简介：BACKGROUND&OBJECTIVE:Themajorityofintramedullaryspinalcordtumors(IMSCT)arelow-gradegliomas.RadicalresectionforIMSCTsremainschallenging.Recently,improvedneuroimagingandadvancedmicrosurgicaltechniquehavemadegreatsuccessinsurgicalmanagementoftheintramedullaryspinalcordtumors.METH-ODS&RESULTS:Twenty-ninepatientswithintramedullaryspinalcordtumorsweretreatedbyradicalresectiondur-ingthepast4yearsinourinstitute.Thehistologicalresultswereasfollows:12ependymomas,4astrocytomas,4heman-gioblastomas,4epidermoids,1cavernoma,2lipomas,2metastatics.Agross-totalresection(>95%)wasachievedin25surgicalprocedures.Subtotalresections(80-95%)wereperformedin4cases.Therewasnosurgicaldeath.Whencomparingthepreoperativeand3-monthpostoperativefunctionalgrades,12patientswerestable14improved,and3deteriorated.Patientswitheithernodeficitoronlymilddeficitbeforesurgerywererarelyimpairedbytheproce-dure,reinforcingtheimportanceofearlydiagnosisandtreatment.Themajordeterminantoflong-termsurvivalwashistologi-calcompositionofthetumor.PatientsinwhomanIMSCTwasonlypartiallyresected(<80%)faredsignificantlyworse.CONCLUSIONS:Thelong-termsurvivalandqualityoflifeforpatientswithlow-gradegliomastreatedbyradi-calresectionaloneiscomparableorsuperiortominimalresectionplusradiotherapy.Theoptimaltherapyforpatientswithhigh-gradegliomaisyettobedetermined.Forbenignlesion,suchashemangioblastomaandcavernomacouldbecuredbytotalresectionofthetumor.Forlipomaandepidermoid,fibrousadhesionstothecordmaketotalremovaldifficult,andthus,removalisnotthegoalofsurgery.Thecarbondioxidelaserisparticularlyusefulduringsurgeryforthislesion.

简介：AbstractPurpose:The aim of this study is to evaluate the application value of virtual surgical planning in the management of mandibular condylar fractures and to provide a reliable reference.Methods:This was a prospective randomized controlled study and recruited 50 patients requiring surgical treatment for their mandibular condylar fractures. The inclusion criteria were patients (1) diagnosed with a condylar fracture by two clinically experienced doctors and required surgical treatment; (2) have given consent for the surgical treatment; and (3) had no contraindications to the surgery. Patients were excluded from this study if: (1) they were diagnosed with a non-dislocated or only slightly dislocated condylar fracture; (2) the comminuted condylar fracture was too severe to be treated with internal reduction and fixation; or (3) patients could not complete follow-up for 3 months. There were 33 male and 17 female patients with 33 unilateral condylar fractures and 17 bilateral condylar fractures included. The 50 patients were randomly (random number) divided into control group (25 patients with 35 sides of condylar fractures) and experimental group (25 patients with 32 sides of condylar fractures). Virtual surgical planning was used in the experimental group, but only clinical experience was used in the control group. The patients were followed up for 1, 3, 6 and 12 months after operation. Variables including the rate of perfect reduction by radiological analysis, the average distance of deviation between preoperative and postoperative CT measurements using Geomagic software and postoperative clinical examinations (e.g., mouth opening, occlusion) were investigated for outcome measurement. SPSS 19 was adopted for data analysis.Results:The average operation time was 180.60 min in the experimental group and 223.2 min in the control group. One week postoperatively, CT images showed that the anatomic reduction rate was 90.63% (29/32) in the experimental group and 68.57% (24/35) in the control group, revealing significant difference (X2= 4.919, p = 0.027). Geomagic comparative analysis revealed that the average distance of deviation was also much smaller in the experimental group than that in the control group (0.639 mm vs. 0.995 mm; t = 3.824, p < 0.001).Conclusion:These findings suggest that virtual surgical planning can assist surgeons in surgical procedures, reduce operative time, and improve the anatomic reduction rate & accuracy, and thus of value in the diagnosis and treatment of condylar fractures.

