Laryngocele - A Case Report and Review of Literature

This is case report of 35-year old male patient presented with hoarseness and swelling on left side of neck. The swelling was noticed by the patient for 8 months. It has been diagnosed clinically and radiologically as a combined laryngocele. The laryngocele has been successfully excised using and combined approach i.e., external and endoscopic methods. This case has been reported for its rarity at this age.     

扩大经蝶入路显露鞍上硬脑膜下腔的应用显微解剖

目的为临床开展扩大经蝶入路进行鞍上显露提供解剖学依据。方法用50例成人头颅标本,在显微镜下对结节隐窝及周围结构进行解剖学观察并测量;并模拟扩大经蝶入路磨除结节隐窝、切开硬脑膜、显露鞍上硬脑膜内结构,测量相关数据。结果结节隐窝和蝶骨平台的骨质为一层薄的皮质骨。鞍结节骨质中含有一小部分的松质骨。鞍结节骨质的平均厚度为1.1 mm,蝶骨平台的骨质厚度为0.7 mm。鞍结节处的颈内动脉(ICA)的间距为13.8 mm,是扩大经蝶入路较易损伤的部位。视神经进入视神经管处的间距是13.9 mm。扩大经蝶入路磨除鞍结节、蝶骨平台显露鞍上硬脑膜下腔的骨窗,在两侧受到ICA和视神经管限制的空间内。鞍膈孔前缘与鞍结节之间的鞍膈,其平均距离为3.2 mm。结论扩大经蝶入路可以显露位于视交叉前方、鞍上池及额叶底部的硬脑膜下腔,并提供相应的操作空间。     

温阳化饮益气活血法对慢性心功能不全大鼠心肌α-MHC、β-MHC基因表达的影响

目的:探讨温阳化饮益气活血法对慢性心功能不全大鼠心肌α- MHC、β-MHC基因表达的影响。方法:采用腹腔注射阿霉素法复制慢性心功能不全大鼠动物模型,利用RT-PCR技术检测心肌重构的相关调控因素α- MHC、β-MHC在慢性心功能不全发病中的作用,同时观察温阳化饮益气活血法对其干预作用。结果:慢性心功能不全大鼠模型组心肌组织α-MHC基因表达下调,β-MHC基因表达上调;温阳化饮益气活血法治疗组心肌组织α-MHC基因表达上调,β-MHC基因的表达下调。结论:温阳化饮益气活血法能上调慢性心功能不全大鼠α-MHC基因的表达,下调β-MHC基因的表达,为温阳化饮益气活血法的临床应用提供了实验依据,这可能是温阳化饮益气活血法防治慢性心功能不全的作用机制之一。     

小儿胸腰椎结核合并后凸畸形的手术治疗

目的探讨小儿胸腰椎结核合并后凸畸形手术治疗的近期和远期疗效。方法追踪观察22例合并后凸畸形的小儿胸腰椎结核患者采用前路小切口清除椎体结核病灶联合后路矫形固定融合一期手术治疗的结果。观察指标主要包括局部病灶有无复发、后凸畸形术后近期矫正度、症状改善情况以及后凸畸形远期变化情况。结果手术耗时180～220min,平均200min,失血量280～450mL(平均350mL)。术后2例并发肺不张,1例并发胸腔积液,均为轻度。术前平均后凸角为51°(31°～72°)外观呈明显角状后凸畸形;术后近期平均为24°(21°～42°),术后随访1～5年(平均2.8年),后凸角平均为26°(18°～40°)。14例合并不同程度瘫痪者下肢肌力均提高1、2级,2例尿潴留患儿于术后3～6个月恢复排尿功能。1例于术后2～4年出现椎板下钢丝断裂。所有患者最后1次随访时均未见原脊柱结核病灶复发。结论经前路小切口清除椎体结核病灶联合后路矫形固定融合一期手术治疗合并后凸畸形的小儿胸椎结核是矫正后凸畸形和预防晚期后凸畸形发生的有效方法。     

颅面联合入路在颅底沟通性肿瘤中的应用

目的探讨颅面联合入路在颅底区沟通性肿瘤治疗中的方法和疗效。方法回顾性分析我院44例经颅面联合入路手术治疗颅底区沟通性肿瘤患者资料,经病理证实恶性肿瘤31例,良性肿瘤13例。位于前颅底区35例,累及前、中颅底区9例。肿瘤切除后造成的硬脑膜缺损用自体组织严密修补,并用额部带蒂复合组织瓣行颅底区组织缺损修复。结果肿瘤全切38例,次全切除3例,部分切除3例,无手术死亡病例。并发症包括脑神经损伤3例,伤口感染2例,出现暂时性脑脊液漏2例,一过性精神症状2例。随访1~6年,10例死于肿瘤复发,失访2例。存活2年以上25例,3年以上17例。结论颅面联合入路是颅底区沟通性肿瘤外科治疗的主要手术入路之一,它是前颅底区(部分可以累及中颅底区)沟通性肿瘤较好的手术入路。     

