胸腰椎转移性肿瘤的外科治疗

目的：探讨胸腰椎转移性肿瘤外科治疗的适应证和方法。方法：1988年2－2001年12月，手术治疗胸腰椎转移性肿瘤47例，男29例，女18例；年龄34－75岁，中位年龄58．5岁。肺癌12例、乳腺癌9例、甲状腺癌7例、前列腺癌5例、肝癌和肾癌各4例、胃癌1例、未发现原发灶5例。前路手术31例，前后联合入路全脊椎切除术11例，后路手术5例。术前Frankel分级：A级6例，B级9例，C级12例，D级13例，E级7例。结果：术后疼痛消失31例（67．39％），缓解12例（26．09％），无明显缓解3例（6．52％），1例术后3d死亡。41例获得随访，随访时间3个月－6年，平均38．2个月。33例死亡，存活8例。术后Frankel分级：A级2例，B级2例，C级3例，D级13例，E级21例。4例内固定松动，1例断裂。结论：胸腰椎转移性肿瘤的治疗根据患者的年龄、全身情况、预期寿命、肿瘤的位置和类型、对各种治疗的敏感性、脊柱的不稳定程度和神经症状综合考虑，手术治疗采用经前路、前后联合入路或后路手术，体现个体化治疗。     

兔膀胱出口部分梗阻所致逼尿肌超微结构的改变

目的　观察兔膀胱出口部分梗阻后逼尿肌细胞超微结构的改变。　方法　建立雄性兔膀胱出口部分梗阻动物模型 ,利用透射电镜观察其逼尿肌细胞内超微结构 ,应用ImagineTool图像分析软件检测粗面内质网面积和线粒体密度。　结果　梗阻组逼尿肌细胞内单位面积平均 1 1 5 .2 8μm2 ,胞质中粗面内质网面积 (5 .377± 2 .31 8) μm2 ,较对照组的 (0 .476± 0 .31 9) μm2 明显扩大 ;线粒体相对密度为 1 .0 2 7± 0 .0 64 ,较对照组的 0 .830± 0 .0 58明显下降 ,P均 <0 .0 1。　结论　膀胱出口部分梗阻后逼尿肌细胞内质网扩张 ,提示其合成蛋白质功能增强 ,从而引起膀胱壁增厚 ;而线粒体水肿明显 ,密度下降 ,提示逼尿肌细胞能量代谢障碍 ,导致其收缩功能下降     

Collateral circulation imaging: MR perfusion territory arterial spin-labeling at 3T

BACKGROUND AND PURPOSE: Current knowledge of the collateral circulation remains sparse, and a noninvasive method to better characterize the role of collaterals is desirable. The aim of our study was to investigate the presence and distal flow of collaterals by using a new MR perfusion territory imaging, vessel-encoded arterial spin-labeling (VE-ASL).MATERIALS AND METHODS: Fifty-six patients with internal carotid artery (ICA) or middle cerebral artery (MCA) stenosis were identified by sonography. VE-ASL was performed to assess the presence and function of collateral flow. The perfusion information was combined with VE maps into high signal-intensity-to-noise-ratio 3-colored maps of the left carotid, right carotid, and posterior circulation territories. The presence of the anterior and posterior collateral flow was demonstrated by the color of the standard anterior cerebral artery/MCA flow territory. The distal function of collateral flow was categorized as adequate (cerebral blood flow [CBF] ≥10 mL/min/100 g) or deficient (CBF <10 mL/min/100 g). The results were compared with those of MR angiography (MRA) and intra-arterial digital subtraction angiography (DSA) in cross table, and κ coefficients were calculated to determine the agreement among different methods.RESULTS: The κ coefficients of the presence of anterior and posterior collaterals by using VE-ASL and MRA were 0.785 and 0.700, respectively. The κ coefficient of the function of collaterals by using VE-ASL and DSA was 0.726. Apart from collaterals through the circle of Willis, VE-ASL showed collateral flow via leptomeningeal anastomoses.CONCLUSIONS: In patients with ICA or MCA stenosis, VE-ASL could show the presence, the origin, and distal function of collateral flow noninvasively.

