39例腹膜假粘液瘤生存预后分析

目的探讨腹膜假性粘液瘤的临床病理特征并分析其生存预后。方法回顾性分析我院2002年5月～2011年12月收治的39例腹膜假粘液瘤患者的临床及随访资料,运用单因素及多因素统计分析方法,寻找影响患者生存期的预后因素。结果全部患者行手术治疗,32例行单纯术中腹腔化疗,7例行腹腔内热化疗。中位随访时间为40个月,随访期内9例患者死亡,其中1例为腹腔内热化疗患者。5年、10年生存率分别为89.0%和35.0%。中位生存期为37个月。单因素分析显示术前肿瘤标志物高于正常及病理分型为腹膜粘液腺瘤病者对生存期延长有统计意义（P=0.027,P=0.048）。多因素分析显示病理类型可作为影响总生存的独立预后因素（P=0.033）。结论术前肿瘤标志物水平可在一定程度上影响患者生存。病理组织分型在影响患者生存期的因素中仍占主导地位。     

腹膜假粘液瘤

腹膜假粘液瘤经近期的免疫组化技术研究业已被证实为阑尾恶性肿瘤的的转移病灶,虽经大块切除,但仍有复发可能,5年生存率为53％,现复习1986～1997年文献有关治疗的方法及其结果。     

治愈腹膜假粘液瘤的方法

本文介绍了一种以术前诱导腹腔化疗、手术及早期术后化疗组成的联合治疗方案,对腹膜假粘液瘤及与之相似的一类低度恶性肿瘤有较好的疗效。     

双侧腹股沟斜疝内容物均为男女生殖器官1例报告

真性两性畸形是最少见的两性畸形，文献报道仅400余例，而疝内容物均为男女生殖器官经查新未见报道。我院最近收治1例，现报告如下。     

腹膜假粘液瘤：综合报道

膜腹假粘液瘤经近期的免疫组化技术研究业已被证实为阑尾恶性肿瘤的转移病灶，虽经大块切除，但仍有复发可能，５年生存率为５３％，现复习１９８６－１９９７年文献有关治疗的方法及其结果。     

腹膜假性粘液瘤八例报告

目的 探讨腹膜假性粘液瘤的诊断和治疗。方法 总结8例患者的诊治经验，并复习文献。结果 8例患者，主要临床表现为腹痛、腹胀、腹部包块和全身消耗，2例术前超声检查提示不均质腹水，4例查CEA者均升高。所有患者均经手术治疗，病理证实7例来自阑尾粘液腺癌，1例来自降结肠粘液腺癌。手术包括切除原发病灶、网膜、或其它脏器及尽可能清除粘液性病变组织。患者均经手术治疗，术后辅助治疗包括化疗和放疗。术后随访率100％（8／8），5年存活率（4／8），10年存活率13％（1／8）。结论 腹膜假性粘液瘤是一种少见病，术前诊断很困难。B超和CEA检查对诊断可能有帮助。由于其低度恶性、极少转移，经过反复侵袭性手术并辅以化疗和／或放疗能明显提高生存率。     

疝内容物为子宫圆韧带囊肿1例

患者女,28岁。因右腹股沟区可复性包块2年余入院。体查:右腹股沟区肿块隆起,经外环口突出约4 cm×3 cm×2 cm。肿块无压痛,还纳后压迫内环处包块不再突出,包块突出时透光试验(-)。诊断:右腹股沟斜疝。择期行局部神经阻滞麻醉下疝无张力修补术。术中见肿物位于腹外斜肌后面,呈条索状约3 cm×3 cm×2 cm大小,为多囊性肿物,表面光滑包膜完整,部分肿物自外环口突出于皮下肿物基底部自内环口突出,内环口大小约2 cm,沿肿物包膜做锐性分离,将肿物完整切除,创面止血。探查疝囊疝环口,腹膜筋膜薄弱。行网塞式补片无张力疝修补术。术后切除标本送病检,…     

