腹腔镜手术治疗卵巢良性肿瘤152例临床分析

目的:探讨腹腔镜手术在卵巢良性肿瘤治疗的临床应用价值.方法:经腹腔镜手术治疗卵巢良性肿瘤152例,其中行肿瘤剥除术130例,行肿瘤剥除加患侧附件切除术22例.结果:152例手术均顺利,并获治愈.术后并发皮下气肿2例(1.31%),2天后自行吸收.134例获1年随访,未见肿瘤复发.结论:经腹腔镜手术治疗卵巢良性肿瘤,出血少,并发症少,术后患者恢复快,创伤小,值得临床推广.     

经纵裂胼胝体入路显微手术切除三脑室肿瘤及囊虫

目的：介绍一种切除三脑室肿瘤的手术入路。方法：显微镜下经纵裂胼胝体入路切除三脑室肿瘤及猪囊虫8例。结果：肿瘤全切除5例、大部切除2例，1例猪囊虫完整摘除。术后死亡1例。5例随访6个月未复发，2例失访。结论：该手术入路可以切除三脑室前、中、后部的肿瘤及猪囊虫，术野暴露清楚，不易造成穹窿、匠脯、大脑内静脉、丘纹静脉的损伤，减少了术后并发症的发生。     

改良面中部翻揭手术在鼻腔鼻窦手术中的应用价值

目的：探讨改良面中部翻揭手术在鼻腔、鼻窦摘除手术中的应用价值。方法：采用自患侧第3磨牙到对侧侧切牙或尖牙的唇龈切口．显露患侧鼻骨、梨状孔、颧骨、眶下壁、鼻中隔以及所在范围内的肿瘤组织并将其彻底切除结果：本组60例肿瘤患者中除对两例内翻性乳头瘤从后鼻孔部侵犯至对侧鼻腔的患者施行面中部翻揭手术，其余均采用改良面部翻揭手术，为肿瘤的摘除提供满意的视野，顺利地切除了肿瘤组织。结论：改良面部翻揭手术是一种简便、微创的手术方法，既可以满足充分的暴露和摘除肿瘤组织的要求，又减少了手术创伤和手术时间，缩短了术后的恢复过程．有利于其他治疗的进行。     

鼻内镜辅助下面中揭翻术治疗翼腭窝及其毗邻区域肿瘤的临床研究

目的：探讨鼻内镜辅助下面中揭翻术切除翼腭窝及其毗邻区域肿瘤的优缺点,以提高疗效,减少并发症和后遗症。方法：采用鼻内镜辅助下面中揭翻进路手术治疗翼腭窝及其毗邻区域肿瘤患者28例,其中良性肿瘤21例、恶性肿瘤7例。结果：本组28例手术均顺利,肿瘤切除彻底。术后随访0．5～5a,21例良性肿瘤患者无一例复发;7例恶性肿瘤患者术后均行放化疗,其中2例分别于术后8个月和10个月死于局部侵犯及远处转移,生存期0．5～4a3例,5a及以上2例。结论：鼻内镜辅助下面中揭翻术适用于鼻腔、鼻窦、鼻咽、翼腭窝的良性肿瘤及生长缓慢侵犯翼腭窝及其毗邻区域的恶性肿瘤,具有微创、恢复快、面部无疤痕等优点。     

