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腔镜辅助乳腺巨大纤维腺瘤切除术10例分析 总被引:1,自引:0,他引:1
巨大纤维腺瘤是纤维腺瘤的少见类型,是指直径超过7cm以上者,好发于15~35岁的年轻女性。这种巨大的乳腺肿块可引起乳腺的畸形,应手术切除。为解决年轻女性患者对手术较为关注的切口瘢痕问题,2006年10月~2008年8月我院对10例巨纤维腺瘤在腔镜辅助下行乳晕切口巨大纤维腺瘤切除术,取得满意效果,现报道如下。 相似文献
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乳腺多发性良性肿物手术的改进 总被引:2,自引:1,他引:1
乳腺纤维腺瘤是最常见的乳腺良性肿瘤,好发于年轻女性,其中多发性纤维腺瘤占10%~25%,对此类患者如何尽可能满足术后的美容要求,一直是一个较为棘手的问题。我们自2001年以来为9例乳腺多发性纤维腺瘤患者行经乳房下皱襞切口后入路切除手术,效果满意,现报道如下。 相似文献
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乳腺纤维腺瘤是最常见的乳房良性肿瘤,好发于年轻女性,约75%为单发,好发于乳房外上象限,目前以手术治疗为主。传统方法是在乳腺肿块表面皮肤做放射状切口,目的是减少乳管损伤,但此手术切口瘢痕明显,影响美观,尤其对于年轻女性难以接受。随着微创理念已拓展至心理微创,从美容角度出发,切口移至胸部的内镜下甲状腺切除术,经脐单孔腹腔镜手术等隐蔽性切口手术的报道越来越多。近年兴起的真空辅助乳腺旋切具有切口小且隐蔽等优点,但费用昂贵不适合在基层医院普及。2009年1月-2011年7月我们对98例中青年女性乳腺纤维腺瘤(遵化市人民医院48例,唐山市妇幼保健院乳腺科50例)根据肿块位置不同,个体化采取不同隐蔽性切口切除,取得了满意效果,现报道如下。 相似文献
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乳腺结核的诊治探讨:附89例报告 总被引:2,自引:0,他引:2
目的:探讨乳腺结核的诊断和治疗方法。方法:回顾性分析21年间收治的89例乳腺结核的临床资料。结果:乳腺结核的发病率逐年增高,边远山区农民及进城打工族是高发群体,误诊率高达62.9%。治疗以手术为主,辅以综合治疗;选择恰当时机,能减少手术切除范围,满足年轻女性生活质量的要求。结论:临床医生应提高对乳腺结核的认识,提高确诊率,以防漏诊误诊,特别是误诊为乳癌,以免给患者造成不应有的痛苦和负担。 相似文献
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目的探讨腔镜治疗乳腺多发性纤维腺瘤的可行性。方法经超声检查结合细针细胞学检查诊断乳腺多发性纤维腺瘤12例。选择腋窝小切口入路,钝性分离乳腺后间隙,充气建立乳腺后间隙手术气腔,腹腔镜下切除共58个纤维腺瘤,术中冰冻切片。结果12例肿瘤均在腹腔镜下成功切除,无手术并发症。手术时间40~150min,平均80min。术后1个月乳房形态良好,乳头感觉正常。12例术后随访1~36个月,平均18.5月,乳房表面无瘢痕,无肿瘤复发,患者对美容效果满意。结论经乳腺后间隙入路,腔镜治疗乳腺多发性纤维腺瘤是一种安全、可行的治疗方法。 相似文献
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乳腺叶状囊肉瘤和巨纤维腺瘤诊治体会(附17例报告) 总被引:1,自引:0,他引:1
施勇 《中国普外基础与临床杂志》2007,14(1):92-94
目的探讨乳腺叶状囊肉瘤和巨纤维腺瘤的诊断和治疗。方法回顾分析我院1985~2002年期间外科收治的9例乳腺叶状囊肉瘤和8例乳腺巨纤维腺瘤的临床资料。结果9例乳腺叶状囊肉瘤中行单纯乳房切除术4例,保留乳头皮下乳房切除术1例,保留乳头和部分压缩腺体 肿块切除术1例,改良根治术3例;术后恢复良好,仅1例复发。8例乳腺巨纤维腺瘤中行单纯乳房切除术2例,保留乳头皮下乳房切除术1例,保留乳头和部分压缩腺体 肿块切除术2例,单纯乳腺肿块切除术3例;术后恢复良好,术后2例复发。结论乳腺叶状囊肉瘤和巨纤维腺瘤临床上均表现为无痛性包块,除乳腺叶状囊肉瘤发病年龄较大、肿块范围大及易恶变外,二者主要依据病理检查结果相鉴别;均以手术治疗为主,根据患者年龄、肿块大小以及病理检查结果选择不同的手术方式。 相似文献
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260例乳腺结节临床分析 总被引:1,自引:0,他引:1
目的探讨乳腺结节的诊疗。方法260例女性乳腺结节进行钼靶X线和彩超诊断,并进行手术治疗,检测乳腺结节的病理类型。结果260例患者中144例确诊为乳腺增生症伴腺瘤样结节形成(占55.4%),58例为乳腺纤维腺瘤(占22.3%),28例为乳腺浸润性导管癌(占10.8%),25例为导管内乳头状瘤(占9.6%),5例为硬癌(占1.9%)。结论乳腺结节多为乳腺良性病变;手术是治疗本病的首选方法。 相似文献
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重视乳腺良性疾病与癌前病变的诊治研究 总被引:3,自引:0,他引:3
姜军 《中国实用外科杂志》2009,29(3):196-198
乳腺增生性疾病发病机制尚不清楚,临床诊断、治疗标准尚缺乏共识,对其可能发生癌变的临床特点和规律认识仍不清楚,对疾病进展缺乏有效的临床监测方法。乳腺纤维腺瘤外科治疗中如何关注到病人美观问题,需要探索微小纤维腺瘤的处理原则和微创手术方法,乳腺纤维腺瘤病的预防和治疗仍然存在困难。聚丙烯酰胺水凝胶类注射式隆乳后发生的哺乳期急性乳腺炎发病和治疗方法具有特殊性,而浆细胞性乳腺炎的治疗方法尚未达成共识。乳腺癌前病变的诊断和临床检测方法和乳腺原位癌的治疗仍须进一步深入研究。努力探索解决这些临床问题的方法是进一步提高乳腺良性疾病治疗效果的关键。 相似文献
