简介：目的总结颅内动脉瘤的显微手术治疗和并发症防治的经验.方法回顾性分析2006年3月至2010年3月期间收治的59例颅内动脉瘤患者的临床资料、手术方式、预后及并发症.结果全组59例共62个动脉瘤.3例因年龄等因素拒绝手术,其余56例均接受手术治疗,其中行显微镜下成功夹闭动脉瘤57个,动脉瘤孤立术1个,巨大动脉瘤瘤腔明胶海绵填塞术1个,手术过程顺利.术后随访3个月以上,生存质量根据日常生活能力（ADL）分级评分：Ⅰ~Ⅱ级47例（83.9%）,Ⅲ~Ⅳ级3例（5.4%）,Ⅴ~Ⅵ级3例（5.4%）,Ⅶ级1例（1.8%）,死亡2例（3.6%）.结论数字减影血管造影（DSA）及CT血管造影（CTA）均可有效诊断颅内动脉瘤.早期显微手术夹闭是治疗颅内破裂动脉瘤的有效方法.翼点入路仍是颅内动脉瘤最常用的手术入路,能明显提高破裂动脉瘤患者的生存率和生存质量.术后积极防治并发症是治疗成功的关键.

简介：背景与目的:海绵窦区颅底贯通性肿瘤临床上并不少见,长期以来均被认为是颅外肿瘤的晚期表现,不适于进行根治性手术治疗。我们应用经眶颧颅内外联合入路显微手术根治性切除海绵窦区颅底贯通性肿瘤,以期提高侵及海绵窦区域的颅底贯通性恶性肿瘤的全切除率,减少手术造成的神经系统并发症的发生。方法:本组收集了我科自1998年3月～2002年2月收治的14例海绵窦区颅底贯通性肿瘤病例,其中女性5例,男性9例;年龄22至73岁,平均43.2岁;腺样囊性癌4例,恶性成纤维细胞瘤2例,鼻咽癌2例,上颌窦癌1例,上颌骨软骨肉瘤1例,骨肉瘤1例,骨巨细胞瘤1例,骨纤维结构发育不良1例,神经纤维瘤1例。所有手术全部采用经眶颧颅内外联合入路,手术方法主要包括整体游离眉弓和颧骨、切除蝶骨嵴外侧、打开眶上裂、眶下裂和视神经管。肿瘤切除常规按无瘤原则(enbloc)进行。结果:本组共14例患者均达到肿瘤根治性全切除。所有患者术后均无神经功能障碍。经CT/MRI随访3个月～36个月,均未复发。结论:应用经眶颧入路显微手术可避免术中对正常脑组织的牵拉、减少手术中颅内操作的时间、并且在巨大型肿瘤的切除过程中控制海绵窦和肿瘤的出血等方面具有十分突出的优点。大大地提高了颅底贯通性肿瘤的根治率,并相应地减少了并发症的发生率,加快了患者恢复的过程。

简介：动脉瘤样骨囊肿（ABC）最早由Jaffe及Linchtenstein发现并命名[1],常起始骨表面,是一种少见的瘤样病变,发生于鼻窦者及颅骨者较为罕见。我们遇到1例前颅窝及左筛窦动脉骨囊肿术后复发病例,经放射治疗,随访32个月。报告如下：

简介：ＥＬＥＭＥＮＴＡＬＳＴＵＤＹＯＦＧＥＮＥＴＨＥＲＡＰＹＷＩＴＨＴＨＲＯＭＢＯＰＯＩＥＴＩＮＬｕＣｈｅｎｇｒｏｎｇ陆承荣ＺｈａｏＪｉａｎｚｅｎｇ赵建增ＷａｎｇＸｉａｏｐｉｎｇ王小平Ｌｉｕｌｉ刘丽ＲｅｓｅａｒｃｈＣｅｎｔｅｒｏｆＭｏｌｅｃｕｌａｒＢｉｏｌ...

简介：背景与目的：近年来，颅底肿瘤手术有较快的发展。为积累和交流经验，本文总结了16例颅底恶性肿瘤病例，探讨手术径路和治疗效果。方法：回顾性分析1985年至今在中山大学肿瘤防治中心采用颅面联合径路切除的16例颅底恶性肿瘤病例资料，探讨手术径路、修复方法，总结生存、复发情况及并发症。结果：16例中前颅底手术12例(13次手术，其中1例两次前颅底手术)，侧颅底3例，后颅底1例。6例硬脑膜切除后用额骨骨膜、颞肌筋膜、阔筋膜和人造硬脑膜修复，颅底缺损3例用钛网、1例用玻璃钢，其它只用额骨骨膜和／或帽状腱膜和／或肌肉修复，皮肤缺损3例用带血管蒂皮瓣、2例用转移皮瓣修复。颅底手术后生存时间为1～99个月，中位生存时间为14个月。8例术后复发，复发的中位时间为20个月，4例术后未控，4例无瘤生存。7例出现较轻微的并发症。结论：根据肿瘤位置选择前、侧、后颅底手术径路进行颅面联合手术可以安全和有效地切除肿瘤，同时配合术后放疗可以获得较好的效果。

