目的 探討幕上手術后遠隔幕下部位出血的臨床特點、發病原因、影像學表現及相關干預結果。 方法 分析2009年1月－2011年1月2例經幕上手術后出現遠隔幕下部位出血的病例的臨床資料。1例患者因顱內動脈瘤經翼點入路行動脈瘤夾閉術，術后出現遠隔幕下部位出血；1例患者因硬膜下血腫行鉆孔引流術，術后出現遠隔幕下部位出血。 結果 2例幕上手術患者均在術中或（和）術后大量引流腦脊液，術后發生出血部位均位于遠隔幕下,均行積極手術干預，恢復良好，格拉斯預后評分均為4分。 結論 過度引流可能為引起幕上手術后形成遠隔幕下部位出血的主要原因，術前、術中、術后應給予高度重視，并通過少量間斷引流腦脊液可以盡量避免發生。
Objective To explore the application value of time of flight magnetic resonance angiography (TOF-MRA) in target bypass surgery for moyamoya disease. Methods The data of patients with moyamoya disease in Affiliated Drum Tower Hospital, Medical College, Nanjing University between May 1 and August 30, 2020 were retrospectively analyzed. Patients were divided into navigation group and control group according to whether navigation technology was used during operation. All patients completed TOF-MRA evaluation before operation, and all patients completed surgical treatment. One week after operation, TOF-MRA was reviewed to evaluate the patency of anastomotic stoma. The intraoperative and postoperative conditions of the two groups were compared. Results Finally, 48 patients with moyamoya disease were included. 22 patients who used intraoperative navigation were included in the navigation group, and 26 patients with moyamoya disease who did not use intraoperative navigation in the same period were included in the control group. There was no significant difference between the two groups in gender, age, Suzuki stage before operation, proportion of posterior circulation involvement, proportion of bleeding type, proportion of hypertension and proportion of diabetes (P>0.05). The operation duration [(3.3±0.4) vs. (3.6±0.6) h] and postoperative hospital stay [(7.3±1.9) vs. (8.8±2.7) d] in the navigation group were shorter than those in the control group (P<0.05). There was no significant difference between the two groups in the proportion of patients who completed bypass surgery, the proportion of middle meningeal artery retained, the postoperative patency rate, the proportion of temporary dysfunction, and the proportion of serious complications (P>0.05). Conclusion TOF-MRA sequence combined with navigation technology can effectively guide the surgical scheme design and postoperative evaluation of moyamoya disease.
Objective To objectively evaluate the efficacy and safety of plasmakinetic enucleation for prostate (PKEP) vs plasmakinetic resection for prostate (PKRP) in treating benign prostate hyperplasia (BPH). Methods Such databases as PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMbase, the ISI Web of Knowledge databases, VIP, CNKI, CBM and Wanfang were searched from their establishment to March 2011 for collecting the randomized controlled trials (RCTs) about PKEP vs PKRP for the treatment of BPH, and the references of those RCTs were also searched by hand. After study selection, assessment and data extraction conducted by two reviewers independently, meta-analyses were performed by using the RevMan 5.1 software. The level of evidence was assessed by using the GRADE system. Results Eight studies involving 991 patients were included. The results of meta-analyses showed that: a) safety indicator: compared with the PKRP, PKEP had shorter operation time (SMD=1.07, 95%CI 0.19 to 1.94, P=0.02), less intraoperative bleeding (SMD=2.06, 95%CI 1.42 to 2.69, Plt;0.01), much quantity of resectable prostate (SMD= –0.91, 95%CI –1.33 to –0.48, Plt;0.000 1), less intraoperative perforation (RR=4.48, 95%CI 1.43 to 14.02, P=0.01), shorter catheterization time (SMD=1.98, 95%CI 0.39 to 3.57, P=0.01), shorter bladder irrigation time (SMD=3.49, 95%CI 0.51 to 6.47, P=0.02) and shorter hospital stay (SMD=0.89, 95%CI 0.64 to 1.13, Plt;0.01), but there was no significant difference in total postoperative complications (RR=0.82, 95%CI 0.54 to 1.24, P=0.35); and b) efficacy indicator: compared with the PKRP, the International Prostate Symptom Score (IPSS) was lower after 3 months, the Quality Of Life (QOL) was higher after 3 months, and the improvement of residual urine volume (RUV) was better after 6 months; but other efficacy indicators had no significant difference between the two groups (Pgt;0.05). Based on GRADE system, all the evidence was at level C and weak recommendation (2C). Conclusion The current evidence indicates that PKEP is similar to PKRP in the treating effect, but it resects the proliferated prostate more cleanly with shorter operation time, lesser bleeding and more safety than PKRP; for the poor quality of the original studies, a prudent choice is suggested; and more high-quality, large-sample studies are need.