Outcome of Surgery for Primary Hyperaldosteronism

Background  

Primary hyperaldosteronism (PHA) frequently causes secondary hypertension and is a surgically amenable disease if associated with unilateral adenoma. Patients who underwent laparoscopic adrenalectomy at the authors’ department were followed to identify clinical parameters that predict resolution of hypertension.     

原发性甲状旁腺机能亢进症的诊断与手术治疗

目的：探讨原发性甲状旁腺机能亢进症（PHPT）的诊断与治疗方法。方法：回顾性总结22例PHPT的临床诊断和手术治疗效果。结果：19例在确诊前均有病程不等的误诊治过程。21例行手术治疗，术后诊断甲状旁腺瘤16例，甲状旁腺增生2例，甲状旁腺癌3例。除1例术后并发多发性肋骨骨折致呼吸衰竭死亡外，20例术后恢复良好，甲状腺机能亢进症状完全得到控制。结论：需普及对PHPT的诊断技术，提高临床医生对该病的认识，一旦确诊并伴有临床征象，均需行手术治疗。     

Surgical Management of Primary Hyperparathyroidism

Primary hyperparathyroidism (PHPT) is a common endocrine disorder in which the inappropriate elevation in serum parathyroid hormone level results in hypercalcemia. Most cases are caused by a single adenomatous parathyroid gland and less than 15% are caused by multiglandular disease. The incidence of PHPT appears to be increasing. More patients are being identified earlier and often before symptoms develop. Parathyroidectomy is the only definitive management; with it, the patient can achieve biochemical homeostasis and symptom relief, and sequelae are prevented. Even for asymptomatic patients with PHPT, there is a growing trend to recommend early surgical intervention. Controversy continues regarding the role of and reliance on various technologies, such as preoperative localization imaging, intraoperative parathyroid hormone level measurements, and minimally invasive surgery. Although both traditional bilateral 4-gland exploration and targeted approaches are accepted surgical techniques, there is a growing trend in unilateral targeted operations often using these technologies. Regardless of surgical approach, the expected success rate is greater than 95%. This article provides an overview of the contemporary surgical management of PHPT.     

Primary Hyperaldosteronism in a Dog with Concurrent Lymphoma

An 11‐year‐old, male castrated English springer spaniel was presented for muscle weakness, lethargy and anorexia while undergoing treatment of Stage IV lymphoma. Persistent hypokalemia prompted multiple diagnostic tests. Serum aldosterone levels, surgical exploration and histopathology confirmed primary hyperaldosteronism. Hyperaldosteronism is a rarely reported endocrinopathy in the dog. This report describes a case in which immunohistochemistry was utilized to confirm the diagnosis of an aldosterone‐secreting tumour.     

原发性骶前肿瘤的诊断与外科治疗(附12例报告)

目的 探讨原发性能前肿瘤的诊断与治疗方法。方法 回顾性分析1979—2001年间收治的12例原发性能前肿瘤思考的临床资料。结果 直肠指诊、B超、CT检查阳性者分别为10／12、12／12及6／6；肿瘤完全切除者9例，部分切除者2例．肿瘤未能切除仅行隐性乙状结肠造口术l例。经病理组织学检查，12例中畸胎瘤4例，上皮样囊肿5例，恶性淋巴瘤l例，神经纤维瘤l例，神经纤维肉瘤l例；8例术后平均随访14个月，治愈6例，好转2例，无手术死亡。结论 原发性能前肿瘤临床表现不典型，直肠指诊、B超及CT检查有助于诊断；完全切除是治疗原发性能前肿瘤的主要措施。     

Diagnosis and Management of Primary Aldosteronism

Identifying primary aldosteronism within the hypertensive population is an important clinical challenge, as most patients with a unilateral source of excess aldosterone secretion are amenable to surgical cure. At least 20% of patients with primary aldosteronism have normal serum potassium levels. Therefore, screening tests should not be based on recognition of hypokalemia alone. Rather, the diagnosis should depend on identifying renin suppression and measuring the ratio of plasma aldosterone concentration to plasma renin activity. The diagnosis may be confirmed by performing an aldosterone suppression test after oral salt loading. Once primary aldosteronism has been established, it is necessary to exclude glucocorticoid-remediable aldosteronism and then proceed to localization studies. Detecting a unilateral source of aldosterone, usually due to an adenoma (Conn syndrome), is achieved by postural hormonal testing and confirmed by selective venous sampling (SVS) with measurement of aldosterone concentrations (expressed as the aldosterone/cortisol ratio) in each adrenal vein. SVS is enjoying a revival in many institutions as it is more sensitive and specific than either cross-sectional imaging or scintigraphy and has the potential to influence significantly both the diagnosis and clinical decision-making. Patients with unilateral disease are ideally treated by laparoscopic adrenalectomy. Patients in whom localization is not achieved usually have bilateral adrenal hyperplasia and are treated medically.     