简介：ＴＨＥＳＴＵＤＹＯＦＥＳＴＲＯＧＥＮＡＮＤＰＲＯＧＥＳＴＥＲＯＮＥＲＥＣＥＰＴＯＲＩＮＮＡＳＯＰＨＡＲＹＮＧＥＡＬＣＡＲＣＩＮＯＭＡＺｈｅｎｇＴｉａｎｒｏｎｇ郑天荣；ＬｉＪｉａｎｃｈｅｎｇ李建成；ＬｉｕＸｉｕｙｉｎｇ刘秀英；（Ｄｅｐａｒｔｍｅｎｔｏｆ...

简介：GFAPisaspecificantigenofglialelement,butAlpha-1-antichymotrypsinhasnotbeenreportedintheliterature.Alpha-1-antichymotrypsinwasguidedbyGFAPusingPAPmethodtotheastrocytesof137gliomas.120(87%)gliomaswerepositiveforAlpha-1-antichymotrypsin.Ofthese120gliomas,86(72%)gavediffusedistribution,17(14%)gavefocaldistribution,and17(14%)gavescattereddistributions.Alpha-1-antichymotrypsiningliomatissuemaybeanimportanttumormarkerfordiagnosis.

简介：ThehistogensisofextramammaryPaget’sdiseasehasnotbeensolvedandremainedcontroversial.EightcasesofextramammaryPaget’sdiseaseofgeni-tocruralregionwereinvestigatedbyalcianblueandPASstainandimmunoreactionofanti-CEAandanti-keratin.Itwasfoundthatthepatternandintensityofalcianblue,PASstainingwereidenticalforPagetcellsandsecretorycellsofapocrinesweatgland;andCEAimmunoreactivitywasuniformlyobservedinbothPagetcellsandeccrinesweatgland.Thekeratinimmunoreactionwaspositiveinkeratinocytes,apocrineandeccrinesweatgland,whereasPagetcellswerenegative.TheseresultssuggestedthatPagetcellsofextramammaryPaget’sdiseasecouldbederivedfrommultipotentialepidermalgermcells.

简介：近年来,由于颅颌面外科与显微外科手术的进步,前颅底、头面部肿瘤手术治愈率明显提高,同时肿瘤切除后缺损与再建方法也逐渐增加,特别是应用各种肌皮瓣,如带蒂帽状腱膜骨膜及颞浅筋膜瓣的采用,游离腹直肌皮瓣及游离背阔肌皮瓣等的应用,使重建外科手术提高到一个新的水平。本文收集13例前颅底、副鼻窦恶性肿瘤,采用经颅-鼻腔双重人路方法切除肿瘤。术中行双额冠状瓣开颅、骨瓣形成、经前颅窝底探查肿瘤侵犯部位及程度,一期整块切除前颅底及筛窦恶性肿瘤。应用鼻窦

简介：背景与目的：颅底肿瘤由于位置深在，解剖复杂，手术难度较大。本文总结我们治疗21例颅底肿瘤的体会，以探讨颅底肿瘤的手术路径选择及治疗效果。方法：回顾性分析我院1991～2004年经颅面联合入路手术切除的颅底肿瘤21例，其中累及前颅底17例，中颅底2例，后颅底2例；累及颅底至硬脑膜14例，累及颅底、硬脑膜至脑组织4例。结果：21例中5例为初治患者，16例为综合治疗后局部复发者；其中18例采用颅面联合人路前颅底鼻窦沟通切除术，3例采用耳前颞下窝人路切除术。13例行手术并放疗，其中1例为术前放疗，12例为术后放疗；8例行单纯手术治疗。本组病例均作了术后随访，随访时间最长为11年，最短为5个月。3年生存率为70．0％。5年生存率为42．9％。结论：颅面联合人路手术连续整块切除颅底肿瘤是可行的；术后结合放射治疗可以提高颅底肿瘤患者的生存率。

简介：ＳＴＵＤＹＯＮＭＥＴＡＳＴＡＳＩＳＡＳＳＯＣＩＡＴＥＤＧＥＮＥＳＣＲＥＥＮＥＤＢＹＭＯＮＯＣＬＯＮＡＬＡＮＴＩＢＯＤＹＨＩＬＱｉＴｅｎｇｐｉｎｇ齐藤平；Ｚｈａｎｇｐｅｉｊｉ张沛基；ＷｅｉＳｈｕｇｕａｎｇ魏曙光；ＣｈｅｎＤｏｎｇ陈东；ＬｉＲｅｎ李仁；Ｗ...

