颈动脉体瘤术中发生顽固性肺水肿一例

我院一例患者在颈动脉体瘤术中发生顽固性肺水肿。现将术中及抢救情况、可能原因和经验教训报道如下。临床资料患者 ,女 ,2 7岁 ,5 0ｋｇ ,左颈部肿块 2ｃｍ× 2 5ｃｍ ,术前心电图无异常 ,ＡＳＡⅠ级。术前用药为苯巴比妥钠 0 1ｇ肌注。于上午 8∶0 0在局部麻醉 ( 0 5 %利多卡因 + 1∶2 0万肾上腺素 )下行肿块切除术。当探查肿块时 ,患者躁动不安 ,全身大汗 ,于 10∶0 0肌注哌异合剂 (哌替啶 75ｍｇ、异丙嗪 3 7 5ｍｇ) ,效果仍不佳。 10∶ 3 0静脉内注射氯胺酮 3 7 5ｍｇ、安定3 75ｍｇ后病人安静。随即测血压为 0 ,心率 15 0次 /分 ,…     

颈动脉体瘤2例报告

颈动脉体瘤２例报告任智李正中鲍民生赵浩亮马艳波何若冲颈动脉体瘤（ｃａｒｏｔｉｄｂｏｄｙｔｕｍｏｒ）又称化学感受组织瘤（ｃｈｅｍｏｄｅｃｔｏｍａ），是发生于颈动脉体的一种少见的内分泌肿瘤。本病由ＶｏｎＨａｌｅｒ（１７４３）和Ｌｕｓｈｋａ（１８６２）首先...     

颈动脉体瘤38例

颈动脉体瘤是一种化学感受器肿瘤,又称副神经节细胞瘤,临床比较少见。由于其病变部位特殊,局部解剖复杂以及血管丰富,外科治疗中有时需切除颈动脉,重建血流,手术难度大,危险性高。可能出现偏瘫、死亡等严重并发症,临床处理较困难。本文收集了我院手术治疗的38例颈动脉体瘤,现将治疗方法及结果报道如下:1资料与方法1.1临床资料我院1979年7月~2006年2月经手术治疗的颈动脉体瘤共38例,男15例,女23例。年龄28~68岁,平均年龄38.5岁。病变位于双侧1例,左侧22例,右侧15例。除常规全麻术前检查外,重点行B超、CT检查和颈动脉造影,了解肿瘤位置、范…     

颈动脉体瘤的外科治疗

目的：探讨颈动脉体瘤（CBT）的外科治疗方法，方法：回顾性分析78例CBT的临床资料。结果：78例共88个肿瘤（双侧CBT10例）中切除83个，手术方式：CBT剥除28例侧；CBT与颈外动脉同时切除12例侧；CBT剥离式切除和颈内动脉部分切除，颈内动脉间置吻合3例侧，颈内动脉对端吻合1例侧，颈外动脉与颈内动脉吻合1例侧；CBT与颈总动脉整块切除颈动脉重建30例侧；CBT切除与颈总动脉结扎8例侧；手术死亡率为3．8％（3／78），65例术后随访1－21年，64例仍存活，1例于术后7年死于肺转移。随访期间，1例术后2年局部复发，行再次切除已8年无复发；1例家族性病例左侧病变切除后10年出现右侧病变。结论：颈动脉体瘤可双侧发病，可有家族性，可恶变和可有内分泌相关的特性，对于较小的瘤体术中常可用分离法加以切除；涉及颈外动脉时可将其与瘤体同时切除；涉及颈内动脉而瘤体难以完全自颈内动脉剥脱时，可切除部分颈内动脉，行对端吻合，人工血管间置移植或以颈外动脉与之吻合，瘤体过大或粘连严重时，对端吻合可在瘤体横断面的颈内动脉上进行。     

