外科治疗囊性听神经瘤14 例临床观察

目的:探讨囊性听神经瘤的临床特点及手术经验。方法:回顾分析2006年1月-2010年12月我院收治的14例囊性听经瘤的临床资料。结果:肿瘤全切除12例,不全切除2例,无死亡病例,术后4例病人面瘫加重,1例病人听力丧失。结论:与实质性听神经瘤相比,囊性听神经瘤体积较大,病程短,始发症状不典型,颅神经常被累及,可不发生内听道扩大,脑积水发生率低,手术效果差。     

显微手术治疗囊性听神经瘤的临床研究

目的:探讨显微外科开颅治疗囊性听神经鞘瘤的肿瘤全切情况及面、听神经的保留情况。方法:回顾性分析2006年8月至2013年9月我院收治的42例经枕下乙状窦后入路开颅囊性听神经鞘瘤手术患者的临床资料,同时对37例患者进行术后随访,并对结果进行统计学分析。结果:囊性听神经鞘瘤(42例)手术全切率simpson(Ⅰ-Ⅱ级)为64.28%(27例),次全切除率(simpsonⅢ级)为26.19%(11例),部分切除率为(simpsonⅣ级)为9.53%(4例),面神经解剖保留率为71.43%(30例),面神经功能保留率为14.29%(6例),听神经解剖保留率为7.1%,听神经功能保留3例,较实质性听神经瘤的手术效果差。结论:囊性听神经瘤的面、听神经解剖与功能保护尚有难度,需要进一步提高。     

囊性听神经瘤的超微病理学观察

听神经瘤好发于桥小脑角,是颅内常见肿瘤之一,囊性变是听神经瘤的重要病理特征,也是导致听神经瘤体积快速增大,压迫周围神经组织,导致临床症状的突然恶化。因此,阐明囊性变听神经瘤的病理、发生机制具有重要的临床意义。本实验取10例听神经瘤标本,其中4例为囊性听神经瘤标本,电子显微镜观察超微病理,与实性听神经瘤相比,     

膀胱再生技术改进及并发症预防和处理的临床分析(附161例报告)

目的:改进膀胱再生方法,预防并发症产生,提高膀胱再生临床治疗效果.方法:膀胱全切除行膀胱再生术66例,大部切除膀胱再生术70例,结核性挛缩膀胱再生扩大术25例.结果:不全随访膀胱全切除者其中1例无瘤生存16年,另1例现已无瘤生存10年.膀胱大部切除无瘤生存10年以上者12例.结核性挛缩膀胱再生扩大术6例死于其它疾病,19例生存.结论:膀胱再生术,可应用于治疗膀胱各种疾病.对膀胱肿瘤切除部位和范围不受限,对病人打击小,年老体弱者可接受.     

听神经瘤的显微外科现状

听神经瘤是主要起源于前庭神经的良性肿瘤,手术切除是其主要治疗方法之一,听神经瘤常用手术入路包括枕下乙状窦后入路(RSC)、经颅中窝入路(MFC)、经迷路入路(TLC)三种手术入路.非手术治疗包括放射治疗以及动态影像学观察.术中面神经监测应用为解决听神经瘤手术中面神经功能保留问题提供了一种很好的途径,使听神经瘤的并发症发生率已大大降低.本文就听神经瘤外科治疗做一综述.     

后腹腔镜肾上腺全部切除与部分切除治疗醛固酮瘤的疗效对比

目的:探讨后腹腔镜肾上腺全部切除与部分切除治疗醛固酮瘤的疗效。方法:收集我院收治的醛固酮瘤患者60例,随机分为部分切除组和全切除组,每组30例,分别给予肾上腺部分切除以及肾上腺全切除手术,手术结束后,对所有患者的住院时间、术中出血量、手术时间、血清钾、血清醛固酮水平以及患者的治疗效果进行检测并比较。结果:手术后,部分切除组和全切除组患者血清钾水平均升高(P0.05),醛固酮水平均降低(P0.05);与全切除组相比,部分切除组患者的术中出血量以及住院时间较短(P0.05),血清钾水平较高(P0.05),血清醛固酮水平较低(P0.05);两组患者的手术时间以及临床疗效无明显差异(P0.05)。结论:后腹腔镜肾上腺部分切除术较全切除术能够缩短醛固酮瘤患者住院时间,减少手术出血量,升高血清钾水平,降低醛固酮水平。但两种术式的手术时间以及临床疗效相当,对临床有指导意义。     

