分化型甲状腺癌再次手术组织病理阴性的原因分析

  目的  分析分化型甲状腺癌再次手术组织病理阴性的可能原因。  方法  回顾性收集并分析2013年1月至2017年12月北京协和医院基本外科再次手术的分化型甲状腺癌患者临床资料。依据再次手术组织病理结果分为组织病理阴性组和组织病理阳性组。比较两组一般资料、首次手术临床资料、再次手术前超声声像特征及再次手术术式差异。  结果  共纳入218例符合纳入标准和排除标准的再次手术分化型甲状腺癌患者, 其中男性70例, 女性148例, 男女比例1:2.11;平均年龄(43.7±12.7)岁。所有患者均在术前临床诊断肿瘤复发转移, 其中组织病理阴性组27例, 组织病理阳性组191例。与组织病理阳性组相比, 组织病理阴性组患者年龄较大[(49.3±12.6)岁比(42.9±12.5)岁, P=0.013], 首次手术为多中心病灶的比率较低(7.4%比24.6%, P=0.045), 两组在性别、首次手术术式、肿瘤大小、再次手术前超声声像特征及再次手术术式方面无统计学差异(P均>0.05)。  结论  分化型甲状腺癌再次手术组织病理阴性病例并不少见。患者年龄及首次手术是否为多中心病灶可能与再次手术组织病理是否阴性有关。     

成人回肠重复畸形的诊治体会

目的探讨成人回肠重复畸形的临床诊断和治疗方法。方法收集1996年2月至2010年12月,我院收治的6例回肠重复畸形患者的临床资料,并结合相关文献对该病的诊治方法进行分析与讨论。结果 本组6例回肠重复畸形患者均为男性,临床表现主要为消化道出血、腹痛、肠梗阻和腹部包块。其中5例行胃镜、结肠镜及腹部CT检查,3例行肠系膜动脉造影检查,均未提示消化道重复畸形;4例行99 Tcm放射性核素显像检查,其中2例提示消化道出血;3例行双气囊小肠镜检查,1例发现双回肠畸形。术前均未明确诊断,仅1例考虑回肠重复畸形可能。6例均行手术治疗,术中发现距回盲部11～100cm范围内有长度为6～25cm的重复肠管。术后病理检查证实均为回肠重复畸形,其中2例见胃黏膜异位,2例见肠腔内憩室,1例并发异位胰腺,1例伴回盲部炎性纤维性假瘤。6例患者术后均恢复良好。结论成人回肠重复畸形极为少见,临床无特异表现,目前暂无敏感性及特异性高的辅助检查,双气囊小肠镜及99 Tcm放射性核素显像有一定提示意义。术前一般很难作出明确诊断。剖腹探查时应考虑到该病的可能,一旦发现,建议手术切除。     

肝脏巨大血管瘤手术切除的临床经验

目的 总结肝脏巨大血管瘤手术切除的临床经验.方法 回顾性分析2003年1月至2007年12月北京协和医院收治的71例肝脏巨大血管瘤患者的临床资料.结果 71例患者均经影像学检查明确诊断,进行可切除性评估后行手术治疗.46例患者以膜外剥离法行肝脏巨大血管瘤切除术,25例行扩大的规则性肝叶切除术.结论 对于单发的,限于半肝内的、远离肝门的表浅巨大血管瘤,可选择膜外剥离法;对于多发病变或体积较大,靠近肝门的肿瘤,应采用扩大的规则性肝叶切除术.控制术中出血是手术成功的关键.     

109例成人型胆管囊肿的诊治经验

Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment.     

贲门胃底平滑肌瘤和平滑肌肉瘤的临床分析

为了研究和认识贲门胃底平滑肌肿瘤的临床特点、检查方法、治疗方式以及影响预后的因素，本文回顾性分析我院外科手术并病理证实的14例贲门胃底平滑肌肿瘤，其中肌瘤10例，肉瘤4例。主要症状是上腹部疼痛不适和反复黑便，无吞咽困难和梗阻。术前造影和胃镜检查基本可明确诊断。平滑肌肉瘤预后不佳。贲门胃底平滑肌瘤和肉瘤的区别主要在病理上核分裂数、瘤细胞坏死以及临床上肿瘤大小，而手术切除范围并不明显影响存活率。     

慢性胰腺炎与胰腺癌的关系及诊治现状与展望

慢性胰腺炎是一种胰腺的进展性和不可逆性炎症病变 ,最终将导致胰腺结构破坏和内、外分泌功能的丧失。病程通常呈反复发作性 ,表现为复发性腹痛或慢性无痛综合征。急性胰腺炎、慢性胰腺炎和胰腺癌这三种疾病之间存在着较复杂的关系。急性胰腺炎的发作通常先于慢性胰腺炎几年时间 ,而胰腺癌往往是在慢性胰腺炎明确诊断后 2 0年左右发生 ,关于他们在发病上是否存在着一定的序贯性或是有其他短暂的联系 ,目前仍有争论。一些资料完整的临床病例随访分析提示 ,长期患慢性胰腺炎的患者发展为胰腺癌的危险性明显高于普通人群。1　慢性胰腺炎和胰腺…     

109例成人型胆管囊肿的诊治经验

Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment.     

骨髓基质干细胞分化来源肝细胞移植的细胞准备及组织学观察

目的 探讨大鼠骨髓基质干细胞向肝细胞分化后体外标记方法及移植肝细胞的肝内组织学表现。方法 分离大鼠骨髓基质细胞，在体外诱导分化为成熟肝细胞。将5-溴脱氧尿嘧啶核苷（BrdU）掺入后的肝细胞移植入已行部分肝切除大鼠体内，分别应用免疫组织化学和免疫荧光方法观察受体肝脏内移植细胞的形态和功能。结果分化成熟肝细胞在BrdU掺入培养后细胞核染色可见特异性棕褐色标记；肝细胞移植后肝组织切片BrdU染色可定位移植细胞；白蛋白抗体染色显示移植细胞具有功能活性。结论 骨髓基质干细胞分化来源的肝细胞移植后形态功能稳定，是进行肝细胞移植的理想细胞来源。     

Ehlers-Danlos综合征Ⅳ型一例

患者男 ,6 3岁 ,教师 ,2 0ｄ前无意中发现右颈部无痛性肿物 ,约 9ｃｍ× 5ｃｍ大小 ,隆起于右颈侧方 ,质地较软 ,边界清楚。患者诉自幼皮肤松弛柔软 ,手、脚腕活动度大 ,能够过度背伸。磕碰等轻微外伤后容易出现血肿 ,自行绷带加压包扎后可好转。全身轻微擦伤后容易生成瘢痕。年轻时即有双眼内眦肿物 ,诉眼睛常发干。ＰＥ :双眼内眦肉阜增生 ,右眼下睑下垂。右颈部胸锁乳突肌深部可及一直径 9ｃｍ× 5ｃｍ大小质韧肿物。全身皮肤松弛 ,尤以颈部、四肢、腹部明显 ,触之如软羊皮样 ,牵拉时如橡皮带般有弹性 ,可拉起 10ｃｍ长 ,皮肤皱褶较多。…     

109例成人型胆管囊肿的诊治经验

Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment.