经腹腔途径腹腔镜行肾盂旁囊肿去顶术45例

目的 探讨腹腔镜经腹腔途径治疗肾盂旁囊肿的微创方式.方法 2008年至2015年,腹腔镜经腹腔途径行囊肿去顶减压术治疗肾盂旁囊肿45例,其中男33例,女12例,年龄区间为35～65岁,左侧27例,右侧18例.观察术后临床恢复及影像学改善情况.结果 44例手术均顺利完成,无中转开腹.1例患者为肾积水误诊为肾盂旁囊肿,术中予以缝合,留置双J管,术后无漏尿;手术时间平均值35min,术中无明显活动性出血,未见明显术中及术后并发症发生,术后住院时间3 ～5d,术后病理44例为肾盂旁囊肿.术后随访3～18个月,临床症状无反复,尚无在影像学下确诊复发病例.结论 经腹腔途径腹腔镜下囊肿去顶减压解剖层次清楚,暴露手术标志物清晰,手术时间短,损伤小,效果确切,是治疗肾盂旁囊肿的理想方法.     

前交叉韧带囊肿的临床表现与关节镜治疗

目的：探讨膝关节前交叉韧带囊肿的临床表现和关节镜手术疗效.方法：回顾性分析自2005年1月至2010年12月收治的12例症状性膝关节前交叉韧带囊肿的资料.男8例,女4例;年龄19～53岁,平均（33.7±9.5）岁;左膝5例,右膝7例;病程3～48个月,平均（15.8±13.2）个月.术中关节镜下完整切除前交叉韧带囊肿.记录术前术后膝关节的活动度,膝关节功能采用Lysholm评分标准进行评定.结果：术后患者切口均Ⅰ期愈合,无相关并发症发生.12例均获随访,时间24～48个月,平均（32.3±6.6）个月.患膝关节疼痛、肿胀、交锁症状均消失,随访期间无复发.术后关节活动度及Lysholm评分均较术前明显改善.结论：关节镜诊治症状性前交叉韧带囊肿具有创伤小、恢复快的优点,是治疗症状性膝关节前交叉韧带囊肿的有效治疗手段.     

彩色多普勒超声引导下腹部脏器囊肿无水乙醇硬化治疗

目的探讨彩色多普勒超声引导下经皮穿刺注射无水乙醇硬化治疗对腹部脏器囊肿的疗效。方法对33例38个肝、肾及卵巢囊肿在彩色多普勒超声引导下，穿刺抽液后，行无水乙醇硬化治疗。结果一次治疗治愈率为8996，3个月后二次治疗治愈率为100％，无严重并发症发生。结论彩色多普勒超声引导下囊肿介入硬化治疗腹部囊肿方法简便，疗效好，并发症少，是一种非常有价值的治疗方法。     

原发性虹膜睫状体囊肿与前房角变化对应关系的研究

目的 探讨原发性虹膜睫状体囊肿的大小、分布特征及其与相应部位前房角变化的关系.方法 横断面观察性病例研究.在本院眼科行常规体检的人群中,若发现浅前房,进一步行UBM检查.对UBM检查中发现有虹膜睫状体囊肿的患者,记录其囊肿数量、大小、眼别、部位和象限,比较UBM图像上囊肿所在部位的前房角形态与非囊肿部位的前房角形态,观察并记录前房角是否变窄或关闭,分析囊肿导致相应前房角变窄或关闭的相关因素.分别采用t检验、X2检验和直线相关分析对数据进行统计.结果 在457例受检者(914只眼)中,发现有囊肿的患者134例(200只眼),占被检人数的29.32%,均为原发性虹膜睫状体囊肿.共检出囊肿502个,其中41.24%(207/502)位于虹膜睫状沟,58.37%(293/502)位于睫状冠;44.22%(222/502)位于颞下象限,26.88%(135/502)位于鼻下象限,23.11%(116/502)位于颞上象限,5.38%(27/502)位于鼻上象限.囊肿的平均大小为(0.6289±0.2329)mm,中囊肿占86.05%(432/502).虹膜睫状沟囊肿导致相应部位前房角变窄或关闭的发生率为82.13%(170/207),睫状冠囊肿导致相应部位前房角变窄或关闭的发生率为22.87%(67/293),二者差异有统计学意义(X2=170.83,P<0.01).囊肿大小导致相应前房角变窄或关闭的比例值,行直线相关分析,二者呈正相关(r=0.9939,P<0.01).结论 正常人群中原发性虹膜睫状体囊肿的发病比例高,部分囊肿可导致前房角变窄或关闭;囊肿的部位和大小是导致相应部位的前房角变窄或关闭的相关因素.     

药物治疗对小鼠棘球蚴病体内细胞因子的变化

目的观察维拉帕米和阿苯哒唑单独及联合用药治疗小鼠继发性棘球蚴病后其体内细胞因子的变化。方法药物治疗90天后,检测小鼠血清IL-2、IL-10和IgE的含量。结果治疗90天后,小鼠血清IL-2、IgE含量与对照组相比有显著性差异(P<0.05),IL-10的含量与对照组相比无明显差异。结论治疗组IL-2、IgE含量与对照组的明显差异提示,药物治疗后小鼠的免疫力提高,有利于体内虫体的清除。     

Cystic nephroma: A rare clinical entity

We report a rare benign renal tumor, the cystic nephroma (CN) in a 35-year old man. CN should be considered in the differential diagnosis when clinical and radiological examinations reveals a multilocular cystic renal mass, but histopathological examination is the unique diagnostic mean.     

