静脉性脑梗死动物模型的建立及相关研究

静脉性脑梗死动物模型的建立是通过不同的栓塞方法闭塞实验动物上矢状窦的不同部位，其目的是观察脑组织的血流量、血氧饱和度、脑组织水含量、脑灌注压、及各种影像学表现等参数指标的变化，从病理生理角度探讨静脉性脑梗死的发病机理及演变过程。     

侵及颅内主要静脉系统脑膜瘤的手术治疗

目的提高侵及颅内主要静脉系统脑膜瘤手术的全切率,总结利用显微外科技术切除肿瘤和处理颅内静脉系统的经验和技巧。方法我院1991年7月至2001年7月,手术治疗300例侵及颅内主要静脉系统的脑膜瘤,包括(1)矢状窦旁脑膜瘤;(2)大脑镰旁脑膜瘤;(3)小脑幕脑膜瘤;(4)横窦和窦汇区脑膜瘤;(5)镰幕脑膜瘤;(6)海绵窦脑膜瘤;(7)乙状窦脑膜瘤;(8)颈静脉孔区脑膜瘤。视肿瘤部位采用相应的手术入路,根据静脉系统受侵及的程度做不同的处理。结果按脑膜瘤切除的Simpson's分级,其中Ⅰ、Ⅱ级为全切除,全切率为86.7%,死亡率为1.7%。结论当脑膜瘤侵及不同的硬脑膜静脉窦或重要的颅内静脉时,手术处理方法不同。采用显微神经外科技术可提高脑膜瘤的全切率,并降低死亡率。     

Cleft closure for the treatment of unhealed perineal sinus

OBJECTIVE: Despite improvements in surgical practice, persistent perineal wound sinus is still a common complication after proctectomy. This study presents the success of a modified cleft closure technique in dealing with this problem. METHODS: From May 1997 patients with a persistent perineal sinus after surgery underwent a cleft closure - similar to that performed for patients with pilonidal sinus disease. RESULTS: Eight patients (6 male, 2 female) with an average age of 52 years underwent a cleft closure for a persistent perineal sinus after surgery. Four patients had undergone a proctocolectomy (ulcerative colitis), 2 an abdominoperineal excision of the rectum (adenocarcinoma) and 2 a proctectomy (1 Crohn's disease, 1 complication of diverticular disease). Symptoms had been present for an average of 41 months (range 5-152 months) and 3 patients had undergone other procedures attempted previously to deal with the problem. The first three patients had the procedure as an inpatient with an average stay of 4.7 days. The next 5 patients had the procedure as a day case (2 local anaesthetic, 3 general anaesthetic). Two patients developed a postoperative wound infection and all but one wound had healed completely by 8 weeks. In this patient the procedure was repeated to achieve healing. There was no other associated morbidity and no postoperative deaths. There have been no recurrences to date. CONCLUSION: Modified cleft closure for persistent perineal sinus is a simple procedure with low morbidity that can be performed under local anaesthetic in the day surgery unit.     

鼻内镜联合显微镜经鼻腔蝶窦及中颅窝手术

目的探讨鼻内镜下经鼻腔直接入路行蝶窦及中颅窝手术的方法. 方法鼻内镜下经较宽大一侧鼻腔将中鼻甲向外推移,鼻腔扩张器扩大视野,直达并开放蝶窦前壁, 鼻内镜与显微镜联合切除病变. 结果 10例孤立性蝶窦炎术后症状消失.6例蝶窦囊肿、脑膜瘤均一次手术切除.32例垂体腺瘤17例全切除,12例次全切除,3例大部分切除,术后补充X刀治疗.48例术后随访6个月～3.5年,平均2.5年,蝶窦囊肿、蝶窦炎、脑膜瘤无复发,3例垂体腺瘤复发,无颅内感染并发症,无鼻腔粘连、鼻出血等鼻腔并发症. 结论鼻内镜联合显微镜经鼻腔蝶窦及中颅窝手术损伤小、出血少、手术时间短、效果好.     

海绵窦上段动眼神经的应用解剖研究

目的：探讨海绵窦上段动眼神经的应用解剖并讨论其临床意义。方法：经血管灌注后观测10例尸颅的海绵窦上段动眼神经及其毗邻与血供。结果：海绵窦上段动眼神经与海绵窦上段背侧紧邻海马钩回，内侧与视交叉、后交通动脉毗邻，外上与脉络膜前动脉相邻，腹侧紧贴鞍背突。海绵窦上段动眼神经80％未见神经外营养血管，可见20％后交通动脉发出1～2根分支进入神经。结论：海绵窦上段动眼神经毗邻结构复杂，滋养血管细小；在海绵窦上缘手术时，应特别注意辨认和保护动眼神经。     

