阴茎神经鞘瘤的临床特点及诊治(附1例报告并文献复习)

目的 探讨阴茎神经鞘瘤的临床特点及诊治要点.方法 报告1例阴茎神经鞘瘤病例,患者以阴茎根部肿块收治,术前细胞学穿刺报告为神经纤维瘤,行肿瘤切除术.结果 患者术后病理诊断为阴茎神经鞘瘤;术后恢复较好.结论 阴茎神经鞘瘤缺乏特异性临床表现,术前诊断较为困难,穿刺活检有助于诊断及鉴别.确诊需依靠病理学证据,必要时可加做免疫组化,手术切除为主要治疗方法.     

胃神经鞘瘤32例的临床诊断与外科治疗

目的：总结胃神经鞘瘤的临床特点、诊断与外科治疗经验。方法：回顾性分析1989—2009年收治的32例胃神经鞘瘤患者的临床资料。结果：临床表现腹痛、腹部肿块、胃出血并休克、柏油样便。钡剂胃造影、BUS及CT平扫均显示胃腔内实质不能定性的肿块。纤维胃镜取部分活组织明确诊断4例,术前确诊率12.5%。术后病理组织学检查确诊28例。所有病例均手术切除,其中胃窦部半胃切除术12例;胃部分切除术13例;胃次全切除术2例;全胃切术或根治性胃切除术5例。结论：胃神经鞘瘤无特异临床表现,术前诊断困难,确诊率低。病理组织学检查能够确诊,免疫组织化学对进一步诊断有帮助。一经确诊或胃存在实质性肿块,应及早手术治疗。根据术前患者病情及术后病灶情况,可分别选择局部切除（距病灶边缘3 cm以上）、半胃切除、胃部分切除、胃次全切除、全胃切除或根治性胃切除术。     

颈静脉孔区神经鞘瘤的诊断和治疗

目的总结颈静脉孔区神经鞘瘤的临床特点和手术方法。方法14例颈静脉孔区神经鞘瘤患者术前应用CT、核磁共振成像（MRI）和数字减影血管造影（DSA）进行诊断;应用远外侧入路手术切除肿瘤,并行三维CT血管成像术（CTA）模拟手术人路9例。结果术中证实,术后病理确诊颈静脉孔区神经鞘瘤。肿瘤全切除8例,次全切除4例,大部分切除2例。术后患者临床症状均较术前明显改善。结论肿瘤的诊断、分型及三维CTA的模拟对手术入路选择具有一定意义,选用远外侧入路能良好显露、切除该区神经鞘瘤。     

臂丛及周围神经鞘瘤手术治疗38例

[目的]探讨臂丛及周围神经鞘瘤的治疗要点和疗效。[方法]1999～2007年共收治经临床和病理证实的神经鞘瘤38例，其中副神经1例，颈丛皮神经2例，臂丛神经6例，膜丛神经2例，上肢神经17例，下肢神经10例。其中37例均在显微镜下获得肿瘤切除，术中均用神经电生理监测，1例将肿瘤切除后，同时行神经移植术。术前复杂部位均行MRI检查，术后所有肿瘤均经病理证实为神经鞘瘤。[结果]本组38例中，36例术后神经功能未受影响，随访6个月～7年，平均4．5年，无复发。1例尺神经鞘瘤切除后出现手内肌功能部分障碍，10d后恢复。L4神经鞘瘤行肿瘤切除神经移植术后，股四头肌肌力下降为2级减，神经移植后疗效正在随访中。[结论]（1）应用显微外科技术显微镜下操作，并采用术中神经电生理监测，可最大限度的切除肿瘤，减少复发，并保留正常神经功能。（2）对于颈部、臂从、膜丛等复杂部位的神经鞘瘤术前尽可能行MRI检查。（3）术后所有神经鞘瘤均应经病理证实。     

四肢周围神经鞘瘤40例临床回顾

目的：分析40例周围神经鞘瘤的临床特点，诊断和手术要点。方法：40例神经鞘瘤，其中臂丛神经5例，上肢神经21例，下肢神经14例，单发者38例，多发者2例（同一肢体2个肿瘤），8例肿块位于颈部及上臂近端者术前作MRI检查，证实5例的肿瘤起源于臂丛神经，2例为颈部肿瘤，1例为肺尖部肿瘤。33例行肿瘤完整切除；1例C8神经根肿瘤因邻近胸膜顶及锁骨下动静脉，很难分离，故只能行肿瘤包膜内切除，6例曾在其它医院误将肿瘤与神经干一同切除，行神经修复术。结果：33例术后神经功能正常，随访6个月，－28年未见复发。1例包膜内切除者术后出现手内肌功能部队障碍，出院时已有大部分恢复，仍在随访中，结论：神经鞘瘤能够完整切除者疗效满意。对起源于神经根的肿瘤可行包膜内切除。     

