经颅入路切除颅眶和颅鼻沟通瘤的探讨

目的 探讨经颅入路切除前颅底--眶、副鼻窦沟通瘤的可行性及并发症。方法 对2000-07～2001-04，采用单纯经颅入路切除广泛累及前颅底眶内和副鼻窦肿瘤9例进行回顾性分析，其中颅底--眶内肿瘤4例，颅底--副鼻窦、眶内肿瘤5例。结果 所有病例均做到病变全切，术后发生脑脊液漏1例，上睑轻度下垂2例，随访20-29个月，1例术后1年死于复发，8例无瘤生存。结论 单纯经颅入路能切除累及前颅底、眶内、副鼻窦的广泛肿瘤；眶顶骨膜的剥离可致提上睑困难而影响关容。因此尽量不用扩展的入路；带蒂颅骨膜瓣修复颅底骨缺损为减少并发症的关键。     

颅眶联合入路显微切除眶内球后肿瘤

目的 探讨经颅眶联合人路显微切除眶内球后肿瘤的手术方法.方法 分析5例手术治疗的眶内球后肿瘤患者的临床资料.采用颅眶联合入路,将眉弓、部分眶上壁连同额骨骨瓣一起取下,咬除眶上壁达视神经管顶壁,经硬膜外显微切除眶内肿瘤.结果 5例患者肿瘤全部根治性切除,仅1例失明患者术后视力未恢复且伴眼球运动障碍,上睑下垂,无其他手术并发症,无手术死亡病例.结论 颅眶联合入路显微手术是眶内球后肿瘤行之有效的治疗方法.     

经颅显微切除眶内球后肿瘤八例临床体会

目的 探讨经颅显微切除眶内球后肿瘤的手术方法.方法 对8例经颅显微切除眶内球后肿瘤患者的临床资料进行回顾性分析.结果 8例患者中有6例为全切,有2例为次全切,其中1例视力较差患者术后视力无恢复且伴有眼球运动障碍,上睑下垂,无其他手术并发症,无手术死亡病例.结论 经颅显微手术是眶内球后肿瘤行之有效的治疗方法,具有手术入路设计科学、定位准确、手术精度高、手术瘢痕隐蔽等诸多优势,术中可以直视切除范围,可以有效提高全切率.     

神经内镜辅助下颅面联合入路切除前颅底沟通性肿瘤19例

目的 总结在神经内镜辅助下前颅底沟通性肿瘤的手术切除与修复方法.方法 对19例前颅底沟通性肿瘤采用神经内镜辅助下颅面联合入路进行鼻腔、鼻窦-颅沟通性肿瘤(15例)、鼻-眶-颅沟通性肿瘤(4例)切除术,并同期行带蒂额肌帽状腱膜裂层颅骨瓣修复术.结果 19例患者术后均未发生脑脊液漏和颅内感染,肿瘤全切率78.9%,次全切除率15.8%,部分切除率5.3%.良性肿瘤4例,至今全部存活;恶性肿瘤15例,2年生存11例,3年生存8例,5年以上生存6例.结论 神经内镜辅助下颅面联合入路,进行前颅底沟通性肿瘤切除术,加以带蒂额肌帽状腱膜裂层颅骨瓣修复,切除范围安全彻底,修复方便可靠,是一种较为理想的手术切除及修复方法.     

颅眶联合入路显微切除眶内球后肿瘤

目的探讨经颅眶联合入路显微切除眶内球后肿瘤的手术方法。方法分析5例手术治疗的眶内球后肿瘤患者的临床资料。采用颅眶联合入路，将眉弓、部分眶上壁连同额骨骨瓣一起取下，咬除眶上壁达视神经管顶壁，经硬膜外显微切除眶内肿瘤。结果5例患者肿瘤全部根治性切除，仅1例失明患者术后视力未恢复且伴眼球运动障碍，上睑下垂，无其他手术并发症，无手术死亡病例。结论颅眶联合人路显微手术是眶内球后肿瘤行之有效的治疗方法。     

经眉弓眶上锁孔入路显微手术切除颅咽管瘤

目的探讨经眉弓眶上锁孔入路显微手术切除颅咽管瘤的方法及效果。方法回顾性分析18例经眉弓眶上锁孔入路颅咽管瘤显微手术及随诊结果。结果肿瘤全切16例,次全切2例,残余肿瘤予于立体定向放射外科治疗。术后出现或尿崩加重9例、高钠血症4例、嗜睡3例、视力下降2例、高热3例。随诊3个月至3．1年,术前症状均有好转,肿瘤复发3例。结论经眉弓眶上锁孔入路显微手术是切除颅咽管瘤的一种微创、安全及高效的手术方法。     

