经鼻蝶入路显微镜下切除垂体瘤118例临床分析

目的探讨经鼻蝶显微镜下入路切除垂体瘤的临床效果。方法回顾性分析118例行经鼻蝶显微镜下垂体瘤切除手术患者术后及各类并发症的处理。结果肿瘤全切93例,次全切20例,部分切除5例,术后临床效果满意。结论经蝶窦入路显微切除垂体瘤手术,肿瘤全切除率高,症状改善明显,并发症较少。     

经鼻蝶入路垂体腺瘤切除围手术期的护理

目的探讨经鼻-蝶入路垂体瘤腺切除术的围手术期护理。方法通过充分的术前准备和术后对各种并发症的行之有效的护理,确保患者顺利康复。结果48例均能主动配合手术,术后并发一过性尿崩5例,轻度脑脊液鼻漏3例,高热2例,经过有效的整体护理,患者均治愈出院。结论经鼻-蝶入路手术切除垂体瘤腺创伤小、并发症少,恢复快。     

经不同入路行垂体瘤切除术的疗效分析

目的分析不同垂体瘤切除手术入路(神经内镜辅助下经单鼻腔-蝶窦入路、经锁孔入路、经翼点入路)切除垂体瘤的疗效。方法 182例垂体瘤患者,根据手术方式分为:神经内镜辅助下经单鼻腔-蝶窦入路垂体瘤切除组(经鼻蝶组,115例)、经锁孔入路垂体瘤切除组(经额下锁孔组,43例);经翼点入路垂体瘤切除组(经翼点组,24例)。观察患者术后疗效及并发症情况。结果 1有效率分别为:经鼻蝶组88.70%(102例),经额下锁孔组86.05%(37例),经翼点组87.50%(21例),组间比较差异无统计学意义(P0.05)。2并发症分别为:经鼻蝶组尿崩症5例(4.35%)、视力下降3例(2.61%),显著低于其他两组(P0.05);经额下锁孔组脑脊液鼻漏6例(13.95%),显著高于经鼻蝶组[6例(5.22%)]和经翼点组[1例(4.17%)],P0.05。各组并发症总发生率:经鼻蝶组12.17%(14例),显著低于经额下锁孔组[44.19%(19例)]和经翼点组[50.00%(12例)],P0.05。3术后生活质量评分:经鼻蝶组(78.0±1.9)分显著高于经额下锁孔组(71.6±5.1)分、经翼点组(74.2±4.8)分。结论神经内镜辅助下经单鼻腔-蝶窦入路较经锁孔入路、经翼点入路垂体瘤切除术后并发症发病率低、患者术后恢复快且生活质量高,有显著优势,值得推广。     

经鼻蝶入路切除垂体腺瘤术后复发应对策略

目的探讨经鼻蝶入路切除垂体腺瘤术后复发应对策略。方法回顾性分析216例经鼻蝶入路切除垂体腺瘤患者的临床资料。结果肿瘤全切除172例,次全切除31例,大部分切除13例,术后随访3个月~2a。结论经鼻蝶入路切除垂体瘤创伤小、疗效好、恢复快,了解术后复发因素并采取相应对策,在神经内镜辅助下显微手术可取得满意效果。     

经鼻蝶入路垂体腺瘤切除术并发颈内动脉损伤的诊断与治疗

目的 探讨经鼻蝶入路垂体腺瘤切除术中和术后并发颈内动脉损伤的预防、诊断及治疗原则.方法 4例施行经鼻蝶入路垂体腺瘤切除术的患者均并发颈内动脉损伤,其中颈内动脉破裂出血2例,颈内动脉假性动脉瘤1例,颈内动脉海绵窦瘘1例.结果 2例颈内动脉破裂出血患者,分别经颈内动脉球囊栓塞术和颈内动脉腔内覆膜支架植入术完全闭塞破裂口,手术后均未再出现新的神经功能障碍.其余2例患者也分别经颈内动脉腔内覆膜支架植入术和海绵窦瘘球囊栓塞术治愈.结论 经鼻蝶入路垂体腺瘤切除术中并发的颈内动脉损伤是一严重的手术并发症,可通过手术前影像学检查、手术中准确定位加以预防;脑血管造影检查可及时显示颈内动脉损伤的类型和部位,并通过颈内动脉球囊栓塞术和腔内覆膜支架植入术进行治疗.     