膀胱憩室疝1例

患者　男 ,34岁。因左侧腹股沟包块 2年入院。体查 :左腹股沟部有一约核桃大小包块 ,无疼痛 ,不能还纳。诊断 :左侧腹股沟斜疝。拟行疝高位结扎修补术。当显露“疝囊”时 ,切开后有黄色液体流出。用手指探查 ,发现其与膀胱相通 ,经探查证实疝内容物为膀胱憩室。切除憩室 ,缝合修补膀胱后行疝修补术。术后留置尿管 5ｄ ,痊愈出院。膀胱憩室疝1例@杨兴勇$四川省康定县姑咱人民医院外科!四川康定626001膀胱憩室疝;;病例报告     

Perforated caecal diverticulum as a content of inguinal hernia — report of a rare case

A tablet induced perforation of a caecal diverticulum into a hernial sac is a rare happening. The report discusses the presentation and outcome of a patient with such an unusual disease. A 55-year-old man presented with features of irreducible right sided indirect inguinal hernia. A hard swelling near upper pole of right testis was noted. Scrotal ultrasound revealed a normal testis. At operation caecum and proximal ascending colon were found in the hernial sac with the caecum adherent to the testis. As caecal malignancy could not be ruled out and enbloc Rt Haemicolectomy with Rt orchidectomy was performed. The patient had an uneventful recovery. Pathological examination of the specimen revealed a perforated caecal diverticulum with presence of multiple tablets in its lumen invaginating the upper pole of right testis without any evidence of malignancy. Tablet induced perforation of a caecal diverticulum into a hernial sac is a rare clinical entity. If malignancy cannot be negated at operation, a right haemicolectomy is a safe and feasible option.     

两性畸形并子宫、附件疝1例

患者男,54岁.农民,因右阴囊可复性包块右斜疝入院.体检:右阴囊包块10cm×8cm,平卧后大部分疝内容物能还纳腹腔,阴囊内可扪及正常大小睾丸,但附睾、精索不清,腹股沟处可触及约5cm×5cm囊实性包块.     

白线Richter疝误诊1例

患者　女 ,61岁。 3年前无意发现上腹壁正中有一肿块 ,大小无明显变化。因肿块增大 ,持续性疼痛 ,伴恶心、呕吐 1ｄ入院。体查 :体温 37 5℃ ,脉搏 82次 /ｍｉｎ ,血压1 61 /90ｍｍＨｇ。脐上白线处触及 3ｃｍ×3ｃｍ包块 ,质软 ,轻度压痛。腹部无压痛、反跳痛、肌紧张、肠鸣音正常。白细胞 1 4 4× 1 0 9/Ｌ ,中性粒细胞 0 82。腹部平片 :未见液平面及膈下游离气体。入院诊断 :上腹壁脂肪瘤并感染。经抗生素治疗 2ｄ ,肿块处疼痛逐渐加重 ,且局部皮肤红肿 ,明显压痛。术前诊断 :白线疝嵌顿 ,即行手术治疗。术中见 :腹白线有一 1 5ｃｍ缺…     

十二指肠旁疝合并肠扭转1例

患者　女,46岁,因脐周阵发性绞痛,伴恶心、呕吐、肛门排气停止1ｄ,加重6ｈ入院。体查:痛苦面容。腹胀,全腹压痛,反跳痛,以上腹部为著,移动性浊音阳性,肠鸣音减弱。血红蛋白120ｇＬ,白细胞12×109Ｌ,中性粒细胞076,腹部透视可见两处液平。诊断:肠梗阻,原因待查。即行剖腹探查术,术中见腹腔内有200ｍｌ血性渗液,大部分小肠呈暗紫色,顺时针方向扭转约720,吸尽渗出,将扭转小肠复位后,发现升结肠游离,距回盲部约20ｃｍ处有长约35ｃｍ的回肠及约30ｃｍ的空肠上部肠管疝入并嵌顿于小肠系膜左侧之腹膜囊内,囊口直径约45ｃｍ,局部见瘢痕增生。打开腹…     

