 ) 0例 ;好转 (症状和体征减轻 ,造影畸形血管明显减少 ) 12例 ;无变化 (症状和体征与治疗前无变化 ,造影畸形血管部分减少 ) 0例 ;加重 (症状和体征加重 ) 2例。结论　节段性脊柱脊髓血管瘤病引起的感觉、运动障碍 ,经脊髓MRA、DSA确诊后应争取早日介入栓塞或 (和 )手术联合治疗。选择恰当的栓塞剂是介入成功的关键。     

松解术治疗Chiari畸形合并脊髓空洞症23例疗效分析

目的探讨小脑扁桃体下疝合并脊髓空洞的Chiari畸形的手术治疗方法及疗效。方法对23例Chiari畸形合并脊髓空洞的患者,应用显微手术进行小脑扁桃体下疝切除+脊髓中央管口松解+枕下减压扩大硬脑膜修补术治疗。结果优9例,良14例,无疗效一般和差的病例。术后出现并发症8例,其中低热6例,头痛3例,1例进入延髓的血管损伤,无明显后遗症,本组无死亡病例。结论应用显微手术进行小脑扁桃体下疝切除+脊髓中央管口松解+枕下减压扩大硬脑膜修补术临床效果好,脊髓空洞减少或消失率高。     

颅内海绵状血管瘤的影像诊断与治疗(附23例分析)

目的：探讨颅内海绵状血管瘤的影像学表现和手术治疗方法与效果。方法：回顾性分析23例（24个病灶）颅内海绵状血管瘤的CT和MRI表现，并应用显微神经外科技术手术切除。结果：23例中，13例行CT检查，其中脑内型10例，脑外型3例，单纯行CT检查的7例中，诊断不明确4例。16例行MR检查，多数表现为混杂的T1、T2信号，周边有低信号包绕，23例病人全部手术治疗，5例术后放疗，术后随访18例，效果良好。结论：MR是诊断该病的理想方法，对于大病灶必须神经外科手术治疗，术后残余病灶和深部小病灶可应用立体定向放射治疗。     

脊髓海绵状血管瘤MRI与病理对照

目的 :探讨脊髓海绵状血管瘤的 MRI特征。方法 :经 MRI诊断、活检及手术病理证实脊髓海绵状血管瘤 6例 ,其中活检 3例 ,手术 3例 ,分析了该组病变的分布范围 ,MRI异常信号特征 ,并与病理切片进行对照研究。结果 :6例脊髓海绵状血管瘤中 4例位于胸段 ,2例位于颈段 ,均为单发 ,脊髓粗细正常或稍增粗。 MRI特征性表现为瘤巢呈爆米花状或桑葚状混合信号团块 ,周围可见短 T2 低信号环。镜下瘤组织由高度扩张的血窦所构成 ,内衬扁平内皮细胞 ,壁薄 ,管腔内可见红细胞 ,血窦间为少许纤维组织分隔 ,并见新旧出血病灶。结论 :MRI诊断脊髓海绵状血管瘤特异性高 ,对病灶不同时期变化如出血、含铁血黄素沉积、胶质增生均具有特征性表现     

海绵窦海绵状血管瘤的影像诊断与手术治疗

目的:探讨海绵窦海绵状血管瘤CT、MRI表现特征和外科治疗方法,以提高其诊断治疗水平。方法:回顾性分析8例海绵窦海绵状血管瘤影像学表现及经额颞联合耳前颞下入路、改良翼点入路的手术治疗方法。结果:海绵窦海绵状血管瘤呈类圆形或哑铃状,CT平扫为均匀的等、稍高或稍低密度影,伴蝶骨轻度骨质侵蚀;MRI检查T1WI呈等、稍低的均匀信号,T2WI为均匀的高信号;增强扫描显著强化。额颞联合耳前颞下入路全切除1例,次全切除2例;改良翼点入路全切除4例,次全切除1例。结论:海绵窦海绵状血管瘤有一定CT、MRI表现特征,有助于术前诊断;额颞联合耳前颞下入路、改良翼点入路是手术治疗的主要方法。     

