颅内转移瘤及胶质母细胞瘤术后骨瓣复位的作用(附43例报告)

对67例颅内转移瘤及胶质母细胞瘤患者进行手术治疗。其中43例行肿瘤全切除 骨瓣复位术者，2例出现伤口少量积液；24例行肿瘤全切除 去骨瓣减压术者，9例有伤口积液或脑组织膨出。认为对颅内转移瘤及胶质母细胞瘤肿瘤施行全切除 术中骨瓣复位手术优于肿瘤切除 去骨瓣减压术。     

44例原发性心脏肿瘤的诊断与治疗

目的总结44例原发性心脏肿瘤的发生部位、肿瘤性质、诊断及外科治疗方法。方法2006年1月至2007年12月44例原发性心脏肿瘤患者接受手术治疗，男性12例，女性32例，年龄25～69（37．6±11．9）岁；其中良性肿瘤42例、恶性肿瘤2例。所有病例均经超声心动图诊断并在体外循环下行手术切除治疗。结果手术死亡1例，其余43例术后随访6个月至2年，1例恶性肿瘤于术后6个月死亡，2例黏液瘤分别于术后10、20个月后复发。结论原发性心脏肿瘤良性以黏液瘤多见，彻底切除肿瘤是防止复发的关键。心脏恶性肿瘤手术近远期效果差。     

von Hippel-Lindau 病一例

ｖｏｎＨｉｐｐｅｌ－Ｌｉｎｄａｕ病一例丁奇龙杜群患者女性，２４岁，１９９５年３月２７日入院。１９８４年手术切除右侧小脑肿瘤，术后切除肿瘤送解放军总医院病理科病理检查，报告为小脑富于血管的瘤组织，病理诊断：小脑血管母细胞瘤（图１）。１９９１年８月因糖尿...     

婴幼儿肝脏肿瘤行精准肝切除术的临床效果及体会

目的 探讨婴幼儿肝脏肿瘤施行精准肝部分切除术的临床效果、手术操作的技术关键、手术适应证及并发症的预防.方法 回顾分析2009年11月至2011年10月间行精准肝部分切除术12例患者的临床病历资料.结果 成功完成精准肝部分切除术12例,肿瘤平均大小8 cm,平均手术时间40 min(30～80 min),术中出血量25 ml(10～40 ml),术后住院时间8 d(7～9d).术后第2d即可进食,复查1次血常规均无明显变化,引流管均未见明显引流液,均于术后第2d拔除.无术后并发症.术后病理诊断肝母细胞瘤8例、肝毛细血管瘤2例、肝错构瘤2例.随访1个月到2年,无肿瘤复发.结论 为婴幼儿施行精准肝部分切除术是安全可行的,具有创伤小、恢复快、并发症少等优点,是治疗婴幼儿肝脏肿瘤的安全有效的手术方式.     

49例肝海绵状血管瘤缝扎治疗

目的：观察缝扎法治疗肝海绵状血管瘤的临床疗效。方法：对４９例肝血管瘤患者进行缝扎治疗，缝扎针自行设计，于瘤体与肝组织之间的界线（限）进针，针距１．５～２．５ｃｍ行贯穿“８”字缝扎。结果：随诊３８例患者６月至６年，２例半年至一年复查肿瘤消失，１例１４个月复查瘤体中心出现液化坏死；１例２４月复查瘤体大小无变化，其余各例瘤体均有不同程度缩小，平均缩小率为４７．１％，结论：经与同期血管瘤切除病例结果对比，     

胸腺切除加前纵隔脂肪清扫术治疗重症肌无力(附17例报告)

采用胸腺切除加前纵隔脂肪淆扫术治疗重症肌无力（ＭＧ）患者１７例，均采用胸骨正中劈开入路。术后病理诊断为胸腺瘤６例，胸腺增生９例，胸腺正常２例。术后２４小时内死于呼吸衰竭１例。对余１６例患者随访１－１０年，症状完全缓解５例，改善８例，好转３例。认为ＭＧ一经确诊，应积极施行手术，保持呼吸道通畅、加强呼吸道管理；对病情较重者行预防性气管切开是降低术后病死率的关键；应扩大手术适应症。     

