Continuous regional arterial infusion and laparotomic decompression for severe acute pancreatitis with abdominal compartment syndrome

AIM:To evaluate the therapeutic effects of abdominal decompression plus continuous regional arterial infusion(CRAI) via a drug delivery system(DDS) in severe acute pancreatitis(SAP) patients with abdominal compartment syndrome(ACS).METHODS:We presented our recent experience in 8 patients with SAP.The patients developed clinical ACS,which required abdominal decompression.During the operation,a DDS was inserted into the peripancreatic artery(the catheter was inserted from the right gastroepiploic artery until it reached the junction between the pancreaticoduodenal and gastroduodenal artery).Through this DDS,a protease inhibitor,antibiotics and octreotide were infused continuously.The duration of the regional artery infusion ranged from 8 to 41 d.The outcomes and the changes in the APACHE Ⅱ score,computed tomography(CT) severity index and intraabdominal pressure(IAP) of the patients were retrospectively evaluated.RESULTS:Eight patients with an initial APACHE Ⅱ score of 18.9(range,13-27) and a Balthazar CT severity index of 9.1(range,7-10) developed severe local and systemic complications.These patients underwent subsequent surgical decompression and CRAI therapy because of intra-abdominal hypertension(IAH).After a mean interval of 131.9 ± 72.3 d hospitalization,7 patients recovered with decreased APACHE Ⅱ scores,CT severity indexes and IAP.The mean APACHE Ⅱ score was 5.4(range,4-8),the CT severity index was 2.3(range,1-3),and IAP decreased to 7.7 mmHg(range,6-11 mmHg) 60 d after operation.One patient died of multiple organ failure 1 wk after surgery.CONCLUSION:CRAI and laparotomic decompression might be a therapeutic option for SAP patients with ACS.

Gynecological tumors in patients with Peutz-Jeghers syndrome (PJS)

Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by the development of hamartomatous polyposis in the gastrointestinal tract and melanin-pigmented macules on the skin mucosa. The responsible gene is a tumor suppressor, STK11/LKB1, on chromosome 19p13.3. PJS complicates with benign and malignant tumors in various organs. In gynecology, there has been a particular focus on complications of PJS with sex cord tumor with annular tubules (SCTAT) and minimal deviation adenocarcinoma (MDA), which are rare diseases. Approximately 36% of patients with SCTAT are complicated with PJS and these patients are characterized by multifocal, bilateral, small and benign lesions that develop into tumors with mucinous to serous ratios of 8:1. In addition, 10% of cases of MDA are complicated with PJS and mutation of STK11, the gene responsible for PJS, has a major effect on onset and prognosis. The disease concept of lobular endocervical glandular hyper-plasia (LEGH) has recently been proposed and LEGH is thought to be a potential premalignant lesion of MDA, however, the relationship between PJS and LEGH remains unclear. Several case reports of PJS patients complicated with gynecological tumors have been published and further studies are needed to determine the underlying

Hypertension, Autonomic Storm, Increased Counter Regulatory Hormones and Suppressed Insulin in Acute Myocarditis in Scorpion Envenoming Syndrome

Death due to scorpion envenoming syndrome is a common event in many of the tropical and non-tropical counties. Initial transient hypertension is commonly observed in scorpion sting victims. Scorpion envenoming causes autonomic storm resulting in initial transient hypertension followed by hypotension, cold clammy skin, hypothermia, cardiovascular disturbances, acute myocarditis, sarcolemmal defects, pulmonary oedema, acute pancreatitis, disseminated intravascular coagulation (DIC), Adult respiratory distress syndrome (ARDS), and many other clinical manifestations. All these manifestations could be due to sudden increase in catecholamines, angiotensin II, glucagon, Cortisol and either due to suppressed insulin secretion or insulin resistance and death. The sudden increase of metabolic A in counter-regulatory hormones along with either suppressed insulin secretion/or insulin resistance results in glycogenolysis in liver, cardiac and skeletal muscles causing hyperglycemia and a sudden increase in free fatty acid levels. Free Fatty Acids increase the susceptibility of the ventricles to the disorganized electrical behavior, inhibit cardiac sarcolemmal Na+-K+ ATPase activity, increase the tendency to intravascular thrombus, increase myocardial oxygen consumption, interfere with tropomyosin-troponin activation of Actin-Myosin coupling, show detergent effects on cell membranes and they could alter the stabilization of lysosomal membranes and probably become toxic to the myocardium. Based on our animal experiments in which insulin administration reversed the metabolic and ECG changes induced by scorpion envenoming and treating the poisonous scorpion sting victims with insulin, we consider that insulin has a primary metabolic role in preventing, counter-acting and reversing all the deleterious effects of FFA by inhibiting the catecholamine induced by lipolysis, and increasing intra-cellular K+, facilitating glucose transport to the myocardium and glucose metabolism through different pathways. Administration of insulin-glucose infusion to scorpion sting victims appears to be the physiological basis for the control of the metabolic response when that has become a determinant to survival. Treatment using continuous infusion of regular crystalline insulin should be given at the rate of 0.3 U/g glucose and glucose at the rate of 0.1 g/kg body weight/hour, for 48 - 72 hours, with supplementation of potassium as needed and maintenance of fluid, electrolytes and acid-base balance.

