多发性内分泌腺瘤病2A型（MEN2A）中嗜铬细胞瘤的临床特点及治疗

目的分析多发性内分泌腺瘤病2A型（MEN2A）家系中嗜铬细胞瘤患者的临床特点,并探讨其治疗方法。方法收集3个MEN2A家系,共有8例MEN2A患者均患有嗜铬细胞瘤,分析这8例患者高血压特点、24h尿VMA及肾上腺CT结果、嗜铬细胞瘤患病情况及治疗方法。结果8例MEN2A患者中7例有甲状腺髓样癌（87．5％）,8例有嗜铬细胞瘤（100％）,没有发现有HPT的发生,其中6例（75％）患者是以嗜铬细胞瘤起病,而且嗜铬细胞瘤中7例（87．5％）为双侧。8例患者中3例（37．5％）为持续性高血压,5例（62．5％）为阵发性发作高血压,6例（75％）24h尿VMA升高,2例（25％）高血压发作时尿VMA／Cr比值明显升高。4例患者经腹腔镜切除肿瘤,4例经开腹手术切除肿瘤,随诊7例（87．5％）良性嗜铬细胞瘤患者术后随诊均未见肿瘤复发。结论本研究结果提示MEN2A中嗜铬细胞瘤常为双侧,临床可表现为持续性高血压也常有阵发性高血压者,生化及影像学检查有助于诊断,RET基因的突变检测能使MEN2A中嗜铬细胞瘤得到早期诊治,腹腔镜下手术是MEN2A中嗜铬细胞瘤治疗的理想方法。     

SPECT／CT ^13I-MIBG肾上腺髓质显像在肾上腺疾病中的应用

目的：评价SPECT／CT ^13I-MIBG肾上腺髓质显像对肾上腺疾病的诊断价值。方法：回顾性对照分析42例拟诊肾上腺疾病的患者SPECT／CT ^13I-MIBG肾上腺髓质显像、B超、CT、MRI、尿-香草基杏仁酸(VMA)及术后病理结果。结果：42例拟诊肾上腺疾病的患者中SPECT／CT ^13I-MIBG肾上腺髓质显像诊断为嗜铬细胞瘤18例(42．85％)，肾上腺髓质增生7例(16．67％)。经术后病理结果证实的13例嗜铬细胞瘤和3例肾上腺髓质增生SPECT／CT ^13I-MIBG显像分别诊断为嗜铬细胞瘤13例(阳性率100％)及肾上腺髓质增生3例，明显高于MRI、CT、B超及24小时尿VMA。结论：SPECT／CT ^13I-MIBG肾上腺髓质显像对嗜铬细胞瘤、异位嗜铬细胞瘤和肾上腺髓质增生具有良好的定位、定性价值，明显优于B超、CT、MRI、尿VMA等检查。     

多发性内分泌腺瘤病2A型(MEN2A)中嗜铬细胞瘤的临床特点及治疗

目的 分析多发性内分泌腺瘤病2A型(MEN2A)家系中嗜铬细胞瘤患者的临床特点,并探讨其治疗方法 方法 收集3个MEN2A家系,共有8例MEN2A患者均患有嗜铬细胞瘤,分析这8例患者高血压特点、24 h尿VMA及肾上腺CT结果 、嗜铬细胞瘤患病情况及治疗方法 结果 8例MEN2A患者中7例有甲状腺髓样癌(87.5%),8例有嗜铬细胞瘤(100%),没有发现有HPT的发生,其中6例(75%)患者是以嗜铬细胞瘤起病,而且嗜铬细胞瘤中7例(87.5%)为双侧.8例患者中3例(37.5%)为持续性高血压,5例(62.5%)为阵发性发作高血压,6例(75%)24 h尿VMA升高,2例(25%)高血压发作时尿VMA/Cr比值明显升高.4例患者经腹腔镜切除肿瘤,4例经开腹手术切除肿瘤,随诊7例(87.5%)良性嗜铬细胞瘤患者术后随诊均未见肿瘤复发.结论本研究结果 提示MEN2A中嗜铬细胞瘤常为双侧,临床可表现为持续性高血压也常有阵发性高血压者,生化及影像学检查有助于诊断,RET基因的突1变检测能使MEN2A中嗜铬细胞瘤得到早期诊治,腹腔镜下手术是MEN2A中嗜铬细胞瘤治疗的理想方法     