腹腔镜联合射频消融和125I粒子治疗肝转移癌

目的探讨腹腔镜切除并联合应用射频消融和^125I粒子植入治疗肝转移癌的临床价值。方法对62例术前经CT或MR确诊肝脏有转移灶的患者，行腹腔镜下肝转移瘤切除或射频消融，最后将^125粒子植入肝脏肿瘤部位。结果术中超声发现新病灶17个，所有患者均顺利行腹腔镜切除或射频消融及^125粒子植入。2例术后出现肝脓肿，1例术后发生腹腔少量出血，余无严重并发症。^125个转移病灶位于肝脏右后内叶或巨大仅行腹腔镜下射频消融及^125粒子植入，22例患者的38个边缘转移病灶行离体切除。随访12～25个月（平均22．3个月），有12例转移癌未见液化，行腹腔镜下二次射频及^125粒子植入。1年生存率为74．2％（46／62），2年生存率为59．7％（37／62）。结论腹腔镜切除并联合应用射频消融和^125粒子植入治疗肝转移癌具有微创、安全、有效，术后恢复快等优点。     

肝脏囊腺瘤的临床特征附8例临床分析

目的 探讨肝脏囊腺瘤的诊断及治疗方法,提高对本病的认识.方法 总结我院2006年1月～2009年8月收治的8例病理诊断为肝内胆管囊腺瘤病例的临床表现、影像学特点、外科手术治疗情况及术后病理结果,回顾性分析各诊断及治疗情况的优缺点. 结果 8例肝脏囊腺瘤患者均为女性,平均47.5岁,影像学肿瘤病灶4例位于左叶,4例位于右叶,7例表现为囊实性,1例表现为实性;8例患者均行手术切除治疗,其中2例行姑息性切除,6例完整切除,术后病理为肝内胆管囊腺瘤,2例行局部切除患者术后1年内复发.结论 肝脏囊腺瘤临床多好发于中年女性,临床表现不典型,术前易误诊,CT及MRI检查有助于术前评估,治疗上首选手术治疗,推荐囊肿全部切除加周围部分正常肝组织切除术,局部切除患者术后复发率100%.     

肝血管瘤的手术指征和术式选择（附46例报告）

手术治疗肝血管瘤患者４６例，对手术指征和术式选择进行了探讨。认为不能排除的恶性肿瘤，伴有压迫症状或严重合并症及小儿患者，肿瘤位于肋缘下或肝表面、生长迅速及肿瘤直径〉８ｃｍ者适合行手术治疗；对暂不手术的患者，每６个月行Ｂ超检查１次。肝肿瘤剜除术为肝血管瘤的首选术式。     

原发性纵隔内胚窦瘤的诊断与治疗（附2例报告）

报告２例原发性纵隔内胚窦瘤，均经组织病理学证实。１例手术如术后化疗存活４个月，另１例手术切除肿瘤加术后放疗和化疗，已生存８个月。结合文献对本病病因，病理，临床表现，诊断，治疗及颈后等进行了讨论。     

