球囊扩张治疗肾移植术后移植肾输尿管狭窄12例体会

目的探讨球囊扩张治疗肾移植术后移植肾输尿管狭窄的临床疗效。方法回顾分析我院于2009~2012年收治的12例肾移植术后移植肾输尿管狭窄患者的临床资料,根据狭窄情况采用球囊扩张法治疗,术后留置2根双J管6月。结果 12例患者肾积水均明显减轻,肾功恢复正常。结论球囊扩张治疗肾移植术后移植肾输尿管狭窄疗效确切,安全可靠。     

上颌窦炎性肌纤维母细胞瘤病例报告及文献回顾

摘要：目的探讨上颌窦炎性肌纤维母细胞瘤的临床表现，病理学特征、诊断、治疗及预后，旨在提高耳鼻咽喉科医生对该病的认识和治疗水平，并减少漏诊误诊。方法报告1例上颌窦炎性肌纤维母细胞瘤，并复习相关的国内外文献。结果CT扫描示窦腔可见低密度肿块影且突入眼眶，邻近窦壁明显受压、变薄，增强明显不均匀强化。MRI示类圆形稍高/等T2、T1信号肿块影，边界不清。病理示瘤组织主要由梭形肌纤维母细胞及大量炎性细胞组成。免疫组化中SMA、VIM等呈阳性，CK呈阴性。术后随访9个月，复查CT示左上颌窦窦腔未见明显新生物，呈术后改变。结论上颌窦炎性肌纤维母细胞瘤是非常罕见的，其诊断主要依靠病理及免疫组化检测。根治性手术切除仍为目前首选治疗方法，对于体积过大的血供占位病变，术前可辅助介入栓塞治疗。     

Holmium: Yttrium-Aluminum-Garnet Laser Endoureterotomy for Benign Ureteral Strictures: a Single-Centre Experience

Purpose: This study aimed to report the results of endoureterotomy for benign ureteral strictures using the holmium: yttrium-aluminum-garnet laser.

Material and methods: Nineteen patients (8 men and 11 women, mean age 51.47 years) underwent holmium: yttrium-aluminum-garnet laser endoureterotomy for benign ureteral strictures (8 proximal, 3 middle, and 8 distal) using semirigid ureteroscopy and 360-μm fibre at 1.2 J/pulse and 10 Hz. After completion of the incision, a 7-Fr double-J ureteral stent was left for 6 weeks. Thereafter, the patients were followed-up by ultrasound and/or intravenous urography at 36 monthly intervals.

Results: Success was defined as the absence of symptoms plus radiographic resolution of obstructions as assessed by diuretic renography and/or intravenous urography. With a mean follow-up of 40.2 months, success was achieved in 10 (52.6%) of the 19 patients. Nine patients developed recurrent strictures and were considered treatment failures. The stricture length and severity of hydronephrosis correlated with successful outcome, but gender, aetiology, side and location of strictures did not predict outcome.

Conclusions: Although endoureterotomy using a holmium: yttrium-aluminum-garnet laser has an equivocal outcome, the procedure is recommended as a safe, less invasive therapeutic option for the initial management of benign ureteral strictures.     

Safety and curative ability of endoscopic submucosal dissection for superficial esophageal cancers at least 50 mm in diameter

Background and Aim: Limited data are available regarding the use of endoscopic submucosal dissection (ESD) for superficial esophageal cancers ≥50 mm in diameter. The aim of the present study was to investigate the safety and success of ESD for superficial esophageal cancers ≥50 mm. Methods: A total of 39 patients with superficial esophageal squamous cell carcinoma ≥50 mm were treated with ESD at Osaka Medical Center for Cancer and Cardiovascular Diseases between January 2004 and April 2011, and were analyzed in a retrospective study. Results: En bloc resection was achieved in all patients. One mediastinal emphysema without perforation occurred during the procedure. Stricture developed in 11 of 39 patients, requiring a median of five endoscopic balloon dilatation procedures. Thirty‐three clinical epithelial or lamina propria mucosal cancers were treated by ESD with curative intent, of which invasion into the muscularis mucosa or deeper was detected in seven and lymphovascular involvement in three. The en bloc resection rate was 100% with a tumor‐free margin achieved in 92% of lesions. The curative resection and complication rates during ESD were 70% and 2.5%, respectively. Conclusion: ESD achieved a high en bloc resection rate of 92% with a tumor‐free margin. Curative resection rate of ESD in patients with clinical epithelial or lamina propria mucosal cancers was not low at 70%. However, the risk of stricture must be taken into account when considering the use of ESD in lesions ≥50 mm.     