巨大垂体腺瘤显微手术中视神经显微解剖及功能保护技术的探讨

目的探讨显微手术切除大型、巨大型垂体瘤视神经保护的操作技术及经验。方法对40例巨大垂体瘤患者采用翼点入路,显微镜下先行瘤内切除,待瘤内空虚再分离视神经。对14例巨大垂体瘤患者采用经鼻蝶入路,采用计算机辅助导航切开鞍底、进入鞍内,取瘤器切除瘤体减压。结果翼点入路全切除肿瘤22例,次全切除肿瘤18例,鼻蝶入路,全切除2例,次全切除6例,部分切除6例,视神经解剖全部保留。视力:翼点入路好转34例,无改善4例,恶化2例。鼻蝶入路好转12例,无改善2例。结论大型、巨大型垂体瘤不同手术入路的选择,利用视神经显微解剖的知识,及视神经保护的操作技术,可减少视神经损害,减少致残率。     

神经内镜辅助单鼻孔-蝶窦入路显微切除垂体瘤

目的探讨神经内镜技术和手术显微镜结合经单鼻孔经蝶入路切除垂体瘤的临床应用及手术技巧。方法对14例经CT扫描和MRI检查确诊为垂体瘤患者在神经内镜辅助下经单鼻孔入路,磨除蝶窦前壁,暴露鞍底,显微镜下切除垂体瘤主体后内镜下切除残余肿瘤。结果全切11例,近全切3例。术后3例出现一过性脑脊液漏,尿崩5例。7例内分泌检查正常,8例视力好转,无严重并发症发生。结论内镜辅助单鼻孔经蝶入路能良好地显示蝶窦、鞍区等结构,弥补显微镜的盲区,而手术显微镜能提供三维视野,在经鼻入路过程及切除鞍区肿瘤主体具有优势,二者结合有利于肿瘤的全切除,手术创伤小,并发症少,患者恢复快。     

三维CT成像在经鼻蝶垂体瘤手术中的应用

目的 探讨螺旋CT三维成像对鼻蝶手术入路的指导作用.方法 40例垂体瘤患者,术前应用螺旋CT行蝶鞍、蝶窦矢状和冠状扫描重建,显示蝶窦的形状、大小,蝶窦纵隔的部位、形状以及与鞍底的关系.39例手术采用经鼻蝶入路切除肿瘤.结果 39例采用经鼻蝶入路手术切除,术中手术入路解剖清晰,未借助x光机,打开鞍底无1例偏斜,无硬脑膜破损、海绵窦大出血等并发症发生.1例因蝶窦气化不良且纵隔明显偏向而采用经额手术入路.结论 术前应用螺旋CT行蝶鞍、蝶窦矢状和冠状扫描重建,对垂体瘤经鼻蝶入路手术适应证的选择,术中代替X光机指引手术入路方向,减少弯路,缩短手术时间,防止并发症的发生具有重要意义.     

经鼻蝶入路显微手术治疗12例垂体瘤卒中

目的探讨垂体瘤卒中的临床特点、诊断和手术治疗方法。方法回顾性分析2008～2010年收治的12例垂体瘤卒中患者的临床资料。所有病例均早期行经鼻蝶入路显微手术治疗。术前、术后均行内分泌障碍激素及头部CT和MRI检查,并行长期随访。结果肿瘤全切除11例;次全切除1例,11例视力障碍、视野缺损患者中10例术后恢复正常;有内分泌症状的10例患者中,9例明显缓解;无死亡病例。结论早期经鼻蝶入路手术治疗垂体瘤卒中安全、有效,是治疗垂体瘤卒中的首选方法。     

神经导航系统辅助鼻蝶入路垂体瘤切除术(附36例临床报道)

目的 探讨神经导航系统在辅助鼻蝶入路垂体腺瘤切除术中的应用.方法 36例垂体瘤患者术前用marker标记后行核磁共振2mm无间隙扫描,将影像学资料输入神经导航系统,做好术前计划.术中在导航棒的引导下精确定位手术入路直达肿瘤部位.结果 36例患者中肿瘤全部切除29例,次全切除7例,术后所有患者症状均有不同程度的改善,无严重并发症.所有患者在经鼻蝶入路过程中均无明显偏差,顺利到达肿瘤部位,平均系统误差1.7mm.结论 神经导航系统辅助鼻蝶入路垂体瘤切除术提高了手术定位的准确性、安全性,最大程度减少了手术并发症.     

