食管超声引导下经胸微创外科封堵术治疗先天性心脏病的疗效

目的:观察食管超声引导下经胸微创外科封堵术治疗先天性心脏病(CHD)的疗效。方法:选取56例CHD患儿,根据手术方案不同分为对照组和研究组各28例。对照组予以右腋下小切口微创术,研究组予以食管超声引导下经胸微创外科封堵术。比较两组术后机械通气时间、住院时间、住院费用和并发症发生情况。结果:研究组机械通气时间、住院时间、住院费用和并发症发生率均明显低于对照组,差异有显著统计学意义(P<0.01)。结论:食管超声引导下经胸微创外科封堵术治疗先天性心脏病的疗效优于右腋下小切口微创术疗效。

Electrocorticography-Guided Surgical Treatment of Solitary Supratentorial Cavernous Malformations with Secondary Epilepsy

Objective To evaluate the efficacy of electrocorticographic(ECoG) monitoring and the application of different surgical approaches in the surgical treatment of solitary supretentorial cavernous malformations with secondary epilepsy. Methods This study enrolled a consecutive series of 36 patients with solitary supratentorial cavernous malformations and secondary epilepsy who underwent surgery with intraoperative ECoG monitoring in the Department of Neurosurgery between January 2004 and January 2008. The patients were composed of 15 males and 21 females, aged between 8 and 52 years(mean age 27.3±2.8 years) at the time of surgery. Epilepsy history, the type of epilepsy at the presentation, lesion location, the incidence of residual epileptiform discharges, and postoperative outcomes were evaluated. Results Histopathological examination indicated cavernous malformations and hippocampal sclerosis in 36 and 5 cases, respectively. Neuronal degeneration, glial cell proliferation, and neurofibrillary tangles were found in all the resected cerebral tissues of extended lesionectomy of residual epileptic foci. Lesionectomy, anterior temporal lobectomy, anterior temporal lobectomy plus cortical thermocoagulation, extended lesionectomy, extended lesionectomy plus cortical thermocoagulation were performed in 4, 4, 1, 14, and 13 cases, respectively. Residual epileptiform discharges were captured in 9 out of the 14 patients who had additional cortical thermocoagulation. According to Engle class for postoperative outcomes, 27 cases were class I(75.00%), 5 were class II(13.89%), 2 were class III(5.56%), and 2 were class IV(5.56%), thus the total effective rate(class I+class II) was 88.89%. Neither of epilepsy history, the type of epilepsy, and the location of cavernous malformation was significantly related to outcomes(P>0.05). A significant relationship was found between the incidence of residual epileptiform discharges and outcomes(P=0.041). Conclusions Intraoperative ECoG monitoring, the application of different surgical approaches, and the resection of residual epileptic foci could produce good result in the surgical treatment of supratentorial cavernous malformation with secondary epilepsy. Postoperative residual epileptiform discharges could be a useful predictor for evaluating the outcomes.

计算机导板指导下采用不翻瓣种植术对无牙颔患者植入四枚或六枚种植体进行即刻功能重建的回顾性研究

目的：根据3D软件设计和不翻瓣引导术．通过使用四枚或六枚种植体对无牙颌患者行固定修复体即刻负重并观察治疗的效果。材料与方法：30例患者（24例女性．6例男性）．平均年龄529岁（35～84岁）．共植入195枚即刻负重种植体（97枚Nobelspeedy Groovy．98枚Branemark MK III Groovy），支持25例上颌和17例下颌全口丙烯酸树脂即刻固定修复体并随访1年。v1．6版和v2．0版的Procera软件用于设计种植体位置，制作不翻瓣引导种植术的手术导板。为了能够即刻负重，种植体必须使用至少35Ncm的扭矩。种植体植入同时放置术前预成的临时修复体．术后6～12个月进行永久修复。从修复体和种植体失败情况、边缘骨高度的变化、并发症、临床时间和患者满意度几方面进行效果评估。结果：本研究包含4例无牙颌患者和26例进行性牙周炎患者．共有195枚种植体即刻负载（上颌128枚．下颔67枚）。有3例患者4枚种植体在愈合期失败：上颌2枚（1枚直植体，1枚斜植体）；下颌2枚（2枚斜植体），这3例患者的再治疗都很成功。在负重1年后．无种植体脱落．也无永久修复体失败。有3例患者出现术中导板折断。1例患者进行重新取模．制作术后临时义齿。有3例患者术后系统使用抗生素进行种植体周围炎的治疗。结论：计算机辅助引导的不翻瓣种植术单颌植入四枚或六枚种植体是可行的、可预测的治疗方法。尽管有一些并发症的发生．但能够成功治疗。值得注意的是：这种方法需要操作者具有一定的临床经验，并且需要经过专门培训。