Treatment of Urethral Stricture Disease by Internal Urethrotomy,Dilation, or Stenting

Management of urethral strictures depends on the characteristics of each individual case and remains a great challenge in reconstructive urology. Treatment of anterior urethral strictures usually starts with minimally invasive procedures, such as urethral dilatation or internal urethrotomy. The popularity of these methods is based on the simple application, the low complication rate, and the fact that most general urologists do not perform open urethroplasty. These methods offer faster recovery, minimal scarring, and fewer infections, although recurrence is always possible. Success depends on adequate vascularity within the underlying spongiosal tissue, which may substantially increase the failure rate. Because the recurrence rate has remained higher than it was in past decades, various modifications of urethral stricture treatment have been suggested, including laser urethrotomy and urethral stents. Since the late 1980s, two different approaches have been studied to prevent scaring contraction: permanent stent versus temporary stents left indwelling for a limited time and then removed. Although the first reports seemed to promise excellent outcomes, longer follow-up began to cast doubt on the usefulness of urethral stenting as a primary treatment modality for urethral stricture disease. The purpose of our study was to evaluate the published literature with respect to any new information on minimally invasive procedures in the treatment of urethral strictures.Patient summaryThe optimal indications for dilatation or internal urethrotomy are simple bulbar strictures <2 cm without spongiofibrosis or history of previous treatment. Recurrent urethral strictures after repeated interventions are usually more complex and can render the definite open urethral surgery more difficult.     

Antesternal Colonic Interposition for Corrosive Esophageal Stricture

Restoration of swallowing in a patient with dysphagia due to nondilatable corrosive stricture of esophagus remains a surgical challenge. Organs available for replacement are stomach, jejunum, or colon. Jejunum is useful to replace a small segment, whereas stomach and colon are required for a long-segment replacement. In cases where the stomach is also injured, colon remains the only option. The route of colonic interposition has also been a subject of debate over the years. Antesternal, retrosternal, or esophageal bed passage are the routes described. In the present series, the data of antesternal colonic interposition (ACI) performed for nondilatable benign esophageal strictures in 32 patients (1988–2011) have been retrospectively analyzed. The results indicate that ACI for corrosive strictures is a quick and simple procedure. Thoracotomy is avoided and anastomosis is easily performed in the neck, and mortality rate due to anastomotic failure or graft failure is diminished. This retrospective analysis discusses the ease, effectiveness, quality of life, morbidity, and mortality of ACI and compares the pros and cons of ACI with other procedures described in the literature.     

The Social Transformation of American Surgery

American surgery, from its humble beginnings in colonial times and especially around 1760, embarked on a long voyage, continuously responding to challenges and worthwhile enterprises. The ascendancy of science, from the late 19th century to our times, gave to this discipline social and cultural empowerment and a well-justified authority. Academic, economic, and political forces, in addition, delayed or sometimes stimulated the acceptance of the surgeon's profession. Patients and society recognized, through various historical American eras, how acceptance was linked to the improved results of less morbidity and mortality. They also recognized that tolerance to pain did not have to be an ingredient of surgery in this century. From this historic review, it is evident that science, surgical research, and good clinical training represented the most important forces shaping the surgery of our day. As one considers the social transformation of American surgery, the road winds from an unsophisticated discipline, suffering from lack of knowledge and minimal interest in science, to growing sophistication, increased knowledge, and full commitment to research and scientific development.