胸腔内高温灌注化学治疗恶性胸腔积液

目的总结电视胸腔镜辅助下胸腔内高温灌注化学治疗恶性病变引起的胸腔积液的方法和效果。方法1999年2月至2005年3月，将58例恶性胸腔积液患者随机分为治疗组（30例）和对照组（28例），治疗组在全身麻醉电视胸腔镜下行胸膜活检术，并用人工心肺机恒温43℃，生理盐水3000ml加顺铂300mg灌注1h；对照组予以胸腔引流，胸腔内灌注顺铂60～80mg。比较两组治疗前、后胸水量的变化、胸水中癌胚抗原（CEA）、细胞角蛋白K19片段（CYFRA21—1）、神经元特异性烯醇化酶（NSE）浓度变化和毒副作用。结果治疗组、对照组有效率分别为100.0％和53，6％，差异有统计学意义（x^2=3．863，P〈0.05）；治疗组治疗后较治疗前胸水中CEA，CYFRA21—1，NSE浓度明显下降（t=2．562，P〈0.05），治疗后治疗组较对照组明显降低（P〈0.05）；两组各种毒副反应比较差异无统计学意义（P〉0.05）。结论电视胸腔镜辅助下胸腔内高温灌注化学治疗恶性胸腔积液安全有效，具有创伤小、视野大、活检准确方便、便于确诊的优点。     

Interstitial laser photocoagulation and interstitial photodynamic therapy of normal lung parenchyma in the pig

. Interstitial laser photocoagulation (ILP) and interstitial photodynamic therapy (PDT) involve delivery of light to lesions in solid organs using thin fibres passed through needles inserted percutaneously under image guidance. In ILP, the laser energy heats the tissue, whereas in PDT it activates a previously administered photosensitising agent. This study looks at their potential for treating localised, small, peripheral lung cancers in patients unsuitable for surgery. Experiments were undertaken on nine normal pigs, up to four fibres being inserted into the lung parenchyma percutaneously under X-ray guidance (ILP: 2–3 W, 1000 q/fibre, from 805 nm diode laser, PDT, 100–200 J/fibre from 652 nm diode laser at 50–100 W, 3 days after 0.15 mg/kg mTHPC). Animals were killed from 3 days to 3 months later and the treated areas examined macroscopically and microscopically. Both techniques were well tolerated, producing well-defined, localised lesions, typically 3.5×2×2 cm using four fibres. Histology showed thermal coagulative necrosis after ILP and haemorrhagic necrosis after PDT. Early small haematomas and late cavitation were sometimes seen after ILP, but not after PDT. PDT lesions healed with preservation of larger arteries and bronchi in the treated area. A few small pneumothoraces were seen which resolved spontaneously, probably related to the chest wall puncture. It was concluded that ILP and PDT lesions of a size large enough to cover a small tumour can be made safely in the lung parenchyma, although healing was better after PDT. Pilot clinical studies with both techniques are now justified on carefully selected patients. Paper received 6 September 1999; accepted after revision 7 July 2000.     

Histological Examination of Bronchial Mucosa after Photodynamic Therapy Showing no Selectivity of Effect between Tumour and Normal Mucosa

.After the treatment for early stage bronchogenic carcinoma including carcinoma in situ with photodynamic therapy (PDT), the degree of bronchial mucosal damage was studied histologically. The influence of treatment modality on bronchial mucosa was also examined. Few studies of histological changes of bronchial mucosa caused by PDT have been done. The histological specimens of bronchial mucosa in patients who received PDT and had a complete response were reviewed retrospectively. Twenty-three patients with 24 carcinomas including six carcinomas in situ had been treated with PDT using argon dye laser, excimer dye laser with or without additional radiotherapy. The degree of epithelial and subepithelial changes was classified as normal, hyperplasia, metaplasia and as mild, moderate and marked fibrosis, respectively. Subepithelial fibrosis was seen after PDT in almost all cases even when the tumour was entirely superficial to this layer. As a whole, epithelial change was found to be hyperplastic in three and metaplastic in 13 cases. Subepithelial fibrosis were found to be mild in four, moderate in 13, and marked in four cases. No differences were seen between the effects with the excimer and argon dye lasers. As used at present, PDT in the bronchi has no selectivity between normal and tumour tissue but may have advantages over other techniques due to the lack of cumulative toxicity and the excellent healing. Received for publication 15 September 1997; accepted following revision 23 February 1998     

