健侧C_7移位后的下干分支修复受损神经

正2007年3~6月,我们采用健侧C7移位后的下干分支修复受损神经治疗2例全臂丛撕脱伤患者,现将手术方法及最初的随访结果报道如下。1材料与方法1.1病例资料本组2例,均为男性,年龄分别为18、29岁;均为车祸造成左上肢全臂丛撕脱伤;受伤至手术的时间分别为27 d和24 d。患侧C5~T1神经支配区全部运动及广泛感觉丧失:Horners征阳性,腱反射引不出,患肢发凉,麻     

术中支架象鼻技术治疗Stanford B型主动脉夹层

目的 总结术中支架象鼻技术治疗Stanford B型主动脉夹层的临床效果和经验.方法 2009年3月至2011年12月,24例锚定区不足或左锁骨下动脉受累及合并升主动脉或心脏病变的Stanford B型主动脉夹层的患者在北京安贞医院接受手术.其中男20例,女4例,年龄(50.6±9.8)岁.合并高血压20例,主动脉瓣关闭不全2例,主动脉根部瘤1例,二尖瓣关闭不全1例,主动脉缩窄1例.14例有吸烟史.4例为胸降主动脉覆膜支架术后内漏.结果 24例患者均行直视下支架象鼻术,同期左锁骨下动脉左颈总动脉转流5例,主动脉瓣替换+升主动脉成形3例,左锁骨下动脉重建2例,二尖瓣和主动脉瓣置换1例,升主动脉降主动脉人工血管转流1例.体外循环(163.1±48.6) min,低流量选择性脑灌时间(29.1 ±12.4) min.无围手术期死亡.二次开胸止血1例;呼吸功能不全气管切开1例;无截瘫及卒中发生.无住院死亡,并发症发生率8.3％(2/24例).1例失访;随访23例,随防率95.8％(23/24),平均随访24个月,随访期间2例因Ⅰ型内漏行修补术,1例因支架远端假性动脉瘤行主动脉覆膜支架修复.20例(86.4％)患者支架附近可见血栓形成.结论 对锚定区不足或左锁骨下动脉受累及合并升主动脉或心脏病变的Stanford B型主动脉夹层患者行直视下支架象鼻手术是一种有效的外科治疗手段,可以获得满意的临床效果.远期结果需进一步随访.     

Neuroanatomy of cervical sympathetic trunk: A cadaveric study

To reduce the risk of iatrogenic injury to sympathetic chain during anterior and anterolateral approaches to the cervical spine, its location has to be well defined and known by surgeons. We analyzed the course of sympathetic chain and its ganglia from C7 up to its entry into the cranial base and its relationship mainly with the longus colli (LC). Formalin fixed 20 human cadavers were dissected under operating microscope. Measurement of the dimensions of the ganglia, distance of the trunk to the LC, and the angles identifying the course of the chain were performed. Superior and inferior cervical/cervicothoracic ganglion were observed in all specimens, the middle cervical ganglion was observed in 48% of the specimens. The middle ganglion consisted of two ganglia in 10% of the dissected sides. Forty percent of the inferior cervical/cervicothoracic ganglion was at the C7 level, 25% was at C7‐Th1 disc level, and 35% was at Th1 level. Vertebral ganglion was detected in only 8% of the specimens. The course of the sympathetic trunk converges medially descending from upper cervical levels to the lower levels. Anterior surgical approach to the cervical spine is a commonly used procedure. Although Horner syndrome due to sympathetic injury is not a common sequence of cervical operations, our findings support the current few reports on the subject and should be useful to any surgeon who operates in the cervical region to avoid this uncommon complication. Clin. Anat. 22:324–330, 2009. © 2009 Wiley‐Liss, Inc.     

Modulation of head movement control in humans during treadmill walking

The purpose of this study was to investigate the coordination of the head relative to the trunk within a gait cycle during gaze fixation. Nine normal subjects walked on a motorized treadmill driven at 1.79 m/s (20 s trials) while fixing their gaze on a centrally located earth-fixed target positioned at a distance of 2 m from their eyes. The net and relative angular motions of the head about the three axes of rotations, as well as the corresponding values for the moments acting on it relative to the trunk during the gait cycle were quantified and used as measures of coordination. The average net moment, as well as the average moments about the different axes were significantly different (P<0.01) between the high impact and low/no impact phases of the gait cycle. However, the average net angular displacement as well as the average angular displacement about the axial rotation axis of the head relative to the trunk was maintained uniform (P>0.01) throughout the gait cycle. The average angular displacement about the lateral bending axis was significantly increased (P<0.01) during the high impact phase while that about the flexion–extension axis was significantly decreased (P<0.01) throughout the gait cycle. Thus, the coordination of the motion of the head relative to the trunk during walking is dynamically modulated depending on the behavioral events occurring in the gait cycle. This modulation may serve to aid stabilization of the head by counteracting the force variations acting on the upper body that may aid in the visual fixation of targets during walking.     

The Characteristics of Celiac Trunk Lymph-node Metastases of Esophageal Cancer in the Thoracic Segment and Clinical Significance for Wide-Excision

L ymph-node metastases are the major metastatic mode of esophageal carcinoma, and are also a key factor influencing the prognosis of postoperative esophageal-cancer patients. Celiac lymph nodes are a common region for lymphatic metastases of thoracic esop…     

The gastrocolic trunk of Henle in pancreatic surgery: an anatomo-clinical study

From 37 peroperative and cadaver anatomical investigations, it was concluded that, in contrast to the information in common texts on anatomy and surgery, a venous gastrocolic trunk was observed in only 46% of subjects; a true bipod gastrocolic trunk of Henle was a rare (8%) phenomenon. In this respect, a variate venous anatomy at the inferior border of the neck of the pancreas, as observed in this study, must be taken into account during pancreatic surgery and radiological procedures in the pancreas. Received: December 27,1999 / Accepted: April 26, 2000     

胃肠道、食管、腹膜后、腹腔干、颈部多发血管瘤1例

湘雅三医院消化科近年收治1例胃肠道、食管、腹膜后、腹腔干及颈部多发血管瘤患者,对其给予食管、胃血管瘤套扎及鱼肝油酸钠注射治疗,出院后随访,患者一般情况可.因本病罕见,现将其报告如下.