2018年 · 第98卷第07期

Advances in science and technology have made neurosurgery more and more minimally invasive, and perioperative bleeding at the surgical site or non-surgical site caused by various reasons increases surgical trauma, reduces surgical treatment effect, impairs patient's postoperative recovery, and increases medical costs. The literature shows that perioperative hemorrhage can lead to increased intracranial pressure and cerebral edema, which can lead to cerebral hernia and central respiratory and circulatory failure, endangering the patient's life; Perioperative bleeding can extend hospital stay by an average of 9 days and increase medical costs by an average of $17,000^[1,2]。 Active prevention of perioperative hemorrhage can reduce surgical blood transfusion^[3]Shorten surgery and hospital stay^[4,5], reduce the risk of rebleeding and secondary surgery, significantly improve the clinical prognosis of patients, and improve the efficiency of the use of medical resources^[6]。

Perioperative hemorrhage in neurosurgery mainly refers to hemorrhage or rebleeding at the surgical site caused by various reasons. In severe cases, it can lead to increased intracranial pressure, cerebral edema, and even clinical crises such as central respiratory and circulatory failure and cerebral hernia, endangering the life of patients. The Neurosurgery Branch of Chinese Medical Association organized and compiled the Expert Consensus on Prevention and Treatment of Perioperative Bleeding in Neurosurgery in 2010, which has improved the prevention and treatment level of perioperative bleeding in neurosurgery in China to a certain extent. However, in recent years, there have been new developments in the clinical practice of neurosurgery. First of all, the disease spectrum of patients or their own conditions have changed. Many elderly people and patients with cardiovascular diseases are using anticoagulants for a long time. More attention should be paid to hemostasis during the perioperative period. Secondly, the development of new technologies has brought new problems, and many operations are faced with the problem of anticoagulation and hemostasis, which has caused great trouble to neurosurgeons; Third, new hemostatic materials are constantly emerging. From the earliest gelatin sponge and regenerated oxidized cellulose to the current fluid gelatin fibrin adhesive (also known as bio-protein glue), the hemostatic effect is getting better and better. Under the above background, in order to respond to the new situations and problems in recent years in time, the Neurosurgery Branch of Chinese Medical Association invited well-known experts from neurosurgery, hematology and anesthesiology in China to revise the 2010 edition of the Expert Consensus on Prevention and Treatment of Perioperative Bleeding in Neurosurgery, and then wrote the Expert Consensus on Prevention and Treatment of Perioperative Bleeding in Neurosurgery (2018) (hereinafter referred to as the Consensus), in order to guide neurosurgeons to rationally select techniques and hemostatic materials, effectively and standardizedly prevent and treat intraoperative and perioperative bleeding, and improve the surgical effect.

A 71-year-old female was admitted to the hospital due to "upper abdominal fullness, acid reflux for half a month, aggravated with vomiting for 3 days". Admission examination: urinary amylase: 621 U/L; Carcinoembryonic antigen: 10.20 μ g/L; Occult blood test (vomit): + + +. The patient underwent modified radical mastectomy for invasive ductal carcinoma of the right and left breast in 2006 and 2009, respectively, and routine chemotherapy after operation, and recovered well. Oral acoustic contrast medium ultrasonography (Figure 1): Diffuse thickening of the gastric wall, obvious gastric antrum, weakened peristalsis, accompanied by retention of gastric content, considering gastric malignant tumor. Gastroscopy (Figure 2): The stomach body, stomach corner and stomach wall are stiff, the stomach cavity is narrowed, it cannot expand after inflation, the mucosa is congested and edematous, and some of them are nodular. Consider leather stomach. Tissue biopsy (Figure 3): Chronic inflammation (active) of the mucosa (of the stomach body), Helicobacter pylori (HP)(－)。 Abdominal CT (Figure 4): Diffuse symmetrical thickening of the gastric wall, irregular shape, especially in the gastric antrum, stenosis of the gastric antrum cavity, obvious enhancement after enhancement, unclear mucosal line, clear surrounding fat space, swollen lymph nodes on the small curved side of the stomach, consider invasive gastric cancer or gastric lymphoma. Four days later, a gastroscopic biopsy was performed, but no tumor cells were found.

A 59-year-old male patient suffered from frequent urination and urgency with poor urination for more than 3 years. His symptoms worsened 3 months ago, and he developed urinary retention 2 weeks ago. He was placed with a catheter in the local hospital and came to our hospital on November 3, 2014 for further treatment. MRI findings on admission: prostate volume increased, anteroposterior diameter × left and right diameter × upper and lower diameter was 32 mm ×42 mm ×62 mm, the shape was irregular, the central gland partially protruded into the bladder and the boundary with the peripheral zone was poor, the bilateral peripheral zone was asymmetric, the right peripheral zone was smaller, the left peripheral zone was thicker, and its T₂Weighted image (T₂WI) Signal underuniformity (Figure 1,Figure 2,Figure 3), diffusion-weighted imaging (DWI) (b =1 000 s/m²No significant diffusion restriction was observed on) (Figure 4), no significant decrease was observed on the apparent dispersion coefficient (ADC) plot. There was no obvious abnormality in the morphological signals of bilateral seminal vesicles. The bladder wall is thickened, and multiple protrusions can be seen. Enhancement scan after intravenous injection of gadolinium diethylenetriamine pentaacetate (Gd-DTPA) showed heterogeneous enhancement in the central zone of the prostate, and mild enhancement in the peripheral zone in the delayed phase, which was lower than that in the central gland (Figure 5)。 Diagnosis: prostatic hyperplasia. During the operation, obvious hyperplasia of the middle lobe of the prostate was observed, which protruded into the bladder and occluded the urethral opening. The prostatic capsule was incised at 3 points and deducted by the finger cleft method. Pathological examination revealed spindle cell tumor, considering leiomyoma (Figure 6)。 immunohistochemistry (Figure 7,Figure 8,Figure 9): Desmin moiety (+), smooth muscle actin (SMA) (+), S-100 (-), Bcl-2 (-), CD34 (+), anaplastic lymphoma kinase (ALK) (-), Ki-67 (~5% +).

In the past two decades, image-guided microwave ablation technology has made great progress in clinical treatment of tumors. With the development of microwave ablation instruments and treatment options, microwave ablation technology has been applied in many medical institutions in China in the past decade to treat small liver cancer and even large liver cancer>5 cm and other solid tumors, and more than 530 hospitals have used this technology. Internationally, the countries that apply microwave ablation are mainly the United States, Italy, Germany and Japan. Multicenter studies of microwave ablation in the treatment of liver cancer have been reported at home and abroad, with the largest patient sample size and the most comprehensive survival and prognosis data reported in China. This article summarizes the application of microwave ablation in the treatment of many kinds of tumors, and reports it as follows.

Metabolic syndrome (MS) is a group of clinical syndromes with central obesity, hyperglycemia (diabetes or impaired glucose regulation), dyslipidemia and hypertension as its main characteristics, and insulin resistance as the common pathophysiological basis. With the development of society and economy, the change of living standard and lifestyle, the incidence of MS has obviously increased in recent years, and it has become one of the public health problems that seriously threaten human health. The pathogenesis of MS has not been fully elucidated. In recent years, it has been gradually discovered that besides genetic factors and lifestyle, intestinal flora plays an important role in the pathogenesis of MS.