隐神经髌下支卡压症

目的 从解剖和临床两方面探讨隐神经髋下支卡压症的的机制及诊治方法。方法 解剖10具成人固定尸体，观察隐神经髌下支与周围结构的毗邻关系。对8例隐神经髌下支卡压症的患进行l临床观察和分析。结果 30％(6侧)隐神经髌下支直接发自股神经，且不行走在Hunter’s管内。30％(6侧)从Hunter’s管内发自隐神经，并穿该管前壁腱板浅出。髋下支发出后80％(16侧)穿缝匠肌至膝内前下部，穿出点周围均为致密结缔组织。在膝内前下部髌下支和深筋膜紧密连在一起。8例患，7例局封治疗，1例手术治疗，均取得了较好的效果。结论 隐神经髌下支在行径途中多处可受到卡压，局封治疗一般可取得较好效果。     

Entrapment neuropathies of the median nerve at and above the elbow

Three surgically verified cases of median nerve entrapment at and above the elbow are reported: one involved a compression of the nerve beneath the Struthers ligament in absence of supracondylar bony spur, and two concerned a compression beneath the lacertus fibrosus bicipitis (aponeurosis musculi bicipitalis brachii). Of the two latter cases, the first entrapment was caused by a hematome and the second the nerve was found to be entrapped between the lactertus and an underlying hypertrophic brachial muscle. The compression mechanisms and clinical and electromyographic findings are presented.     

椎孔外颈神经根卡压松解术

目的探讨用神经松解术治疗颈神经根椎孔外卡压综合征。方法对符合手术指征的24例患者经系统的保守治疗无效后行颈神经根探查松解术。对术中发现的相应神经根卡压进行彻底松解。结果除2例术前有明显肌萎缩者未见恢复外,其余22例术后症状均得到明显改善。结论颈神经根椎管外卡压是导致颈肩痛的重要原因之一,手术治疗效果明显。     

Malignant Adenomyoepithelioma of the Breast with Lung Metastases: Report of a Case

Adenomyoepithelioma of the breast is a rare lesion, and has a bicellular pattern of epithelial and myoepithelial cells which are regularly distributed in the tubular structures based on the histologic and ultrastructural features. It is thought to be a benign or a low-grade malignant disease. We herein describe a case of malignant adenomyoepithelioma of the breast with lung metastases in an 86-year-old woman. A primary massive tumor in the left breast grew rapidly within a short period of time. A simple mastectomy with sampling of the axillary lymph nodes was performed. The obtained lymph nodes did not include any metastatic lesions. Malignancy was evidenced by the presence of a high mitotic rate and severe nuclear atypia. Three months after the operation, radiology showed multiple lung metastases, and the patient died 2 weeks thereafter. Reviewing the literature, nine similar cases were reported, and the prognosis of malignant adenomyoepithelioma of the breast with distant metastases was very poor with the time of recurrence varying after initial treatments. Malignant adenomyoepithelioma should be followed up with careful screening for distant metastases. Received: November 16, 2000 / Accepted: May 15, 2001     

功能性腘动脉陷迫综合征的CTA解剖特点初探

目的运用CTA标线法探讨功能性腘动脉陷迫综合征(functional popliteal artery entrapment syndromef,PAES)是否存在"解剖畸形"。方法 2007～2011年手术确诊的14条fPAES患肢与180条对照肢体的CTA进行比较,并用CTA标线法分析腘窝轴位上两组的解剖位置差异。结果 fPAES组所有患肢腓肠肌内侧头向外移位且13条(93%)向外超过了腘动脉,所有腘动脉均向深方移位;对照组腓肠肌内侧头完全起自"股骨内侧髁后上方"(解剖学所描述的标准位置)的仅占12%(21/180);对照组21%(38/180)腓肠肌内侧头与腘动脉相对位置关系及38%(68/180)的腘动脉深浅位置关系不符合标准解剖。结论腓肠肌内侧头的外移普遍存在,解剖"移位"可能从量变到质变f,PAES可能是严重移位导致的结果。内侧头外移超越腘动脉及腘动脉向深方移位是fPAES两个有意义的观察指标。     

肺癌肿瘤标志物早期诊断研究进展

肺癌是一种常见的恶性肿瘤,其发病率及死亡率已占全球恶性肿瘤的首位。肺恶性肿瘤目前常用的诊断工具是CT扫描、支气管镜检查、痰病理细胞学检查及肿瘤标志物检测,但在早期肺癌的诊断中尚缺乏敏感的诊断方法。为了提高肺癌的诊断治疗,近年来许多肿瘤标志物已经被应用于肺癌领域。因为晚期肺癌预后很差,人们正在尝试进行肺癌筛查,所以寻找合适的肿瘤标志物在肺癌的早期诊断中变得尤为重要。     