经结膜下穹隆至上颌窦插管术治疗泪道阻塞的临床研究

采用经结膜囊下穹隆至上颌窦插管的术式引流泪液，治疗泪道阻塞引起的溢泪症，获得较为满意的效果。手术的主要步骤是：局麻后于结膜囊下穹隆内1／3区作一4mm长的结膜切口，自筋膜下分离至眶线下5mm。从切口伸入上颌窦骨钻钻通上颌窦顶壁，插入长短适度的义管，并向管内注入生理盐水，证实有液体流入鼻咽部后，固定义管。术后定期冲洗，无需拆线，应用这种术式治疗泪道阻塞引起的溢泪症218眼，其中溢泪完全消失151眼占82．1％，溢泪减轻的27眼占14．6％，总效率96．7％。     

Atypical Form of the Fourth Criterion for Transient Entrainment

The typical fourth criterion for transient entrainment is defined when both a sudden shortening in conduction interval to and a distinct change in electrogram morphology at a bipolar recording site are demonstrated while performing overdrive pacing of a reentrant tachycardia from a single pacing site at two different constant rates. The purpose of this article was to test the hypothesis that if an intracardiac recording site showing both orthodromic and antidromic capture with entrainment pacing is located suitably distant from the circuit, sudden shortening in conduction interval to that site may occur without any significant change in the bipolar electrogram morphology (i.e., atypical form of the fourth criterion). Atrial overdrive pacing of orthodromic tachycardia was performed in 20 patients with either left anterior (12 patients) or left posterior (8 patients) accessory pathways. We investigated the effects of overdrive pacing from the proximal or distal coronary sinus, specifically effects on the electrogram interval and the electrogram morphology at the right atrial appendage. Overdrive pacing of orthodromic tachycardia from the proximal coronary sinus was performed in 10 of the 12 patients with left anterior accessory pathways; those 10 patients demonstrated the first entrainment criterion at the right atrial appendage site. Overdrive pacing of orthodromic tachycardia at still shorter cycle lengths demonstrated a sudden shortening in conduction interval to the right atrial appendage site. Despite shortening in conduction interval the morphology of the right atrial appendage electrogram was completely or almost identical to that during orthodromic tachycardia, indicating an atypical form of the fourth criterion. This criterion was not demonstrated in patients with left posterior accessory pathways. Thus, atypical fourth entrainment criterion was demonstrated during overdrive pacing of orthodromic tachycardia from the proximal coronary sinus only in patients with left anterior accessory path ways. Demonstration of atypical fourth criterion seems largely dependent on the location of the accessory pathway, the pacing, and the recording sites.     

A new operational approach for the piriform sinus fistula

It has been well documented that piriform sinus fistulae often cause suppurative thyroditis; however, when a piriform sinus fistula does not present this symptom, making a correct diagnosis is very difficult. We have experienced 11 cases of a piriform sinus fistula. The conventional operational approach was performed in the initial eight patients, among which there were four recurrences in two patients. Therefore, a new operational approach was introduced for the three most recent cases and one recurrent case. First, the existence of the internal orifice of the fistula is confirmed with a laryngoscope, after which a transverse incision on the neck is made and the abscess dissected. The side wall of the piriform sinus is then opened with the help of a laryngoscope and the bottom part of the mucosa of the sinus transected with the internal orifice of the fistula, after which the fistula is removed en bloc with the bottom part of the sinus and abscess cavity. Using this operation, we experienced no complications and there has been no recurrence so far.This paper was presented at the 23rd Annual Meeting of Pacific Association of Pediatric Surgeons, June 1990 in Kona, Hawaii.     

神经导航在经单鼻孔入路垂体腺瘤切除术的应用

目的 探讨神经导航系统在经单鼻孔入路垂体腺瘤切除术中的应用技术及对鞍区解剖结构识别的价值。方法 对39例垂体腺瘤使用StealthStation神经导航系统进行指导定位、识别入路相关的解剖结构并引导手术操作。结果 平均注册误差为2．3mm（1．6～3．3mm），肿瘤全切除32例，次全切除4例，大部切除2例。部分切除1例。未全切除病例主要是肿瘤巨大、向海绵窦侵袭性生长、质地坚硬或血供异常丰富者。结论 神经导航系统提供了准确可靠的定位，能够准确指示中线结构、鞍底和颈内动脉，有效地减轻了创伤，使之成为良好的手术辅助工具。     

超声心动图对主动脉窦瘤破裂合并畸形的诊断价值

目的 评价超声心动图对主动脉窦瘤破裂合并畸形的诊断价值，探讨漏诊原因，以提高诊断阳性率。方法 回顾分析23例主动脉窦瘤破裂合并畸形的超声心动图特征，比较超声心动图与手术诊断结果。结果 超声心动图对主动脉窦瘤破裂合并畸形诊断符合率为86．95％（20／23），漏诊率为13．04％（3／23）。结论 超声心动图检查对诊断主动脉窦瘤破裂合并畸形有重要的临床价值，全面掌握超声知识，仔细认真地检查可避免漏诊。