窦

The available operation range in clivus and anterior cranial base by transsphenoidal opproach was also observed during the operation under the help of neuronavigational pointer. Forty-one patients underwent sublabial, transseptal, transsphenoidal approach to the pituitary region guided by Surgical Microscope Navigation was studied. The piriform aperture was 27. 2mm±3. 1 , the origin of inferior nasal concha 30mm±4. 1, the origin of middle nasal concha 27. 9mm±4. 3. These data are important for transsphenoidal approach, because the piriform aperture and the origin of both inferior and middle nasal conchas restricted the opening width of the Hardy specula. If any distance of these bony structures was much less than the mean one, may cause inadequate opening of the specula blade and resulting dissatisfied operative field. Microadenomas or cystic tumors perhaps can be operated even in a narrow exposure, but large or giant solid adenomas may need a proper evaluation including changing the operative approach or performing a bilateral submucous inferior conchotomy or posterior ethmoidectomy firstly.

手术中还利用CT导航系统观察棒研究了经口—鼻蝶窦入路在斜坡区和前颅底能够达到的实际有效操作范围，为扩大经蝶窦入路手术在斜坡区和前颅底的应用奠定基础，在国内外尚未见同类报道。41例垂体瘤患者梨状孔平均宽度27.2mm±3.1，下鼻甲根部附着处间距30mm±4.1，中鼻甲根部附着处间距27.9mm±4.3，这是经口—鼻蝶窦入路手术中，对Hardy双瓣鼻窥器张开限制的主要骨性结构，若患者这些径线值明显小于平均值，则可能因为鼻窥器打开不充分而影响手术暴露，当然对于垂体微腺瘤和以囊变为主的垂体瘤可能影响不大，但对于大和巨大垂体瘤必须要有充分的准备，包括评估是否改用其他入路，或先行鼻甲切除再行经蝶手术。

Methods Twelve patients with open maxillary or frontal sinus defects have been repaired with this type of flap. The homolateral superficial temporal vessels were used as nutritional vein to form the temporal fascia island flap of the top superficial temporal artery and the island skin flap of the frontal superficial temporal artery.

对上颌窦、额窦开放性缺损12例患者，利用同侧颞浅动脉、静脉作为供养血管，形成颞浅动脉顶支颞筋膜岛状组织瓣和额支额部岛状皮瓣，通过皮下组织隧道将组织块移植到缺损的副鼻窦区，进行副鼻窦窦腔的充填和皮肤缺损的修复。

Results: Anterior to the coronal suture and posterior to the lambdoid suture were two segments of SSS void of bridging vein draining into. The number of bridging veins observed by microanatomy, DSA and CTV was 11.2, 8.9 and 7.0 respectively.

结果：上矢状窦前部和后部分别有一缺乏桥静脉注入段，显微解剖、DSA和CTV观察上矢状窦旁桥静脉的数量分别为11.2支、8.9支和7.0支，DSA和CTV观察发现桥静脉注入上矢状窦处常显示不清。

Methods Axial lamellate computed tomography scans of frontal drainage system were firstly performed with four layers spiral CT, and coronal, sagittal sections then reconstructed with AW 4.1 software on 65 adults ,both frontal sinusitis group (35 cases, 66 sides) and control group (30 cases. 59 sides). Related cells in frontal drainage system were studied and compared dynamically.

采用4层螺旋CT对65例成人，30例正常成人及35例额窦炎患者的额窦引流通道行水平位薄层扫描后用Advantage Windows 4.1(AW4.1)影像工作站进行冠状位、矢状位重建，动态分析和比较两组额窦引流通道内出现的相关气房。

Results Among the 8 cases,the center of lesion located in ethmoid sinus was in 3 cases,sphenoid sinus in 3 cases,frontal sinus in 2 cases.4 of 5 primary cases revealed expansible masses,1 case with irregular and lobulated shape;all 3 recurre...

结果8例中病变中心位于筛窦3例，蝶窦3例，额窦2例；5例原发病例中4例病变呈膨胀性生长，1例形态不规则呈分叶状；3例术后复发病变的形态均不规则并呈分叶状；所有病变边界均清晰，伴周围结构不同程度受压。

Among the sampling methods used to investigate the pathogens responsible for rhinosinusitis, maxillary sinus puncture is considered to be the gold standard. Although endoscopic middle meatal culture seems to correlate well with the results obtained by maxillary sinus puncture, the reliability of documentation of bacteria by endoscopic culture in children with rhinosinusitis is still unknown. Finally, because studies on current bacterial resistance patterns in pediatric patients are limited, we employed maxillary sinus puncture to obtain sinus secretions for bacterial culture and analysis of antibiotic resistance in children with chronic rhinosinusitis.

