胰腺囊性肿瘤15例分析

作者报告了该院３０年来经手术及病理证实的１５例胰腺囊性肿瘤，男５例，女１０例，其中囊腺瘤３例，囊腺瘤恶变３例，囊朱癌９例，肿瘤位于胰尾部８例，体尾部６例，胰头部１例。２例有肝转移，１例肿瘤浸润胃后壁，根治生切除１０例，单纯肿瘤切除、肿瘤切除加肝转移瘤局部切除、囊腺癌内外引流、肿瘤活检各１例。术后死亡１例。随访１２例，１０例效果满意，２例囊腺癌行内外引流者术后６、９个月死亡。文中讨论了胰腺囊性肿瘤的     

结,直肠癌术后孤立性肺转移

目的：探讨结、直肠癌术后肺孤立性转移瘤的影像表现，与原发肺癌的鉴别。材料与方法：３１年间１３例结、直肠癌术后肺孤立肿物，均经手术切除及病理证实。转移性腺癌１１例１３次，原发肺癌２例。结、直肠癌切除与肺转移瘤切除间隔时间为３￣９６个月，中位３３个月。均有正侧位胸片，病灶体层和ＣＴ各６例。结果：肿物直肠１．５￣８．５ｃｍ（中位３．４ｃｍ），类圆形３例，椭圆形８例１０个，浅分叶１０例；边缘光整８例１０个     

中药白芨作为栓塞剂运用于骨骼肿瘤的治疗

目的：评价中药白芨作为栓塞的对骨骼系统肿瘤治疗的临床疗效。材料与方法：６例患分别患有骨母细胞肉瘤，软骨母细胞肉瘤，纤维肉瘤并骨转移，肺癌耻骨转移，脊索瘤及纤维异常增殖症，行动脉选择性造影后病人知动脉注入白芨颗粒达到完全栓塞，再采用平片，血管造影及手术后病理分析评价疗效。结果：（１）３例恶性骨肿瘤栓塞后使原有剧疼症状明显减轻；（２）２例恶性骨肿瘤栓塞后１个月显示病灶内明显钙化；（３）５例手术后病理     

经皮肝门脉导管药盒系统植入术

目的：研究经皮肝门脉导管药盒系统（ＰＣＳ）植入术治疗少血性肝转移癌的可行性。材料与方法：对８例不能手术的肝转移瘤患者和２例原发性肝癌肝动脉化疗栓塞术后肝动脉闭塞的患者，行经皮肝穿门脉，沿导丝送入留置管，导管留置于肠系膜上静脉或脾静脉内，药盒植入右上腹壁皮下。术后定期用５－氟尿嘧啶、阿霉素、卡铂经药盒导管系统内滴注或推注化疗。结果：所有患者门脉ＰＣＳ植入术均成功，未见手术并发症。术后随访无门脉血栓形成，２例术后留置管移位脱入腹腔。术后定期行Ｂ超或ＣＴ复查，显示５例肝转移瘤明显缩小，２例无变化，２例肿瘤增大，１例术后１２个月死亡。结论：作者认为经皮肝穿门脉导管药盒系统植入术是可行的，其创伤小、安全、操作技术简单，为少血性肝转移癌及原发型肝癌经门脉内的化疗灌注提供了一种有效的途径。     

肺原发性癌肉瘤二例

肺原发性癌肉瘤二例周灌河，陈玉林原发性肺癌肉瘤少见。笔者介绍２例如下：例１女，６０岁。主诉咯血丝痰５个月。既往曾患子宫肌瘤，经手术切除。体检：一般情况好。痰涂片检查见癌细胞。胸片：示左下肺有一１０ｃｍ×１０ｃｍ块影，有分叶征，边缘清楚，无钙化及空洞（...     

原发性骨横纹肌肉瘤(附8例报告及29例文献分析)

目的：探讨原发性骨横纹肌肉瘤的临床与Ｘ线特点，材料与方法；对本组８例及文献中２９例共３７例临床和Ｘ线资料进行了分析。结果：３７例中男２８例，女９例，年龄９～６１岁，平均３７．４岁，病程２～１４个月，平均７．５个月，病变位于胫骨１３例，占３５．１％，股骨１０例，占２７％，肱骨５例，占１３．５％；胸椎２例，占５．４％，骶骨２例，占５．４％，颅骨２例，占５．４％，腓骨１例，占２．７％，腰椎１例，占２．７     

