破裂腹主动脉瘤的外科治疗体会(附20例报道)

目的探讨破裂腹主动脉瘤的诊断和外科治疗方法。方法回顾性分析2000年1月至2010年12月期间新疆维吾尔自治区人民医院收治的20例破裂腹主动脉瘤患者的临床资料。结果男18例,女2例;年龄31～82岁,平均65.4岁。所有患者中突发性腹或腰背部疼痛20例,血压下降和(或)休克11例,发病前有明确腹主动脉瘤病史7例。所有患者均经彩超、CTA或手术探查确诊。19例患者采用传统开腹手术,1例行腔内支架人工血管置入术。20例患者中围手术期死亡4例,死亡率为20%,死亡原因为循环衰竭1例,多器官功能障碍综合征3例。存活的16例患者恢复顺利。结论手术治疗破裂腹主动脉瘤有效,早期诊断,急诊外科手术,是降低病死率的关键。     

Giant Cell Tumor of the Tendon Sheath in the Foot and Ankle: Case Series and Review of the Literature

Giant cell tumor of tendon sheath (GCT-TS) in the foot and ankle has been reported as rare. The purpose of the present study was to describe 20 cases of GCT-TS in the foot and ankle treated in the orthopedic department of Huashan Hospital. From January 2007 to January 2012, a retrospective review was performed of 20 cases of GCT-TS in the foot and ankle, all of which were treated by local excision, including both arthroscopy and local excision. The follow-up of all cases was 3 months to 5 years. Of the 20 patients, 14 were female and 6 were male, with a mean age of 38.7 (range 15 to 59) years. Seventeen presented with a painless, solitary, well-defined soft tissue mass with good or poor mobility. Three had discomfort on weightbearing, because the mass was on the plantar aspect of the foot. One patient had neurologic symptoms. A correct preoperative diagnosis was made in only 5 cases. Magnetic resonance imaging proved to be the most useful noninvasive preoperative investigation, because GCT-TS has a characteristic appearance that allows for planned local excision to be performed. Four cases recurred after surgical excision, for a recurrence rate of 20%. After reviewing the published data and comparing them with our results, we concluded that a definite preoperative diagnosis of GCT-TS in the foot and ankle would help in planning the surgical treatment and that complete local excision is probably the only method to prevent recurrence.     

Surgical treatment of metastases from thyroid cancer in the axial skeleton. A retrospective study of 18 cases

Between 1990 and 1997, 18 patients with a mean age of 55.5 years (11 females, 7 males) underwent surgical treatment for a metastasis from thyroid cancer involving the axial skeleton. At the time of surgery all patients had a poor prognosis: 7 metastases revealed the thyroid cancer, all 18 patients had a neurological or mechanical complication, 9 had multiple metastases, all were over 40 years of age. After arteriography with embolization, the surgical procedure consisted of curettage of the tumor and reconstruction, followed by treatment with iodine 131. The survival rate 3 years after surgery was 50%. At the last review, the functional outcome was good and 17 patients had total neurological recovery. Four complications occurred: 1 operative hemorrhage, 3 postoperative infections. Four patients had local recurrence of the metastasis with a one-year survival rate of 20%. When the thyroid cancer was revealed by the axial metastasis, the 3-year-survival rate was 42%. In cases with huge metastases, the 3-year-survival rate was 71%. It appears from these data that surgical treatment of metastases from thyroid cancer in the axial skeleton still achieves a good functional outcome even in cases where neurological or mechanical complications had occurred before surgery.     

Urinary tuberculosis: Experience of a teaching hospital in Syria

This study was designed to show our experience of urinary tuberculosis in one of the large teaching hospitals in Syria. It was a prospective study involving 48 patients (29 males and 19 females) with confirmed tuberculous lesions in the urinary tract. The study period was between 1982–1987. The presenting symptoms were protean, and there were often delays between onset of symptoms and eventual diagnosis. The highest age incidence was in the second and fourth decades. Beside the suggestive clinical manifestations, final diagnosis was reached by various means. Repeated examinations of EMU smears were positive in about 20% of cases. Urine culture was positive in 33.3%, while varied percentage of cases showed some radiological changes suggestive of tuberculosis. Other investigations included cystoscopy and biopsy of suspected lesions. Treatment was conservative by chemotherapy in 45% of cases, with complete recovery in about 33%, while acceptable results were shown in ≃19%, and failure of treatment or recurrence of active disease in 48% of cases. Some forms of surgical intervention were carried out in 55% of patients. Cure was seen in 50% of them, while 25% had acceptable results and failure was shown in the remaining 25%. It is concluded that urinary tuberculosis remains an important infectious disease problem in our country. The high rate of failure of both medical or surgical treatment is mainly due to late diagnosis.     