膀胱平滑肌瘤合并子宫多发性平滑肌瘤一例报道并文献复习

目的对一例膀胱平滑肌瘤合并子宫多发性平滑肌瘤患者诊疗进行回顾性分析。方法回顾分析一例膀胱平滑肌瘤合并子宫多发性平滑肌瘤患者临床资料,并结合相关文献进行复习。结果膀胱平滑肌瘤行局部切除,子宫多发性平滑肌瘤行全子宫切除,术后随访5年,未见肿瘤复发、恶变、侵袭转移及盆腔其他并发症。结论膀胱平滑肌瘤是一种少见的良性肿瘤,术前诊断主要依赖彩超、CT等影像学检查。手术探查能明确肿瘤部位,确诊依赖病理。手术治疗为主,预后良好。     

腹膜后椎前副神经节瘤3例报道并文献复习

目的:提高腹膜后椎前副神经节瘤的CT诊断水平.方法:报道3例经手术病理证实的腹膜后椎前副神经节瘤的临床资料、CT表现、病理结果并复习相关文献.结果:3例患者均位于腹膜后椎前、腹主动脉右侧、右侧肾上腺前内方.动脉期病灶实性部分呈中等程度不均匀强化;门脉期强化更广、更均匀;延迟期病灶强化程度开始减低;坏死区不强化,于门脉期边界显示最清.2例患者手术完全切除.1例部分切除,随访一年患者基本情况良好.结论:CT检查尤其是双期扫描并结合临床可提高诊断率,并为手术提供相关资料.     

显微镜下锁孔手术的临床应用研究

目的：探讨显微镜下锁孔手术的临床应用。方法：回顾性分析近10年来收治的锁孔手术459例的手术经验,总结锁孔手术临床应用。经眉弓锁孔入路治疗颅内病变的手术270例。经翼点锁孔入路治疗颅内病变的手术52例。经后颅窝锁孔入路的手术137例。结果：外伤及高血压引起脑内血肿23例,经翼点锁孔入路治疗效果良好。颅内肿瘤全切除266例（74．7％）,次全切除90例（25．3％）。术后并发症发生率为3．8％,无与手术入路相关并发症。结论：显微镜下锁孔手术是一种安全、有效的微创手术,值得进行深入研究和广泛应用。     

临床护理路径对囊性动脉瘤介入手术患者的应用研究

目的：应用临床护理路径,提高囊性动脉瘤介入手术患者的护理质量。方法：采用病例对照研究随机选择囊性动脉瘤患者60例。其中病例组30例,对照组30例,在相同治疗条件下病例组使用临床护理路径干预,对照组予以常规护理。结果：病例组使用临床护理路径后,与对照组相比平均住院日缩短P〈0．05,住院费用减少P〈0．05,患者满意度提高P〈0．05。结论：临床护理路径对囊性动脉瘤患者介入手术的干预效果有效,值得临床护理应用。     

Parental origin of chromosome 22 loss in sporadic and NF2 neuromas.

It has recently been proposed that the maternally derived chromosome might be preferentially lost in nonfamilial cases of embryonal or early onset malignant tumors. This observation pointed to a potential role of the parental imprinting of the genome during gametogenesis which would be at least partly maintained in the somatic cells. Neuromas are benign tumors that develop from Schwann cells. They occur either sporadically or in individuals that have a genetic predisposition due to neurofibromatosis type 2 (NF2) and usually are multiple. Regardless of the context of occurrence, in approximately 40% of the investigated cases a loss of a chromosome 22 has been documented either by karyotype analysis or by monitoring somatic loss of heterozygosity. We have now examined the parental origin of the chromosome 22 lost in 19 cases of neuromas of patients with unaffected parents among which 11 were non-NF2 patients (sporadic and unique neuroma) and 8 were NF2 patients (bilateral acoustic or multiple neuromas). In both sets of tumors, the lost chromosome 22 can be of either parental origin. A close to threefold preference for the loss of the maternally derived chromosome was observed and should be either confirmed or disproved by studying a larger number of patients.     