术中电生理动态监护下显微手术切除椎管神经鞘瘤（附65例报告）

目的 探讨术中电生理监护对椎管神经鞘瘤显微手术中的作用及意义，提高对椎管内神经鞘瘤的治疗水平。方法 回顾性分析65例术中电生理动态监护下，显微手术切除椎管内神经鞘瘤。结果 治愈60例（占92．3％），好转5例（占7．7％），无死亡；肿瘤全切62例，次全切除3例，全切率95．4％。结论 常规动态电生理监测下显微手术切除椎管神经鞘瘤，能保全脊髓神经的功能，减少副损伤，提高手术安全性；显微手术有助于提高肿瘤全切率，可有效减少术后复发。对影响脊柱稳定性的行脊柱融合内固定。     

脊髓神经鞘瘤诊治分析16例报告

目的：探讨脊髓神经鞘瘤的诊断及治疗方法。方法：对16例脊髓神经鞘瘤患者进行脊髓造影或MRI检查。13例患者肿瘤全部切除，2例次全切除，1例部分切除。结果：肿瘤全部切除者术后神经功能均有明显恢复，次全切除2例有好转，部分切除1例复发。结论：脊髓神经鞘瘤行手术全部切除是可行的，取得良好效果的关键。     

淋巴管造影对前列腺癌盆腔淋巴结转移的诊断价值

目的 评价淋巴管造影在诊断前列腺癌盆腔淋巴结转移的价值。方法 61例前列腺癌患者行足背淋巴管造影，对10例阳性、4例可疑及47例阴性患者行细针穿刺抽吸细胞学检查和淋巴结活检。结果 10例淋巴管造影阳性者，经细针穿刺抽吸细胞学检查和病理证实淋巴结转移9例，假阳性1例。4例可疑患者，经细针穿刺抽吸细胞学检查和前列腺癌根治术后病理证实无淋巴结转移。47例阴性者中，经细针穿刺抽吸细胞学检查和病理证实假阴性4例（8．5％）。结论 淋巴管造影对前列腺癌淋巴结转移有较高的诊断价值，对阳性或可疑淋巴结细针穿刺抽吸细胞学检查可避免假阳性，但有一定的假阴性。     

甲状腺癌的诊断治疗

目的探讨甲状腺癌诊断及治疗方法。方法回顾性分析我院2002—2008年行手术治疗的甲状腺癌患者236例的临床资料。结果本组患者术前B超检查发现甲状腺内实性或囊实性结节2 2 5例(9 5.5 3%),结节内伴微钙化灶者7 8例(3 3.0 5%);B超引导下细针穿刺活检8 1例,阳性率8 7.6 5%;术中冰冻切片检查2 2 1例,诊断甲状腺癌2 0 8例,阳性率9 4.1 1%;术后病理检查证实有淋巴结转移者为6 8例(2 8.8 1%)。行甲状腺部分切除1 5例,患侧叶全切4 4例,根治性切除1 7 7例。因误诊行甲状腺癌局部或患侧叶切除术后确诊行二次以上手术者2 5例,残癌率为5 6.0%(1 4/2 5)。结论 B超检查提示甲状腺结节内微钙化灶对甲状腺癌诊断有重要提示意义,结合B超引导下细针穿刺活检可明显提高术前诊断准确率,术中冰冻切片检查是确诊甲状腺癌的重要方法。患叶全切+峡部全切+对侧大部切除+选择性颈清扫术是甲状腺癌的主要手术方式。对术中误诊术后确诊者应及早行二次手术。     

腹膜后神经鞘瘤1例报告并文献复习

目的报告1例腹膜后神经鞘瘤,并复习相关文献,分析其临床诊治现状。方法通过对1例腹膜后神经鞘瘤的诊断、治疗方法及术后病理、随访的回顾,结合国内外有关文献报道,综合分析腹膜后神经鞘瘤的诊断及治疗状况。结果本例行手术治疗,术后病理证实为腹膜后神经鞘瘤,随访半年无复发。结论腹膜后神经鞘瘤诊断困难,影像学检查无特异性,确诊依靠病理检查,理想的治疗方法是通过外科手术完整切除肿瘤,其预后良好,早期复发率低。     