Vertical deviation and A pattern of type Ⅲ Duane retraction syndrome

Background Researches in ocular electromyography （EMG） and Magnetic resonance imaging （MRI） of patients with Duane retraction syndrome （DRS） suggest that there may be additional abnormalities such as paradoxical innervation between horizontal rectus muscles and vertical rectus muscles, hypoplasia of vertical rectus muscle and that oblique muscles may also contribute to the heterogeneity of the clinical manifestation of DRS. This paper reports the results of superior rectus recession for vertical deviation and A pattern in DRS Type III and discusses the pathogenesis of the disease. Methods Superior and lateral rectus recession were performed in 5 cases of Huber type III DRS to treat vertical deviation and A pattern strabismus. Before operation, MRI of the brain, brainstem, cavernous sinus, and orbits were performed. Results All subjects had unilateral limitation of both abduction and adduction, with palpebral fissure narrowing and globe retraction in adduction. Three cases had A pattern of strabismus, three cases had hypertropia. The abducens nerves （CN6） were either absent or hypoplasitic in the brainstem in all patients. Two eyes had larger oculomotor foramen. Two eyes had hypoplasia of the superior rectus and the inferior rectus. There was presumably a branch of the third cranial nerve （CN3） innervating the lateral rectus （LR） in one eye. While in another eye, two branches of CN3 sent into medial rectus were revealed. After surgery, vertical deviation in the primary position was reduced in all patients and A pattern was eliminated in 3 patients. One patient developed 10A consecutive esotropia postoperatively. Conclusion The results suggest that structural abnormalities of vertical muscle and abnormal orbital innervation may be related to vertical deviation and the presence of A pattern in DRS type Ⅲ. Recession of the superior rectus muscle seems to be a safe and effective treatment for vertical deviation and A pattern strabismus in DRS Type Ⅲ.

Cardiac Sarcolemmal Defects in Acute Myocarditis Due to Scorpion Envenoming Syndrome

Death due to scorpion envenoming syndrome is a common event in tropical and subtropical countries. Severe scorpion envenoming causes autonomic storm, massive release of catecholamines, counter-regulatory hormones, suppressed insulin/hyperinsulinemia, acute myocarditis, hyperglycemia, increased free fatty Acid levels, acute pancreatitis, disseminated intra-vascular coagulation, acute pulmonary oedema and death. Severe scorpion envenoming causes cardiac sarcolemmal defects displayed by alterations in Na+ - K+ ATPase, Mg++ ATPase and Ca2+ ATPase activities, inhibition of erythrocyte Na+ - K+ ATPase activities, hyperkalemia and may result in death. Based on our animal experiments in which insulin administration reversed the metabolic and ECG changes induced by scorpion envenoming and treating the poisonous scorpion sting victims with insulin, we consider that insulin has a primary metabolic role in preventing and reversing acute myocarditis, the cardiovascular, haemodynamic, and neurological manifestations and pulmonary oedema induced by scorpion envenoming. Administration of insulin-glucose infusion to scorpion sting victims appears to be the physiological basis for the control of the metabolic response when that has become a determinant to survival. Continuous infusion of regular crystalline insulin should be given at the rate of 0.3 U/g glucose and glucose at the rate of 0.1 g/kg body weight/hour, for 48 - 72 hours, with supplementation of potassium as needed and maintenance of fluid, electrolytes and acid-base balance. The observation of cardiac sarcolemmal defects and physiological basis of various patho-physiological mechanisms involved in the genesis of scorpion envenoming syndrome and its reversal (in the experimental animals and scorpion sting victims) by administration of insulin are reviewed.