胰腺实性假乳头状肿瘤的诊断与外科治疗

目的 总结胰腺实性假乳头状肿瘤的诊治及预后.方法 回顾性分析我院1999年1月至2008年4月手术切除的42例胰腺实性假乳头状肿瘤的临床特征、手术、病理情况及生存状况.结果 1999年1月至2008年4月我院共手术切除胰腺实性假乳头状肿瘤42例,其中,男性5例,女性37例;平均年龄37.6岁;胰头肿瘤18例,胰体尾24例;首发症状以腹痛最为多见(47.6%),28.6%患者无症状;MRI诊断正确率达93%(14/15);胰十二指肠切除10例,胰体尾加脾切除20例,肿瘤摘除术8例,保留脾胰体尾切除3例,节段胰腺切除1例;术后总并发症率38.1%,无再手术及围手术期死亡病例;肿瘤平均直径6.1 cm,34例实性肿瘤,6例为囊实性,2例为囊性;部分病例出现血管、神经侵犯;3例失访,其他均存活,平均随访时间38.6个月,其中4例术后出现肝转移,3例行介入栓塞治疗,1例行肝叶切除.结论 胰腺实性假乳头状肿瘤是一种好发于年青女性的低度恶性肿瘤,正规胰腺切除预后良好,应避免肿瘤摘除术;术后必须长期随访,如出现肝转移,采取介入栓塞或转移灶切除有较好的疗效.     

肝门部胆管癌的手术治疗：附41例报告

目的:探讨肝门部胆管癌手术疗效及其预后的相关因素。方法:对近7年来收治的经病理诊断确诊的41例肝门部胆管癌患者的临床资料进行回顾性分析。结果:41例肝门部胆管癌患者中，术前影像检查联合诊断正确率为95.1%；行手术切除32例，总手术切除率为78.1%，其中根治性切除15例，姑息性切除17例；胆管内引流术9例。全组住院期间死亡2例，病死率4.9%。手术切除组中位生存时间和1，3，5年生存率分别为28个月和70.0%，40.0%，23.3％,内引流组为8个月和44.4%，11.1%，0，手术切除组患者的生存率优于引流组（P<0.05和P<0.05）。其中施行R0有14例，占46.7%，其中位生存时间和1，3，5年生存率为52个月和85.7%，64.3%，35.7%，不同手术级别的术后疗效存在差别（P<0.05）。Bismuth分型以Ⅱ型生存率最高，有7例，占18.0%，其中位生存时间和1，3，5年生存率为72个月和85.7%，71.4%，42.9%;不同病理类型切除率中以乳头腺癌和高分化腺癌为最高的切除率分别为77.8% 和78.3%，其1，3，5年的生存率分别为77.8%，44.4%，33.3%和73.9%，65.2%，17.4%；低分化癌为20%,0,0。结论:肝门部胆管癌手术治疗的预后主要与肿瘤的临床病理特征和手术方式相关，根治性切除是改善肝门部胆管癌长期生存和预后的关键因素。     

骨原发尤文肉瘤预后相关因素的分析

目的 明确骨原发尤文肉瘤患者的治疗结果,分析影响预后相关因素.方法 回顾性分析1998年7月至2007年7月就诊的78例骨原发尤文肉瘤患者的临床资料.通过随访了解肿瘤学预后,明确5年总体生存率及局部复发率.通过回顾病例,分析年龄、性别、肿瘤部位、肿瘤大小、初次诊断时有无转移、乳酸脱氢酶、碱性磷酸酶水平、治疗方式、外科边界等因素对总体生存率的影响.利用Kaplan-Meier生存分析确定对生存有影响的单个因素,并通过Cox回归分析明确影响预后的独立危险因素.结果 53例患者获得随访,中位随访时间37.6个月(8.0～101.0个月).患者5年总体生存率为33.7%,局部复发率20.8%,中位复发时间20个月.单因素分析结果显示:年龄＜20岁、初诊时元转移、病变位于四肢、肿瘤直径＜10 cm、取得广泛外科边界的患者预后较好(P＜0.05);多因素分析显示初诊时转移情况、肿瘤部位、肿瘤直径是影响预后的独立危险因素.结论 初诊时有无转移、肿瘤的部位和大小是影响骨尤文肉瘤预后的独立危险因素.     

