乳房脂肪坏死的诊断、鉴别诊断及治疗

乳房脂肪坏死(fat necrosis of the breast,FNB)是一种少见的乳房良性疾病,由于其临床表现与乳癌有相似之处,不易与乳癌作鉴别诊断,甚至有因其而错误实施乳癌根治术者[1]。因此,对乳房脂肪坏死做出正确的诊断是十分重要的。一、病因FNB大多继发于外伤、手术、放疗等诱因之后,无明确诱因病例也不为少数。1.外伤史:外伤是可引起FNB的病因中最重要的一项。因乳房为富含脂肪的组织,外伤常引起脂肪细胞的坏死液化引起无菌性炎症,导致FNB。我院收治的50例中有18例为外伤所致[2]。2.手术史:手术及穿刺是FNB的另一重要原因,因其可造成局部FN…     

乳房脂肪坏死35例分析

本文报告乳房脂肪坏死35例,均为女性.平均年龄35.9岁,30岁以上占62.8%.文中讨论了脂肪坏死的病理、误诊原因、诊断依据.特别强调误诊原因是:①缺乏时乳房脂肪坏死的认识;②乳房脂肪坏死缺乏特征性的临床表现:③缺乏有价值的实验室和辅助检查手段.     

乳房脂肪坏死77例临床分析

目的总结乳房脂肪坏死（fat necrosis of beast,FNB）的病因、病理、诊断及治疗经验。方法回顾性分析1966年至2010年经病理证实的FNB患者77例的临床资料。结果FNB以乳房局限性肿块为卞要表现,有外伤史57例,占74％。FNB术前36例正确诊断（46．8％）;41例（53．2％）误诊,其中32例（41．6％）误诊为乳癌。77例均行手术治疗,分别采用肿块局部及包括周同0．5em健康脂肪组织切除术、乳房区段切除术、脂肪液化切开引流术等方法。77例均痊愈,随访1～5年,末出现癌变及复发。结论FNB易误诊,难以与乳癌鉴别,术前应先行肿块切除或穿刺病理榆查为上策。     

高分辨力超声检查在乳房脂肪坏死诊断中的应用

目的 探讨超声检查在诊断乳房脂肪坏死中的应用价值。方法 对2l例乳房肿块采用高频率超声探头行二维超声(B超)检查，同时结合彩色多谱勒血流成像检查(CDFI)。结果 所有病例获病理诊断。B超及CDFI诊断为脂肪坏死15例，误诊6例，其中乳腺癌4例，乳腺纤维瘤2例，误诊率28．6％。结论 B超与彩色多普勒血流成像检查相结合能提高乳房脂肪坏死的诊断率，是乳腺疾病检查的首选方法。     

乳房外伤性脂肪坏死27例诊治体会

目的：探讨乳房外伤性脂肪坏死的临床特征、诊断要点、误诊原因及治疗方法。方法回顾性分析2003~2012年收治的27例乳房外伤性脂肪坏死的临床资料。结果27例均以乳房肿块就诊，肿块质硬，边界欠清18例（66.67），可与皮肤粘连或伴有皮肤凹陷、乳头变形等，酷似乳腺癌。术前误诊19例（70.37%），误诊为乳腺癌或疑似癌7例（25.93%）。1例非手术治疗，26例手术治疗，全部治愈。结论乳房脂肪坏死易误诊，应重点与乳腺癌鉴别，术中宜做快速冰冻切片检查，手术治疗效果好。     

乳腺脂肪坏死42例分析

济于医学院附属医院普外科乔岩利李彦东乳腺脂肪坏死是一种临床少见的乳腺良性疾病．临床表现有时酷似乳腺癌，易误按乳腺癌行根治性手术。我们自1981年至1996年11月共收治42例，现报告如下。临床资料一、一般资料：平组42例．均为女性、年龄］8～63岁．平均38．7岁．其中3｛～     