小儿原发性睾丸肿瘤诊治分析

目的 探讨小儿原发性睾丸肿瘤的诊治。方法 分析小儿原发性睾丸肿瘤32例，其中卵黄囊瘤16例，畸胎瘤10例，胚胎型横纹肌肉瘤4例，表皮样囊肿2例。所有病例均行手术治疗，术中行冰冻切片活检，良性者行保留睾丸手术；恶性者行根治性睾丸切除、腹股沟淋巴结清扫术。20例恶性肿瘤病人术后行系统化疗。结果 术中冰冻病理与术后病理结果完全一致。24例获得随访，除4例卵黄囊瘤病人术后1年内因广泛转移死亡外，其余病例均无瘤生存4个月至7年，平均73个月。结论 超声对小儿原发性睾丸肿瘤有诊断价值，列为常规检查。手术为首选的治疗，术中冰冻切片活检非常必要。睾丸良性肿瘤患儿行保留睾丸手术对其生理功能、美观及心理方面均有重要意义。对预后好的病例尽量减少化疗，对预后差的病例应加强化疗。     

全身骨扫描时不典型的一两个浓聚灶的特异诊断

众所周知，全身骨扫描对于发现骨病变有较高的灵敏度但特异性低。本研究的目的在于揭示全身骨扫描对一些没有明确转移现象而骨扫描有一两个不典型浓聚灶的恶性肿瘤病人的诊断价值。１９９３ 年 １０ 月至 １９９４ 年 ５ 月间 １ ２８６ 例肿瘤患者近期随访无转移迹象，其中 １７２ 例病人发现以下部位有一两个放射性浓聚灶：颈椎横突、胸骨柄、第 ５腰椎横突或骶椎横突、肩和肋软骨高达 ４ 个热点、单一肋骨和胸琐关节，１３５ 例病人通过至少６ 个月后的骨扫描和术后组织学诊断或尸检获得最终诊断，剩下的那些未进行特殊治疗而自愈的为良性病变。结果：１３５ 例病人中 ２３ 例有两个浓聚灶，１１２ 例只有一个。１３５ 例病人中原发肿瘤是乳腺癌的为４７例，黑色素瘤 ２２ 例，前列腺癌 １６ 例，支气管癌 １５例，肾癌７ 例，肉瘤６ 例， Ｅｗ ｉｎｇ′ｓ 肉瘤５ 例，淋巴瘤３例，其它肿瘤 １４ 例。大约 １２０ 例病人（８８９％ ）随访发现骨转移阴性，剩下的 １５ 例病人被证实有骨转移，包括 ４ 例乳腺癌，３ 例支气管癌，１ 例黑色素瘤，１例肾癌，１ 例肉瘤，５ 例其它肿瘤。所有的前列腺癌、淋巴瘤和 Ｅｗ ｉｎｇ′ｓ 肉瘤的病人都显示为骨转移阴性，但由于病例太少，统计学上无显著差异     

CO2激光配合药物治疗尖锐湿疣

资料：３０例中女性１６例,男性１４例;年龄１８～３５岁;病程３～８个月。方法：常规消毒后,用输出功率为３０Ｗ的ＣＯ２激光聚焦切除疣体及基底部（深度＜０３ｍｍ）。创面敷以法莫替丁粉（自制）,１天后换药一次。结果：术后３～５日愈合。１２例随访３个月,１...     

儿童颅内转移性肿瘤的CT特点

目的：分析儿童颅内转移性肿瘤的ＣＴ特点。材料和方法：１６例颅内转移的原发灶中颅外神经母细胞瘤６例、颅内生殖细胞瘤４例、髓母细胞瘤２例、白血病２例、淋巴瘤１例和脑干肿瘤１例。１５例中原发灶或／和转移灶经组织学证实，仅１例脑干肿瘤及其转移为ＣＴ诊断。原发肿瘤诊断年龄从２至１３岁，平均８．７岁，从原发肿瘤诊断至发现转移的间隔时间从０至４２个月，平均１３．１个月。结果：柔脑膜转移在１６例中有１０例，占６２．５％：脑实质转移８／１６，占５０％：硬膜外转移４／１６，占２５％。结论：ＣＴ对各种类型颅内转移的诊断是有价值的。与成人相比，儿童脑外转移（硬膜外转移和柔脑膜转移１４／１６，占８７．５％）明显多于脑内转移（８／１６，占５０％），脑内转移主要是由柔脑膜转移而不是血行转移发展而来。     