The protective effect of collateral circulation influences final clinical outcomes for patients with hemodynamically significant arterial stenosis. The principal source of collateral flow of cerebral arteries is through the arteries of the circle of Willis. Secondary collateral pathways include the external carotid artery via the ophthalmic artery and leptomeningeal anastomoses at the brain surface. However, the size and patency of these arteries are quite variable.Doppler sonography is the most common tool used to investigate the presence of collateral flows. MR angiography (MRA) can be used for determining the collaterals through the circle of Willis. However, both sonography and MRA do not show leptomeningeal collateral pathways, distal collateral flows, or the actual contribution of collateral flow to brain perfusion. Intra-arterial digital subtraction angiography (DSA) shows the presence and distal arteries of the collateral pathways.¹ However, to visualize all the collateral pathways, this technique requires an invasive and selective 3-vessel approach and is typically not performed in patients with acute stroke or cerebral arterial stenosis. Therefore, a noninvasive method that demonstrates selectively angiographic information may be desired to investigate collateral blood flow.²In MR perfusion territory arterial spin-labeling (ASL),^3–7 blood in individual or groups of feeding arteries is tagged by using ASL methodology, and images are acquired that map the vascular distribution of those feeding arteries. Recently, vessel-encoded ASL (VE-ASL) MR imaging⁸ was introduced as a more time-efficient method for mapping multiple vascular territories. The aim of our study was to investigate the presence and distal flow of collateral blood supply by using the VE-ASL technique at 3T on patients with carotid stenotic disease.     

Stent management of coil herniation in embolization of internal carotid aneurysms

BACKGROUND AND PURPOSE: Coil herniation into the parent artery after detachment is an uncommon complication of embolization of the intracranial aneurysm. We report our experience with stent reconstruction of the lumen and flow of the internal carotid artery (ICA) after coil herniation during embolization for intracranial ICA aneurysms and the possible mechanisms of coil herniation.MATERIALS AND METHODS: A series of 216 consecutive patients was treated by endovascular coil embolizations for intracranial aneurysms. Of these patients, there were 9 (4 men, 5 women; 32–68 years of age) complicating with coil herniation into the ICA and undergoing stent deployment to reconstruct the ICA lumen (n = 8) or both lumen and flow (n = 1). Wide-neck aneurysms were found in 8 and narrow-neck, in 1. Aneurysms were in the posterior communicating artery (n = 5) and the paraophthalmic (n = 3) and cavernous portions (n = 1) of the ICA. Self-expandable stents were deployed in the ICA in 6; balloon-mounted stents were selected in 3.RESULTS: The causes of coil herniation appeared to be coil instability after detachment (n = 6), excessive embolization (n = 1), microcatheter-related problems (n = 1), or being pushed by subsequent coil embolization (n = 1). Endovascular stent placement to reconstruct the lumen and/or flow of the ICA was technically successful in all 9 patients; 1 needed a second stent due to further coil migration. No significant procedure-related complications were found. Clinical follow-up was 8–35 months.CONCLUSION: Coil herniation occasionally occurs during endovascular embolization of ICA aneurysms because of coil instability after detachment, excessive embolization, microcatheter-related problems, or pushing by subsequent coil embolization. In this small series, stent placement was safe and effective in the reconstruction of the arterial lumen and/or restoration of flow past a herniated coil mass.

Endovascular detachable coil embolization of intracranial aneurysms has increasingly become an alternative treatment technique to neurosurgical aneurysm clipping.¹ Despite increasing clinical experience and technologic improvements, endovascular treatment still has inherent risks of morbidity and mortality. The most common complication of endovascular embolization of the aneurysm is thromboembolic events, which may result from poor technique, endovascular devices, and/or poor flushing of the catheter systems. These complications may occur in 2.5%–28% of patients treated.^2-4 Stent-assisted aneurysm embolization is a well-known tool in the management of intracranial wide-neck aneurysms to prevent coil protrusion into the parent vessel and may allow safer and denser packing of the aneurysm sac.^5-8 However, to our knowledge, stent as a salvage procedure to reconstruct the lumen and/or blood flow of the parent artery during the procedure has not been well evaluated.The purpose of our study was to report our experience using stents to reconstruct the lumen and/or blood flow of the parent artery after coil herniation in the internal carotid artery (ICA) during embolization of intracranial ICA aneurysms and to report possible mechanisms of coil herniation.     

