超声诊断盆腔巨大神经鞘瘤1例

患者 ,男 ,6 3岁。高血压病史 10年。近日因心前区疼痛 ,血压持续升高住院治疗。体检发现其右下腹隆起 ,触诊发现一巨大包块 ,质地略硬 ,无移动感 ,无压痛。追问病后 ,该患自述于 1年前在右下腹触及一 14ｃｍ× 10ｃｍ× 14ｃｍ包块 ,1年来逐渐增大。因无腹痛、无排便、排尿困难而未曾就诊。超声检查 :膀胱充盈佳。盆腔右侧探及 14 .1ｃｍ× 10 .6ｃｍ× 15ｃｍ大小的囊性均质光团。轮廓规整 ,包膜完整 ,其内部回声上部呈液性 ,下部为密集光点 ,于左右壁及下壁可见粗细不均的条状回声交织 ,似呈分隔状。嘱患者作腹式深呼吸 ,可见前方肠管回…     

神经鞘膜瘤的显微外科治疗

目的介绍应用显微外科技术治疗神经鞘膜瘤的特点及疗效.方法对86例神经鞘膜瘤在放大6倍的手术显微镜下行肿瘤的包膜内切除术.结果 86例皆得到6～84个月的随访,切除部位无1例复发,其中3例多发性神经鞘膜瘤因肿瘤数量太多而无法全部切除,3例术后6月内有局部感觉麻木,其余皆神经功能正常.结论应用显微外科技术治疗神经鞘膜瘤的疗效满意,有瘤体切除彻底,神经干保护好、损伤少等特点.     

喉神经鞘膜瘤1例报告

喉神经鞘膜瘤是喉部少见肿瘤 ,我科自 1 991年收治喉良性肿瘤 1 6例 ,发现喉神经鞘膜瘤 1例。1　临床资料　　患者 ,男 ,2 9岁 ,因“咽喉异物感、呼吸费力 3年 ,运动后喘鸣半年”于 2 0 0 0年 4月 1 2日入院。未出现明显声嘶 ,喝水后偶有呛咳 ,其爱人反映患者睡觉时常气蹙 ,鼾声极大。检查 :全身无异常发现 ,耳鼻咽部正常 ,喉部纤维镜检查 :会厌正常 ,声门裂狭小 ,双侧声室带充血 ,左侧披襞活动度受限 ,右侧梨状窝见一肿物 ,约 5ｃｍ× 4ｃｍ× 3ｃｍ大小 ,表面光滑 ,压迫右披襞向左移位。胸透及常规检查无异常。于 2 0 0 0年 4月 1 8日在全…     

膀胱神经鞘膜瘤1例报告

神经鞘膜瘤是临床上少见的良性肿瘤,多发生于头颈、四肢,发生于膀胱者罕见.我们收治1例,报告如下.     

盆腔腹膜后神经鞘瘤一例

1病例资料〈br〉 患者,女,57岁,2012年8月年无明显诱因出现下腹部疼痛,未行特殊处理,来我院前1周腹痛加剧。既往病史：2003年行腹膜后纤维瘤切除术,2006年行全子宫切除术。查体正常,下腹部压痛,无反跳痛。实验室检查：肿瘤标志物CA15-3为28．86 U／ml;白带常规：白细胞10～20个／HP,阴道清洁度3度;血常规：白细胞计数2．85×10^9／L;肝肾功能、空腹血糖、血脂、凝血功能、尿常规等未见异常。 CT表现为右侧附件区类椭圆形等密度影,其内不甚均匀,界限清晰,与邻近肠管分界清晰。 MRI平扫示左侧附件区见类椭圆形等T1、稍长T2信号影,其内见多处小结节状长T1、更长T2信号影,病灶周围见低信号包膜影环绕,边缘光滑、锐利,增强扫描肿块呈明显不均匀强化,其内更长T2信号影未见强化。     

