肾上腺囊肿的诊断与治疗(附15例报告)

目的:探讨肾上腺囊肿的诊断与治疗方法。方法:回顾性分析15例肾上腺囊肿的临床资料。结果:B超检查12例,9例显示肾上腺区为无回声液性囊性暗区, 3 例提示为低回声包块。14 例行CT检查为低密度肿块,其中7例提示囊壁有钙化影。MRI检查1例为包膜完整的占位病变。15 例均行手术治疗,其中行囊肿及同侧肾上腺切除6例,囊肿及肾上腺部分切除术7例,单纯囊肿切除术2例。9例行开放手术,6例经后腹腔镜手术。假性囊肿7例,内皮性5例,上皮性1例,2例未标明囊肿类型。结论:肾上腺囊肿临床上无特征性症状与体征,内分泌功能检查多数正常。B超与CT在诊断中占有重要的地位。注意与肝、胰、肾及脾囊肿,以及肾上腺肿瘤相鉴别。除直径<3 cm、内分泌功能正常、无症状、CT提示单纯性肾上腺囊肿外,均应采取积极手术治疗。建议囊肿切除加同侧肾上腺切除。后腹腔镜手术相对开放手术更有优越性。     

肾上腺囊性病变的诊断和外科治疗(附31例报告)

目的探讨肾上腺囊性病变的诊断和外科治疗方法，提高肾上腺囊性病变的诊治水平。方法回顾性分析31例肾上腺囊性变患者资料，经影像学检查，手术及病理证实非肿瘤源性患者21例，肿瘤源性患者10例。结果非肿瘤源性患者21例，其中单纯性囊肿15例，囊内出血感染或自发性出血所致的高密度囊肿6例。肿瘤源性患者10例，其中嗜铬细胞瘤9例，肾上腺神经节细胞瘤囊性变1例，8例嗜铬细胞瘤有激素活性症状。全部病例均行手术治疗，效果满意。结论B超、CT、MRI是诊断肾上腺囊性病变最可靠的定位诊断方法。强调在CT检查中有增强效应的囊性病变，要做内分泌功能检查。对直径〉4cm或有内分泌功能的肾上腺囊性病变应行外科治疗，〈4cm单纯性或单侧自发性出血性囊肿，无症状者可定期观察。     

肝脏囊性病变外科治疗的回顾性分析

目的　提高肝脏囊性病变 (囊肿≥ 4cm )的外科治疗水平。方法　对 1983～ 2 0 0 3年我院外科治疗肝脏囊性病变的病因、外科治疗方式及预后进行回顾性分析。结果　本组肝脏囊性病变病人 64例 ,其中单纯性肝囊肿 5 7例 ,肝棘球蚴病 4例 ,肝胆管囊腺瘤 2例 ,肝胆管囊腺癌 1例。囊肿平均直径为 10 .4cm。 16例单纯性肝囊肿行经皮囊肿穿刺抽液术 ,术后所有病人囊肿复发。 5 2例单纯性肝囊肿病人施行了手术治疗 ,其中 2 8例剖腹行囊肿去顶术 ,6例术后复发 ;18例腹腔镜辅助下手术 ,2例术后复发 ;囊肿切除术 2例 ,肝叶或肝部分切除术 4例。 4例肝棘球蚴病行包虫囊肿内囊摘除术 ,无复发。 2例肝胆管囊腺瘤和 1例肝胆管囊腺癌 ,均行肝叶切除术。结论　巨大 (≥ 4cm)、有临床症状的单纯性肝囊肿行经皮囊肿穿刺抽液术均复发 ;囊肿去顶术复发率低 ,腹腔镜辅助下手术较剖腹手术创伤小。肝棘球蚴病行包虫囊肿内囊摘除术是有效的 ,复发率低。肝胆管囊腺瘤可能恶变 ,应早期手术切除。     

肾上腺囊肿的诊断和外科治疗(附22例报告)