乳腺癌根治术后皮瓣坏死的简易处理

目的 探讨乳腺癌根治或改良根治术后大块皮瓣坏死的理想处理方法。方法 1998～2002年我院乳腺外科行乳腺根治或改良根治365例,较大范围皮瓣坏死(≥3×3cm)40例(11％),进行简单清创后直接将坏死皮瓣切除缝合。结果 40例病人中39例经过坏死皮瓣切除缝合后成功(97.5％),其中 2例术后皮瓣再次坏死,行再次上述手术而治愈。1例病人再坏死皮瓣小而浅,经过数次换药后迅速愈合。结论 就乳腺癌根治或改良根治术后较大皮瓣发生坏死而言,局部坏死皮瓣切除加立即缝合是一种经济、简单、实用的方法。     

经椎弓根椎间融合与AF治疗胸腰椎骨折

目的：总结32例经椎弓根椎间融合与AF治疗胸腰椎骨折的经验。方法：应用经伤椎椎弓根椎体间融合并AF系统复位内固定，以提高复位效果与脊柱的稳定性。结果：全部病例获随访，时间3～23个月，伤椎均与上位椎体间融合，无矫正角度与高度丢失，无断钉及螺钉松动，神经功能平均1．5级以上的恢复。结论：经椎弓根椎间融合与AF治疗胸腰椎骨折，操作简单，复位可靠，可重建脊柱的稳定性，椎体间融合更符合生物力学内环境的持久稳定。     

维汉族BPH患者前列腺形态与尿流动力学的相关性

目的 探讨维汉民族前列腺增生患前列腺的体积、症状积分和膀胱排尿症状的相关性。方法 对71例住院手术的维汉不同民族前列腺增生症(BPH)患进行国际前列腺症状评分(BPSS)，生活质量评分(L)，前列腺体积(V)，重量(M)，患年龄(age)，尿流动力学指标的直线相关分析。结果 40例汉族及31例维族BPH患的前列腺体积与膀胱颈压，膀胱颈压与膀胱顺应性，最大尿流率与膀胱顺应性均呈正相关。结论 最大尿流率、前列腺体积、膀胱顺应性、膀胱颈压四个参数不但能了解膀胱排尿功能和形态改变，也可做为临床上手术切除增生前列腺组织，解除梗阻，缓解症状，评价治疗效果的指标。     

经后路一次切除半椎体治疗先天脊柱畸形

目的　回顾性分析 9例由先天性半椎体造成的脊柱侧弯和后凸畸形经后路一次半椎体切除植骨固定矫正术的手术治疗效果。方法　 9例患者 ,半椎体的位置在胸腰段或腰椎 ,手术采用后路切口 ,切除半椎体后 ,内固定矫正畸形 ,植骨融合 ,术后平均随访时间为 2 0 .6月 ,术前、术后拍摄站立位的脊柱正侧位片。结果　所有患者均有不同程度的侧弯和后凸畸形 ,侧弯角由术前的 37.7°矫正至 10° ,后凸角由术前 30 .5°矫正至 6°,躯干位移从 2 3mm恢复至 5mm ,无任何手术并发症 ,无内固定断裂脱落 ,均融合。结论　此手术方法对发育前期的患儿且半椎体位于胸腰椎或腰椎造成的先天性脊柱畸形 ,是一有效、安全的方法。     

桡骨远端不稳定性骨折手术与保守治疗疗效比较

目的　评价桡骨远端不稳定性骨折外固定器治疗与石膏固定的效果。方法　将桡骨远端不稳定性骨折患者随机分为两组 ,分别采用外固定器治疗和手法复位石膏固定治疗。用Dionst标准行功能评估、Stewart标准行解剖学评估。结果　外固定器组复位质量和疗效优于石膏组 (P <0 0 5 )。结论　桡骨远端不稳定性骨折行外固定器治疗是一种安全、简便、实用的方法。     

手术治疗男性膀胱颈挛缩(附42例报告)

目的：探讨手术治疗男性膀胱颈挛缩的疗效。方法：回顾性分析男性膀胱颈挛缩手术方法的选择及其疗效。结果：行膀胱颈Y—V成形术2例，膀胱颈Y—V成形术加后唇楔形切除术2例，经耻骨上前列腺切除术22例，经尿道膀胱颈狭窄环切除(TUR)8例以及TUR加经尿道前列腺电切术(TURP)8例。结论：TUR或TUR加TURP与其他手术治疗方法相比较，具有损伤小、出血少、疗效好、住院日短和康复快等优点。