脾动脉瘤伴附壁血栓侵及胰尾一例

病人,女,72岁.以左上腹隐痛半年人院.既往乙肝肝炎病史13年,高血压病史20年,多次妊娠史,否认急慢性胰腺炎病史.     

脾动脉瘤伴附壁血栓侵及胰尾一例

病人,女,72岁.以左上腹隐痛半年人院.既往乙肝肝炎病史13年,高血压病史20年,多次妊娠史,否认急慢性胰腺炎病史.     

巨大左心耳瘤样扩张伴附壁血栓一例

患者　男,９岁。活动后心悸、气促１周。查体：心界向两侧明显扩大,心律不齐,脉搏短绌,心前区无震颤,各心瓣膜听诊区未闻及杂音。心电图示心房颤动;胸部Ｘ线片示心脏球形增大（图１）;超声心动图示心脏左后外侧有一直径１５ｃｍ的无回声区,下部有４ｃｍ增强的回声光团,左心房和左心室受推压变形并向右移位（图２）;肺动脉造影发现左心房显影后在左心缘左侧有一椭圆形的造影剂延迟排空区,搏动较弱;超高速ＣＴ显示心包内、左心缘后外侧巨大占位性病变,密度均匀,无钙化。１９９６年４月在全身麻醉低温体外循环下行探查,术中切开…     

脾动脉瘤一例

脾动脉瘤一例陈益强陈发桂患者男，５３岁。原有血吸虫病史，因左上腹包块３月余入院。检查：左上腹可及７ｃｍ×６ｃｍ大小表面光滑包块，有搏动感，肝肋下未及，脾脏肋下２指。Ｂ超示肝硬化，胰尾部探及５．５ｃｍ×５．６ｃｍ囊性包块，包膜完整。ＣＴ平扫示胰尾部见团...     

胰尾内异位副脾表皮样囊肿一例

患者男,42岁.因"发现胰尾部占位8个月余"入院.否认外伤史及胰腺炎病史.查体:皮肤巩膜无黄染,全腹无压痛,未及腹部包块.CT示胰尾部可见一大小约为1.7 cm×1.5 cm的低密度类圆形小肿块,未见明显强化,边界欠清(图1).临床诊断:胰尾部占位.行保留脾脏的胰尾切除术,术中见肿物位于胰尾的背面,质软,色泽暗红.手术顺利,术后9 d康复出院.病理报告:切除胰尾内有一大小为2.0 cm×1.6 cm×1.6 cm囊性肿块,界清,单房性,囊液淡黄色,浑浊,切面见囊肿外围约2/3被一肿块包裹,3.0 cm×2.0 cm×2.0 cm,与周围胰腺组织界限清楚,灰红色,质软.镜下:副脾组织内见多个囊腔样结构,囊壁内多量淋巴细胞浸润,并衬以鳞状上皮(图2),该内衬上皮CEA和CA199(+).病理诊断:"胰尾"副脾表皮样囊肿.     

胰尾内异位副脾表皮样囊肿一例

患者男,42岁.因"发现胰尾部占位8个月余"入院.否认外伤史及胰腺炎病史.查体:皮肤巩膜无黄染,全腹无压痛,未及腹部包块.CT示胰尾部可见一大小约为1.7 cm×1.5 cm的低密度类圆形小肿块,未见明显强化,边界欠清(图1).临床诊断:胰尾部占位.行保留脾脏的胰尾切除术,术中见肿物位于胰尾的背面,质软,色泽暗红.手术顺利,术后9 d康复出院.病理报告:切除胰尾内有一大小为2.0 cm×1.6 cm×1.6 cm囊性肿块,界清,单房性,囊液淡黄色,浑浊,切面见囊肿外围约2/3被一肿块包裹,3.0 cm×2.0 cm×2.0 cm,与周围胰腺组织界限清楚,灰红色,质软.镜下:副脾组织内见多个囊腔样结构,囊壁内多量淋巴细胞浸润,并衬以鳞状上皮(图2),该内衬上皮CEA和CA199(+).病理诊断:"胰尾"副脾表皮样囊肿.     

胰尾内异位副脾表皮样囊肿一例

患者男,42岁.因"发现胰尾部占位8个月余"入院.否认外伤史及胰腺炎病史.查体:皮肤巩膜无黄染,全腹无压痛,未及腹部包块.CT示胰尾部可见一大小约为1.7 cm×1.5 cm的低密度类圆形小肿块,未见明显强化,边界欠清(图1).临床诊断:胰尾部占位.行保留脾脏的胰尾切除术,术中见肿物位于胰尾的背面,质软,色泽暗红.手术顺利,术后9 d康复出院.病理报告:切除胰尾内有一大小为2.0 cm×1.6 cm×1.6 cm囊性肿块,界清,单房性,囊液淡黄色,浑浊,切面见囊肿外围约2/3被一肿块包裹,3.0 cm×2.0 cm×2.0 cm,与周围胰腺组织界限清楚,灰红色,质软.镜下:副脾组织内见多个囊腔样结构,囊壁内多量淋巴细胞浸润,并衬以鳞状上皮(图2),该内衬上皮CEA和CA199(+).病理诊断:"胰尾"副脾表皮样囊肿.     