脐尿管癌诊断治疗及预后分析（附36例报告）

目的总结脐尿管癌的临床特征,提高对脐尿管癌的诊治水平。方法回顾性分析36例脐尿管癌的临床资料。结果男26例,女10例。平均年龄（50.0±2.5）岁。肉眼血尿31例,血尿伴尿频、尿急5例,血尿中位时间22d。尿中有黏液者16例。肿瘤直径平均（5.0±1.0）cm。盆腔淋巴结转移3例。TNM分期：T221例,T312例,T43例。临床分级：G118例,G213例,G35例。均行扩大性膀胱部分切除术。术后病理诊断黏液性腺癌28例,非黏液腺癌混合癌5例（含肠型、印戒细胞亚型）,乳头状腺癌3例。术后膀胱内灌注表阿霉素治疗25例。36例患者均获随访,随访1-8年,平均2.5年。术后1年生存率为50%（18/36）,5年生存率为19.44%（7/36）。T2期患者的5年生存率为23.81%（5/21）,T3期患者的5年生存率为16.67%（2/12）。结论脐尿管癌不容易被早期发现和诊断。血尿是脐尿管癌的最常见症状。扩大性膀胱切除术为标准手术方式。脐尿管癌预后较差。     

Aggressive surgical intervention in N2 non-small cell cancer of the lung.

An aggressive attitude toward surgical treatment was taken in patients with N2 non-small cell lung cancer in the past 10 years. Computed tomographic scanning was employed in the diagnosis of N2 disease, and had a true-positive rate of 57%. Among patients with N2 disease detected by computed tomographic scanning, surgical intervention was attempted except for those with unresectable disease. Of 190 patients with clinical N2 disease, 115 underwent surgical exploration: 9 patients had only an exploratory thoracotomy, 53 patients underwent a curative operation, and 53 had a noncurative operation. The overall 5-year survival rate of these patients was 16% and that of curatively resected patients was 20%. There were 47 patients whose N2 disease was not recognized before operation. The 5-year survival rate of this group was 20% overall and 33% in curatively resected cases. The overall 5-year survival rate of patients with N2 disease who underwent resection (106 with clinical N2 disease and 47 with clinically unrecognized N2 disease) was 17%, and that of the 84 patients undergoing curative operations was 24%. An aggressive attitude toward surgical intervention can be advocated for patients with N2 disease on the basis of our present results.     

腹腔镜在外科急腹症诊治中的应用

目的:探讨腹腔镜技术在外科急腹症中的诊断与治疗价值。方法:回顾性分析了20例腹腔镜外科急腹症探查及疗效。结果:20例经腹腔镜探查全部明确诊断,17例免除开腹手术,所有病例均恢复顺利,无术后并发症及死亡。结论:急诊腹腔镜探查可以提高急腹症的确诊率,降低阴性剖腹探查率。     

Coarctation of the abdominal aorta

Coarctation of the abdominal aorta remains a surgically treatable cause of hypertension in children and young adults. Average age of the patients is 21 years at the time of diagnosis and a second peak in the fourth to fifth decade. If left untreated, most patients die as a result of complications from untreated hypertension by the age of 35 years. Aortography remains the diagnostic test of choice with associated visceral and renal artery stenoses occurring in 26% of cases. Of the 146 cases reported, 109 had surgical treatment with an operative mortality rate of 6.9%. Of those patients having surgery 96% were normotensive or were easily controlled postoperatively with antihypertensive medications. Because claudication is a minor problem in most cases, surgical correction of the hypertension by hepatorenal or splenic-renal bypasses may be the preferred initial surgical treatment in patients without significant visceral artery involvement or severe symptomatic lower extremity ischemia.     