以磨玻璃样密度影为表现的早期肺癌并发肺结核患者的诊治分析

目的 分析以磨玻璃样密度影(ground-glass opacity,GGO)为表现的早期肺癌并发肺结核患者的临床特点,以达到早期识别及治疗的目的。方法 对山东大学附属山东省胸科医院自2013年1月至2018年2月确诊的14例以GGO为首要表现的肺癌并发肺结核患者的临床表现、CT扫描征象、手术方式、病理类型等进行回顾性分析。结果 以GGO为表现的早期肺癌并发肺结核以查体时发现多见(9/14),CT表现为陈旧性结核病灶并发混合密度GGO(mGGO) 12例;GGO与结核病灶位于同侧同叶4例。术前对患者进行规范抗结核药物治疗9例,术后继续行规范抗结核药物治疗6例。术前有3例患者行CT引导下肺穿刺活检确诊肺癌,其余11例为术中冰冻切片病理检查证实。行肺叶切除加纵隔淋巴结清扫10例,肺叶(GGO病灶所在处)切除加同侧异叶肺结核瘤局部切除2例,肺段切除1例,楔形切除1例。肺结核病灶标本经病理检查确诊10例,另4例依据病史及影像学表现符合陈旧性肺结核诊断;表现为GGO的早期肺癌病灶标本经病理检查确诊腺癌11例,鳞癌1例,腺鳞癌1例,大细胞癌1例。纵隔淋巴结病理检查均未见转移。本组患者术后均顺利康复,短期随访未见肿瘤复发、转移及结核复燃等。结论 GGO为表现的早期肺癌并发肺结核患者其临床表现无特异性,薄层CT扫描加动态观察有利于诊断。手术方式需在肺癌切除的基础上兼顾结核病灶的处理,规范的抗结核药物治疗加手术切除治疗效果满意。     

Hepatic adenoma. Timing for surgery

BACKGROUND/AIMS: Hepatic adenoma (HA) is a rare benign tumor of the liver. Tumor resection has been recommended for symptomatic or enlarging HA because of the risk of intraperitoneal, intrahepatic hemorrhage or even the development of hepatocellular carcinoma. From 1989 to 2003 we reviewed the medical records and radiology files of 28 patients with a proved diagnosis of hepatic adenoma. This article summarizes a single-center experience with surgical treatment of hepatic adenoma. METHODOLOGY: 24 patients were female and 4 were male. Twenty-two patients had a history of oral contraceptive use. Abdominal pain was presented in 19 patients and 3 of them had had an acute episode. The mean age was 36.3 years. Preoperative assessment included liver test, ultrasonography and computed tomography in all patients plus technetium (99mTc)-sulfur colloid and 99mTc-labeled DISIDA (dimethyliminoacetic acid) liver scintigraphy (n=19) and magnetic resonance imaging (n=22). RESULTS: Operative procedures included enucleation in 3 patients, two of them associated with hepatic segmentectomy; resection of one or two segments in 14 patients; left and right hemihepatectomy respectively in 7 and 3 patients; right extended hepatectomy in one patient and nonanatomic resection in one patient. There was no postoperative death and the complications were: bile leakage (re-operation) one patient, intraperitoneal abscess (re-operation) one patient, pleural effusion two patients, venous thrombosis one patient and wound infection one patient. CONCLUSIONS: We recommend that since the diagnosis has been well-established both enucleation or anatomically based resections of hepatic adenoma should be performed in all cases mainly in female patients taking oral contraceptives with tumors greater than 3cm for the risk of hepatic hemorrhage or even when malignancy cannot be excluded.     

Hepatic tuberculoma: presentation of cases and review of the literature

Hepatic involvement by tuberculosis is a rare type of manifestation of the disease. There are several forms of clinical presentations. One of them is the hepatic tuberculoma in which we base our presentation. Given that hepatic tuberculoma is a rare entity and generally shows inespecific symptoms, it is rarely suspected by the clinical picture. The diagnosis of hepatic tuberculosis is generally done in the intraoperative or postoperative period by analyzing a specimen taken by laparoscopy or laparotomy during the study of a hepatic mass. Laboratory tests or image studies do not give pathognomonic information to conform the diagnosis. The cornerstone in the treatment of this pathology is the antituberculous therapy. Surgical or endoscopic interventions are occasionally required. The role of surgery in the treatment of this pathology is reserved for a few solitary lesions. Once the correct treatment is performed the outcome is favorable. We present 4 cases of hepatic tuberculoma with different imaging and clinical presentations.     