左颈部迷走神经体瘤伴发对侧颈动脉体瘤1例

患者,女,46岁,因右颈部无痛性肿物9个月伴干咳于2006年12月18日入院。患者既往体健,否认家族性遗传病史。查体：患者一般情况好．心肺腹未见异常。右侧下颌角下胸锁乳突肌深面有一肿物,大小约2cm×2．5cm×3cm,肿瘤由颈外动脉供血。诊断为右颈动脉体瘤。左颈部近颅底处显示一富血性肿瘤。初步诊断为左颈部迷走神经体瘤。     

外膜下剥离切除颈动脉体瘤13例体会

目的探讨外膜下剥离切除颈动脉体瘤的疗效。方法对１９８９～１９９７年收治的１３例颈动脉体瘤的诊治资料进行回顾性总结。结果本组１３例颈动脉体瘤包括单侧发病１２例，双侧发病１例，术前Ｂ型超声证实５例，ＣＴ确诊７例；１３例均经手术治疗，其中１１例行外膜下剥离切除术，无手术死亡和术后并发症。术后随访１０例，随访率为７７％，随访时间１～５年，平均２年３个月，无肿瘤复发。结论颈部Ｂ型超声、ＣＴ扫描和颈动脉造影对本病有重要诊断价值，外膜下剥离切除颈动脉体瘤的方法较为安全和有效。     

颈动脉体瘤手术前后的护理

本文介绍了15例颈动脉体瘤手术前后的护理,也括术前颈动脉压迫训练及颈动脉造影前后的护理的效果检验、注意事项。作者认为术前的颈总动脉压迫训练及术后对病人生命体征和对侧肢体功能情况的观察,及时对症处理是保证手术成功的重要一环,也是护理的关键。     

颈动脉体瘤22例临床分析

目的：探讨合理的颈动脉体瘤临床治疗方案。方法：回顾22例颈动脉体瘤临床资料，分析手术方式与并发症的关系，并对存活病例进行随访观察。结果：手术后近期21例存活，1例死亡为颈动脉结扎手术引起急性脑缺血所致。21例中发生面神经损伤、迷走神经损伤各1例。6月-10年随访，平均4年5个月，1例术后5年复发，1例术后3年因其它疾病死亡。结论：肿瘤单纯切除和肿瘤切除、颈动脉重建是安全、有效的治疗方案，手术中脑神经的保护和减少脑缺血时间是预防术后严重并发症的关键。     

颈动脉体瘤的诊断与外科治疗

目的 总结颈动脉体瘤的诊断与外科治疗经验.方法 回顾性分析42例(46侧)颈动脉体瘤的治疗情况,包括术前准备、麻醉方法、手术方式、手术效果及并发症发生情况.结果 18例(19侧)患者行颈动脉体瘤剥离术,24例(27侧)行颈动脉体瘤切除+颈动脉重建术.围术期无死亡病例,1例患者发生脑梗塞,10例出现颅神经麻痹表现.随访期间未发现肿瘤复发.结论 手术是颈动脉体瘤的首选治疗,完整地保留或重建颈动脉是手术的关键.     

对侧颈动脉切除后的颈动脉体瘤手术

目的 探讨对侧颈动脉已被切除的颈动脉体瘤的手术方法.方法 左颈动脉体瘤患者1例,女,54岁.右侧颈动脉31年前因右颈动脉体瘤手术已经切除,本次手术以成对的蚊式钳逐步直接分离至瘤体与颈内动脉的Gorldon-Tayler白线,在保证颈内动脉完整的情况下,完整切除瘤体及包裹其内的颈外动脉.结果 患者术后无声音嘶哑、呛咳、头晕等并发症,顺利出院.结论 充分的术前准备及正确的分离平面是保证手术顺利的关键.     

