枕下经颈-颈静脉突入路达颈静脉孔区的显微解剖研究

目的 研究一期切除颈静脉孔区复杂性肿瘤的微创手术人路。方法 选择经10％福尔马林固定成人头颈标本10具，显微镜下模拟枕下经颈一颈静脉突人路的手术操作，逐层显露颈静脉孔区，研究该区显微解剖特征及显露范围。结果 该人路直接沿乙状窦、颈内静脉的移行方向显露颈静脉孔区结构，其中后颅窝可经枕下显露，颞下窝藉寰椎与下颌升支间的自然间隙显露。通过切除颈静脉突和迷路下骨质分别自后、外、下和上方显露颈静脉孔。头侧直肌是界定颞下窝结构和枕下三角内结构的确切标志。后组颅神经，交感千和颈内动、静脉行于其前方，椎动脉寰椎上段及其周围的静脉丛行于其后方。结论 枕下经颈一颈静脉突人路可自多个方向充分显露颈静脉孔区结构，且可保护面神经、迷路、耳蜗和椎动脉等结构免受不必要的损伤。     

枕下远外侧入路解剖研究与临床应用

目的　探讨枕下远外侧入路的相关解剖研究和临床应用效果。方法　选用 2 0例成人头颅湿标本进行显微解剖测量。应用枕下远外侧入路切除枕大孔区和前外侧肿瘤 10例。结果　枕骨髁为术中重要的解剖标志 ,枕下三角为显露椎动脉的重要标志 ,枕下三角由三条肌肉形成 ,即头后大直肌、头上斜肌和头下斜肌。枕下三角内有椎动脉及肌支 ,椎静脉丛和颈 1神经。测量寰椎横突孔外缘至椎动脉入颅处距离 ,左侧 (16 .87± 2 .0 8)mm、右侧 (16 .79± 1.90 )mm。枕大孔区肿瘤 10例手术中 ,肿瘤全切 6例 ,次全切 3例 ,大部分切除 1例 ,无手术死亡。结论　枕下远外侧入路手术应了解枕大孔区的相关解剖参数和局部解剖结构 ,该入路优点能增加术野空间 ,最大程度上显露肿瘤组织 ,减少对脑干和重要血管神经牵拉。     

乙状窦后进路桥小脑角区手术并发症分析

目的总结乙状窦后进路桥小脑角区手术并发症的临床表现和发病机理,为临床医生提供相关观察指征和处理方法.方法回顾性分析1993年6月至2001年12月间进行的639例乙状窦后进路桥小脑角区手术的临床资料.结果639例患者中,出现的一般并发症有:眩晕、耳鸣、术侧唇部带状疱疹、暂时性面神经麻痹、皮下明胶海绵液化、伤口感染、眼睑下垂、脑脊液耳鼻漏等;严重并发症有:脑膜炎症22例,蛛网膜下腔出血3例,迟发性小脑血肿2例,化学性脑膜炎3例,应激性胃溃疡1例,脑血管意外致死亡1例.严重并发症发生率5.01%(32/639),经积极治疗,除死亡1例,其余均治愈出院.结论乙状窦后进路是切口小,难度大的手术,熟练的手术技巧是减少手术并发症的关键,及时发现和治疗是减少并发症死亡率的保证,了解并发症的类型和发病机理对预防和处理并发症是非常重要的.     

Cyclophosphamide-induced cystitis in freely-moving conscious rats: behavioral approach to a new model of visceral pain

PURPOSE: To develop a model of visceral pain in rats using a behavioral approach. Cyclophosphamide (CP), an antitumoral agent known to produce toxic effects on the bladder wall through its main toxic metabolite acrolein, was used to induce cystitis. MATERIALS AND METHODS: CP was administered at doses of 50, 100 and 200 mg./kg. i.p. to male rats, and their behavior observed and scored. The effects of morphine (0.5 to 4 mg./kg. i.v.) on CP-induced behavioral modifications were tested administered alone and after naloxone (1 mg./kg. s.c.). In addition, 90 minutes after CP injection, that is, at the time of administration of morphine, the bladder was removed in some rats for histological examination. Finally, to show that the bladder is essential for the CP-induced behavioral modifications, female rats also received CP at doses of 200 mg./kg. i.p. and of 20 mg. by the intravesical route, and acrolein at doses of 0.5 mg. by the intravesical route and of 5 mg./kg. i.v. RESULTS: CP dose-relatedly induced marked behavioral modifications in male rats: breathing rate decrease, closing of the eyes and occurrence of specific postures. Morphine dose-dependently reversed these behavioral disorders. A dose of 0.5 mg./kg. produced a reduction of almost 50% of the behavioral score induced by CP 200 mg./kg. This effect was completely prevented by pretreatment with naloxone. At the time of administration of morphine, histological modifications of the bladder wall, such as chorionic and muscle layer edema, were observed. In female rats, CP 200 mg./kg. i.p. produced the same marked behavioral modifications as those observed in male rats. Administered at the dose of 20 mg. intravesically, CP did not produce any behavioral effects, whereas acrolein at 0.5 mg. intravesically induced behavioral modifications identical to those under CP 200 mg./kg. i.p., with the same maximal levels. Conversely, acrolein 5 mg./kg. i.v. did not produce any behavioral effects at all. CONCLUSIONS: Overall, these results indicate that this experimental model of CP-induced cystitis may be an interesting new behavioral model of inflammatory visceral pain, allowing a better understanding of these painful syndromes and thus a better therapeutic approach to them.     