盆腔神经鞘瘤二例并文献复习

目的：探讨盆腔神经鞘瘤的临床症状、诊断、治疗及预后。方法回顾性分析2例盆腔神经鞘瘤误诊为卵巢肿瘤的原因,并结合相关国内外文献进行复习。结果2例患者早期无明显临床症状,均因肿块增大引起非特异性症状就诊,均行肿瘤完整切除手术,病理诊断为盆腔神经鞘瘤,术后1~2年随访均未见复发。结论盆腔神经鞘瘤临床少见,缺乏临床特异性,易被误诊为卵巢肿瘤,确诊靠病理组织学,手术切除是最佳治疗方法,良性神经鞘瘤预后好。     

巨大型椎管神经鞘膜瘤的显微手术治疗

目的 提高巨大型椎管神经鞘膜瘤的诊治水平。方法 回顾性分析5年来收治的9例病人临床资料及相关文献资料。结果 9例中男6例，女3例。年龄21～41岁。主要表现为神经根痛和肢体运动、感觉及大小便功能障碍。病程2～8年。MRI表现符合Sridhar建议的巨大型椎管肿瘤的诊断标准；采用显微手术，全切除6例，大部分切除3例。术后症状元加重。痊愈6例，好转3例。结论 提高对本病的认识可以减少误诊、漏诊，采取合理手术入路，显微神经外科技术等利于肿瘤全切除。     

鼻中隔神经鞘膜瘤1例

患者 ,女 ,41岁。 2年前逐渐出现不明原因的左鼻腔阻塞伴头痛 ,嗅觉减退。未接受任何诊治。近半年来 ,左鼻腔阻塞及头痛加重 ,伴左耳鸣 ,听力下降 ,无左鼻腔出血。以“左鼻腔息肉”收住院。入院查体 :一般情况好 ,外鼻 (- ) ,双鼻前庭 (- ) ,右鼻腔未见异常 ,左鼻腔鼻中隔上后端见一呈粉红色的新生物 ,表面光滑、质中 ,与周围组织无粘连 ,可活动 ,基底来源不清。鼻咽部左侧也可见大块的呈粉红色 ,表面光滑的新生物。入院后在局麻下行手术摘除 ,由于新生物组织大 ,分部摘除 ,术中发现新生物来源于左鼻腔中隔上后端 ,有蒂 ,基底很小 ,约 0 5…     

髓外硬膜下神经鞘膜瘤与脊膜瘤的MRI诊断(附31例报告)

目的：探讨髓外硬膜内神经鞘膜瘤及脊膜瘤的ＭＲＩ表现及其鉴别诊断；材料与方法：本文回顾分析一附院１９９５～１９９７年间经ＭＲＩ诊断，手术病理证实为髓外硬膜内神经鞘膜瘤２４例及脊膜瘤７例共３１例的ＭＲＩ及临床表现；结果：ＭＲＩ对髓外膜内肿瘤的定位准确率达１００％。Ｔ１ＷＩ低信号，尤其是Ｔ２ＷＩ不均匀高信号，ＧｄＤＴＰＡ强化明显而不均匀，肿瘤沿扩大的椎间孔突出到椎旁呈哑铃状是神经鞘膜瘤的特征，而脊膜瘤的ＭＲＩ表现常为Ｔ１ＷＩ等信号，Ｔ２ＷＩ呈稍高信号，信号较均匀，且发病部位、好发年龄及性别有一定特点，但两者的临床及ＭＲＩ表现尚有一定的重叠率。结论：椎管内髓外硬膜下神经鞘膜瘤与脊膜瘤的术前诊断，ＭＲＩ具有准确的定位和较高的定性能力，如结合患者的姓别、发病年龄、发病部位等综合分析，将更能提高两者的诊断与鉴别诊断水平。     

