Resected cases with primary lung cancer after preoperative high dose irradiation

After greater than 60 gray (Gy) irradiation, we performed the pulmonary resection in the 18 primary lung cancer cases. The mean irradiation dose to the tumor was 68.2 (range 60-101) Gy, and the mean irradiation dose to the bronchial stump was 47.1 (range 0-82) Gy. Median time from end of irradiation to surgical resection was 136 (range 20-894) days. One partial resection, 9 single lobectomies, 3 double lobectomies, and 5 pneumonectomies were done. Mainly, we closed the bronchial stump by the automatic stapling device and additional hand suturing. The bronchial stump was covered in the 12 cases by the owner stalk thymus, the intercostals muscular flap, the omentum flap, and et al. The major postoperative complications due to preoperative irradiation were not seen. Bronchopleural fistulas did not occur. Pathologically, the wall of the submucosal capillary vessels were getting thick in the patients operated more than 3 months later after irradiation. In such cases with the decrease of the blood flow, the bronchial stump should be covered. The pulmonary resection after the high dose irradiation was considered to be tolerable.     

Resected case of thymic cyst with primary lung cancer

Thymic cyst is a rare and benign tumor of mediastinal tumor. A 77-year-old male was pointed out the tumor shadow on Chest X-ray film and diagnosed lung cancer. On admission some examination was performed and revealed mediastinal tumor accidentally. Primary lung cancer was completely resected and mediastinal tumor was extirpated. Pathological examination revealed lung cancer (poorly differentiated squamous cell carcinoma) and thymic cyst. Many methods of examination were tried for diagnosis of thymic cyst, but couldn't diagnose exactly before its resection. Some of the patients with thymic cyst was reported to develop SVC syndrome or change to malignant tumor. Therefore we think complete resection is the best treatment.     

Primary lung cancer of the right middle lobe

During the period from 1973 to 1986, 230 patients with lung cancer were operated on at our Surgical Clinic of Kagoshima University Hospital. There were fourteen patients (6.1%) with lung cancer in the right middle lobe. There were 13 male and 1 female patients. The histological types were adenocarcinoma (10), squamous cell carcinoma (4). Five-year survival rate of 14 patients was 34.9%. Statistically, it was similar to that of the patients with lung cancer in the other lobes. As concerns with the histological type of lung cancer in the right middle lobe, the case of squamous cell carcinoma revealed poorer prognosis than those of adenocarcinoma, because there were many cases of advanced cancer in the former case.     

尾叶原发性肝癌的手术切除(附12例报告)

总结１２例尾叶原发性肝癌手术切除的经验，应用ＰＭＯＤ采取刮吸法断肝，可清楚解剖出管道结构，便于可靠结扎并节省时间；肝正中裂完全切开，有利于尾叶的显露。介绍了左侧尾叶切除、右侧尾叶切除、双侧尾叶切除和单独尾叶切除的操作方法     

中肝叶巨大原发性肝癌的手术切除

目的　探讨中肝叶巨大肝癌的手术切除技术。方法　回顾性分析 1996年 10月至 2 0 0 1年 12月施行肝切除术的 16 6例中肝叶巨大肝癌的术中处理、术后并发症及原因。结果　全组均为常温间歇性第一肝门阻断下切肝 ,单例总阻断时间最长 6 8min ,最短 7min ,平均 2 4 .5min ;输血量最多为5 2 0 0ml,5 4例未输血 ;肿瘤切除 12 3例 (74 .1% ) ,规则性肝叶切除 4 3例 (2 5 .9% ) ;术后并发症 9例(5 .4 % ) ,手术死亡 2例 (1.2 % )。结论　术前良好的肝功能储备是保证中肝叶巨大肝癌手术切除术后顺利恢复的首要条件 ,术中仔细操作是降低术后并发症的关键     

经尿道前列腺中叶剜除术治疗高危前列腺中叶增生

目的 探讨经尿道前列腺腔内中叶剜除术治疗高危前列腺中叶增生患者的临床疗效.方法 采用经尿道前列腺腔内中叶剜除术治疗高危前列腺中叶增生患者42例,对其手术前后前列腺体积、残余尿量、国际前列腺症状评分(IPSS)、生活质量评分(QoL)和最大尿流率(Qmax)等指标进行统计学分析.结果 42例患者均顺利完成手术,术中及术后无严重并发症发生.术后3个月时复查残余尿量、IPSS、QoL和Qmax,与术前比较差异有统计学意义.结论 经尿道前列腺中叶剜除术治疗高危前列腺中叶增生具有手术时间短、出血量少、可控性强和疗效确切等优点,是一种安全、有效的微创治疗高危前列腺中叶增生的术式.     

Thoracoscopic middle lobe resection]

The authors report a case of middle lobectomy by a thoracoscopic procedure. A forty-year old patient had carcinoma of the middle lobe (6 cm diameter). The use of staplers and ligatures by this way allows the control of the different vessels and bronchus. The indications of that technique must be evaluated in the future.     