硬脊膜外海绵状血管瘤MRI表现

目的评价硬脊膜外海绵状血管瘤MRI特征表现。方法回顾性分析3例经手术病理证实的硬脊膜外海绵状血管瘤的MR表现及文献复习。结果3例硬脊膜外海绵状血管瘤中,1例位于腰段椎管,2例位于胸段椎管,3例均发生于脊髓背侧,两端尖细,长轴与脊椎纵轴一致,相应平面的脊髓均受压推移;3例均表现为T2WI高信号,Gd-DTPA增强扫描呈均匀一致的明显强化。结论MRI检查是诊断此病的最佳无创检查方法。     

Nd:YAG激光配合手术切除血管瘤9例报告

增生型血管瘤侵犯广,无明显包膜,常累及深层肌肉,手术切除出血多、不易彻底。1990年2月至7月,我们对9例血管瘤用Nd:YAG激光配合手术行开放式切除。男性5例,女性4例,年龄8～39岁。诊断:海绵状缸管瘤7例,动静脉瘘2例。病变分布:上肢4例,下肢3例,颌面部2例。此9例中8例曾分别或联合作过手术、硬化剂注射、激     

下唇巨大海绵状血管瘤的治疗体会

下唇巨大海绵状血管瘤治疗后应恢复下唇的正常形态和功能.1989年以前我科为防术中大出血,对较大的血管瘤一般先行硬化剂注射2～3次,然后再行手术.由于下唇血管丰富,感觉灵敏,又其进食、语言等多种功能,局部硬化剂注射后肿胀严重,疼痛剧烈,因而病人往往不能坚持治疗.自1989年始作者对2例下唇巨大海绵状血管瘤采用一次性切除并下唇整形术,然后再行硬化剂局部注射,治疗后随访3年,效果满意.     

改良翼点入路显微直视手术切除海绵窦肿瘤

为总结海绵窦肿瘤显微神经外科治疗的经验，作者对1990年1月－2001年6月收治的26例海绵窦肿瘤病例进行了回顾性分析。手术均采用改良翼点入路，显微直视手术，其中6例在神经导航辅助下进行。结果全切19例（73.1%)部分切除7例（26.9%)。术后14例（53.8%)颅神经症状逐渐改善，6例（23.1%)出现新的颅神经损害症状，无死亡。对部分切除的病人，术后加立体定向放射外科治疗。随访8个月－12年，未见肿瘤复发。作者认为，熟悉海绵窦区的显微解剖并具备熟练的显微神经外科技术，可使该类手术取得良好效果。     

脊髓海绵状血管瘤的MRI诊断与临床、病理对照分析

目的探讨脊髓海绵状血管瘤(spinalcavernoushemangioma,SCH)的常见及少见MRI特征与临床、病理特征的相关性。方法回顾20例经手术病理证实的脊髓海绵状血管瘤,分析其信号特点,并与临床资料及病理切片进行对照研究。结果20例SCH中,5例位于颈段,12例位于胸段,2例位于腰段,1例位于圆锥马尾部位。SCH分为4型:髓内型、髓外硬膜下型、硬膜外型、椎体型。典型SCH的MRI表现为T1、T2加权像上混合信号团块,周边见低信号环,以T2显示明显。脊髓受压症状是其主要临床特征。SCH系红色或紫红色桑椹样病变,镜下由扩张的薄壁血窦组成,窦壁为薄层纤维外膜内衬单层内皮细胞构成。结论MRI是诊断SCH的最可靠方法,其MRI信号特征与其临床、病理特征相符。     

The risk of radiation-induced cancer in patients with squamous cell carcinoma of the head and neck and its results of treatment

