鼻内镜下单鼻腔蝶窦入路垂体腺瘤切除术(附6例报告)

目的总结鼻内镜下单鼻腔蝶窦入路垂体腺瘤切除的经验. 方法回顾分析2003～2004年间通过鼻内镜单鼻腔蝶窦入路治疗的6例垂体腺瘤的临床资料,总结经验. 结果按Hardy-wilson分级,Ⅱ级者1例,全切除瘤体;Ⅲ级者5例,全切除3例,大部分切除1例,另1例因出血多,改变手术方式,而完成治疗.5例患者术后均予放疗.所有患者均无严重并发症发生.随访12个月,无复发或瘤体增大现象. 结论鼻内镜下单鼻腔蝶窦入路切除垂体腺瘤是一种微创、安全、有效的方法,但应有熟练的鼻内镜手术技术.     

The transglabellar subcranial approach for nasal dermoids with intracranial extension

OBJECTIVES/HYPOTHESIS: Nasal dermoids are the most common congenital midline nasal lesions. When a midline nasal pit or cyst is identified, scans should be obtained to look for an intracranial connection. The intracranial portion of the lesions has traditionally been approached by the performance of a frontal craniotomy. The transglabellar subcranial approach is a useful technique to resect these lesions and offers several advantages over a traditional craniotomy approach. STUDY DESIGN: Retrospective case review. METHODS: Records of two patients who underwent excision of nasal dermoids by way of a subcranial approach were analyzed. RESULTS: Two patients underwent successful resection of nasal dermoids with intracranial extension by way of a subcranial approach. The patients were 13 months and 19 months old at the time of excision and have been followed for 7 years and 6 years, respectively. There has not been any recurrence of the lesions. There has been no apparent negative impact on facial growth in either of these cases. CONCLUSIONS: The subcranial approach is an effective technique for the resection of nasal dermoids with intracranial extension. These lesions have traditionally been managed with lateral rhinotomy, midface degloving, or external rhinoplasty approaches combined with a frontal craniotomy. The subcranial approach offers excellent exposure, minimizes frontal lobe retraction, reduces the likelihood of cerebrospinal fluid leak, and provides for excellent cosmetic result. This approach was used in two cases with long-term follow-up. The lesions were successfully resected in both cases. Long-term follow-up has shown no recurrence or negative effect on craniofacial growth.     

CTA影像模拟眶上锁孔入路手术中颈内动脉的显露

目的 应用CT血管造影（CTA）模拟去除前床突前后颈内动脉颅内段的显露情况,为眶上锁孔入路处理颈内动脉动脉瘤提供解剖数据。方法 收集30例双侧颈内动脉及颅底骨质无解剖异常的CTA影像数据,利用容积再现技术+图像融合技术重建颅骨及颅内主要动脉影像,然后用CTA重建影像模拟眶上锁孔入路手术时颈内动脉和颅骨的显露情况,测量去除前床突前后双侧颈内动脉颅内段的显露长度。结果 30例CTA影像获得60组去骨前后颈内动脉颅内段长度共120个。去除前床突前,颈内动脉的显露长度为4.1~21.9 mm,平均（14.7±3.7） mm;去除前床突后,颈内动脉的显露长度为21.4~39.4 mm,平均（30.6±4.1） mm。去骨前后测量长度有统计学差异（P<0.01）。去除前床突后,增加的长度为10.0~25.5 mm,平均（15.8±3.5） mm。结论 眶上锁孔入路中磨除同侧前床突能增加颈内动脉颅内段的显露范围,术中可利用此方法处理被前床突遮挡的颈内动脉动脉瘤。     

Personality Types as Predictors of Breast Cancer Screening Compliance in Korean Patients: A Mixed-Method Approach

ObjectiveThe purpose of this study is to identify personality types that can influence breast cancer screening (BCS) compliance among Korean women with breast cancer using a mixed-method approach. MethodsThe participants consisted of 93 women who underwent surgery for breast cancer between July 2010 and March 2012. The demographic and medical characteristics of the participants were evaluated through structured interviews. To identify personality types, in-depth interviews were performed and the transcribed interviews were evaluated using interpretive phenomenological analysis. The participants were categorized into two groups (compliance and non-compliance) based on compliance with the Korean Breast Cancer Society recommendations for BCS. ResultsFive personality types were identified through phenomenological analysis. There were significant differences in the chi-square test results for the BCS compliance and non-compliance groups according to age (p=0.048), cancer stage (p<0.001), and personality types (p=0.018). Logistic regression showed that the odds ratio for compliance with BCS was 9.35 (p=0.01) for individuals with a cautious-organized personality type, 9.38 (p=0.02) for those with a cautious-dependent personality, and 10.58 (p=0.04) for those with a sensitive-downcast personality compared to those with a cautious personality type. ConclusionParticipants with cautious-organized, cautious-dependent, and sensitive-downcast personality types were less likely to follow the BCS recommendations than those with a cautious personality type. This study provides a basis for the future development of an effective questionnaire to investigate the personality types of individuals with breast cancer in order to predict compliance with BCS.     

后腹腔镜手术治疗肾上腺囊肿42例报告

目的:总结后腹腔镜手术治疗肾上腺囊肿的手术经验及疗效。方法:回顾分析2004年12月至2011年3月为42例肾上腺囊肿患者行后腹腔镜手术的临床资料。患者平均(45.6±10.8)岁,囊肿直径平均(6.8±3.1)cm。其中单纯囊肿切除术29例,合并肾上腺部分切除术11例,合并肾上腺全切除术2例。结果:42例手术均获成功,无一例中转开放手术,围手术期无严重并发症发生。手术时间平均(58.5±22.4)min,术中出血量平均(37.5±27.1)ml,术后平均住院(6.0±1.8)d,平均随访(45±28.5)个月,患者不适症状消失或明显缓解,术后肾上腺功能正常,无局部复发。结论:腹腔镜手术治疗肾上腺囊肿安全、有效,具有患者创伤小、康复快等优点,可作为治疗肾上腺囊肿的首选方法。     

经常规前路间盘切除植骨融合治疗Hangman骨折

目的 探讨经前路间盘切除植骨融合治疗Hangman骨折的治疗结果和治疗特点.方法 对天津医院脊柱外科2005年6月至2008年12月诊治的36例Hangman骨折患者进行回顾性分析.所有患者均行X线片、CT和MRI检查.其中手术治疗27例患者,按照Levine-Edwards分型标准:Ⅱ型17例,Ⅱa型10例.在全麻下行常规颈前方入路显露C2-3椎体,切除C2-3椎间盘组织,充分减压,取自体髂骨植骨及钢板固定.术后颈托保护4周,对手术时间、住院时间、并发症、合并症、神经恢复情况及融合率做评估.结果 27例手术患者均获随访,平均随访15(10～36)个月.无一例出现椎体再移位和成角畸形.术前疼痛均获得缓解,术前神经功能障碍获得改善.未发现脊髓损伤、椎动脉损伤、脑脊液漏等并发症,没有发生与内植物相关的并发症,手术时间和住院时间与下颈椎手术时间相似,所有患者6个月内完全融合.结论 经常规颈前路C2-3间盘摘除植骨融合钢板内固定治疗Hangman骨折疗效确切,安全可行.