神经切除术

Past experiences with scalenotomy have shown that postoperatively the muscle can scar down to the nerve roots or, in some patients in whom we had reoperated, the anterior scalene can completely reconstruct itself.

以前对斜角肌切除的经验是术后瘢痕可侵及神经根或出现在一些翻修术的病人中，前斜角肌可自行完全修复。

The bone resection was divided into four steps via FLA:① drilling of the jugular tuberculum;② partial mastoidectomy;③ removal of the occipital condyle;④resection of the lateral mass of C1 with mobilization of the vertebral artery. After each step of the bone resection was completed, the exposed area of the central clival depression and the area of exposure 15 cm above the central point were calculated.

利用CT和立体定向仪对20例甲醛溶液固定的头颅标本标记斜坡中央凹陷区中心点，采用FLA入路，骨切除分四步进行：磨除颈静脉结节，部分乳突切除，枕髁全切，C1侧块切除；分别于每一步骨切除及血管神经牵拉完成后测量斜坡中央凹陷区的显露范围和位于中心点上方15 cm处术者的操作范围。

Methods Central point at the central clival depression was marked with the help of CT and stereotactic apparatus in 20 formalin-fixed cadaveric heads. The bone resection was divided into four steps via FLA:① drilling of the jugular tuberculum;② partial mastoidectomy;③ removal of the occipital condyle;④resection of the lateral mass of C1 with mobilization of the vertebral artery. After each step of the bone resection was completed, the exposed area of the central clival depression and the area of exposure 15 cm above the central point were calculated.

利用CT和立体定向仪对20例甲醛溶液固定的头颅标本标记斜坡中央凹陷区中心点，采用FLA入路，骨切除分四步进行：磨除颈静脉结节，部分乳突切除，枕髁全切，C1侧块切除；分别于每一步骨切除及血管神经牵拉完成后测量斜坡中央凹陷区的显露范围和位于中心点上方15 cm处术者的操作范围。

Methods Sixty cases of inoperable pancreatic cancer were enrolled from May 1995 to August 2000. Of them, 36 cases were treated by cholangiojejunostomy and/or gastroenterostomy as well as intratumoral injection and celiac plexus blockage by anhydrous alcohol, while 24 cases received only cholangiojejunostomy and/or gastroenterostomy.

1995年5月至2005年8月60例不能切除之晚期胰腺癌患者，其中36例在行胆肠和胃肠改道手术基础上，术中行瘤体内以及腹腔神经丛无水酒精注射处理，术后定期随访，观察症状缓解和生存期(术后0.5、1a存活率情况)。

Objective To evaluate the feasibility and clinical value of preserving intercostobrachial nerve during axillary lymph node dissection for breast neoplasms.

目的探讨保留肋间臂神经在乳腺癌腋淋巴结清扫术中的可行性及临床应用价值。方法1999~2003年322例Ⅰ、Ⅱ期乳腺癌的腋淋巴结清扫术中，保留ICBN 102例，切除ICBN 220例，术后对病人观察并随访。

The intercostobrachial nerves were reserved and resected in 39 and 7 cases respectively. The sensory function of internal upper arm was been studied by follow-up after operation.

在46例乳癌根治术中完整保留肋间臂神经39例，切除肋间臂神经7例，术后对46例上臂内侧皮肤感觉随访观察。

Methods 46 patients with breast cancer were underwent radical resection. The intercostobrachial nerves were reserved and resected in 39 and 7 cases respectively. The sensory function of internal upper arm was been studied by follow-up after operation.

在46例乳癌根治术中完整保留肋间臂神经39例，切除肋间臂神经7例，术后对46例上臂内侧皮肤感觉随访观察。

Resultsthe operating time was from 40 to 200 minutes,the average weight of removed prostate was 25～92（46±22）g, hemorrhage volumn was 75ml during operation. no transurethral resection syndrome and obturator nerve reflex occurred. the 62 patients were followed up for 2～12months,they micturate freely. the symptom of night-urination mend well. the international prostate symptom scoresdecreased from 25.2 to 8.5. the qmax increased from the 5.4ml/s before operation to 16.9ml/s after operation.

结果 手术时间40～200min，切除前列腺组织重量25～92（46±22）g，术中出血量平均75ml，无turp综合征及闭孔神经反射发生。62例患者随访2～12个月，排尿通畅，夜尿症状缓解，ipss评分由术前的平均25.2分下降为术后平均8.5分，qmax由术前8.0ml/s增到18.5ml/s。

If by means of a prereduction MRI or after neurologic deterioration during closed reduction, the surgeon becomes aware of a fragment of disc material displaced into the spinal canal, then an anterior discectomy, open reduction, fusion, and plating becomes necessary.2,7,9 In approximately half of the cases, a closed reduction will be successful in reducing the dislocation before surgery.50 In the majority of the others, an intraoperative reduction performed after the discectomy and decompression will achieve anatomic reduction.9,51 For those patients in whom an anterior discectomy and decompression have not been successful in reducing the dislocation, then a supplemental posterior open reduction should be performed.52

假如借助MRI检查，或在闭合复位过程中神经症状进一步加重，外科医生意识到有椎间盘碎片突入了椎管，此时就需要前路椎间盘切除减压、开放复位和固定融合。大约有一半的病例手术以前能够通过闭合复位来成功的将脱位复原，剩下的病例则需要在术中将椎间盘切除减压来达到解剖复位。假如有病人经过前方的椎间盘切除和减压后仍然不能成功的还原脱位，则需要再行后方的开放复位术。

Methods to improve anorectal function after anterior re section include autonomic nerve preservation, puborectalis muscle preservation and anorectal angle restruction, etc.

针对以上前切除术后的病理生理改变，许多学者提出了一系列方法来改善前切除术后的肛门直肠功能，包括术中保留植物神经、保留耻骨直肠肌及肛门直肠角重建以及增加新建直肠的容量。

The split between the two groups can hardly be papered over.

这两个团体间的分歧难以掩饰。

This approach not only encourages a greater number of responses, but minimizes the likelihood of stale groupthink.

这种做法不仅鼓励了更多的反应，而且减少跟风的可能性。