The purpose of this study was to determine the incidence and the results of treatment of cancer induced by radiotherapy for early stage (stage I and II) squamous cell carcinoma of the head and neck (SCH). The clinical records of 355 patients with early stage malignant lymphoma of the head and neck region treated by radiotherapy were reviewed, and then the records of 1358 patients with early stage SCH (oral cavity, 956; larynx, 154; oropharynx, 110; maxillary sinus, 86; lip, 20; epipharynx, 17; hypopharynx, 15) who underwent radiotherapy were reviewed. The disease-specific 10-year survival rate of the patients with 355 malignant lymphoma was 61%, and 5 cases of radiation-induced cancer occurred more than 8 years after irradiation. The crude incidence of radiation-induced cancer in the malignant lymphoma patients was 1.4%, and the 10-year probability by the actuarial life table method was 0.8%. The 10-year survival rate of the early stage SCH patients was 71%. The crude incidence of a second cancer in a previously irradiated field after an 8-year latent period (SCI) in the SCH patients was 1.8% (25/1358), and the 10-year probability was 1.6%. 12 SCIs were treated by surgery and 8 of those 12 patients (67%) resulted in success, whereas treatment by radiation resulted in failure in every other case. The risk of SCIs in the SCH group was higher than in the early stage malignant lymphoma group, although the difference was not statistically significant. The possibility of radiation-induced cancer in SCH is small, and the advantage of radiation therapy compares favourably with the risks of other treatments.     

DSA全脑血管造影431例分析

目的:分析431例全脑血管造影,探讨颅内血管病变用DSA全脑血管造影的价值。材料和方法:92年至96年行DSA全脑血管造影431例。采用Seldinger技术,经股动脉穿刺置管行选择性或/和超选择性全脑血管造影。前交通及后交通动脉瘤经显微神经外科证实。结果:动脉瘤155例,血管畸形76例,占位性病变48例。颅内动脉瘤发生在大脑前动脉系统为42.58％,而前交通动脉瘤为大脑前动脉系统的74.24％。颅内动脉瘤为全脑血管造影阳性发现的首位,其次为血管畸形,颅内占位。本组阴性率为25.75％。结论:CT、MR发现颅内出血或血管畸形时,不一定全脑血管造影有阳性改变。     

垂体生长激素腺瘤及其手术治疗

本文报道垂体生长激素腺瘤126冽,均有肢端肥大症或巨人症的表现。有视力损害者15例。进行血生长激素测定者57例,其基础水平在11～80μg/L。全组均进行了X线及CT检查。除4例因鞍上瘤块过大而采用额下入路外,其余122例均采用经蝶窦入路显微手术切涂肿瘤,全组无死亡。术后发生脑脊液漏及瘤床出血各2例,施行了再次手术。术后尿崩症35例,短期内自愈。随访3个月至6年3个月。有3例因肿瘤复发而再次手术。本文对这种垂体瘤的诊断与治疗进行了讨论。     

Biodistribution and radiation dosimetry of radioiodinated-SCH 23982, a potential dopamine D-1 receptor imaging agent

Radioiodinated-SCH 23982 is a potential agent for the imaging of dopamine D-1 receptors in the human brain. In vivo binding of [125I]SCH 23982 to D-1 receptors in rat brain was determined over 4 hr. The ratio of activity in striatum and frontal cortex to that in cerebellum increased over the first 2 hr to maximum values of 4.4:1 and 2.1:1, respectively. The percent injected dose in whole brain at 0.5 and 2 hr were 0.62 and 0.15, respectively. Administration of the antagonists propranolol (beta-1), prazosin (alpha-1), haloperidol (D-2) and ketanserin (5HT-2) did not significantly alter the striatum/cerebellum ratio; however, SCH 23390, a D-1 antagonist, totally blocked ligand uptake by striatum and frontal cortex. Biologic distribution data in the rat were determined after injection of 3 microCi of [125I]SCH 23982. 76% of the injected dose was excreted in 48 hr via the liver and kidneys. Internal radiation absorbed dose estimates to nine source organs, total body, the GI tract, gonads and red bone marrow were calculated for humans using the physical decay data for 123I. The critical organ was found to be the lower large intestine which received 1.1 rad/mCi of the administered dose. The total-body dose was 63 mrad/mCi. The data indicate that [123I]SCH 23982 should be a suitable agent for imaging the D-1 dopamine receptor in the human brain by single photon emission computed tomography.     

