目的：探讨巨大听神经瘤治疗抉择，从而降低并发症。方法：通过36例巨大听神经瘤显微手术大部分切除肿瘤，残留肿瘤行伽玛刀治疗，并进行观察。结果：手术后无神经功能废损，伽玛刀治疗后随访2 ～4年，肿瘤被有效控制。结论：显微手术后配合伽玛刀治疗巨大听神经瘤可作为减少术后并发症，提高生活质量的有效手段。
【摘要】 目的 探讨伴有动眼神经麻痹的后交通动脉瘤的显微手术治疗效果。 方法 回顾性分析2008年1月—2010年12月采用显微外科手术治疗的伴随动眼神经麻痹的后交通动脉瘤患者52例的临床资料，观察动眼神经麻痹的恢复情况，总结临床经验。术后随访时间3～36个月，平均16个月。 结果 发病至手术时间lt;14 d患者34例，22例（64.7%）完全恢复，12例（35.3%）部分恢复。gt;14 d者18例，6例（32.3%）完全恢复，12例（67.7%）不完全恢复。不完全性麻痹15例，12例（80.0%）完全恢复，3例（20.0%）得到改善；而术前完全动眼神经麻痹的37例中，仅11例（29. 7% ）彻底恢复、26例（70. 3% ）部分恢复。 结论 早期明确诊断及尽早手术治疗，对于伴随有动眼神经麻痹的后交通动脉瘤患者的神经功能恢复极为重要。【Abstract】 Objective To explore the curative effect of microsurgical treatment for posterior communicating artery aneurysms associated with oculomotor palsy. Methods The clinical data of 52 patients with posterior communicating artery aneurysms associated with oculomotor palsy treated microsurgically from January 2008 to December 2010 were retrospectively analyzed. Recovery of oculomotor palsy was observed, and clinical experiences were summarized. Results The follow-up time ranged from 3 to 36 months with a mean period of 16 months. Among the 34 patients operated on within 14 days after the onset of oculomotor palsy, 22 (64.7%) showed complete recovery, and 12 (35.3%) partial recovery. In the 18 patients operated on more than 14 days after the onset of the disease, 6 (32.3%) showed complete recovery, and 12 (67.7%) partial recovery. Incomplete palsy occurred in 15 patients among whom 12 (80%) had complete recovery and 3 (20%) alleviation. Among the other 38 patients with complete oculomotor palsy, only 11 (29.7%) got complete recovery, and the remaining 26 (70.3%) partial recovery. Conclusion Early and positive diagnosis and treatment of patients with posterior communicating artery aneurysms associated with oculomotor palsy is of great importance to the nerve function recovery.
目的 探讨经肛门内镜显微手术(TEM)治疗直肠肿瘤的疗效。方法 回顾性分析2009年1~12月期间我院行TEM治疗7例直肠腺瘤患者的临床资料。结果 7例直肠肿瘤均获完整切除，切缘均阴性。手术时间55～240 min，平均110 min; 术中出血量5～100 ml,平均45 ml。术后病理诊断: 直肠绒毛状腺瘤4例，绒毛管状腺瘤2例，直肠腺癌1例。手术并发症: 术中直肠穿孔1例，肺部感染1例，尿潴留1例。 7例随访6~13个月,平均8个月，肿瘤无复发。结论 TEM治疗直肠肿瘤安全、有效。
ObjectiveTo summarize the experience of microsurgery in primary hospital for the posterior communicating artery aneurysms (PCOAan). MethodsThe clinical data of 48 patients with PCOAan who underwent microsurgery from January 2008 to December 2012 were retrospectively analyzed. ResultsAll the necks of aneurysms of 48 cases were successfully clipped, Acording to the Glasgow outcome score (GOS), the early curative effects were good in 36 cases (75.0%, GOS 4-5) poor in 10 cases (20.8%, GOS 2-3) and death in 3 cases (2.1%, GOS 1). After the operation was carried out, the operation time was shorten, aneurysm intraoperative rupture rate was lower, postoperative complications were lower, and the average medical expense was reduced; the difference was significant in 24 cases before and after the operation (P<0.05). ConclusionMicrosurgery for PCOAan is an effective method which should be popularized in primary hospitals.
ObjectiveTo summarize the research progress of peripheral nerve surgery assisted by Da Vinci robotic system. MethodsThe recent domestic and international articles about peripheral nerve surgery assisted by Da Vinci robotic system were reviewed and summarized. ResultsCompared with conventional microsurgery, peripheral nerve surgery assisted by Da Vinci robotic system has distinctive advantages, such as elimination of physiological tremors and three-dimensional high-resolution vision. It is possible to perform robot assisted limb nerve surgery using either the traditional brachial plexus approach or the mini-invasive approach. ConclusionThe development of Da Vinci robotic system has revealed new perspectives in peripheral nerve surgery. But it has still been at the initial stage, more basic and clinical researches are still needed.
