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Objective:To investigate the efficacy of minimally invasive puncture and drainage versus small bone window craniotomy in the treatment of hypertensive basal ganglia hemorrhage. Methods:Seventy-three patients with hypertensive basal ganglia hemorrhage who received treatment in Hequ County People's Hospital from April 2018 to December 2020 were included in this study. They were divided into a minimally invasive puncture and drainage group ( n = 38) and a small bone window craniotomy group ( n = 35) according to surgical methods. Clinical efficacy and postoperative complications were compared between the two groups. Results:At 3 months post-surgery, the National Institutes of Health Stroke Scale score in the minimally invasive puncture and drainage group was significantly lower than that in the small bone window craniotomy group [(3.58 ± 1.23) points vs. (6.87 ± 0.97) points, t = 12.62, P < 0.001]. Barthel index in the minimally invasive puncture and drainage group was significantly higher than that in the small bone window craniotomy group [(62.15 ± 6.78) points vs. (43.15 ± 7.15) points, t = 11.65, P < 0.001]. The total response rate in the minimally invasive puncture and drainage group was significantly higher than that in the small bone window craniotomy group [92.11% (35/38) vs. 74.3% (26/35), χ2 = 4.21, P < 0.05]. The incidence of complications in the minimally invasive puncture and drainage group was significantly lower than that in the small bone window craniotomy group [5.2% (2/38) vs. 25.7% (9/35), χ2 = 6.18, P < 0.05]. Conclusion:Minimally invasive puncture and drainage have better clinical efficacy and fewer postoperative complications in the treatment of hypertensive basal ganglia hemorrhage than small bone window craniotomy. Therefore, minimally invasive puncture and drainage for the treatment of hypertensive basal ganglia hemorrhage are worthy of clinical promotion.
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Objective@#To investigate the clinical characteristics and risk factors of congenital choledochal cysts (CCC).@*Methods@#This retrospective study recruited 52 cases who were antenatally diagnosed with CCC and underwent surgical treatment after birth in Guangdong Women and Children Hospital from January 2013 to August 2018, with complete clinical data. According to the enlargement of cysts during pregnancy, they were divided into two groups: progressive group (≥15 mm, 22) and stable group (<15 mm, 30). Antenatal and postpartum ultrasound and MRI features of the two groups were analyzed. Clinical manifestations and biochemical examination results before and after operation were compared between the two groups. Other data, including amylase level in cyst fluid during operation, cholangiography findings, liver biopsy results, and post-operation follow-up, were also analyzed. Chi-square test, t (t') test, and Pearson correlations tests were performed for data analysis.@*Results@#(1) The average age of the 52 patients at operation was 46(7-822) d. The cysts of all cases were first detected during 19-21 weeks of gestation. The maximum diameter of the cyst in the progressive group was larger than that in the stable group after 34 weeks of pregnancy [31-34 weeks: (31.1±8.4) vs (23.1±6.6) mm, t=3.911; >34 weeks: (36.1±6.8) vs (27.1±7.3) mm, t=4.557; pre-operation: (51.8±18.0) vs (34.0±15.6) mm, t=3.809; all P<0.01]. (2) In the progressive group, the cysts were irregular in shape and enlarged after birth. The common hepatic duct and intrahepatic bile duct were dilated and gradually distended after birth, while the distal end of the common bile duct was narrowed, thus to form a cone-like duct. Deposits could be seen inside the cysts after delivery. Irregular cysts were also presented in the stable group, and five of them had dilatation of common hepatic duct and intrahepatic bile duct after birth. However, no cone-like formation was seen, the distal end of the common bile duct was visible, and deposits in cysts were occasionally found. (3) Twenty-five patients underwent laparotomy, and seven of them showed increased amylase level in cyst fluid including four with 2-5 times above the upper limit of normal value (one in the progressive group and three in the stable group). The other three cases were all in the stable group and their amylase levels in cyst fluid were more than ten times of the upper limit. The level of direct bilirubin in the progressive group was higher than that in the stable group before the operation [18.40(2.50-113.30) vs 8.70(0.00-16.80) μmol/L, u=2.400, P<0.05]. (4) Among the 52 cases, patients with type Ⅰ, Ⅳ and Ⅴ cyst accounted for 71.1% (37/52), 26.9% (14/52) and 2.0% (1/52), respectively. All cases were followed up regularly six months to one year after the operation. Liver function and bilirubin became normal and the growth and development of the babies were similar to those of the same age. (5) Different degrees of liver fibrosis and inflammation were shown in 46(88.5%) cases and more severe in older babies among those who underwent surgery in the progressive group. The time at operation was not associated with the severity of liver fibrosis and inflammation in the stable group. Hepatic fibrosis and inflammation were more serious in the progressive group than in the stable group (fibrosis grading: χ2=14.260, P=0.006; inflammatory activity grading: χ2=9.904, P=0.019).@*Conclusions@#Larger diameter (≥30 mm) in the initial prenatal examination or a significant increase in cystic diameter (≥15 mm) during pregnancy are risk factors for early stenosis or occlusion in the distal end of common bile duct requiring close follow-up after birth. When jaundice or abnormal liver function occur and stool color becomes light, early surgical treatment (one to two months after birth, generally within three months) for CCC is recommended to rule out the anomalous union of the pancreaticobiliary duct and hepatic disorders, as well as the cystic biliary atresia.
