胰岛素瘤诊治经验(附61例临床分析)

目的 探讨胰岛素瘤的临床诊治经验.方法 回顾性分析我院1986年8月至2011年7月间61例胰岛素瘤患者的临床资料.结果 均表现典型Whipple三联征,血胰岛素/血糖(IRI/G)均＞0.3.术前腹部超声、CT、EUS、术中超声、MRI和DSA诊断的阳性率分别为77.4%、63.2%、72.7%、91.7%、46.2%、33.3%.行胰岛素瘤剜除术50例,行胰体尾切除术4例,行胰体尾联合脾切除术5例,行保留十二指肠的胰头切除术1例,行胰十二指肠切除术1例.术后病理均为良性胰岛素瘤,无恶性病例.结论 胰岛素瘤的定性诊断主要靠典型Whipple三联征与IRI/G>0.3,术前定位诊断主要依靠EUS、腹部超声和CT,术中超声结合扪诊是最有效的定位方法.肿瘤剜除术是胰岛素瘤的主要术式.     

胰岛素瘤诊治分析：附72例报告

目的:探讨胰岛素瘤的诊断和外科治疗方法。方法:回顾性分析我院31年余诊治的72例胰岛素瘤的临床资料。结果:84.72%有典型的Whipple三联征表现。80.56%血浆免疫反应性胰岛素/血糖(IRI/G)比值>0.3。术前定位诊断方法的阳性率分别为:腹部超声78.13%,CT(平扫或增强)60.97%,多排螺旋CT胰腺灌注100%,MRI 37.50%,内镜超声(EUS)72.73%,选择性动脉造影(DSA)28.57%。术中超声联合扪诊诊断阳性率92.31%。肿瘤最大直径≤2 cm者占88.75%。37.5%的肿瘤位于胰头颈部,27.50%位于胰体部,35.0%位于胰尾部。81.58%的病例可行胰岛素瘤局部剜除术。病理诊断均为胰岛素瘤,65例(90.28%)为功能性胰岛素瘤,7例(9.72%))为无功能性胰岛素瘤;4例(5.56%)为多发性肿瘤,2例(2.78%)恶性倾向,1例(1.39%)合并多发性内分泌肿瘤1型(MEN-1)。结论:Whipple三联征和IRI/G>0.3可作为胰岛素瘤定性诊断的主要依据。应联合应用超声,CT,多排螺旋CT胰腺灌注,MRI,内镜超声和DSA多种方法进行术前定位。术中超声联合扪诊是简单有效的定位诊断方法。肿瘤的局部剜除术是多数胰岛素瘤的最佳手术治疗方式。     

胰岛素瘤的诊断和治疗：附30例报告

目的:总结探讨胰岛素瘤的诊断和治疗方法。方法:回顾性分析近11年来治疗的30例胰岛素瘤的临床资料。结果:全组30例均表现Whipple三联征。术前B超，CT，MRI诊断的阳性率分别为34.8 %(8/23)， 58.3 %(7/12)，71.4 %(5/7)，术中B超诊断的阳性率为87.5 %(7/8)。单个肿瘤27例，多发性肿瘤3例。单发者，位于胰头8例,胰体7例,胰尾12例;多发者，1例2枚肿块均位于胰体，另2例均为2枚肿块分别位于胰体和胰尾。行肿瘤局部摘除术21例,胰体尾切除术6例，胰体尾切除术＋脾切除术2例，胰十二指肠切除术1例。良性肿瘤29例，恶性1例。术后胰瘘4例,均经充分引流后治愈。30例术后低血糖症状均消失，随访27例，良性肿瘤术后4年复发1例，再次手术切除胰体肿块后治愈，恶性肿瘤术后3年复发，因腹腔转移死亡。结论:Whipple三联征,测定IRI/G比值是定性诊断的主要依据,术中扪诊联合术中B超是最有效的肿瘤定位手段,肿瘤摘除术仍为胰岛素瘤的主要术式。     