颅眶联合入路显微切除眶内球后肿瘤25例的手术配合

目的 探讨经颅眶联合入路显微切除眶内球后肿瘤的护理配合要点.方法 分析25例手术治疗的眶内球后肿瘤患者的临床资料.采用颅眶联合入路,将眉弓、部分眶上壁连同额骨骨瓣一起取下,咬除眶上壁达视神经管顶壁,经硬膜外显微切除眶内肿瘤.结果 25例患者肿瘤全部根治性切除,其中2例失明患者术后视力未恢复且伴有眼球运动障碍,上睑下垂,无其他手术并发症,无手术死亡病例.结论 颅眶联合入路显微手术是眶内球后肿瘤行之有效的治疗方法,能够直接改善治疗效果,手术护士术前备好显微器械,术中娴熟配合是手术得以顺利进行的必备条件.     

眶尖区肿瘤改良经颅眶上外侧壁入路开眶显微术式治疗探讨

目的 探讨眶尖区肿瘤改良经颅眶上外侧壁入路开眶治疗的显微外科手术策略及疗效.方法 回顾性分析48例眶尖区肿瘤患者的临床资料,采用改良经颅眶上外侧壁入路开眶,其中以眶-翼点为主34例,联合眶-额、眶灏、颧-翼点入路14例.术后常规复查增强MRI,并进行随访.结果 肿瘤全切除33例,次全切除7例,大部或部分切除6例,活检2例.术后视功能良好40例,存在动眼神经和视神经损伤7例,偏瘫1例.结论 改良经颅眶上外侧壁入路开眶结合显微技巧可较好治疗眶尖区肿瘤;合适的角度开眶可最大限度地切除眶尖区肿瘤和保护神经功能,减少不必要的创伤.     

颅-眶-颧入路显微手术切除颅中窝底肿瘤

目的探讨经颅-眶-颧入路显微手术治疗颅中窝底肿瘤的经验.方法回顾性分析我科显微手术治疗的30例颅中窝底肿瘤的临床资料,重点分析总结经颅-眶-颧入路的优点、操作关键点及切除肿瘤的手术技巧.结果本组30例全部采用颅-眶-颧入路,发现该入路可缩短手术操作距离,深部病变的观察角度明显扩大,降低了颅中窝底肿瘤的手术难度,术后亦未见明显的脑牵拉性伤,未发生额肌麻痹、眼球内陷、视力损害等并发症.结论改善手术疗效的关键在于恰当的手术入路和精湛的显微外科技术.经颅-眶-颧入路显微手术治疗颅中窝底肿瘤,效果确切,值得推广.     

鼻腔鼻窦肿瘤累及颅眶的手术切除及入路选择(附16例报告)

本文回顾分析近年耳鼻咽喉科、眼科和神经外科协作处理的颅鼻眶沟通肿瘤16例的治疗结果，探讨鼻腔鼻窦肿瘤累及颅眶手术治疗效果和最佳手术入路选择。结果表明，最佳手术入路的选择应根据肿瘤的部位、大小、累及范围，能充分地切除肿瘤，保护正常结构及功能修复进行综合考虑。     

Retroperitoneal leiomyosarcoma: report of 3 cases

BACKGROUND: Retroperitoneal leiomyosarcomas are neoplasma which are best treated with complete exeresis. AIM: We reported three new cases of retroperitoneal Leiomyosarcoma operated during last ten years. CASES: The authors reported 3 cases of Retroperitoneal leiomyosarcomas in 3 patients (2 men and a woman) aged respectively 53, 55 and 57 year-old. Incomplete resection was performed in the 3 cases because of the important local extension. All patients died 18, 19 et 51 months after diagnosis.     

腮腺浅叶良性肿瘤功能性切除术与全切术治疗比较分析

目的比较腮腺浅叶良性肿瘤功能性切除术与全切术两种手术治疗方式的临床效果。方法 60例腮腺浅叶良性肿瘤患者,32例行腮腺浅叶良性肿瘤的功能性切除术,28例行肿瘤及全部浅叶切除面神经解剖术。观察手术伤口愈合情况、术后涎瘘发生率、术后1周面瘫率、术后两年内肿瘤复发率。结果手术伤口均为甲级愈合,两组患者术后均无涎瘘、面瘫并发症;所有病例随访2年,行肿瘤功能性切除术患者的复发率为6.25%（2/32）,行肿瘤及全部浅叶切除面神经解剖术者的复发率为7.14%（2/28）,两组肿瘤的复发率无明显差异（P〉0.05）。结论腮腺浅叶良性肿瘤功能性切除术在不增加肿瘤术后复发率基础上,保留了腮腺分泌唾液的功能,减少了术后面部味觉性出汗综合征的发生,不会造成大块切除后的面部畸形。     