Clinical analysis of 73 cases of intraspinal nerve sheath tumor

Seventy-three patients with spinal nerve sheath tumor who were surgically treated in our hospital during the years 2004-2010 were retrospectively reviewed with respect to recovery of neurological function, recurrence of the tumor and occurrence of kyphotic deformities. Preoperative clinical manifestations, imaging data, surgical records and follow-up results were comprehensively analyzed. The follow-up duration was 12-60 months with an average of 32.0 months. Out of the 73 cases enrolled, 69 had gradual recovery of sensation, motor and sphincter functions 1 week to 3 months after operation. Forty-six cases had incomplete paralysis, whose American Spinal Injury Association (ASIA) grades, however, were gradually increased during the follow-up period, 4 cases had no significant improvement of the clinical symptoms and no change in ASIA grades during the follow-up period. Two cases had postoperative recurrence of the tumor. There were no deaths, no spinal instability, and no kyphotic malformations found in any cases. Our study indicated that complete removal of the tumor is important for good recovery, and an ideal surgical method may reduce the recurrence of the tumor or the occurrence of complications.     

吉非替尼通过促进H3K27甲基化水平抑制恶性周围神经鞘瘤细胞的增殖

目的:研究表皮生长因子受体（EGFR）抑制剂吉非替尼（gefitinib）对恶性周围神经鞘瘤（MPNST）细胞增殖、迁移的影响。方法:选择STS26T细胞、ST88-14细胞,分为对照组和给药组（10 μmol/L）,其中药物IC50实验、蛋白印迹实验给药组浓度分为5、10、15 μmol/L。CCK-8法检测吉非替尼对STS26T、ST88-14的半数抑制浓度并绘制药物IC50曲线;平板克隆形成实验检测吉非替尼对细胞增殖能力的影响;划痕实验检测吉非替尼对细胞迁移能力的影响;实时荧光定量PCR检测加药后各组细胞Kras、SUZ12、EED、EZH2 mRNA的表达情况;蛋白印迹实验检测加药后Kras、组蛋白H327位赖氨酸三甲基化蛋白（H3K27me3）的表达。结果:STS26T、ST88-14细胞的药物IC50曲线显示半数抑制浓度均为10 μmol/L（t=11.42、16.51,均P＜0.05）;与对照组比较,吉非替尼给药组（10 μmol/L）STS26T、ST88-14细胞增殖能力显著降低（t=5.48,P＜0.05;t=4.89,P＜0.01）、细胞迁移能力显著降低（t=4.94,P＜0.01;t=4.75,P＜0.01）;与对照组比较,吉非替尼给药组（10 μmol/L）STS26T细胞中Kras mRNA表达显著降低（t=4.87,P<0.01）,SUZ12、EED、EZH2表达显著升高（t=11.36、15.54、13.19,均P＜0.05）;与对照组比较,吉非替尼给药组（10 μmol/L）ST88-14细胞中Kras mRNA表达显著降低（t=13.75,P<0.05）,SUZ12、EED、EZH2表达水平显著升高（t=12.56、7.48,16.33,均P＜0.05）;与对照组比较,吉非替尼给药组（5、10、15 μmol/L）STS26T、ST88-14细胞Kras蛋白表达显著降低（t=13.70、15.21,均P<0.05）;与对照组比较,吉非替尼给药组（5、10、15 μmol/L）STS26T、ST88-14细胞H3K27me3蛋白表达显著增加（t=14.31、12.40,均P<0.05）。结论:EGFR抑制剂吉非替尼通过促进MPNST中PRC2的表达,提高表观遗传学标志物H3K27me3的表达,降低MPNST细胞株增殖、迁移的能力。     

Comparative analysis of CT and pathological findings of peripheral nerve sheath tumors

Objective: To improve the qualitative diagnosis of peripheral nerve sheath tumors by computed tomography(CT). Methods: CT findings of 64 cases of pathologically confirmed nerve sheath tumors were compared with the pathological findings of the tumors. Results: Low density of the tumors shown in plain CT images was related to dominating reticular structure in the tumor as found pathologically. Tumors with intact capsule found by pathological findings were shown with smooth margin in CT images. Inhomogencous density and enhancement of the tumors in CT images was related to tumor necrosis, liquefaction and cystic degeneration, and inhomogeneous enhancement also involved the retieular structure. Conclusion: Nerve sheath tumors are characterized by distribution along the nerves, lower density than that of muscles in plain CT images, and inhomogeneous enhancement in enhanced CT, which can help differentiate nerve sheath tumors from other soft tissue tumors. When nerve sheath tumors lack distinctive CT features, the diagnoses have to depend on their pathological findings.     

