后交通动脉动脉瘤夹闭术中瘤夹的选择和应用

目的探讨开颅夹闭后交通动脉动脉瘤(PCoAA)的手术中,动脉瘤夹的选择规律和使用方式。方法回顾性分析2007年1月—2011年6月,北京大学第一医院开颅手术夹闭的46例PCoAA患者的临床资料。根据动脉瘤颈与载瘤动脉的关系对动脉瘤进行分型,分析瘤颈的位置、术中动脉瘤夹的型号及放置方式等。术后对患者以门诊、电话、DSA进行随访4个月至4年。结果①将46例PCoAA分为颈内动脉、后交通动脉、分叉型3种类型。其中分叉型22例、颈内动脉型19例、后交通动脉型5例。动脉瘤的位置(按时钟模式的12个钟点方向)位于1个钟点的2例,跨2个钟点的34例,跨3个钟点的10例。②对37个动脉瘤选用弯型动脉瘤夹、6个选用直型、2个选用成角度跨血管型(90°)、1个选用枪型。瘤夹长度54.3%(25/46)的为6～7 mm,另有21.7%(10/46)的长度为5～7 mm。对后交通动脉型及分叉型动脉瘤夹放置均采用平行于血管方向,而对颈内动脉型动脉瘤,垂直血管放置瘤夹13例,平行于血管放置瘤夹6例。③术后随访显示,患者均无动脉瘤复发及破裂的临床表现。对12例行DSA随访,显示动脉瘤颈均夹闭完全,无动脉瘤残留。结论 PCoAA夹闭术中,确认动脉瘤颈的位置,辨别瘤周血管的解剖关系,对动脉瘤夹的选择和放置至关重要。首选弯型动脉瘤夹,能提高完全夹闭PCoAA的成功率。

颅内动脉瘤夹闭术后瘤夹对CTA图像质量的影响研究

目的:探讨颅内动脉瘤夹闭术后动脉瘤夹对计算机断层血管造影(computed tomography angiography,CTA)图像的影响。方法:对62例颅内动脉瘤夹闭术后病人行同步CTA检查,运用容积再现(volume rendering,VR)及多平面重组(multiplanar reconstruction,MPR)方法,观察动脉瘤夹对CTA图像的影响,比较VR、MPR对动脉瘤夹闭术后载瘤动脉是否狭窄及狭窄程度。结果:CTA可清楚体现瘤夹与载瘤动脉的关系。使用Kappa系数分析,常规VR与MPR对比K=0.452,P=0.000;常规MPR与减影VR对比K=0.132,P=0.019,P<0.05。即常规VR与MPR评价血管狭窄有一定一致性,而常规MPR与减影VR一致性差。瘤夹伪影分为3个等级:Ⅰ级49例(79.0%),Ⅱ级11例(17.7%),3Ⅲ级2例(3.2%)。瘤夹数量与瘤夹伪影等级秩和检验P>0.05。结论:CTA图像质量受金属伪影及瘤夹减影不全的影响,减影CTA需要结合的多种图像重组方法提高对动脉瘤夹闭术后疗效评价的可靠性。

内撑式动脉瘤夹在颅内前循环动脉瘤术中的应用

目的探讨内撑式动脉瘤夹在颅内前循环动脉瘤术中的应用,比较其与Yasarjil动脉瘤夹的不同,以指导术中对动脉瘤夹的选择。方法回顾性分析21例颅内前循环动脉瘤患者的临床资料,分析其瘤颈位置、术中动脉瘤夹类型、术中瘤夹置入过程。术后对患者以脑血管造影或头部CT血管成像进行随访。结果 21例患者均动脉瘤成功夹闭。术后恢复良好者,无明显神经功能障碍,完全恢复正常生活和工作18例;重度残疾,完全偏瘫,失语,日常生活不能自理2例;死亡1例。结论内撑式动脉瘤夹系统具有良好的操作视角及动脉瘤夹开放角度,用1把动脉瘤夹持器可以完成施夹、调夹、取夹操作,尤其适合后交通动脉瘤、前交通动脉瘤的夹闭应用。

主动脉夹层动脉瘤的诊断探讨(附20例临床分析)

本文分析主动脉夹层动脉瘤(以下称夹瘤)20例(其中尸解8例,手术1例,CT 加造影确诊1例)的诊断,提示:掌握夹瘤疼痛的特点,认识夹瘤具有特征性的体征及其临床表现类型,结合 X 线和 B 超等检查,是提高早期诊断水平的关健。

复合手术室内采用多枚瘤夹塑形夹闭大脑中动脉复杂动脉瘤的临床疗效

目的观察在复合手术室内采用多枚动脉瘤夹塑形夹闭大脑中动脉(MCA)复杂动脉瘤患者的疗效。方法回顾性分析2015年1月至2019年2月南方医科大学南方医院神经外科收治的13例MCA复杂动脉瘤患者的临床资料。患者均于复合手术室内行单侧翼点入路开颅手术,术中采用多枚动脉瘤夹塑形夹闭动脉瘤。13例患者中,7例为破裂动脉瘤患者,术前Hunt-Hess分级Ⅰ级者4例,Ⅲ级者1例,Ⅳ级者2例;6例为未破裂动脉瘤患者。13例患者共19个动脉瘤,其中5例为双侧MCA单发动脉瘤,1例为单侧双发MCA动脉瘤,其余7例患者为单发MCA动脉瘤。采用Raymond分级标准评估动脉瘤即刻栓塞情况,采用改良Rankin量表评分(mRS)标准评估临床预后。结果13例患者19个动脉瘤均成功夹闭,共采用动脉瘤夹60枚,每个动脉瘤采用1~6(3.3±1.6)枚。动脉瘤夹闭后,术中造影复查显示4个动脉瘤夹闭不全(Raymond分级Ⅱ级),2例载瘤动脉狭窄,经调整动脉瘤夹后,所有动脉瘤均完全不显影(Raymond分级均为Ⅰ级),载瘤动脉瘤无狭窄。仅1例患者因动脉瘤瘤壁上发出的分支闭塞,术后发生基底核区梗死,有轻偏瘫。出院时mRS 0分10例,2分2例,5分1例。13例患者术后随访6~36个月(中位数为18个月),mRS 0分10例,1分2例,4分1例。复查造影6例,动脉瘤均无复发。结论复合手术室内采用多枚动脉瘤夹塑形夹闭MCA复杂动脉瘤疗效好,并发症少。