198例宫颈疾病的LEEP刀诊治分析

目的:探讨LEEP刀对各类宫颈疾病诊断及治疗的临床应用价值。方法:对198例宫颈慢性炎症、增生及赘生物患者进行LEEP刀宫颈环切或锥切并跟踪观察。结果:198例各类宫颈良性疾病患者经LEEP刀治疗,连续观察3个月,一次性成功治愈191例(96.5%),显效7例,总有效率为100.0%,其中宫颈上皮内瘤变(CIN)5例。结论:LEEP刀治疗各类宫颈疾病疗效显著,手术时间短,操作简单易行,且可提供完整的病理标本,降低了宫颈癌的误诊率和漏诊率。     

MRI imaging of liver neoplasma

MRI by 1.5 T imager with spin echo pulse sequence was performed on 53 liver neoplasms (13 hepatocellular carcinomas (HCC), 28 cavernous hemangiomas and 12 metastasis). Lobulated and notched contour were observed in 72% of our cases of hemangioma. It is well known that in hemangioma several kinds of echographic patterns appear, but in MRI, almost all hemangioma appear to show the same signal pattern as high intensity homogeneous on T2 weighted image. No liver neoplasma showed high intensity on T1 image except in 1/3 of cases of HCC. Contrast enhancement with Gd-DTPA is useful for differential diagnosis of liver neoplasma because it shows different signal patterns from the other diseases.     

Surgical resection as treatment of spinal intramedullary tumors

The authors retrospectively report the results of surgical treatment of spinal cord tumours in the Department of Neurosurgery, University Hospital Utrecht, Holland and review the recent literature. Twenty-eight patients were operated on for an intramedullary spinal cord tumour between 1981 and 1990. The mean follow-up period was 31 months. Neurological evaluation was done using the grading system described by Cooper and Epstein, immediately postoperatively and after 6 months. A total or subtotal resection could be performed in 22 (79%) of the 28 patients. Postoperatively, the neurological function of the legs improved or remained stable in 21 of the 28 patients, and the function of the arms in 26 of the 28 patients. After six months the neurological function in arms and legs had improved or remained stable in 19 of 21 patients. The most frequently occurring tumour, ependymoma, could be radically resected more often (82%) than astrocytoma (33%). Postoperative morbidity is closely related to the level of involvement. Microsurgical exploration at the cervical level is far less dangerous than has always been believed. Surgical mortality was 0%. Radical resection of intramedullary tumours should be attempted and can be achieved with stabilisation or improvement of neurological deficit in the majority of patients.     

颅底肿瘤的显微外科治疗

目的提高对颅底肿瘤治疗的认识。方法回顾分析显微外科手术治疗颅底肿瘤56例的临床特点和总结手术体会。结果56例颅底肿瘤中,手术全切除46例,次全切除4例,大部切除6例。术前颅神经功能损伤35例46条,术后恢复23条（50%）,好转8例（17.4%）,症状无改善9条（19.6%）,加重6条（13.0%）,出现新的颅神经症状者5例。结论术前精确的诊断对手术及预后非常重要。手术入路主要取决于肿瘤的位置、延伸及大小。显微外科手术是减少术后并发症、获得良好预后的关键。     

单鼻孔经蝶人路治疗垂体瘤的临床疗效观察

[目的]探讨经单鼻孔蝶窦入路神经内镜下垂体腺瘤切除手术技术。[方法]对符合病例入选标准的垂体瘤患者给予单鼻孔蝶窦入路神经内镜下垂体腺瘤切除手术,观察手术情况。[结果]本组58例患者均成功完成手术,术后随访1～12个月,平均(6.2±0.3)个月;其中肿瘤全切除45例,次全切除13例;手术时间1～2.5h,平均(85±13.8)min,本组58例患者术后有13例患者出现尿崩症,其中12例短期内恢复,1例经使用垂体后叶素或醋酸去氨加压素(20mg/d)1～2周后恢复;5例患者出现轻度的脑脊液鼻漏,经对症处理后好转;未发生脑脊液鼻漏及视力恶化。[结论]经单鼻孔蝶窦垂体瘤神经内镜手术技术简便、安全和有效,提高肿瘤全切率。     

The plain radiograph in ophthalmology: a wasteful and potentially dangerous anachronism.

The indications for 822 consecutive referrals for skull radiography were prospectively studied in a large eye hospital over a one year period. In 85.9% of patients the results were normal, and in 89% of the remainder they had no positive effects on management; all patients in whom a 'beneficial' effect could be identified would have been more appropriately investigated by other means. Fourteen of 25 patients whose skull radiographs were normal were shown by computed tomography or magnetic resonance imaging to have orbital or intracranial lesions. Views of the optic canals, orbits or paranasal sinuses were also requested in 336 patients. With appropriate use of alternative imaging methods, no patient's treatment would have been adversely affected if none of the skull radiographs had been obtained.