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find Author "徐学君" 3 results
  • 经鼻蝶入路的鞍底重建

    目的 探讨经蝶手术利用神经补片及生物蛋白胶进行鞍底重建的效果。 方法 2005年1月-2009年5月对31例经鼻蝶手术术中鞍底重建资料进行回顾分析。肿瘤切除后,瘤床以全溶性止血纤维止血,鞍内以明胶海绵填塞,鞍底硬膜缺损使用神经补片适形修补,最外层以生物蛋白胶封闭。对于术中发生大量脑脊液漏及术后发生脑脊液漏的患者,术后辅以腰大池持续引流。 结果 术中少量脑脊液漏8例(25.81%),大量脑脊液漏3例(9.68%),平均脑脊液漏发生率35.49%;术中无明显脑脊液漏20例及少量脑脊液漏8例;术后继发脑脊液漏1例(3.23%)。术后脑脊液漏1例及术中大量脑脊液漏3例,辅以腰大池持续引流,5~7 d后脑脊液漏停止。无脑膜脑炎或视力下降等并发症发生。 结论 利用神经补片结合生物蛋白胶进行鞍底重建能够有效减少术后脑脊液漏。

    Release date:2016-09-08 09:47 Export PDF Favorites Scan
  • The Treatment Discussion with γ-knife of 36 Cases of Huge Acoustic Neurilemoma after Operation

    目的:探讨巨大听神经瘤治疗抉择,从而降低并发症。方法:通过36例巨大听神经瘤显微手术大部分切除肿瘤,残留肿瘤行伽玛刀治疗,并进行观察。结果:手术后无神经功能废损,伽玛刀治疗后随访2 ~4年,肿瘤被有效控制。结论:显微手术后配合伽玛刀治疗巨大听神经瘤可作为减少术后并发症,提高生活质量的有效手段。

    Release date:2016-09-08 10:14 Export PDF Favorites Scan
  • Impact of tumor spread through air spaces on surgical decision-making and accuracy of identifying spread through air spaces on frozen sections: A systematic review and meta-analysis

    Objective To investigate the significance of spread through air spaces (STAS) in early-stage non-small cell lung cancer (NSCLC) patients undergoing either sublobar resection or lobectomy by pooling evidence available, and to assess the accuracy of frozen sections in determining types of resection among patients with suspected presence of STAS. MethodsStudies were identified by searching databases including PubMed, EMbase, Web of Science, and The Cochrane Library from inception to July 2022. Two researchers independently searched, screened, evaluated literature, and extracted data. Statistical analysis was conducted using RevMan 5.4 and STATA 15.0. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the study. ResultsA total of 26 studies involving 23 surgical related studies (12 266 patients) were included, among which, 11 compared the outcomes of lobectomy with sublobar resection in the STAS-positive patients. NOS score≥6 points. Meta-analysis indicated that presence of STAS shortened patients' survival in both lobectomy group and sublobar resection group (RFS: HR=2.27, 95%CI 1.96-2.63, P<0.01; OS: HR=2.08, 95%CI 1.74-2.49, P<0.01). Moreover, lobectomy brought additional survival benefits to STAS-positive patients compared with sublobar resection (RFS: HR=1.97, 95%CI 1.59-2.44, P<0.01; OS: HR=1.91, 95%CI 1.47-2.48, P<0.01). Four studies were included to assess the accuracy of identifying presence of STAS on intraoperative frozen sections, of which the pooled sensitivity reached 55% (95%CI 45%-64%), the pooled specificity reached 92% (95%CI 77%-97%), and the pooled area under the curve was 0.68 (95%CI 0.64-0.72) based on the data available. Conclusion This study confirms that presence of STAS is a critical risk factor for patients with early-stage NSCLC. Lobectomy should be recommended as the first choice when presence of STAS is identified on frozen sections, as lobectomy can prolong patients' survival compared with sublobar resection in STAS-positive disease. The specificity of identifying STAS on frozen sections seems to be satisfactory, which may be helpful in determining types of resection. However, more robust methods are urgently in need to make up for the limited sensitivity and accuracy of frozen sections.

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