The diagnosis and local staging of renal cancer--an appraisal

The standard pattern of investigation for renal masses usually involves excretion urography, ultrasonography and angiography. This study was undertaken to determine whether computed tomography (CT) and fine needle aspiration cytology could provide information that might allow this pattern to be modified. Diagnostic information was obtained by needle aspiration cytology in 25 patients who were shown at operation to have a neoplasm. The diagnosis was correct in 22 cases (88%). By comparison, arteriography was accurate in 22 out of 24 (92%), and computed tomography provided the correct diagnosis in 19 out of 21 (90%). Staging was performed surgically and histologically in 21 patients, and when this was compared with the results of CT staging there was complete agreement in 13 cases (62%). A literature review revealed an average staging accuracy for CT of 81% while arteriography was accurate in only 57%. Thus CT appears to be as good as arteriography for diagnosis and potentially better for local staging. It is also less invasive, rapid and cost effective and could supersede arteriography as the primary diagnostic and staging investigation in patients with a solid renal mass.     

THE DIAGNOSIS AND LOCAL STAGING OF RENAL CANCER — AN APPRAISAL

The standard pattern of investigation for renal masses usually involves excretion urography, ultrasonography and angiography. This study was undertaken to determine whether computed tomography (CT) and fine needle aspiration cytology could provide information that might allow this pattern to be modified. Diagnostic information was obtained by needle aspiration cytology in 25 patients who were shown at operation to have a neoplasm. The diagnosis was correct in 22 cases (88%). By comparison, arteriography was accurate in 22 out of 24 (92%), and computed tomography provided the correct diagnosis in 19 out of 21 (90%). Staging was performed surgically and histologically in 21 patients, and when this was compared with the results of CT staging there was complete agreement in 13 cases (62%). A literature review revealed an average staging accuracy for CT of 81% while arteriography was accurate in only 57%. Thus CT appears to be as good as arteriography for diagnosis and potentially better for local staging. It is also less invasive, rapid and cost effective and could supersede arteriography as the primary diagnostic and staging investigation in patients with a solid renal mass.     

黄色肉芽肿性肾盂肾炎(附30例报告)

目的 探讨黄色肉芽肿性肾盂肾炎垢早期诊断方法及治疗效果。方法 回顾性总结３０例ＤＸＧＰ临床表现、实验室检查结果、影像学特点及不同治疗方法的疗效。结果 ＩＶＵ及Ｂ超检查无特异性。ＣＴ扫描１９例,５例懔弥温型ＸＧＰ,３例经Ｂ超引导下穿刺活检而确诊,３０例ＸＧＰ中１例经抗炎治疗痊愈,２９例手术治疗,其中肾部分切除术２例,肾根治切除术１０例,肾切除术１７ 。结论 弥漫型ＸＧＰ可通过ＣＴ扫描而确立诊断,局灶     

Fine needle aspiration cytology for soft tissue tumours of the hand

The purpose of this study was to evaluate the usefulness of fine needle aspiration cytology for the preoperative diagnosis of soft tissue tumours of the hand. Fine needle aspiration cytology was performed on 93 soft tissue tumours of the hand which were classified as malignant, benign or unclassified based on cytological findings. We also attempted to make specific diagnosis by cytology. The cytological diagnosis was then compared with the postoperative histopathological diagnosis. The cytological differentiation between benign and malignant tumours showed neither false-positive nor false-negative results. Of the 47 lesions with sufficient material for cytology and that were postoperatively diagnosed histologically, 35 (including one recurrent lesion) were correctly diagnosed by fine needle aspiration cytology. No complications were encountered. Fine needle aspiration cytology has a high degree of diagnostic accuracy and safety for soft tissue tumours of the hand.     