结节性甲状腺肿58例手术治疗体会

目的：总结结节性甲状腺肿（ NG）的手术治疗经验,提高NG的治疗效果。方法：2009年4月至2012年6月我院收治NG患者58例,均采取手术治疗。17例单侧NG患者中,4例行患侧甲状腺腺叶全切除＋峡部切除术,9例行患侧甲状腺腺叶切除术,4例行患侧甲状腺腺叶次全切除术。41例双侧NG患者中,行一侧甲状腺腺叶全切除＋峡部切除＋对侧部分切除术9例,一侧甲状腺腺叶全切除＋对侧部分切除术18例,双侧甲状腺次全切除术7例,一侧甲状腺腺叶次全切除＋对侧大部分切除术3例,甲状腺全切除术1例,3例术中冰冻发现合并甲状腺微小癌者行患侧甲状腺腺叶全切除＋峡部切除＋对侧大部切除术2例、双侧甲状腺全切除术1例;后3例均行中央区淋巴结清扫,其中1例行功能性淋巴结清扫。结果：58例患者均顺利完成手术。术后单侧喉返神经损伤1例,患者声音嘶哑,于3个月后恢复;甲状旁腺功能减退1例,患者术后出现低钙血症,经补钙治疗后恢复。术后无切口感染、喉头水肿、出血等并发症。55例患者获随访5个月～3 a,平均2 a。有3例出现结节复发,行二次手术切除甲状腺结节,效果满意。3例合并微小癌患者术后随访无复发及远处转移。结论：NG切除不彻底,可引起复发、癌变,而再次手术明显增加损伤神经及甲状旁腺的机率。临床上应根据病变部位、数量及累及范围选择手术方式;术中应遵循精细化操作,尽可能彻底切除;术后结合病理检查特点给予相应的激素预防性或替代性治疗,可提高疗效,减少并发症和术后复发率。     

颞下窝肿瘤8例临床诊治分析

目的：探讨颞下窝肿瘤的诊断和治疗疗法。方法：2007年1月～2012年5月,于术治疗颞下窝肿瘤患者8例。译纯手术2例;综合治疗6例,其中于术＋放疗4例,手术＋化疗1例,手术＋放疗＋化疗1例。结果：8例患者手术顺利,无术后并发症。术后随访3个月至5a5个月,2例分别于术后19个月和24个月复发,1例于术后2年半死于肺转移。结论：颞下窝肿瘤仅靠临床症状及体征诊断困难,CT、MR榆夼对颞下窝肿瘤诊断具有再婴价值。于术治疗足本病主要治疗手段,熟知颞下窝的解洲层次可明屁减少下术创伤及预防手术并发症的发生。术后放化疗有助于改善生存率。     

手指甲下血管球瘤的手术治疗

目的：探讨手指甲下血管球瘤的诊断及显微外科手术治疗效果：方法：采用显微镜下血管球瘤切除术治疗手指甲下血管球瘤12例。结果：术后病理证实为血管球瘤，随访8个月～3a，无指甲营养不良、残余痛及复发病例。结论：血管球瘤是一种具有典型的临床表现、影像及病理特征的良性肿瘤，应用显微外科技术切除肿瘤是治疗该病的有效方法。     

巨大垂体瘤的经鼻蝶窦进路显微切除术

目的：总结经蝶窦进路显微手术治疗巨大垂体瘤的经验。方法：经蝶窦进路显微手术治疗直径在30mm以上的巨大垂体瘤58例。结果：58例中,镜下全切除者52例、大部分切除者6例,经手术治疗后症状均有不同程度的改善。1例于术后1个月死于垂体危象。余57例患者术后随访2～5a,复发5例均经再次手术治愈。结论：巨大垂体腺瘤的手术治疗仍以经蝶窦进路为首选。     

喉癌喉部分切除术的术后分析

目的：分析喉癌喉部分切除术后复发的原因和对部分切除术的回顾分析。方法：用免疫组化的方法分析部分喉切除术肿瘤切缘组织PCNA表达和9例肿瘤复发的关系及7例喉切除术后治疗效果的回顾分析。结果：在77例部分喉切除病例中，13例在术后2周拔管，11例3个月拔管，41例1个月拔管，1例6个月拔管，11例未能拔管。3年、5年生存率分别为94％、81％。共9例复发，其中3例做了全喉切除术。结论：如适应症掌握恰当，肿瘤切除足够，部分喉切除治疗喉癌是安全有效的。肿瘤切除保留组织中PCNA阳性可为防止肿瘤复发提供较敏感依据。     

