肝脏血管内皮肉瘤的临床诊治及预后分析

目的探讨成人肝脏血管内皮肉瘤的临床特点、诊断依据及治疗方法。方法回顾性分析16例成人肝脏血管内皮肉瘤的临床资料。结果16例患者中,10例表现为肝区疼痛不适,3例自觉腹部巨大肿物;AFP、CEA、CA19—9检测均无明显异常,大部分病例有血清GGT、ALP、γ-GT升高,但无特异性;B超、CT、MRI均提示肝脏占位性病变;均行探查术并经病理证实;均获随访。12例切除肿瘤者中位生存时间为33个月;至2009年12月31日存活4例;1例行肝移植治疗,己生存5个月;3例未能切除肿瘤者,行介入治疗,生存时间为5～8个月。结论成人肝脏血管内皮肉瘤无明确病史及基础疾病,血清学检查无特异性．可通过影像学方法检查早期发现,确诊最终依赖于病理结果,目前手术切除治疗是最为有效的治疗方法,肝脏移植也值得关注。     

原发性眼眶肿瘤诊治策略分析

目的 探讨眼眶肿瘤的临床表现、影像学特点、病理分类、治疗方法.方法 回顾性分析26例眼眶肿瘤患者的临床资料和诊疗过程.结果 男16例,女10例.年龄15 ～ 72岁,平均46岁.住院时间9～21d,平均13d.26例均行手术治疗.术后病理组织学报告：海绵状血管瘤11例,炎性假瘤5例,眶内皮样囊肿3例,静脉性血管瘤2例,泪腺腺样囊性癌4例,横纹肌肉瘤1例.26例术后视力提高者9例,视力不变者11例,视力下降者6例,无视力意外丧失者.术后失访2例.24例术后随访18～48个月,平均25个月.4例恶性肿瘤患者术后6～ 20个月复发,均行眶内容物摘除术.术后随访临床表现及影像学检查均无肿瘤复发.结论 眼眶空间狭小,结构复杂,手术操作异常困难.结合临床表现、影像学检查和病理检查为患者选择个体化的治疗、随访方案尤为重要.     

乳腺肉瘤诊断治疗体会(附10例报告)

目的探讨乳腺肉瘤的诊断治疗。方法分析本院1998~2002年收治10例乳腺肉瘤的诊治资料。结果3/6叶状囊肉瘤术中冰冻病理为良性,术后石蜡病理确诊;原发性恶性淋巴瘤、血管内皮瘤、肉瘤样癌等3例,术中冰冻病理仅考虑为恶性,术后石蜡病理确诊。本组4例行单纯乳房切除,6例行改良根治术,均未发现腋窝淋巴结有肿瘤转移。随访8例1~7年,均无肿瘤复发。结论⑴乳腺肉瘤误诊率比较高,冰冻病理与石蜡病理有一定的差异。⑵乳腺肉瘤诊断明确,行乳房单纯切除即可。     

胰十二指肠联合门静脉切除治疗胰头癌

目的探讨胰头癌侵犯门静脉联合血管重建的适应证和方法。方法对2001年5月~2004年12月收治的8例肿瘤侵犯门静脉的胰头癌患者,行胰头十二指肠联合门静脉切除及门静脉对端吻合血管重建的手术资料进行回顾性分析。全组均行联合肠系膜上静脉-门静脉切除,门静脉阻断时间为22~35min;同时清扫腹膜后重要血管周围的淋巴组织。结果手术后8例患者均顺利恢复,无胆、胰瘘、感染及出血、血栓发生。病理检查切除肿瘤均为腺癌。切除血管内膜和胰腺边缘均无肿瘤浸润。随访时间6个月~4年,2例患者死于术后6~12个月。存活超过2年者4例。结论在门静脉-肠系膜上静脉侵犯小于3cm的选择性病例中施行联合切除血管的胰头癌根治术可提高其切除率,患者存活率有一定程度提高。     

成人原发性肾脏肉瘤11例临床分析

目的 探讨成人原发性肾脏肉瘤的临床表现、病理学特点、影像学表现及预后影响因素.方法 收集浙江省肿瘤医院自1987年1月至2012年6月收治的11例成人原发性肾脏肉瘤患者的临床资料,进行回顾性分析.结果 11例患者中,8例以腹部肿块为首发症状.所有患者均接受手术治疗,8例患者行根治性肾切除术,2例患者行肾切除术,1例患者行探查术.术后5例患者接受辅助性放疗,1例患者接受术后姑息性化疗,3例接受术后免疫制剂治疗.其中完整切除肿瘤的患者术后平均生存期为59个月,而未完整切除肿瘤的患者术后平均生存期为9个月.结论 成人原发性肾脏肉瘤的最常见临床症状为腹部肿块.手术是肾脏肉瘤的最重要的治疗方法,病理类型和术后有无肿瘤残留是决定预后的重要因素.     