Diagnostic problems of abdominal desmoid tumors in various locations

BACKGROUND: Abdominal desmoid tumor is one of the forms of deep (musculoaponeurotic) fibromatosis. It occurs more often as a desmoid tumor in the abdominal wall, less often in various intra-abdominal locations. In this work, we performed retrospective study concerning diagnostic problems of this disease with the use of imaging techniques. METHOD: Four patients (three females and one male) were examined by postcontrast CT (computed tomography) and one of them also by MR (magnetic resonance). All findings were correlated with the operational findings and histologic examination. RESULTS: The findings were typical only in the case with the lesion located in the abdominal wall, three described cases of the intra-abdominal desmoid provided a broad range of differentially diagnostic possibilities (metastases, GIT tumors, lymphomas, etc.). In particular, the findings in infiltrative processes in intra-abdominal location and retroperitoneal involvement were less typical. Ultimately, the histological findings were decisive. CONCLUSION: The possibility of the occurrence of intra-abdominal desmoid tumor must be considered particularly in younger individuals with rapidly growing tumorous process, which does not immediately arise from the surrounding organs (digestive tract, internal genitalia, etc.), and is located in the abdominal wall or in the abdominal cavity.     

腹部神经源性肿瘤CT分析34例

目的：探讨腹部神经源性肿瘤的CT特征，提高CT诊断能力，方法：分析34例手术病理证实的腹部神经源性肿瘤，其中神经鞘瘤16例，神经纤维瘤12例，节细胞神经瘤及神经母细胞瘤6例，良性18例，恶性16例，扫描方法以肿瘤为中心行CT平扫，28例增强扫描，层厚10mm。结果：腹部神经源性肿瘤大部分位于腹膜后及腹膜后脏器（23／34）占67．65％，其余11例来源于腹腔脏器和腹壁，良性神经源性瘤大多表现为圆形，类圆形组织密度影，边缘光滑，密度均匀，节细胞神经瘤可见斑点状钙化，增强扫描肿瘤大多表现为中度均匀或不均匀强化，恶性肿瘤体积大，形态不规则，边缘欠光滑，密度不均匀，有的肿瘤中心液化坏死或相互融合或侵蚀周围组织，结论：腹部神经源性肿瘤如果与大神经干走行无关，定性诊断较困难，肿瘤大小和密度不是区分良恶性神经源性肿瘤的特性表现，肿瘤边缘不光滑，形态不规则，并对周围组织的侵蚀破坏才是诊断恶性神经源性肿瘤的特征。     

胸部孤立性转移瘤X线表现与临床特点

目的：探讨胸部转移瘤的x线特点，提高对胸部孤立性转移瘤的认识和诊断水平。方法：回顾性分析了近10年来我院经病理或临床观察证实的48例胸部孤立性转移瘤X线胸片，对其特点进行分析。结果：本组48例孤立性转移瘤中40例肿瘤X线表现为圆形、边缘光滑、密度均匀阴影。病变边缘呈浅分叶状4例，3例边缘有毛刺、分叶。48例中发现转移瘤最早者为查出原发肿瘤前2年，最迟者是原发肿瘤术后17年，4例在证实原发肿瘤的同时发现肺内病灶，其余均在半年至5年内不等。发生部位包括肺内44例，纵隔内1例，胸膜3例。结论：胸部孤立性转移瘤缺乏I临床症状，有时难与原发性肿瘤鉴别，其特点为病变多呈圆形、密度均匀、边缘光滑，右肺多于左肺，好发于肺外围。恶性肿瘤术后应常规定期胸部X线检查。     

甲状腺肿瘤的CT诊断

目的：笔者收集1989年来经我院手术诊治的甲状腺肿瘤137例，其中甲状腺癌120例，甲状腺瘤16例和甲状腺淋巴瘤1例，就其CT表现与鉴别作回顾性分析。材料和方法：本组甲状腺扫描层厚层距各5—8cm．其中平扫6例，平扫加增强扫描5例．余125例均为直接增强扫描。结果：甲状腺肿瘤CT表现无特征性，伴有囊性变时甲状腺癌可见瘤壁和瘤结节不均匀增强．壁厚薄不均；而腺瘤则瘤壁呈环状均匀增强，壁厚薄较均匀．57．5%甲状腺癌颈深下淋巴结转移，多为等高密度，尤以高密度为其特征．颈总动脉部位对鉴别肿瘤与伴结外浸润的淋巴结有意义．60．74％甲状腺肿瘤出现钙化。结论：CT为甲状腺肿瘤的诊断、分期和手术提供信息．     

外伤性小肠破裂8例延误诊治的原因分析

目的　分析外伤性小肠破裂误诊的原因 ,以吸取教训。方法　对延误诊治的 8例外伤性小肠破裂进行回顾性分析。结果　 5例治愈且无并发症 ,1例腹壁疝形成者腹壁感染延期愈合 ,2例死于ARDS。结论　早期诊断与及时手术是降低小肠破裂病人死亡率的关键。延误诊治者 ,大多是早期体征不明显或只注意其它损伤 ,忽略了腹部体征的观察。     

