Laparoscopically assisted gastric surgery using Dexterity Pneumo Sleeve

Background: Laparoscopic surgery has been successfully applied to several gastrointestinal procedures. Although the totally laparoscopic gastrectomy is feasible, tactile sensation and manipulation of the organ as well as the lesion are decreased when compared to open surgery. The Dexterity Pneumo Sleeve is a new device which allows the surgeon to insert a hand into the abdominal cavity while preserving the pneumoperitoneum. This device was used for patients who underwent laparoscopic gastric surgery. Methods: The first patient presented with a non-Hodgkin's lymphoma of the stomach. A laparoscopically assisted distal gastrectomy was performed with Roux-en-Y reconstruction. The second patient had a 5-cm leiomyoma involving the greater curve of the stomach, and this device was used for manipulation of the tumor. The last patient suffered from morbid obesity with its associated medical complications and a ventral hernia. The Sleeve was applied at the hernia site and a laparoscopically assisted gastric bypass was performed. Results: The Pneumo Sleeve was useful in these cases for tactile localization of the tumor and for retraction and manipulation of the stomach and surrounding upper abdominal organs. Conclusions: The utilization of this device resulted in a more easily performed dissection, resection, and anastomosis and was felt to decrease operation time. Received: 18 September 1996/Accepted: 26 December 1996     

壁间型膀胱平滑肌瘤十例患者诊治经验的初步探讨

目的通过对壁间型膀胱平滑肌瘤的诊疗进行回顾性分析,初步探讨其临床诊疗方式。方法回顾性分析2010年1月至2019年1月于徐州医科大学附属医院泌尿外科行手术治疗壁间型膀胱平滑肌瘤10例患者资料。其中男性1例,女性9例,年龄33~51(44±6)岁。其中5例患者以膀胱刺激症状为主要临床表现,1例患者以下腹痛为主要表现,还有4例患者无明显临床症状,患者发病时间1周至2年,平均4.9个月。患者泌尿系彩超检查发现膀胱壁上形态规则、表面覆盖黏膜高回声的低回声包块。CTU检查为膀胱壁均质样实性肿块,边界清楚、光滑,无侵蚀表现,膀胱壁走形自然,且壁周脂肪间隙清晰,膀胱内可见充盈缺损。膀胱镜检查可见瘤体表面黏膜常完整连续,可见局部稍向膀胱内隆起。根据患者肿瘤部位、大小,10例患者分别采用经尿道平滑肌瘤剜除术和腹腔镜下平滑肌瘤剜除术,3例患者术中冰冻切片示:膀胱平滑肌瘤。结果10例患者中有临床症状者:其中5例以膀胱刺激症状为主诉的患者术后症状明显缓解,表现为下腹部疼痛症状的患者术后腹痛症状消失,所有患者术后均未发生并发症,术后随访4~24个月(平均16个月)均未见肿瘤复发且未诉漏尿等常见并发症。结论泌尿系彩超,CTU等影像学检查与膀胱镜相结合是诊断壁间型膀胱平滑肌瘤的主要手段,经尿道肿瘤剜除术、腹腔镜下肿瘤剜除术是治疗壁间型膀胱平滑肌瘤安全有效的手术方式且预后较好。     

11例食管平滑肌瘤临床病理X线分析

本文对11例食管平肌瘤的临床病理X线表现进行分析,本病临床症状轻微,具有典型粘膜下良性肿瘤膨胀性生长的病理特征,X线检查能充分反映其病理基础．除边线光滑的腔内充盈缺损或范围一致的腔内外肿块、“环形征”、粘膜不同程度挤压等固有X线特征外,作者认为“扇形增宽皱襞”、“肿瘤移动征”等特异征象,对诊断也很有帮助．术前诊断主要依靠食管钡餐检查．文中并讨论了鉴别诊断．     

食管平滑肌瘤诊断的新征象

本文报告2例食管平滑肌瘤,经食管钡透检查,发现两种新的征象,我们称之为“粘膜折叠征”和“粘膜外凸征”。经食管镜检查与术中观察分析可印证:这两种征象的出现是食管粘膜深陷于肿瘤表面的凹陷处,或深陷于两个肿瘤挤压在一起的间隙中而形成的,而食管壁以外的任何肿瘤压迫食管壁都不可能出现的征象。出现上述两种征象,可以作为食管平滑肌瘤与纵隔肿瘤鉴别诊断的依据,也可以作为多发性食管平滑肌瘤挤压在一起的征象。     

Quadruplet in vitro fertilization pregnancy complicated by fetal reduction and leiomyoma

A woman had a quadruplet IVF pregnancy with a leiomyomatous uterus. Pregnancy resulted in the birth of one baby after missed abortion of one fetus and selective reduction of two others. The woman had a left deep calf vein thrombosis in the first half of pregnancy.     