介入联合手术治疗急性下肢深静脉血栓形成1

目的：探讨下肢深静脉血栓形成的手术治疗方法。方法：急性下肢深静脉血栓形成14例，先经健侧股静脉置入下腔静脉滤器，再切开患侧股静脉，远端血栓以挤压法驱出，近端髂股静脉内血栓以Fogarty球囊取出；球囊扩张左髂静脉狭窄11例，其中5例放置支架；最后做临时性股动静脉瘘。结果：14例手术成功。13例随访2。30个月，其中12例患肢肿胀消退，1例复发：结论：本方法创伤小，恢复快，疗效好，多数患者能耐受。下腔静脉滤器应以临时性为首选。     

中段胰腺切除术的临床应用（附14例报告）

目的：探讨中段胰腺切除术治疗胰腺中段良性或低度恶性肿瘤的临床应用价值。方法：采用中段胰腺切除术治疗胰腺中段良性或低度恶性肿瘤14例。结果：手术完整切除肿瘤，术后病人胰腺功能无明显变化，症状改善。术后胰瘘发生率14．3％（2／14）。14例均获随访，随访时间为2～54个月，疗效满意。结论：中段胰腺切除术适用于位于胃十二指肠动脉左侧和脾静脉与肠系膜下静脉汇合处之间的良性或低度恶性的胰腺肿瘤；该术式安全、有效、器官功能损伤小，值得推广。     

Granular cell tumor--a rare, benign respiratory tract neoplasm in the material of the Institute of Tuberculosis and Lung Diseases

The granular cell tumor (GCT) is a nodule that arises most commonly in the skin, the breast or the tongue. The vast majority are benign. Approximately 6-10% of granular cell tumors have been reported in the lower respiratory tract. The clinical, pathological and immunohistochemical findings of eleven cases are described in our material consisted of 6 males and 5 females aged from 35 to 58 years (median, 46 years). The GCT were solitary lesions in all our patients. The tumors were located in trachea (6 cases) and in bronchus (5 cases). They were found during bronchoscopy performed because of symptoms of pneumonia, lung cancer and hemoptysis or dyspnea alone. Diameter of the tumors ranged from 0.2-2.5 cm (median 1.2 cm). Six tumors were surgically excised and 5 were endoscopically removed. Pulmonary GCT behave in a benign fashion. It was observed that tumors of less than 8 mm were more amenable to endoscopic removal and larger tumors were more likely to infiltrate through the bronchial wall. Histologically, the GCT showed submucosal infiltrates of round or oval cells with abundant granular cytoplasm. The tumors cells were positive for S-100 protein, neuron specific enolase, CD68 and vimentin. Our immunohistochemical results are consistent with this concept.     

融合影像导航和电生理监测显微手术治疗运动区肿瘤

目的:探讨血氧水平依赖性功能磁共振成像(BOLD-fMRI)及弥散张量-纤维示踪成像(DTI-FT)融合神经导航,结合术中电生理监测在手术治疗颅内运动区肿瘤的临床应用价值.方法:对15例运动区肿瘤患者,术前行导航薄层扫描、BOLD-fMRI及DTI-FT,并在导航仪上进行三者影像融合,了解肿瘤、运动区及锥体束相对关系.术中在导航引导下定位肿瘤、运动区及锥体束,结合术中电生理实时定位肿瘤周围脑功能边界,在显微镜内导航引导下切除肿瘤.结果:导航精确成像,BOLD-fMRI与术中电生理提示基本一致,DTI-FT指导切除肿瘤中保护纤维束.15例肿瘤中全切除12例,次全切除2例,大部切除1 例.术后随访3 ～10个月,术后4 例出现一过性肌力减退加重,随访末期其肢体肌力均基本恢复至术前,其余11例肌力水平与术前比较均有好转或不变.结论:MRI、BOLD-fMRI及DTI-FT融合导航,结合术中电生理监测,可实现镜内导航下最大程度切除运动区肿瘤的同时尽量避免运动区和锥体束的损伤,有效保护神经功能,提高病人术后的生活质量.     