嗜铬细胞瘤93例临床诊治总结

目的：探讨嗜铬细胞瘤的临床诊治经验。方法：收集分析1994年1月至2003年12月中山大学附属第一医院和中山大学附属汕头医院收治的93例嗜铬细胞瘤患者的临床资料。结果：93例患者临床表现主要为高血压（75例），90例患者接受尿香草扁桃酸检查，阳性者82例。B超、CT、MRI的定位诊断准确率分别为90％、96％、100％。全部病例均经手术和病理证实，其中良性75例，恶性18例。结论：术前做好充分的准备是关键，手术切除肿瘤是根本治疗方法。     

肾上腺肿瘤和瘤样病变1166例病理分析

目的：研究肾上腺手术标本的组织学类型和病理诊断的主要问题。方法：收集本科1980—2002年间全部肾上腺手术标本，根据世界卫生组织(WH0)内分泌肿瘤组织学分类(1999)标准进行病理分析。结果：肾上腺病变共1166例，其中肿瘤913例(78．3％)，非肿瘤性病变253例(21．7％)。肿瘤中良性881例(96．5％)，恶性32例(3．5％)。占良性肿瘤前三位的依次是肾上腺皮质腺瘤634例(72．0％)、嗜铬细胞瘤196例(22．2％)和髓性脂肪瘤30例(3．4％)；恶性肿瘤32例中肾上腺皮质癌22例(68．8％)，恶性嗜铬细胞瘤5例(15．6％)。非肿瘤性病变中肾上腺皮质增生206例(81．4％)，皮质萎缩13例(5．1％）；原发性色素性结节状肾上腺皮质病7例(2．8％)。肾上腺髓质增生8例(3．2％)。结论：①肾上腺病变占送检标本的0．32％，其发生率近年来呈上升趋势。②肾上腺皮质病变的主要组织学类型为皮质腺瘤和皮质增生。③髓质病变中93．8％为嗜铬细胞瘤。④肾上腺间质病变以髓性脂肪瘤最常见。⑤肾上腺恶性肿瘤非常少见，主要为皮质癌。因此，外科病理中的主要问题是皮质腺瘤与皮质结节状增生的鉴别，皮质癌的诊断应参照Weiss组织学标准。     

16层螺旋CT对肾上腺外嗜铬细胞瘤的诊断价值

目的：探讨16层螺旋cT检查对肾上腺外嗜铬细胞瘤的诊断价值。材料与方法：回顾性分析经16层螺旋CT检查发现,并有完整临床资料及手术病理结果的21例。肾上腺外嗜铬细胞瘤。结果：本组发现肾上腺外嗜铬细胞瘤共21例,发生部位：腹主动脉旁区14例,纵隔脊柱旁3例,膀胱壁2例,髂动脉附近1例,睾丸1例。良性18例,占85．7％,恶性3例,占14．3％。结论：MSCT能准确定位肾上腺外嗜铬细胞瘤,并能对良恶性肿瘤作出较准确的判断,可作为肾上腺外嗜铬细胞瘤一线影像检查技术。     