胰岛素瘤64例的诊断与外科治疗

目的 总结胰岛素瘤的诊断与外科治疗方法.方法 回顾性分析64例胰岛素瘤的临床资料.结果 64例均表现Whipple三联征.术前BUS、CT及强化CT、MRI、DSA诊断阳性率分别为46.9%(30/64),58.2%(23/39),66.7%(18/27),91.7%(11/12).IOUS诊断阳性率为92%(23/25).单个肿瘤58例,多发肿瘤6例.单发者位于胰头19例,其中直径4cm 1例,胰体17例,胰尾22例;多发者6例均为2枚肿瘤,4例位于胰体,2例分别位于胰体和胰尾各1枚.治疗行肿瘤局部切除39例,胰体尾切除13例加作脾切除6例,胰尾切除8例加作脾切除4例,胰体表面肿瘤直径2cm行腹腔镜下单纯肿瘤摘除1例,自左向右分段切除(盲切法)2例,行胰头十二指肠切除1例.良性肿瘤62例,恶性2例.术后胰瘘3例、急性胰腺炎4例均经非手术治愈.64例术后低血糖症状消失.62例良性胰岛素瘤术后随诊1～5年血糖正常,其中2例分别于术后4年和5年复发,再次手术发现胰尾近脾门处分别有直径1cm和1.5cm肿瘤,经胰尾切除后治愈.45例随访8年血糖正常,17例失访.2例恶性胰岛素瘤分别于术后3年和4年复发,因肝转移死亡.结论 Whipple三联征和测定IRI/G＞0.3是定性诊断的依据.术中触诊联合IOUS是最有效的肿瘤定位诊断方法.胰岛素瘤切除术是最佳的治疗方法.     

胰岛素瘤的诊断和外科治疗

目的探讨胰岛素瘤的诊断和外科治疗方法。方法回顾性分析经手术和病理确诊的55例胰岛素瘤患者的临床资料。结果 7例为无功能性,48例(87.27%)功能性胰岛素瘤均有典型的Whipple三联征表现,且血胰岛素/血糖比值(IRI/G)0.3。术前超声,CT,MRI,内镜超声(EUS),术中超声和选择性动脉造影(DSA)诊断的阳性率分别为83.64%(46/55),62.07%(18/29),40.00%(4/10),100%(8/8),90.00%(9/10)和40.00%(2/5)。胰岛素瘤剜除术48例次,胰体尾切除术5例,胰体尾联合脾切除术3例,胰腺中段切除术1例,胰十二指肠切除术1例;肿瘤直径小于或等于2 cm者占95.00%(57个)。23.33%(14个)的肿瘤位于胰头部,33.33%(20个)位于胰体部,43.33%(26个)位于胰尾部,3例(5.46%)为多发性肿瘤。病理诊断均为胰岛素瘤,无恶性者。术后无低血糖症状发作,发生胰瘘1例。结论 Whipple三联征和IRI/G0.3可作为胰岛素瘤定性诊断的依据。联合应用超声,CT,MRI和内镜超声多种方法进行术前定位。内镜超声在胰岛细胞瘤定位诊断中的阳性率最高;术中超声是有效的定位方法。肿瘤剜除术是胰岛素瘤的最佳治疗方法。     

胰岛素瘤的诊治分析(附49例报告)

目的　评价胰岛素瘤的各种诊断方法和外科治疗方法。方法　回顾性分析我院 2 0年来诊治的 4 9例胰岛素瘤。结果　 4 5例病人均有典型的Whipple三联征表现 ,术前B超、CT、MRI、SA定性诊断的阳性率分别为 4 7 3%(18/ 38)、6 0 %(15 / 2 5 )、6 4 7%(11/ 17)、83 3%(5 / 6 ) ,手术探查的阳性发现率为 97 8%(44 / 4 5 ) ,术中B超为 10 0 %(12 / 12 )。肿瘤局部切除术 31例 ,胰尾切除术 4例 ,胰体尾切除术 7例 ,加做脾切除者 2例 ,Whipple手术 1例 ,PPPD手术 1例。结论　Whipple三联征和IRI/G >0 3可作为胰岛素瘤定性诊断的依据 ,胰岛素瘤的术前定位诊断较为困难 ,手术探查加术中B超检查是定位诊断的最佳方法。肿瘤局部摘除术是胰岛素瘤的最佳治疗方法 ,且其并发症最少。     