急性心肌梗死急诊介入治疗中替罗非班冠状动脉内注入对疗效的影响

目的探讨胰头癌侵犯门静脉联合血管重建的适应证和方法。方法对2001年5月-2004年12月收治的8例肿瘤侵犯门静脉的胰头癌患者，行胰头十二指肠联合门静脉切除及门静脉对端吻合血管重建的手术资料进行回顾性分析。全组均行联合肠系膜上静脉-门静脉切除，门静脉阻断时间为22～35min；同时清扫腹膜后重要血管周围的淋巴组织。结果手术后8例患者均顺利恢复。无胆、胰瘘、感染及出血、血栓发生。病理检查：切除肿瘤均为腺癌。切除血管内膜和胰腺边缘均无肿瘤浸润。随访时间6个月-4年，2例患者死于术后6～12个月。存活超过2年者4例。结论在门静脉-肠系膜上静脉侵犯小于3cm的选择性病例中施行联合切除血管的胰头癌根治术可提高其切除率，患者存活率有一定程度提高。     

直肠间质瘤临床诊治分析

目的?探讨直肠间质瘤的外科诊断及治疗.方法?回顾性分析我院收治的13例直肠间质瘤患者临床资料.结果?13例均行手术治疗,均经病理及免疫组化证实为直肠间质瘤.行肿瘤完整切除10例,不完整切除2例,探查1例,2例于术后12~28个月局部复发再次行手术切除.随访1~5年,行肿瘤完整切除无死亡.结论?直肠间质瘤在临床上较少见,临床表现一般无特异性,影像学检查可作出初步诊断,病理及免疫组化可确诊,临床治疗以外科手术切除为主,术中尽可能完整切除肿瘤,可提高治疗效果,对患者的预后具有重要意义.     

脾脏原发性恶性肿瘤的诊断和治疗

目的 探讨脾脏原发性恶性肿瘤的诊断和治疗措施.方法 回顾性分析1995-2007年收治的11例脾脏原发性恶性肿瘤患者的临床资料.11例患者行超声、CT检查,诊断率为100%,11例均行脾脏切除术,其中3例行联合脏器切除术,术后病理10例为恶性B细胞淋巴瘤,1例为血管肉瘤.结果 术后随访8例,3例失访,恶性B细胞淋巴瘤患者最短生存期为16个月,死亡原因为肿瘤复发,4例生存期超过5年,血管肉瘤患者生存1年,死于复发转移.结论 脾脏原发性恶性肿瘤的诊断以CT为主,治疗方法采用以外科手术为主的综合治疗.     

肝脏炎性假瘤23例诊治分析

目的 探讨肝脏炎性假瘤的诊断和治疗.方法 回顾性分析1994年5月至2007年6月收治的23例肝脏炎性假瘤患者的临床资料.肝脏炎性假瘤患者以右上腹部不适、发热为主要症状,术前检查7例(30.4%)WBC计数升高,9例(39.1%)转氨酶升高,2例(8.7%)糖链抗原(CA)19-9升高;无甲胎蛋白(AFP)升高病例,HBsAg阳性5例.超声检查多表现为偏低回声,内部多无血流信号.CT、MRI增强扫描后多表现为周边强化或中央分隔状、小结节状强化.DSA检查未发现肿瘤染色征象.行肝左外叶切除2例,肝局部切除6例,肝段切除2例,射频消融术1例,微波固化治疗1例,肝动脉化疗栓塞1例,局部切除+结肠癌根治术1例,肝左外叶切除+胰腺穿刺活检+胆肠吻合+胰管空肠吻合1例,8例未行手术治疗.结果 手术患者或介入治疗患者均恢复顺利,无并发症发生,术后按期出院.随访3个月至11年,3例患者分别于术后13个月、第2次术后11个月、化疗栓塞治疗后8个月死于恶性肿瘤,其余患者均健康存活.结论 肝脏炎性假瘤无特异性临床表现,CT、MRI增强扫描后的影像学特征,对其诊断有所帮助;诊断明确者可密切观察,诊断不明确或不能排除恶性肿瘤者建议手术治疗,术后患者应密切随访观察.     