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目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。 相似文献
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Background: Anterior interosseous nerve (AIN) palsy is a very uncommon cause of upper extremity pain and weakness that comprises less than 1% of all upper extremity nerve palsies. Rarely reported but also mentioned in the literature is AIN palsy after shoulder arthroscopy. Methods: A systematic review of the literature to date using PubMed was conducted to identify patients who suffered AIN palsy after shoulder arthroscopy procedures. Articles included met the following criteria: (1) published in English; (2) primary presentation of the data; (3) patients had undergone shoulder arthroscopy before developing symptoms of AIN palsy; and (4) diagnosis was confirmed with clinical symptoms of AIN palsy. Measured outcomes included patient demographics, specific shoulder procedure, anesthesia procedure, intra-operative patient positioning, intra-operative compressive dressing, intra-operative traction, surgical versus conservative treatment, abnormal findings during decompression procedure, proposed mechanism of injury, and follow-up. Results: The search yielded 6 articles, of which 4 (13 cases) met inclusion criteria. An additional 2 cases were included in this report totaling 15 cases. The average patient age was 49 years (range: 31-64) with 73% males. At average follow-up of 24 months, 67% of patients experienced complete resolution of symptoms—more than half of which underwent surgical decompression. Patients who failed to progress experienced weakness of the flexor digitorum profundus and flexor pollicis longus muscles. Conclusions: Proposed injury mechanisms for AIN palsy after shoulder arthroscopy range from mechanical trauma, compressive hematoma, and direct anesthetic neurotoxicity. Management should be directed by clinical symptoms, imaging, and patient factors with majority of patients expected to have excellent clinical outcomes. 相似文献
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目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。 相似文献
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Objective:
To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.Design:
Case report; literature review.Findings:
Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.Conclusion:
Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment. 相似文献15.