彩色多普勒超声对外周神经鞘类肿瘤的诊断分析

目的探究彩色多普勒超声对外周神经鞘类肿瘤的诊断分析的方法和规律。方法选取46例外周神经鞘类肿瘤患者,采用GE公司Vivid7型、东芝公司SSA-660A型和西门子Sequoia-512彩色多普勒超声诊断仪,5~15 MHz线阵探头进行观察。结果肿瘤均成类圆形、类椭圆形和梭形,肿块边界无模糊情况,包膜完整。肿瘤以低回声为主,分布不均匀。结论超声探测可从外周神经的高低回声中简单分辨出患者是否患有外周神经鞘类肿瘤,为临床医生选择手术方法、方式提供了准确的参考数据,大大降低了误诊的发生和对周围神经的损伤。     

盆腔脂肪增多症2例诊治

目的提高对盆腔脂肪增多症的认识。方法回顾性分析2例盆腔脂肪增多症患者诊断和治疗的临床资料，并复习文献就本病的临床特点进行分析。结果2例患者经影像学和病理检查诊断。1例行盆腔脂肪剔除术，1例行口服药物保守治疗，随访4个月和15个月，目前病情稳定，效果良好。结论X线、CT、MRI等影像学检查是诊断盆腔脂肪增多症的主要依据。手术彻底清除异常增多的脂肪是理想的治疗方法，但根据不同的患者及病情，可采用不同的方法。     

肾盂输尿管癌诊治及预后分析(附68例报告)

目的探讨肾盂输尿管癌的诊治方法及其预后。方法回顾性总结68例经病理证实的肾盂输尿管癌，对诊治中若干问题进行探讨分析。结果肉眼血尿、腰痛和肾积水是本病三大临床表现。CT和尿细胞学检查的阳性率是92％和33％，46例随访，5a生存率80％。结论尿脱落细胞是较好的定性诊断方法，CT检查是重要定位诊断方法，肾输尿管及膀胱袖状切除术仍是主要的治疗方法。病人的预后与肿瘤部位、临床分期、病理分级及DNA的倍体类型有关。     

COA:Biomechanical properties of peripheral nerve after acellular treatment

Background Peripheral nerve injury causes a high rate of disability and a huge economic burden, and is currently one of the serious health problems in the world. The use of nerve grafts plays a vital role in repairing nerve defects. Acellular nerve grafts have been widely used in many experimental models as a peripheral nerve substitute. The purpose of this study was to test the biomechanical properties of acellular nerve grafts. Methods Thirty-four fresh sciatic nerves were obtained from 17 adult male Wistar rats (age 3 months) and randomly assigned to 3 groups： Normal control group, nerve segments underwent no treatment and were put in phosphate buffered saline (pH 7.4) and stored at 4°C until further use; Physical method group, nerve segments were frozen at -196oC and then thawed at 37oC; and Chemical method group, nerve segments were chemically extracted with the detergents Triton X-200, sulfobetaine-10 (SB-10) and sulfobetaine-16 (SB-16). After the acellularization process was completed, the structural changes of in the sciatic nerves in each group were observed by hematoxylin-eosin staining and field emission scanning electron microscopy, then biomechanical properties were tested using a mechanical apparatus (Endura TEC ELF 3200), Results Hematoxylin-eosin staining and field emission scanning electron microscopy demonstrated that the effects of acellularization、 demyelination, and integrity of nerve fiber tube of the chemical method were better than that of the physical method. Biomechanical testing showed that peripheral nerve grafts treated with the chemical method resulted in some decreased biomechanical properties (ultimate load, ultimate stress, ultimate strain, and mechanical work to fracture) compared with normal control nerves, but the differences were not statistically significant (P > 0.05). Conclusion Nerve treated with the chemical method may be more appropriate for use in implantation than nerve treated with the physical method.     