枕大神经(卡压)痛的解剖学研究

在30县(60侧)经防腐处理的成人头颈部标本上,对枕大神经(卡压)痛有关的应用解剖作了观察。主要结果是:1.枕大神经浅出通过的腱膜孔的形态多见为椭圆形(70.0％);2.枕大神经在出孔处的形态一般为扁形(95.0％),其宽径为3.44±0.86mm;3.枕大神经在浅出腱膜孔处与枕血管的排列关系(由内侧向外侧)多数为神经、动脉、静脉(67.92％);4.枕大神经浅出腱膜孔处的体表投影点,位于通过枕外隆凸中点垂直线(y轴)的左侧18.55±4.28mm;右侧为27.48±4.33mm;水平线(x轴)下方左侧为18.54±5.02mm,右侧为19.81±4.92mm。     

Lung cancer: diagnosis,staging and treatment

Lung cancer is the most common malignancy worldwide and carries a high mortality rate. The risk of developing lung cancer is strongly associated with smoking. The predominant subtypes of lung cancer are non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC forms the majority of cases while SCLC makes up a smaller proportion. Patients with symptoms and signs suggestive of lung cancer are managed by a multi-disciplinary team approach in order to diagnose and stage the disease. The type and stage of lung cancer guides further management. Early stage lung cancer should be treated aggressively; with the most appropriate modality which may include surgery, chemotherapy and radiotherapy, or a combination of these various modalities.     

Surgical Intervention for Malignant Fibrous Histiocytoma of the Lung: Report of a Case

Malignant fibrous histiocytoma (MFH) of the lung is rare, accounting for less than 0.2% of all pulmonary neoplasms, and an optimal treatment strategy has not yet been elucidated. We encountered a 62-year-old male patient with MFH of the lung who underwent a resection of the lymph node of recurrence 7 months after a lobectomy. We herein review 93 cases of pulmonary MFH in the literature, and discuss the surgical treatment for this disorder with special reference to lymph node involvement. Lymphogenic metastasis was observed in 14 of 72 cases (19%) who underwent surgical treatment. The 5-year survival rates for these reported patients with and without surgical treatment were 43% and 0% (P = 0.01) and the 5-year survival rates for “resected” patients with and without lymph node metastasis were 27% and 49%, respectively (P = 0.03). A complete resection with the systematic dissection of regional lymph nodes is therefore considered to positively contribute to the survival of patients with primary pulmonary MFH.     

The Piriformis Muscle Syndrome: Sciatic Nerve Entrapment Treated with Section of the Piriformis Muscle

The piriformis muscle syndrome, a term applied to an abnormal condition of the piriformis muscle, is characterized by symptoms and signs due to sciatic nerve entrapment at the greater sciatic notch. Two patients with this syndrome, successfully treated with section of the piriformis muscle, are reported. The piriformis muscle syndrome should be suspected as part of the differential diagnosis in cases of low back and hip or thigh pain.     

电视胸腔镜手术在肺恶性肿瘤合并气胸诊断和治疗中的应用

目的探讨电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）对肺恶性肿瘤合并气胸的诊断和治疗价值。方法 2002年4月～2008年5月,19例术前胸部CT提示单侧周围型肺肿瘤合并气胸,术前均无明确病理诊断,行VATS手术探查,术中取肺肿瘤组织快速冰冻切片,根据病理结果和病人情况决定手术方式,同时处理肺脏漏气部位。结果全胸腔镜肺肿瘤楔形切除10例,胸腔镜辅助小切口手术9例（其中原发肺癌根治4例,肺肿瘤射频消融5例）。14例肺转移瘤均行胸膜摩擦固定。均手术顺利,均明确病理诊断。手术时间45～90 min（平均51.4 min）,术中出血量50～280 ml（平均150 ml）,胸管引流时间3～8 d（平均4.5 d）。术后2例轻度漏气,无特殊处理自愈,无围手术期死亡。术后所有患者肺复张良好。19例术后随访2～49个月,平均23个月,仅1例气胸复发,行胸腔闭式引流治愈。结论 VATS对明确周围型肺肿瘤病理诊断有重要作用,同时及时有效治疗气胸和肺恶性肿瘤,值得推荐。     

Recurrent Ulnar Nerve Dislocation at the Elbow: Report of a Non-Traumatic Case with Ulnar Entrapment Neuropathy

An unusual case of habitual recurrent ulnar nerve dislocation at the elbow is described. The case was complicated by non-traumatic ulnar entrapment neuropathy interfering with the patient's profession as a musician (cello).