简介：TheallelicdistributionofEcoRIandBamHIfragmentsofrasfamilygenesbetweenthehumanprimarygastriccancertissuesandthecorrespondingadjacentnormaltissuesdidnotshowanydifferences.ThreegenotypesofBamHIrestrictionfragmentslengthpolymorphismofc-H-raswererevealed.NosignificantdifferencesintheRFLPswereobservedbetweennormalindividualsandgastriccancerpatients.Fourprotooncogenes,c-H-ras,N-ras,c-mycandc-fos,werefoundtobetranscriptionallyactiveinthegastriccancertissuesinsomecasesexamined.Thecomparisonoftheexpressionoftheseoncogenesbetweenthemalignanttissuesandthecorrespondingnormaltissuesshoweddifferentialpatterns.Theexpressionofc-H-rasatcellularlevelwasdetectedwithinsituhybridization.Theenhancedexpressionofc-H-rasinthegastriccancercellswasdemonstrated,butthedegreeoftheexpessionamongthecancercellswasshowntobeheterogeneous.Inaddition,theenhancedexpressionofc-H-raswasseeninthei

简介：Objective:Toexploretheclinicopathologicalfeatures,surgicaltreatmenttechniques,andprognosticriskfactorsofintrahepaticcholangiocarcinoma(ICC).Methods:Atotalof104ICCcaseswerecollectedfromJanuary2008toDecember2013atTianjinMedicalUniversityCancerInstituteandHospitalanddividedintothehepatichilumlymphadenectomy(HLL,21cases),extendedhepatichilumlymphadenectomy(EHLL,12cases),andnon-lymphadenectomy(NL,71cases)groups.Theclinicaldataofthepatientswereretrospectivelyanalyzed,andtheprognosticdifferenceswerecomparedamongdifferentgroups.Results:The1-,2-,and3-yearoverallsurvival(OS)ratesofallcaseswere72.1%,56.1%,and43.7%,respectively.Themediansurvivaldurationwas34months.The1-,2-,and3-yearOSratesoftheHLLgroup(42.9%,28.6%,and28.6%,respectively)weresignificantlylowerthanthoseoftheNLgroup(78.9%,62.5%,and47.8%,respectively).Meanwhile,the1-,2-,and3-yearOSratesoftheEHLLgroup(75.0%,56.1%,and33.3%,respectively)werenotsignificantlydifferentfromthoseoftheothertwogroups.Univariateanalysisshowedthatage,gender,AmericanJointCommitteeonCancer(AJCC)stage,differentiation,ferritin(Fer),carbohydrateantigen19-9(CA19-9)andcarcinoembryonicantigen(CEA)levels,lymphnodemetastasis(LNM),andlymphnodedissection(LND)wereprognosticfactorsforthelong-termsurvivalofICC.Meanwhile,multivariateanalysisrevealedthatage,AJCCstage,differentiation,Ferlevels,andLNMwereindependentriskfactorsforsurvival.Conclusions:ICCpatientswillnotbenefitfromlymphadenectomyintheabsenceofLNM.However,systematiclymphadenectomymayimproveICCoutcomesifthelocationoflymphaticmetastasisisknown.Age,AJCCstage,differentiation,Ferlevel,andLNMareindependentriskfactorsforsurvivalinICC.

简介：目的评价Gasket-Seal技术在颅底肿瘤内镜手术颅底重建中应用的效果.方法在中外文文献数据库中检索2007年10月至2016年10月已发表的关于应用Gasket-Seal技术进行颅底肿瘤内镜手术颅底重建的病例对照研究.利用ReviewManager（5.3版）软件进行荟萃分析.结果按文献入选标准共纳入5篇病例对照研究,共210例颅底肿瘤内镜手术患者纳入荟萃研究.荟萃分析表明,与非GS组相比,GS组患者术后远期脑脊液漏发生率低（OR=0.32,95％CI=0.11～0.89,P=0.03）,术后脑膜炎发生率低（OR=0.10,95％CI=0.01～0.67,P=0.02）.根据GS组是否联合NSF进行亚组分析,结果表明两亚组术后远期脑脊液漏发生率间比较,差异无统计学意义（P=0.85）.在GS组中,采用人工骨组与采用同种骨（包括自体骨和异体骨）组病例术后脑脊液漏发生率比较,差异无统计学意义（P=0.25）.结论应用Gasket-Seal技术能安全有效地完成颅底肿瘤内镜手术中的颅底重建.相较其他颅底重建方法,术后脑脊液漏及脑膜炎的发生率更低.

