大,巨型垂体腺瘤的手术入路选择

自１９９０年以来收治直径在２－５．６ｃｍ的大、巨型垂体腺瘤３３例。依肿瘤生长形态与扩展范围将其简略分为三种类型。Ａ型：瘤体位于鞍内或侵入蝶窦；Ｂ型；瘤体呈椭圆形或哑铃向鞍上扩展，三脑室明显移位抬高；Ｃ型：瘤体巨大侵入三脑室阻塞室间孔或明显的鞍周扩展。     

改良Sugiura术与青木春夫式断流术的比较

目的评价改良Sugiura术的疗效。方法回顾性分析2001年3月～2004年12月施行的改良Sugiura术50例患者的临床资料，并与随机抽取的以往施行的青木春夫式断流术50例做比较。结果改良Sugiura术：术后发生并发症10例，手术死亡5例，远期出血5例，肝性脑病3例，术后死亡4例；青木春夫式断流术：术后发生并发症7例，手术死亡2例，远期出血6例，肝性脑病2例，术后死亡4例，上述指标两者比较差异均无统计学意义，P〉0．05。改良Sugiura术手术时间和住院时间分别为（2．6±0．9）h、（27．5±10．5）d，显著短于青木春夫式断流术的（3．8±0．8）h和（53．2±34．2）d，P〈0．01。结论改良Sugiura术总体疗效肯定，是一种较好的青木春夫式断流术的替代手术，其操作简便，手术时间和住院时间短，值得临床推广。     

翼点入路开颅手术中面神经额支的保护

目的:评价翼点入路开颅术中筋膜下分离技术保护面神经额支的有效性。方法 :经翼点入路开颅患者共 6 0例 ,随机分为 A、B两组 ,A组采用筋膜间翼点入路 ,B组采用筋膜下翼点入路 ,每组各 30例。结果 :采用筋膜间入路面神经额支保护率为 70 .0 % ,采用筋膜下分离技术面神经额支保护率为 96 .7% ,两组差异有显著性 (P <0 .0 1)。 结论:与筋膜间分离技术比较 ,翼点入路中采用颞肌筋膜下分离技术能更有效地保护面神经额支     

危险管理法在农村儿童保健中应用效果评价

在儿保领域应用危险管理法目的是充分利用有限的卫生资源,减轻基层儿保人员负担,提高儿保服务效果和儿童健康水平。通县农村于1990年以来婴幼儿保健中应用危险管理法的研究显示,高危儿健康状况在加强管理后与非高危儿的相近;实验组与对照组儿童在婴幼儿期的死亡及婴幼儿后期生长发育方面差别无统计学意义;儿童满5岁时,两组生长发育水平无显著性差别。提示在我国有限卫生资源基础上,应用危险管理法于儿保领域有重要现实意义。     

Oblique transcorporeal approach to anteriorly located lesions in the cervical spinal canal

Summary The technique of obliquely drilling out the postero-lateral part of the cervical vertebral bodies is described. It uses the antero-lateral (retro carotico-jugular) approach to control and displace the vertebral artery postero-laterally and to expose the lateral aspect of the vertebral bodies. It provides, through a wide field and with minimal retraction of the carotid artery and the internal jugular vein, an extensive view of the anterior aspect of the spinal cord. It has already been used to treat 15 anterior lesions compressing the spinal cord including neurinomas and osteophytes.     

A Biotin–Avidin-Based Enzyme Immunoassay for βh-Endorphin

An avidin–biotin enzyme-linked immunosorbent assay (ELISA) is described for _h-endorphin (_h-EP). Microtiter plates coated with commercially available antibodies were used together with _h-EP tracer derivatives that were biotinylated in positions 24, 28, and 29 via a C₆ spacer arm. Nonspecific binding of biotinylated derivatives to the microtiter plates was blocked with a mixture of 1% casein and 10% ethanolamine in 0.1 M NaHCO₃. A sequential saturation procedure using a high-affinity antiserum in combination with an avidin–alkaline phosphatase complex matched the sensitivity of reported radioimmunoassays (RIAs), with a detection limit of 0.5 fmol/assay. The intra- and interassay coefficients of variation were 5 and 12%, respectively. Results obtained by ELISA and RIA showed good correlations (r = 0.95). The -EP concentration in extracted rat plasma after high-performance liquid chromatographic (HPLC) fractionation was determined by this method to be 1600 fmol/ml.     

