40例蛛网膜下腔出血病人的护理体会

我科于2002-05～2005-05收治蛛网膜下腔出血病人40例，经一系列综合治疗和护理措施，取得良好的治疗效果。现将护理体会总结如下。     

眶肌筋膜韧带提紧在睑袋整形术中的应用

睑袋整形手术为眼部美容外科中最常见的美容手术。很多求美者在去除睑袋的同时都十分关注下睑组织松弛情况,在去除睑袋的同时也要求去除下睑皮肤皱褶,恢复睑缘自然形态。做好睑袋整形手术,除应有熟练的手术技巧,丰富的临床经验外,还需要有认真细致的科学态度。自2003年至2005年     

慢性胰腺炎患者行包括临时支架的内镜下介入：一种有效的治疗

目的：过去15年在慢性胰腺炎（CP）的内镜治疗中取得了巨大进展。然而，经内镜行胰腺内放置支架的价值还有争议。材料与方法：对98例（84例男性，14例女性，年龄49±12岁，极差23～83）有症状的CP患进行包括胰管内临时支架的内镜下介入治疗。将最后支架取出时作为内镜治疗的主要研究终点，96例患共随访了35±28个月（极差8d～111个月），对所有数据进行回顾性分析。结果：与其他的内镜下操作一样，共有358个支架放置在胰管内且留置了3±1个月（极差1d～11个月）。总的支架治疗时间是10±10个月（极差6d～49个月）。在有限的内镜治疗后的46±27个月（极差4～111个月）中，57例患不需要再次介入治疗，甚至2／3患没有更多的疼痛感。在22例需要外科治疗和17例需要再次内镜治疗的患中明显与继续摄入乙醇有关。结论：临时支架植入作为CP患内镜介入治疗的一部分有较高的技术含量和长期临床成功率，而且在相当多患中不需要二次治疗。禁止乙醇摄入明显有助于治疗效果的维持。     

小针刀加拔罐治疗冈下肌损伤23例

冈下肌损伤在临床较为常见，近两年来，笔者采用小针刀加拔罐治疗，取得了满意的疗效，现总结如下。     

侧脑室联合蛛网膜下腔持续引流治疗继发性脑室出血

继发性脑室出血通常是由于高血压性脑实质出血直接穿破所致,是一种病情凶险,病情复杂,并发症多,病死率很高的急性脑血管病,总死亡率达83.3% [1] ,目前国内外治疗方法不一。2 0 0 1年1月至2 0 0 3年10月我院采取超早期侧脑室引流,术后蛛网膜下腔置管持续引流治疗继发性脑室出血2     

甲状旁腺嗜酸性细胞瘤伴微小癌1例

甲状旁腺肿瘤较为少见,甲状旁腺癌更罕见。我院近期手术治疗甲状旁腺癌1例。报告如下。病人男性,25岁。因发现颈前肿物1年于2005-03-20入院。1年前因脑外伤检查发现右颈前有一肿物,如鸽卵大小。声音无嘶哑。同时伴有右髋关节疼痛,右肾结石。入院查体:颈前可见局限性隆起,右甲状腺下极可触及一直径约4cm大小肿物,颈部淋巴结未触及肿大。辅助检查:碱性磷酸酶(ALP)1600U/L,血清磷0.68mmol/L,血清钙3.0mmol/L,尿钙2.01mmol/L,24h尿钙4.6mmol/L,总尿量2300mL;甲状腺功能正常;肾功能正常;甲状旁腺激素-全段(iPTH):1703ng/L。右髋关节诸骨骨…     

浅表性胃炎患者胃液氨浓度测定

目前，国内对胃氨浓度的测定方法及正常值，胃氨浓度与浅表性胃炎的关系报道较少，为了探讨我国成年人胃氨浓度正常值及对浅表性胃炎疾病的影响程度，以我院就诊患为对象，内镜下用胃管取胃液并测定氨浓度。现将结果报告分析如下。     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

上胸椎前方手术入路

上胸椎前方解剖关系复杂，由浅及深为肌层：颈阔肌，胸锁乳突肌；骨性结构：胸骨柄，胸锁关节；血管性结构：左、右颈总动脉，主动脉弓，无名动脉，左无名静脉，左、右头臂静脉，甲状腺下动脉，胸导管；神经组织：喉返神经，交感神经链；其他深层组织：食管，气管，甲状腺，胸腺。这些器官和组织相互交错，互为邻里，错综复杂。此处椎体或脊髓前方病变时，前方入路可直接暴露病变部位，术野清晰，手术直接，效果明确，但易损伤以上相邻组织，严重者损伤胸髓，导致患者高位截瘫。     

肌筋膜缝线悬吊法下睑袋整复术

下睑袋整复术作为常见的面部美容手术，虽然术式众多，但术后并发症仍时有发生。自2002年以来，我们用了新的肌筋膜缝线悬吊法，行下睑袋整复手术40例。它主要针对重度睑袋，下睑缘外露，下睑松弛，下睑退缩，外眦下移，或下睑外翻需要再次手术的病例，经临床观察满意，报道如下。