腹后淋巴管瘤的诊断与治疗

腹膜后囊性淋巴管瘤临床少见，这是一种淋巴管畸形或发育障碍所致的疾病。作者近２０年间收治６例。首发症状为腹部肿块及消化道功能障碍。术前确诊仅１例，蓁误诊为胰腺囊肿，畸胎瘤及卵巢囊肿。６例均行手术治疗，单纯囊肿切除３例，囊肿大部分切除２例，囊肿并胰尾切除１例。手术均获成功。术后随访１－１９年，均未复发。作者认为，Ｂ超、ＣＴ对此病的诊断有重要意义，手术切除是目前治疗本病的理想方法。     

肠系膜囊肿

作者了报道１３例肠系膜囊肿，位于小肠系膜６例，结肠系膜６例，另１例在小肠及结肠系膜各有一囊肿。其中１２例为良性，１例为低度恶性血管外皮瘤。１３例均行手术治疗，９例将囊肿完整摘除，４例连同囊肿及相邻部分肠管作肠系膜扇形切除。如果囊肿与肠系膜血管粘连，可以切除不粘连的囊壁，保留粘连的部分，并用石碳酸烧灼内膜，效果良好。１例低度恶性的血管外皮瘤只作单纯囊肿摘除，随访３年，无复发症状。本组无手术死亡。作者还就本病的病因、分型、临床特点及其治疗进行了讨论。     

肠系膜囊肿

作者了报道１３例肠系膜囊肿，位于小肠系膜６例，结肠系膜６例，另１例在小肠及结肠系膜各有一囊肿，其中１２例为良性，１例为低度恶性血管外皮瘤，１３例均行手术治疗，９例将囊肿完整摘除，４例连同囊肿及相邻部分肠管作肠和纱膜扇形切除，如果囊肿与肠系膜血管粘连，可以切除不粘连的囊壁，保留粘连的部分，并用石碳酸烧灼内膜，效果良好，１例低度恶性的血管外皮瘤只作单纯囊肿摘除，随访３年，无复发症状，本组无手术死亡，作     

儿童梨状窝瘘的诊断与处理

作者报告了近年收治的１２例儿童梨状窝瘘的诊断与处理经验。患者年龄为１．５～１０岁。１１例表现为左侧颈部炎性肿块，发作期颈部超声检查及核素显像示炎症累及甲状腺左叶，炎症消退后作食管吞钡造影，均证实存在左侧梨状窝瘘；１例为左侧甲状腺无痛性囊性肿块。６例行手术治疗，其中４例予瘘管高位结扎切除；１例术中未能找到瘘管，术后吞钡复查，瘘管消失；１例甲状腺左叶无痛性囊性肿者，术中证实梨状窝瘘伴甲状腺内囊肿形成，行囊肿切除及瘘管高位结扎术。患者术后均恢复良好，随访１～５年无复发。另６例未手术者，５例１～６年无症状，１例２年间有３次发作。作者认为，充分认识梨状窝瘘，对于化脓性甲状腺炎或原因不明的颈部感染的处理具有重要意义。     

甲状旁腺囊肿的诊断与外科治疗

作者１０年来共收治６例甲状旁腺囊肿，占同期颈部肿块手术患者的０．２７％。６例中男性２例，女性４例。平均年龄４７．５岁，病程３个月至３０年不等。６例囊肿均为单发，直径２．８～７．０ｃｍ，位于下甲状旁腺区域。５例为无功能囊肿，囊壁薄，囊液清亮；１例为伴甲旁亢症状的功能性囊肿，组织学证实为甲状旁腺腺瘤出血囊性变。６例囊肿均经手术切除，术后经过良好。作者强调影象检查、经皮活检、囊液ＰＴＨ测定在术前诊断上的价值。     

颅内蛛网膜囊肿显微手术治疗

目的：回顾性分析开颅显微手术治疗颅内蛛网膜囊肿的疗效。方法：应用显微外科手术治疗上述病例２８例，男１９例，女９例，平均年龄２３岁。结果：囊肿全切除１５例，次全切除６例，部分切除加脑池（或蛛网膜下腔）交通术７例。术后平均随访３年，患者症状与体征均有改善。ＣＴ随访２１例，１８例囊腔消失或明显缩小，２例稍有缩小，１例较术前无变化。结论：精细操作，防止囊肿破裂并尽量完整切除或大部分切除囊肿，充分建立囊腔与周围脑池之间交通是手术成功的关键。     

苗勒管囊肿的诊断及治疗

应用腔内超声诊断苗勒管囊肿８例。１例手术切除囊肿，１例经尿道切开引流，６例由超声引导经会阴穿刺抽液治疗。８例均获治愈。苗勒管囊肿的腔内Ｂ超特征为：位于前列腺中央的圆形无回声区向前列腺后上方延伸。囊液不含精子。认为腔内超声及其引导的经会阴穿刺术为诊治苗勒管囊肿提供了有效、创伤小的方法。对于表现为肿块的病例宜手术治疗     