Biomechanical properties of peripheral nerve after acellular treatment

Background  Peripheral nerve injury causes a high rate of disability and a huge economic burden, and is currently one of the serious health problems in the world. The use of nerve grafts plays a vital role in repairing nerve defects. Acellular nerve grafts have been widely used in many experimental models as a peripheral nerve substitute. The purpose of this study was to test the biomechanical properties of acellular nerve grafts.

Methods  Thirty-four fresh sciatic nerves were obtained from 17 adult male Wistar rats (age of 3 months) and randomly assigned to 3 groups: normal control group, nerve segments underwent no treatment and were put in phosphate buffered saline (pH 7.4) and stored at 4°C until further use; physical method group, nerve segments were frozen at –196°C and then thawed at 37°C; and chemical method group, nerve segments were chemically extracted with the detergents Triton X-200, sulfobetaine-10 (SB-10) and sulfobetaine-16 (SB-16). After the acellularization process was completed, the structural changes of in the sciatic nerves in each group were observed by hematoxylin-eosin staining and field emission scanning electron microscopy, then biomechanical properties were tested using a mechanical apparatus (Endura TEC ELF 3200, Bose, Boston, USA).

Results  Hematoxylin-eosin staining and field emission scanning electron microscopy demonstrated that the effects of acellularization, demyelination, and integrity of nerve fiber tube of the chemical method were better than that of the physical method. Biomechanical testing showed that peripheral nerve grafts treated with the chemical method resulted in some decreased biomechanical properties (ultimate load, ultimate stress, ultimate strain, and mechanical work to fracture) compared with normal control nerves, but the differences were not statistically significant (P >0.05).

Conclusion  Nerve treated with the chemical method may be more appropriate for use in implantation than nerve treated with the physical method.

     

11例口腔颌面部恶性外周神经鞘肿瘤临床分析

目的：初步探讨口腔颌面部恶性外周神经鞘肿瘤(malignant peripheral nerve sheath tumor, MPNST)的临床特点、治疗和预后。方法：对1987年11月至2008年11月诊治的11例MPNST患者的临床特点、病理资料、治疗方法和疗效进行总结和分析。结果：10例患者局部渐进性增大的肿物为其主要症状,5例患者受累神经出现支配区域麻木或疼痛。11例患者经组织病理证实,免疫组织化学染色, SMA（5/11）、S-100（7/11）、p53（5/11）、Ki-67(11/11) 和vimentin (11/11)呈阳性表达。2年和5年生存率分别为30%和9.5%,平均生存时间为33.9个月。结论：口腔颌面部恶性外周神经鞘肿瘤是一种高度恶性肿瘤,预后差,易出现局部复发和远处转移,彻底的手术切除是口腔颌面部MPNST主要的治疗方法和重要的预后因素。     

松果体区肿瘤的诊断和治疗--附30例报告

目的 探讨松果体区肿瘤的诊断和治疗方法。方法 回顾性分析30例松果体区肿瘤的临床资料。结果 16例(53．3％)经组织学诊断,其中生殖细胞瘤12例(75％)。3例手术部分切除,27例行脑室分流减压术,l3例行立体定向活检。2例先行立体定向内照射,全部病例均给予常规外照射。5例(16．7％)颅内种植性播散,7例(23．3％)松果体区局部复发,未发现脊髓转移。1、3、5、10年生存率分别为93．3％(28／30)、83.3％(25／30)、70．0％(21／30)、52．1％(12／23)。结论 对不能取得组织学诊断的松果体区肿瘤,可依据临床和影像学表现来诊断。常规放射治疗仍然是多数松果体区肿瘤主要的治疗手段,且疗效较好。