Hilar cholangiocarcinoma—surgical anatomy and curative resection

We have studied the surgical anatomy of the intrahepatic bile duct, hepatic hilus, and caudate lobe based on intraoperative findings and selective cholangiography of surgical patients and resected specimens, and have established the cholangiographic anatomy of the intrahepatic subsegmental bile duct. Thorough knowledge of the three-dimensional anatomy of the subsegmental bile duct, hepatic hilus, and caudate lobe is indispensable for curative surgery of hilar cholangiocarcinoma. We designed and actually performed 15 kinds of hepatic segmentectomies with caudate lobectomy and extrahepatic bile buct resection in 100 consecutive patients, with curative resection being possible in 82 patients. Postoperative survival after curative resection of hilar cholangiocarcinoma was better than expected, and the 5-year survival rates for all 82 patients with curative resection and for 55 patients with curative surgery without portal vein resection were 31% and 43%, respectively. Hepatic segmentectomy with caudate lobectomy and extrahepatic bile duct resection should be designed not only in accordance with the preoperative diagnosis of tumor extension into the intrahepatic bile ducts but also so that curative surgery for advanced hilar cholangiocarcinoma can be performed.     

Primary hepatic neuroendocrine tumor: successful hepatectomy in two cases and review of the literature

BACKGROUND/AIMS: Primary hepatic neuroendocrine tumor represents an extremely rare clinical entity with only very few cases having been reported to date. METHODS: The case histories of 2 patients with presumably primary hepatic neuroendocrine tumor were analyzed and a complete follow-up obtained. The literature was reviewed to provide comprehensive data collection. RESULTS: Both patients underwent partial hepatic resection. Histomorphologic diagnosis revealed a neuroendocrine tumor in both cases. Extensive preoperative as well as intra- and postoperative search for the primary tumor did not identify another site of neuroendocrine tumor tissue. Six and ten years after hepatic segmentectomy, the 2 patients are alive and show no clinical signs of malignancy. Their most recent thorough follow-up included computed tomography and somatostatin receptor scintigraphy. Neither a nonhepatic primary neuroendocrine tumor site nor recurrent disease was found in the 2 patients. The literature review resulted in a complete survey of all previously reported cases of primary hepatic neuroendocrine tumors. CONCLUSION: We conclude that the liver was the primary site of the neuroendocrine tumor in both patients. Radical surgery was successfully performed as the only treatment option with curative intention.     

Incidence of Cholangiocarcinoma with or without Previous Resection of Liver for Hepatolithiasis

Background/Aims

To investigate the incidence of cholangiocarcinoma in patients with hepatolithiasis with or without previous resection of liver.

Methods

From 2002 to 2009, we retrospectively reviewed 117 patients who were diagnosed and treated for hepatolithiasis in Korea University Guro Hospital. Among the 117 patients, 55 patients who were lost during follow-up were excluded, and 62 patients were eligible for analysis. The hepatic resection group (n=25) included patients who underwent left hemihepatectomy (n=2); left lateral segmentectomy (n=10); left lobectomy (n=9); right lobectomy (n=3); or wedge resection (n=1). The nonhepatic resection group (n=37) included transhepatic cholangiographic lithotomy and endoscopic retrograde cholangiopancreatography-treated patients. The mean follow-up period was 47 months.

Results

The incidence of cholangiocarcinoma while patients were followed for hepatolithiasis was 12.9% (8/62) (hepatic resection group, three cases [12%] vs nonhepatic resection group, five cases [13.5%]; p=1.000). The mean follow-up period was 53 months (47±11 months) until the diagnosis of cholangiocarcinoma.

Conclusions

There was no difference in the incidence of cholangiocarcinoma according to previous liver resections. Patients with hepatolithiasis should be carefully followed up for detection of cholangiocarcinoma even after a previous liver resection.     