肝门部胆管癌的诊断和治疗

肝门部胆管癌是指发生于肝总管、左右肝管及其汇合部的肝外胆管癌肿,又称高位胆管癌和上段胆管癌。起源于肝内Ⅱ级以上胆管的癌肿累及肝门部胆管者属肝癌范畴,两者在临床表现和处理方式上有所不同,应予以区分。肝门部胆管癌因发病率上升、切除率低、预后差而引起外科界的关注。我们亦在不断地应用新技术的过程中,摸索诊断和治疗上的临床经验。 术前诊断步骤 肝门部胆管癌患者就诊时大多已出现黄疸,经Ｂ超检查,发现肝内胆管扩张、胆总管不扩张,胆管梗阻水平可基本确定于肝门部胆管。进一步检查的目的是确定病变的性质和范围,尤其是寻…     

Surgical Management of Normocalcemic Primary Hyperparathyroidism

Background  

Primary hyperparathyroidism (pHPT), typically defined as elevated serum calcium levels associated with inappropriately elevated parathyroid hormone (PTH) levels, can occur also in patients with normal serum calcium levels. This study investigated the characteristics, workup, and surgical management of patients with normocalcemic pHPT.     

Jugular Foramen Schwannomas: Diagnosis and Suggestions for Surgical Management

Schwannomas arising in the parapharyngeal space are rare lesions; however, those originating in the jugular foramen are even less common. Two cases, each with marked intra- and extracranial extensions, are discussed. Clinical presentation and preoperative evaluation emphasizing computerized tomographic and magnetic resonance imaging will be presented. An aggressive two-stage surgical approach consisting of a retrosigmoid craniectomy combined with infratemporal removal is advocated for those lesions arising within the jugular foramen.     

心脏原发性恶性肿瘤的诊断与治疗

目的探讨心脏原发性恶性肿瘤的诊断和治疗方法,以提高诊疗水平。方法2004年4月～2008年6月,共19例心脏原发性恶性肿瘤患者在我科接受诊断及治疗,其中男11例,女8例;年龄17～64岁（40．7±12．1岁）。术前临床诊断：心脏占位性病变,原发性恶性肿瘤。在全身麻醉体外循环下完整切除肿瘤3例,部分切除1例,行同种异体心脏移植1例,开胸探查取活组织检查5例;9例（47．4％）患者失去了手术治疗的机会。结果全组无围手术期死亡。住院时间9～15d（10±7d）,均顺利出院。术后发生心包积液2例,发热1例,均经对症治疗治愈。术后病理检查：平滑肌肉瘤1例,恶性间皮瘤1例,血管内皮肉瘤8例。随访14例（73．7％）,随访时间1～38个月,死亡14例（73．7％）,死于肿瘤复发或远处转移,失访5例（26．3％）。结论心脏原发性恶性肿瘤预后差,尽早明确诊断,尽可能完整地切除肿瘤可改善患者的生存质量。     

原发性肺动脉肿瘤的诊断与外科治疗

目的 探讨原发性肺动脉肿瘤的诊断和外科治疗,提高对原发性肺动脉肿瘤的认识.方法 1994年1月至2004年12月,我院收治的5例患者经手术和病理检查证实为原发性肺动脉肿瘤.术前误诊为肺动脉瓣狭窄3例,肺动脉血栓栓塞2例.行单纯肺动脉肿瘤切除术1例,肺动脉肿瘤切除+同种肺动脉置换术4例,同期行右心室流出道加宽补片2例.结果 手术死亡1例;2例术后4个月死于脑转移;1例术后存活9个月,局部复发;1例术后存活2年,无肿瘤复发和转移.病理诊断肺动脉恶性间叶细胞瘤4例,肺动脉纤维肉瘤1例.结论 原发性肺动脉肿瘤非常少见,临床表现与肺动脉血栓栓塞等肺动脉阻塞性疾病并无明显差异,诊断困难.电子束CT和磁共振成像有助于该病的诊断.治疗的关键是外科手术彻底切除肿瘤并结合放疗和化疗,但易发生局部复发和转移,预后较差.     

原发性十二指肠恶性肿瘤的诊断和外科治疗

目的:探讨原发性十二指肠恶性肿瘤的诊断及治疗方法。方法:回顾分析79例原发性十二指肠恶性肿瘤患者的资料,通过内镜及影像学检查获得诊断,行根治切除手术60例,旁路手术19例。结果:各种检查方法的准确率:十二指肠镜93.0%,上消化道造影88.0%,CT59.5%。根治手术组和姑息手术组的中位生存期分别为2.32年、0.57年,根治术后辅助化疗组中位生存期为3.35年。统计学分析显示单纯根治组与根治化疗组生存期存在显著差异。结论:十二指肠肿瘤缺乏临床特异性,联合内镜及影像学检查可以提高术前诊断率。治疗以胰十二指肠切除和局部根治性十二指肠段切除术为主,姑息的捷径手术可改善生活质量,辅助化疗可能延长术后生存期。