简介：Amongallcongenitalheartdisease,Ebsteinanomalyisthelesionwiththewidestspectrumofpresentation.Itcanpresentasearlyastheneonatalperiodwhereimmediateinterventionisoftenneededtotheadultwithnodiscernablesymptoms.Itisalsoonewhereoveralloutcomegreatlyrelatestoageatpresentation.Generally,presentationintheneonatalperiodisassociatedwithpooroutcomeswhilepresentationbeyondtheneonatalperiodhasexcellentoutcomeswithlowoperativemortality.ItisthusapparentthatunderstandingeveryaspectoftheanatomyandphysiologyofEbsteinanomalyandhowitmanifestsclinicallyisparamounttosuccessfultreatment.ThepurposeofthisreviewistooutlinethecurrentconceptsandstrategiesinthesurgicalmanagementofEbsteinanomaly,andtodiscussthecurrentexpertconsensusonhowbesttotacklethiscongenitalheartdiseaseatdifferentagesofdiagnosis.

简介：Primaryesophagealadenocarcinoma(PEAC)isararemalignantdiseaseofesophagus.Becauseofitslowerincidence,theknowledgeaboutitislimitedandtherearesomeproblemsrequiringfurtherstudy.Duringrecent30years,106patientswithPEAChadbeentfeatedsurgicallyinourdepartment...

简介：<正>OtitisMediaisacommondiseaseinthepracticeofotolaryngologyandoneofthefamous"threeinflammationsandonedeafness".Otitismediahasbeenwithhumansfromtheverybeginning.Treatmentforotitismediastartedinthewestin1774andmuchlaterinChina.

简介：AbstractThe petrous apex is a difficult to reach surgical area due to its deep position in the skull base and many vital surrounding structures. Petrous apex pathology ranges from extradural cholesterol granulomas, cholesteatomas, asymmetric pneumatization, and osteomyelitis to intradural meningiomas and schwannomas. Certain lesions, such as cholesterol granulomas, can be managed with drainage while neoplastic lesions must be completely resected. Surgical options use open, endoscopic, and combined techniques and are categorized into anterior, lateral, and posterior approaches. The choice of approach is determined by the nature of the pathology and location relative to vital structures and extension into surrounding structures and requires thorough preoperative evaluation and discussion of surgical goals with the patient. The purpose of this state-of-the-art review is to discuss the most commonly used surgical approaches to the petrous apex, and the anatomy on which these approaches are based.

简介：Objective:Tosummarizesurgicaltreatmentsandtheircorrespondingcurativeeffectsonsciaticnerveinjuries.Methods:Surgicaltreatmentsonsciaticnerveinjurywereperformedin28patientsfromJanuary1990toJuly2000.Thetreatmentsincludedneurolysis,neurolysispluspartialnerveanastomosis,nerveanastomosisandnervetransplantation.ThecurativeeffectwasevaluatedaccordingtoSunderlandcriteria.Results:Of28cases,22patientswerefollowedupwithafollow-upperiodof13monthsto5years(average30months).Of22nerves,7wereexcellent,5good,7fairand3poor,withanexcellencerateof54.5%.

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简介：Necrotizingpancreatitisisanuncommonyetseriouscomplicationofacutepancreatitiswithmortalityratesreportedupto15%thatreach30%incaseofinfection.Traditionallyopensurgicaldebridementwastheonlytoolinourdisposaltomanagethisseriousclinicalentity.Thisapproachishoweverassociatedwithpooroutcomes.Managementhasnowshiftedawayfromopensurgicaldebridementtoamoreconservativemanagementandminimallyinvasiveapproaches.Contemporaryapproachtopatientswithnecrotizingpancreatitisand/orinfectiouspancreatitisissummarizedinthe3Ds:Delay,DrainandDebride.Patientscanbemanagedintheintensivecareunitandanyinterventionshouldbedelayed.Percutaneousdrainagecanbeutilizedfirstandearlyinthecourseofthedisease,followedbyendoscopicdrainageorvideoassistedretroperitoneoscopicdrainageifnecrosectomyisdeemednecessary.Opensurgeryisnowlessfrequentlyperformedandshouldbereservedforcasesrefractorytoanyotherapproach.Themanagementofnecrotizingpancreatitisthereforerequiresamultidisciplinarydynamicmodelofapproachratherthanbeingasurgicaldisease.