Expression of FOXG1 is associated with the malignancy of human glioma

Objective： Recent evidence indicates that the increased expression of FOXG1 is associated with tumor genesis. This study was designed to explore the expression and role which FOXG1 plays in human glioma. Methods： We detected the expression of FOXG1 by immunohistochemistry in glioma tissue samples. Following the down-regulation of FOXG1 in glioma cell lines by a specific short hairpin RNA, the function of FOXG1 in proliferation and apoptosis was assessed. Results： Glioma tissues exhibited notably higher expression of FOXG1 compared with control brain tissues and was positively corre- lated with histological malignancy. The down-regulation of FOXG1 in glioma cells led to a cell apoptosis in vitro. Cenclusion： The overexpression of FOXG1 is a novel glioma malignancy marker, and FOXG1 may be used as a new target in therapeutic strategies for human glioma.

The influence of down-regulation of ACP1 by RNAi on the metastasis capability of osteosarcoma cell line MG-63

Objective： The aim of this study was to study the inhibition effect of small interfering RNAs （siRNA） on gene expression in MG-63 cells,and to study the inhibitory effect on metastasis of MG-63. Methods： A plasmid of a short hairpin RNA targeting acid phosphatase 1 （ACP1） was constructed and transfected into MG-63 cell line. ACP1 expression of MG-63 cells before and after transfection was detected by RT-PCR and Western blot. The capacity of adhesion, migration and inva- sion was examined by adhesion assay, migration assay and transwell assay. Results： The recombinant plasmid pGenesil-l/ ACPI-shRNA was successfully constructed, shRNA efficiently inhibited the expression of ACPI by gene and protein level and suppressed cell migration. The adhesion decreased from 96.41±8.83 to 43.38 ± 6.03 （P 〈 0.01）, invasion ability from 56.5 ± 4.8 to 36.3 ± 6.1 （P 〈 0.05）. Conclusion： Down-regulating ACP1 by shRNA reduced the capacity of metastasis of MG-63 cell,which providing a novo-approach to biotherapy of cancer.

后交通动脉动脉瘤瘤颈位置与分型

目的探讨后交通动脉动脉瘤的瘤颈位置和分型，以指导手术中动脉瘤夹的选择。方法回顾2007年1月至2012年6月北京大学第一医院单一术者开颅手术夹闭的后交通动脉动脉瘤患者的临床资料，搜集其瘤颈位置、宽窄、术中动脉瘤夹类型和型号等。瘤颈位置按时钟模式的12个钟点方向分类，根据动脉瘤颈与载瘤动脉的关系对动脉瘤进行分型。术后对患者以门诊、电话、脑血管造影进行随访。结果55例后交通动脉动脉瘤开颅夹闭病例纳入研究。瘤颈位置和宽窄按时钟模式的12个钟点方向记录：位于1个钟点的3例，跨两个钟点的42例，跨三个钟点的10例。根据动脉瘤颈与载瘤动脉的关系分为颈内动脉、后交通动脉、分又三种类型。其中分叉型30例、颈内动脉型20例、后交通型5例。84％（46／55，30例分叉型、13例颈内动脉型、3例后交通动脉型）动脉瘤选用弯型动脉瘤夹，11％（6／55）直型，4％（2／55）成角度跨血管型，2％（1／55）枪型。术后随访1个月-5年，所有患者均无动脉瘤复发及破裂的临床表现，21例行DSA检查随访患者动脉瘤颈均夹闭完全，未见动脉瘤残留。结论后交通动脉动脉瘤瘤颈位置和宽窄对动脉瘤夹的选择至关重要，弯型动脉瘤夹在本组后交通各型动脉瘤中使用最多，建议首选。

Three-dimensional CT angiography and surgical correlation in the evaluation of intracranial aneurysms

OBJECTIVE: To evaluate the diagnostic accuracy of three-dimensional CT angiography in the surgical treatment of intracranial aneurysms. METHODS: Twenty-four patients suspected of intracranial aneurysms underwent routine catheter four-vessel angiography, three dimensional CT angiography (3D-CTA), magnetic resonance angiography (MRA) or conventional digital subtraction angiography (DSA). RESULTS: A total of 28 aneurysms were detected by CT angiography in this study. Twenty-one patients each had a single aneurysm, two patients each had two aneurysms, and one had three aneurysms. The shapes of aneurysms revealed by 3D-CTA were round in 20 lesions, elliptical in 5, and 1 obulated in 3. Of the 24 lesions which were completely disclosed during surgery, the shapes correlated well with the 3D-CT angiograms. The mean diameter of the aneurysmal neck was 5.9 mm in 3D-CTA images, with the smallest being 1.6 mm and the largest 13.7 mm. The size was very close to the actual size measured at surgery (P