巨大垂体腺瘤二次经蝶手术30例分析

目的探讨巨大垂体腺瘤二次经蝶手术策略、技巧及术后并发症处理方法。方法回顾性分析30例巨大垂体腺瘤二次经蝶手术病人的临床资料,对手术切除程度、术后症状、激素水平变化及并发症处理等进行总结和分析。结果术后病理结果显示：无功能性腺瘤22例,其中无功能性促肾上腺皮质激素腺瘤1例;生长激素腺瘤8例。功能性垂体腺瘤病人术后激素水平均不同程度下降。术后并发一过性尿崩症9例,脑脊液鼻漏4例,无死亡或严重并发症病例。术后3个月行MRI复查17例,肿瘤全切除4例,次全切除7例。部分切除6例。结论对单纯经蝶或经颅入路均无法一期全切除或术后随访肿瘤复发的巨大垂体腺瘤病例．二次经蝶手术应作为首选治疗方法。     

高级别颅内动静脉畸形的治疗策略及并发症防治

目的探讨高级别颅内动静脉畸形（arteriovenous malforation,AVM）的治疗策略及并发症防治。方法回顾性分析13例高级别AVM病人的临床资料,采用显微手术为主结合介入和（或）放射治疗。术中均应用自体血回吸收技术,2例术前行AVM部分栓塞．1例行分次手术,2例术后病变残留病人行伽马刀治疗。结果无死亡病例;1例术前持续昏迷,术后轻度改善;其余病例均得到较好恢复。AVM全切除11例,次全切除2例。随访11—59个月,GOS评分：5分10例,4分2例,3分1例。结论娴熟的显微神经外科技术、科学的个体化治疗方案的制定是取得高级别AVM良好疗效的重要因素。术前辅助行栓塞技术,术中应用自体血回收技术,术后放射治疗,可以降低并发症的发生。     

游离旋髂浅动脉皮瓣修复足部皮肤缺损的临床应用

目的探讨游离旋髂浅动脉皮瓣修复足部皮肤缺损的临床效果。方法 2015年5月—2017年4月周口淮海医院采用游离旋髂浅动脉皮瓣修复足部皮肤缺损13例,其中男性10例,女性3例;年龄13～65岁,平均37. 5岁。致伤原因:道路交通伤4例,机械绞伤3例,压砸伤6例。皮肤软组织缺损范围4. 0cm×6. 5cm～9. 0cm×12. 5 cm,创面均不同程度存在泥沙、碎屑等异物残留,并伴有足部的肌腱、骨骼等深部组织损伤外露。皮瓣切取范围为5. 0cm×7. 0cm～10. 0cm×14cm,其中急诊修复4例,经清创术后应用VSD技术处理7～10d,择期修复创面9例。结果 11例皮瓣完全成活,2例皮瓣边缘局部皮肤坏死,经拆线、换药等对症治疗后创缘愈合。供区切口均Ⅰ期愈合。13例经术后6个月～2年随访,皮瓣外形满意及足部功能恢复满意,无皮肤破溃及磨损现象,患足负重、行走功能恢复良好。结论应用游离旋髂浅动脉皮瓣修复足部皮肤缺损,临床效果良好。     

神经内镜辅助下经乙状窦后入路显微手术切除大中型听神经瘤

目的 探讨神经内镜辅助下经乙状窦后入路显微手术切除大中型听神经瘤的效果。方法 回顾性分析2019年5月至2022年5月神经内镜联合显微镜经乙状窦后入路手术治疗的16例大中型听神经瘤的临床资料。结果 16例肿瘤均全切除,面神经解剖保留14例（87.5%）,术后面神经功能依据House-Brackmann分级Ⅰ级5例,Ⅱ级6例,Ⅲ级3例。术后无脑脊液漏及颅内感染。术后随访3~24个月,复查MRI增强未见肿瘤复发。结论 神经内镜辅助显微手术切除切除大中型听神经瘤,有助于减少手术创伤,减少脑脊液漏等并发症,保护面听神经功能,提高肿瘤全切除率。     

显微手术治疗颅内动脉瘤术后CVS发生的相关因素及对预后的影响

目的  探讨显微手术治疗颅内动脉瘤的临床效果,并分析影响术后脑血管痉挛（CVS）发生的相关因素及对预后的影响。方法  回顾性分析2009年5月-2013年5月于郑州人民医院收治的128例颅内动脉瘤患者的临床资料。评价总体治疗效果,并分别应用单因素及Logistic多因素分析影响患者术后CVS发生的相关因素及对预后的影响。结果  128例患者总体治疗效果良好,术后发生CVS 32例（25.00%）,与非CVS组比较,CVS组术后治愈率显著下降,而死亡率显著上升,差异有统计学意义（P <0.05）。经单因素分析可知,影响患者显微手术术后CVS发生的相关因素包括年龄、Hunt-Hees分级、Fisher’s分级、动脉瘤位置、手术时机、感染、基础疾病、终板造瘘、腰穿次数、血糖及白细胞水平。经Logsitic多因素进一步分析可知,Hunt-Hees分级、Fisher’s分级、动脉瘤位置、终板造瘘、腰穿次数是影响显微手术治疗颅内动脉瘤术后CVS发生的独立危险因子,并影响预后。结论  显微手术治疗颅内动脉瘤临床效果良好,但须防范Hunt-Hees分级、Fisher’s分级、动脉瘤位置、终板造瘘、腰穿次数等影响术后CVS发生的独立危险因素,改善颅内动脉瘤患者预后。

     

A minimally invasive surgical technique with an enamel matrix derivative in the regenerative treatment of intra-bony defects: a novel approach to limit morbidity

AIMS: This study was undertaken to describe a new surgical approach (minimally invasive surgical technique, MIST) and to evaluate preliminarily its clinical performance and patient perception associated with the application of enamel matrix derivative (EMD) in the treatment of isolated deep intra-bony defects. METHODS: Thirteen deep isolated intra-bony defects in 13 patients were surgically accessed with the MIST. This technique was designed to limit the mesio-distal flap extension and the corono-apical reflection in order to reduce the surgical trauma and increase flap stability. The incision of the defect-associated papilla was performed according to the principles of the papilla preservation techniques. EMD was applied on the debrided root surfaces. Stable primary closure of the flaps was obtained with internal modified mattress sutures. Surgery was performed with the aid of an operating microscope and microsurgical instruments. Clinical outcomes were collected at baseline and at 1 year. Intra-operative and post-operative patient perception was also recorded. RESULTS: Early wound healing was uneventful: primary wound closure was obtained and maintained in all sites with the exception of one site with a small wound dehiscence at week 1. No oedema or haematoma were noted. Patients did not report any pain. Three patients experienced slight discomfort for 2-days post-operatively. The 1-year clinical attachment level (CAL) gain was 4.8+/-1.9 mm. The 1-year percent resolution of the defect was 88.7+/-20.7%, and reached 100% of the baseline intra-bony component in seven sites. Residual probing depths (PD) were 2.9+/-0.8 mm. Differences between baseline and 1-year CAL and PD were both clinically and statistically highly significant (p<0.0001). A minimal increase of 0.1+/-0.9 mm in gingival recession between baseline and 1 year was recorded (p=0.39). CONCLUSIONS: This case cohort indicates that MIST associated with EMD resulted in excellent clinical improvements while limiting patient morbidity. These preliminary findings need to be confirmed in a larger study.