哑铃形垂体腺瘤经蝶显微手术技巧

背景与目的：哑铃形垂体腺瘤的手术治疗入路一直存在争议，本文探讨经蝶显微手术哑铃形垂体腺瘤的手术技巧和手术疗效。方法：回顾性分析经蝶显微手术治疗45例哑铃形垂体腺瘤的临床资料、手术疗效、术后并发症及随访结果。结果：全切除35例，次全切除7例，大部分切除3例。术后所有患者的临床症状得以改善，16／19患者的内分泌功能恢复正常。术后1周视力、视野恢复率分别为90．6％和81．3％。术后并发症有一过性尿崩17例、短暂性脑脊液鼻漏3例等，无持续性尿崩，无手术死亡。结论：除质地硬的哑铃形垂体腺瘤外，绝大多数哑铃形垂体腺瘤经蝶手术是安全、有效的。     

胸椎管内肿瘤的诊治和术后随访研究

目的总结胸椎管内肿瘤的诊断并评价手术治疗效果。方法回顾性分析青岛大学医学院附属医院2002年1月至2010年12月施行手术治疗的188例胸椎管内肿瘤患者的临床资料,总结胸椎管内肿瘤的治疗及预后情况。结果胸椎管内肿瘤多位于髓外硬膜下,以神经鞘瘤和脊膜瘤最常见。经全切除或次全切除后,近期神经根性疼痛、感觉障碍、运动障碍、括约肌功能障碍明显改善。神经功能ASIA评分及分级均明显提高。结论在MRI影像的基础上,配合适当的显微外科技术,选择合适的手术径路和恰当的手术方式是治疗胸椎管内肿瘤的关键。     

巨大椎管内外哑铃形肿瘤的手术治疗（11例报告并文献复习）

目的 :探讨巨大椎管内外哑铃形肿瘤的手术治疗方法。方法 :11例均一期全切肿瘤 ,对不同部位肿瘤 ,采用不同手术入路 ,首先切除椎管外肿瘤 ,然后再切除椎管内肿瘤。结果 :随访 3个月～ 5年 ,9例痊愈 ,1例血管内皮肉瘤基本痊愈 ,1例恶性神经纤维瘤复发行多次手术。结论 :本病一经确诊 ,均应行手术切除。手术入路的选择是决定能否一期切除肿瘤 ,减少不必要损伤和恢复机体功能的关键 ;必要时请胸科和骨科医师协助手术 ,可保证手术顺利进行     

巨大椎管内外哑铃形肿瘤的手术治疗(11例报告并文献复习)

目的：探讨巨大椎管内外哑铃形肿瘤的手术治疗方法。方法：11例均一期全切肿瘤，对不同部位肿瘤，采用不同手术入路，首先切除椎管外肿瘤，然后再切除椎管内肿瘤。结果：随访3个月～5年，9例痊愈，1例血管内皮肉瘤基本痊愈，1例恶性神经纤维瘤复发行多次手术。结论：本病一经确诊，均应行手术切除。手术人路的选择是决定能否一期切除肿瘤，减少不必要损伤和恢复机体功能的关键；必要时请胸科和骨科医师协助手术，可保证手术顺利进行。     

复杂原发性颈椎及颈椎管内肿瘤的外科治疗

目的探讨复杂颈椎肿瘤治疗的外科手术策略。方法本组共治疗了14例复杂颈椎肿瘤，分别为：椎管内外哑铃型神经鞘瘤8例、神经纤维瘤1例、骨巨细胞瘤2例、动脉瘤样骨囊肿2例、脊索瘤1例。年龄19～71岁（平均43．3岁），男7例，女7例。术前采用MR、CT、MR血管造影等技术对肿瘤性质、范围，肿瘤与椎动脉等周围重要解剖结构的关系进行评估，以易于显露肿瘤及尽可能不骚扰脊髓为原则，选择前路、后路或前后路联合手术入路，以尽可能将肿瘤完全切除并行力学重建。术前术后分别对脊髓功能进行JOA评分，评价手术减压效果。结果14例患者肿瘤被肉眼下完全切除，所有病例随访6个月～2年，14例均获得随访。术前评分平均12．2±0．5分，术后平均评分15．4±0．6分。除1例脊索瘤患者患者及1例神经纤维瘤患者复发再次手术外，其余病例未见复发，疗效满意。结论对于侵犯颈椎椎管内外的哑铃型肿瘤、解剖部位较高范围较大的原发性椎体肿瘤，通过术前影像学检查，确定相应的手术入路，可以安全彻底的将肿瘤切除，收到比较理想的效果。     