肾上腺肿瘤的诊断和治疗

目的 提高肾上腺肿瘤的诊断和外科治疗水平。方法 回顾性分析72例肾上腺肿瘤的诊疗资料，其中库欣综合征32例，原醛症24例，嗜铬细胞瘤11例，偶发瘤5例。结果 72例中有功能性肿瘤67例(93．1％)，其中恶性5例(7．4％)；无功能性肿瘤5例(6．9％)，其中恶性1例。恶性肿瘤中皮质癌1例，恶性嗜铬细胞瘤4例，非霍奇金淋巴瘤1例。本组手术切除肿瘤68例，无手术死亡病例。结论 肾上腺肿瘤中库欣综合征和原醛症女多于男。肾上腺肿瘤主要依据，临床表现，内分泌检查，CT等定位影像检查确诊。术前充分准备是保证手术成功的重要因素。手术是治疗肾上腺肿瘤的有效方法。     

彩色多普勒超声诊断嗜铬细胞瘤

目的:提高彩超对嗜铬细胞瘤的诊断水平。方法:回顾分析近五年超声诊断并经手术病理证实的嗜铬细胞瘤11例。结果:11例中7例肿瘤位于肾上腺内(左3,右4),4例肿瘤位于肾上腺外。3例恶性嗜铬细胞瘤中,1例位于肾上腺内,另2例肿瘤位于肾上腺外(下腔静脉旁1例,主动脉旁1例)。静止型嗜铬细胞瘤2例。超声定位诊断符合率为91％(10/11)。结论:嗜铬细胞瘤定性诊断需结合临床和生化测定,对钙化型嗜铬细胞瘤的诊断需持谨慎态度,对静止型嗜铬细胞瘤采用“肿瘤激惹征”协助定位和定性诊断。     

肾上腺嗜铬细胞瘤的超声诊断在手术治疗中的价值

目的：为探讨肾上腺嗜铬细胞瘤的超声定位定性诊断在外科治疗中的价值。方法：均经手术与病理证实的肾上腺嗜铬细胞瘤患23例，术前均行经腹部超声检查，将术前的超声定位定性诊断与手术进路的选择及病理结果对照分析。结果：23例肾上腺嗜铬细胞瘤定位诊断符合率为95．7％（22／23），定性诊断符合率为91．3％（21／23），19例手术进路选择肋缘下切口，4例选择经腹“人”字形切口。结论：肾上腺铬细胞瘤的定位定性诊断在手术治疗中起到重要的作用。     

腹膜后腹腔镜手术治疗肾上腺嗜铬细胞瘤

目的探讨经腹膜后入路施行腹腔镜肾上腺嗜铬细胞瘤切除术的疗效。方法行腹膜后腹腔镜肾上腺嗜铬细胞瘤切除术32例，术前经尿VMA、MRI及^131I-MIBG确诊为肾上腺嗜铬细胞瘤26例，拟诊嗜铬细胞瘤6例。术前均用苯苄胺等药物准备2—4周。手术采用气管内麻醉，取患侧向上的全侧卧位，经腹膜后入路，“手指分离法”建立腹膜后工作空间，显露肿瘤，用超声刀分离肿瘤周围组织，较大的血管及肾上腺中央静脉用钛夹双重钳夹后剪断，将瘤体置入标本袋内取出。结果32例均在腹膜后腹腔镜下顺利切除肿瘤。手术时间45—180min，平均（91．2±22．5）min。出血量20—160ml，平均（64．3±24．1）ml。29例（90．6％）在分离瘤体时血压波动〈40mmHg。瘤体直径28—53mm，平均（39．5±7．7）mm。术后血压稳定，疼痛较轻，术后4—9d出院。病理检查证实均为肾上腺嗜铬细胞瘤。结论腹膜后腹腔镜肾上腺嗜铬细胞瘤切除术具有操作精细准确，不需过多地推动和挤压肿瘤，出血少，创伤小，恢复快等优点。     

