内镜经鼻腔- 蝶窦入路垂体瘤切除 术后并发症分析

目的 探讨神经内镜下经鼻蝶垂体瘤切除术后并发症的原因、治疗方法及预防措施。方法 回顾 该院在神经内镜下经鼻蝶垂体瘤切除术的51 例患者临床资料,探究术后并发症的原因。结果 术后暂时性尿 崩症8 例,予弥凝替代治疗后痊愈出院;脑脊液鼻漏2 例,经严格卧床、腰大池引流,再次行内镜下封堵后治 愈;蝶窦感染1 例,升级抗生素治疗后痊愈;甲状腺功能减退3 例,予左旋甲状腺素替代治疗3 ～ 9 个月后 激素恢复正常;视力下降1 例,急诊内镜下清除止血纱、明胶海绵,患者视力开始逐渐好转,出院时和内镜探 查术前比较,左眼光感恢复,右眼视力尚可。结论 神经内镜经鼻蝶垂体瘤切除手术创伤小、视野清晰,术前 详细的风险评估,术中谨慎操作,可减少术后并发症的发生,提高垂体瘤患者的治愈率。     

缺氧诱导因子-1α反义寡核苷酸体外对胶质瘤U87细胞增殖和侵袭的影响

目的 观察缺氧诱导因子-1α(HIF-1α)反义寡核苷酸体外对人胶质瘤U87细胞增殖、凋亡和侵袭的影响.方法 人工合成的HIF-1α反义短发夹经阳离子脂质体包裹后瞬时转染人胶质瘤细胞株U87,采用Western blot法检测转染后胶质瘤细胞HIF-1α蛋白表达,证实转染成功,再采用噻唑蓝(MTT)比色法和Transwell小室体外侵袭实验检测转染后对U87细胞增殖体外侵袭能力的影响,流式细胞仪检测细胞凋亡.结果 转染靶向HIF-1α的短链发夹RNA的胶质瘤细胞,HIF-1α蛋白表达较空白细胞组明显降低,MTT法检测转染组、空载体组和空细胞组24 h细胞的增殖率分别为5.46%、21.25%、22.32%,体外侵袭性实验表明转染组、空载体组和空细胞组细胞12 h侵袭ECM的细胞数分别为(22±4)、(124±3)、(122±6);流式细胞仪检测表明转染组、空载体组和空细胞组细胞凋亡率分别为(53.35±2.80)%、(12.02±1.60)%、(10.19±3.15)%,转染组与空白细胞组及空载体组比较差异均有统计学意义(P＜0.05).结论 封闭HIF-1α蛋白的表达,可以抑制人胶质瘤U87细胞增殖和侵袭能力,促进细胞凋亡.

Abstract：

Objective To investigate the effects of antisense oligodeoxynucleotides (ODNs) targeting hypoxia inducible factor-1α (HIF-1α) on the apeptosis, proliferation and invasion of U87 glioma cell line. Methods Antisense ODNs were constructed and transfected into U87 cells by Dosper liposomal reagent. The HIF-1α gene expression was detected by Western blotting, the cell proliferative index was determined by methyl thiazol tetrazolium (MTT) assay, the cells cycle and apoptosis of the cells were examined by flow cytometry and the changes of the U87 cells invasive ability were measured by Transwell chamber.Results The protein expression of HIF-1α in U87 cells was down-regulated by HIF-1α ASONDN. The cell proliferative index in transfected group, empty vector group and control group was 5.46％, 21.25％and 22. 32％ respectively. Transwell chamber assay showed that the cell number in transfected group,empty vector group and control group was (22 ±4), ( 124 ±3) and ( 122 ±6) respectively; and the apoptosis rate was (53. 35 ± 2. 80) ％, ( 12.02 ± 1.60 )％, ( 10. 19 ± 3. 15 )％ respectively, and there was significant difference between transfected group and other groups ( P ＜ 0. 05 ). Conclusion Silencing the expression of HIF-1α protein can inhibit proliferation and invasion, and promote apoptosis of human glioma U87 cells. HIF-1α is expected to become a target for cancer therapy.     

^125I粒籽颅内植入内放射治疗脑胶质瘤（附9例报告）

目的 采用^125I粒籽颅内植入作胶质瘤内放射治疗，从而提高脑胶质瘤的疗效。方法我们2004年2月～20004年9月对9例脑胶质瘤病人采用手术切除肿瘤后，在瘤床及残余肿瘤内植入^125I粒籽作内放射治疗。观察内放射的并发症和肿瘤复发情况。结果本组9例中肿瘤全切除8例，次全切除1例。全部病例均植入^125I粒籽，平均总活度3．4mci。发生1例头发斑片脱落，1例切口部分渗出，有2cm长裂口经重新缝合后愈合。全部病例随访至今未见肿瘤复发。结论^125I粒籽植入脑胶质瘤，局部控制率高，并发症发生率低，是一种有效的治疗方法。对远期疗效还需进一步长期随访。     

手术时间对机械取栓病人术后症状性颅内出血及预后的影响

目的 探讨急性缺血性脑卒中病人进行机械取栓治疗时,手术时间对术后症状性颅内出血(symptomatic intracranial hemorrhage,sICH)及预后的影响.方法 回顾性分析145例行机械取栓治疗的急性缺血性脑卒中病人的临床资料.分别比较sICH组与无sICH组之间、预后良好组和预后不良组之间病人的临...     