目的：探讨肾上腺囊肿的诊断与外科治疗方法。方法：回顾性分析22例肾上腺囊肿的诊断与治疗资料。结果：22例中，上皮性囊肿1例，内皮性肿囊8例，假性囊肿13例，均行囊肿切除术。结论：B超与CT是诊断肾上腺囊肿最可靠的定位诊断方法；强调在CT检查中有增强效应的囊肿要作内分泌功能检测，对直径＞3cm或有内分泌功能的肾上腺囊肿应进行外科治疗。     

胰腺囊性疾病破裂的诊断与治疗(附20例临床病例分析)

目的探讨胰腺囊性疾病破裂的诊断与治疗。方法回顾性分析2011年6月至2015年12月期间哈尔滨医科大学附属第一医院胰胆外科收治的20例胰腺囊性疾病破裂患者的临床资料,其中胰腺假性囊肿15例,胰腺囊性肿瘤5例。结果 5例胰腺囊性肿瘤患者均行手术切除,其中2例行胰十二指肠切除术,3例行胰体尾脾切除术。15例胰腺假性囊肿患者中,行超声引导下胰腺假性囊肿穿刺置管引流2例;内镜下胰管内支架引流2例;内镜下胰管内支架引流联合超声引导下胰腺假性囊肿穿刺置管引流2例;手术治疗9例,其中假性囊肿外引流1例,假性囊肿内引流8例(胰腺假性囊肿空肠吻合5例,胰腺假性囊肿胃吻合3例)。术后发生胰瘘3例(A级2例,B级1例),胃排空障碍1例,肺部感染2例,腹腔积液1例。随访3个月至5年,平均25.6个月,1例胰腺假性囊肿患者行内镜下胰管内支架引流术后假性囊肿复发,还有1例胰腺假性囊肿患者行假性囊肿内引流术后复发,2例复发患者均经非手术治疗后症状好转,痊愈出院。结论正确地鉴别胰腺囊性肿瘤与胰腺假性囊肿是胰腺囊性疾病破裂治疗方式选择的前提。胰腺囊性疾病破裂的治疗较常规胰腺囊性疾病的治疗急迫,治疗方式的选择至关重要,应根据患者具体情况制定出个体化治疗方案,使患者最大程度获益。     

肾上腺假性囊肿1例

目的：探讨肾上腺假性囊肿患者的临床特征。方法：报告1例本病患者的临床资料,患者为女性,22岁,体检时行腹部B超检查发现,相关实验室生化检查均无异常,腹腔镜下将大部分囊壁和类似实性的包块切除,术后病理证实为肾上腺假性囊肿。结果：随访6个月,B超复查未见囊肿及其他异常。结论：肾上腺假性囊肿少见,诊断有赖影像学检查和病检,腹腔镜下或开窗切手术切除可列为首选。     

超声内镜引导下经胃引流治疗早期胰腺假性囊肿23例

目的 探讨超声内镜引导下经胃引流治疗早期胰腺假性囊肿的疗效.方法 回顾性分析2003至2008年在超声内镜引导下早期经胃穿刺置管引流进行治疗的23例巨大胰腺假性囊肿患者的临床资料.结果 假性囊肿位于胰头部3例,胰体部11例,胰尾部9例,囊肿平均直径11 cm(8～18 cm),均为单发囊性,所有病例在超声内镜引导下经胃引流治疗胰腺假性囊肿,假性囊肿发现至穿刺手术间隔17～65d,平均31 d.2例术后发生囊肿感染,1例改用外引流,另1例改用手术内引流治疗治愈;3例出现消化道出血,保守治疗后治愈.2～3个月后CT复查,6例患者假性囊肿完全消失,余15例患者囊肿明显缩小,所有患者腹胀、腹痛症状缓解.随访1年,无溃疡、出血、囊腔感染等并发症发生.结论 超声引导下早期经胃穿刺置管引流治疗胰腺假性囊肿是安全、有效的.     