Treatment of the painful neuroma by neuroma resection and muscle implantation

The successful treatment of the painful neuroma remains an elusive surgical goal. This report evaluates one approach to the management of this problem which entails neuroma excision and placement of the proximal end of the nerve away from denervated skin, away from tension, and into a well-vascularized environment: muscle. Seventy-eight neuromas in 60 patients with a mean follow-up of 31 months (range 18 to 43 months) were evaluated. Sixty-seven percent of these patients involved Workmen's Compensation and 57 percent had had at least one previous operation to treat their pain. The results demonstrated good to excellent results in 82 percent of the treated nerves in the entire group. Factors that were predictive of a poorer outcome were (1) digital neuroma (p less than 0.0005), (2) Workmen's Compensation (p less than 0.01), and (3) three or more previous operations for pain (p less than 0.01). Transposition of nerves into small superficial muscles or muscles with significant excursion resulted in treatment failures. The etiology and histopathology of treatment failures are reviewed. Treatment of radial sensory neuromas by transposition of the radial sensory nerve into the brachioradialis muscle when any associated injury to the lateral antebrachial cutaneous nerve was also treated, gave good to excellent relief of pain, and improved hand function in 88 percent of the patients.     

B超在肝囊型包虫病诊断中的临床价值与意义

目的：评价B超在肝囊型包虫病诊断中的价值与临床意义。方法：回顾性分析我院2000年12月至2011年12月收治的接受B超检查和手术治疗的332肝囊型包虫病例的临床资料。结果：332例肝囊型包虫病患者中,303例经过手术证实;肝囊型包虫病的B超分型可分为单发单囊型、多发单囊型、多子囊型、破裂感染型和坏死钙化型。单发单囊型患者以低年龄组多发,而高年龄组较少;破裂感染型以高年龄组多发;坏死钙化型病人共3例年龄均在60岁以上;破裂感染型占各型中病例数最多。结论：B型超声检查是肝囊型包虫病的主要检查方法,可确定包虫病的分型,了解包虫囊肿的部位、数目、大小和结构,为术前诊断、手术定位、观察治疗效果提供参考依据。     

Treatment of painful hand neuromas by their transfer into bone

Painful neuromas in the hand are not only very disabling for the patient, but difficult to treat. We present the results of 20 painful neuromas treated by burying the neuroma in the bone. Eighteen of the 20 neuromas operated on had acceptable results, according to the criteria of Herndon et al. We present our technique and compare our results with other treatments in the literature.     

Analysis of chromosome 22 deletions in neurofibromatosis type 2-related tumors.

The neurofibromatosis type 2 (NF2) gene has been hypothesized to be a recessive tumor suppressor, with mutations at the same locus on chromosome 22 that lead to NF2 also leading to sporadic tumors of the types seen in NF2. Flanking markers for this gene have previously been defined as D22S1 centromeric and D22S28 telomeric. Identification of subregions of this interval that are consistently rearranged in the NF2-related tumors would aid in better defining the disease locus. To this end, we have compared tumor and constitutional DNAs, isolated from 39 unrelated patients with sporadic and NF2-associated acoustic neuromas, meningiomas, schwannomas, and ependymomas, at eight polymorphic loci on chromosome 22. Two of the tumors studied revealed loss-of-heterozygosity patterns, which is consistent with the presence of chromosome 22 terminal deletions. By using additional polymorphic markers, the terminal deletion breakpoint found in one of the tumors, an acoustic neuroma from an NF2 patient, was mapped within the previously defined NF2 region. The breakpoint occurred between the haplotyped markers D22S41/D22S46 and D22S56. This finding redefines the proximal flanking marker and localizes the NF2 gene between markers D22S41/D22S46 and D22S28. In addition, we identified a sporadic acoustic neuroma that reveals a loss-of-heterozygosity pattern consistent with mitotic recombination or deletion and reduplication, which are mechanisms not previously seen in studies of these tumors. This finding, while inconsistent with models of tumorigenesis that invoke single deletions and their gene-dosage effects, lends further support to the recessive tumor-suppressor model.     

