结扎速血管闭合切割系统在巨大神经纤维瘤手术中的应用效果

目的：探讨结扎速血管闭合切割系统(LigaSure vessel sealing system, LVSS)在巨大神经纤维瘤手术中的应用效果。方法：选取2013年10月至2020年5月行巨大神经纤维瘤手术的患者22例纳入本研究。传统手术组12例采用常规缝扎电凝止血手术方式,LigaSure组10例采用LigaSure血管闭合切割的手术方式,对比两组患者切除瘤体大小、手术时间、术中出血量、术后引流量、术后拔管时间及术后并发症情况。结果：两组间患者的一般资料具有可比性。LigaSure组术中出血量、术后引流量、术后拔管时间均较传统手术组显著降低(P＜0.05)。两组间切除瘤体大小、手术时间及术前术后血红蛋白差值无统计学差异。传统手术组出现1例术后皮下积液,予再次引流后伤口愈合良好。结论：LigaSure在手术治疗巨大神经纤维瘤方面的应用安全有效,能显著地减少出血量,简化手术操作,缩短术后恢复时间,值得在临床上进一步推广。     

外周神经鞘类肿瘤的超声诊断

目的 探讨神经鞘类肿瘤超声特点。方法 回顾85例病理证实的神经鞘类肿瘤资料。结果 良性神经鞘瘤61例，均单发．以低回声实质光团为主，亦可呈囊实性，边界清，多见包膜，血流较丰富。良性神经纤维瘤7例，4例多发，均实性，界清，多发者串珠状，血流不丰富。恶性神经纤维鞘膜瘤17例，单发，实性或囊实性，多回声不均。结论 神经鞘瘤类肿瘤声像图有一定特征，超声是首选的影像诊断方法。     

The tibial neuroma transposition (TNT) model of neuroma pain and hyperalgesia

Peripheral nerve injury may lead to the formation of a painful neuroma. In patients, palpating the tissue overlying a neuroma evokes paraesthesias/dysaesthesias in the distribution of the injured nerve. Previous animal models of neuropathic pain have focused on the mechanical hyperalgesia and allodynia that develops at a location distant from the site of injury and not on the pain from direct stimulation of the neuroma. We describe a new animal model of neuroma pain in which the neuroma was located in a position that is accessible to mechanical testing and outside of the innervation territory of the injured nerve. This allowed testing of pain in response to mechanical stimulation of the neuroma (which we call neuroma tenderness) independent of pain due to mechanical hyperalgesia. In the tibial neuroma transposition (TNT) model, the posterior tibial nerve was ligated and transected in the foot just proximal to the plantar bifurcation. Using a subcutaneous tunnel, the end of the ligated nerve was positioned just superior to the lateral malleolus. Mechanical stimulation of the neuroma produced a profound withdrawal behavior that could be distinguished from the hyperalgesia that developed on the hind paw. The neuroma tenderness (but not the hyperalgesia) was reversed by local lidocaine injection and by proximal transection of the tibial nerve. Afferents originating from the neuroma exhibited spontaneous activity and responses to mechanical stimulation of the neuroma. The TNT model provides a useful tool to investigate the differential mechanisms underlying the neuroma tenderness and mechanical hyperalgesia associated with neuropathic pain.     

眶部丛状神经纤维瘤的MRI表现

目的探讨眶部丛状神经纤维瘤(PNF)的MRI特点。方法回顾性分析79例85侧眶部PNF的MRI表现。79例均接受眼眶MR检查,其中71例接受增强MR扫描。结果眶部PNF均表现为侵袭性生长,增强后不均匀强化。位于眼睑及眶周表浅部位的病变呈弥漫性生长并穿透筋膜和肌层,与肌肉相比,76侧T1WI呈等信号,T2WI呈不均匀略高信号,9侧病变T1WI呈低信号,T2WI呈高信号;3侧可见靶征。眶腔和(或)颞下窝等深层部位病变呈多发边界清楚的小结节或束状病变,主要沿神经干生长并压迫周围结构,77侧T1WI呈等或略低信号,T2WI呈不均匀略高信号,7侧病变T1WI呈低信号,T2WI呈高信号;34侧可见靶征。结论眶部PNF多呈侵袭性生长,MRI可清晰显示PNF累及范围,眼眶表浅部及深部病变有着不同的形态及信号特点。     

1例神经纤维瘤贯通腹腔盆腔和臀部患者的围手术期护理

报告了 1 例神经纤维瘤贯通腹腔盆腔和臀部患者的围手术期护理对策。 术前对患者进行全面评估,多学科联合制订诊疗方案,做好心理护理,全肠道灌洗,完善术前准备。 术后密切监测病情,协助纠正休克,做好皮瓣观察及护理,积极预防和处理并发症,完善出院指导和随访。 术后 26 d ,患者康复出院。 随访半年,患者生活自理,对生活质量满意。     

Peripheral nerve tumors of the hand: Clinical features,diagnosis, and treatment

The majority of the tumors arising from the peripheral nerves of the hand are relatively benign. However, a tumor diagnosed as malignant peripheral nerve sheath tumor (MPNST) has destructive consequences. Clinical signs and symptoms are usually caused by direct and indirect effects of the tumor, such as nerve invasion or compression and infiltration of surrounding tissues. Definitive diagnosis is made by tumor biopsy. Complete surgical removal with maximum reservation of residual neurologic function is the most appropriate intervention for most symptomatic benign peripheral nerve tumors (PNTs) of the hand; however, MPNSTs require surgical resection with a sufficiently wide margin or even amputation to improve prognosis. In this article, we review the clinical presentation and radiographic features, summarize the evidence for an accurate diagnosis, and discuss the available treatment options for PNTs of the hand.     

MRI of pelvic neurofibromatosis

Pelvic neurofibromatosis is a rare disease and rarely involves the prostate. A 19-year-old male presented with irritative and obstructive voiding symptoms. Magnetic resonance imaging showed a large mass extending from the sacral promontory to the perirectal and perivesical spaces and to the proximal root of the penis. The mass also involved the prostate. The characteristics of the mass were highly suggestive for neurofibroma. Prostate biopsy showed neurofibroma, and the immunohistochemistry stain for S-100 protein was positive.