Modified inferior oblique anterior transposition for dissociated vertical deviation combined with superior oblique palsy:A case report

BACKGROUND Inferior oblique anterior transposition(IOAT)has emerged as an effective surgery in the management of dissociated vertical deviation(DVD)combined with superior oblique palsy(SOP).Traditional IOAT usually provides satisfactory primary position alignment and simultaneously restricts the superior floating phenomenon.However,it also increases the risk of the anti-elevation syndrome and narrowing of the palpebral fissure in straight-ahead gaze,especially after the unilateral operation.CASE SUMMARY We report the outcomes of the modified unilateral IOAT in two patients with unilateral DVD combined with SOP.The anterior-nasal fibers of the inferior oblique muscle were attached at 9 mm posterior to the corneal limbus along the temporal board of the inferior rectus muscle,the other fibers were attached a further 5 mm temporal to the anterior-nasal fibers.Postoperatively,both hypertropia and floating were improved,and no obvious complications occurred.CONCLUSION In these cases,the modified unilateral IOAT was an effective and safe surgical method for treating DVD with SOP.

Basic and clinical research progress in acute lung injury/acute respiratory distress syndrome

Acute lung injury(ALI)/acute respiratory distress syndrome(ARDS) is an acute progressive respiratory failure caused by severe infection, trauma, shock, poisoning, inhaled harmful gas, acute pancreatitis, and pathological obstetrics. ALI and ARDS demonstrate similar pathophysiological changes. The severe stage of ALI is defined as ARDS. At present, a significant progress has been achieved in the study of the pathogenesis and pathophysiology of ALI/ARDS. Whether or not ALI/ARDS patients can recover depends on the degree of lung injury, extra-pulmonary organ damage, original primary disease of a patient, and adequacy in supportive care. Conservative infusion strategies and protective lung ventilation reduce ARDS disability and mortality. In this study, the pathogenesis of ALI/ARDS, lung injury, molecular mechanisms of lung repair, and conservative infusion strategies and pulmonary protective ventilation are reviewed comprehensively.

Minimal residual disease-directed immunotherapy for high-risk myelodysplastic syndrome after allogeneic hematopoietic stem cell transplantation

The efficacy of minimal residual disease (MRD)-directed immunotherapy,including interferon-α (IFN-α) treatment and chemotherapy plus granulocyte colony-stimulating factor-primed donor leukocyte infusion (chemo-DLI),was investigated in patients with high-risk myelodysplastic syndrome (MDS) who were MRD-positive after allogeneic hematopoietic stem cell transplantation (allo-HSCT).High-risk MDS patients who received non-T-cell-depleted allo-HSCT at the Peking University Institute of Hematology and were MRD-positive after ailo-HSCT were studied (n =47).The MRD-positive status was considered if leukemia-associated aberrant immune phenotypes or Wilms' tumor gene 1 expression is present in a single bone marrow sample.The cumulative incidence of the relapse and non-relapse mortality 2 years after immunotherapy were 14.5% and 21.4% (P=0.377)and 9.1% and 0.0% (P=0.985) for patients in the IFN-α and chemo-DLI groups,respectively.The probability of disease-free and overall survival 2 years after immunotherapy were 76.4% and 78.6% (P =0.891) and 84.3% and 84.6% (P=0.972) for patients in the IFN-α and chemo-DLI groups,respectively.Persistent MRD after immunotherapy was associated with poor survival.Thus,the MRD-directed immunotherapy was effective for patients with high-risk MDS who were MRD-positive after alIo-HSCT,and the efficacy was comparable between chemo-DLI and IFN-α treatment.