原发性腹膜后脂肪肉瘤的诊断及外科治疗(附19例分析)

目的 探讨原发性腹膜后脂肪肉瘤的诊断及外科治疗方法.方法 对1990年1月～2006年10月收治的19例原发性腹膜后脂肪肉瘤患者,就其临床表现、辅助检查及外科治疗进行回顾性分析.结果 17例患者行手术治疗,其中11例行肿瘤完全切除术,肿瘤完全切除率为64.7%,8例复发,复发时间为5.0～93.0个月,再手术7例,3例完全切除;6例行肿瘤部分切除术,全部复发,复发时间为1.5～11.0个月,2例发生远处转移.结论 影像学检查尤其是B超及CT是诊断本病的主要手段,手术完全切除肿瘤(包括联合脏器切除)是治疗的主要方法,对复发肿瘤亦应争取再次手术.     

Evolution of thorotrast-induced hepatic angiosarcomas

A histological review of 25 cases of thorotrast-induced angiosarcoma revealed characteristic antecedent or precursor changes which are similar to previously described changes present in hepatic angiosarcoma secondary to vinyl chloride, arsenicals, or of unknown etiology. The antecedent or precursor change consists of areas with simultaneous activation of both the hepatocytes and sinusoidal cells and associated lesions in the sinusoidal and perisinusoidal spaces. The hepatic cell plates surrounding these areas are compressed with subsequent development of fibrous septa at the interface between the areas of mixed hyperplasia and the areas of compression. In these multiple areas multicentric angiosarcomas develop in close approximation to the portal tracts but not to the thorotrast deposits.     

Screening for liver disease in vinyl chloride workers.

Following the occurrence of hepatic fibrosis and angiosarcoma in polyvinyl chloride autoclave workers, a screening programme was set up for workers at risk in a large production plant. There was no significant difference in liver function tests between workers and a control group of men in the same factory, not exposed to vinyl chloride. Four exposed workers out of 422 were found to have enlarged spleens compared with none out of 202 controls. Liver biopsies from selected cases showed no significant pathological changes, although there was minimal increase in portal tract and sinusoidal fibrosis in exposed workers.     

Angiosarcoma of the liver in Great Britain in proximity to vinyl chloride sites.

OBJECTIVES: To study the incidence of angiosarcoma of the liver in England and Wales 1979-86 and Scotland 1975-87. To investigate whether any non-occupational neighbourhood cases occurred near a vinyl chloride site. METHODS: This is a geographical study of incident cases among the general population of Great Britain. Diagnosis of angiosarcoma of the liver was based mainly on the national cancer registry, the world register of cases among vinyl chloride workers, and the register of cases (including histological review) maintained by the Health and Safety Executive. Proximity (< 10 km) of residence to a vinyl chloride site was based on postcode of address at the time of diagnosis. RESULTS: 55 cases were ascribed to angiosarcoma of the liver in England and Wales with a further six cases in Scotland (annual incidence in Great Britain from all sources of around 1.4 cases per 10 million population). There were two cases with documented exposure to Thorotrast, and 10 cases among vinyl chloride workers. There were no vinyl chloride sites in Scotland. Among the 25 cases in England and Wales with histological diagnosis after review by a panel of pathologists, only 15 were confirmed as angiosarcoma, and one of the two Scottish cases after histological review was also confirmed. Overall, 11 cases ascribed to angiosarcoma were resident within 10 km of a vinyl chloride site; nine were vinyl chloride workers, one further case on histological review was not considered to have been correctly diagnosed as angiosarcoma, and the remaining case, confirmed as angiosarcoma, was employed at a vinyl chloride factory during the late 1950s, although not as a vinyl chloride worker. CONCLUSION: The incidence of angiosarcoma of the liver in Great Britain remains extremely rare. The one confirmed case in a non-vinyl chloride worker within 10 km of a site must nevertheless be presumed to have been exposed to vinyl chloride in the workplace. In the period of study, there were no confirmed non-occupationally exposed cases of angiosarcoma among residents living near a vinyl chloride site in Great Britain.     

Eidemiology of thorotrast-induced hepatic angiosarcoma in the United States

An epidemiologic investigation of hepatic angiosarcoma (HAS) in the United States, directed primarily at the years 1964–1974, has identified 26 cases of Thorotrast-induced HAS. This study indicates that the occurrence of Thorotrast-induced HAS was still increasing in the early 1970s and that a larger proportion of the more recent cases had relatively low-dose Thorotrast procedures and a prolonged latent period. A number of cases were identified who had a history of preexisting liver disease, associated vascular malformations, or exposure to arsenic or iron; the possible role of such additional risk factors is uncertain.     

