2种硬化剂在单纯性肝肾囊肿硬化治疗中的对比研究

目的:对超声引导下单纯性肝肾囊肿穿刺注射新型硬化剂和无水乙醇治疗的疗效进行对比研究。方法:对32例患者36个肝肾囊肿(18例肝囊肿,14例18个肾囊肿)经超声引导抽净囊液后,注入适量新型硬化剂1%聚桂醇注射液(国药准字H20080445),并留置囊内,观察治疗过程中发生的不良反应、患者耐受程度,6月跟踪统计有效率;并与我院采用传统无水乙醇硬化剂治疗的肝肾囊肿统计数据进行对比。结果:32例36个囊肿均一次穿刺成功,按1/10～1/4的比例注入新型硬化剂并保留囊内,患者耐受性良好,无刺激性疼痛和醉酒症状,治疗后1周内,9例患者诉侧腹轻微胀痛,间断低热2 d,未经特殊处理自行消失,无严重不良反应。6月复查33例全部消失,3个囊肿缩小2/3以上,有效率达100%,长期疗效仍在跟踪中。采用传统无水乙醇作为硬化剂注射治疗肝肾囊肿20例(12例肝囊肿,8例肾囊肿),抽净囊液后,按1/4～1/3比例注入无水乙醇,注射时均有短暂刺激性疼痛,18例出现面红、心跳加快、口干、恶心呕吐等醉酒症状。6月复查15例完全消失,5例缩小2/3以上。结论:新型硬化剂聚桂醇治疗肝。肾囊肿疗效与传统无水乙醇硬化治疗一致,但它留置体内,无刺激性剧痛,无醉酒症状,操作简单,不良反应少,患者耐受性好,优于无水乙醇,有望在肝肾囊肿的硬化治疗中成为无水乙醇的替代物。     

中药外敷和TDP照射结合治疗在卵巢囊肿中的应用

目的：观察中药外敷和TDP照射结合治疗卵巢囊肿的临床疗效。方法：将80例卵巢囊肿患者,随机分为治疗组和对照组,治疗组给予中药冰黛散外敷和TDP照射结合治疗,对照组给予安慰剂外敷和TDP照射结合治疗,观察两组临床疗效。结果：治疗组总有效率95%,对照组总有效率30%,有显著差异（P〈0.01）。结论：中药外敷和TDP照射结合治疗卵巢囊肿临床疗效好,值得临床推广应用。     

Cystic dysplasia of the rete testis

Cystic dysplasia of the rete testis is a rare benign testicular tumor that is found mainly in the pediatric population and that must be distinguished from malignant lesions. Ultrasonography can aid in diagnosis and in evaluation for associated renal lesions. Treatment options include orchiectomy, testicular-sparing excision of the cystic mass, and nonoperative surveillance. To increase awareness of the disorder, we present the case of a 2-month-old male infant with cystic dysplasia of the rete testis.     

New classification of midline cysts of the prostate in adults via a transrectal ultrasonography-guided opacification and dye-injection study

OBJECTIVES

To reclassify midline cysts (MLCs) of the prostate according using the results from transrectal ultrasonography (TRUS)‐guided opacification and dye injection.

PATIENTS AND METHODS

Eighty‐six patients (mean age 60.9 years) who had MLCs detected in the pelvis by TRUS were investigated. In all patients the size of the MLC was measured and they had transperineal aspiration under TRUS guidance. After aspiration of the MLC a mixture of water‐soluble contrast medium and indigo carmine dye was injected to check for communication with the urethra or seminal tract by endoscopic and pelvic X‐ray examination.

RESULTS

We classified MLCs into four categories: (i) type 1 (nine cases), MLC with no communication into the urethra (traditional prostatic utricle cyst); (ii) type 2a (60 cases), MLC with communication into the urethra (cystic dilatation of the prostatic utricle, CDU); (iii) type 2b (14 cases), CDU which communicated with the seminal tract; (iv) type 3 (three cases), cystic dilation of the ejaculatory duct. The location, shape and volume of the MLC, and the prostate‐specific antigen level of MLC fluid, did not influence the classification.

CONCLUSIONS

The most common type of MLC was CDU. A new classification that depends on the communication with the urethra or seminal tract is proposed.     

Nerve root prolapse into a spinal arachnoid cyst—An unusual cause of radiculopathy

Arachnoid cysts are rare lesions of the spine and can present with myelopathy, radiculopathy, local pain or a combination of these symptoms. Nerve root prolapse into an arachnoid cyst causing radiculopathy has not been reported before. We report a nerve root prolapse into a spinal arachnoid cyst presenting clinically as radiculopathy. An 18-year-old female patient presented with mid-back pain, right anterior thigh pain and hip flexor weakness. Magnetic resonance imaging (MRI) and computerized tomography (CT) myelography revealed an arachnoid cyst at T12-L1 level on the right side. At surgery, a nerve root was seen prolapsing into an extradural arachnoid cyst. The nerve root was replaced back into dural sac and the dural defect closed. At 20 months of follow-up, the patient continues to be asymptomatic with no evidence of recurrence on imaging. Replacing the prolapsed nerve root into the dural sac with meticulous closure of the dural defect could lead to good clinical outcome. We propose a modification to the popular classification of these lesions to better rationalize their surgical management. Classification of extradural arachnoid spinal cysts (Nabors's type 1) should be based on the presence or absence of dural communication. Sacral meningoceles (Nabors’ type 1B) should be excluded from the classification as they have free communication with the thecal sac and are not true spinal cysts.     