右美托咪定减轻大鼠丙泊酚输注综合征的研究

目的探讨右美托咪定对大鼠丙泊酚输注综合征所致器官损伤的保护机制。方法选取健康雄性SD大鼠18只,8~10周龄,体重250~280g,采用随机数字法分为空白对照组(C组)、丙泊酚组(P组)及右美托咪定组(D组),三组大鼠分别尾静脉输注生理盐水、丙泊酚、右美托咪定+丙泊酚。每组于T0、T6、T12取大鼠颈动脉血检测血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、尿素氮(BUN)、肌酐(Cr)、肌钙蛋白I(cTn-I)水平;各组输注完成后取大鼠心肌组织,行HE染色观察心肌结构变化,ELISA法检测心肌组织线粒体呼吸链复合体II活性、细胞色素C、肉碱棕榈酰转移酶I(CPT-I)、丙二酰辅酶A(Malonyl-CoA)表达量。结果与C组相比,P组T6、T12时ALT、AST、CK、CK-MB、BUN、cTn-I水平均升高;D组T6及T12时ALT、AST、CK、CK-MB、BUN、Cr水平均升高,D组T6时cTn-I升高(P<0.05)。与P组相比,D组T6及T12时ALT、AST、CK、cTn-I水平均下降,T12时CK-MB、BUN水平下降(P<0.05)。P组心肌纤维排列紊乱,细胞水肿,溶解,少量散在炎细胞浸润;D组心肌纤维排列较P组规则整齐。与C组相比,P组、D组呼吸链复合体II活性下降,Cyt-C、CPT-I、Malonyl-CoA表达均降低(P<0.05);与P组相比,D组复合体Ⅱ活性增加,Cyt-C、CPT-I、Malo-nyl-CoA表达水平升高(P<0.05)。结论右美托咪定可减轻大鼠丙泊酚输注综合征所致器官损伤,其机制可能与减轻线粒体内呼吸链的功能损害及改善脂肪酸分解代谢相关。

晚期肝癌患者行HAIC术后股动脉并发假性动脉瘤致骨筋膜室综合征的护理1例

1临床资料患者男,68岁,因“发现肝脏肿瘤2周”于2022年7月27日入院,诊断为肝细胞肝癌伴肝内外多发转移。既往有高血压病史及吸烟史。查体:体温36.3℃,心率85次/min,呼吸14次/min,血压144/89 mmHg(1 mmHg=0.133 kPa);查血结果示血红蛋白138g/L,血小板计数179×10^(9)/L,凝血酶原时间为16.2 s。完善术前检查,7月29日在DSA下行肝动脉灌注化疗(hepatic artery infusion chemotherapy,HAIC)手术,返回病房后予以FOLFOX方案动脉灌注。7月30日13∶10动脉输注结束,拔管,予以加压器止血失败后改用纱布绷带加压包扎。7月31日3∶43患者主诉右大腿根部疼痛5分(NRS),予以止痛药对症后缓解;查血示血红蛋白为129 g/L。14∶50拆除纱布,穿刺点周围见大片淤青,腹股沟处可扪及10 cm×5 cm血肿,质硬,无搏动,穿刺处予沙袋压迫,右下肢制动。

小儿助长方加减联合重组人生长激素治疗小儿特发性矮小症脾肾两虚证的效果及安全性

目的观察小儿助长方加减联合重组人生长激素(rhGH)治疗小儿特发性矮小症(ISS)脾肾两虚证的效果及安全性。方法选取2022年3月—2023年12月南京中医药大学附属医院儿科叶进教授门诊收治的ISS脾肾两虚证患儿60例,采用随机数字表法分为试验组和对照组,各30例。对照组患儿采用rhGH治疗,试验组患儿在对照组用药基础上联合小儿助长方加减治疗,2组均持续用药6个月。比较2组用药前、用药6个月后身高标准差积分(HtSDS)、骨龄(BA)、ΔHtSDS、ΔBA、胰岛素样生长因子-1(IGF-1)、25羟维生素D[25-(OH)D]、中医证候积分及安全性指标[空腹血糖(FPG)、胰岛素(INS)、甲状腺功能指标、肝功能指标、肾功能指标]。结果用药6个月后,2组HtSDS较用药前升高(P<0.01),试验组ΔHtSDS高于对照组(P<0.05);2组血清IGF-1、25-(OH)D均较用药前升高,且试验组高于对照组(P<0.05或P<0.01);对照组中医主症总积分低于用药前,试验组中医主、次症总积分均较用药前降低及低于对照组(P<0.01);用药6个月后,2组FPG、INS水平高于用药前,试验组FPG水平低于对照组(P<0.05或P<0.01)。结论小儿助长方加减联合rhGH治疗小儿ISS脾肾两虚证具有良好疗效,可在不加速BA进展的前提下有效增强促生长疗效,明显改善患儿临床症状,且可能会降低rhGH对糖代谢的影响,具有良好的安全性。

