2017年 · 第97卷第11期

Vascular disease is an important disease that endangers human health. Cerebrovascular lesions represented by intracranial aneurysms and arteriovenous malformations have high mortality and disability rates. Since 1970s, with the development of microsurgery, the therapeutic effect of this kind of disease has been continuously improved. However, some cerebrovascular diseases, especially complex cerebrovascular diseases, are still not satisfactory in the traditional microsurgical treatment mode, which may cause serious complications. Therefore, its therapeutic indications and treatment options are still controversial. The emergence of Hybrid operating room provides a new treatment for cerebrovascular diseases. Compound surgery, also known as Hybrid operation, refers to a surgical method that combines interventional therapy with microsurgical therapy in a compound operating room. Compound surgery emphasizes complementary advantages of different techniques rather than simple superposition. In recent years, the construction of composite operating room and composite surgery have been carried out in some international and domestic neurosurgical centers, and good results have been achieved. Compound surgery is still in the primary exploration stage. This article will combine the experience of compound surgery carried out by the neurosurgery department of Beijing Tiantan Hospital and some domestic brother units, and review the application of compound surgery as follows, and look forward to the prospect of compound surgery technique.

neurovascular diseases mainly refer to diseases caused by brain or spinal cord vascular abnormalities, including stroke, intracranial aneurysm, cerebral arteriovenous malformation (AVM), dural arteriovenous fistula (DAVF), spinal cord vascular malformation, blood-rich nervous system tumors and a series of broad diseases. Taking neurovascular diseases as the main research object, vascular neurosurgery and neurointerventional surgery with surgery as the main intervention means were born and developed. However, there are bottlenecks in microsurgery alone or interventional surgery alone, and it is still difficult to obtain safe, minimally invasive and effective diagnosis and treatment of some complex neurovascular diseases. With the technical progress and clinical demand of vascular neurosurgery and interventional surgery, neurovascular composite surgery emerged as the times require. Combined surgery based on high-quality neuroimaging combined with microsurgical technique and endovascular therapy technique solves the main shortcomings of single surgical mode and improves the surgical efficacy of complex neurovascular diseases. The purpose of this consensus is to make constructive recommendations on the rational configuration of neurovascular composite operating rooms and the operating specifications of composite surgery.

A 27-year-old woman with dopa-responsive dystonia (DRD) for 15 years, 1 birth 0 pregnancy 37^＋3Zhou, was admitted to the hospital for delivery. Usually menstruation is regular, menarche is 12 years old, each menstruation is 5 days, and the menstrual cycle is 30 days. The last menstrual period was 21 July 2015, and the expected date was 28 April 2016. Fifteen years ago, due to poor exercise ability, general tremor, spinal rigidity, limited movement, difficulty walking, and mild morning and severe evening symptoms, I went to Tianjin Medical University General Hospital and was diagnosed with DRD. I was treated with Antan (trihexyphenidyl hydrochloride tablets) (2~3 tablets/d), and the symptoms could be completely relieved. Once underwent "right lower limb ankylolysis" due to restricted movement of right lower limb. Regularly take drugs during pregnancy, reduce the dose to 1 tablet/d, and self-complaint symptoms are worse than those during non-pregnancy. There were no other abnormalities during pregnancy, and Down's syndrome screening was low risk. Physical examination: General condition is OK, heart and lung are not abnormal. The mobility of spine and limbs is acceptable, the muscle strength of upper and lower limbs is normal, grade V, and the muscle tension of lower limbs is high. Dyskinesia of both lower limbs, clubfoot of right foot, knee tendon reflex and Achilles tendon reflex exist, and double Pap sign is not drawn out. Obstetric situation: uterine height 37 cm, abdominal circumference 87 cm, left occipital anterior position (LOA), articulation floating, no contractions, presence of fetal membranes, fetal heart rate 140 beats/min. After admission, after neurological consultation, it is recommended to continue taking trihexyphenidyl hydrochloride tablets 4 mg/d for symptomatic treatment. Due to the uncoordinated exertion of lower limbs in patients with DRD, the onset or aggravation of DRD may be induced during labor, resulting in limb spasm, insufficient labor, prolonged labor, postpartum bleeding, dyspnea during labor, respiratory and cardiac arrest, etc. Therefore, cesarean section under general anesthesia was performed to terminate the pregnancy. During the operation, amniotic fluid was clear, the volume was 400 ml, and a live female was delivered in LOA position, weighing 2 350 g. The Apgar score of the newborn was 9 (A1~9) and A5~10 in 1 min. The newborn was transferred to the neonatal department for treatment. He recovered well 4 days after surgery and was granted discharge.

Twin pregnancies are divided into monozygotic twins and dizygotic twins, and unlike bichorionic twins with two separate fetal placental circulatory systems, the two fetuses of monochorionic twins share a placenta. Monochorionic twins (MCDA) cause a series of complex twin complications due to placental share allocation and the presence of superficial anastomotic vessels, such as twin transfusion syndrome (TTTS), selective intrauterine growth restriction (sFGR), twin anemia-polycythemia sequence sign (TAPS), etc. sFGR is more common in MCDA, and its disease outcome and prognosis are diverse and complex, and there are many controversies in clinical management. This article reviews sFGR to provide reference for clinicians.

Dual antiplatelet therapy is standardized for patients with acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI)^[1]。 In the past 10 years, clopidogrel has been the most commonly used P2Y12 receptor antagonist in clinical practice, and the continuous advent of new antiplatelet drugs has provided a new choice for safer and more effective antiplatelet therapy. Prasugrel has been shown to be useful in clopidogrel-resistant patients treated with percutaneous coronary intervention^[2]。 The large PLATO study demonstrated that ticagrelor improves the prognosis and reduces the incidence of post-treatment platelet hyperreactivity (HTPR) in patients with acute coronary syndrome compared with clopidogrel, and has been recommended by guidelines as a first-line antiplatelet therapy in patients with ACS^[3]。 The choice of antiplatelet drugs in clinical work is influenced by numerous factors. In the process of early treatment, especially in the early emergency treatment of acute patients, it is not possible to obtain sufficient information in time to assess the ischemia and bleeding risk, socioeconomic status, etc. of patients, and to obtain more information to assess patients in subsequent treatment, and at the same time, combining the respective characteristics of antiplatelet drugs, thereby promoting the mutual conversion between antiplatelet drugs. Whether this increases the potential risk of hemorrhage or ischemia in the process of mutual conversion and how to develop the best conversion protocol deserves further research.