乳房缩小术56例报告

以乳头乳晕带蒂移植行乳房缩小成形术治疗乳房肥大症近十年来在国内已经开展,然而,在国外文献上早有报导,而且术式繁多,各有其优点和适应症。乳房肥大继而下垂,不仅上下加长,而且左右也加宽,乳房缩小成形术既要缩小体积,也要塑造优美的外形,健美的乳房近似圆锥体,术中既要缩小长度也要缩小宽度,因此术后多形成“?”状的切口疤痕,如果没有下方正中的垂直切口,则很难缩小乳房的宽度,结果形成上下短,而左右宽的乳房,如同本文所附的术后照片所示。除非将下方弧形切口向两侧上方延长,使两侧缩小宽度,这就等于是正中的垂直切口两侧方的换位而己,作者就此未加说明,希读者在引用时加以注意。     

Percutaneous nephrolithotripsy: a report of 50 cases

Fifty patients with renal (33 patients), renal and ureteral (4 patients) and ureteral (13 patients) stones were treated by percutaneous nephrolithotripsy (PNL) between November 15, 1984 and December 14, 1985. Complete stone removal was achieved in 39 cases (78%). Four of the 11 cases of incomplete stone removal were among the first 5 cases we treated. We have not experienced any severe complications in our 50 cases. The cause of the unsuccessful attempts, complications and other factors of PNL are briefly discussed.     

阑尾黏液囊肿50例诊治分析

目的 探讨阑尾黏液囊肿的诊断及外科治疗的方法.方法 回顾性分析2004-2008年阑尾黏液囊肿50例的诊治情况.结果 术前正确诊断率为8%,8例患者合并腹膜假黏液瘤,恶变率为4%;50例患者全部采用手术治疗,全部治愈出院,无明显手术并发症,恶性肿瘤患者术后经随访及复查未见肿瘤复发及转移. 结论阑尾黏液囊肿术前诊断困难,B超检查右下腹囊实性肿物应高度怀疑阑尾黏液囊肿的可能,结合腹部CT及必要的消化道造影检查可提高术前确诊率.阑尾黏液囊肿可并发腹膜假黏液瘤,且易恶变;手术切除是有效的治疗方法.     

两孔法腹腔镜阑尾切除术50例报告

目的:探讨两孔法腹腔镜阑尾切除术的安全性及有效性。方法:总结分析1995年6月至2011年12月为50例患者行两孔法腹腔镜阑尾切除术的临床资料。结果:50例均顺利完成手术,无手术死亡、切口感染、脂肪液化、腹腔内脏损伤、腹腔内脓肿及肠粘连等并发症发生,术后2～5 d痊愈出院。结论:两孔法腹腔镜阑尾切除术安全、有效,与开腹及三孔法腹腔镜阑尾切除术相比,脂肪液化率、切口感染率、盆腔感染率明显降低,具有美容效果好、易学、患者创伤更轻、痛苦更小、费用更低等优点。     

原发性输尿管癌50例临床分析

目的:提高早期诊治原发性输尿管癌水平。方法:对1973～1996年经手术及病理证实的50例原发性输尿管癌进行回顾性分析。结果:46例获得随访,随访时间6个月～10年,总的5年生存率为54.3%,根治性与保守性手术术后5年生存率分别为55.2%和52.9%;根治性手术后的膀胱癌发生率(24.1%)低于保守性手术(41.2%)。结论:原发性输尿管癌的预后主要取决于肿瘤的分期、分级,进一步提高早期诊治水平是提高患者生存率的关键     

Diverticulum of the female urethra: a report of 50 cases

In the last ten years 50 patients were treated for urethral diverticulum. In contrast to data in the literature the condition does not seem to be infrequent. The main symptoms are recurrent or long persisting disorders of urine flow often accompanied by loin pain during coitus. Beside the history, the diagnosis is based on anterograde or retrograde cystourethrography, urethroscopy , catheterization combined with vaginal exposure and bimanual examination. In treatment, diverticulectomy is a simple and successful method without complications, always relieving the long persisting or recurring complaints.     

Bilateral renal cortical necrosis: a report of 2 cases.

