超声引导下经皮微波消融治疗肝癌胸腹壁种植转移

目的:探讨超声引导下经皮微波消融治疗肝癌胸腹壁种植转移的有效性和可行性。方法:选取2007年1月至2017年1月在中国人民解放军总医院出现肝癌胸腹壁种植转移后接受超声引导下经皮微波消融治疗的患者15例,男13例,女2例,平均年龄(57.2±17.6岁)。收集种植转移的人口和肿瘤特征,分析患者治疗情况,采用Log-Rankχ2检验统计分析种植灶消融后的局部进展率及患者的总生存率,采用多因素Cox回归分析肝癌胸腹壁种植转移患者总体生存情况的危险因素。结果:15例患者的中位随访27.8(3.8~67.2)个月,消融治疗后种植肿瘤患者的0.5、1、2年的累积局部进展率分别为6.7%、23.0%、23.0%;1、3、5年的累积总生存率分别为80.0%、61.7%、46.3%。多因素Cox回归分析显示年龄>65岁、肝内病灶控制差及肿瘤分型差是影响肝癌胸腹壁种植转移患者总体生存情况的危险因素。结论:超声引导下经皮微波消融治疗肝癌胸腹壁种植转移能够产生令患者满意的肿瘤结局,但延长患者生存时间还主要依靠对肝内病灶的控制。     

原发性肝癌腹壁转移的介入治疗

目的探讨对原发性肝癌腹壁转移灶采用介入治疗的方法和疗效。方法对8例原发性肝癌腹壁转移患者行动脉插管灌注化疗、栓塞治疗,或经皮穿刺瘤内无水乙醇注射术。结果7例患者行动脉插管化疗栓塞术获得技术成功,术后5例患者腹壁转移灶内碘油沉积良好;2例患者部分瘤灶内碘油沉积不满意,行分次瘤体内无水乙醇注射术;1例患者动脉插管未能找到供血动脉,单纯采用经皮穿刺瘤体内无水乙醇注射。所有患者瘤灶处腹壁疼痛缓解或消失,3例腹壁体表肿块隆起者,肿块变小,变软。7例AFP升高患者,术后有不同程度下降。1例隆起肿块发生破溃、感染,其他患者未发生严重并发症。结论对原发性肝癌腹壁转移灶采用动脉插管灌注化疗、栓塞治疗,结合经皮穿刺瘤体内无水乙醇注射,对控制肿瘤生长、缓解疼痛,提高生存质量是可行方法之一。     

经皮微波凝固治疗肝癌

肝癌是最常见的恶性肿瘤之一 ,手术根治是中小肝癌的传统治疗方法 ,由于受肝功能异常、多结节病变及分布广泛、患者意愿等诸多因素的影响 ,目前肝癌的实际切除率 <30 %。近年来随着医疗技术与设备的发展 ,经皮酒精注射疗法 (ｐｅｒｃｕｔａｎｅｏｕｓｅｔｈａｎｏｌｉｎｊｅｃｔｉｏｎｔｈｅｒｐｈｙ,ＰＥＩＴ)、经皮射频消融疗法 (ｒａｄｉｏ ｆｒｅｑｕｅｎｃｙ ,ＲＦ)、激光凝固疗法 (ｉｎｔｅｒｓｉｔｉａｌｌａｓｅｒｐｈｏ ｔｏｃｏｇｕｌａｔｉｏｎ,ＩＬＰ)、经动脉导管栓塞疗法 (ｔｒａｎｓｃａｔｈｅｔｅｒａｒｔｅｒｉａｌｃｈｅ…     

原发性肝癌脾转移1例

病例男,42岁,因上腹部饱胀不适半月,于2011年3月16日至我科就诊。既往有18年慢性乙型病毒性肝炎病史,未接受正规诊治。查体肝右锁骨中线肋缘下约6 cm,质地硬,表面凹凸不平,活动度差,无明显触压痛。上腹部平扫+增强CT见Ⅳ～Ⅷ肝段巨大低密度占位,呈快进快出强化;伴门脉右支充盈缺损。脾脏未见明确异常。乙肝标志物检查示:HBsAg、HBeAb、HBcAb阳性;血清甲胎蛋白644 ng/ml;肝组织穿刺活检病理诊断:肝细胞癌。患者于     

介入放射治疗肝癌腹壁转移癌一例

我们收治了 1例原发性肝癌腹壁转移的患者 ,经介入放射治疗后 ,效果比较满意。现报道如下。患者男性 ,6 8岁 ,原发性肝癌。第 1次ＴＡＣＥ术后 2个月余。入院拟行第 2次介入治疗。体检 :脐周可见放射状静脉扩张 ,发现脐左侧腹直肌表面可见一约鸡蛋大小的包块 ,质软 ,光滑 ,有压     

微波凝固术治疗肥厚性鼻炎

微波组织凝固(Microwaves Tissue Co-agulation MTC)是80年代医学领域兴起的一门新技术。它通过针状或接触式辐射器将微波导入病变组织内,使组织内的液体分子在电磁场作用下极短时间产生高温,从而达到治疗病变组织的目的。我科于1995年4～7月应用微波凝固术治疗肥厚性鼻炎98例,取得满意效果,报告如下。     