Intramural leiomyoma of the bladder

Mesodermal tumors of the urinary bladder are rare and the majority of them are malignant. We report a case of an intramural leiomyoma of the bladder presenting with symptoms of a mild lower urinary tract infection. The patient was managed with partial cystectomy and the outcome was excellent. Received: 31 May 1999; Revised: 21 September 1999; Accepted: 21 September 1999     

Endogenous urinary steroids in premenopausal women with uterine leiomyomas.

OBJECTIVES: To study the effect of endogenous steroids on the presence of uterine leiomyomas. METHODS: Urine samples of 27 premenopausal women with leiomyomas and 25 age-matched healthy premenopausal women were collected. The concentration of estrogens and androgens in the urine samples of the two groups were determined using a gas chromatography mass spectrometer and the two groups were compared. To study metabolic changes in patients indirectly, the concentration ratios of precursor metabolite to product metabolite of the two groups were also compared. RESULTS: Urinary concentrations of 17beta-estradiol, 5-androstene-3beta, 16beta, 17beta, triol, 11-keto-ethiocholanolone, 11beta-hydroxy-androsterone, 11beta-hydroxy-etiocholanolone, THS, THA, THE, alpha-cortol and beta-cortol were significantly higher in patients than in controls. The concentration ratios of 17beta-estradiol/estrone and 11/beta-hydroxy-ethiocholanolone/11beta-hydroxy-androsterone increased in patients. CONCLUSIONS: The presence of uterine leiomyomas correlates with an increase in urinary concentrations of estrogens and androgens, and it appears to be caused by a decrease in patients' metabolism of steroids.     

右上腹壁恶性纤维组织细胞瘤合并回盲部腺癌及子宫肌瘤一例

患者女,52岁。因间断性右下腹疼痛1个月余入院。查体:腹部平坦,右下腹部压痛明显,无反跳痛,腹肌软,右肋缘下腋前线水平可触及约5cm×5cm×3cm大小肿块,边界清楚,活动度可,无触痛。肠镜提示回盲部肿块,肠镜下取肿块组织送病检,报告为回盲部腺癌。腹部B超提示右肝前腹壁深层可见多个大小不等低回声光团,周边轮廓清晰,深吸气时不随肝脏移动。CT检查发现肝脏前下方见5.2cm×4.9cm、3.4cm×1.9cm和6cm×1.7cm边缘清楚光滑的肿块,与肝脏分界清楚,肝脏受压,肝脏大小、形态正常,轮廓规则,各叶比例适中;增强可见肝脏前下肿块明显不均匀强化,腹壁下…     

子宫动脉栓塞术治疗子宫肌瘤42例临床分析

目的 探讨子宫动脉栓塞术（UAE）治疗子宫肌瘤的疗效。方法 选择42例子宫肌瘤患者,以Seldinger技术完成单侧股动脉插管,根据数字减影血管造影（DSA）检查结果,选用管径为4－5F（1F=0.33mm)的脾管、肝管或cobra导管,或选用3F微导管,插管至双侧子宫动脉并经DSA检查证实后,以携带有抗生素的明胶海绵颗粒栓塞该处血管。结果 DSA检查发现,子宫肌瘤血液供应丰富。UAE治疗6－12个月后,子宫肌瘤患者的临床症状明显缓解,月经量减少26．3％－75．2％;UAE治疗后第12个月、第18个月肌瘤体积分别缩小77．7％、83．0％,子宫体积分别缩小54．9％、62．7％。术后有不同程度的下腹痛、低热,持续1－3周,经对症处理后症状逐渐消失。结论 UAE可有效地缩小肌瘤及子宫的体积,并明显改善子宫肌瘤患者的临床症状。