梭形细胞血管内皮瘤的临床组织病理和超微结构的观察

梭形细胞血管内皮瘤－一种新近认识的血管肿瘤。自１９８６年Ｗｅｉｓｓ和Ｅｎｚｉｎｇｅｒ首镒报导以来，１９９８年Ｓｃｏｔｔ和Ｒｏｓａｉ也曾有过报导。著者对本病例作了临床，组织病理和超微结构的观察，旨在揭示其形态学特征，探讨其发病机理。     

Mesenchymal tumors of the pancreas: computed tomography patterns

PURPOSE: To report the CT patterns of pancreatic mesenchymal lesions and to investigate the capabilities and limitations of this technique in terms of characterization. MATERIAL AND METHODS: We selected the CT examinations of 23 patients from all CT examinations of the pancreas performed from 1986 to 1998. The patients were 10 to 85 years old and all lesions but two (1 lipoma and 1 lymphoma) had pathologic confirmation. Two lymphangiomas, 2 lipomas, 4 Schwannomas (SCH), 1 plexiform neurofibroma, 1 cystic teratoma, 1 pancreatoblastoma, 9 non-Hodgkin's lymphomas (NHL), 1 undifferentiated sarcoma and 2 leiomyosarcomas were diagnosed. RESULTS: Lipomas had typically homogeneous negative HU values, and NHL a homogeneous hypodense pattern with mild contrast enhancement, with no necrosis or calcifications in both diffuse and nodular forms; SCH had variable appearance, with water/slightly negative HU numbers or highly enhanced patterns with a central necrotic core depending on the main Antoni A or B histology. Lymphangiomas appeared as complex cysts, with thin and regular or calcified walls and intracystic septa, while the plexiform neurofibroma had near-water homogeneous density with mild contrast enhancement and an infiltrating growth pattern. Our teratoma had multiple calcifications, mucinous and lipid components. The pancreatoblastoma, sarcomas, and leiomyosarcomas exhibited no specific findings. CONCLUSIONS: In selected cases, CT can provide virtually diagnostic information (lipoma and teratoma), or at least highly suggestive findings (NHL, plexiform neurofibroma, lymphangioma). Moreover, knowledge of the variable morphostructural patterns of mesenchymal histotypes (SCH, sarcoma etc.) permits to include them in the differential diagnosis of pancreatic masses.     

Synthesis of [11C]SCH 23390 for dopamine D1 receptor studies

The optimal conditions for the synthesis of ¹¹C-labeled SCH 23390 by radio-methylation of its desmethyl precursor, SCH 24518, with [¹¹C]iodomethane are described. Isocratic reversed phase HPLC was used for the purification of [¹¹C]SCH 23390. The specific activity range in 30 runs was 10–235 Ci/mmol and average radiochemical yield was 72% based on [¹¹C]iodomethane. Mean synthesis time was 40–60 min from the end of bombardment. Preliminary animal studies indicate that [¹¹C]SCH 23390 would be useful in visualizing D1 receptors in a living brain by positron tomography.     

Synthesis of carbon-11 labelled SCH 39166, a new selective dopamine D-1 receptor ligand,and preliminary PET investigations

SCH 39166 [(—)-trans-6,7,7a,8,9,13b-hexahydro-3-chloro-2-hydroxy-N-methyl-5H-benzo(d)naphtho-(2,1-b)azepine] is a new more selective dopamine D-1 receptor antagonist than the widely used SCH 23390. [¹¹C]SCH 39166 was prepared by N-methylation of the desmethyl compound SCH 40853 [(—)-trans-6,7,7a,8,9,13b-hexahydro-3-chloro-2-hydroxy-5H-benzo(d)naphtho-(2,1-b)azepine] with [¹¹C]methyl iodide. Reaction in acetone with subsequent straight-phase semi-preparative HPLC resulted in 20–30% radiochemical yield (from EOB and decay-corrected) with a total synthesis time of 35–40 min and a radiochemical purity >99%. The specific activity obtained at EOS was about 1500 Ci/mmol (55 GBq/μmol). [¹¹C]SCH 39166 was injected into a Cynomolgus monkey. PET-analysis demonstrated accumulation in the striatum, a region known to have a high density of dopamine D-1 receptors. In a displacement experiment, radioactivity in the striatum was markedly reduced after injection of 6 mg unlabelled SCH 23390, thus demonstrating the specificity and reversibility of [¹¹C]SCH 39166 binding to dopamine D-1 receptors.