Amyand's hernia a case report

Introduction and importanceAmyand's hernia (AH) is a form of inguinal hernia which is consider as very rare and this type of hernia occurred up to 1% of all inguinal hernia cases. In this type of inguinal hernia, the content of hernia sac is appendix. Most patient with AH often remains asymptomatic and diagnosed intraoperatively. The diagnosis is challenging, since needs a high index of suspicion and imaging is key. Surgery is the mainstay management. We report a case of Amyand's hernia that was managed operatively in our medium complex public institution.Case presentationA 28 year's old man with normal body mass index (BMI) who had a history of right-side reducible linguino-scrotal swelling for 8 years, was admitted for elective right inguinal hernia repair. Two weeks back before admission, he noticed that swelling was slightly painful. Ultrasound of the abdomen reported normal findings. There was no history of abdominal pain and vomiting. Laboratory parameters were within normal limit. So, with a diagnosis of right sided partially reducible, incomplete, and indirect inguinal hernia, patient was operated for open hernia repair surgery, intra operatively we found dense adhesions within the sac, adhesions were released which revealed herniation of appendix into the inguinal canal. Appendix was mildly congested without gross evidence of inflammation. Hence, in view of noninflamed appendix, preperitoneal mesh (polypropylene) hernioplasty from Lichtenstein tension-free mesh repair was performed with appendicectomy. Postoperative period was uneventful, patient discharged at second day.Clinical discussionAmyand's hernia is very uncommon and characterized by the presence of the appendix in the hernia sac and it is 0.4–1% of all inguinal hernia cases, literature review also showed that incidence of Amyand's hernia is very rare, whereas only 0.1% of cases complicate into acute appendicitis due to late presentation and missed diagnosis.ConclusionAmyand's hernia (AH) makes up only a small proportion of most inguinal hernia cases, and its diagnosis is usually based on incidental finding intra-operatively. This condition may remain asymptomatic and behave like a normal inguinal hernia. Management of this type of hernia should be individualized according to appendix's inflammation stage, presence of abdominal sepsis and co-morbidity. With this approach it enables surgeons to manage more variations of Amyand's hernia. Laparoscopy for dealing Amyand's hernia is frequently diagnostic as well as therapeutic.     

Mobile caecum as a content in recurrent incisional hernia an incidental finding: A rare case report

IntroductionRecurrence in ventral hernia after laparoscopic repair is less as compared to conventional approach. Mobile caecum as a content of ventral hernia is a very rare entity. Standard treatment for mobile cecum is caecopexy using lateral peritoneal flap.Case reportA 40-year-old obese female, homemaker by occupation with a history of incisional hernia 2 year back and treated with intraperitoneal on lay mesh repair presented with swelling in the left lower abdomen for past 6 months. Radiological investigations revealed defect in left lower anterior abdominal wall with protruding bowel loops. Urgent exploratory Laparotomy revealed mobile segment of ileocecal junction in the hernial sac cavity. Caecopexy for the mobile caecum was done.DiscussionMobile caecum is due to embryological failure of fusion of right colonic mesentery with lateral peritoneal wall. Pre-operative diagnosis of mobile caecum is difficult to establish unless it presents as caecal volvulus Caecopexy using the lateral peritoneal flap is the standard of care.ConclusionMobile caecum can surprise the attending surgeon as a content of ventral hernia. Caecopexy using lateral peritoneal flap is the treatment of choice in all with a mobile caecum.     

Transmesosigmoid hernia: report of a case

Sigmoid mesocolon hernia is an uncommon type of internal hernia. A 63-year-old man who presented with pain in the left side of the abdomen and nausea was referred to our department for treatment of ileus. He was initially managed conservatively, but as his symptoms became progressively worse, a laparoscopy was done, which revealed hemorrhagic ascites and necrosis of the small intestine in the lower abdomen. An open laparotomy was subsequently performed and the intraoperative findings were consistent with a transmesosigmoid hernia. There was an abnormal defect in the sigmoid mesocolon and protrusion of about 30 cm of small bowel through this abnormal opening, which had resulted in strangulation of the bowel. The necrosed part of the intestine was resected and the defect was closed. Received: November 9, 2001 / Accepted: May 7, 2002 Reprint requests to: T. Sasaki