颈动脉体瘤8例报告

颈动脉瘤少见难治，１９９６年３～１１月内收治１２个瘤体。其中双侧病变４例（５０％），３例属同一家族（一男二女，为亲兄妹）。对６例８个瘤体施行了切除，除１例术后有短期吞咽困难外无并发症。认为：对本病应争取采用瘤体剥脱术，其次为瘤体与颈外动脉同时切除，当颈动脉明显受累时，应采取颈总动脉重建分叉与瘤体切除和颈动脉重建法；应力求避免结扎颈总和颈内动脉；当需重建动脉时，我们提倡先重建动脉，后切除瘤体；对巨大或紧贴颅底者，可在施行近侧动脉吻合后，横断瘤体，自断面上显露颈内动脉开口，完成吻合，最后便可从容地切除瘤体。     

Huge Localized Fibrous Tumor of the Pleura Resembling a Mediastinal Tumor: Report of a Case

A 67-year-old man was admitted to our hospital because of an abnormal chest echoic lesion detected incidentally by echocardiography. A chest roentgenogram showed the presence of a giant mass, and computed tomography of the chest confirmed the presence of a mass with a nonhomogeneous density in the left mediastinum, just adjacent to the left ventricle of the heart. Percutaneous aspiration cytology of the mass showed benign fibrous cells and a small amount of lymphocytes. The preoperative diagnosis of the tumor suggested a thymoma, and the patient underwent a thoracotomy. A pedunculated tumor arose from the visceral pleura of the left upper lobe of the lung, and it was capsulated within the pleura. The tumor measured 15 × 12 × 8cm in size and it was successfully resected. The pathological diagnosis of the tumor was benign localized fibrous tumor of the pleura.     

Extravesical Tumor Implantation Caused by Perforation during Transurethral Resection of a Bladder Tumor: A Case Report

We report a case of invasive bladder cancer in which cancer dissemination occurred through a perforation of the vesical wall during transurethral resection of the tumor. A radical cystectomy was performed 1 month later and several clusters of viable cancer cells were histologically identified in a fibrous foreign body granuloma in the paravesicular adipose tissue of the lymphadenectomy specimen. The patient received adjuvant chemotherapy, but developed right inguinal lymph node metastasis 21 months after cystectomy.     

Lateral Malleolus Reconstruction After Tumor Resection in Children: A Case Report and Literature Review

BackgroundPediatric reconstruction of lateral malleolus was necessary and challengeable. Up to now, vascularized fibular was the optimal graft to reconstruct epiphyseal defection. However, the sophisticated microvascular operation has limited the wide application of this technique.Case PresentationWe present the case of a 9‐year‐old boy with Ewing sarcoma in left distal fibula. In order to restore the growth capacity, we used reverse‐flow vascularized fibular epiphyseal graft with tibialis anterior artery to reconstruct the bone defect after tumor resection with no microvascular anastomosis. More than 4 years after the operation and adjuvant chemotherapy, the patient was free of pain and recurrence, and the function and stability of ankle joint was perfect. Radiology examination revealed satisfied bony union of fibula and normal growth of the fibular head transplant.ConclusionsThe advantage of reverse‐flow vascularized fibular epiphyseal graft is requiring no microvascular anastomosis which could not only shorten operating time, but also reduce factitious damage of vessels. This report presented that this technique might be an available option for reconstruction of lateral malleolus in children.     

肠系膜上动脉切除及重建的胰头癌扩大根治术1例报告

目的 探讨胰头癌侵犯肠系膜上动脉时行根治性切除的可行性。方法 采用联合将受侵犯的肠系膜上动态一并切除的胰十二指肠切除术，肠系膜上动态断端与腹主动脉端侧吻合方式重建。结果 患者术后恢复顺利，已随访14个月，仍存活。结论 肠系膜上动态侵犯的胰头癌仍可行扩大的胰十二指肠切除术，并可延长患者的生存时间和提高生活质量。     

Extra-Abdominal Fibromatosis (Desmoid Tumor) Arising in the Infratemporal Fossa: A Case Report

Aggressive fibromatosis (or desmoid tumor) refers to a histologically benign but locally aggressive lesion arising from musculoaponeurotic structures in various anatomic sites. Extra-abdominal desmoids represent about one third of all desmoid tumors; of these only about 11 to 15% arise in the head and neck. Desmoid tumors arising in the infratemporal fossa are exceedingly rare; to our knowledge only one such tumor has been reported in the literature. We present a desmoid tumor arising in the infratemporal fossa with intracranial extension in a twenty-seven year old male and review the literature on this rare condition.