Efficacy of Single-Session Percutaneous Drainage and 50% Acetic Acid Sclerotherapy for Treatment of Simple Renal Cysts

Purpose To evaluate the efficacy and long-term results of single-session 50% acetic acid sclerotherapy for the treatment of simple renal cysts, and to compare the therapeutic results of 5 and 20 min sclerosant dwell techniques. Methods During the past 9 years, 50% acetic acid sclerotherapy was performed on 67 cysts in 66 patients. An acetic acid volume corresponding to a mean of 23% of the aspirated cyst volume was injected into the cysts. A 20 min dwell time with position changes was performed in 32 cysts (31 patients; group I) and 8% of volume for a 5 min dwell time in 35 cysts (35 patients; group II). Three- and 6-month sonographic or CT follow-up was performed for a minimum of 1 year. Complete regression was defined as no remaining cyst measurable on sonography with or without a scar at the renal cortex. Partial regression was defined as a decreased cyst volume compared with that before sclerotherapy. The Mann-Whitney U-test was used to compare the therapeutic results between the two groups. Results For 67 simple renal cysts, complete regression on follow-up was observed in 21 of 32 cysts (66%; group I) and 22 of 35 cysts (63%; group II); the remaining 24 cysts all showed partial regression. The partial reduction rate of the cyst’s volume was 97.4% (91.3–99.4%) in group I and 96.9% (90.8–99.5 %) in group II. There were no procedure-related major complications, and no statistically significant differences in the complete regression and partial volume reduction rates between the two groups (p > 0.05). Conclusion Fifty percent acetic acid is an effective and safe sclerosing agent for simple renal cysts. Fifty percent acetic acid sclerotherapy with a 5 min sclerosant dwell time, using a volume of about 10% of the aspirated volume, is sufficient for satisfactory results of simple renal cyst sclerotherapy.     

Long-term outcome after surgical treatment of nonparasitic splenic cysts

Background The optimal treatment for patients with nonparasitic splenic cysts is controversial. This study aimed to evalulate the clinical outcome of patients treated for a symptomatic splenic cyst, and to define a surgical strategy. Methods Spleen-preserving surgery (9 laparotomies and 6 laparoscopies) was performed for a primary cyst in six patients and a secondary cyst in nine patients. The median follow-up time was 37.5 months. Partial splenic resection was performed for eight patients and cyst decapsulation for seven patients. Results Cyst recurrence was observed in four patients after decapsulation of a primary splenic cyst, as compared with none after resection. Postoperative complications were encountered only after laparotomy (5/9). The median hospital stay was 3.5 days (range, 2–5 days) after laparoscopy, as compared with 9 days (range, 5–14 days) after laparotomy. Conclusions Symptomatic splenic cysts should be treated laparoscopically. For patients with recurrent or suspected primary splenic cysts, laparoscopic partial splenectomy is preferable. For other cases, a laparoscopic decapsulation is advocated.     

Pregnancy in chronic renal failure: a novel cause of theca lutein cysts at MRI

We describe the MRI findings of bilateral ovarian theca lutein cysts in a pregnant patient with chronic renal failure. The recognition that pregnancy in chronic renal failure may result in theca lutein cysts, presumably due to excessive serum beta human chorionic gonadotropins (hCGs) secondary to impaired renal excretion, expands the differential diagnosis for this MRI appearance, in addition to the usual considerations of gestational trophoblastic disease, multiple gestation, and ovarian hyperstimulation.     

Laparoscopic unroofing of splenic cysts results in a high rate of recurrences

Purpose

Laparoscopic unroofing is described as an appropriate treatment modality of nonparasitic splenic cysts. However, we repeatedly encountered recurrences with this technique. Because splenic cysts are rare, we analyzed the combined experience of 3 German pediatric surgical departments.

Materials and Methods

Between 1995 and 2005, primary and secondary nonparasitic splenic cysts were unroofed laparoscopically in 14 children (aged 5-12 years; median, 8.5 years). In 3 patients, the inner surface was coagulated with the argon beamer. In most children, the cavity was surfaced with omentum. In addition, in 4 patients the omentum was sutured to the splenic parenchyma.

Results

No intraoperative complications occurred, and no inadvertent splenectomy or blood transfusions were necessary. However, in 9 children (64%) the cysts recurred at intervals ranging from 6 to 12 months (median, 12 months). Also, argon laser treatment of the surface resulted in recurrence.

Conclusion

Laparoscopic unroofing of true splenic cysts alone proved inadequate in this series. Either removal of the inner layer or partial splenectomy appears to be necessary to prevent recurrences.