ObjectiveTo investigate the effect of microsurgical therapy and the key techniques in resection of large bilateral olfactory groove meningiomas via unilateral subfrontal approach.MethodsThe clinical data and follow-up results of 181 patients with large bilateral olfactory groove meningiomas who underwent microsurgical removal between June 2007 and May 2014 were retrospectively analyzed. The initial symptom was headache or (and) dizzy in 95 cases, hyposmia or anosmia in 53, impairment of visual function or (and) visual field deficits in 26, cognitive deficits in 3, epilepsy in 2, and accidentally discovered in 2. Unilateral subfrontal approach was applied in all patients (neuroendoscopy was applied in some cases in the later period); incision of falxcerebri, and when necessary, ligation of superior sagittal sinus to resect contralateral tumor were performed. Simultaneous or staged period resection of tumors invading skull base such as ethmoid sinus and superior meatus and reconstruction of the skull base were performed.ResultsThere was no perioperative mortality. Simpson grade Ⅰ resection was obtained in 33 cases, grade Ⅱ resection was in 141, grade Ⅲ resection was in 4, and grade Ⅳ resection was in 3. Among the 229 eyes with preoperative visual impairment, postoperative visual improvement was found in 215 eyes, unimproved was in 12, and aggravation was in 2. The 59 sides which lost their function of olfactory nerve before surgery obtained no recoveries after surgery, while olfactory nerve with residual function preoperative still kept sensing after surgery in 149 lateral sides (149/303). The patients were followed up for (76.9±43.8) months, and postoperative recurrence or residual tumor growth were found in 21 cases.ConclusionsBecause of the contralateral ocular and (or) nasal compensation, early discovery is very difficult for patients with olfactory groove meningioma. The unilateral subfrontal approach can provide sufficient exposure for resection of large bilateral olfactory groove meningiomas and improve the visual acuity and visual field deficits. But it is poor at the preservation of olfactory function. The approach, better with the aid of neuroendoscopy, can improve the total cutting rate, with the advantages of minimally invasion and fewer complications. It is a worthy priority for these tumors.
ObjectiveTo explore the changes of intraoperative temperature and influencing factors of the short-term prognosis of patients undergoing clipping of posterior communicating artery aneurysms.MethodsThe basic clinic data and intraoperative temperature of patients undergoing elective clipping of posterior communicating artery aneurysms between October 2018 and July 2019 were collected, and the minimum intraoperative temperature was categorized into ≥36.0 and <37.5℃, ≥35.0 and <36.0℃, and <35.0℃. According to the Glasgow outcome scale (GOS) at discharge, the patients were divided into good prognosis group (GOS 4-5) and bad prognosis group (GOS 1-3). Multiple logistic regression analysis was used to obtain the risk factors of short-term prognosis.ResultsA total of 127 cases were involved, and intraoperative hypothermia (<36.0℃) occurred in 64 cases (50.4%). The intraoperative temperature presented classical three-phrase changes, i.e. it dropped rapidly at 1 hour after anesthesia introduction, decreased slowly during 2-3 hours after anesthesia introduction, and then entered the plateau. In the 127 cases, 93 (73.2%) had good prognosis, with an intraoperative hypothermia proportion of 44.1% (41/93); and 34 (26.8%) had bad prognosis, with an intraoperative hypothermia proportion of 67.6% (23/34). Univariate analysis showed that Hunt-Hess grade (χ2=18.999, P<0.001), intraoperative bleeding (χ2=7.074, P=0.008), minimum intraoperative temperature (Z=−3.473, P=0.001), and postoperative complications (χ2=43.060, P<0.001) were related to the short-term prognosis of patients undergoing clipping of posterior communicating artery aneurysms. Multiple logistic regression analysis presented that high Hunt-Hess grade (Ⅳ, Ⅴ) [odds ratio (OR)=6.456, 95% confidence interval (CI) (1.141, 36.532), P=0.035], the minimum intraoperative temperature <35.0℃ [OR=7.552, 95%CI (1.450, 39.345), P=0.016], and postoperative complications [OR=22.866, 95%CI (6.778, 77.142), P<0.001] were independent risk factors of the short-term prognosis. The difference in short-term prognosis between patients with the minimum intraoperative temperature ≥35.0 and <36.0℃ and the ones with the minimum intraoperative temperature ≥36.0 and <37.5℃ was not statistically significant (P>0.05).ConclusionsThe minimum intraoperative temperature<35.0℃ and postoperative complications were changeable factors to effect progonosis of patients undergoing elective clipping of posterior communicating artery aneurysms. Clinical staff should set medical intervention measures based on the individual conditions of patients to improve patients’ quality of life.