Morphological study of osteosarcomas in children

Osteosarcoma is the most frequent primary osteal tumor in children. Our study evaluates morphological aspects of osteosarcomas during last 20 years. We present the results of study that includes 32 cases of classical osteosarcomas that had been diagnosed and treated at the "Sf. Maria" Hospital from Iasi (Romania). The diagnosis is based on usually histopathological methods applied to bioptic and surgical exeresis pieces. Male sex is most involved (56%). Patients' age is between 12-15 years in 68% of total cases. In 50% cases the tumour was localized in distal femoral metaphysis. Histological forms were: osteoblastic (66%), chondroblastic (18%), fibroblastic (16%). Enneking's staging was: II A (6.25%), II B (81.25%), and III (12.5%). Metastasis appeared in 75% cases' evolution. Concluding, 25% of studied patients had a favourable evolution during a 5 years period. Survival rate at 2 years was 39%.     

儿童甲状腺癌60例临床分析

目的 探讨儿童甲状腺癌的临床特点、诊断、治疗及预后。方法 回顾性分析我校三个医院1975～2002年收治并获随访的儿童甲状腺癌60例。结果 在60例儿童甲状腺癌中，乳头状腺癌49例，滤泡状腺癌8例，髓样癌3例，伴颈部淋巴结转移36例。全组患者均手术治疗，其中患侧甲状腺加峡部切除20例(33．3％)，患侧甲状腺全切加对侧甲状腺次全切36例(60％)，甲状腺全切除4例(6．7％)。术后均服甲状腺素片。平均随访10．5年(1～20年)，5年生存率为93％，10年生存率为87．1％。结论 儿童甲状腺癌多分化良好，极少发生未分化癌。重视其临床特点是早期诊治的关键，合理选择术式及术后综合治疗可取得满意疗效。     

The clinical presentation of intracranial abscesses. A study of seventy-eight cases.

From 1980 through 1991, 78 patients with brain abscess were treated at the Cukurova University School of Medicine Department of Neurosurgery by surgical excision and antimicrobial therapy. Males predominated in all age groups. Although only 17 percent had a predisposing conditions such as local sinus infection, cyanotic heart disease, the majority of the cases had some evidence of a systemic infection such as peripheral leucocytosis and elevated erythrocyte sedimentation rate. The correct diagnosis was commonly not considered despite to these clues of an infective process on admission. The operative mortality was 20% which was similar to the other series reported in the literature. However in spite of significant progress with the advent of computerized tomography, microbiology and antibiotic treatment, difficulties in early diagnosis are held to be responsible for the residual high mortality. Although the appropriate antibiotic therapy, adjuvant medical therapies to control perioperative brain swelling, and the application of reliable surgical techniques have decreased the mortality and morbidity rates, the best result can only be obtained to a wider number of patients if the physician remains alert to the possibility of an intracranial abscess.     

Wandering spleen in children: multicenter retrospective study

Wandering spleen in children is a rare condition. The diagnosis is difficult, and any delay can cause splenic ischemia. An epidemiologic, semiological, and surgical diagnosis questionnaire on incidence of wandering spleen in children was sent to several French surgical teams. We report the results of this multicenter retrospective study.Fourteen cases (6 girls, 8 boys) were reported between 1984 and 2009; the age range varies between 1-day-old and 15 years; 86% were seen in the emergency department. Ninety-three percent had diffuse abdominal pain. For 57% of the cases, it was their first symptomatic episode of this type. No diagnosis was established based on the clinical results alone. All patients had presurgical imaging diagnosis. Open surgery was performed on 64% cases. Forty-three had splenectomy for splenic ischemia. Thirty-six percent had splenopexy, 14% had laparoscopic gastropexy, and 7% had spleen repositioning and regeneration. Complications were noted in 60% of the cases resulting in postsplenopexy splenic ischemia.Early diagnosis and surgery are the best guarantee for spleen preservation. Even if the choice of one technique, splenopexy or gastropexy, can be argued, gastropexy has the advantage of avoiding splenic manipulation and restoring proper physiologic anatomy. When there is no history of abdominal surgery, laparoscopy surgery seems the best procedure.     