功能性甲状旁腺囊肿的诊断及外科处理

目的了解功能性甲状旁腺囊肿（ＦＰＴＣ）的特点,总结其诊治经验。方法回顾性研究了我院１９８４～１９９６年收治功能性甲状旁腺囊肿６例的临床表现及血钙、甲状旁腺素、Ｂ型超声和ＣＴ等辅助检查的特点;并结合文献讨论了功能性甲状旁腺囊肿诊治的有关问题。结果本组６例患者均经手术切除、病理检查证实为ＦＰＴＣ;其中囊实性２例,合并甲状旁腺腺瘤１例,位于纵隔１例;术后均恢复正常。结论功能性甲状旁腺囊肿应手术切除,避免囊肿穿刺活检。     

胰腺假性囊肿的治疗（附76例分析）

９８６年６月至１９９６年６月，华西医科大学附一院普外科共收治胰腺假性囊肿７６例，其中保守治疗１６例（２１％），手术治疗６０例（７９％）。手术治疗组中行外引流术１８例，内引流术３３例，囊肿切除９例。内外引流术后的疗效差别甚大，现报告如下。１临床资料本组...     

对胰腺假性囊肿诊断及治疗的再认识

作者通过总结２６年来诊治５２例胰腺假性囊肿的经验，提出了自己的看法。本组５２例中，保守治疗１０例，其中３例囊肿自行消散，均为近期患急性胰腺炎者；手术治疗４２例，内引流２８例，外引流８例，其他手术６例。外引流术后发生胰瘘３例，囊肿复发１例，死亡２例。内引流的患者术后均无合并症出现，比较术后平均住院时间，与外引流的患者之间差异有显著意义。我们认为慢性囊肿不同于急性囊肿，前者入院后一经诊断即可行内引流治疗，无需再观察６周或更长时间，以防合并症的出现。急性囊肿则应观察６～８周，以待囊壁成熟纤维化；有些病例有自行消散的可能     

Infected retroperitoneal cystic lymphangioma masquerading as psoas abscess

A 2-year-old male is described who presented with fever, fixed flexion deformity of the right hip and a tender mass in the right iliac fossa. A clinical diagnosis of psoas abscess was made. Abdominal ultrasound was suggestive of an echogenic retroperitoneal cyst but could not accurately determine the nature of the cyst. A contrast CT scan showed a retroperitoneal cyst. At laparotomy, a large retroperitoneal cyst containing turbid fluid was found and was excised completely. Histopathological examination was suggestive of cystic lymphangioma. Clinical presentation of retroperitoneal lymphangioma may be variable and misleading, therefore complex imaging studies are necessary in the evaluation of this condition.     

原发性腹膜后巨大淋巴管瘤1例报告并文献复习

目的：提高原发性腹膜后淋巴管瘤的诊治水平。方法：报道1例原发性腹膜后淋巴管瘤患者的诊治过程,术前诊断腹膜后囊肿,行单孔腹腔镜双侧腹膜后囊肿切除术。结果：术后病理（腹膜后囊肿）检材由扩张的淋巴管组成,囊壁由内皮细胞、平滑肌及纤维组织组成,符合腹膜后淋巴管瘤。术后随访6个月未见复发。结论：原发性腹膜后淋巴瘤是一种良性病变,临床罕见,确诊需结合术后病理和影像学表现,手术切除是最佳治疗方式。     

BosniakⅠ型肾囊性病变发生癌变的诊治经验(附5例报告)

目的:总结BosniakⅠ型肾囊性占位病变发生癌变的诊治经验。方法:回顾性分析5例BosniakⅠ型肾囊性恶性病变的B超、CT、病理特征、治疗方法和随访结果:男3例,女2例;年龄42～72岁,平均54岁。患侧腰酸1例,体检发现4例。囊腔直径5.5～8.0cm。术前B超及CT均诊断为肾囊肿。结果:5例均行腹腔镜下肾囊肿去顶术,术后病理检查诊断为透明细胞癌,再次行根治性肾切除术。5例随访6～33个月,4例无瘤存活,1例因心血管疾病死亡。结论:重视BosniakⅠ型肾囊性病变的影像学和病理学特征,术中行冷冻切片病理检查是提高BosniakⅠ型囊性肾癌诊治水平的关键。     

成人腹膜后淋巴管瘤八例分析

目的探讨成人腹膜后淋巴管瘤的诊断和治疗。方法回顾性分析我院自1995年8月至20（18年3月收治并经病理学检查证实的成人腹膜后淋巴管瘤8例的临床资料。结果本组均行手术治疗。其中,行完整切除6例,行大部分切除2例。术后随访未见肿瘤复发。结论腹膜后淋巴管瘤临床表现缺乏特异性,术前难确诊,CT等影像学检查对该病的定性、定位具有一定的提示性。手术切除是该病的首选治疗方法。     

A case of retroperitoneal cystic lymphangioma]

A case of retroperitoneal cystic lymphangioma in a 62-yr-old woman presented as symptom-free abdominal swelling. The intraoperative diagnosis was confirmed histologically. Radical management consisted of stripping of the cyst from its adjacent structures. The postoperative course was uneventful.     