Juan Manuel Suá rez-Grau Carlos Bernardos Garcí a Carmen Cepeda Franco Cristina Mendez Garcí a Salud Garcí a Ruiz Fernando Docobo Durantez Salvador Morales-Conde Javier Padillo Ruiz 《World journal of gastrointestinal surgery》2016,8(9):627-633
AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions. 相似文献
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目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。
方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者,按照随机数字法分为对照组和观察组,每组各60例。对照组采用常规护理治疗,观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。
结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组(P<0.05);术后观察组患者的抑郁自评量表(SDS)和焦虑自评量表(SAS)评分显著低于对照组(P<0.05);术后2组患者均无切口感染发生,2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异(P>0.05);术后观察组患者护理满意度为96.67%,显著高于对照组的83.33%(P<0.05)。
结论在常规护理的基础上,罗伊适应模式用于患者腹股沟疝无张力修补围手术期,能有效改善术后患者的焦虑/抑郁情绪,不增加围手术期并发症,促进术后患者的恢复及提高治疗满意度。 相似文献
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Favipiravir, an antiviral agent originally used for influenza infections, has become popular due to its beneficial signals in coronavirus disease. It is currently used in some countries within COVID-19 treatment protocols. This is an initial report of favipiravir-related fluorescence observed in three healthcare providers working in the same ward in our hospital. All three individuals had been diagnosed with COVID-19 two months earlier and were treated with favipiravir. None of the three individuals received hydroxychloroquine or tetracyclines. Wood’s light examination led to an incidental discovery of favipiravir-induced fluorescence involving the sclera, nails, and teeth. In all patients, white linear, square, and band-like specks of fluorescence were noticed on the sclera of both eyes, some teeth, and the proximal part of all fingernails and toenails. Exposure of the eyes to the Wood’s light was for a brief duration of 3 to 5 seconds during examination and photodocumentation. Favipiravir might cause bright white fluorescence of nails, sclera, and teeth, detectable by Wood’s light even two months after its cessation. 相似文献
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Cammu G De Kam PJ Demeyer I Decoopman M Peeters PA Smeets JM Foubert L 《British journal of anaesthesia》2008,100(3):373-379
BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time. 相似文献
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Jonathan Lans Bo J.W. Notermans Lazin Germawi Hang Lee Jesse B. Jupiter Neal C. Chen 《Hand (New York, N.Y.)》2021,16(4):461
Background: Silicone proximal interphalangeal (PIP) joint arthroplasty has a high revision rate. It has been suggested that persistent ulnar deviation and joint instability influence the durability of PIP silicone arthroplasties. The goal of this study was to evaluate what factors are associated with reoperation after silicone PIP arthroplasty. Methods: We retrospectively evaluated all adult patients who underwent PIP silicone arthroplasty between 2002 and 2016 at one institutional system for inflammatory-, posttraumatic-, and primary degenerative arthritis. After manual chart review, we included 91 patients who underwent 114 arthroplasties. Fingers operated included 14 index, 41 middle, 38 ring, and 21 small fingers. Results: The overall reoperation rate was 14% (n = 16). Non-Caucasian race (P = .040), smoking (P = .022) and PIP silicone arthroplasty for post-traumatic osteoarthritis (P = .021) were associated with reoperation. The 1-, 5- and 10-year implant survival rates were 87%, 85%, and 85%, respectively. Conclusion: Caution should be exercised when considering PIP silicone arthroplasty of the index finger or in patients with post-traumatic osteoarthritis. It may be worthwhile addressing smoking behavior before pursuing silicone PIP arthroplasty. 相似文献
20.
目的探讨血浆凝血因子VIII(factor VIII,FVIII)水平与IgA肾病(IgAN)患者临床参数及预后的关系。方法收集2016年1月至2016年12月中南大学湘雅二医院确诊的IgAN患者的临床资料。按照时间依赖的受试者工作特征曲线(ROC)得出的血浆FVIII预测IgAN预后的临界值,将患者分为高FVIII组(FVIII>140.50%)和低FVIII组(FVIII≤140.50%),比较两组患者肾活检时基线临床参数的差异。以估算肾小球滤过率(eGFR)下降≥30%或进入终末期肾脏病(ESRD)为终点事件,采用Kaplan-Meier生存曲线及Cox回归方程法分析血浆FVIII水平对IgAN患者预后的影响。结果共93例IgAN患者纳入本研究,中位随访时间为35.15(33.77,36.76)个月,12例(12.90%)患者发生终点事件。高FVIII组患者年龄、血肌酐、尿素氮、血三酰甘油、血总胆固醇、血浆纤维蛋白原、D-二聚体、24 h尿蛋白量、蛋白C、蛋白S和eGFR下降速率高于低FVIII组(均P<0.05);eGFR、血白蛋白、中位随访时间低于低FVIII组(均P<0.05)。Kaplan-Meier生存分析结果显示,与低FVIII组比较,高FVIII组患者肾脏累积生存率降低(χ2=5.635,P=0.018)。在校正收缩压、eGFR、尿蛋白、肾小管萎缩/间质纤维化程度等因素后,多因素Cox回归分析结果显示,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素(HR=4.147,95%CI 1.055~16.308,P=0.042)。结论血浆FVIII水平与IgAN患者临床指标及预后相关,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素。 相似文献