简介：<正>Thefacialnervepassesthroughthetemporalboneandisthelongestnervethattravelsinabonycanalwithacomplexcourseandhighsusceptibilitytoinjury.Whenfacialnervebecomesswollenfrominsultssuchastrauma,inflammation,tumororiatrogenicinjury,itsdistal

简介：<正>AcousticNeuroma(AN)arisesfromtheeighthcranialnerve.Itprimarilyinvolvesthevestibularbranchofthenerveandisthereforealsocalledvestibularschwannoma(VS).Tothedate,diagnosisandsurgicaltreatmentofANhaveadvancedsignificantly.Alongwithadvancesinaudiologyandimagingtechnologies,casesofdiagnosedANhavebeenincreasing,makingitacommon

简介：Objective:Toprobeintoeffectivesurgicalproceduresandimprovetheoutcomeoftreatmentforpatientswithseverehepaticinjury.Methods:Aretrospectivestudyinvolving113patientswithseverehepatictrauma(AASTgradeIVandV)duringthepast12yearswascarriedout.Ninety-eightpatientsunderwentsurgicaltreatment.SurgicalinterventionsincludinghepatectomyordirectcontrolofbleedingvesselsbyfingerfracturetechniquewithPringlemaneuver,selectiveligationofhepaticartery,retrohepaticcavalrepairwithtotalhepaticvascularocclusion,andperihepaticpackingweremainlyused.Results:Inthe98patientstreatedoperatively,thesurvivalratewas69.4%(68/98).Among40patientswithjuxtahepaticvenousinjury(JHVI),15werecuredwiththemaximumbloodtransfusionof12000ml.EightcasesofGradeIVinjurytreatednonoperativelywerecured.Thepercentageoffailureofnonoperativemanagementwas42.9%(6/14).Theoverallmortalityratewas32.7%(37/113),and57%ofthedeathswereduetoexsanguination.Conclusions:Reasonablesurgicalproceduresbasedonclassificationofhepaticinjuriescanincreasethesurvivalrateofseverelivertrauma.AccurateperihepaticpackingiseffectiveindealingwithJHVI.

简介：Chronicsubduralhematoma(CSDH)representsoneofthemostfrequenttypesofintracranialhemorrhage.ManagementofthepatientswithCSDHhasbeenevolvedthroughavastvarietyofmethodsandtechniques.Althoughthereisgeneralagreementthatsurgicaltherapyisusuallythepreferredtreatment,therearefewotherneurosurgicalconditionsthatsparksuchstrongdiscussionsanddifferencesofopinionconcerningtheoptimalsurgicaltechnique.1,2Inthispaper,wereviewadvancesinsurgicaltreatmentofCSDH.

简介：ObjectivesToevalu-atetheoutcomeofdiagnosisandsurgicaltreatmentforcortriatrium(CTA)in6patientsseenbetween1994and2002.Methods6patientsranginginagefrom5monthsto25yearswereobserved.Allofthemhadothercardiovasculardefects,andpresentedwithdyspnea,palpitations(andlowweightgrowingonlyintheinfants).Preopreativetwodimensionalechocardiogra-phyhaddemonstratedanabnormalseptumintheleftatriumandothercoexistentanomalies.In3ofthemthemembranewasobstructedbetweentheleftatrialaccessorychamberandtheleftatrium.Thecommunicationwereatrialseptaldefect(ASD)indirectly;Theclinicalfindingswereduetothepulmonaryhypervas-cularity.Onlyonecasehadafenestrationintheseptumwithasmallpatentforamenovale(FO)directly,andtheclinicalfindingswereduetotheobstructiontoflowthroughthemembraneintheleftatrium,producingvenocapilarpulmonaryhypertension.TwoofthemhadASDandfenestrationontheseptum.Theot

简介：FromJune,1986toJune1989,24casesofhilarbileductcarcinomawereexploredintheSurgicalDepartmentofGeneralHospitalofPLA,16/24caseswereresected,aresectabilityrateof66%.Theincreaseofresectabilityratewasduetoearlierrecognitionofthisconditionandtheextensionofsurgery,includingmajorresectionofliveraswellasradicaldissectionofthehepato-duodenalligamentandrepairativeoperationsonthebloodvessels.Amongthese16cases,majorhepaticresectionwasperformedin10cases,inwhich,3casesofresectionsofthemiddlelobeoftheliverweredoneinsteadofrightorextendedrightlobectomy.Nooperativemortalityinthe30days’postoperativeperiod,butthepostoperativemorbidityratewasstillhighandmostofthecomplicationswererelatedtobiliaryleakageandinfection.Threepatientsdiedinthefollowupperiodat6,14and15monthsrespectively.Allofthemdiedfrombiliaryinfection.Theremaining13patientswerestillalive,thelongestbein