肝癌患者超声引导下微波凝固治疗前后免疫指标的动态变化

目的：观察超声引导下微波凝固治疗肝癌前后患者免疫指标的动态变化。方法：分别于微波治疗前1周及治疗后1、2、3、4周采集患者外周静脉血,用Cr^51释放法检测自然杀伤细胞活性,酶联免疫法测定可溶性白介素2受体水平。结果：肝癌患者存在严重免疫功能低下,与正常人比较,自然杀伤细胞（NK细胞）活性下降,可溶性白介素2受体（SIL－2R）水平上升（P＜0．01）。微波凝固治疗肝癌后,NK细胞活性明显上升（P＜0．05）,SIL－2R水平明显降低（P＜0．01）。结论：微波热疗后机体免疫功能增强,提高了抗肿瘤能力。     

微波介入疗法治疗晚期肝癌1例

目的 探讨对于原发性肝癌术后复发患者的综合治疗方法。方法 原发性肝癌术后复发患者1例。男性，74岁，1995年因原发性肝癌行左肝外叶切除术，术后5年发现肝右后叶肿瘤复发，伴有肝内转移灶。入院后先行肝动脉插管，由于血管走行变异，插管效果不满意，于2001年1月手术探查，术中考虑到如果切除肿瘤，剩余肝脏体积过小，难以维持功能，即行肝右后叶肿瘤4点微波固化，右前叶肿瘤1点微波固化。同时于肝动脉及门静脉行双化疗泵植入。术后定期经肝动脉及门静脉化疗泵进行化疗及栓塞。并于术后10个月开始进行了4次B超引导下肿瘤内无水酒精注射。结果 患者术后恢复顺利，未出现全身及局部并发症。现状后10个月，患者饮食、活动如常。术后1个月时体重56．2kg，现在体重为59．6kg。甲胎蛋白于术后3个月降至正常，并维持5个月，近2个月又升高。计算机体层摄影片示碘油栓塞效果好，肿瘤明显缩小，甲胎蛋白升高后，目前肿瘤仍无增大。结论 该疗法对本例原发性肝癌术后复发患者有显著疗效，延长了患者生命，提高了患者生活质量。今后应增加病例数量，以求对该疗法进行科学评估。     

原发性肝癌综合治疗1例

病例男,58岁.曾于1991年健康体检超声发现肝右叶上段直径约1.6 cm×1.8 cm实质性低回声结节,界清欠规则,无包膜,其周边无声晕,肝内外胆管不扩张.随行手术根治性切除,病理组织学检查提示：肝细胞型肝癌.术后定期复查时发现原手术区附近约1.2~1.5 cm边界不清的占位,考虑复发.在超声引导下,行经皮肝脏肿瘤无水乙醇灌注术,术后定期复查肿瘤缩小,术区呈不均匀强回声改变.     

原发性肝细胞肝癌骶尾部转移1例报告

病例 男,52岁,2012年9月下旬无明显诱因出现右下肢麻木,伴疼痛。11月在当地医院行骶部CT示：右侧骶尾部5．8cm×6．0cm大小占位性病变,考虑神经源性肿瘤（脊索瘤可能性大）。上腹部平扫MRI示：肝癌（HCC）伴肝内转移灶;胆、胰腺、脾脏及双肾未见异常。     

Abdominal aortic coarctation treated with percutaneous transluminal angioplasty: a case report

Abdominal aortic coarctation is a rare congenital vascular by nosis of abdominal aorta. Surgical management may be complex. This paper application of balloon dilation angioplasty in a case of abdominal aortic coarctation.     

胰腺原发性平滑肌肉瘤伴肝脏转移1例

患者女,50岁。反复腹痛20 d入院,超声发现肝脏多发占位2d。体检：剑突下明显压痛,无反跳痛、肌紧张、恶心、呕吐、高热、寒战、黄疸,否认胰腺炎病史。肿瘤标记物：糖类抗原-199(CA-199)78.63 kU/L(正常值0~37 kU/L),铁蛋白(FER)330μg/L(正常值35~55μg/L),其余正常。     

Non traumatic intrathoracic liver herniation mimicking a pulmonary metastasis in patient with breast cancer: A case report

Non-traumatic hepatic hernia is defined as hepatic protrusion through acquired or congenital defects on diaphragm without prior trauma. This event is rare among adults and infrequently reported in literature. 52-year-old Caucasian woman with surgically treated breast cancer with suspected lung metastasis detected during a routine Multidetector Computed Tomography lung exam. Ultrasound and subsequently Magnetic Resonance Imaging (MRI) was performed which revealed an overdiaphragmatic mass in contiguity with liver parenchyma compatible with overdiaphragmatic hepatic hernia. Differential diagnosis should be made with diaphragmatic or pulmonary nodule. Correct diagnosis can avoid further diagnostic investigations or invasive procedures such as biopsy. Magnetic Resonance Imaging is a non-risky method and can clarify interpretative doubts. Currently there are still controversies about traumatic or idiopathic nature of this hernia.     

