硬膜

Objective:To evaluate the safety and efficacy of laparoscopicassisted rectectomy under combined general and epidural anesthesia.

目的：评价全麻复合硬膜外麻醉在腹腔镜直肠癌根治术中的应用效果及安全性。

Methods:Forty ASA Ⅰ~Ⅱ patients scheduled for selective laparoscopicassisted rectectomy were randomly divided into two groups:group A and group B.Group A received combined general and epidural anesthesia and group B received general anesthesia only.Hemodynamics changes,PaO2 HCO-3 and anesthetic doses were observed preoperation,perioperation and postoperation.

40例ASAⅠ~Ⅱ级择期行腹腔镜直肠癌根治术的病人，随机分为A组和B组各20例。A组为全麻复合硬膜外麻醉组，B组为单纯全麻组，分别观察两组病人手术期血流动力学变化、血气变化及全麻药用量。

Objective:To observe the effects of patient controlled epidural analgesia with ropivacaine mesilate and fentanyl and patient controlled intravenous analgesia with fentanyl and droperidol on clinical result and blood gas urdergoing laparoscopic rectectomy in aged patients.

目的：观察老年患者腹腔镜直肠癌术后甲磺酸罗哌卡因、芬太尼硬膜外自控镇痛（patient controlled epidural analgesia，PCEA）与芬太尼、氟哌利多静脉自控镇痛（patient controlled intravenous analgesia，PCIA）的临床效果及对血气的影响。

Objective:To observe the effects of patient controlled epidural analgesia with ropivacaine mesilate and fentanyl and patient controlled intravenous analgesia with fentanyl and droperidol on clinical result and blood gas urdergoing laparoscopic rectectomy in aged patients.Methods:Fifty??two patients ASAⅠ?

目的：观察老年患者腹腔镜直肠癌术后甲磺酸罗哌卡因、芬太尼硬膜外自控镇痛（patient controlled epidural analgesia，PCEA）与芬太尼、氟哌利多静脉自控镇痛（patient controlled intravenous analgesia，PCIA）的临床效果及对血气的影响。

a three steps sequence therapy was designed for patients suffered post dural puncture headache total 45 cases:step one,patient keep supine recumbence,and intravenous injection of ringer's solution 1000ml with intramuscular injection of tramadol 100mg was administrated. if pdph could not relieve within 24hr,the next step should be use. step two,drinking a cup of coffee three times a day for patients who were allowed to eating or intravenous injection ketamine 0.5mg/kg for patient in fasting diet.

选择椎管内麻醉后发生头痛的病例共45例，按设定的序贯疗法分别为a：去枕平卧1d，每天补液量增加1000ml平衡液，肌注曲马多100mg，无效时进入b和c；b：能进食者给予市售咖啡饮品，每天三次；c：不能进食者静脉注射氯胺酮0.5mg/kg，连用2d；以上治疗无效时进入d：行硬膜外填充自体血10ml。

A three steps sequence therapy was designed for patients suffered post dural puncture headache total 45 cases:step one,patient keep supine recumbence,and intravenous injection of Ringer's solution 1000ml with intramuscular injection of Tramadol 100mg was administrated.

选择椎管内麻醉后发生头痛的病例共45例，按设定的序贯疗法分别为A：去枕平卧1d，每天补液量增加1000ml平衡液，肌注曲马多100mg，无效时进入B和C；B：能进食者给予市售咖啡饮品，每天三次；C：不能进食者静脉注射氯胺酮0.5mg/kg，连用2d；以上治疗无效时进入D：行硬膜外填充自体血10ml。

The distance between rear part of posterior semicircular canal andanterior margin of the sigmoid sinus increased by 4.45 mm(57.8%),exposure areas ofposterior fossa dura increased by 157.32 mm~2 (64.3%)and operative angle of visionwas 329.6% that of retrolabyrinthine approach when performing PLPA approachcompared with retrolabyrinthine approach.

PLPA入路与迷路后入路相比，半规管后端与乙状窦前缘的距离较迷路后入路增加了4.45 mm (57.8%)，后颅窝硬膜的暴露面积增加了157.32 mm~2 (64.3%)，手术视角为迷路后入路的329.6%。

The anterior part of Rolandic vein (n=1), Rolandic vein (n=3), the posterior part of Rolandic vein (n=2), straight sinus (n=1), straight sinus and sinus confluens (n=1) were embolized. On MRI, gyrus swelling, brain swelling or slight ventriculomegaly, and cerebral hemorrhage (n=2), subdural hemorrhage(n=2) were observed.

Rolandic静脉处栓塞3例，Rolandic静脉后栓塞2例，直窦栓塞1例，直窦和窦汇栓塞1例，MRI显示有不同程度脑回肿胀、脑肿胀或轻度脑室扩大，伴脑出血2例，硬膜下出血2例。

RESULTS:①The myelography and CTM revealed that factors contributing to DLSS included not only zygapophysial joint hyperplasy, hypertrophic ligamentum flavum and intervertebral disc protrution which resulted in degenerative lumbar spinal stenosis, but also zygapophysial joint semiluxation and pedicle shift.

结果：①脊髓造影与CT脊髓造影的表现：DLSS对硬膜囊或神经根的压迫较退行性腰椎管狭窄症复杂，除与关节突肥大增生、黄韧带肥厚、椎间盘退变突出有关外，还与关节突关节半脱位、椎弓根移位压迫神经根等因素有关。

Abstract］ Objective To evaluate the application of neuroendoscopy in septated chronic subdural hematoma.

目的 总结神经内镜治疗分隔型慢性硬膜下血肿的临床疗效及优势。

We are in a real jam.

我们的麻烦大了。

Hey, it's Ahmet from India, that foreign exchange guy.

看，那是印度的阿曼特，国际交换生