B超引导下肾囊肿穿刺硬化剂治疗的护理体会

目的探讨B超引导下穿刺硬化剂治疗肾囊肿的治疗及护理方法。方法 25例肾囊肿在B超引导下无水乙醇硬化治疗。结果 25例病例有效率100%,无严重并发症发生。结论 B超引导下硬化剂治疗肾囊肿安全经济效果好良好的术前术后护理是减少和避免并发症发生的必要条件。     

五例罕见的下颌阻生智齿拔除术并发症

<正> 下颌阻生智齿拔除术的并发症,在拔牙术的并发症中最为多见。损伤邻牙或周围组织,局部牙槽骨骨折,干槽症等是阻生智齿拔除术中最常见的并发症。而将阻生牙推入邻近间隙,阻生牙落入病理性囊腔或阻生牙根端有病理性囊腔,在拔牙术的外力作用下引起下颌骨骨折等并发症则属罕见。本文报告我科近十年来门诊拔除阻生智齿时出现罕见并发症的五例,其中牙齿推入翼颌间隙2例,落入病理囊腔2例,下颌骨骨折1例。     

Comparative Study on Two Surgical Procedures for Middle Cranial Fossa Arachnoid Cysts

In this study, we explored the operation options for middle cranial fossa arachnoid cysts （MCFAC）. One hundred and forty-nine patients who were operated for a symptomatic MCFAC between 1993 and 2006 in our hosptial were analyzed. Follow-up time ranged from 1 y to 14 y （mean=5.4 y）. All these patients were divided into three subgroups according to Galassi classification. Long-term outcome and complications were studied respectively. Fenestration （F） resulted in a more favorable long-term outcome and less complication for cysts of types I and Ⅱ, whereas a favorable outcome was noted in type Ⅲ patients who underwent cysto-peritoneal shunting （S）. We are led to conclude that Fenestration is suitable for cysts of types Ⅰ and Ⅱ （Galassi classification）, cysto-peritoneal shunting is better for cysts of type Ⅲ.     

无功能甲状旁腺囊肿的诊断与治疗

目的 回顾性分析无功能甲状旁腺囊肿的临床病理特点和手术治疗策略.方法 检索1991年1月至2013年1月在北京协和医院接受治疗的无功能甲状旁腺囊肿患者的病例资料,分析其临床诊治特点.结果 22例经术中探查和术后病理证实为无功能甲状旁腺囊肿,其中男5例,女17例,就诊时平均年龄47.4（21 ～67）岁.所有患者均通过术前颈部超声检查发现颈部囊性肿物,其中10例同时伴有甲状腺多发占位.所有患者术前和术后的血清钙及血清磷水平均正常.11例行甲状旁腺囊肿单纯切除术,4例因术中判断肿物与囊肿关系密切而行甲状腺大部切除术.6例因甲状腺肿物同时行甲状腺肿物切除术或甲状腺大部切除术,术后甲状腺病理报告均为结节性甲状腺肿.1例因同时伴有甲状腺乳头状癌,而行根治性切除手术.所有患者均未出现手术相关并发症,术后随访7个月以上无囊肿复发迹象.结论 甲状旁腺囊肿应作为一种颈部肿物的鉴别诊断之一,手术切除是一种有效安全的治疗方法.     

儿童巨大骨囊肿的微创治疗

目的 报道经皮注射自体骨髓加异体骨移植治疗儿童巨大骨囊肿的疗效。方法 对7例儿童巨大单房性骨囊肿在C臂X光机监视下经皮穿刺抽尽囊液后注入自体骨髓和异体骨粉。结果 随访8-15个月。7例X线片示骨囊肿囊腔消失，骨皮质厚度恢复正常，未见并发症发生。结论 经皮注射自体骨髓加异体骨粉移植治疗儿童巨大单房性骨囊肿是一种简单、微创、疗效确切的方法。     

CT导向下囊内注射无水乙醇治疗肝囊肿效果观察

目的评价CT导向下经皮穿刺注射无水乙醇治疗肝囊肿的临床应用价值。方法19例23个肝囊肿,其中单纯性肝囊肿15例,多发性肝囊肿4例。在CT导向下行穿刺元水乙醇硬化治疗,分析其并发症,并追踪观察其疗效。结果19例中23个囊肿顺利完成穿刺硬化治疗,无并发症发生。对23个囊肿术后追踪观察6～12个月,CT复查囊腔缩小50％以上2例,70％以上9例,囊腔闭合无复发8例。结论CT导向下经囊内注射无水乙醇治疗是一种安全有效的治疗方法。     

Intracardiac blood-filled cysts of the heart: a rare cause of embolic stroke

Intracardiac blood cysts are thin-walled congenital cysts located in the endocardium and are seen predominantly in infants. They are rare in adults and are typically asymptomatic. However, complications such as valve dysfunction and left ventricular outflow tract obstruction have been reported in adults. We report a 42-year-old woman who developed an embolic stroke in association with intracardiac blood cysts. To the best of our knowledge, this is the first case report of intracardiac blood cysts manifesting as an embolic stroke.     