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Objective To investigate the clinical characteristics and risk factors of congenital choledochal cysts (CCC).Methods This retrospective study recruited 52 cases who were antenatally diagnosed with CCC and underwent surgical treatment after birth in Guangdong Women and Children Hospital from January 2013 to August 2018,with complete clinical data.According to the enlargement of cysts during pregnancy,they were divided into two groups:progressive group (≥ 15 mm,22) and stable group (＜15 mm,30).Antenatal and postpartum ultrasound and MRI features of the two groups were analyzed.Clinical manifestations and biochemical examination results before and after operation were compared between the two groups.Other data,including amylase level in cyst fluid during operation,cholangiography findings,liver biopsy results,and post-operation follow-up,were also analyzed.Chi-square test,t (t1) test,and Pearson correlations tests were performed for data analysis.Results (1) The average age of the 52 patients at operation was 46(7-822) d.The cysts of all cases were first detected during 19-21 weeks of gestation.The maximum diameter of the cyst in the progressive group was larger than that in the stable group after 34 weeks of pregnancy [31-34 weeks:(31.1 ±8.4) vs (23.1 ± 6.6) mm,t=3.911;＞34 weeks:(36.1 ± 6.8) vs (27.1 ± 7.3) mm,t=4.557;pre-operation:(51.8± 18.0) vs (34.0± 15.6) mm,t=3.809;all P＜0.01].(2) In the progressive group,the cysts were irregular in shape and enlarged after birth.The common hepatic duct and intrahepatic bile duct were dilated and gradually distended after birth,while the distal end of the common bile duct was narrowed,thus to form a cone-like duct.Deposits could be seen inside the cysts after delivery.Irregular cysts were also presented in the stable group,and five of them had dilatation of common hepatic duct and intrahepatic bile duct after birth.However,no cone-like formation was seen,the distal end of the common bile duct was visible,and deposits in cysts were occasionally found.(3) Twenty-five patients underwent laparotomy,and seven of them showed increased amylase level in cyst fluid including four with 2-5 times above the upper limit of normal value (one in the progressive group and three in the stable group).The other three cases were all in the stable group and their amylase levels in cyst fluid were more than ten times of the upper limit.The level of direct bilirubin in the progressive group was higher than that in the stable group before the operation [18.40(2.50-113.30) vs 8.70(0.00-16.80) μmol/L,u=2.400,P＜0.05].(4) Among the 52 cases,patients with type Ⅰ,Ⅳ and Ⅴ cyst accounted for 71.1％ (37/52),26.9％ (14/52) and 2.0％ (1/52),respectively.All cases were followed up regularly six months to one year after the operation.Liver function and bilirubin became normal and the growth and development of the babies were similar to those of the same age.(5) Different degrees of liver fibrosis and inflammation were shown in 46(88.5％) cases and more severe in older babies among those who underwent surgery in the progressive group.The time at operation was not associated with the severity of liver fibrosis and inflammation in the stable group.Hepatic fibrosis and inflammation were more serious in the progressive group than in the stable group (fibrosis grading:x2=14.260,P=0.006;inflammatory activity grading:x2=9.904,P=0.019).Conclusions Larger diameter (≥ 30 mm) in the initial prenatal examination or a significant increase in cystic diameter (≥ 15 mm) during pregnancy are risk factors for early stenosis or occlusion in the distal end of common bile duct requiring close follow-up after birth.When jaundice or abnormal liver function occur and stool color becomes light,early surgical treatment (one to two months after birth,generally within three months) for CCC is recommended to rule out the anomalous union of the pancreaticobiliary duct and hepatic disorders,as well as the cystic biliary atresia.