Primary cerebral neuroblastoma (neurocytoma) in adults

Summary We report a case of a third ventricular neuroblastoma (neurocytoma) in a 66 year old man. A stereotactic needly biopsy was performed to obtain a tissue diagnosis and was followed by total resection. We elected not to give radiation or chemotherapy and to follow the patient closely with serial CT scans. Presently, 48 months postoperatively, the patient is free of tumor by head CT scan and able to live independently. We reviewed the literature of primary cerebral neuroblastomas/neurocytomas occurring in adults (15 years of age) and found 32 cases. Our patient is the oldest of this group with a mean age of 32 ± 14 years (S.D.). The location of the 33 neoplasms was intraventricular in 17 cases (52%) and intraparenchymal in 16 cases. The male to female ratio was 2: 1. Of the 17 patients having a minimal follow-up period of 5 months (mean 51 months), five developed recurrences after 5 to 144 months (mean 50 months) compared to 12 patients without recurrence after a 6- to 72-month follow-up period (mean 52 months). Recurrences occurred statistically significantly more often in parenchymal neuroblastomas/neurocytomas than in intraventricular tumor locations.     

上部颈椎经颈前外侧手术入路的应用解剖

目的：为上部颈椎经颈前外侧手术入路提供解剖学基础。方法：在２０具固定成人尸体上，按手术入路逐层解剖，观测有关的血管、神经等结构及其毗邻关系。结果：入路有甲状腺上动脉、舌动脉、面动脉自颈外动脉不同高度发出，其中舌动脉与舌下神经；喉上动脉与喉上神经喉内支伴行关系有三种：甲状腺上动脉与喉上神经喉外支伴行关系有二种。结论：经颈前外侧手术入路具有显露充分，操作方便，可处理颈上部３个颈椎病变，具有推广价值。     

神经导航辅助眉弓锁孔入路量化研究及临床意义

目的:报道经眉弓锁孔入路对鞍区结构的显微外科解剖和显微技术。方法:在15例(30侧)经颈内动脉、椎动脉灌注红色乳胶的成人头标本上模拟经眉弓锁孔入路,借助手术显微镜(6~25倍)观察鞍区显微解剖结构,并在神经导航下量化Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ间隙面积,颈内动脉及分支、视神经长度。结果:眉弓锁孔入路对5间隙结构有很好暴露,通过第Ⅱ间隙打开Liliequist膜后可见基底动脉(BA)分叉,大脑后动脉(PCA),小脑上动脉(SCA)及其穿通血管和动眼神经出脑干处及其行程,各间隙面积Ⅰ(85.64±6.87mm2)、Ⅱ(46.62±5.34mm2)、Ⅲ(18.97±2.78mm2)、Ⅳ(49.27±4.86mm2)、Ⅴ(35.95±3.41mm2);颈内动脉眼段长(6.64±1.45mm),交通段长(3.35±0.46mm),脉络膜段长(3.75±0.67mm),仔细分离切断周围的蛛网膜小梁,充分游离血管及其分支,在视交叉后上方可充分显露大脑前动脉(ACA)A1、A2段,前交通动脉复合体及Heubner返支,A1长(22.12±3.65mm)。左侧视神经为(15.15±2.54mm),右(14.42±1.89mm)。结论:眉弓锁孔入路可对鞍区结构很好暴露,第Ⅰ间隙面积最大,Ⅰ、Ⅳ与入路方向一致,显露更为满意,通过Ⅱ间隙可观察Willis后环周围结构;处理鞍区肿瘤,以鞍区4个常规解剖间隙为主,联合第Ⅴ间隙可获得满意效果。     

Neurosurgical anatomy of the anterior interhemispheric approach for aneurysms of the anterior communicating artery (26.6.92)

Summary The anterior interhemispheric approach for aneurysms of the anterior communicating artery was studied in ten cadavers. This approach presents several advantages over the pterional approach widely used in neurosurgery. It allows direct access to the region of the anterior communicating artery complex with minimal retraction of the brain and preservatioin of the olfactory tract and the gyrus rectus.

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Bases anatomiques de l'abord inter-hémisphérique antérieur lors de la chirurgie des anévrysmes de l'artère communicante antérieure

Résumé Ce travail concerne l'abord neurochirurgical des anévrysmes de l'artére communicante antérieure par voie frontale interhémisphérique. L'étude anatomique a été réalisée sur dix sujets. Cette exposition possède de nombreux avantages comparée à la voie ptérionale habituelle : voie d'abord reduite médiane permettant une visualisation directe et symétrique du complexe artériel de l'artére communicante antérieure ; avec le moindre manipulation et retraction du cerveau en respectant les voies olfactives et le gyrus rectus.