经颅底硬膜外切除海绵窦肿瘤12例

目的：探讨经颅底硬膜外切除海绵窦肿瘤的可能性及实用性。方法：应用最新的海绵窦解剖理论，对12例侵入海绵窦的颅中窝肿瘤进行手术治疗，经硬膜外切除窦内肿瘤。结果：经颅中窝硬膜外可以进入海绵窦，全切肿瘤8例，次全切4例。4例窦内结构保全良好。结论：侵入海绵窦的颅内外沟通性肿瘤可经颅底硬脑膜外入路全切除。     

枕大孔区脑膜瘤的显微手术治疗

目的:探讨枕大孔区脑膜瘤的临床特点、手术入路选择及显微手术技巧.方法:采用显微手术治疗枕骨大孔区脑膜瘤21例,其中,肿瘤位于背侧4例、腹侧3例、腹外侧14例;背侧者选择后正中入路,腹侧或腹外侧者选择远外侧入路.结果:肿瘤全切17例(81%),次全切除1例(椎动脉上下型)、部分切除3例(2例为椎动脉上下型、1例为椎动脉上型);不全切除4例均为腹侧或腹外侧患者,术后均行γ-刀治疗.无手术死亡.随访1～88个月(平均27个月),期间无肿瘤复发病例;21例中,临床症状改善16例,保持原状3例,加重2例.结论:枕大孔区脑膜瘤的临床症状无特征性,术前的位置分型有助于手术入路的选择,而正确选择手术入路和娴熟的颅脑显微外科手术技巧是安全有效切除肿瘤的关键.     

Swallowing dysfunction in nephropathic cystinosis

BACKGROUND. Nephropathic cystinosis causes renal failure in most patients at approximately 10 years of age. This can be prevented or retarded by cystine-depleting therapy with oral cysteamine. Many patients who do not receive adequate cysteamine therapy undergo renal transplantation, but the accumulation of cystine continues in other organs, resulting in various clinical abnormalities. We report age-related swallowing dysfunction in patients with nephropathic cystinosis. METHODS. We studied 43 patients with cystinosis (24 who had received a renal transplant and 19 who had not), 3 to 31 years of age. Oral motor function was assessed by a cranial-nerve oral sensorimotor examination, and an oral motor index was calculated for each patient. The oral phase of swallowing was assessed by ultrasonography, and the pharyngeal and esophageal phases were evaluated by videofluoroscopy. RESULTS. Approximately half the patients were slow eaters. Oral motor dysfunction, reflected by a higher oral motor index, increased with age. Speech, oral structure and anatomy, and tongue and lip strength were particularly affected. Seven of nine patients 21 to 31 years old had abnormalities in all three phases of swallowing; the deficits were variable in younger patients. In 28 patients with cystinosis, the mean (+/- SD) duration of oropharyngeal swallowing for a dry swallow (3.06 +/- 1.06 seconds) was longer than in 14 normal subjects (1.89 +/- 0.57 seconds; P less than 0.001). This prolongation reflected impairment of the initiation phase of swallowing. CONCLUSIONS. Swallowing dysfunction is a late complication of nephropathic cystinosis, probably related to muscular dysfunction. Changes in the consistency of foods, swallowing exercises, and long-term cysteamine therapy should be considered for patients with cystinosis who have difficulty in swallowing.     