胰岛素瘤22例诊治分析

【摘要】 目的 探讨胰岛素瘤的诊断和治疗方法。方法 回顾性分析南通市瑞慈医院和南通市第一人民医院近15年来治疗的22例胰岛素瘤的临床资料。结果 全组22例均有Whipple三联征。术前B超、CT、MRI、门静脉穿刺分段取血胰岛素测定诊断的阳性率分别为15.8%（3/19）、67.5%（10/16）、71.4%（5/7）、100%（2/2）,术中B超的诊断阳性率85.7%（6/7）。行肿瘤局部切除13例,胰体尾切除3例,胰体尾切除+脾脏切除1例,胰十二指肠切除1例,保留十二指肠的胰头切除1例,腹腔镜下胰岛素瘤切除3例。22例均为良性肿瘤。术后低血糖症状均消失。结论 Whipple三联征结合IRI/G比例的测定是定性诊断的主要依据。多层螺旋CT双期胰腺薄层扫描是定位诊断的主要手段,术中B超是对术前定位诊断的检验和补充。肿瘤切除是胰岛素瘤的主要术式,腹腔镜胰岛素瘤切除应得到推崇。     

胰岛素瘤23例诊治分析

目的总结探讨胰岛素瘤的诊断和外科治疗方法。方法回顾性分析我院1998~2005年23例胰岛素瘤的临床资料。结果本组19例有典型Whipple三联征。术前B超、CT、选择性动脉造影诊断的阳性率分别为47.8%(11/23)、64.7%(11/17)、85.7%(6/7)。行单纯肿瘤摘除术14例、局部切除术6例、胰体尾部切除术1例、胰十二指肠切除术1例、腹腔镜下胰岛素瘤摘除术1例。术后血糖均恢复正常,但有2例发生胰漏并发症,1例发生假性囊肿,2例伴有精神症状者术后症状无改善。结论Whipple三联征和血清胰岛素与血糖比值(IRI/G)>0.3对于胰岛素瘤有诊断意义。术前B超、CT、选择性动脉造影用来明确定位。单纯肿瘤摘除术是最常用的手术方法,术中超声及血糖监测的应用有重要意义。     

胰岛素瘤的定性、定位诊断及治疗分析

目的:探讨胰岛素瘤的定性、定位诊断和治疗。方法:回顾性分析中国医科大学附属第一医院2005年1月—2014年9月收治的50例胰岛素瘤患者的临床资料。结果:50例患者中,男9例,女41例,有典型的Whipple三联征的患者占98%(49/50)。影像学定位诊断阳性率:腹部超声联合增强CT为91.7%(33/36),腹部超声联合MRI为85.7%(12/14),增强CT联合MRI为88.9%(8/9),腹部超声、增强CT、MRI联合检查为100%(7/7),胰腺灌注CT扫描为100%(13/13)、超声内镜(EUS)为100%(3/3),术中超声(IOUS)为50%(1/2)。38例患者行手术治疗切除肿瘤。结论:Whipple三联征、血清胰岛素水平是胰岛素瘤定性诊断的重要方法;胰腺增强CT联合腹部超声是术前定位诊断的首选方法,胰腺灌注CT、EUS检查是术前定位诊断中最准确的检查方法。定位检查顺序:B超→增强CT→MRI→灌注CT→EUS等。手术切除肿瘤是治疗胰岛素瘤的最佳治疗方案。     