Mechanisms of Nerve Capping Technique in Prevention of Painful Neuroma Formation

Nerve capping techniques have been introduced as a promising treatment modality for the treatment of painful neuroma with varied outcomes; however, its exact mechanism is still unknown. RhoA is one of the members of the RAS superfamily of GTPases that operate as molecular switches and plays an important role in peripheral nerve regeneration. Our aim was to investigate the structural and morphologic mechanisms by which the nerve capping technique prevents the formation of painful neuromas after neuroectomy. We also hoped to provide a theoretical basis for this treatment approach. An aligned nanofiber conduit was used for the capping procedure and the sciatic nerve of Sprague-Dawley rats was selected as the animal model. Behavioral analysis, extent of neuroma formation, histological assessment, expressions of pain markers of substance P and c-fos, molecular biological changes as well as ultrastructural features were investigated and compared with the findings in a no-capping control group. The formation of traumatic neuromas was significantly inhibited in the capping group with relatively “normal” structural and morphological features and no occurrence of autotomy and significantly lower expression of pain markers compared to the no-capping group. The gene expression of RhoA was consistently in a higher level in the capping group within 8 weeks after surgery. This study shows that capping technique will alter the regeneration state of transected nerves and reduce painful neuroma formation, indicating a promising approach for the treatment of painful neuroma. The initiation of the “regenerative brake” induced by structural as well as morphological improvements in the severed nerve is theorized to be most likely a key mechanism for the capping technique in the prevention of painful neuroma formation.     

Expression of AMPA receptor subunits at synapses in laminae I–III of the rodent spinal dorsal horn

Neuropathic pain may arise following peripheral nerve injury though the molecular mechanisms associated with this are unclear. We used proteomic profiling to examine changes in protein expression associated with the formation of hyper-excitable neuromas derived from rodent saphenous nerves. A two-dimensional difference gel electrophoresis (2D-DIGE) profiling strategy was employed to examine protein expression changes between developing neuromas and normal nerves in whole tissue lysates. We found around 200 proteins which displayed a >1.75-fold change in expression between neuroma and normal nerve and identified 55 of these proteins using mass spectrometry. We also used immunoblotting to examine the expression of low-abundance ion channels Nav1.3, Nav1.8 and calcium channel α2δ-1 subunit in this model, since they have previously been implicated in neuronal hyperexcitability associated with neuropathic pain. Finally, S³⁵methionine in vitro labelling of neuroma and control samples was used to demonstrate local protein synthesis of neuron-specific genes. A number of cytoskeletal proteins, enzymes and proteins associated with oxidative stress were up-regulated in neuromas, whilst overall levels of voltage-gated ion channel proteins were unaffected. We conclude that altered mRNA levels reported in the somata of damaged DRG neurons do not necessarily reflect levels of altered proteins in hyper-excitable damaged nerve endings. An altered repertoire of protein expression, local protein synthesis and topological re-arrangements of ion channels may all play important roles in neuroma hyper-excitability.     

Neuroma under the fifth metatarsal head. A retrospective study

This retrospective study was carried out over 83 surgical cases at the distal portion of the fifth metatarsal, compromising the treatment of tailor's bunion, fifth metatarsal overload and the concomitant presence of both pathologies in some cases. Neuromas were founded under the fifth metatarsal head in 18 of the cases studied (21.7%). The results look at whether if there is an association between different fifth metatarsal pathologies and the presence of neuromas and found a significant association between the appearance of neuromas in patients with the same metatarsal overload, especially if it is accompanied by a tailor's bunion pathology.