Fine needle aspiration biopsy of thyroid nodules

The clinical value of the fine needle aspiration of thyroid nodules was evaluated by comparing preoperative cytology to subsequent pathology in 109 patients undergoing thyroidectomy. Preoperative cytology was reported as insufficient cellular material (31 patients), benign goiter (27 patients), follicular neoplasm (22 patients), thyroiditis (12 patients), suspicious for papillary carcinoma (nine patients), Hurthle cell neoplasm (five patients), medullary carcinoma (one patient), lymphoma (one patient), and metastatic adenocarcinoma (one patient). Operative findings demonstrated that the overall sensitivity of fine needle aspiration in diagnosing thyroid neoplasia (carcinoma or adenoma) was 88% and its specificity was 80%. Operation verified the cytologic diagnosis of medullary carcinoma, lymphoma, metastatic adenocarcinoma, and seven of nine papillary carcinomas. Of the five patients with an aspiration biopsy diagnosis of Hurthle cell neoplasm, three patients had carcinoma and one had an adenoma. Four carcinomas and 12 follicular adenomas were found in patients with a cytologic diagnosis of follicular neoplasm. Thyroiditis was confirmed at operation in all 12 patients with this diagnosis on fine needle aspiration. One carcinoma was found in the 27 patients with benign goiter diagnosed on cytology. Fine needle aspiration is a valuable tool that can lead to earlier diagnosis and treatment of thyroid cancer. However, a negative aspiration does not supplant good clinical judgement in determining the need for thyroidectomy.     

Replace fine needle aspiration cytology with automated core biopsy in the triple assessment of breast cancer

All patients presenting with a symptomatic breast lump are assessed by means of triple assessment (clinical examination, radiology in the form of mammography and cytology by means of a fine needle aspiration) performed by the clinician in the rapid access breast clinic at the Royal Gwent Hospital, Newport, UK. In our initial experience, it was found that a significant number of patients were returning to clinic for the results of the triple assessment to find that the cytology was not conclusive and hence needed a core biopsy, thus delaying diagnosis and definitive treatment. Therefore, a prospective study was carried out over a 6-month period, where all patients presenting with a symptomatic lump with a clinical or radiological suspicion of breast cancer had, in addition to the standard triple assessment, an automated core biopsy, thus giving rise to the quadruple assessment of the breast lump. A total of 52 patients with a clinical or radiological suspicion of breast cancer were included over this 6-month period. Of these 52 patients, 31 had a definitive diagnosis of breast cancer on fine needle aspiration (sensitivity 60%) compared with 50 of the 52 patients on core biopsy (sensitivity 96%). When radiology was diagnostic of breast cancer (R 5), the sensitivity of cytology was 61% compared with 97% with core biopsy. However, when radiology was not diagnostic of cancer (R 1-4), the sensitivity of cytology fell to 53% while the sensitivity of core biopsy remained high at 95%. The overall cellularity rate for cytology was 96%, which exceeds the BASO requirement for fine needle aspiration cytology. From these results, we conclude that automated core biopsy has a superior diagnostic power when compared with fine needle aspiration cytology and hence should replace fine needle aspiration cytology in the assessment of symptomatic breast lumps.     

Cervical vagus nerve schwannoma

Schwannomas arising from cervical cranial nerves rarely present as neck swelling. Ultrasonography, computerised tomography, magnetic resonance imaging and fine needle aspiration cytology are helpful in reaching a diagnosis. Surgical excision is the treatment of choice. A case of large cervical vagus nerve schwannoma occurring in a young lady is presented with its management.     

In situ carcinoma of the pancreas

Two cases of pre-invasive in situ carcinoma of the pancreas treated by surgery are reported. In each case the resection was carried out because of the probable diagnosis of invasive carcinoma of the pancreas. In situ carcinoma of the pancreas is not included in standard clinical classifications of pancreatic cancer. This is an important omission because of the prognostic implications of this diagnosis, and because of the difficulties in interpreting fine needle aspiration cytology or histology on needle biopsy in such cases.     

胰头部肿块鉴别诊断和临床对策

胰头部肿块的鉴别诊断中最为困难的是胰头肿块型胰腺炎与胰腺癌的鉴别。近年来,血清肿瘤标记物检查、多排螺旋CT和内镜超声引导穿刺活检等技术的发展为临床鉴别诊断提供了很多帮助,但仍有部分病人不能通过非手术方法获得确诊。对于这些病人,在与病人及家属进行充分沟通后,可以考虑行剖腹探查,建议术中对胰头部肿块行细针多点穿刺细胞学检查,并由专业人员及时处理标本。慢性胰腺炎是胰腺癌的癌前病变,并且可以导致胰管、胆管及十二指肠梗阻,行胰十二指肠切除术或保留十二指肠的胰头切除术能切除病变,缓解疼痛症状,改善病人的生活质量。但由于该手术创伤大,术后并发症发生率较高,应严格掌握手术适应证,加强围手术期处理,由经验丰富的医师实施手术,将并发症的发生率降到最低。