用二维电离室阵列对螺旋断层治疗的调强计划进行剂量验证

Objective To investigate the feasibility of dose verification of intensity modulated (IM) planning of helical tomotherapy (HT) using two-dimensional ion chamber array (2DICA),and develop an efficient way to validate the dose delivered under the parameters mirroring those during the treatment. Meth-ods A 2DICA,I'mRT MatriXX and MULTICube equivalent solid water phantom from IBA company were used to verify the dose distribution of 10 IM planning. The combined phantom was set up to measure the dose distributions on coronal and sagittal surface. The precise setup of phantom was guided by HTMVCT images. After the irradiation, the measured dose distributions on the coronal and sngittal plane were compared with those calculated by the IM planning system for verification. The results were evaluated and the feasibility of the different measuring methods was studied. Results The dose distribution measured by the MatriXX 2DICA was well consistent with that calculated by the treatment planning system. The errors between the measured dose and predicted dose in the selected points were within ±3%. In the comparison of the pixel-segmented ionization chamber versus treatment planning system using the 3 mm/3% γ criteria, the passing ratio of pixels with γ parameter ≤1 was 97.76% and 96.83%, respectively. Conclusions MatriXX is a-ble to measure the absolute and relative dose distributions simultaneously,which can be used for dose verifi-cation of IM planning.     

显微血管神经减压在神经外科临床的应用

显微血管神经减压在神经外科临床的应用解放军第一六三医院王连元，孙念胜，郭国华，卢明，姚兴发，彭立辉显微血管神经减压治疗三叉神经痛、面肌抽搐及舌咽神经痛，国内外已有不少报道。但治疗神经原性高血压则报道不多，我院自１９８６年以来开展射频治疗三叉神经痛、面...     

岩斜区脑膜瘤的临床治疗研究

【目的】通过65例岩骨尖斜坡区脑膜瘤临床外科治疗的疗效分析,探讨显微手术切除岩斜区脑膜瘤的手术方法及术后疗效,达到提高显微手术的全切率,总结临床治疗经验。【方法】熟练掌握肿瘤与岩骨尖斜坡区周围解剖关系,总结65例岩骨尖斜坡区脑膜瘤的临床表现,手术入路,手术结果和术后处理。【结果】肿瘤全切除50例(77％),死亡4例(6．1％)。经岩骨乙状窦前幕上下联合入路30例,全切除20例(66．7％),死亡3例(10％)。【结论】选择好手术入路和运用好显微外科技术可以提高岩骨尖斜坡区脑膜瘤的切除率,加强手术后的临床治疗可降低病死率。     

脑外伤及颅脑手术后急性脑血管病的早期诊断和治疗

急性脑血管病在正常情况下发作时较易作出诊断,但是,在脑外伤或颅脑手术后发作,则由于脑血管病的临床表现和头部ＣＴ等检查的某些特点常被脑外伤或脑手术损伤所掩盖,尤其是伤前或术前无症状者,加之伤后或术后病情的限制常舍弃了脑血管造影等检查,因此,极易被漏诊和误诊,延误治疗。１９９４～１９９８年,作者等诊治此类患者３９例,效果满意。现就其早期诊断和治疗问题总结如下。１　临床资料１．１　一般资料　本组３９例,男性２４例,女性１５例,平均年龄５２（２～７６）岁。其中脑挫裂伤或伴硬膜下小血肿１９例,硬膜下血肿清…     

用二维电离室阵列对螺旋断层治疗的调强计划进行剂量验证

目的 研究采用二维电离室阵列对螺旋断层治疗(HT)的调强计划实施剂量验证的可行性,寻求建立一套临床上针对该条件下患者治疗更为有效的剂量验证方法 .方法 采用IBA公司I'mRT MatriXX二维电离室阵列及其相配套MULTICube等效同体水模体对10例患者HT的调强计划实施验证.分别对二维电离室阵列实行冠状及纵向位测量,并获取模体中阵列轴平面和纵断面剂量分布.通过HT系统兆伏级CT图像实现模体精确配准及校正,以确保二维电离室阵列摆位准确性.束流照射后将二维阵列剂量测量平面分布与HT计划系统模体计划中计算平面结果 进行比较,定性或定量分析其绝对剂最及相对剂量验证情况.探讨其不同位置摆放来实现其测量方法 的可行性.结果 定性或定量分析所测量与计算绝对剂量点及相对剂量分布的结果 均显示出了较好一致性,点绝对测量与计算剂量偏差保持在±3%以内.MatrXX阵列测量的相对剂量分布与治疗计划系统模体中计算平面相比较,采用了Gamma法(3 mm或3%)进行2 mm栅格精度分析,γ≤1像素点平均通过率分别为97.76%、96.83%.结论 MatriXX二维电离室阵列可较好地进行绝对剂量及相对剂量测量,能较好地实现调强计划的剂量验证.     