泌尿系包虫囊肿的诊断及外科治疗

目的探讨泌尿系包虫囊肿的临床特点和诊治要点。方法1956-2005年共收治泌尿系包虫囊肿患者27例。男21例,女6例。年龄3～53岁,平均35岁。腰部胀痛5例、腰腹部包块5例、发热2例、尿中排出白色小圆囊及白色粉皮样物1例、轻度肉眼血尿1例、进行性排尿困难4例、因其他疾病体检中发现9例。27例分别行B超、IVU、CT和膀胱镜检或造影检查。单囊型21例,其中破入肾盂2例,多子囊型6例。包虫囊肿直径7．0～13．8cm。行内囊摘除术19例,其中2例破入肾盂者置入双J管。内囊完整摘除2例、肾切除2例、膀胱后壁全外囊切除2例,2例膀胱直肠陷窝内包虫行内囊摘除,外囊壁纤维化部分剪除后,内翻缝合闭死囊腔。结果27例患者术后均痊愈出院,未出现任何并发症,病理检查均为细粒棘球蚴病。22例随访3～9年,包虫囊肿无复发。结论泌尿系包虫病囊肿诊断主要依据典型的临床表现、Casoni试验、B超、IVU、CT及膀胱镜等辅助检查。手术摘除包虫内囊是目前惟一有效的治疗方法,但应根据囊肿大小、位置和产生的不同病况确定手术方案。     

胰腺假性囊肿的综合处理

目的探讨胰腺假性囊肿的综合处理。方法回顾性总结近7年来我院收治胰腺假性囊肿36例的临床资料。结果急性胰腺炎后28例,慢性胰腺炎后3例,腹部外伤后5例。囊肿直径≤6cm者10例,均为单房性囊肿;直径〉6cm者26例,其中9例为多房、17例为单房性囊肿。ERCP造影显示67%囊肿与主胰管沟通,绝大多数发生在〉6cm的囊肿。囊肿直径≤6cm的10例病人,除1例作了囊肿切除和2例并发感染行外引流治愈外,7例皆经保守治愈;〉6cm的26例病人,除1例保守治愈外,其余25例均行囊肠Roux-en-Y吻合术,无手术死亡。结论不与胰管沟通或直径≤6cm的囊肿,可行非手术治疗;与胰管沟通或直径〉6cm的囊肿,6周后不消退均应行内引流术或内镜治疗;术前了解囊肿与胰管的沟通情况十分必要。     

肾上腺囊肿的诊断与治疗（附七例报告）

１９６７～１９９４年共收治肾上腺囊肿７例，其中假性囊肿３例，内皮性囊肿２例，上皮性囊肿及包虫囊肿各１例。经Ｂ超、ＣＴ、ＭＲ可获确诊，良、恶性囊肿的鉴别比较困难。本组５例行手术切除，１例穿刺抽液治疗，１例观察未做处理，经随访效果满意。结合文献就其分类、病理、临床表现，诊断及治疗进行讨论。     

Primary hydatid cyst of adrenal gland. Report of two cases

Primary hydatid cyst of adrenal gland is still an exceptional localization. The adrenal gland is an uncommon site even in our country in which echinococcal disease is endemic. We report two cases of primary hydatid cyst of adrenal gland presented with isolated abdominal pain. The diagnosis was based on CT-scan, which showed a cystic mass of respectively the right and left adrenal gland with a calcified wall. The echinococcal immunologic test (Elisa) was positive in one case. The surgical treatment consisted on a total resection of the cyst, without rupture of the cystic wall and preserving the gland. The diagnosis was confirmed on the macroscopic examination of the resected pieces. In the first case the cyst was multilocular filled with daughter cysts and in the second case the cyst was unilocular filled with hydatid membrane and clear fluid. In the two cases, the postoperative course was uneventful. No recurrence had occurred respectively after 24 months and 36 months of follow up.     