Frequency of metastatic tumors in the heart

INTRODUCTION: Secondary or metastatic tumors in the heart occur more frequently than primary ones, and, according to the published series, their frequency found in autopsic material ranges from 1.6% to 20.6%. Metastatic tumors in the heart are rarely clinically symptomatic, and, therefore, they are rarely diagnosed within the lifetime. They are mostly diagnosed at autopsy. The aim of this study was to analyze the frequency of metastatic tumors of the heart, their primary localization, as well as the localization of the metastases found in the autopsic material within the period 1972-2004. METHODS: During the autopsy of the patients died of metastatic tumors, we microscopically and macroscopically analyzed all the organs and tissues to determine the metastases of primary tumors in other organs, especially in the heart and pericardium. RESULTS: Within the period from 1972-2004, 11 403 autopsies were performed. In 2 928 (25.6%) out of 11 403 autopsies, the presence of malignant tumor was diagnosed, and in 79 (2.7%) of these cases, metastasis of the heart was found out. Only in 5 of the cases, the presence of metastasis in the heart was diagnosed during the lifetime. The most frequent metastases in the heart were caused by pulmonary carcinoma (18 cases), leukemia and malignant lymphoma (8 cases, each), then pancreatic and breast carcinoma, while the metastases of other carcinomas were rather rare. In 40 (60.76%) cases, the metastasis was localized in the myocardium, but more often in the left ventricle, in 24 (30.38%) cases in the pericardium, in 4 cases in the epicardium and in the 3 of them in the mitral and tricuspid valve. Only in one case of renal carcionoma, metastasis was found in the right atrium and it occurred by spreading (dissemination) through the lumen of the inferior vena cava. CONCLUSION: Metastatic tumors of the heart are rather rare, and rarely clinically symptomatic, and, thus, rarely diagnosed during life. The methods of choice for the diagnosis of the metastasis in the heart are echocardiography, computerized tomography, magnetic resonance imaging, cytological analysis of the pericardial effusion and biopsy. The treatment includes surgery, chemotherapy and radiotherapy.     

Accumulation of leucocytes labelled with technetium-99m hexamethylpropylene amine oxime in malignant abdominal tumours

A total of 343 leucocyte scans labelled with technetium-99m hexamethylpropylene amine oxime were reviewed that had been performed in 338 patients suspected of having abdominal infection or inflammation. There was uptake by malignant abdominal tumours in 10 cases (2.9%), which represents 62.5% of known malignancies at the time of the scintigram. Accumulation was seen in 8 patients with adenocarcinoma of the colon associated with a secondary infection in the tumour or pericolic inflammation. A large tumour that had spread beyond the bowel wall was related to a positive scintigram. Accumulation was also found twice in a malignant fibrous histiocytoma in which bleeding and an inflammatory reaction to necrosis were probably responsible for the uptake. The relevant treatment was delayed for 2 weeks-2 months in 4 patients with adenocarcinoma of the colon in whom the positive uptake was regarded as confirmation of the clinically suspected acute diverticulitis.Offprint requests to: E. Lantto     

尿路上皮移行细胞癌肺转移18例临床分析

目的 探讨尿路上皮移行细胞癌肺转移的临床特点及治疗方法.方法 收集整理天津医科大学第二医院2005年7月-2009年3月收治的18例尿路上皮移行细胞癌肺转移患者的I临床资料,并进行分析总结.结果 18例尿路上皮移行细胞癌的原发部位分别为肾盂(8例)、输尿管(6例)、膀胱(4例).双肺多发转移14例,X线胸片示双肺弥漫性大小不等结节致密影,CT检查见双肺满布大小不等结节状软组织影,均给予全身化疗,其中13例膀胱局部复发者行手术治疗;孤立肺转移4例,X线胸片示孤立性团块状结节致密影,CT示肺部近胸壁软组织影,行放射性粒子植入术及全身化疗,其中1例膀胱局部复发者行手术治疗.所有患者随访6～36个月,其中6～12个月死亡2例,12～24个月死亡14例,2例生存超过24个月.结论 尿路上皮移行细胞癌肺转移发生率较低,X线胸片及胸部CT检查是主要的诊断手段.对于弥散性肺转移者全身化疗是主要治疗手段,对于局限性肺转移者可选择放射性粒子植入术及全身化疗,膀胱局部复发者可给予局部手术治疗.