【摘要】 目的 探討高血壓基底節出血的顯微外科治療技巧、效果和預后。 方法 回顧分析2007年3月-2009年10月52例高血壓所致基底節出血患者的臨床表現、影像學資料、手術方式、治療效果及隨訪資料。 結果 52例患者均于顯微鏡下清除血腫，無手術死亡。39例患者術后神經功能障礙得到改善，8例癥狀加重持續昏迷，5例術后1周死亡。術后隨訪6~18個月，35例生活基本能夠自理[日常生活能力量表（ADL）Ⅰ~Ⅲ級]，12例長期臥床（ADL Ⅳ級）。 結論 采用顯微外科技術治療高血壓基底節出血效果良好。【Abstract】 Objective To investigate the technique, effectiveness, and prognosis of microsurgical treatment of hypertensive basal ganglia hemorrhage. Methods A retrospective study was carried out on 52 patients with hypertensive basal ganglia hemorrhage from March 2007 to October 2009. The clinical presentation, neuroradiological data, surgical approach, therapeutic efficacy and follow-up data were reviewed. Results All of the hematoma were removed under microscope without surgery-related death. After operation, the functional disorders of nervous system were improved in 39 patients. Eight patients deteriorated with persistent coma after operation, five patients died. The survivors were followed-up for six to 18 months. Thirty-five patients were able to self-care with some efforts (ADL Ⅰ-Ⅲ), and 12 patients had hemiparalysis or coma (ADL Ⅳ). Conclusion Microsurgery is an effective treatment for hypertensive basal ganglia hemorrhage with microsurgical technique.
目的研究SiewertⅡ型食管胃結合部腺癌（adenocarcinoma of the esophagogastric junction，AEG）患者淋巴結轉移規律及其合理的手術方式。
方法回顧性分析2007年1月至2010年2月四川大學華西醫院胸外科和胃腸外科收治的162例SiewertⅡ型AEG患者的臨床資料。將患者分為3組：其中經左胸組96例，經上腹組46例，經Ivor Lewis組20例，分析患者的臨床病理資料及淋巴結清掃轉移情況。
結果共120例有淋巴結轉移，轉移率為74.1%，單純胸腔淋巴結轉移2例（1.7%），單純腹腔轉移98例（81.7%），胸腹均有轉移20例（16.6%）。清掃淋巴結共2 898枚，平均清掃17.9枚/例，陽性淋巴結661枚，轉移率為22.8%。經胸（左胸組或Ivor-Lewis組）清掃下縱隔淋巴結要優于經上腹術式。對于腹腔淋巴結，經腹清掃（上腹組或Ivor-Lewis組）要明顯優于經左胸手術組。三組下縱隔淋巴結以及腹腔淋巴結轉移率差異均無統計學意義。
結論SiewertⅡ型AEG轉移以腹腔轉移為主，但不能忽視胸腔淋巴結的清掃，對食管旁淋巴結、膈上淋巴結等轉移率較高的淋巴結應重點予以清掃。在手術入路選擇上，對SiewertⅡ型AEG采用Ivor-Lewis能更徹底清掃胸腔及腹腔淋巴結。