Pharmacotherapy for the soul and psychotherapy for the body

The "mind-body" dualism has shaped the development of psychiatry. At the very beginning psychiatry was related to the mind and the rest of the medicine to the body. The main reasons for such division were lack of biological evidence for psychiatric disorders and wrong beliefs about demonic origins of "lunacy". But although the development of science offered more than enough biological evidence to understand brain as an organ of origin for psychiatric disorders, the dualism of mind and body remained alive even in the modern classification systems. One of the consequences was another dualism that differ biological (e.g. pharmacotherapy) from psychological therapy (e.g. psychotherapy) as completely different approaches. The purpose of this article is to offer enough evidence to reframe the existing dualisms into a different paradigm. In every illness both mind and body can be affected to a different extent. Which part of an illness is body and which part is mind is often difficult to differentiate even when we compare a person with broken leg with a person with acute stress reaction. For that reason it might be an over-simplification to differentiate sharply between biological and psychological therapies. The evidence show that psychotherapy influences biology of the brain and that pharmacotherapy influences psychological, social and developmental dimensions of the diseased person as well as overall well-being and functionality. In the era where medicine discovered psychology and psychiatry discovered biology, the debates and divisions that steam out of past dualisms should end. Every practising physician regardless of the medical discipline uses in everyday practice both biological and psychological approaches to help the patient successfully.     

Models proposed for the fibrinogen molecule and for the polymerization process

Biochemical, physicochemical and ultrastructural data are used in this work to propose a schematic model for the fibrinogen molecule and the polymerization process. The fibrinogen molecule appears to be a non compact sphere; such a shape needs a folding of the chains around the N-terminal disulfide knot and is stabilized by intramolecular interactions. The last ones are modified by the enzymatic peptide cleavage or by the action of some paracoagulant factors. The resulting conformational changes allow an unmasking of the sites involved in the fibrin polymerization and cross-linking.     

老年失智失能量表的质量评价

目的 对老年失智失能量表进行可行性和信效度分析.方法 采取方便抽样方法纳入成都市十三大区县共17个调查点的痴呆患者290例,使用基本资料调查表、简易精神状态评价量表(MMSE)、神经精神问卷(NPI)、躯体生活自理量表(PSMS)和老年失智失能量表进行评定.采用Cronbach'sα系数、Spearman-Brown系...     

A two-factor structure for the Schedule for the Deficit Syndrome in schizophrenia

The deficit subtype is hypothesized to constitute a homogeneous subgroup of schizophrenia patients. The Schedule for the Deficit Syndrome (SDS) was developed to categorize schizophrenia patients into deficit and non-deficit subtypes. Only one report, however, has suggested the use of a two-factor SDS. The present study used a two-factor SDS and examined the relationships between the factors and the demographic and clinical variables in deficit-type schizophrenia patients. Principal component analysis was performed on data obtained from 70 schizophrenia patients with the deficit syndrome. The two-factor SDS was replicated. Factor 1, avolition, was significantly correlated only with the relational disorder domain, which consisted of two negative items from the Positive and Negative Syndrome Scale. Factor 2, poor emotional expression, was significantly correlated with both the negative symptom domain, which consisted of three negative items, and the relational disorder domain. Since the SDS has two factors, there appear to be different underlying processes for these two factors.     

Surgery for intracerebral hematoma: the search for the elusive right candidate

The value of surgery for patients with intracerebral hemorrhage (ICH) remains a topic of debate. Although several studies have been unable to prove the benefit of surgical intervention of ICH, there is available evidence to suggest that some patients may experience favorable outcome with surgery. Identifying optimal candidates and the timing of surgery for the treatment of ICH are crucial issues. Studies have explored the value of early and ultra-early surgical intervention, as well as the role of stereotactic hematoma evacuation. The International Surgical Trial in Intracerebral Hemorrhage suggested that favorable surgical outcome was more likely for patients with superficial hematomas, and patients who underwent craniotomy in the trial seemed to fare better than those treated with other surgical techniques. A retrospective study of patients with brain tissue shift has provided evidence that surgery may benefit some deteriorating patients; treatment decisions in this patient population should be based on case-by-case assessments of the likelihood of recovery after evacuation. It is critical that therapeutic alternatives for patients with ICH continue to be explored.