神经外科

颅内动脉瘤和颈内动脉破裂止血

YONGWUJUNXIGUANCONGANBUZHONGXICHUYIYONGJIAO(PENWUXINGJIANGYIYONGJIAOZHURUPEIBEIDEPENJIAOPINGZHONGBINGNINGJINPENTOU,ANYAPENTOUSHOUXIANJIANGYA,TIWAIYAPOTONGCEJINGZONGDONGMAI,YONGXIYINQIXIQINGSHUYEXUEYE,KANDAOPOLIEKOU,TONGSHIZAIYIXIAOKUAIMIANPIANSHANGFANGZHI1cm X 1cmDADEMINGJIAOHAIMIAN,SHANGMIANZAIFANGYIXIAOKUAINIEJI,TUSHAOXUYIYONGJIAO。RANHOUXUNSUJIANGDAIJIAODEJIROUDUZHUCHUXUEKOU,YAPOPIANKEJIKEZHIXUE。


颅骨瓣固定术

WEIJIANSHAOLUNAOSHOUSHUHOUBINGFAYINGMOWAIXUEZHONGHESUODUANKAI、GUANLUSHIJIAN,ZAISHUZHONGJIANGPIBANQUANCENGZILUGUSHANGFENLI,JIANGLUGUBANQUXIAFANGRUSHENGLIYANSHUIZHONG,SHUHOUZAIGUBANBIANYUANTUYIYONGJIAOHOUFANGHUI,GUDINGZHANHE。


颅骨修补术

FANKAIPIBANHOU,JIANGZHUNBEIHAODEYOUJIBOLIBIANYUANTUJIAOHOUZHIJIEFANGZAILUGUQUESUNCHU,YUZHOUWEIDERUANZUZHIZHANHE,BIYAOSHIJIANGBIANYUANYONG7HAOSIXIANYURUANZUZHIFENGHE,GUDING3DIAN,XIAOGUOMANYI。


颅前凹低修补术

QUYIKUAIDAXIAOSHIDANGDENIEGU,TUJIAOHOUZHIYULUDIGUQUESUNCHU,RANHOUZAIYONGTUJIAODENIEJIZHANDUZAISIZHOUWEI,YANMIFENGBI。


颅脑损伤手术

WAISHANGXINGLUGUFENSUIXINGGUZHE:JINXINGLUGUXIUBUSHU,JIANGSUIGUKUAIYONGJIAOZHANHEGUDINGHUOYUPIBANZHANHEZAIYIQIFENGHE,ZHEIYANGZHANHEDELUGUBANBIJIAOLAOGU,DANGYUDAOYINGNAOMOPOSUNBUYIFENGHESHI,QUNIEJIJINMOYUYINGNAOMOZHANHEZAIYIQIJINXINGXIUBU,HUOJIANDUANFENGHEMAOZHUANGJIANMOHOU,PIBANXIATUJIAO,JIANGQIZHANHEYULUGUSHANG。ZAIFENGHETOUPI,TONGYANGNENGFANGZHISHUHOUNAOJIYELOU。


颅脑肿瘤开颅切除术

 BAOKUONAOMOLIU、JIAOZHIXIBAOLIU、XUEGUANWANGZHIXIBAOLIU、JISUOLIU、JITAILIU、GULIUDENG。ZHUYAOYONGYUSHOUSHUZHONGDUILIUCHUANGJIZHOUBIANNANYIKONGZHIDECHUXUECHUZHANFUZHIXUE。


颅脑外伤

DUOYONGYUNAOXUEGUANPOSUNDEZHANHEYUXIUFU,LUMIAN、LUDIGUQUESUN,LUGUFENSUI、AOXIANXINGGUZHEDEFUWEISHOUSHU。ZAIXIUFUNAOXUEGUANPOSUNDEBINGLISHI,XIANYONGMINGJIAOHAIMIANTIANSAIYUXUEGUANPOSUNCHU,ZAIJIANGTUMOYOUYIYONGJIAODEXIUBUPIANTIEYUQISHANG,YIBIANQIDAOJIAGUZUOYONG。