A case of retroperitoneal lymphangioma successfully treated by pancreatoduodenectomy

A rare case of retroperitoneal lymphangioma in 44-year-old male complaining of high fever and right hypochondralgia is reported. Retroperitoneal malignant tumor was suspected preoperatively, and pancreatoduodenectomy was performed because the tumor infiltrated to duodenum and head of the pancreas. Histopathological examination revealed that the tumor was lymphangioma infiltrating to the duodenum. There are two types of lymphangioma, solitary lymphatic cyst and true proliferating lymphangioma and in this case, the tumor is diagnosed as true proliferating lymphangioma which is cavernous and infiltrating.     

Abdominal lymphangiomas in children: interest of the laparoscopic approach

Background Lymphangiomas are rare benign lesions of the lymphatic system. The most common symptoms are abdominal tumor or “acute abdomen” in children. The treatment of choice is complete surgical resection, but the recurrence rate with incomplete resection is high, and laparotomy exposes the patient to adhesions. The authors report their experience with the lymphangioma laparoscopic approach. Methods This retrospective study examined 15 consecutive operations for lymphangiomas in children, ages 5 months to 14 years, treated during the 5-year period from 1999 to 2004. Results Six patients were treated using the primary laparotomy approach, and nine patients underwent the laparoscopic procedure, six successfully. Three conversions were necessary (1 case requiring partial colectomy, 1 retroperitoneal case with adherence on the aorta and vena cava, 1 case with partial volvulus). Morbidity included two cases of acute occlusion caused by adhesions after laparotomy. There was no recurrence of lymphangioma during a mean follow-up period of 35 months. Conclusion The laparoscopy procedure could be used successfully for abdominal lymphangioma, even in an emergency. When the laparoscopic resection is impossible, laparotomy or sclerotherapy can be discussed.     

A case of retroperitoneal cavernous lymphangioma with the content of chylous fluid

We report a case of retroperitoneal lymphangioma in a 26-year-old man whose chief complaint was lumbar discomfort. Ultrasonography revealed pararenal cyst on his left side. At the operation, we discovered a cystic tumor between peritoneum and Gerota's fascia. Pathological study indicated cavernous lymphangioma containing chylous fluid. There has been no recurrence for a year after the operation.     

Primary retroperitoneal hydatid cyst: report of 2 cases and review of 41 published cases

This paper gives an overview of the literature between 2000 and 2010 on primary retroperitoneal hydatid cyst. We reported 2 cases of primary retroperitoneal hydatid cyst, and studies published in English literature on hydatid cyst developing in the retroperitoneal space were accessed via Pubmed and Google Scholar databases. Forty-one published primary retroperitoneal hydatid cyst cases were evaluated, and 2 patients (1 man, 78 years old; 1 woman, 75 years old) who presented with abdominal mass caused by retroperitoneal hydatid cyst were reported. Twenty-five of the patients were men (including our patient), and 18 were women; patients ranged in age from 3 to 80 years, and the median +/- standard deviation age was 41.37 +/- 20.4 years. On presentation, 72% of the patients complained of back or abdominal pain; 13.9% had urinary tract symptoms, and 65.1% were determined as having a palpable mass. Ultrasonography was performed on 93% of the patients, computed tomography was performed on 81.4%, magnetic resonance imaging was performed on 18.6%, and intravenous pyelography test was performed on 13.9%. The results of these tests showed a cystoid mass located on the left in 32.5% of the patients, on the right in 37.2%, and in the retrovesical area in 16.2%. Serologic tests determined 67.8% of the patients were indirect hemagglutination positive, and 71.4% were positive on enzyme-linked immunosorbent assay. As a surgical approach, total exision was performed on 55.8% of patients, partial cystectomy was performed on 39.5%, and 4.6% of patients underwent unroofing. If a cystic lesion is determined in the retroperitoneal area in a patient living in an area of endemic hydatid disease, a differential diagnosis of hydatid cyst should be considered. Clinical, radiologic, serologic, and histopathologic evaluations should be made for a differential diagnosis.     

Ultrasonography with contrast agent for diagnosis of benign retroperitoneal cyst. Case report

Intraabdominal tumors require precise diagnosis for patient preparation for optimal surgical procedure. For diagnosis of these lesions, the principal studies used are ultrasonography, computed axial tomography (CAT) and occasionally the use of magnetic resonance imaging, a study not always possible to accomplish in all hospitals. We present the case of a patient with a giant retroperitoneal cyst whose diagnosis was missed by means of conventional ultrasound and CAT. For this reason, we chose to use ultrasound with echography using contrast agent (Levovist) to determine if the tumor was dependent on the liver or pancreas. By means of this technique, we were able to make the diagnosis that the tumor did not depend on any organ, but rather was an independent retroperitoneal tumor. Final surgical and histopathological diagnosis was a retroperitoneal multilocular lymphangioma. We conclude that ultrasonography with contrast agent (Levovist) is an alternative method for studying intraabdominal tumors.