咽旁间隙肿瘤的诊断及手术入路

目的：探讨咽旁间隙肿瘤的诊断与手术人路。方法：对1997年-2007年32例咽旁间隙肿瘤的临床资料进行回顾性分析。结果：32例中良、恶性肿瘤分别占84．38％、15．62％，其中以神经源性及涎腺来源最为常见。术前CT、MRI明确肿瘤的大小、位置、侵犯范围以及与周围组织关系。手术采用口内径路1例，颈侧径路27例，颈外及下颌骨外侧裂开3例，颈腮腺径路1例。结论：颈部CT、MRI是诊断、鉴别诊断的良好手段，颈侧径路则是最常用且安全有效的手术径路方式。     

肾上腺肿瘤的诊治体会

肾上腺肿瘤并非少见，可出现高血压及水电解质紊乱等临床症状，也可无临床症状。1995年1月至2002年1月我院收治了2l例肾上腺肿瘤患，并进行了手术治疗，总结报告如下：     

乳管内乳头状瘤428 例诊治体会

安徽省阜阳肿瘤医院外科自１９８６年１月～１９９６年１月经手术治疗并病理证实４２８例乳管内乳头状瘤总结报告如下。１　临床资料女性４２６例,男性２例,年龄１７～７８岁,平均４６岁。病程７天～１８年,平均４２个月。临床表现：乳头溢液２９８例,占６９％,以血性溢液为主,占４８％,局部有轻微疼痛占２０％;乳晕或乳晕旁放射状条索状增粗或小结节（０３～１ｃｍ以上）３２０例,占７５％;按压局部有恒定部位乳头溢液３１６例,未触及肿块者１０８例,但按压乳腺一定部位引起恒定乳管溢液者１０７例。乳腺区段切除３０４例…     

Surgical treatment of thoracic dumbbell tumors

BackgroundThoracic dumbbell tumors are uncommon neoplasms arising from neurogenic elements of the posterior mediastinum. Surgical removal of these tumors with mediastinal, neuroforaminal and intraspinal components can often be challenging. The purpose of this study is to present our experience of single-stage removal of dumbbell tumors of the posterior mediastinum and to discuss the surgical strategies for such tumors.MethodA retrospective analysis was performed on 20 patients who underwent surgery for thoracic dumbbell tumors at our department during the period 2008 to 2016. Patient demographics, clinical features, operative reports, and pre- and postoperative images were reviewed.ResultComplete resection was achieved in all patients, with no postoperative mortality. Surgical excision was performed by laminectomy plus Video-assisted thoracoscopic surgery (VATS) in 10 patients and laminectomy plus thoracotomy in 4 patients. Two patients underwent VATS alone. Supraclavicular and transthoracic approach was performed in 2 patients. Another 2 patients were treated with supraclavicular approach alone. The mean operative time was 244 min (range 55–370 min), with mean estimated blood loss (EBL) of 360 ml (range 50–790 ml). Postoperative complications included one case of Horner's syndrome and one case of cerebrospinal fluid (CSF) leakage. At a mean follow-up of 29 months no patients showed recurrence of the tumor.ConclusionThoracic dumbbell tumors should be evaluated for intraspinal and neuroforaminal involvement. Single-stage posterior laminectomy plus VATS/thoracotomy, VATS/thoracotomy, and supraclavicular alone or combined with transthoracic approach all could be the preferred method for removing these dumbbell tumors with satisfactory outcomes.     

