Chiari Ⅰ畸形颅颈减压手术中的硬膜下显微操作

目的总结Chiari Ⅰ畸形颅颈减压手术中的硬膜下显微操作的关键步骤，强调硬膜下显微操作内容的重要性。方法12例Chiari Ⅰ畸形患者（8例合并脊髓空洞症）行颅颈减压、硬膜成形、硬膜下探查术。硬膜下显微操作包括部分切除下疝的小脑扁桃体，探查第四脑室正中孔、延髓及高位颈髓外侧。结果术中证实小脑扁桃体与延髓间蛛网膜粘连并松解6例，小脑扁桃体与尾组颅神经间蛛网膜粘连并松解4例。术后近期观察8例患者临床症状有改善，4例无变化。远期随访患者神经功能均有不同程度改善。5例患者（3例合并脊髓空洞症）术后磁共振成像（MRI）复查示小脑扁桃体达正常水平，枕大池成形，脊髓空洞呈不同程度缩小。结论Chiari Ⅰ畸形颅颈减压手术中的硬膜下显微操作是达到手术目的、改善患者临床症状的重要步骤之一。

The imaging analysis of metachronous multiple primary carcinoma of esophagus and stomach

Objective To study imaging manifestation and differentiating diagnosis of metachronous multiple primary carcinoma of intra-thoracic stomach after surgical operation of esophageal carcinoma. Methods There were total 10 cases of metachronous multiple primary carcinoma of intra-thoracic stomach (male 9,female 1). The age of all cases varied from 40 to 67 years old with a median age of 53 years old. All cases underwent chest multiple detector computed tomography(MDCT) contrast enhancement scanning,upper digestive tract barium meal,esophageal endoscope and pathological examination. Computed tomography scanning field located between inferior cervical part and diaphragmatic angle with 5 mm slice thickness,5-8 mm reconstruction. 100 ml contrast media was injected with a speed of 2 ml/s during enhancement scanning. Results There were 9 adenocarcinomas and 1 signet-ring cell carcinoma among 10 cases. All cases got their diagnosis after relapsing of esophageal carcinoma or gastric involving from lymph node metastasis was precluded. Six,4 and 1 case's multiple primary carcinoma of stomach were respectively found 1-2 years,over 2 years and 15 years later after surgical operation of esophageal carcinoma. The location of lesions included gastric body(n=5)and gastric sinus(n=5).The lesion size varied from 1.5 to 7.0 cm. All lesions showed contrast enhancement in MDCT enhancement scanning with lymph node metastasis(n=3) and other region metastasis(n=2). Conclusion MDCT examination is an important method for evaluating multiple primary carcinoma of stomach after surgical operation of esophageal carcinoma,moreover,it can find lymph node of clavicular region and mediastinum and pulmonary metastatic lesion .