Patient Capacity in Mental Health Care: Legal Overview

The discriminatory effects of categorizing psychiatric patients into competent and incompetent, have urged lawyers, philosophers and health care professionals to seek a functional approach to capacity assessment. Dutch and English law have produced some guidelines concerning this issue. So far, most legal systems under investigation have concentrated on alternatives for informed consent by the patient in case of mental incapacity, notably substitute decision-making, intervention of a judge and advance directives. It is hard to judge the way in which the law may further adapt to a more functional assessment of capacity, because the nature of law shows that legal reforms usually take place only when new methods have been accepted by the field. This is not yet the case today.     

某有色金属公司1956～2003年间尘肺病发病状况分析

[目的]探讨某有色金属公司50年来尘肺病发病的动态变化。[方法]对某有色金属公司50年来确诊为尘肺病患者的有关资料,按全国尘肺流行病学调查方案进行分析,建立数据库并进行统计处理。[结果]50年来共诊断尘肺病人1896例,死亡1112例,现患784例;尘肺病人的主要工种为凿岩、运搬、支柱和爆破;尘肺病的平均发病年龄和平均发病工龄逐年增加;尘肺结核的发病率逐年下降;尘肺病的病程逐年延长;早期肺结核是尘肺病的主要死因;现在前四位死因分别为呼吸系统疾病、肺结核、恶性肿瘤和心血管系统疾病。[结论]综合防尘及综合治疗措施延迟了尘肺的发病,延长了尘肺病患者的寿命,但尘肺病的防治任务仍任重而道远。     

眶周小切口在颧骨颧弓骨折中的应用

目的探讨下睑缘和眉弓及前庭切口在颧骨骨折中的应用.方法本组42例额骨复合体骨折患者,采用睑下缘、眉弓外1/3及上颌前庭切口充分暴露骨折线,使颧颌段、眶下缘、颧颞段及颧牙槽嵴充分复位,选用合适的微型钛板行坚强内固定.结果42例患者伤口均一期愈合,经3月~2 a复诊,外形和功能恢复良好,局部无明显瘢痕遗留.结论局部眶周小切口行颧骨骨折复位并作坚强内固定,创伤小,径路短,能有效恢复颧部外形和口腔功能.     

改良经皮层脑室入路切除丘脑肿瘤

目的探讨提高丘脑肿瘤的切除率和减少术后并发症的手术方法。方法对17例丘脑肿瘤采用改良经皮层脑室入路进行显微手术切除并获得6个月至3年的随访。结果肿瘤全切除11除、次全切除4例、大部切除1例，无手术死亡。结论改良经皮层脑室入路可提高丘脑肿瘤的手术全切率和减少术后并发症。     

经口进路行上颌骨切除术

目的:探讨经口进路行上颌骨切除术的可行性和适应证。方法:选择16例上颌骨肿瘤患者(恶性13例、良性3例),采用美国Stryker公司的微型电动力系统行经口进路上颌骨切除术。结果:16例患者中,上颌骨部分切除术15例,上颌骨次全切除术1例。经术后1～8年随访,面部均无疤痕,无下睑水肿及面部畸形。除1例恶性黑色素瘤患者死于术后两年外,其余患者均存活。结论:经口进路行上颌骨切除术疗效满意,其适应证主要为良性及低恶度上颌骨肿瘤,需行上颌骨部分切除或次全切除术者。     

再次经鼻蝶入路切除复发或残留的垂体瘤

目的：探讨经鼻蝶手术后复发或残留的垂体瘤再次经单鼻孔直达蝶窦入路显微外科手术的技术方法与疗效。方法：我科2001年8月至2005年8月对经鼻蝶手术后复发或残留的32例垂体瘤进行了经单鼻孔直达蝶窦入路显微外科再次手术治疗。结果：14例（43．8％）肿瘤获全切除，10例（31．2％）肿瘤达到次全切除，8例（25．0％）肿瘤仅获部分切除，无手术死亡。在垂体激素异常增高的13例功能性垂体腺瘤中，6例激素水平降至正常，3例激素水平下降〉50％，4例激素水平下降〈50％。24例术后随访观察6—48个月，8例（8／9）头痛消失或减轻；21例（21／22）视力、视野障碍改善；5例（5／7）肢端肥大症减轻；3例（3／4）溢乳停止，月经恢复。结论：经单鼻孔直达蝶窦入路显微外科手术最大限度的利用了鼻腔的自然间隙，具有入入路直接、创伤轻微和并发症少等优点；尽管有一定难度，但仍然是治疗经鼻蝶手术后复发或残留垂体瘤的一种安全有效的微创方法。