前列腺中叶增生与膀胱出口梗阻程度的相关性分析(附131例报告)

目的:分析良性前列腺增生(BPH)患者中叶增生大小与膀胱出口梗阻(BOO)程度之间的相关性。方法:对2008年5月~2010年6月因排尿困难就诊的BPH患者131例,通过经腹超声测定前列腺三径和前列腺突入膀胱的距离(IPP),尿动力学检查测定最大尿流率(Qm ax)、最大尿流率时的逼尿肌压力(Pdet@Qm ax),利用L in-PURR图判断梗阻级别和逼尿肌收缩力,并计算出AG值(AG=Pdet@Qm ax-2Qm ax)。不同IPP梗阻程度的比较采用方差分析,并对前列腺体积(PV)、IPP与AG值进行相关性分析。结果:当IPP>10 mm时,IPP与BOO高度正相关(相关系数r=0.821,P<0.01)。PV与BOO相关度较低(r=0.475,P<0.01)。IPP与Pdet@Qm ax高度正相关(r=0.865,P<0.01)。结论:前列腺中叶增生与BOO存在高度相关性,超声测定中叶突入膀胱的距离是判断BOO程度较为可靠的方法。     

右肺中叶疾病的诊断与外科治疗

目的　探讨右肺中叶疾病 (简称中叶疾病 )的诊断与外科治疗的特殊性和规律性 ,为临床诊治提供依据。　方法　回顾分析我院 1989年 1月～ 2 0 0 2年 4月手术治疗中叶疾病 16 3例的临床资料及随访结果。　结果　 16 3例中 ,78例 (47 9% )为恶性肿瘤 ,85例 (5 2 1% )为良性疾病 ;<5 0岁者 91例 ,81 3% (74例 )为良性疾病 ,显著高于恶性肿瘤的发生率 (P <0 0 1) ,≥ 5 0岁者 72例 ,84 7%(6 1例 )为恶性肿瘤 ,显著高于良性疾病的发生率 (P <0 0 1) ;11例结核患者中 8例 (72 7% )合并支气管扩张。术后除 1例因呼吸衰竭死亡外均康复出院 ;7例 (4 3% )叶间积液 ,穿刺抽液后恢复。恶性肿瘤患者的 1、3、5年生存率 ,Ⅰ、Ⅱ期分别为 88 4 % (38/ 4 3)、6 2 8% (2 7/ 4 3)、5 1 2 % (2 2 / 4 3) ,Ⅲ、Ⅳ期分别为 76 5 % (2 6 / 34)、4 1 2 % (14 / 34)、14 7% (5 / 34)。 4例楔形切除恶性肿瘤者均术后 1年内复发 ,1例接受再次手术切除中叶及下叶者术后 38个月死于全身衰竭 ,良性病变无复发。结论　 (1)对中叶疾病应重视肺癌的可能 ,尤其对 5 0岁以上者 ;(2 )中叶疾病性质难以明确时 ,宜剖胸探查 ;(3)中叶结核多合并支气管扩张 ,保守治疗效果不佳 ;(4)单纯中叶切除术后在右侧第 4肋间锁骨中线内侧 2cm处放置     

Two cases of primary female urethral cancer

Herein, we report two cases of female urethral cancer. Case 1 presented with acute urinary retention and case 2 presented with a painful perineal mass. Magnetic resonance imaging (MRI) revealed a urethral tumor in both cases. Histopathological examination of transperineal biopsy specimens from both patients suggested clear cell adenocarcinoma in case 1 and squamous cell carcinoma in case 2. Both cases underwent total urethrectomy with partial resection of the vaginal wall and cystostomy urinary diversion. With reference to case 1, obturator lymph node metastases were observed during surgery, and treatment comprised combined radiotherapy to 60 Gy and chemotherapy with 5-fluorouracil and cisplatin following surgery. However, metastases appeared in the lung 6 months after initial treatment and she died 20 months after surgery. For case 2, tumor marker failure was observed 5 months after surgery. The same combined treatment was performed and a complete response was obtained. At 19 months after surgery, the patient showed no evidence of recurrence.     

Isolated middle lobe atelectasis: aetiology, pathogenesis, and treatment of the so-called middle lobe syndrome.

Isolated atelectasis of the middle lobe has been known for many years as the "middle lobe syndrome". Several clinical studies have shown that it may bae caused by malignant tumours. A 10-year study of 135 patients with isolated middle lobe atelectasis is presented. Fifty-eight patients (43%) had malignant tumours. Of 38 who had a thoracotomy, lung resection was possible in 25. In 20 patients regional or systemic dissemination of the tumour had been diagnosed before operation. Seventy-seven patients had benign diseases, of which 74 were non-specific infections. Bronchography was performed in 46 of these cases, and all had abnormal findings in the middle lobe, eight revealing definite bronchiectasis. In three cases tuberculosis was found. In 16 cases the benign diagnosis was established at thoracotomy. Only three patients out of 58 with malignant tumours lived more than five years. Atelectasis of the middle lobe is always a sign of potential malignancy especially in patients with a previously normal chest radiograph.