简介：Objective:Todescribeseveralapproachesofearsurgeriesforexperimentalstudiesinrats.Methods:Anesthetizedratswerepreparedfordemonstrationofvariousearsurgeryapproachesdesignedtooptimizeexperimentaloutcomesinstudieswithspecificgoalsandexposurerequirements.Thesurgicalapproachesincludedtheposteriortympanum,superiortympanum,inferiortympanumandoccipitalapproaches.Results:Themiddleearcavityandinnerearweresuccessfullyexposedfromdifferentanglesviathementionedsurgicalapproaches.Forexample,electrodeplacementforrecordingofcochlearbioelectricresponseswaseasilyachievedthroughtheposteriortympanumorinferiortympanumapproach.Alternatively,drugdeliveryorgenetransfectionviaroundwindowmembranewasmosteasilyaccomplishedusingtheposteriortympanumapproach.Cochlearperfusionofprotectiveorototoxicdrugswasbestperformedusingtheinferiortympanumapproach.Ossicularchaininterruptiontoinduceaprolongedconductivehearinglosswasreadilyachievedusingasuperiortympanumapproach.Lastly,surgicaldestructionoftheendolymphaticsactoinduceexperimentalendolymphatichydropswasreadilyperformedviaanoccipitalsurgicalapproach.Conclusion:Thesestandardizedsurgicalapproachescanbeappliedinscientificstudiesoftheearwithdifferentpurposescoveringelectrophysiology,conductivehearingloss,intra-cochleardrugperfusionandexperimentalstudiesrelevanttoMeniere’sdisease.

简介：目的将在ICU与多重损害为病人调查外科的治疗。病人们从2006年1月承认了到我们的医院的ICU到2009年1月的163多重损害的方法临床的数据回顾地被学习，包括118男性和45女性，与36.2年的吝啬的年龄(范围，5-67年)。包括的损害区域出发，颈(29个案例)，脸(32个案例)，胸(89个案例)，腹部(77个案例)，骨盆和手足(91个案例)和身体出现(83个案例)。有57个案例，与吃惊相结合。ISS价值从10～54变化了，18.42平均。病人们分别地在在内的ICU接受了外科的治疗24个小时(10个案例)，24-48小时(8个案例)，3-7天(7个案例)和8-14天(23个案例)。为163个病人，结果ICU停留的持续时间从2～29天，与7.56天的平均价值。在他们之中，143被治好(87.73%)，11由于严重出血性的吃惊(6个盒子)在医院(6.75%)里死了，craniocerebral损害(3个盒子)和多重机关失败(2个盒子)，并且9在自愿地从医院(5.52%)排出以后死了。全部的死亡率是12.27%。当多重损害病人在ICU被复活时，损坏控制原则应该被跟随的结论。外科的治疗策略活跃地包括控制出血，对待以前错过的损害和相关创伤或外科的复杂并发症并且动计划阶段手术。

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简介：AbstractBackground:Historically sinonasal malignancies were always addressed via open craniofacial surgery for an oncologic resection. Increasingly esthesioneuroblastomas are excised using an exclusively endoscopic approach, however, the rarity of this disease limits the availability of long-term and large scale outcomes data.Objective:The primary objective is to evaluate the treatment modalities used and the overall survival of patients with esthesioneuroblastoma managed with exclusively endoscopic surgery.Methods:In accordance with PRISMA guidelines, PubMed was queried to identify studies describing outcomes associated with endoscopic management of esthesioneuroblastomas.Results:Forty-four out of 2462 articles met inclusion criteria, totaling 399 patients with esthesioneuroblastoma treated with an exclusively endoscopic approach. Seventy-two patients (18.0%) received adjuvant chemotherapy and 331 patients (83.0%) received postoperative radiation therapy. The average age was 50.6 years old (range 6-83). Of the 399 patients, 57 (16.6%) were Kadish stage A, 121 (35.2%) were Kadish stage B, 145 (42.2%) were Kadish stage C, and 21 (6.1%) were Kadish stage D. Pooled analysis demonstrated that 66.0% of patients had Hyams histologic Grade Ⅰ or Ⅱ, while 34.0% of patients had Grade Ⅲ or Ⅳ disease. Negative surgical margins were achieved in 86.9% of patients, and recurrence was identified in 10.3% of patients. Of those with 5-year follow-up, reported overall survival was 91.1%.Conclusion:Exclusively endoscopic surgery for esthesioneuroblastoma is performed for a wide range of disease stages and grades, and the majority of these patients are also treated with adjuvant chemotherapy or radiation therapy. Reported overall recurrence rate is 10.3% and 5-year survival is 91.1%.