病历资料 患者,男,43岁,因左眼视力下降、左眼鼻侧偏盲半年,进行性视力下降1个月,于2008年4月6日入院.视力:右侧正常,左侧0.02,右侧瞳孔3.5mm,左侧瞳孔4.0mm.右侧瞳孔直接光反射灵敏,间接光反射迟钝;左侧瞳孔直接光反射迟钝,间接光反射灵敏.左眼鼻侧偏盲,眼底:左侧视乳头边界模糊.其他神经系统检查均正常.

目的:探讨颅内外颈内动脉临时阻断,直接夹闭颈内动脉眼动脉大型及巨大动脉瘤的入路及方法。方法:经头颅CTA成像术前确诊。术中先暴露颈内动脉颈部,置粗线用作临时阻断,后行同侧侧裂入路,暴露颈内动脉床段、后交通动脉,最后分离和暴露动脉瘤及其周围结构,临时阻断颈内动脉颈段及交通段之前,抽吸颈内动脉颈段,使动脉瘤塌陷后直接夹闭动脉瘤颈。术中颈内动脉造影明确动脉瘤是否被夹闭完全及颈内动脉颅内段分支血流是否通畅。结果:患者全部清醒,2例出现同侧动眼神经麻痹,1例出现対侧轻偏瘫,1例未出现新的神经系统阳性体征。结论:颅内外颈内动脉阻断,动脉瘤抽吸,直接夹闭动脉瘤颈,术中颈内动脉造影是治疗颈内动脉眼动脉巨大动脉瘤的一种安全有效的方法。

Objective To analyze the factors influencing cosmetic results of breast-conserving surgery in 176 cases with stage Ⅰ-Ⅱ breast cancer.Methods Data of breast-conserving surgery for breast cancer in past eleven years were studied retrospectively.The cosmetic results by location of the cancer,incision,resected area and plastic surgery were analyzed.Results 170 cases were followed up,the following-up time was 3-60 months.Harrrs cosmetic evaluation standard was used.The breast was scored cosmetically as excellent and good in 155 cases,accounting for 91.2%.Conclusion The cancer negative incision margin is very important and wide resection for tumor is not useful to cosmetic results.Plastic surgery during operation is necessary.

治疗股骨头缺血性坏死的方法,从目前的医学研究来看,是向保守疗法方面进展,尤其是中医药的应用.目前治疗股骨头缺血性坏死的保守疗法虽然很多,但疗效大都不能肯定.具体包括以下几方面.

股骨头缺血性坏死的病因及临床表现与祖国医学的"瘀"、"痹"证的表现相一致,可将本病归属于瘀血范畴.<诸病源候论>指出:"血之在身,随气而行,常无停积.若因坠落损伤,即血行失度,随伤损之处,即停积……".瘀血形成,"卒然致损,故血气隔绝,不能周荣".故血行失度,壅塞不通致瘀而疼痛.