嗜铬细胞瘤的影像学定位诊断评价

目的:评价影像学对嗜铬细胞瘤的定位诊断价值,以指导临床手术与治疗。方法:回顾分析影像学诊断的45例嗜铬细胞瘤影像学表现,并与手术病理对照。结果:左侧肾上腺单发17例,右侧肾上腺单发15例,双侧肾上腺单发2例,右侧肾上腺多发1例,异位10例。良性嗜铬细胞瘤39例,恶性嗜铬细胞瘤6例;USG、CT、MRI、131I-MIBG SPECT检查定位诊断敏感性分别为90%,96%,95%,100%。结论:应用综合影像技术对嗜铬细胞瘤的定位诊断具有重要的临床价值。     

SPECT/CT ~(131)I-MIBG肾上腺髓质显像在肾上腺疾病中的应用

目的:评价SPECTCT131I-MIBG肾上腺髓质显像对肾上腺疾病的诊断价值。方法:回顾性对照分析42例拟诊肾上腺疾病的患者SPECTCT131I-MIBG肾上腺髓质显像、B超、CT、MRI、尿-香草基杏仁酸(A)及术后病理结VM果。结果:42例拟诊肾上腺疾病的患者中SPECTCT131I-MIBG肾上腺髓质显像诊断为嗜铬细胞瘤18例(42.85%),肾上腺髓质增生7例(16.67%)。经术后病理结果证实的13例嗜铬细胞瘤和3例肾上腺髓质增生SPECTCTI-MIBG显像分别诊131断为嗜铬细胞瘤13例(阳性率100%)及肾上腺髓质增生3例,明显高于MRI、CT、B超及24小时尿VMA。结论:SPECTCTI-MIBG肾上腺髓质显像对嗜铬细胞瘤、异位嗜铬细胞瘤和肾上腺髓质增生具有良好的定位、定性价值,明显优于B131超、CT、MRI、尿VMA等检查。     

Dual-Time-Point FDG-PET/CT for the Detection of Hepatic Metastases

Purpose  To prove the sensitivity of dual-time-point imaging with 18F-flourodeoxyglucose-positron emission tomography (18F-FDG-PET) of the liver to evaluate possible changes in the tumor-to-background ratio considering an improved detection rate of liver lesions. Procedures  Image acquisition for the first whole-body scan started at a mean time point of 69 min (55–110 min). The mean time interval between the injection of 18F-FDG and the second delayed scan was 100 min (85–166 min). Results  Of 90 proven liver metastases in 34 patients, the first scan detected 53 (59%) liver lesions correctly, whereas in the second, delayed scan 81 (90%) lesions were diagnosed correctly (p<0.001). The mean Standardized uptake values in the first and second delayed scan were 6.59 g/ml versus 8.09 g/ml, respectively (p<0.001). Tumor-to-background ratio of the first and second delayed scan were 2.0 and 2.7, respectively (p = 0.04). Conclusions  Dual-time-point-imaging of the liver showed a significant increase of tumor-to-background ratio and hypermetabolic lesion diameter. Although, 30% of all verified liver lesions could only be detected in the second delayed scan 10% of all malignant liver lesions were missed with FDG-PET.     

应用服水低张和改良式团注增强CT扫描技术检查胃肿瘤

目的：探讨常规ＣＴ在胃肠道肿瘤诊断中的价值和检查方法。材料和方法;作者回顾性分析４０例经ＣＴ检查手术病理证实的胃肠道肿瘤资料。使用日立Ｗ－５５０Ｅ,ＣＴ检查采用服水低张技术和改良式团注增强方法。结果;４０个病例,ＣＴ发现３６个病灶,其中胃腺癌２４例,平滑肌瘤７例。平滑肌肉瘤４例,胃神经鞘瘤１例,检出率９０％,定性总准确性８５％。     

嗜铬细胞瘤55例临床分析

目的:探讨嗜铬细胞瘤(PHEO)的临床特点。方法:回顾性分析55例PHEO的临床资料。结果:肾上腺PHEO占87%,肾上腺外占13%,恶性占9%。阵发高血压型占65%。24h尿VMA、5h尿VMA/Cr测定、B超、CT或MR、131I-MIBG测查阳性率分别为85%、75%、82%、96%、96%。结论:PHEO临床表现复杂多样,病程长、病情重者引发心、脑、肾、消化、内分泌等系统严重并发症。充分的术前准备十分重要。     

Percutaneous transluminal angioplasty of the subclavian arteries.