绒毛上皮癌肝转移1例

患者女,46岁。因上腹部不适来院就诊。超声检查:肝脏体积增大,边缘显示不清,内探及多发强回声占位,大者约3·2cm×4·1cm,位于右后叶,边界尚清,内回声尚均匀,CDFI示内有点状血流信号,肝右前叶可探及12·1cm×16·0cm囊状无回声区,内可见条索状物和点状强回声,CDFI示内未见血流信号。胆囊、胰腺、脾脏、双肾、膀胱未见异常。子宫前位,宫体大小约4·0cm×4·5cm×5·6cm,实质回声均匀,内膜厚约0·7cm,双侧附件区可见大小分别为2·4cm×2·7cm和2·3cm×2·5cm囊性占位,子宫直肠窝见深约2·9cm无回声区。超声诊断:①肝内多发强回声占位;②…     

Ureteral metastasis from gastric cancer after two years of subtotal gastrectomy: a case report

True ureteral metastases from gastric cancer are extremely rare. Only a few cases of this condition have been reported. CT is the first-line imaging technique and may aid the diagnosis, even if the definitive diagnosis is histologic. We report a case of a 45-year-old female with a history of gastric cancer who underwent subtotal gastrectomy and presented 2 years later with ureteral metastasis and subsequently renal pelvis metastasis in absence of peritoneal involvement. A biopsy was required to rule out primary urothelial carcinoma and make a well-timed and proper diagnosis. We describe the pathologic and radiological features of this case, followed by a brief review of the literature included in the discussion.Keyword: Gastric cancer, Ureteral metastasis, Renal pelvic metastasis, Hydronephrosis     

Abdominal aortic angioplasty: a case report with angiographic follow-up

Two women with typical clinical and angiographic findings of aorto-iliac occlusive disease underwent a successful percutaneous transluminal angioplasty of a severe stenosis of the lower abdominal aorta. One of them in whom control aortograms provide information on the mechanism of balloon angioplasty is reported here.     

Abdominal cryptococcoma in AIDS: a case report

Cryptococcosis is a recognized opportunistic pathogen in the acquired immune deficiency syndrome. Although central nervous system infection and disseminated cryptococcosis is common in acquired immune deficiency syndrome, localized infection is rare. We present a case of massive retroperitoneal and mesenteric adenopathy in a male homosexual patient with acquired immune deficiency syndrome with clinical and radiologic features suggestive of lymphoma. However, this was proven pathologically to represent cryptococcal infiltration of the lymph nodes. Our experience indicates that Cryptococcus neoformans should be included in the differential diagnosis of massive abdominal adenopathy in the acquired immune deficiency syndrome.     

分化型甲状腺癌罕见部位转移伴糖类抗原升高一例

患者女,69岁,2019年4月于外院经超声检查发现左侧甲状腺结节,后结节明显增大,外院PET/CT提示甲状腺癌可能性大、双肺及多发骨转移;未发现其他部位肿瘤表现。患者于2019年4月29日在本院行甲状腺癌扩大根治术,术后病理示:左侧甲状腺高侵袭性乳头状癌(4.5 cm×2.5 cm×2.5 cm),部分细胞为高柱状,伴坏死;右侧甲状腺桥本甲状腺炎;左2区淋巴结、右肌间淋巴结及右侧4区淋巴结见癌转移;基因检测示B-Raf原癌基因丝/苏氨酸蛋白激酶(B-Raf protooncogene,serine/threonine kinase,BRAF)V600E野生型,糖类抗原(carbohydrate antigen,CA)125及CA19-9免疫组织化学染色提示两者均为弱阳性(图1)。     

颅内间变性血管外皮细胞瘤伴骨转移一例

笔者报道了1例颅内间变性血管外皮细胞瘤（AHPC）伴骨转移的病例,从临床表现、影像学检查尤其是全身骨显像检查以及术后病理综合分析了该病特点。并通过文献复习加深了对AHPC骨转移的认识。多数恶性肿瘤常见骨转移,而颅内AHPC是一种少见的中枢神经系统肿瘤,较少发生骨转移。通过全身骨显像发现了该例患者多处骨骼病变,术后病理提示颅内AHPC骨转移,因此提示恶性肿瘤尤其是少见骨转移者应把骨显像检查作为随访的一个重要检查,对于早期发现骨转移、确定临床分期及治疗方案的选择等都是至关重要的。     

Incarcerated primary anterior liver hernia: A case report

The anterior liver hernia is a very rare entity that mainly occurs within an incisional hernia. Primary anterior liver hernia, in the absence of a previous abdominal incision, is extremely rare. The diagnosis is suspected in patients with epigastric bulging. The confirmation requires imaging studies such as computed tomography scan (CT scan). We report the case of an incarcerated primary ventral liver hernia, in an 83-year-old man who presented with a sudden epigastric swelling. A contrast-enhanced CT scan confirmed the diagnosis of incarcerated epigastric hernia with liver and epiploic content. Risk factors were thought to be the increased intra-abdominal pressure related to benign prostate hyperplasia, as well as the old age of the patient. The surgical conservative management was successful.