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Objective To explore the diagnostic value of prenatal MRI in fetal Joubcrt syndrome and related disorders (JSRD).Methods Prenatal MRI data of 5 JSRD fetuses were analyzed retrospectively.The ratio of AP diameters of crown to root of molar tooth sign,the ratio of AP diameters of isthmus to interpeduncular fossa,and the ratio of the transverse to AP diameters of the roof of the fourth ventricle on the axial images of the midbrain were measured.Results Molar tooth signs were observed in 5 fetuses on the axial images of midbrain.The cerebellar vermis disappeared,and cleft sign was observed.Enlarged cisterna magna was observed in 3 fetuses.The ratios of AP diameters of crown to root were 0.58-0.90,of AP diameters of isthmus to interpeduncular fossa were 0.84-1.00,and of transverse to AP diameters of the fourth ventricle roof were 0.42-0.60.Conclusion Molar tooth sign and cleft sign were characteristic findings for JSRD on MRI,therefore being helpful to prenatal diagnosis of JSRD.
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Objective To compare prenatal ultrasonography and MRI in view of the accuracy in the diag-nosis of congenital cystic adenmatiod malformation(CAMM)of the lung. Methods From January 2014 to Octo-ber 2015,68 fetus who were examined with both prenatal ultrasonography and MRI and diagnosed as CAMM by pathological findings after operation or autopsy in our study. Taking the final pathological diagnosis of fetal CCAM genotyping as the gold standard,the accuracy of prenatal ultrasonography and MRI were compared in the diagnosis of CAMM of the lung.P<0.05 was considered as statistically significant. Results The alignment degree of prena-tal ultrasound in the diagnosis of CAMM was significantly larger than that of MRI examination to the pathological di-agnosis.Conclusion Prenatal ultrasound is an important method for diagnosing CCAM before pregnancy with high accuracy and affordability.
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Objective To discuss the diagnosis and early intervention treatment of fetal congenital broncho-genic cysts based on the cases reviewed. Methods The clinical features of 7 infants presenting bronchogenic cysts diagnosed antenatally from January 2013 to May 2014 in Guangdong Women and Children's Hospital and Health In-stitute were reviewed retrospectively. Pathology,the prenatal diagnosis and treatment of bronchogenic cysts experience were summarized combined with CT after birth and surgery. Results Based on the prenatal diagnosis of fetal and postnatal CT and surgical pathology,a total of 7 cases with congenital bronchial cysts were diagnosed. Of which 4 ca-ses were suggestive of congenital cystsic adenomatoid malformation by prenatal diagnosis,and the other 3 cases had fetal bronchial cysts by prenatal diagnosis,antenatal diagnosis was accurate in 42. 9%(3 / 7 cases). CT examinations were taken in 7 cases after birth,and the cyst excision was performed on them with surgery thoracic approach;the average age at surgery was(5. 3 ± 1. 7)months. Four cases had simple bronchial cystss,2 cases with congenital cystsic adenomatoid malformation,1 case with congenital pulmonary sequestration. The accuracy of CT diagnosis was 85. 7%(6 / 7 cases). All surgical treatment was effective. Conclusions Fetal bronchial cysts is always associated with the other presence of lung congenital malformations. Prenatal diagnosis of congenital bronchial cysts is difficult. Prenatal diagnosis is difficult to exclude congenital cystsic adenomatoid malformation. To avoid symptoms like oppres-sion,infection,prenatal diagnosis combined with CT examination after birth and early treatment are necessary and reliable clinically.