小剂量氯胺酮治疗复杂性区域疼痛综合症

复杂性区域疼痛综合症（Complex Regional Paln Syndrome,GRPS）是一种传统治疗方法难以毒效的慢性严重疼痛。Harbut and Correll等人【GE Gorrell，J Malekl．EJ Gracely，JJ Muir, and RE Harbut．Subanesthetic ketamlne Infusion therapy：a retrospective analysis of a novel therapeutic approach to complex regional pain syndrome．Paln Med．2004；5（3）：263—75】尝试输注小剂量氮胺酮进行治疗。

自体CIK细胞输注治疗老年骨髓增生异常综合征的临床研究

本研究旨在评价自体细胞因子诱导的杀伤细胞(cytokine-induced killer cells,CIK)治疗老年骨髓增生异常综合征(myelodysplastic syndromes,MDS)的安全性和有效性。采集6例老年MDS患者外周血单个核细胞,在体外经细胞刺激因子培养,诱导成CIK细胞,回输至患者体内,28天为1个疗程。观察CIK细胞回输后患者体内效应细胞的比例变化、不良反应以及对感染的发生、血红蛋白水平和对输血依赖程度的影响。结果表明,经CIK细胞治疗后CD3+、CD3+CD8+、CD3+CD56+细胞比例明显升高(p<0.05),所有患者未出现严重不良反应。CIK细胞治疗有效地减少了MDS患者感染的发生,缩短了高热时间。在疾病稳定期,CIK细胞输注可减少红细胞的输注量,稳定血红蛋白水平,但不能改变MDS向高危亚型转化的自然病程。结论 :自体CIK细胞输注治疗老年人MDS安全有效。

葛根素对实验性代谢综合征影响的研究

目的观察葛根素对实验性代谢综合征的影响。方法10%果糖水喂养Wistar大鼠6周后,检测血甘油三酯及空腹血糖、空腹胰岛素浓度,计算胰岛素敏感指数。然后腹腔注射葛根素高剂量(100 mg.kg-1)和低剂量(50 mg.kg-1),以二甲双胍为阳性对照,连续给药6周后,检测血压、口服葡萄糖耐量、葡萄糖输注率、甘油三酯、总胆固醇、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇。结果模型组大鼠血糖升高,胰岛素敏感指数下降。葛根素干预后,与模型组比较,口服葡萄糖耐量降低,葡萄糖输注率增加(P<0.01);血压、甘油三酯、总胆固醇、低密度脂蛋白胆固醇降低,高密度酯蛋白胆固醇升高(P<0.05)。结论葛根素对果糖诱导的代谢综合征有治疗作用。

超声乳化术中灌注液迷流综合征表现及治疗方法的临床观察

目的:总结白内障超声乳化手术中发生的灌注液迷流综合征的临床表现和治疗方法。方法:从2002-09/2009-12我院共8例患者术中发生灌注液迷流综合征。这些患者的临床表现为突发性眼压升高、浅前房、虹膜脱出,通过注入黏弹剂以及升高灌注瓶高度无法维持前房深度。所有患者无明显疼痛、烦躁等症状。术中及术后间接眼底镜检查均未发现暴发性脉络膜出血等眼内出血现象。8例患者中1例未予特殊处理继续进行手术操作,其余7例患者经过缝合主切口,包眼安静休息联合200g/L甘露醇注射液快速静脉点滴处理。结果:未予特殊处理的1例患者手术中发生后囊膜破裂,进行前段玻璃体切除,悬吊人工晶状体。经过处理的7例患者中1例经过处理后前房仍无法形成,故行经睫状体平坦部玻璃体腔穿刺;其余患者前房形成,其中1例患者在植入人工晶状体后眼压再次升高,未予置换残余黏弹剂。所有患者手术完成后缝合主切口1针。结论:超声乳化术中灌注液迷流综合征是一种罕见的白内障术中并发症。经过恰当处理,可以解决突发高眼压引起的各种体征,顺利完成手术操作。