DIAGNOSIS AND SURGICAL TREATMENT OF BRONCHOGENIC CYSTS

Between 1974 and 1993, 22 patients with bronchogenic cysts were operated on in our hospital; there were 14 men and 8 women, ranging in age from 11 to 62 years, The cyst locations were mediastinal in 13 (59.1%) and intrapulmonary in 9 (40.9%). There were symptoms (chest pain and recurrent bronehiolits) in 20 patients (91%). The preoperative complications included infection in the lung and in the cyst and dysphagia due to esophageal eornpression. Chest pain was the main symptom in mediastinal cyst and recurrent infection of lung in intrapulmonary cyst. Plain chest radiograms showed that a rousd shadow, occasional air-fluid levels, and peripheral calcification may be found in cysts. An operation is the best treatment for cysts. All cysts were completely excised. No postoperative complieations, late complica-tions, or recurrence developed in our patients.     

肾囊肿后腹膜腔镜手术并发症及其处理

目的探讨肾囊肿后腹膜腔镜手术的并发症及其处理。方法采用后腹膜腔镜手术治疗肾囊肿116例,其中囊肿位于右侧49例,左侧67例,肾上极45例,中部23例,肾下极48例。囊肿大小3.3 cm×3.5 cm×4.0 cm-10.4 cm×8.2 cm×9.8 cm,均一次性完成手术。结果 116例中13例有不同程度的残腔存留和复发;2例肾盏憩室术前诊断明确,术中术后各发现1例,术中发现1例行开放手术修补,另1例术后出现尿漏,经双＂J＂管引流2个月后好转;盂旁囊肿4例,1例出现短暂漏尿;多发囊肿2例,1例多房囊肿术后引流血液量较多,延迟拔管。结论后腹膜腔镜手术治疗肾囊肿安全有效,但应提高认识,积极治疗和预防并发症的发生。     

B超引导下经皮穿刺硬化术与后腹腔镜下去顶术治疗单纯性肾囊肿的比较

目的 B超引导下肾囊肿经皮穿刺抽液术联合无水乙醇注射硬化术和后腹腔镜下肾囊肿去顶术是目前治疗单纯性肾囊肿的常用方法,文中比较2种术式的疗效、安全性及适用性。方法回顾性分析112例单纯性肾囊肿患者资料,其中55例行B超引导下肾囊肿穿刺术(穿刺硬化组),57例行后腹腔镜下肾囊肿去顶术(腹腔镜组)。比较2组患者的一般情况、病程、症状、肾囊肿位置与大小、手术并发症、住院天数、医疗费用和术后复发率。结果穿刺硬化组患者年龄较腹腔镜组大[(59.7±12.7)岁vs(52.0±12.8)岁,P<0.05];2组肾囊肿病程、伴随症状、单发与多发比例、肾囊肿大小、术后并发症差异无统计学意义(P>0.05);穿刺硬化组肾囊肿位于上极和腹侧面的比例显著低于腹腔镜组(P<0.01);穿刺硬化组患者平均住院日明显短于腹腔镜组[(2.5±1.5)d vs(7.8±3.0)d,P<0.01],平均住院费用也明显低于腹腔镜组[(2003.2±1140.5)元vs(16421.5±2740.8)元,P<0.01]。结论与后腹腔镜下去顶术相比,B超引导下经皮穿刺硬化术具有操作简便、疗效好、并发症少、住院天数短、医疗花费小的特点,是一种值得推广的治疗肾囊肿的方法。但对于位于肾上极或腹侧面的囊肿,后腹腔镜下去顶术具有更大的优势。     

儿童胰腺炎的内镜治疗

作者报道了3例接受胰腺炎内镜逆行胆胰管造影（ERCP）治疗的患儿。第1例患儿有家族性的胰腺炎病史，接受了括约肌切开术和结石去除术。第2例患儿是继发于胰腺分裂的胰腺炎，接受了括约肌切开术和stunt of small caroncula。第3例患儿表现为伴有假性胰腺囊肿的严重胰腺炎，引流后接受了括约肌切开术、Wirsung扩张术和结石去除术。ERCP是一种有效的治疗方法，可作为复杂胰腺炎外科治疗的选择方法。     

B超引导下经皮穿刺注射消痔灵与无水乙醇治疗肾囊肿疗效比较

目的 观察比较B超引导下经皮穿刺注射消痔灵液或无水乙醇治疗肾囊肿的疗效。方法 86例单纯性肾囊肿随机分成2组，在B超引导下经皮穿刺抽液后，注入硬化剂，1个月和3个月复查B超。结果 消痔灵液与无水乙醇在治疗肾囊肿疗效方面无明显差异，而在副反应与并发症方面，消痔灵液发生率明显低于无水乙醇组。结论 B超引导下经皮穿刺注射硬化剂治疗肾囊肿方法简便，疗效确切，消痔灵液治疗肾囊肿具有和无水乙醇相似的疗效。且更为安全。     