经胸联合后正中径路切除后纵隔哑铃状神经源性肿瘤

目的探讨后纵隔哑铃状神经源性肿瘤的切除方法.方法1994年6月～2003年5月经胸联合后正中径路切除后纵隔哑铃状神经源性肿瘤4例,其中神经纤维瘤3例,神经鞘瘤1例.全部病人均选择经胸联合后正中径路切除肿瘤.结果4例肿瘤均全部切除,症状均有不同程度改善,术后病人均能正常生活,未见肿瘤复发.结论经胸联合后正中径路一期切除后纵隔哑铃状神经源性肿瘤是安全可靠的手术方式.     

手术治疗颈椎管内外哑铃型肿瘤的临床研究

目的 探讨颈椎管内外哑铃形肿瘤的临床特点、Toyama分型及手术治疗策略.方法 回顾分析我院2008年8月至2011年8月期间治疗的5例颈椎哑铃形肿瘤患者的临床表现、影像学特征、病理类型、手术治疗方法和预后.肿瘤节段位于Cl～2 2例,C3～5 1例,C4～6 1例,C5～7 1例.神经鞘瘤5例.采用Toyama方法分型,II B型1例,III A型1例,IV型1例,VI型2例;IF分期I期2例,II期3例;TF分期I期3例,II期2例.2例行颈后正中入路,2例行颈前右侧入路,1例行颈前左侧入路.结果 肿瘤均完全切除,无椎动脉损伤,无神经功能障碍加重.患者局部疼痛和神经症状均有明显改善,术后即刻出现单侧上肢一过性瘫痪1例,经激素及脱水药物治疗5d后缓解;脑脊液漏1例,保守治疗后闭合;未见颈椎反屈畸形,无术后感染病例.随访6个月至2年,平均9个月.所有患者神经功能均有不同程度恢复,其中3例患者神经功能完全恢复.所有病例均未见局部复发.结论 颈椎管内外哑铃形肿瘤可通过Toyama分型选择合适的手术方式和入路,减小对颈髓、椎动脉、神经根损伤风险,并且肿瘤可一次性手术切除.     

哑铃型椎管肿瘤的临床诊治分析

目的　探讨哑铃型椎管肿瘤的临床特征以及诊疗方法。方法　回顾性分析我院自１９９８至２００８年１０年间收治的２８例哑铃型椎管肿瘤患者的临床资料。结果　２８例哑铃型椎管肿瘤患者均经ＭＲＩ和术后组织病理学检查明确诊断,临床特征主要为椎管内压迫症状（根性疼痛、感觉异常、肌无力）和椎管外压迫症状（椎体周围发现包块）。所有病例均行Ⅰ期手术切除,无手术死亡,２３例获得随访,随访７个月～１０年,１８例恢复正常工作。结论　对椎管肿瘤患者应重视临床病史和体格检查;ＭＲＩ检查在哑铃型椎管内肿瘤的诊断和手术方式的选择上占重要地位;早期诊断、Ⅰ期手术完全切除肿瘤是优选有效的治疗方法。     