PURPOSE: To review the feasibility, risks, and long-term results of subclavian artery angioplasty with and without Palmaz stent placement. METHODS: Over a 9-year period, 113 patients (67 males; mean age 63 +/- 13 years) underwent percutaneous balloon angioplasty of subclavian occlusive lesions for a variety of indications: vertebrobasilar insufficiency (n = 70), upper limb ischemia (n = 50), coronary steal syndrome (n = 6), or anticipated coronary artery bypass grafting using the internal mammary artery in 12 asymptomatic patients. There were 94 (83%) stenoses and 19 (17%) occlusions with a mean percent stenosis of 80.1% +/- 7.4% (range 70 to 100). Mean lesion length was 24 +/- 8 mm (range 10 to 50). Beginning in 1989, stents were implanted for suboptimal dilation; in 1995, stenting became routine. RESULTS: Overall, 103 (91%) of 113 lesions were successfully treated; 10 (53%) occlusions could not be recanalized. Fifty-one stents were implanted in 46 patients. There were 3 (2.6%) procedural complications: a transient ischemic attack, one major (fatal) stroke, and an arterial thrombosis 24 hours after the procedure (treated medically) (0.9% major stroke and death rate). During a mean 4.3-year follow-up (range to 10), 16 (15.5%) restenoses were treated with angioplasty (n = 4), stenting (n = 7), or surgery (n = 5). Primary and secondary patencies for all treated lesions (n = 113) at 8 years were 75% and 81%, respectively; in patients without initial stent placement, the rates were 69% and 76%, while in those with stents, the rates rose slightly to 87% and 94% at 2.5 years (NS). Patency rates for all 103 recanalized lesions were 83% and 90% at 8 years (81% and 90% without stent and 87% and 94% with stent at 2.5 years, respectively [NS]). CONCLUSIONS: Balloon angioplasty with or without stenting is safe and effective for treating subclavian artery occlusive diseases with good long-term patency. Recanalization of occlusions is more difficult to achieve. Stents (implanted only for suboptimal dilation) do not seem to improve long-term patency.     

Reliability of single-lead VDD atrial sensing and pacing during exercise

If atrial sensing ability of a single-lead VDD pacemaker is well accepted at rest, the detection quality by atrial floating electrodes remains less recognized during exercise. The aim of this study was to verify, during treadmill test and a continous telemetry, the atrial tracking performance using four different leads technologies. From November 1994 to July 1997, 21 patients (71.3 +/- 6.3 years old, 7 female, cardiopathy: 57%) were paced for isolated high degree (permanent: 13, paroxystic: 8) AV block. The implanted devices were the Vitatron Saphir/Brillant lead (13 patients), Intermedics Unity/425/04-13 lead (5 patients), Pacesetter Addvent (2 patients), and Biotronik Eikos (1 patient). The acute atrial signal amplitude was 1.66 +/- 0.75 mV. The treadmill test used the chronotropic assessment exercise protocol after pacemaker reprogramming to detect atrial undersensing (AV delay < or = 120 ms, no hysteresis, no flywheel, upper rate increase). The mean delay was 31.1 weeks (range 1-100). The testing duration was 6.1 +/- 2.3 minutes, the number of steps was 3.3 +/- 1.3 per patient, and the peak exercise rate was 135 +/- 19 beats/min. At rest, complete atrial tracking was complete in 90% of the patients, and during testing in only 23.8% of the patients, while AV synchronization > 95% was present in 57.1%, > 90% in 71.4%, and > 85% in 90.4% of patients (Vitatron 13/13, Intermedics 3/5, Biotronik 1/1, and Pacesetter 1/2). During the recovery period synchronization was always > 95%. The mean P wave amplitude at rest was 1.1 +/- 0.5 mV; during the first step, 1.04 +/- 0.61 mV; second step, 0.94 +/- 0.53 mV; third step, 0.82 +/- 0.58 mV; fourth step, 0.67 +/- 0.39 mV; and during recovery, 1.13 +/- 0.67 mV. The mean P wave decrease signal at peak of exercise is 0.21 mV (from -1.31 to +0.5). In fact, P wave variations have several patterns: a decrease was measured in 7 patients, an increase in 2 patients, and no significant change in 7 patients. Single-lead VDD P wave identification during exercise was almost accurate. However, often there was progressive lowering of atrial sensing with transient loss of AV synchrony.     