肾上腺偶发瘤（附16例报告）

１９９０年１０月～１９９４年１月收治肾上腺偶发瘤１６例，术前Ｂ超、ＣＴ及ＭＲ确诊为肾上腺囊肿４例，肾上腺骨髓脂肪瘤２例。术前诊断不明确者１０例中，肿瘤直径＜３．０ｃｍ４例为肾上腺皮质腺瘤；肿瘤直径３～６ｃｍ３例，为肾上腺髓质肿瘤；肿瘤直径＞６ｃｍ３例，２例为肾上腺皮质癌，１例为肾上腺嗜铬细胞瘤。肾上腺偶发瘤除直径＜３ｃｍ的肾上腺囊肿和骨髓脂肪瘤外均应手术治疗。     

Adrenal cysts: diagnosis and management

We present 7 patients (5 adult females and 2 neonate males) with adrenal cysts. The cysts included 1 hydatid, 1 lymphatic and 5 pseudocysts. Three cysts were diagnosed preoperatively and all were resected surgically. The existence of true epithelial cysts of the adrenal gland is doubted by many authors; the present series includes most types of adrenal cyst.     

肾上腺髓性脂肪瘤的诊疗(附9例报告)

目的:探讨肾上腺髓性脂肪瘤的诊断与治疗方法.方法:回顾性分析9例肾上腺髓性脂肪瘤患者的临床资料,并总结其诊断和治疗经验.9例中,7例无症状,1例有腰部不适,1例血压增高.B超与CT诊断8例,1例误诊为肾错构瘤.肿瘤发生于左侧肾上腺区4例,右侧肾上腺区5例,开放手术8例,腹腔镜手术1例.结果:肿瘤直径5～11cm,术后病理检查证实均为肾上腺髓性脂肪瘤.术后随访6个月～5年,无肿瘤复发.结论:肾上腺髓性脂肪瘤可依靠B超、CT或MRI等影像学检查诊断,手术切除肿瘤安全有效,腹腔镜手术较开放手术更有优越性.     

后腹腔镜手术治疗肾上腺囊肿42例报告

目的:总结后腹腔镜手术治疗肾上腺囊肿的手术经验及疗效。方法:回顾分析2004年12月至2011年3月为42例肾上腺囊肿患者行后腹腔镜手术的临床资料。患者平均(45.6±10.8)岁,囊肿直径平均(6.8±3.1)cm。其中单纯囊肿切除术29例,合并肾上腺部分切除术11例,合并肾上腺全切除术2例。结果:42例手术均获成功,无一例中转开放手术,围手术期无严重并发症发生。手术时间平均(58.5±22.4)min,术中出血量平均(37.5±27.1)ml,术后平均住院(6.0±1.8)d,平均随访(45±28.5)个月,患者不适症状消失或明显缓解,术后肾上腺功能正常,无局部复发。结论:腹腔镜手术治疗肾上腺囊肿安全、有效,具有患者创伤小、康复快等优点,可作为治疗肾上腺囊肿的首选方法。     

Intra-Abdominal Extrahepatic Echinococcosis

Twenty-seven patients who were treated surgically because of extrahepatic abdominal hydatid disease between 1981 and 1999 were retrospectively reviewed. Nineteen patients had coexistent hepatic cysts while 8 patients had only peritoneal cysts. The cysts were located in the spleen, pancreas, adrenal gland, mesentery of the intestines, ovaries, retroperitoneum, omentum, abdominal wall, rectovesical region, and the psoas muscle. Due to organ destruction because of large cysts in 8 patients, the involved organ had to be sacrificed. The other 19 patients were treated by a pericystectomy. No postoperative mortality or severe morbidity was seen. In conclusion, symptomatic or large cysts should be surgically treated. In cases suspected of having peritoneal spillage, antihelminthic drugs should be administered. In addition, small asymptomatic cysts may also be effectively treated with antihelminthics. Received: September 18, 2000 / Accepted: May 15, 2001     

Hydatid cyst of the adrenal gland. A case report

The hydatid cyst of the adrenal gland is still an exceptional localization. Only eleven cases have been described in the literature. A new case of isolate suprarenal hydatidosis is reported in one 28 years old patient, that the signs consisted in pains of the right flank and vomiting. The diagnosis has been based on the imagery, particularly the computed tomography associated to the hydatid serology, confirmed during the operation and by the pathologic examination of the resected piece. The treatment consisted in a simple cystectomy with conservancy of the gland, the operative sequelae have been simple. The interest of this cases lies in the rare feature of this hydatid localization that the diagnosis is difficult. Among the various suggested surgical methods, the simple resection of the cyst is still the best treatment that permits to keep the gland.     