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目的 总结胰岛素瘤的诊断和治疗经验.方法 回顾性分析北京协和医院1953-2007年诊治404例胰岛素瘤的临床资料.结果 肿瘤直径＜2cm者占79.6%.36.2%的肿瘤位于胰头部,28.2%位于胰体部.35.6%位于胰尾部.18例(4.5%)为恶性胰岛素瘤,34例(9.0%)为多发性肿瘤.96.0%有典型的Whipple三联征.89.6%血胰岛素/血糖比值＞0.3.术前定位检查发现胰岛素瘤敏感性经腹超声检查36.8%,普通平扫CT24.7%,增强CT66.7%,多排螺旋CT胰腺灌注92.7%,MRI 31.6%,生长抑素受体显像33.3%,超声内镜(EUS)79.1%,选择性动脉造影(SAG)84.6%,经皮经肝门静脉置管取血(眦)测定胰岛素88.1%,动脉刺激静脉取血(ASVS)测定胰岛素87.0%.术中定位诊断方法的敏感性细针穿刺活检89.2%,术中超声(包括腹腔镜超声)检查90.0%.73.1%的病例可行肿瘤的局部摘除术.结论 多排螺旋CT胰腺灌注是目前胰岛素瘤术前定位诊断的首选方法.随着微创外科技术在胰腺外科中的应用,对部分条件适宜的病例可选用腹腔镜手术,但对多发胰岛素瘤仍应仔细开腹探查,避免遗漏病灶.     

Hazards and complications of endoscopic transurethral ureterolithotripsy and lithoextraction and means of prevention

Complications related to ureterolithotomy and ultrasonic ureterolithotripsy performed under the control of visual endoscope were analyzed in 86 ureterolithiasis patients, methods of their prevention discussed. All the aforementioned complications were distributed into three groups: inapplicability of surgery due to anatomic and functional defects of lower and upper urinary tracts, intraoperative, and postoperative complications. The commonest ones were ureteral abruption and perforation, acute pyelonephritis, temporary vesicoureteral reflux. Their control measures were considered as relative methods of treatment: immediate surgical intervention in case of ureteral abruption, renal catheterization in patients with insignificant ureteral perforation or acute pyelonephritis. Adequate ureteroscopy, careful consideration of pro- and contraindications, catheterization of renal pelvis and urinary bladder performed within 2-3 days after the surgery and adequate antibacterial therapy are the most decisive steps in the control of aforementioned complications.     

牙体牙弓颌骨阻力中心及其临床意义

牙体、牙弓及颌骨的阻力中心在正畸矫治力系统中具有重要的意义,也是正畸学领域争论较多的一个问题。Dermaut等研究表明,当力作用于物体阻力中心时,物体将发生平动,否则将发生平动和转动的复合运动。目前,国内外多数学者认为牙体、牙弓及颌骨存在阻力中心,但其位置存在争议。本文就牙体、牙弓及颌骨的阻力中心及其临床意义作一综述。     

Characterisation and differentiation of chondroblastomas and chondromyxoidfibromas - presence and expression of collagen types I and II

AIM: Chondroblastomas and chondromyxoidfiibromas are rare benign skeletal neoplasms with reported overlapping histology. Aim of this study was to analyse the biochemical composition of the matrix of these tumour entities in order to further characterise the cellular phenotypes of these neoplasms using typical cell biological marker genes. METHODS: The matrix compositions of chondroblastomas and chondromyxoidfibromas were analyzed by HE-histology, histochemistry, and immunolocalization techniques. Cellular gene expression patterns were detected by mRNA in situ hybridization. RESULTS: Chondroblastomas are rich in collagen type I and show foci of an osteoid-like matrix, whereas collagen type II as a typical marker of chondrocytic differentiation was not detected in any of the specimens. Chondromyxoidfiibromas had foci of chondroid appearance with chondroblastic cellular differentiation characterised by collagen type II expression. CONCLUSION: These results characterise chondroblastomas and chondromyxoidfiibromas as skeletal neoplasms that have a different biology and which can be distinguished by matrix protein expression products: collagen type II, the typical marker of chondroblast differentiation, could only be detected in chondromyxoidfibromas, but not in chondroblastomas. Thus, both neoplasms are clearly different on the cell biological level.     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.