鞍区病变经蝶手术

CAIYONGJINGDIERULUQIECHUANQUBINGBIAN(RUCHUITIXIANLIU、LUYANGUANLIU、ANNEIJIAOYANGNANGZHONG、KONGDIEANDENG),SHOUSHUJIESHUSHIYONGYIYONGJIAOJIANGJIROU、MINGJIAOHAIMIANJIGUPIANZHANHEXIUBUANDI,FANGZHIFASHENGNAOJIYELOU。


颅骨缺损修补术

RUYOULIGUBANDEZHANHE,LU–KUANG–BIBULIANHESHOUSHUDETONGDAOZHANDUSHU,ZAICTNAOLITIDINGXIANGKAIFANGSHOUSHUSHI,XUYAOYONGJIAOJIANGHUANXINGGUBANZHANHEGUDING。


脑瘤切除后修补硬脑膜


脑脊液耳(鼻)漏的修补术

DUIYUCHUANGSHANGXINGHUOZIFAXINGNAOJIYEER(BI)LOUHUANZHE,SHUZHONGXUNZHAOLOUKOUHOU,JIANGLOUKOUZHOUBIANYONGSHOUSHUQIJUZHIZUOCHUCUCAOMIAN,QULVEDAYULOUKOUDEJINMO、YINGNAOMOPIANHUOJIROUKUAI,ZAIQISHANGTUJIAO,TIEFUYULOUKOUCHU,BINGZAIXIUBUWUSHANGFANGZAITUYICENGJIAO,YONGMINGJIAOHAIMIANFUGAI,CHANGKEDADAOXIUBUSHIFENYANSHIZHIMUDE


脑(脊髓)血管瘤或AVM手术

ZAIJIABIHUOQIECHUNAO(JISUI)XUEGUANLIUHUOAVMSHOUSHUZHONG,WEILEFANGZHIHUANZHESHOUSHUHOUYOUYUMOUZHONGYUANYINYINQIDEXUEYAZENGGAO,DAOZHIXUEGUANPOLIECHUXUE,KEZAIBEIJIABIDEDONGMAILIUHUOBEIQIEDUANDEJIAOCUDADEAVMGONGYINGDONGMAIDUANDUAN,YONGTUJIAODEXIAOPIANJIROUHUOMINGJIAOHAIMIANJIANGQIBAOGUO。ZHEIZHONGFANGFAYESHIYONGYUNEIXIEWUFAJIABIDEGUANGJIXINGNAODONGMAILIUDEGULIXINGSHOUSHU。


骨纤维异常增殖症的手术

SHUZHONGYAODUIBEIJIECHUDELUGU、KUANGDINGBAN、MEIGONG、BILIANGDENGSHIXINGZHONGJIANYUZAIZAO。JIAODEYINGYONGJIQIZHANHEZUOYONGXIANDEHENZHONGYAO。


颅颈与椎管成形术

XUDUOLUJINGQUJIZHUIGUANNEIJIBING(BAOKUOZHONGLIU、ZHUWANGMONANGZHONG、ZHUIJIANPANTUOCHU、HUANZHENJIXING、ZHUIGUANXIAZHAIDENG),JINXINGSHOUSHUZHILIAOHOU,KEJIANGQIEKAIDELUJINGGUZHIJIZHUIBANFUWEI,SHIXINGCHENGXINGSHU,YIBIANBAOCHISHOUSHUHOUZHUIGUANDEWANZHENGXING。LIRULUJINGQUSHOUSHUHOUDEHUANZHENRONGHEHEZHUIBANQIEKAIDE“HOUKAIMEN”SHOUSHU。




颅脑手术切口处的CSF漏

医用胶自体颅骨碎片原位粘合成型
彻底清创后,小心取出颅骨碎片,用3%H202浸泡消毒5分钟后包于湿纱布中备用。然后清除颅内血肿及挫伤脑组织,修补硬脑膜,取胶0.5 ml 或1ml仔细将颅骨碎片原位粘合。骨窗范围较大时,可在骨折中心处缝吊硬脑膜,缝线粘合在骨折缝中即可,最后将皮瓣与碎骨片表面粘合,分层缝合头皮并不必置管引流。
(1)对于骨瓣或骨缺损的粘合,常将颅骨钻孔时的骨粉末填塞于骨瓣锯缝之中,然后滴入胶,可使其粘合较为牢固。
(2)胶的使用环境,要求在手术中对于需要粘合的部位及组织,应将血性或液性成分清除干净,保持局部的清洁与干燥,才可使其发挥较强的粘合性能。
(3)对血管和神经进行粘合与止血时,先将医用胶涂于明胶海绵或肌片上,再贴于用胶部位,不要直接涂于组织上。
(4)在脑深部手术时,用胶(如经口–鼻–蝶窦入路的鞍区病变手术),需要用载有长针头的注射器将胶注入作用部位。