关於鼻窦的培养方法，一般而言上颌窦穿刺为公认获得鼻窦细菌培养的准则，虽然证据显示在成人使用内视镜中鼻道培养的结果与上颌窦穿刺所获得的培养结果相关性很高，不过目前儿童使用内视镜中鼻道培养的可信度依然不明，因此我们的研究也比较鼻及鼻窦炎病童上颌窦穿刺与内视镜中鼻道培养的结果，以厘清在儿童使用内视镜中鼻道采样培养鼻窦致病菌的可信度。

The oculomotor nerve should be protected during the operation of incising superior wall of cavernous sinus.

切开海绵窦上壁分离窦腔时，应注意保护经上壁入窦的动眼神经。

Multiple anomlaies often lead to pansinusitis,of which maxi llary and ethmoid sinusitis were most frequently involved.

多种解剖变异并存时往往同时引起多窦腔炎症，受累最重的是上颌窦其次是筛窦。

A 2. 5～5. 5 MHz transducer was used according to the acoustic depth of the heart examined. Group B was used x-ray fluoroscopy (a Philip mono-rotatable C arm X-ray equipment) as image guide with routine method reported by american college of cardiology cardiovascular technology assessment committee. TTE guiding CSC in site: The guide wire was inserted into left subclavicular vein and inferior vena cava and it was displayed clearly by TTE. The sheath could be displayed clearly too by TTE. CSC was put through the sheath into right atrium in prone position and was thoroughly showed by TTE via untypical parasternal four-chamber view.

本研究对60例心内电生理检查患者，应用TTE作为影像学引导的可行性和临床应用的方法学进行了探讨，并对5只犬TEE引导射频导管消融术时大头电极导管到位的可行性进行了动物实验研究，具体为：(1)专用冠状窦电极导管置放时TTE引导的可行研究；(2)普通电极导管置放时TTE引导的可行研究；(3)专用冠状窦电极导管和普通冠状窦电极导管置放时TTE的对比研究：(4)TTE引导His束电极导管和右室电极导管到位的临床应用研究；(5)TTE在心内电生理检查中的应用研究；(6)TEE引导射频导管消融术大头电极导管到位的实验研究。

Later, under the untypical parasternal four-chamber view which can thoroughly display the ostium of coronary sinus, the catheter was promoted further to the ostium of coronary venous sinus. Then the echocardiography technician adjusted the transducer of TTE in order to thoroughly confirm the position of the catheter tip. After confirming the position of catheter tip in the coronary venous sinus, the operator inserted the catheter into the coronary venous sinus for 3～4 mm farther. It was noted that if resistance was encountered by operator, the operation must be stopped, which was the same as x-ray fluroscopy as image guiding. TTE guiding His bundle elactric cahteter、high right atrium electric cahteter and right ventricular electric catheter in site: It is difficult using TTE singly since there are too many crossroads in inferior venous.

本研究结果显示，(1)单独应用TTE作为影像学引导进行冠状窦电极导管置放的成功率为93.8％～96.7％，并且应用TTE作为影像学引导放置专用冠状窦电极导管和普通电极导管的成功率和放置时间在统计学上无显著差异；(2)TTE作为影像学引导，除过度肥胖患者外，可完全替代X线引导进行冠状窦电极导管置放，包括鞘管和扩张管的放置、指引导丝在静脉而非动脉内的证实均可由TTE完成引导，且较X线C型臂有一定优越性；(3)TTE结合普通X线胃肠透视机作为影像学导引，可顺利完成心内电生理检查时导管的安全到位，而不需昂贵的X线C型臂，可将心内电生理检查扩大到广大的基层医院；(4)TTE较X线更易和更早期发现介入治疗的并发症如急性心包填塞等，对并发症的防治甚至挽救病人的生命至为重要；(5)动物实验研究表明，TEE可引导射频导管消融术时大头电极导管成功到位。

They weren't aggressive, but I yelled and threw a rock in their direction to get them off the trail and away from me, just in case.

他们没有侵略性，但我大喊，并在他们的方向扔石头让他们过的线索，远离我，以防万一。

In slot 2 in your bag put wrapping paper, quantity does not matter in this case.

在你的书包里槽2把包装纸、数量无关紧要。