复发性椎管内肿瘤的显微外科治疗

目的探讨椎管内肿瘤术后复发的显微外科治疗体会。方法对1993—06～2002—06收治的16例复发性椎管内肿瘤的病例进行回顾性研究，分析其显微外科手术特点、手术方法、手术结果及手术并发症等。结果显微镜下全切除10例，近全切除4例，大部切除2例。出院时症状体征改善者10例，无变化3例，加重3例。随访5个月至8年，良好者11例，残废4例，死亡1例。结论椎管内肿瘤复发经确诊，再次手术效果良好，但术中须更加小心，注意脊髓功能的保护。对恶性肿瘤或切除不完全者应行放射治疗。     

甲状腺癌再次手术36例临床分析

目的探讨甲状腺癌再次手术治疗的原因及对策。方法对10年收治的甲状腺手术后病理证实为甲状腺癌,需要再次手术治疗的36例临床病理资料进行回顾性分析。结果23例再次手术的原因为将甲状腺癌误诊为甲状腺良性病变,手术切除范围不够;3例原因为甲状腺癌术后复发。随访31例,5年生存率为83.3%(30/36)。结论甲状腺癌的误诊是造成甲状腺癌再次手术的主要原因,提高术者对甲状腺癌的认识水平,强调术中快速冰冻检查在甲状腺手术中的常规应用,选用恰当的手术方式,是避免甲状腺癌再次手术的关键。     

Dukes'A期结直肠癌术后复发转移分析

目的探讨Dukes’A期结直肠癌根治术后复发转移相关的临床病理因素。方法回顾性分析172例行根治术的Dukes’A期结直肠癌病例的临床病理资料。其中，非复发组144例，复发组28例。结果Dukes’A期直肠癌术后复发转移率（20．9％）比结肠癌（8．1％）高（x^2=4．800，P〈0．05）。肿瘤浸润至肌层术后复发转移率（18．4％，28／152）明显高于局限于黏膜下层肿瘤（0．0％，0／20）（P〈0．05）。而性别、年龄、病程、大体类型、肿瘤大小、组织学类型、分化程度与术后复发转移无关。结论Dukes’A期直肠癌比结肠癌术后更易发生复发转移。Dukes’A期结直肠癌浸润至肌层术后复发转移风险高于局限于粘膜下层。     

复发性骨巨细胞瘤的临床特点及治疗

目的 了解复发性骨巨细胞瘤的临床特点，观察复发性骨巨细胞瘤的治疗效果。方法总结分析1980～2000年收治的42例复发性骨巨细胞瘤的一般资料、复发部位、临床表现、影像学改变、病理分级变化及手术疗效。结果复发性骨巨细胞瘤多发生于20～40岁，女性多于男性，大多在手术后2年内复发；膝关节是复发的好发部位；大多数复发病例以局部疼痛为主要症状，影像学上有膨胀性、皂泡样改变。长期随访证实经治疗的复发性骨巨细胞瘤再复发1次2例，再复发4次1例。结论骨巨细胞瘤术后2年内应加强随访观察；骨巨细胞瘤术后再次出现局部疼痛，影像学检查有膨胀性、皂泡样改变提示肿瘤复发；就病理而言，复发并不意味着恶变；手术应以彻底性为原则，手术方式的选择应考虑到复发性骨巨细胞瘤的恶性程度、复发部位、侵袭范围、肢体功能的保留和重建。     

脑膜瘤瘤周水肿与手术预后的关系

目的探讨脑膜瘤瘤周水肿程度与手术预后的关系.方法对92例脑膜瘤术前瘤周水肿程度与术中肿瘤分离难易程度、术后病理组织学分类及复发率进行统计学对比分析.结果血管瘤型脑膜瘤、恶性及低度恶性脑膜瘤瘤周中、重度水肿发生率明显高于其它类型脑膜瘤（P＜0.01）;脑膜瘤周围水肿越严重,术中脑膜瘤的分离难度越大（P＜0.01）,同时复发率也较高（P＜0.05）.结论脑膜瘤周围水肿程度与手术预后密切相关,可作为判断预后的一个重要指标.     