Spontaneous hepatic rupture: a report of five cases

BackgroundSpontaneous hepatic rupture is a well recognised but rare condition. Because of the difficulty in diagnosis, it is often associated with a high mortality rate. Pregnant women with HELLP syndrome are more prone to hepatic rupture, but it can also occur with other liver pathology. Different modalities of treatment, including liver resection, packing, hepatic artery ligation and even liver transplantation have been described for this condition.Patients and resultsWe report a series of five cases, three of which were associated with pregnancy and two with no identifiable pathology. Pre-operative diagnosis was not made in any of these cases.Two of the five patients had hepatic resection, two had peri-hepatic packing and one was treated with laparoscopic drainage.DiscussionFrom our experience we conclude that no single form of treatment is applicable to all cases of hepatic rupture.The treatment should be individualised,depending on the extent of hepatic rupture and the expertise available, to obtain best outcome.     

Hepatocellular carcinoma in a case of Dubin-Johnson syndrome treated successfully with a central bilateral segmentectomy

A 72-year-old woman with hepatocellular carcinoma and HCV cirrhosis combined with Dubin-Johnson syndrome was successfully treated by a central bilateral segmentectomy. While the preoperative serum bilirubin level is one of the established criteria for determining the indications for a hepatic resection, it is not effective for HCV cirrhosis cases associated with Dubin-Johnson syndrome. Postoperative hyperbilirubinemia may be cured without special treatment such as bilirubin absorption or plasma exchange, but such patients must be carefully observed to ensure that liver failure does not occur.     

CT定位下经皮肺活检诊断肺炎性假瘤的价值分析

目的分析CT引导下经皮肺活检(CT-LB)诊断肺炎性假瘤PIPT的价值。方法对57例经CT-LB诊断或误诊的PIPT手术治疗病例进行分析。结果术前CT-LB诊断PIPT的49例中,术后诊断PIPT 44例、鳞癌2例、结核球1例、错构瘤1例、腺癌1例;另8例术前CT-LB诊断结核球1例、鳞癌1例、腺癌1例、可见较多炎性细胞浸润但不能明确诊断5例,术后均诊断PIPT。结论 CT-LB诊断PIPT与术后病理诊断符合率高,对怀疑PIPT的肺周围型肿块患者可作为首选;为减少假阴性率,对CT-LB不能明确诊断但可见较多炎性细胞浸润者,需结合临床及其它辅检,综合诊断。     

Hepatic resection in 485 R0 pT2 and pT3 cases of advanced carcinoma of the gallbladder: results of a Japanese Society of Biliary Surgery survey—a multicenter study

Purpose

We conducted this study to evaluate the optimal hepatic resection for pT2 and pT3 advanced carcinoma of the gallbladder without invasion of the hepatoduodenal ligament.

Methods

We conducted a questionnaire survey regarding 4,243 cases of carcinoma of the gallbladder treated during the recent 10-year period at 112 institutions belonging to the Japanese Society of Biliary Surgery. The questionnaires included questions on preoperative-diagnosis, complications, treatment, and surgical treatment, procedures of resection, surgical result, path histological findings, mode, and site of recurrence, additional post-operative treatment. They included 293 pT2 and 192 pT3 R0 cases, which were negative for hepatoduodenal ligament invasion, and the cumulative survival rates and sites of postoperative recurrence in the form of liver metastasis, were retrospectively analyzed in these 485 cases.

Result

There were no significant differences in survival rate or recurrence rates in the form of liver metastasis between the groups that underwent resection of the gallbladder bed, the group that underwent segmentectomy 4a+5, and the group that underwent hepatectomy in patients with of both pT2 or pT3 gallbladder cancers. Our results also did not show that liver metastasis to segment 4a5 alone was particularly common.

Conclusion

For gallbladder cancer, neither with hepatoduodenal ligament invasion nor hepatic invasion, resection of the gallbladder bed is more preferable for surgical hepatic procedure. For gallbladder cancer that invades any hepatic sites, a hepatic surgical procedure that could eliminate surgical margins would be desirable.