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目的观察小骨窗开颅术与常规去骨瓣开颅术治疗高血压脑出血的临床效果。方法回顾性分析105例小骨窗开颅术(观察组)及93例常规去骨瓣开颅术(对照组)患者临床资料,比较2组患者手术相关情况、术后并发症发生情况及ADL评分。结果观察组手术相关情况优于对照组(P<0.05),术后ADL评分结果显示观察组治疗效果优于对照组(P<0.05),2组术后并发症发生情况无显著性差异。结论临床医生应根据患者具体临床表现及影像学检查结果选择最适合患者的术式,以获得最佳的治疗效果。 相似文献
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目的 探讨磷脂酰肌醇3-激酶(PI3K),磷酸化蛋白激酶B(p-AKT)和磷酸化哺乳动物雷帕霉素靶蛋白(p-mTOR)在人脑胶质瘤组织中的表达及其与人脑胶质瘤恶性进展和预后的相关性.方法 选取南京医科大学附属淮安第一医院神经外科自2004年9月至2008年9月间手术切除并经病理证实的人脑胶质瘤标本88例,另取非肿瘤组织中的正常脑组织标本20例作为对照.采用免疫组织化学染色检测脑胶质瘤组织和正常脑组织中PI3K、p-AKT及p-mTOR的表达,并统计分析其与患者的临床病理学特征及预后的关系.结果 PI3K、p-AKT、p-mTOR在脑胶质瘤组织中的阳性表达率均显著高于正常脑组织,差异有统计学意义(PI3K:x2=14.028,P=0.009;p-AKT:x2=15.132,P=0.008和mTOR:x2=15.293,P=0.008);不同病理分级、治疗前KPS评分以及临床分期脑胶质瘤组织中PI3K、p-AKT和p-mTOR阳性表达率的差异均有统计学意义(P<0.05);PI3K、p-AKT、p-mTOR阳性表达组患者的5年总体生存率均显著低于其阴性表达组(PI3K:x2=8.381,P=0.026;p-AKT:x2=12.923,P=0.011;mTOR:x2=13.252,P=0.013).结论 PI3K/Akt/mTOR信号传导通路在脑胶质瘤组织中被过度激活,与肿瘤的恶性程度密切相关,可以作为判断脑胶质瘤患者预后的生物学指标.Abstract: Objective To investigate the protein expression of phosphatidylinositol 3-kinase (PI3K), phosphorylated Akt B (p-Akt) and p-mTOR in human gliomas, and evaluate their clinical significance in clinicopathological status and prognosis of these patients with gliomas. Methods Eighty-eight patients, admitted to our hospital from September 2004 to September 2008, were chosen in our study; these patients were performed surgical resection and the samples were pathologically confirmed as gliomas. Another 20 samples, cut from the normal brain tissue were adopted as controls.Immunohistochemistry was employed to examine the protein expression of PI3K, p-AKT and p-mTOR.Then, the correlation of their expression with the clinicopathological features of the gliomas and prognosis of the patients was further analyzed. Results The positive expression rates of PI3K in gliomas and normal brain tissues were 68.18% (60/88) and 18.18% (16/88), respectively; those of p-AKT were 73.86% (65/88) and 17.05% (15/88), respectively;, those of p-mTOR were 75.00% (66/88) and 18.18% (16/88), respectively; the expression levels of these 3 proteins were all significantly higher than those in normal brain tissues (PI3K: x2=14.028, P=0.009; p-AKT: x2=15.132, P=0.008 and mTOR:x2=15.293, P=0.008). The positive expression rates of PI3K, p-AKT and p-mTOR were significantly different in the gliomas with pathological grades, different scores of Karnofsky performance status and different clinical stages (P<0.05). In addition, the 5-year overall survival rate in PI3K-positive group,p-AKT-positive group and p-mTOR-positive group was significantly lower than in those negative groups (PI3K: x2=8.381, P=0.026; p-AKT: x2=12.923, P=0.011; mTOR: x2=13.252, P=0.013). Conclusion PI3K/Akt/mTOR signal transduction pathway is over-activated in gliornas, which is closely correlated to the grade-malignancy; and the positive expression of PI3K, p-AKT and p-mTOR may predict the poor prognosis of the patients with gliomas. 相似文献
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目的研究三维重建结合手术体位改变于老年脑动脉肿瘤介入治疗中的临床疗效。方法选择30例经CT证实为蛛网膜下腔出血(SAH)的60岁以上患者做为研究对象,股动脉插管后行造影,使用数字减影血管造影(DSA)系统对患者采集的原始影像学资料进行三维重建结合,并使用advantage workstation工作站进行后期处理得到3D图像。在工作站重建处理同时,将超过DSA系统C臂机架患者使用头颅固定架保证透视图像中患者头颅为正位。结果 30例患者中15例经动脉造影可清晰显示动脉瘤,12例患者瘤体与周围血管的关系显示不甚清楚,进行三维重建,清晰显示患者动脉瘤体及其周围血管间的关系。另外3例患者DSA系统无法显示正位头颅图像,通过使用头颅固定架旋转适宜角度,可清晰显示脑动脉瘤。结论老年脑动脉瘤患者基础疾病较多,脑动脉瘤血管充盈不充分或角度投射不当,血管走行重叠等,造成手术中动脉瘤的显示不清楚,可以通过DSA检查结合血管三维重建并进行手术中体位的适当改变可以弥补因机械无法达到的体位,使具体操作更加清晰地显示瘤体与载瘤动脉间的关系,提高手术的成功率。 相似文献
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目的总结枕下乙状窦后入路切除听神经瘤的临床经验。方法采用单侧枕下乙状窦后入路,运用显微外科技术切除听神经瘤71例,其中17例采用内窥镜辅助小骨窗(3.0cm×3.5cm)手术。结果肿瘤镜下全切除63例(88.7%),次全切除8例(11.3%)。面神经解剖保留54例(76.1%),功能保留37例(52.1%),有效听力保留2例(2.8%),无手术死亡。结论经枕下乙状窦后入路显微手术治疗听神经瘤,能获得对听神经瘤及桥小脑角的良好显露,手术效果满意。 相似文献
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目的介绍一种Arnold-Chiari Ⅰ型畸形(ACM-Ⅰ)的外科治疗方法,并探讨其临床效果.方法采用枕大孔减压加环枕筋膜切除或松解,但不切开硬脑膜的技术,以硬脑膜膨起搏动恢复为有效.结果23例中除1例恶化外,术后神经功能状况均好转和稳定,总有效率为95.7%.结论硬膜外枕大孔减压术能提高治疗效果,降低手术并发症,是ACM-Ⅰ微创手术的一种选择. 相似文献
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