论文部分内容阅读
患者,女,23岁,南溪县罗龙新码头一组农民,因与人斗殴被对方用石块击伤枕部出现头痛3小时入院。人院后4小时出现意识模糊,尿失禁。立即行右侧脑血管(颈内动脉)造影检查。造影示右额叶前方占位影,考虑为“脑肿瘤”。在气管插管全麻下行右额颞顶大骨瓣开颅探查术,术中发现右额叶前方靠近中线部位一4×4 cm肉红色高出脑表面的肿块,周围脑组织水肿严重。予以肉眼切除肿块去骨瓣。病理组织送泸州医学院行病理检查,诊断为右额叶星形脑胶质细胞瘤Ⅲ级,随访半年后死亡。本例患者有确切外伤史,外伤并非肿瘤症状所致,不易首诊脑瘤,明确的诊断依赖有价值的辅助检查。有些脑血管意外和个别脑瘤患者,因头晕等症状跌伤,门诊常以外伤收住院,单靠病史查体作鉴别诊断是有困难的,尤其是对于没有实践经验的基层医院的非专科医生。本例既往无任何症状,但在跑动中被飞石击伤头枕部,属于加速损伤,着力点多半是受损最厉害的地方,然而X线摄片未发现颅骨骨折。临床表现最先为尿失禁,意识状态逐渐恶化,结合脑动脉造影检查结果,确定脑肿瘤诊断就有比较充分的依据。在没有
The patient, female, 23 years old, a group of peasants at Luo Long New Terminal in Nanxi County was hospitalized for 3 hours with headache caused by wounded people suffering from headache. 4 hours after hospitalization, confusion, urinary incontinence. Right right cerebral blood vessels (internal carotid artery) angiography. Angiography showed frontal right frontal occupying the shadow, considered as “brain tumor ”. In the endotracheal intubation general anesthesia the right frontotemporal large craniotomy exploration, intraoperative findings of right frontal lobe near the midline part of a 4 × 4 cm meat red above the brain surface of the mass of the brain tissue around the edema. The macroscopic removal of lumps to the bone flap. Pathology sent to Luzhou Medical College pathological examination, diagnosis of right frontal lobe astrocytoma grade Ⅲ, followed up for six months after the death. In this case, the patient had a definite history of trauma. The trauma was not caused by the symptoms of the tumor. It was not easy to diagnose the brain tumor. A definitive diagnosis depended on valuable auxiliary examinations. Some patients with cerebrovascular accident and some brain tumors, due to dizziness and other symptoms fall injury, often outpatient hospital admission, medical history alone for differential diagnosis is difficult, especially for non-practicing grassroots hospital non-specialists . This case in the past without any symptoms, but flying in the running head injury head injury, are accelerating injury, the focus is most likely to be the most damaged areas, however, X-ray film found no skull fracture. The first clinical manifestations of urinary incontinence, progressive deterioration of state of consciousness, combined with cerebral arteriography results to determine the diagnosis of brain tumors have a more adequate basis. In the absence of