垂体腺瘤经蝶手术中脑脊液漏的处理

目的 分析垂体腺瘤经蝶手术中脑脊液漏的原因和发生率,探讨术中修补蝶鞍治疗脑脊液漏的方法.方法 回顾性分析1998年1月至2008年5月手术治疗的118例垂体腺瘤患者的临床资料,经蝶手术134例次.术中蝶鞍修补采用两种方法:第一种以自体脂肪组织填充蝶鞍和蝶窦,以自体骨片修补鞍底骨质缺损;第二种以氧化纤维素片、人纤维蛋白明胶海绵和生物胶修补鞍膈及鞍底硬膜缺损,并以自体脂肪组织填充蝶鞍.计算各种垂体腺瘤的比例及其术中、术后脑脊液漏的发生率,所得数据进行统计学分析.结果 生长激素腺瘤患者术中脑脊液漏发生率(26.5%,9/34)明显高于其他类型垂体腺瘤(13.0%,13/100)(P＜0.05).侵袭性垂体腺瘤患者术中脑脊液漏发生率(21.1%,8/38)高于非侵袭性垂体腺瘤(14.6%,14/96)(P＜0.05).术中见鞍膈下降、肿瘤全切除患者术中脑脊液漏发生率(18.7%,20/107)高于部分切除患者(7.4%,2/27)(P＜0.05).采用第二种方法修补蝶鞍的患者手术10例次,其术后无脑脊液漏发生,术后出现并发症1例次(10.0%);而采用第一种方法修补蝶鞍的患者手术12例次,其术后发生脑脊液漏3例次(25.0%),术后出现并发症4例次(33.3%).结论 垂体腺瘤经蝶手术中发生脑脊液漏时以氧化纤维素片、人纤维蛋白明胶海绵和生物胶修补鞍膈和鞍底硬膜缺损的方法可靠,术后无脑脊液漏发生.     

改良微创颅内血肿清除术治疗大量脑出血的临床观察

目的：探讨微创颅内血肿清除术应用于治疗高血压大量脑出血的可行性。方法：选择高血压脑出血病人25例行微创手术治疗、25例行小骨窗手术治疗,从格拉斯哥评分、再出血机率、血肿残留量、颅内感染率、病死率5个方面进行对比。结果：微创治疗组和小骨窗手术组比较：3天后格拉斯哥评分、5天后血肿残留量、再出血率、颅内感染率和病死率均无统计学意义。结论：改良微创颅内血肿清除术可以应用予大量脑出血的治疗。     

微创血肿清除术配合中药逐瘀利水汤治疗急性脑出血61例

目的观察颅内血肿微创清除术配合逐瘀利水方治疗急性脑出血的疗效。方法选择120例急性高血、压脑出血患者,随机分为手术组、手术加中药组,治疗前后观察神经功能缺损程度、临床疗效、血肿吸收情况。结果颅内血肿微创清除术后加用中药组61例与59例单纯手术组进行对照,加服中药组疗效优于单纯手术组,P〈0．05。结论颅内血肿微创清除术后加用中药疗法可显著提高临床疗效,改善神经功能缺损,加速血肿吸收。     

腰椎管狭窄症术后迟发性血肿形成相关因素分析

目的:探讨腰椎管狭窄术后迟发性血肿形成的各种相关因素。方法与结果:本院2年来共行腰椎管狭窄手术241例,其中3例患者术后并发血肿,且均为迟发性,发生率为1.3%。3例患者均采用后路全椎板减压植骨融合内固定术,出现血肿压迫症状时间,最长术后5天,最短2天,平均为3天,分别于血肿发生后4～12h内行血肿清除术及止血,血肿清除后4～6h运动及感觉等功能开始恢复。结论:术后引流不畅是形成迟发性血肿的最主要因素,止血不彻底及处理不当、抗凝剂的应用也增加了血肿形成的可能。     

心肌壁内血肿的诊治进展

心肌壁内血肿是指心肌出血或冠状动脉破裂引起的血液在心肌内(心外膜下)积聚,从而引发一系列病理改变及临床表现的一种病症,该疾病本身在临床上并不常见,国内外文献偶有报道,但严重的心肌壁内血肿可导致心脏破裂或压塞而危及生命,需要临床医师对其发病原因、分类、诊断及治疗加强认识.     