Two cases of renal cortical necrosis, one of which occurred after an obstetric complication (abruptio placentae) and the other after postpartum haemorrhage, are described. The diagnosis was made by percutaneous renal biopsy, intravenous pyelography and selective nephro-angiography. Immunofluorescence studies of the kidney showed no abnormality in one patient, but showed the presence of IgM in the glomerular basement membrane in the second patient. Hypotension was not observed when anuria occurred. Both patients survived. The importance of prolonged haemodialysis is stressed, since one patient was oliguric for 57 days and required intermittent haemodialysis for 5 months, while the second patient was oliguric for 17 days, required haemodialysis for 5 months and now has established hypertension.     

隐匿性血管损伤的临床特点与诊疗策略

目的 探讨临床骨科中隐匿性血管损伤的临床特点、诊断与治疗,以期提高对此类损伤的认识和临床诊治效率.方法 2003年3月至2010年10月共收治649例血管损伤患者,其中隐匿性血管损伤50例(7.7%),男42例,女8例;年龄13～66岁,平均34.0岁.血管损伤类型:静脉损伤1例,动脉损伤42例,动、静脉同时损伤7例.根据张英泽等提出的肢体动脉编码和损伤分型:A型14例,B型20例,C型16例.初始损伤至诊断时间平均为43.4 d(2～337 d),表现为肢体缺血、骨筋膜室综合征、血肿或假性动脉瘤、出血、神绛受压等征象.辅助检查包括:彩色多普勒超声17例,CT血管造影7例,X线血管造影25例.手术治疗43例,包括血管修补、直接吻合、自体静脉移植、结扎及截肢,其中2例术后行血液滤过治疗;内科治疗3例;介入栓塞治疗4例.结果 4例患者截肢后伤口愈合良好,无并发症发生;其余46例患者出院时患肢皮肤温度、颜色均恢复正常,远端动脉搏动存在,平均随访6.7个月(1～42个月),患肢血运良好.结论临床工作中的隐匿性血管损伤并非少见,其临床表现具有延迟出现、多种多样及不典型的特点.诊断方法应优先选择血管造影.治疗以手术为主,酌情采用血管内介入治疗和血液滤过治疗.

Abstract：

Objective To investigate clinical characteristics, diagnosis and treatment of insidious vascular injuries in orthopaedic cases. Methods Between March 2003 and October 2010, we treated 649 cases of orthopedic and vascular injuries, 50 (7. 7% ) of which were identified as insidious injuries. They were 42 men and 8 women, aged from 13 to 66 years (average, 34. 0 years). The insidious injury affected the vein in one case, the artery in 42 cases and both in 7 cases. The vascular injuries were categorized as type A (14 cases), type B (20 cases) and type C (16 cases) according to the classification system proposed by Zhang Ying-ze. The diagnoses were made after an average of 43. 4 days from primary injuries, with the assistance of color Doppler ultrasound in 17 cases, CT angiography in 7 and X-ray angiography in 25. Clinical manifestations included limb ischemia, compartment syndrome, hematoma or pseudoaneurysm, hemorrhage and nerve entrapment. Forty-three patients were treated by a variety of surgical options, such as angiorrhaphy, anastomosis, transplantation of autogenous venous graft, ligation and amputation. Among them, hemofiltration was performed in 2 cases as adjuvant therapy. Endovascular embolization was performed in 4 cases and conservative treatment in the other 3. Results Forty-six patients had their limbs salvaged, with normal temperature and color of the skin and existence of distal arterial pulses at discharge from hospital. The other 4 patients had to sustain amputation. An average follow-up of 6. 7 months (from one to 42 months) revealed that all the affected limbs regained normal blood circulation. Conclusions The insidious presentations and atypical clinical manifestations make diagnosis of insidious vascular injury very difficult. We recommend angiography as the first step in diagnosis. Surgical approaches should be considered as the main treatment choice, and hemopurification can be used as adjuvant therapy if necessary. In some cases, endovascular intervention may be faster and safer.     

腹腔镜手术治疗急性胆囊炎50例分析

目的:探讨腹腔镜治疗急性胆囊炎的可行性。方法:采用腹腔镜技术对急性胆囊炎进行手术治疗。结果:50例患者均治愈,其中2例中转开腹处理,无并发症发生。结论:只要熟练掌握腹腔镜的操作技术,对急性胆囊炎都可以采用腹腔镜治疗。