用二维电离室阵列对螺旋断层治疗的调强计划进行剂量验证

Objective To investigate the feasibility of dose verification of intensity modulated (IM) planning of helical tomotherapy (HT) using two-dimensional ion chamber array (2DICA),and develop an efficient way to validate the dose delivered under the parameters mirroring those during the treatment. Meth-ods A 2DICA,I'mRT MatriXX and MULTICube equivalent solid water phantom from IBA company were used to verify the dose distribution of 10 IM planning. The combined phantom was set up to measure the dose distributions on coronal and sagittal surface. The precise setup of phantom was guided by HTMVCT images. After the irradiation, the measured dose distributions on the coronal and sngittal plane were compared with those calculated by the IM planning system for verification. The results were evaluated and the feasibility of the different measuring methods was studied. Results The dose distribution measured by the MatriXX 2DICA was well consistent with that calculated by the treatment planning system. The errors between the measured dose and predicted dose in the selected points were within ±3%. In the comparison of the pixel-segmented ionization chamber versus treatment planning system using the 3 mm/3% γ criteria, the passing ratio of pixels with γ parameter ≤1 was 97.76% and 96.83%, respectively. Conclusions MatriXX is a-ble to measure the absolute and relative dose distributions simultaneously,which can be used for dose verifi-cation of IM planning.     

显微手术切除岩斜区巨大脑膜瘤的策略和技巧

目的 探讨显微手术切除岩斜区巨大脑膜瘤的策略和技巧。方法 总结35例岩骨头斜坡区巨大脑膜瘤的临床表现，显微手术方法、手术结果和术后处理。结果 肿瘤全切除21例（60%），死亡2例（5.7%），其中经岩骨乙状窦前幕上下联合入路22例，全切除18例（82%），无死亡。结论 根据术前与术中的策略，选择好手术入路和运用好显微外科术可以提高岩骨尖斜坡巨大脑膜瘤的切除率，降低手术病死率。     

额颞骨瓣开颅加Weber-Fergusson手术切除累及颅眶鼻腔鼻窦肿瘤

目的：探讨额颞骨瓣开颅加Weber-Fergusson手术切除累及颅眶的鼻腔鼻窦肿瘤的疗效。方法：采用额颞骨瓣开颅加Weber-Fergusson切口手术切除侵犯颅眶的鼻腔鼻窦肿瘤9例。结果：肿瘤全切除7例，大部切除2例，无手术死亡及严重颅脑并发症病例。随访2～8年，死亡4例，5例无瘤生存。结论：此手术方法不仅能完整地切除肿瘤，而且可一期切除肿瘤后修复颅底及硬脑膜缺损，有效地预防了脑脊液鼻漏和颅内感染等并发症的发生，是较为理想的外科手术入路。     

严重颅脑损伤病人的护理

重度颅脑外伤是最严重的外伤之一,早期正确的临床诊断和护理对及时发现病情变化、判断有否手术探查指征、稳定病情和防治并发症等有重要意义.加强临床观察,防止并发症发生,合理的营养支持,有助于减少病死率,提高治愈率和生存质量.本院自2001年1月至2004年12月收治重型颅脑损伤518例,现将护理体会报道如下     

176例外伤性脑脊液漏的临床分析

【目的】了解颅底骨折部位及其与脑脊液漏发生之间的关系，探求有效的治疗方法。【方法】分析近9年来本院收治的716例颅底骨折患者脑脊液漏的发生率、发生部位、治疗方法及效果。【结果】脑脊液漏共176例，发生率为24．6％。发生于前颅窝者112例，中颅窝者46例，前中颅窝者18例。150例经保守治疗痊愈，26例手术治疗，其中20例经一次手术痊愈，6例经二次手术痊愈。26例手术病人中，有10例和五官科医师合作在鼻内窥镜下结合腔内摄像系统经鼻行脑脊液漏修补一次成功，其中包括经颅内修补失败后4例经鼻内窥镜手术成功。【结论】颅底骨折部位，脑脊液漏口大小。决定了治疗方案的选择。鼻内窥镜下手术具有副损伤小。瘘孔定位准确．可作为脑脊液漏治疗的一种补充手段。