Acute sporadic non-A, non-B hepatitis in India

A total of 293 sporadic cases of acute viral hepatitis were identified in Kashmir, India, from April 1979 to December 1981; 44 (15%) were found serologically to be hepatitis A, 94 (32%) hepatitis B, and 155 (53%) non-A, non-B type. The non-A, non-B hepatitis observed was a disease of young adults (29.8 +/- 15 years) with slight male predominance (1.4:1). Six of the 155 non-A, non-B cases had history of prior parenteral exposure, while 51 (33%) had a recent contact with another case of jaundice, suggesting that this form of hepatitis was spread by person-to-person contact. Fulminant hepatic failure occurred in 19 cases, and six (31.5%) of the 19 cases occurred in pregnant women. None of 90 non-A, non-B cases followed up six months later had developed chronic hepatitis. The acute sporadic non-A, non-B hepatitis described in Kashmir resembles epidemic non-A, non-B hepatitis epidemiologically and seems to be distinct from the non-A, non-B hepatitis described in the West.     

超声造影在射频消融治疗肝转移癌疗效评估的价值

目的探讨超声造影(contrast-enhanced ultrasound,CEUS)评价射频消融(radiofrequency ablation,RFA)治疗肝脏转移瘤疗效的临床应用价值。方法将31例肝转移瘤病例(共51个病灶)分别行射频消融治疗及超声造影检查;射频消融术前造影观察病灶并制定治疗策略,术后分析病灶造影增强的变化以判断消融效果;病例随访时间为2～22月,术后30min及术后三个月内每月一次、术后3个月后每3个月一次CEUS及增强CT/MRI对照。结果术前超声造影较常规超声多发现病灶8个;治疗后30min46个(46/51,90.2%)病灶动脉期呈无增强区域,5个病灶(5/51,9.8%)动脉期见异常增强信号,即刻行射频消融治疗;随访中4个病灶(4/51,7.8%)见复发。结论超声造影能优化RFA治疗肝脏转移瘤的各个步骤,减少病灶复发,有良好的临床应用前景。     

Hepatic mesenchymal hamartoma in adulthood: a case report with literature review

Mesenchymal hamartoma is a rare and benign tumor.. Representing 5 to 8 % of children's hepatic tumors, it is rarely described in adults. Authors report a new case of hepatic mesenchymal hamartoma in a 21-year-old woman, diagnosed after a sudden onser of clinical and biological cholestasis. Abdominal US and CTscan exminations showed a medial liver tumor with cystic formations suggestive of a hydatid cyst. The diagnosis of hepatic mesenchymal hamartoma was based onn hitology of the resected liver specimen. Radiological findings can suggest the diagnosis but only histology can confirm it. Treatment is surgical involving in most of the cases; a wide hepatic resection because of the size of the tumor. Progosis is excellent when complete exeresis is possible.     

空心加压螺钉治疗青壮年股骨颈骨折32例疗效分析

目的探讨空心加压螺钉治疗青壮年股骨颈骨折的疗效。方法对32例青壮年股骨颈骨折患者采用3枚双重加压中空螺钉固定。结果32例伤口均一期愈合。随访6月～2年,平均1年2个月。下地负重时间4～6个月,骨折愈合时间4～6个月。术后Harrris评分优11例,良16例,差5例。发生并发症6例,其中骨折不愈合3例,股骨头坏死3例。结论双重中空加压螺钉治疗青壮年股骨颈骨折具有固定确切、费用低、操作简单、损伤小、骨折愈合效果好、便于早期发现股骨头坏死以便早期治疗等优点,是较理想的方法。     

空心加压螺钉治疗青壮年股骨颈骨折32例疗效分析

目的探讨空心加压螺钉治疗青壮年股骨颈骨折的疗效。方法对32例青壮年股骨颈骨折患者采用3枚双重加压中空螺钉固定。结果32例伤口均一期愈合。随访6月～2年,平均1年2个月。下地负重时间4～6个月,骨折愈合时间4～6个月。术后Harms评分优11例,良16例,差5例。发生并发症6例,其中骨折不愈合3例,股骨头坏死3例。结论双重中空加压螺钉治疗青壮年股骨颈骨折具有固定确切、费用低、操作简单、损伤小、骨折愈合效果好、便于早期发现股骨头坏死以便早期治疗等优点,是较理想的方法。     

Incidence of cancer among vinyl chloride and polyvinyl chloride workers.

The results of a follow up study of the incidence of cancer and the mortality in a cohort of 454 male workers producing vinyl chloride and polyvinyl chloride are presented. The study population was restricted to employees with more than one year's work experience in the study plant between 1950 and 1969 and the cohort was followed up from 1953 to the end of 1979. Twenty three new cases of cancer were observed compared with 20.2 expected; one case of liver angiosarcoma was found. Five cases of lung cancer were found (2.8 expected) and four cases of malignant melanoma of the skin were observed (0.8 expected). The possibility of a causal relationship between exposure to vinyl chloride and the development of malignant melanomas is discussed.