Pulmonary hydatidosis: surgical treatment and follow-up of 240 cases

Objective: We review a series of 240 patients treated surgically for pulmonary hydatid cyst in our center between 1966 and 1988, assessing the results with our surgical technique, which involves a novel needle aspiration device designed by Professor D. Figuera, and postoperative treatment protocol. Patients and methods: The majority (60.4%) of the patients were from areas endemic for hydatid disease. The mean age of the patients at the time of the surgical procedure was 31.5±7.2 years (range: 4–70 years). A trocar-suction device was used for the needle aspiration of 276 (92%) of the 300 cysts encountered in the 240 patients. The remaining 24 cysts were removed integrally by means of different surgical techniques such as cyst enucleation, lobectomy, segmentectomy and atypical pulmonary resection. The residual cavity was treated by pericystectomy and eversion to the pleural surface in 238 cases (86.2%) and by capitonnage in 38 (13.7%). High vacuum suction (−30 cm H₂O) was employed in every case. Depending on when the procedure was performed, the patients were treated with mebendazole or albendazole according to the protocol designed by Bekhti. Results: Clinical assessment of the symptoms and plain chest X-ray led to the correct diagnosis in 228 cases (95%). In six (2.5%), imaging studies such as ultrasonography, computed tomography and nuclear magnetic resonance were required, and in the remaining six cases (2.5%), the diagnosis was established intraoperatively or in the subsequent histopathological study. One hundred and seventy patients (70.8%) presented a solitary lung cyst, while the remaining 70 (29.2%) were found to have multiple cysts in one or more lobes of one or both lungs. In addition, 45 patients (18.7%) presented hepatic cysts and 25 (10.4%) had cysts in other locations. After 18 years of follow-up, the survival rate was 94.6%. Of the surviving patients, 98.3% were free of pulmonary hydatid disease and 95.1% were free of hydatid disease. Conclusions: The trocar-suction device employed here for needle aspiration of hydatid cysts has demonstrated its efficacy in preventing the rupture of the cyst and its possible dissemination. With its use, the parasite is eradicated and the residual cavity can be excised.     

Cysts of the adrenal gland: Diagnosis and management

Objective Cysts of the adrenal gland are rare, but with the wider application of sonography and computed tomography more adrenal cysts are detected incidentally. To gain more insight into this entity, five such cases are reported and their diagnostic approach and management are discussed. Patients and methods The records of five patients with six cysts of the adrenal glands seen at our department from 1987 till 1995 are reviewed. There were four males and one female and their age ranged from 24 to 72 years, with a mean age of 43 years. One patient had a primary hydatid cyst of the right adrenal gland, which was preoperatively thought to arise from the liver or the right kidney. A second patient had a very large pseudocyst of the left adrenal gland, which is the largest ever reported in the literature. The other four cysts in three patients were found incidentally during sonography or computed tomography. Results The hydatid cyst with a rim of normal adrenal tissue was excised. The large pseudocyst was removed together with the adrenal gland. In the cases of the incidentally found cysts, observation of the patient with regular follow-up was decided upon. All patients are in good condition and without symptoms 2 to 10 years after the initial diagnosis. Conclusions Adrenal cysts are rare and their diagnosis may pose problems. Symptomatic adrenal cysts should be operated, but small, asymptomatic, non-functional cysts with benign characteristics may be treated conservatively with regular follow-up by sonography or computed tomography and hormonal evaluation.