腹腔镜手术治疗巨大卵巢囊肿31例的临床分析

目的探讨腹腔镜下治疗巨大卵巢囊肿的手术方法及其临床应用价值。方法对31例经腹腔镜治疗的巨大卵巢囊肿（直径〉10cm）患者临床资料进行回顾性分析。结果 31例巨大卵巢囊肿均在腹腔镜下完成,手术经过顺利,术后恢复良好。结论腹腔镜手术治疗巨大卵巢囊肿是安全有效的,具有损伤小,恢复快等优点。     

超声引导穿刺及乙醇硬化治疗肾囊肿的临床价值

目的:探讨超声引导下穿刺并注射99.9%乙醇治疗肾囊肿的效果。方法:采用超声对26例肾囊肿行定位穿刺抽液和注入99.9%乙醇,并保留5min,随后抽出所有液体,随访半年到1年。结果:超声引导下共治疗26个囊肿,5例未完全消失,进行二次治疗,穿刺次数共31次,无严重并发症。结论:超声介入治疗肾囊肿是一种安全、微创、高效、经济的治疗方法。     

Splenic cysts: a report of six cases and a brief review

Six cases of splenic cysts, removed surgically in the Royal Free Hospital during the last 10 years, are presented. These include a hydatid cyst, two primary, epithelium lined, and three secondary, non-epithelium lined cysts. The histology, aetiology, symptomatology, diagnosis, treatment and complications of splenic cysts are discussed.     

超声下穿刺无水乙醇硬化治疗肾囊肿疗效观察

目的评价超声引导下穿刺无水乙醇硬化治疗肾囊肿疗效。方法回顾性分析2004—2008年在超声引导下穿刺抽尽囊液并注入无水乙醇硬化治疗肾囊肿96例。结果96例肾囊肿患者1例囊内出血,1例酒精过敏,术后随访1个月-1年,有效率100％,治愈率95．8％。结论超声引导下穿刺无水乙醇硬化治疗肾囊肿是一项有价值的介入性治疗,方法简便易行、安全有效、并发症少、疗效确切,可作为肾囊肿的首选治疗方法。     

Solitary cyst of the liver presenting as an abdominal emergency

A case of torsion of a solitary non-parasitic cyst of the liver presenting as an acute abdominal emergency is described. Reference is made to the pathogenesis of such cysts, which occur infrequently and only rarely present with complications. A review of previous reports of complications in such cysts is presented.     

微创经皮肾技术治疗单纯性肾囊肿18例

目的:探讨经皮肾技术处单其纯性肾囊肿的疗效和安全性.方法:2001年8月至2004年7月对本科住院单纯肾囊肿18例患者采用经皮肾技术处理,囊肿平均直径为6 cm.其中采用经皮穿刺囊肿、输尿管镜下电切外壁(直接法)治疗10例;采用微创经皮肾输尿管镜下囊壁切开内引流(间接法)治疗8例.结果:手术均成功,囊肿处理时间5～25 min,无严重并发症发生.平均随访16个月,直接法2例、间接法3例有原囊肿复发.结论:微创经皮肾技术是处理单纯性肾囊肿安全、有效的方法.     

深部肛周脓肿B超引导下经皮穿刺抽脓36例

目的观察B超引导下经皮穿刺抽脓治疗深部肛周脓肿的疗效和临床应用价值。方法对临床诊断明确并经实验室及影像学检查证实的36例患者在B超引导下经皮穿刺抽脓,术后积极进行有效的抗菌药物治疗。结果 36例深部肛周脓肿患者经皮穿刺抽脓治疗后,临床症状均消失,无并发症发生,经B型超声或CT复查脓肿消失,全部治愈出院。结论B型超声引导下经皮穿刺抽脓具有操作简便、手术创伤小、并发症少、患者痛苦小、住院费用低、疗效肯定等优点,是临床治疗深部肛周脓肿的有效方法之一。     

脑脊液循环通路上囊肿导致梗阻性脑积水的内镜治疗

目的 探讨由脑脊液循环通路上囊肿所致的梗阻性脑积水的内镜手术方法和技术要点.方法 对30例脑脊液循环通路上囊肿所致的梗阻性脑积水患者术前术后均行磁共振脑脊液电影成像检查,并行内镜手术治疗.其中包括脑室内囊肿11例(侧脑室囊肿7例,第四脑室囊肿4例),鞍上池囊肿4例,四叠体池囊肿1例,Dandy-Walker畸形6例,后颅窝蛛网膜囊肿8例.结果 术后所有患者脑脊液循环动力学都存在不同程度的改善,行三脑室底造瘘术的患者造瘘口均有脑脊液通过.有9例脑室内囊肿,4例鞍上池囊肿,1例四叠体池囊肿,4例后颅窝囊肿术后缩小.无手术相关的严重并发症及死亡病例,随访期间无囊肿扩大及造瘘口堵塞病例.结论 脑脊液循环通路上囊肿所致的梗阻性脑积水是神经内镜手术的最佳适应证.除了部分切除囊肿,还需行三脑窜底造瘘重建脑脊液循环,提高脑组织顺应性.术前应根据Cine MRI和同位素脑池显像结果综合分析其脑脊液循环动力学变化及脑脊液的吸收情况,确定手术方案.