简介：Acombinedhistopathological,mucinhistochemi-calandimmunohistochemicalstudyofthetransitionalmucosa(TM)adjacenttocolorectalcancerispresented.Twenty-sixresectedspecimenswerestudiedbyhematoxylinandeosin(HE)andhighirondiamine-alcianblue(HID-AB).Carcinoem-bryonicantigen(CEA)wasdemonstratedbyperoxi-daseantiperoxidass(PAP)technique.TheappearanceoftheTMisusuallythicker,longeranddilatedcryptswithincreasedimmatureandintermediatecells.VariableamountofsialomucinsanddecreasesulphomucinscontentaswellasincreasedCEAcontentarefoundintheTM.Thesechangesarenotseeninnon-transitionalzoneandnormalcolorectalmucosa.ItissuggestedthatthemucinchangesandexpressionofCEAintheTMmayindicateanearlyprimarypremalignantchangesandmaybeoneofthereasonsfortheTMaffectingtheprognosisofpatientswithlargebowelcancerafterradicalresection.

简介：Objective:TostudytheeffectofantisenseVEGFRNAonratC6gliomasinvivoandfindoutthefeasibilityofantiangiogenesistherapywithantisenseVEGFRNAformalignantgliomas.Methods:ParentalratC6gliomacellsandC6cellstransfectedwithantisenseVEGFcDNAwereimplantedintracerebrallyandsubcutaneouslyintoSDratsascontrolandtransfectedgroup.RatsbearingcerebralandsubcutaneousC6gliomasweretreatedwithantisenseVEGFcDNAastreatedgroupandsenseVEGFcDNAandemptyvectorascontroloftreatedgroup.Thegeneralmanifestation,survivaltime,MRIandhistopathologicalchangesofallratswereobserved.Thevolumeofsubcutaneouslyimplantedtumorswasdeterminedregularly.InsituhybridizationandimmunohistochemicalstainingwereusedfordetectionofVEGFgeneexpressionofgliomaswhilePCNAimmunostainingandTUNELmethodforexaminationofproliferationactivityandapoptosisofgliomas,respectively.Results:Thesurvivaloftheratsintransfectedandtreatedgroupwasprolonged.Thereweretworatssurvivingover90dinthetreatedgroupandtheirtumorsdisappeared.TheVEGFgeneexpression,thenumberofmicrovesselsandtheproliferationactivityweredecreasedandalargeamountofapoptoticcellscouldbefoundincerebralandsubcutaneousgliomasintreatedandtransfectedgroups.Conclusion:VEGFisoneofthecandidategenesforgenetherapyofmalignantgliomas.AntisenseVEGFRNAcombinedwithothertherapiesshouldbestudiedfurtherforenhancingthetherapeuticeffectofmalignantgliomas.

简介：

简介：Gingivaladenoidcysticcarcinoma(ACC)isararemalignancy.Wedescribethediagnosisandtreatmentofa43year-oldwomanwhopresentedwithapersistentoralulcerforapproximately1year,andsubsequentpainintheleftposteriormaxillaryregion.Clinicalexaminationrevealedanulcerintheleftuppermolargingiva,withswellingintheregionfromthesecondpremolartothethirdmolar.X-rayimagesdemonstratedtheinvolvementofthemaxillaryalveolarbone.ThehistopathologicalandimmunohistochemicalfeatureswerediagnosticofACC.ACCisoftenpresentedasagingivallesion;thus,itmayeasilybeneglectedbypatients.Theidentificationofthistumorusingspecificpathologicalanalysespreventsmisdiagnosisandenablesclinicianstodeterminetheappropriatetreatment.Inthiscase,norecurrenceordistantmetastasiswasobservedafter2yearsoffollow-up.

简介：背景与目的:颅内脊索瘤好发于颅底,侵袭范围广泛,手术全切除困难,是神经外科的难题之一。本文探讨颅内脊索瘤临床特点、诊断及手术入路的选择。方法:对自1992年1月～2002年8月间在本院手术治疗的64例颅内脊索瘤进行回顾性分析。结果:64例发病年龄为5～67岁,平均37.5岁。男女比例约为1.6:1。头痛、复视是本病最常见的症状。64例患者共接受69次手术,肿瘤全切21例,次全切除24例,部分切除19例。结论:目前颅内脊索瘤手术全切率仍低,预后差,宜行积极手术治疗,手术入路的选择需根据肿瘤的解剖位置和侵袭的方向而定。

简介：儿童颅内肿瘤发病率高，其治疗涉及儿童的生长发育及智力发育，与成人肿瘤有很大区别。本文总结几种常见儿童颅内肿瘤的诊断与治疗的现状和进展。