●脑动静脉畸形(AVM)的栓塞治疗

经过适当选择的病例,单纯应用医用胶栓塞可治愈,而不需手术治疗或放射治疗
医用胶和碘苯酯混合后可延长其聚合时间,并且随二者的混合比例不同,聚合时间也相应发生变化
在栓塞前后用5%的葡萄糖冲洗导管,避免了其在导管内发生聚合,阻塞导管。碘苯酯不仅改变其聚合时间,还可使其在透视下显影。加入适量钽粉,可进一步增加显影效果。
注意;如微导管粘附于血管壁,在栓塞后的手术切除中取出,无严重并发症。这一问题是粘附性栓塞材料所特有的。由于其粘附性,注胶时间受到限制,注射后必须立即撤管,否则有将微导管粘附于畸形团的危险。这就要求术者具有丰富的注胶经验,掌握胶的浓度,把握注射速度和注射时间,严格控制返流,及时撤除微管。为防止"粘管"的发生,可采取以下措施:ⅰ)确保微导管的头端置于畸形团内,防止胶的返流。ⅱ)注胶前理顺过度屈曲的微导管以利于注胶后微导管的撤除。ⅲ)采用降低浓度的胶。ⅳ)注射过程结束时抽吸微管,同时迅速将输送导管和微导管一起撤除。


●医用胶颅骨游离骨瓣(片)粘合

YOULIGUBAN(PIAN)ZHANHE、MUSHANGGUBANKAILU,GAILUGUJIBANWEIYOULIGUBAN,QIEKOUYIQIESHENDAGUMOXIA,GUMOLIANTONGJIROU,PIFUYIBINGXIANQI,ZUANLU,JUXIAGUBANBINGJIANGQIYIQUHOUJINYIBUCAOZUORUTONGJIWANGGELUNEIJIHUAN。QIECHULUNEIBINGBIANHOU,FENGBIYINGNAOMO,GUCHUANGSIZHOUJIANGYINGNAOMOXUANDIAOSHUZHEN,YINGMOWAIFANGZHIYINLIUTIAO,YONGYUMIANSHAJIANGGUCHUANGBIANYUANJIYOULIGUBANBIANYUANMOGANBINGTUSHANGBOCENGGONGHUNXINGYIYONGJIAO,HUINAGUBANJIAYA8-10CHAOZHONG,YULUGUWAIBANZAITUJIAO;ERHOU,JIANGGUMOJIPIBANTANKAIBINGXUNSUJIANGQIFUGAIYULUGUWAIBANBIAOMIANSHANG,ANYAPIANKE(5-6MIAOZHONG),SHUANGCENGFENGBIQIEKOU,GUPIANZHANHEZHUYAOYONGYUJINGDIECHUITILIUQIECHUHOUANDIZHONGJIAN,JUTIZUOFASHI:ZHONGLIUQIECHUHOUANDIZHIRUXIAOKUAIMINGJIAOHAIMIAN,JIANGDAXIAOHESHIDEXIAOKUAIGUPIANZHIRUCHUITIWOKAYUANDI,XIGANSHENYEHUOSHENXUEHOUYONGYICIXINGZHIYIHAOSHENGZHUSHEQICHOUXIGONGHUNXINGYIYONGJIAO,JINGXIAJIANGJIAOSHUIDIYUANDIGUYUANYUGUPIANJIAN,ZAIJIANGXIAOKUAIMINGJIAOHAIMIANZHIQIBIAOMIAN。XIGUANANYAPIANKEHOUQIZHANJINCHENGXIAOYINGKUAIHOUCHECHUDIEDOUQIANKAIQI,FENGBIQIEKOU。


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