胰尾无损伤性脾切除术36例

对2008年2月—2012年7月收治的36例胰尾无损伤性脾切除病例进行回顾性分析,患者术后均痊愈出院,无手术死亡及胰瘘、发热和胃结肠损伤;其中14例出现术后并发症:门静脉血栓形成7例,胃排空障碍2例,腹水5例,均经保守治疗后痊愈。完善的术前评估,规范的手术操作,精细地解剖、分离及脾蒂的处理,分束、分支断扎脾蒂血管后,再将脾脏移出切口外,是确保胰尾无损伤性脾切除的关键。     

原发性脾胰尾结核性脓肿1例

原发性脾胰尾结核性脓肿１例田博成史庆路患者男性，２７岁。于两个月前无诱因出现左上腹隐痛不适，无低热，盗汗，乏力，无恶心呕吐，既往无结核病史。查体：体温３６．８℃，全身浅表淋巴结无肿大，心肺无异常。腹平软，左上腹轻度深压痛，无肌紧张及反跳痛，左季肋部叩...     

脾巨大动脉瘤伴脾肿大1例

病人男性,67岁.于2008-10-22入院.1个月前出现中上腹隐痛不适,未向他处放射,无发热,无腹胀.3d前在当地医院行B超检查:脾肿大,左中上腹脾脏内侧见12.0cm×12.0cm×11.5cm液性暗区,壁光整.以"脾动脉血管瘤"收入院.     

胰尾肿瘤误诊为脾脏肿瘤一例

病人，女性，52岁，因体检发现“脾脏占位”于2006年6月26日收入解放军总医院肝胆外科。一般情况好，无不适主诉。查体未见阳性体征，实验室检查无异常，仅CA19—9升高：4755U／ml（正常值〈37U／ml）。MRI报告：脾脏可见多发类圆形长T1长T2信号，动态增强可见周围环形低信号，少许实性部分强化。诊断：脾脏巨大肿块伴明显出血和囊变，考虑恶性肿瘤，以肉瘤可能性大。入院诊断：“脾脏占位性病变”，拟行“脾脏切除术”。术中发现：肿瘤位于脾脏上后极与胰尾之间并与二者粘连紧密，     

Salmonella infection of a ventricular aneurysm with mural thrombus

We describe a case of salmonella infection of a left ventricular aneurysm with a mural thrombus and review 12 cases described in the literature. This entity should be looked for in any patient with persistent or relapsing salmonella bacteremia in whom an intracardiac thrombus is demonstrated. Nuclear imaging may help in the diagnosis. A combined medical and surgical approach should be aggressively pursued because patients who do not undergo an aneurysmectomy are unlikely to survive.     

Laparoscopic resection of the pancreatic tail with splenic preservation

OBJECTIVE: Evaluation of feasibility and efficacy of left resection of the pancreas with preservation of the splenic vessels and spleen as a laparoscopic procedure. BACKGROUND: Laparoscopic technique is used less often on the pancreas than on other organs. The most common indications are enucleation of endocrine-active tumors and distal resections for benign primary pancreatic lesions. An important premise of these operations is atraumatic removal of as little of the pancreas as possible and the preservation of the spleen and its main vessels. METHODS: Five patients aged 16 to 56 years, all female, underwent laparoscopic left resection of the pancreas with preservation of the splenic vessels and the spleen. There were 4 cases of benign epithelial tumors of the pancreas and 1 case of a left-sided adrenal cyst, which pre- and intraoperatively gave the impression of a pancreatic cystadenoma. RESULTS: In all 5 cases, the laparoscopic procedure was completed with preservation of the splenic vessels and the spleen itself. No patient required blood transfusion, and there was only 1 postoperative fluid collection at the site of the tumor resection, which was drained percutaneously on the fourth postoperative day. CONCLUSION: Distal pancreas resection can be performed as a laparoscopic procedure, with the usual advantages that this techniques has for the patient. Optimal closure of the cut edge of the pancreas and the preservation of the spleen and its main vessels are the most important aspects of this operation.     

尿毒症并发粒细胞缺乏症一例

女,45岁,因胸闷气促、全身水肿半年加重伴咳嗽3 d于2008年8月29日入院.患者有类风湿关节炎病史30年,尿毒症病史1年.入院时血白细胞(WBC)3.14×109/L,中性粒细胞比例0.784,血红蛋白74 g/L,BUN31.5 mmol/L,Scr 801 μmol/L.入院诊断:慢性肾衰竭(尿毒症期),心功能Ⅵ级,类风湿关节炎,肺部感染.     

巨大脾囊肿一例

病人,女,36岁.左上腹胀感半月余,无发热、腹痛、腹泻,无外伤史.查体:左上腹可扪及一巨大包块,达左肋下10 cm,质中,呈囊性感,无压痛.血常规示:WBC 2.37×109/L,HGB 108 g/L,PLT 108×109/L.B超显示:脾脏体积明显增大,脾内侧探及一约16 cm×16 cm大小圆形囊性肿块,形态规则,边界清,囊壁厚约0.5 cm,内回声不均,与脾脏关系密切,与胰体尾、胃底紧贴,胃被挤压推向右前方,肝、胆、胰、双肾未见异常,无腹水征.     

巨大脾囊肿一例

病人,女,36岁.左上腹胀感半月余,无发热、腹痛、腹泻,无外伤史.查体:左上腹可扪及一巨大包块,达左肋下10 cm,质中,呈囊性感,无压痛.血常规示:WBC 2.37×109/L,HGB 108 g/L,PLT 108×109/L.B超显示:脾脏体积明显增大,脾内侧探及一约16 cm×16 cm大小圆形囊性肿块,形态规则,边界清,囊壁厚约0.5 cm,内回声不均,与脾脏关系密切,与胰体尾、胃底紧贴,胃被挤压推向右前方,肝、胆、胰、双肾未见异常,无腹水征.