腹腔镜与开放手术行肾囊肿去顶术的效果比较

目的评价腹腔镜经后腹膜路径治疗肾囊肿的临床价值。方法回顾分析腹腔镜肾囊肿去顶术30例(A组)及开放性肾囊肿去顶术30例(B组)的临床资料,就两组术前抑郁与焦虑的心理评分、手术时间、术中出血量、术后肠功能恢复情况、术后下床活动时间、抗生素应用时间、止痛药应用次数、恢复正常工作时间、手术治疗费用、住院总费用、术后住院总天数等指标进行比较。结果A组在手术中出血量[(100±20)ml]、手术操作时间[(100±30)min]、术后肠功能恢复情况、术后下床活动时间[(24±12)h]、术后住院总天数[(7±1)d]、恢复正常工作时间[(14±7)d]、抗生素应用时间[(3±1)d]、止痛药应用次数[(1±1)次]明显优于B组,差异有统计学意义(均P<0.05);B组在术前抑郁与焦虑评分、手术治疗费用、住院总费用优于A组,差异有统计学意义(均P<0.05)。结论腹腔镜肾囊肿去顶术具有创伤小、术后恢复快、疼痛轻等优点,效果优于开放手术。     

CT in the evaluation of complicated autosomal dominant polycystic kidney disease

Purpose: We retrospectively reviewed the CT findings in 24 cases of autosomal dominant polycystic kidney disease (ADPKD) to assess the role of CT in the diagnostic work-up of patients with complicated ADPKD.Material and Methods: Twenty-four patients with ADPKD underwent unenhanced and contrast-enhanced CT for flank pain, haematuria, or fever. The images were retrospectively reviewed for presence of complicated cysts, their morphological features and associated findings in the perinephric space/retroperitoneum.Results: Cyst haemorrhage was present in all patients, seen as high-density cysts, which were mostly bilateral. Most of these cysts had sharply outlined contours, sharp interfaces with adjacent renal parenchyma, imperceptible walls, and homogeneous density, and did not enhance following i.v. contrast administration. However, a few haemorrhagic cysts (9 cysts in 6 patients) showed inhomogeneous density (n=7), dependent layering of high-density blood leading to fluid-fluid level (n=2), and contour irregularity (n=3).CT revealed presence of cyst infection in 6 cases; the involved cysts were larger (average size 4.2 cm) than adjacent cysts, had only a mildly increased or near water density, and showed wall thickening and enhancement. Other findings included air within the infected cyst (n=1), thickening and enhancement of peri- and paranephric fasciae (n=5), and abscesses in the posterior paranephric space and adjoining psoas muscle (n=2). In 2 other patients, although CT suggested cyst infection because of presence of wall enhancement, diagnostic needle aspiration revealed only sterile haemorrhagic fluid. In 1 case, CT revealed a soft tissue density enhancing mass in one of the cysts; this proved to be a renal cell carcinoma by fine-needle biopsy. Calculi were observed in 7 patients, and cyst wall calcification in 11 cases.Conclusion: A combination of unenhanced and contrast-enhanced CT allows correct diagnosis and differentiation amongst the various complications affecting patients with ADPKD. However, in a small subgroup of patients, it may not be possible to differentiate between haemorrhage and infection; such cases require diagnostic needle aspiration for diagnosis.     

小儿先天性肝囊肿

目的 探讨小儿先天性肝囊肿的临床表现、诊断及鉴别诊断，正确选择治疗方法。方法 回顾性研究我院自1972年至今的14例小儿先天性肝囊肿病例，评价其治疗手段。结果 本组14例均行手术治疗，其中6例多囊肝病例中，1例术后呼吸衰竭死亡。8例孤立性肝囊肿中，2例行开窗引流，5例行不同形式的肝切除手术，1例行囊肿空肠Roux—Y吻合术。除3例多囊肝病例术后仍有轻度肝肿大外，其余患儿预后良好。结论 小儿先天性肝囊肿的治疗，应根据其不同表现，采取不同治疗手段，以达到满意疗效。     

Intra-articular ganglion cysts of the knee: clinical and MR imaging features

The purpose of this study was to present clinical and MR imaging features of intra-articular ganglion cysts of the knee. Retrospective review of 1685 consecutive medical records and MR examinations of the knee performed at three imaging centers allowed identification of 20 patients (13 men and 7 women; mean age 35 years), in whom evidence of intra-articular ganglion cyst was seen. Of the 20 ganglion cysts, 5 were found in the infrapatellar fat pad, 10 arose from the posterior cruciate ligament, and 5 from the anterior cruciate ligament. Three of five patients with ganglion cyst in the infrapatellar fat pad had a palpable mass. In 7 of 15 patients with ganglion cyst in the intercondylar notch, exacerbation of pain occurred in a squatting position. On four MR arthrographies, ganglion cysts were an intra-articular round, lobulated, low signal intensity lesion. Five cases of fat-suppressed contrast-enhanced T1-weighted SE images demonstrated peripheral thin rim enhancement. The clinical presentation of intra-articular ganglion cyst is varied according to its intra-articular location. The MR appearance of intra-articular ganglion cyst is characteristic and usually associated with the cruciate ligament or the infrapatellar fat pad. Magnetic resonance arthrography has no definite advantage over conventional MR in the evaluation of the lesion. For intra-articular ganglion cyst in the infrapatellar fat pad, fat-suppressed contrast-enhanced MR imaging could be useful, because a thin, rim-enhancing feature of intra-articular ganglion cyst allows it to be distinguished from synovial hemangioma and synovial sarcoma. Received: 29 June 2000 Revised: 13 September 2000 Accepted: 15 September 2000