脑出血血肿体积动态演变的相关因素及CT定量评价

目的探讨脑出血血肿体积动态变化规律。方法使用脑出血血肿体积测量软件测算脑出血血肿体积,对血肿体积扩大及吸收分别进行分析。结果血肿扩大与出血部位、血肿形态、慢性肝病及长期饮酒史有关。血肿吸收组于第1天、第3天及第7天复查,血肿平均吸收比率分别为9．31％、16．04％、28．05％;首次出血量分别为〈10ml、10～20ml、20～30ml者血肿吸收比率依次减小。结论出血部位、血肿形态、慢性肝病及长期饮酒史是脑出血后血肿扩大的相关因素;血肿吸收速度与首次出血量相关：首次出血量小吸收快,反之则越慢;血肿吸收组随时间进展,吸收速度增快。     

Medicinal leeches for the treatment of venous congestion and hematoma after plastic reconstructive surgery

Background: Leeches were used for medical purposes as long as 2 000 years ago in ancient Egypt. In recent years the use of medicinal leeches became rather popular again, e. g. to improve blood circulation in ischemic tissue after reconstructive plastic surgery. Patients and Methods: In a single center, retrospective study 23 consecutive cases were analyzed in which medicinal leeches had been used therapeutically after plastic reconstructive surgery. All cases were categorized regarding the indication for leech therapy, the onset, the duration, the number of leeches and the number of sessions. Results: Among the group of patients there were 7 female and 16 male patients with a mean age of 73 ± 14 years (48–94 years) altogether. The main indications were venous congestion (12/23; 52 %) and hematoma (9/23; 39 %). Two cases were diagnosed with a necrosis of the tip of the flap and therefore received leech therapy (2/23; 9 %). The average number of leeches was 2.6 leeches/session, the number of sessions was 1.7 ± 0.8. 20/23 patients (87 %) showed a restitutio ad integrum after leech therapy, in 3/23 patients (13 %) a necrosis of the tip of the flap could not be prevented. A clinical improvement was noticed after an average of 1.1 ± 0.3 days. Conclusions: The early application of medicinal leeches can improve local hemodynamic conditions. Leech therapy is a simple and effective method; the cost efficiency of the treatment is high.     

化瘀涤痰方治疗慢性硬膜下血肿临床研究

目的:观察化瘀涤痰方对慢性硬膜下血肿(CSDH)的治疗作用。方法:将58例CSDH患者随机分为治疗组31例和对照组27例。采用多田氏法计算2组初诊和每疗程的血肿量变化,同时观察2组初诊和每疗程眩晕及肢体麻木症状变化的情况。结果:总有效率治疗组为87.10%,对照组为51.85%,2组比较,差异有非常显著性意义(P<0.01)。对照组治疗前后血肿量变化比较,差异有非常显著性意义(P<0.01);治疗组治疗前后血肿量变化比较,差异有非常显著性意义(P<0.01)。2组间治疗后血肿量比较,差异有非常显著性意义(P<0.01)。治疗组眩晕症状改善率为83.33%,对照组为57.89%,2组比较,差异有非常显著性意义(P<0.01)。治疗组肢体麻木症状改善率为88.89%,对照组为50.00%,2组比较,差异有非常显著性意义(P<0.01)。结论:化瘀涤痰方治疗CSDH,可在一定程度上加快血肿吸收,改善患者眩晕及肢体麻木症状。     

Organized hematoma of the maxillary sinus

OBJECTIVE: Organized hematoma of the maxillary sinus can develop by means of organization of hematoma in the unaerated maxillary sinus. To our knowledge, this is only the second article describing organized hematoma in the maxillary sinus. MATERIAL AND METHODS: We have observed eight cases of organized hematoma of the maxillary sinus recently and here we describe the clinical features (using CT scans and medical records), radiologic characteristics and pathologic findings. RESULTS: The patients comprised five males and three females (mean age 58 years), all of whom had a history of frequent epistaxis. They also complained of nasal obstruction, hyposmia, headache and swollen cheeks. Rhinoscopy revealed obliterated nasal cavities due to bulging lateral walls. CT scans showed soft-tissue densities expanding the maxillary sinus into the nasal cavity. The treatment modalities used (applied either alone or in combination) were Denker's operation, Caldwell-Luc's operation and endonasal endoscopic surgery, and the outcomes were successful. CONCLUSION: Organized hematoma should be included in the differential diagnosis when patients have frequent epistaxis and an expansile mass in the maxillary sinus.     

急性自发性椎管内硬膜外血肿的临床特征及治疗

目的:总结急性自发性椎管内硬膜外血肿(acute spontaneous spinal epidural hematoma,ASSEH)的临床和影像学特征,探讨其治疗方法及预后.方法:收集我院2005年1月～2020年12月收治的27例ASSEH患者的临床和影像学资料,回顾性分析病因、临床表现、影像学特征、治疗过程、手...