地西他滨联合改良CAG及单倍体相合外周血淋巴细胞回输治疗老年高危恶性血液病

本研究旨在观察地西他滨联合改良CAG及单倍体相合外周血淋巴细胞回输免疫治疗新方案,作为初治老年高危骨髓增生异常综合征(MDS)和急性髓系白血病(AML)的诱导缓解方案的初步疗效及其不良反应。对2012年4月至2012年7月在本院血液科应用地西他滨联合改良CAG及HLA半相合外周血淋巴细胞回输免疫治疗新方案治疗的5例老年高危MDS和AML患者进行前瞻性研究,观察完全缓解率及副反应。结果表明:5例初治老年患者治疗总有效率100%,4例达到完全缓解,1例患者达到部分缓解。既往无MDS病史患者,中性粒细胞数恢复至0.5×109/L的中位时间为15 d,血小板数恢复至20×109/L的中位时间为16 d。主要副作用为IV度骨髓抑制,全部患者治疗中无新发肺部感染等严重并发症。结论:地西他滨联合改良CAG及外周血淋巴细胞回输免疫治疗新方案,治疗老年MDS和AML患者安全有效,值得进一步研究。

子宫腔灌注人绒毛膜促性腺激素对多囊卵巢综合征患者植入窗期子宫内膜容受性的影响

目的 探讨子宫腔灌注人绒毛膜促性腺激素(hCG)对多囊卵巢综合征(PCOS)患者植入窗期子宫内膜容受性的影响。方法 选择2016年4月至2018年4月新乡医学院第三附属医院收治的已婚PCOS患者31例为研究对象,对患者的连续2个月经周期进行自身对照试验,第1个月经周期为对照周期,第2个月经周期为灌注周期,其中对照周期28例(3例因无排卵予以排除),灌注周期29例(2例因无排卵予以排除)。患者2个月经周期的第5~9天均给予来曲唑2.5mg,口服;从月经周期第10天开始,连续阴道超声卵泡监测直至排卵,分别于第2个月经周期的排卵前2日及排卵日子宫腔灌注hCG500IU(0.5mL)。于排卵后第6~8天(植入窗期)检测患者血清雌激素(E2)和黄体酮(P)水平,并使用一次性S型子宫腔组织吸引管抽取少许子宫内膜组织,S-3500N扫描电子显微镜下观察子宫内膜胞饮突发育情况。结果 对照周期与灌注周期的植入窗期患者血清E2水平比较差异无统计学意义(t=0.501,P>0.05);灌注周期的植入窗期患者血清P水平显著高于对照周期(t=3.193,P<0.05)。对照周期和灌注周期有子宫内膜成熟胞饮突的患者分别为9例(32.14%)、17例(58.62%),灌注周期有成熟胞饮突患者比例显著高于对照周期(χ^2=4.032,P<0.05)。结论 PCOS患者植入窗期胞饮突发育不良,宫腔灌注hCG可增加成熟胞饮突数量,提高血清P水平,改善子宫内膜容受性。

动脉灌注化疗治疗并发于肺癌的上腔静脉综合症

目的： 评估经瘤体供血动脉灌注化疗药物治疗肺癌合并上腔静脉综合症（ＳＶＣＳ） 的疗效，并与静脉全身化疗效果进行比较。材料与方法： 肺癌合并ＳＶＣＳ 患者２８ 例，研究组１４ 例行动脉灌注化疗，对照组１４ 例行静脉全身化疗，比较两组的肿瘤退缩率及临床症状改善率。结果： 治疗前后ＫＰＳ 平均分差研究组增加１２ ．９ ，对照组增加１ ．４ 。胸片评估近期有效率，研究组为２９ ％ ，对照组为０ ％ ，经卡方检验，两组疗效差异显著（ Ｐ＜ ０ ．０５） 。结论： 动脉灌注化疗治疗肺癌并发的ＳＶＣＳ 临床有效率及显效速度均优于静脉全身化疗。

Helveston综合征的手术治疗

目的：探讨Helveston综合征的手术治疗方法。方法：回顾分析我院手术治疗且资料完整的15例30眼Helveston综合征病例,根据患者上斜肌亢进及分离性垂直偏斜（dissociated vertical deviation,DVD）程度的不同选择不同的手术方式。结果：患者8例16眼行双眼上斜肌鞘内断腱术,术后随访1-3a,A征均消失,其中3例6眼DVD消失,5例10眼DVD减轻,均未再次行DVD矫正手术;患者4例8眼行双眼上直肌后徙联合双眼外直肌后徙并垂直移位术,术后随访1-3a,眼位正位,A征消失,1例2眼DVD消失,3例6眼DVD减轻,未再行二次手术;患者3例6眼行双眼水平直肌后徙联合垂直移位术,术后随访6mo,眼位正位,A征消失,DVD减轻,未再次行二次手术。结论：Helveston综合征可根据患者上斜肌亢进及DVD程度的不同选择不同的手术方式。