Evaluation of tissue harmonic imaging for the diagnosis of focal liver lesions

This was a prospective study to evaluate tissue harmonic imaging (THI) for the diagnosis of focal liver lesions. A total of 15 reviewers read 100 randomly arranged liver images, a fundamental grey-scale image (FGI) and a THI (transmitted: 2 MHz, received: 4 MHz) of each of 50 patients (29 with liver cirrhosis, 42 with focal lesions) taken from the same section. The mean value of overall accuracy for detecting lesions (presence or absence) was significantly higher with THI (82.3%) than with FGI (79.6%) (t = 1. 96, p< 0.05). When only the 29 cirrhosis patients were analyzed, the difference was more significant (t = 2.48, p < 0.02). The correct count rate of the number of focal lesions was higher with THI (78. 0%) than with FGI (67.0%) (t = 3.61, p< 0.005) in 23 cirrhosis patients with focal lesions. The correct diagnosis of HCC was achieved at a higher rate with THI (42.5%) than with FGI (36.8%). THI was statistically effective for detecting focal lesions, particularly in cirrhotic livers.     

特殊类型肾上腺嗜铬细胞瘤的超声诊断与临床研究

目的探讨超声对特殊类型肾上腺嗜铬细胞瘤的诊断价值,指使临床上对该病特殊性有更深入地了解,以便处理时采取有效对策.方法从收治36例嗜铬细胞瘤患者中,对其中11例特殊类型肾上腺嗜铬细胞瘤的临床特点及超声资料进行回顾性分析,并将声像图表现与病理结果对照.结果 4例为家族性(其中2例为双侧);1例伴有对侧肾上腺皮质腺瘤;4例为功能静止型;1例伴有顽固性低血钾;1例为双侧肾上腺区域多发性肿瘤(其中左侧子瘤3个,右侧子瘤2个).超声诊断符合率86.67%(13/15),超声对其定位符合率100%(15/15处),超声对肿瘤个数检出率83.33%(15/18个).结论超声显像对特殊类型肾上腺嗜铬细胞瘤的诊断具有重要的临床价值.但应指出,并发症与肿瘤个数检出的准确性尚应进一步提高.     

内镜微波联合抗幽门螺杆菌治疗隆起糜烂性胃炎研究

目的研究应用内镜微波联合抗幽门螺杆菌(Hp)治疗隆起糜烂性胃炎(EGP)的价值和安全性。方法将54例EGP患者随机分成A组(先药物后微波治疗组)和B组(药物+微波治疗组),比较两种方法的疗效。结果54例患者43例Hp阳性,37.0%(20/54)的患者发现肠上皮化生。A组:单纯药物治疗仅有11.5%(3/26)的患者糜烂性病变消失,而应用微波治疗后,95.7%的患者隆起糜烂性病变消失;B组:隆起糜烂性病变治愈率达92.9%(26/28),与单纯药物治疗比较差异具极显著性(P<0.01)。有5例出现轻微上腹胀或上腹隐痛,但均在术后1周内消失。共治疗隆起性病灶246个。结论EGP的发病与Hp感染有关,容易发生肠上皮化生。单纯药物治疗疗效欠佳。内镜微波联合抗Hp治疗EGP不仅疗效确实,而且安全简便。