DJ-1和mTOR表达在良性脑膜瘤复发中的意义

目的：探讨DJ-1和哺乳动物雷帕霉素靶蛋白（mammalian target of rapamycin,mTOR）在各类型脑膜瘤中的表达及其与良性脑膜瘤复发和演进的关系。方法：收集广东同江医院和中山大学附属第一医院行手术切除并随访的脑膜瘤病例72例,其中术后无复发的良性（WHO I级）脑膜瘤50例,术后复发良性脑膜瘤12例,高级别脑膜瘤（WHO II~III级）10例。采用免疫组织化学方法检测DJ-1和mTOR在脑膜瘤组织中的表达。结果：DJ-1和mTOR在术后无复发和术后复发的良性脑膜瘤及高级别的脑膜瘤中表达不同,DJ-1在3种脑膜瘤组织中的高表达分别为3,5和6例,mTOR的高表达分别为3,4和5例,DJ-1和mTOR在高级别和复发性良性脑膜瘤中均呈高表达状态（P〈0.05）。mTOR与DJ-1的表达有关（P〈0.05）,DJ-1,mTOR的表达强度与良性脑膜瘤的复发有关（P=0.001）。结论：DJ-1和mTOR的高表达可能促进了良性脑膜瘤的复发,结合组织学分级,二者的高表达可能是预测良性肿瘤复发的有临床价值的生物学指标。     

The Clinical,Radiological, and Bronchoscopic Findings and Outcomes in Patients with Benign Tracheobronchial Tumors

Purpose

We evaluated the characteristics of and treatment outcomes in patients with benign tracheobronchial tumors.

Materials and Methods

We reviewed the records of patients with benign tracheobronchial tumors who underwent bronchoscopic intervention with mechanical removal and Nd: YAG laser cauterization, and evaluated the characteristics and treatment outcomes of 55 patients with hamartomas, leiomyomas, papillomas, typical carcinoids, or schwannomas seen between April 1999 and July 2012.

Results

The most common tumors were hamartoma (n=24), leiomyoma (n=16), papilloma (n=7), typical carcinoid (n=5), and schwannoma (n=3). Forty-one patients (75%) had symptoms. On chest computed tomography, 35 patients (64%) had round or ovoid lesions, accompanied by atelectasis (n=26, 47%) or obstructive pneumonia (n=17, 31%). Fatty components (n=9, 16%) and calcifications (n=7, 13%) were observed only in hamartomas, leiomyomas, and typical carcinoids. At bronchoscopy, the typical findings were categorized according to tumor shape, surface, color, and visible vessels. Fifty (91%) patients underwent complete resection. Forty patients (73%) achieved successful bronchoscopic removal defined as complete resection without complications or recurrence. Recurrences occurred in four papillomas, one leiomyoma, and one typical carcinoid. The proportions of tumor types (p=0.029) differed between the successful and unsuccessful removal groups, and a pedunculated base (p<0.001) and no spontaneous bleeding (p=0.037) were more frequent in the successful removal group.

Conclusion

We described clinical, radiological, and typical bronchoscopic findings in patients with benign tracheobronchial tumors; these findings might help to differentiate such tumors. Bronchoscopic intervention was a useful treatment modality, and tumor type, pedunculated base, and vascularity may influence successful tumor removal.     

晚期非小细胞肺癌组织中ERCC1、RRM1表达水平与含铂治疗方案疗效及预后相关性分析

目的：探讨ERCC1及RRM1的表达在预测晚期非小细胞肺癌含铂治疗方案疗效及预后中的作用。方法：用免疫组织化学的方法检测124例ⅢB和Ⅳ期非小细胞肺癌患者的石蜡包埋活检组织标本中ERCC1和RRM1的表达水平,并分析其与临床病理特征以及疗效、预后的相关性。124例均为接受以铂类为基础的三代药物联合化疗的初治患者。结果：ERCC1、RRM1表达阳性者分别为43例（35％）和50例（40％）。ERCC1及RRM1的表达与疗效相关,ERCC1表达阴性者疗效达PR的患者（54％）明显高于阳性者（33％）,差异有统计学意义（P=0．022）。同样,RRM1表达阴性患者疗效为PR的明显高于RRM1阳性者（53％VS34％,P=0．042）。ERCC1和RRM1同时阴性表达者的中位生存时问明显长于同时阳性表达者（11．7个月VS9．2个月,P=0．025）,多因素分析表明,ERCC1为独立的预后预测因素（P=0．0066）。结论：ERCC1的表达与晚期非小细胞肺癌预后及含铂治疗方案疗效相关。