肿瘤脊柱转移的诊断和治疗

肿瘤脊柱转移是癌症患者的严重并发症,随着治疗理念的转变以及治疗手段的完善,许多患者可提高生活质量,延长生存期,防止病理性骨折、脊髓受压。     

肿瘤脊柱转移的诊断和治疗

肿瘤脊柱转移是癌症患者的严重并发症,随着治疗理念的转变以及治疗手段的完善,许多患者可提高生活质量,延长生存期,防止病理性骨折、脊髓受压。     

Diagnosis and treatment of carcinoid tumors

Carcinoid tumors belong to the family of neuroendocrine tumors, which are usually slow growing with distinct biological and clinical characteristics. The incidence of these tumors is approximately 2.5 in 100,000 people per year. The former classification system of foregut, midgut and hindgut tumors is still used in clinical routine, although there is a new World Health Organization classification. Determination of the histopathology of carcinoid tumors is of utmost importance and involves specific immunohistochemical staining for chromogranin A, synaptophysin, serotonin and gastrin. Proliferation capacity measured by Ki67 is used to guide forthcoming medical treatment. Localization procedures include computerized tomography, ultrasound, magnetic resonance imaging, somatostatin receptor scintigraphy and positron emission tomography. Surgery remains the cornerstone of treatment and provides the only chance of a cure. Other cytoreductive procedures include radiofrequency ablation, laser treatment and chemoembolization. Biological treatment includes cytotoxic agents, such as somatostatin analogs and interferon-α, which should be applied in slow-growing neoplasms. Combination regimens including cisplatin, etoposide, streptozotocin and 5-fluorouracil should be reserved for treatment of highly proliferating tumors. Future therapy of carcinoid tumors will be based on the specific tumor biology and treatment will be customized for each individual patient. New therapies, such as antiangiogenic agents and new, long-acting somatostatin analogs, together with further development of tumor-targeted treatments, will come into clinical use in the near future.     

Diagnosis and treatment of adrenocortical tumors

Adrenocortical tumors can be divided into two groups based on their histopathological characteristics, i.e., benign (adenoma) and malignant (carcinoma), and also classified as functioning (or hormonal) and non-functioning (or non-hormonal) tumors, depending on the presence or absence of recognizable clinical syndromes due to excessive steroids. The syndrome of functioning adrenocortical tumors includes Cushing's syndrome, primary aldosteronism and the adrenorge genital syndrome, of which a minority presents most of the specific clinical features: Cushing's syndrome; red face, typical moon face, truncal obesity, and purplisch red striae, primary aldosteronism; muscle weakness, noctural polyuria, hypertension and hypokalemia, adrenogenital syndrome; virilization or feminization, but many of them present complete clinical picture. The diagnosis of these syndromes needs to measure urinary 17-OHCS and 17-KS and plasma concentrations of cortisol, aldosterone, dehydroepiandrosterone (DHEA) and the other steroids. Dexamenthasone suppression test, various stimulation tests and the measurement of plasma ACTH are also useful for diagnosis. Usually, adrenocortical tumors can be detected preoperatively by physical examination or radiographic studies. Some are massive enough to be palpable through the abdominal wall. Some are large enough to cause displacement of the kidney, as seen intravenous urography. Most are visible by adrenal scintigraphy using 131I-iodocholesterol, computerized tomography, or adrenal arteriography. The standard treatment for adrenocortical tumors are surgical resection. Unresectable adrenocortical carcinomas may be treated with an adrenocorticolytic drug, o'p'-DDD. Metyrapone and aminoglutethimide can be also employed to inhibit the production of steroids.     

Diagnosis and treatment of carcinoid tumors

Carcinoid tumors belong to the family of neuroendocrine tumors, which are usually slow growing with distinct biological and clinical characteristics. The incidence of these tumors is approximately 2.5 in 100,000 people per year. The former classification system of foregut, midgut and hindgut tumors is still used in clinical routine, although there is a new World Health Organization classification. Determination of the histopathology of carcinoid tumors is of utmost importance and involves specific immunohistochemical staining for chromogranin A, synaptophysin, serotonin and gastrin. Proliferation capacity measured by Ki67 is used to guide forthcoming medical treatment. Localization procedures include computerized tomography, ultrasound, magnetic resonance imaging, somatostatin receptor scintigraphy and positron emission tomography. Surgery remains the cornerstone of treatment and provides the only chance of a cure. Other cytoreductive procedures include radiofrequency ablation, laser treatment and chemoembolization. Biological treatment includes cytotoxic agents, such as somatostatin analogs and interferon-alpha, which should be applied in slow-growing neoplasms. Combination regimens including cisplatin, etoposide, streptozotocin and 5-fluorouracil should be reserved for treatment of highly proliferating tumors. Future therapy of carcinoid tumors will be based on the specific tumor biology and treatment will be customized for each individual patient. New therapies, such as antiangiogenic agents and new, long-acting somatostatin analogs, together with further development of tumor-targeted treatments, will come into clinical use in the near future.