肾脏偶发瘤诊治体会

目的提高肾脏偶发瘤的术前诊断率和手术治愈率。方法回顾性分析66例。肾脏偶发瘤患者的术前影像学特点诊断、治疗方法及预后。患者中男40例，女26例；年龄33—67岁，平均52岁。均因体检或行临近器官检查发现肿瘤。肿瘤位于左肾36例，右肾30例。肿瘤直径1．2—4．8cm，其中〉3．0cm者4例。结果66例患者中肾癌36例，行肾癌根治术30例，肾切除术6例；肾错构瘤24例，肾囊肿6例，均行手术治疗。B超诊断肾癌26例，准确率72．2％；CT诊断32例，准确率88．9％。结论肾脏偶发瘤的术前诊断是关键，影像学检查对术前诊断的意义最大。术中可疑病例应行冰冻病理检查，以提高肿瘤的手术治愈率，偶发肾癌的术式选择应根据患者的具体情况决定。     

闭合性胰腺损伤的诊断和手术治疗分析

目的探讨闭合性胰腺损伤的诊断和手术治疗体会。方法回顾性分析我科收治的闭合性胰腺损伤36例临床资料。结果本组病例超声确诊11例,CT确诊23例,腹腔穿刺确诊20例。本组病例均行手术治疗,胰漏6例,腹腔出血2例,胆漏1例,腹腔感染2例。全组死亡4例,死亡原因主要为多器官功能衰竭。结论胰腺损伤的诊断首选B超、CT检查。根据胰腺损伤的程度,选择合理的手术方式,有效的手术方案和术后通畅的引流可提高治愈率,降低病死率。主胰管损伤的识别和定位是治疗成功的关键。     

Clinical characteristics and validation of diagnosis in individuals with Hirschsprung disease and inflammatory bowel disease

Background/purposeHirschsprung disease has previously been reported to be associated with inflammatory bowel disease (IBD). The aim was to clinically confirm the diagnosis and to describe characteristics among individuals with both conditions in a national populationbased cohort.MethodsNationwide, population-based cohort study, including all individuals with a Hirschsprung disease diagnosis and an IBD diagnosis registered between 1964 and 2016, in which clinical data were collected from the medical records of 18 validated cases with both Hirschsprung disease and IBD. The medical record of each individual in the study cohort was reviewed for age at IBD diagnosis, type of aganglionosis, type of surgical treatment, subtype of IBD, and treatment for IBD.ResultsMedian age at follow up was 34 years (range 19–66), and 3 of 18 indivduals (17%) were females. Median age at first diagnosis of IBD was 21 years (range 10–46). Six patients had ulcerative colitis, ten had Crohn's disease and two had unclassified IBD. Most of the patients had pharmacological treatment for IBD and 5 (28%) individuals had surgical treatment.ConclusionHirschsprung disease and IBD was clinically confirmed in 18 cases. Age at IBD onset and subtype of IBD is similar to IBD patients without Hirschsprung disease. Five individuals had undergone surgical treatment for IBD.     

右半结肠癌并发急性阑尾炎：附51例报告

目的 总结右半结肠癌并发急性阑尾炎的诊治经验.方法 回顾性分析经手术和病理证实的右半结肠癌并发急性阑尾炎51例临床资料.结果 右半结肠癌2400例中并发急性阑尾炎51例(2.1%).有内科合并症者39例(76.5%).术前诊断13例(25.5%),漏诊结肠癌38例(74.5%).结肠腺癌40例(78.4%),黏液腺癌7例(13.7%),未分化癌4例(7.8%).Dukes B期2例(3.9%),C期29例(56.9%),D期20例(39.2%).单纯性阑尾炎28例(54.9%),化脓性阑尾炎11例(21.6%),坏疽性阑尾炎8例(15.7%),蜂窝织炎性阑尾炎4例(7.8%).3,5年生存率分别为95.2%,40.0%.结论 右半结肠癌并发急性阑尾炎发生率低,误诊率高,5年生存率较低,中老年阑尾炎伴有消瘦、贫血及消化道症状、右下腹肿块者,应做相应检查,避免右半结肠癌漏诊.     

Surgical treatment of hydatid cysts of the pancreas

This series consists of seven patients with hydatid cysts of the pancreas; five females and two males, with an average age of 31 years. In a follow-up extending up to 33 years, about a 50% rate of correct preoperative diagnosis was recorded. The most sensitive and effective diagnostic modalities such as latex agglutination, ultrasonic, radionuclide, computerized tomographic and magnetic resonance imaging techniques were not available till the late seventies and therefore were only used during diagnosis of the latter 3 cases. Four patients had cysts located in the head of the pancreas. Three cysts were situated in the body and tail. Two distal pancreatectomies, two cystectomies and three marsupialization and external drainage procedures were performed for the surgical management of these cases. Two of the marsupialized and externally drained patients had fistulas which eventually dried up within a month leading to a total morbidity of 29% and a mortality rate of nil.