外伤性气颅型颅高压症二例

开放性颅脑损伤,颅底骨折导致颅内大量积气,颅内压升高,出现神经系统症状和体征的病例临床罕见。本文报告2例如下。例1,男,26岁。1990年7月10日前额部跌伤,原发昏迷约30min,醒后头痛明显,呕吐频繁,左侧肢体轻偏瘫。体检:神清,右侧瞳孔(0.4cm)大于左侧     

颅脑外伤再次开颅17例经验教训

我院自1979～1986年底,因颅脑外伤行开颅术212例,其中再次开颅17例,约占8%。本文就再次手术原因及预防措施分析如下。一、临床资料1.一般资料:男12例,女5例,平均年龄48.1岁,50岁以上10例。车祸10例,跌伤5例,打击伤1例,挤压伤1例,其中后枕部着力9例,颞部6例,额部1例。11例伴     

对冲性颅骨骨折及硬脑膜外血肿2例报告

对冲性颅骨骨折合并硬脑膜外血肿，临床罕见，本科近16年来共遇到2例，均由手术证实，现报告如下。例l，女，63岁。1986年11月8日从拖拉机上跌下，右后枕部着地，当时有数分钟昏迷史，醒后4小时，病人再度昏迷，伴大、小便失禁。立即送来我院。检查：BP21／13kPa，深昏迷，GCS6分，右后枕部头皮挫裂伤，皮下可见约4cmX5cm头皮血肿，其它部位未见损伤。左侧瞳孔散大，约60mm，光反射消失，右侧正常。右侧肌力巨”，病理反射阳性。头颅CT提示：左侧额额顶硬膜外血肿，左侧颤颤叶脑挫裂伤，左侧颈骨骨折。立即行左侧额预顶硬脑膜外血肿清除…     

经眉弓锁孔手术切除巨大型垂体肿瘤(附11例报告)

目的　探讨巨大型垂体肿瘤经眉弓锁孔切除手术疗效。方法　沿右侧眉弓 (眉毛内 )作手术切口 ,额弓骨铣成 3cm× 2 .5cm大小的骨孔形成锁孔 ,在显微条件下分块切除肿瘤。结果　 11例巨大型垂体肿瘤患者 ,肿瘤全切除 8例 ,次全切除 3例 ,术后视力、视野改善 7例 ,无变化 4例 ,并发尿崩 2例。结论　本手术方法创伤小、恢复快 ,疗效满意 ,值得推广。     

-80℃保存机采浓缩血小板的研究

目的:探讨–80℃冰冻保存机采浓缩血小板的功能及止血效果。方法:随机抽取冰冻保存3个月之内、3～6个月之间、6～9个月之间的冰冻血小板样品于42℃解冻后进行相关实验,比较不同保存时期冰冻血小板的功能及回收率;分血液病组和非血液病组观察患者输注冰冻血小板24h后出血症状的控制及校正血小板增高指数CCI值。结果:冻存3个月内、3～6个月的两组冰冻血小板的黏附功能、聚集功能与新鲜机采血小板相比差异均无显著性(P>0.05),而冻存6～9个月的冰冻血小板的黏附功能与新鲜机采血小板相比则差异有高度显著性(P<0.01)。3组冰冻血小板的第Ⅲ因子活性测定与新鲜血小板相比,均在正常范围,平均回收率为85.2%。两组患者在输注冰冻血小板24h后能有效控制出血症状的比率平均为93.3%;而CCI值≥10000/μL的比率,非血液病组显著高于血液病组。结论:5%二甲基亚砜-80℃冰冻保存半年以内的机采浓缩血小板具有良好的止血功能。     

颅内夹层动脉瘤血管内栓塞治疗

目的 分析颅内夹层动脉瘤的临床特点,总结血管内栓塞治疗的经验.方法 对16例颅内夹层动脉瘤患者采用血管内栓塞治疗,其中3例采用单支架或双支架置入术,9例应用支架辅助下弹簧圈栓塞技术,3例使用球囊或弹簧圈辅助下球囊载瘤动脉闭塞术,1例使用单纯弹簧圈动脉瘤栓塞术.结果 16例中,动脉瘤完全闭塞9例(包括载瘤动脉闭塞病例),次全闭塞3例,不全闭塞4例(包括支架植入病例).随访6个月-3年,除早期1例死亡外,GOS结果评定:Ⅰ级8例,Ⅱ级4例,Ⅲ级2例,Ⅳ级1例.8例随访时脑血管造影,7例未见复发,1例瘤颈再通,正在随访.结论 根据颅内夹层动脉瘤的不同部位、不同病理特点,选择不同的血管内栓塞治疗方法,是治疗夹层动脉瘤安全、有效的方法之一.

Abstract：

Objective To analyze the clinical features of intracranial dissecting aneurysm and summarize the experience of its endovascular embolization. Methods 16 cases of intracranial dissecting aneurysm were treated by endovascular embolization. Among these 16 patients, 3 patients were treated with single stent or double stent placement technique, 9 patients were treated with stent- assisted coil embolization technique, 3 patients were ball artery occluded using the balloon - assisted or coil - assisted technique, and 1 patient was treated by simple coil embolization. Results Out of the 16 patients, 9 cases were completely occluded ( including parent artery occlusion cases ), 3 cases were subtotally occluded, 4 cases were incompletely occluded ( including cases of stent implantation ). Followed up for 6 months to 3 years, in addition to 1 case of early death, GOS evaluation results were respectively: grade Ⅰ 8 cases, grade Ⅱ 4 cases, grade Ⅲ 2 cases, grade Ⅳ 1 case. Cerebral angiography was carried out in 8 follow - up patients. No recurrence was watched in 7 cases, aneurysm neck recanalization was watched in 1 case, follow up was continued. Conclusion According to different localization of intracranial aneurysm and different pathological features, different methods of endovascular embolization are selected. It is the safe and effective treatment of dissecting aneurysm.