MVD及VEGF在颅咽管瘤中的表达及其与预后的关系

背景与目的：颅叫管瘤为难治性肿瘤，其预后不良，复发机制尚不清楚。本研究检测颅Ⅱ阏管瘤组织中微血管密度（microvascular density，MVD）及血管内皮生长因子vascular endothelial growth factor，VEGF表达．分析其与肿瘤预后等生物学行为的关系。方法：采取前瞻性队列研究方案，经纳入、排除标准筛选卅颅咽管釉质上皮型肿瘤32例、鳞形乳头瘤型肿瘤31例，平均随访843个月，收集原发及复发患者的肿瘤组织标本，应用单克隆抗体CD34、VEGF抗体检测肿瘤组织MVD及VEGF蛋白表达，计算机辅助成像系统对其作出定量分析，分析其与肿瘤复发等生物学行为的关系。结果：VEGF蛋白、MVD计数在颅咽管瘤队列复发组、非复发组间不具有显著性差异（P〉0．05），而在颅咽管瘤不同病理类型间差异则具有显著性（P〈0．05）。结论：VEGF蛋白、MVD计数与肿瘤复发无关，不能预测颅咽管瘤复发的危险性，但可为了解肿瘤的同有侵袭性行为提供参考。     

40例不同类型舌下腺囊肿的临床分析

目的：探讨不同类型舌下腺囊肿的临床特征、诊治方法、临床疗效及手术并发症的处理。方法：对某医院口腔颌面外科收治的40例不同类型舌下腺囊肿进行回顾性分析，其中单纯型30例，潜突型4例，哑铃型6例。结果：在40例不同类型舌下腺囊肿中。单纯型及哑铃型因其临床特征明显，易于诊断，对于潜突型舌下腺囊肿，则通过颌下区穿刺及彩色超声检查辅助诊断。手术方法均采用口内入路切除患侧舌下腺囊肿邻近囊壁及腺体。其中1例发生术后出血。通过紧急手术探查予以结扎止血处理，其余病例均未发生手术并发症。结论：局部穿刺及超声检查是值得推荐的用于舌下腺囊肿鉴别诊断的有效手段，完整摘除患侧舌下腺腺体是治疗不同类型舌下腺囊肿并预防其复发的关键。     

Post-treatment surveillance of thyroid cancer

An increased incidence of differentiated thyroid cancer (DTC) has resulted in an increased population of thyroid cancer survivors requiring ongoing disease surveillance. Our institution's risk-adapted surveillance strategy is based on a contemporary understanding of disease biology, guided by analysis of prognostic factors and balanced application of available surveillance modalities. The goal of this strategy is to detect recurrent disease early, identify patients who would benefit from further treatment and reduce over investigation of low-risk patients. This article describes our center's risk-stratified approach to the postoperative surveillance of patients with differentiated thyroid cancer with reference to the recent 2015 American Thyroid Association management guidelines.     

Chronic subdural hematoma associated with dural metastasis leads to early recurrence and death: A single-institute,retrospective cohort study

The prevalence of chronic subdural hematoma (CSDH) associated with dural metastasis is uncertain, and appropriate treatment strategies have not been established. This study aimed to investigate the characteristics of and appropriate treatment strategies for CSDH associated with dural metastasis. We retrospectively reviewed the charts of 214 patients who underwent surgery for CSDH. The patients were divided into the dural metastasis group (DMG; n = 5, 2.3%) and no dural metastasis group (No-DMG; n = 209, 97.3%). Patient characteristics, treatment, and outcomes were compared between the two groups. Active cancer was detected in 31 out of 214 patients, 5 of whom (16.1%) had dural metastasis. In-hospital death (80.0% vs. 0%; p < 0.001) and recurrence within 14 days (80.0% vs. 2.9%; p < 0.001) and 60 days (80.0% vs. 13.9%; p = 0.002) were significantly prevalent in the DMG. All patients in the DMG developed subdural hematoma re-accumulation requiring emergent surgery because of brain herniation, and patients in the DMG had significantly worse recurrence-free survival (p < 0.001). This relationship remained significant (p < 0.001) even when the analysis was limited to the active cancer cohort (n = 31). CSDH associated with dural metastasis leads to early recurrence and death because of the difficulty in controlling subdural hematoma re-accumulation by common drainage procedures. Depending on the primary cancer status, withdrawal of active treatment and change to palliative care should be discussed after diagnosing CSDH associated with dural metastasis.