经单鼻孔蝶窦入路垂体腺瘤切除术

目的探讨经单鼻孔蝶窦入路显微手术治疗垂体腺瘤的方法技巧和疗效。方法32例垂体腺瘤患者,包括微腺瘤6例,大腺瘤17例,巨大腺瘤9例,均经单鼻孔蝶窦入路显微手术治疗。回顾性总结其临床疗效和手术经验。结果完全切除27例,大部切除2例,部分切除2例,仅进行活检1例。结论经单鼻孔蝶窦入路显微手术切除垂体腺瘤是一种安全、有效的手术方法。     

transcervical approach for resection of lateral skull base tumors

Objectives Conventional approaches for removal of lateral skull base tumors, including transmandibular, infratemporal fossa, preauricular transzygmatic subtemporal approaches, are major invasive procedures that often sacrifice hearing and cause abnormal occlusion and cosmetic defects. Reports of the transcervical approach for resection of skull base tumors are rare, although it was described for resection of clival chordomas in as early as 1966. The purpose of this study is to review our experiences in management of lateral skull base tumors using the transcervical approach. Study Design Retrospective chart review. Methods Six lateral skull base tumor cases treated with transcervical approach procedures were reviewed, including the medical records. Results There were 4 males and 2 females. Age ranged from 12 through 52 years. Histopathological diagnoses included malignant schwannoma(n = 1), malignant carotid body tumor(n = 1), heamangioma(n=1), schwannoma (n=2) and pleomorphic adenoma (n = 1). Transcervical techniques were used in all cases with the use of microscope in the lateral skull base area. Complete tumor removal was achieved in all cases. Postoperative radiotherapy was implemented in 1 case of malignant schwannoma and 1 case of malignant carotid body tumor. Jugular foramen syndrome occurred as a surgical complication in 1 case of malignant Schwannoma of the vagus nerve. There was no tumor recurrence during the 10 - 42 month follow-up period. Conclusion Compared with conventional approaches, the transcervical approach provides a easy, safe, minimal invasive and effective procedure for removal of selected lateral skull base tumors.     

乙状窦后锁孔入路微血管减压治疗原发性三叉神经痛

目的：探讨原发性三叉神经痛微血管减压治疗的疗效和手术技巧。方法：选择Teflon棉为减压垫,采用乙状窦后锁孔入路对30例原发性三叉神经痛行显微血管减压术治疗,随访观察其疗效。结果：三叉神经入脑干区有血管压迫者28例。术后疼痛立即消失27例,显著减轻者2例,1周内明显减轻者1例。随访3～15个月（平均8个月）,疼痛消失29例（96．3％）,服用卡马西平片控制满意者1例,无复发病例。结论：微血管减压术是原发性三叉神经痛有效的治疗方法,准确判定责任血管并采取适当材料及方法使三叉神经痛入脑干区减压是提高有效率,减少复发的主要措施。     

参与式教学方法在妇产科学教学中的应用

本文探讨了参与式教学方法在妇产科学教学中的应用，发现参与式教学方法提高了学生的学习兴趣和积极性，有利于促进学生个性发展和知识面拓展，培养了学生的创新能力，活跃了课堂气氛，增加了学生与教师的交流机会，融洽了师生关系。但是，参与式教学方法消耗时间过多，不宜推广到每一堂课。     

Some considerations on middle ear cholesteatoma in ‘foreign workers’*

The treatment of cholesteatoma in patients without a permanent residence or in medically underdeveloped countries presents a serious problem in middle ear surgery. Methods which erradicate disease safely and reduce the risk of recurrence to a minimum are necessary. We differentiate 3 clinical types of cholesteatoma: 1 Retraction of Shrapnell's membrane or in the postero-superior quadrant with very little cholesteatoma lateral to the ossicles. A transcanal technique is used to evert the cholesteatomatous pocket into the meatus intact, followed by reconstruction of the outer attic wall. 2 Circumscribed cholestatoma lateral and often also medial to the ossicles. Combined approach tympanoplasty is used in such cases. 3 Marginal perforations with large cholesteatomas, situated medial to the ossicular chain. For these ears, classical radical mastoidectomy is the method of choice. (Radical mastoidectomy also has to be performed in all cases of type II, where luxation of the matrix in toto has failed.) Results: No recurrence has been detected in cases where follow-up was possible.