胰腺 囊肿囊液CA72-4（TAG-72）测定——一个鉴别恶性胰腺囊性肿瘤和良性肿瘤及假性囊肿的新指标

胰腺囊肿中绝大多数是炎性假性囊肿，仅10%是肿瘤，包括浆液性囊腺瘤、粘液性囊性瘤和粘液性囊腺癌。但是，根据囊肿的临床症状和X线特点，术前常不能作出诊断，术中冰冻切片活检也易漏诊，且胰腺假性囊肿不能采用冰冻活检确诊。针吸囊液检查有助于术前鉴别诊断。已采用的指标有多种．包括淀粉酶含量、肿瘤标记抗原(CEA，CA125及CA15，3)、相对粘稠     

胰腺囊性肿瘤的诊断与治疗

自１９６５～１９９４年，作者收治了１６例胰腺囊性肿瘤病人。男性４例，女性１２例，平均年龄５０９岁。１６例中浆液性囊腺瘤２例，良性的粘液性囊腺瘤７例，粘液性囊腺癌４例，乳头状囊腺癌１例，低分化腺癌１例，未分化癌１例。Ｂ超和ＣＴ检查对于肿物的检出、浆液性囊腺瘤内多发小囊的分辨，以及肿物周边钙化的显示具有一定价值。囊肿壁不完全的活组织检查可导致冰冻甚至石腊切片的误诊。除了个别已被确诊的无症状的浆液性囊腺瘤可进行观察，其余各种类型的病变均要行手术切除。本文对各种类型囊性肿瘤的特征、囊性肿瘤与假性囊肿的鉴别诊断以及各类手术方式进行了讨论。     

CT及MRI对胰腺囊性病变鉴别诊断的作用

胰腺囊性病变发病率较低,临床较为少见,可以分为肿瘤性和非肿瘤性。最常见的胰腺囊性病变包括胰腺假性囊肿、浆液性囊腺瘤、黏液性囊性肿瘤、导管内乳头状黏液性肿瘤和实性假乳头状瘤,其鉴别诊断具有挑战性。随着影像学检查技术的发展,其对于术前诊断及准确选择治疗方案颇有帮助。     

胰腺囊性肿瘤的诊治98例报告

目的探讨胰腺囊性肿瘤的常见类型、诊断及合理手术方式的选择。方法对2000年1月至2008年12月期间收治98例胰腺囊性肿瘤患者的临床资料进行回顾性分析。结果本病无特征性的临床表现,B超、CT和Mill等影像学检查也能发现胰腺囊肿病灶但不能确定具体类型。本组胰腺囊腺瘤57例（浆液性囊腺瘤32例,黏液性囊腺瘤25例）,黏液性囊腺癌13例,实性假乳头状瘤19例,导管内乳头状黏液性肿瘤9例。所有患者均手术治疗,胰十二指肠切除26例,保留十二指肠胰头切除28例,胰腺节段切除术7例,胰体尾切除加脾脏切除25例,肿瘤摘除术12例。术后均进行随访,3例胰腺囊腺癌患者于术后6个月到4年期间死于癌转移或其他疾病,1例囊腺癌患者术后9个月肿瘤复发,再次手术后现仍生存,其他均存活。结论B超,CT和MRI等影像学技术是胰腺囊性肿瘤的主要诊断方法。手术切除为治疗该肿瘤的最有效手段。正确的诊断和合理手术方式的选择是提高其临床治愈率的关键。     

胰腺囊性肿瘤的诊断和治疗

目的 探计胰腺囊腺瘤和囊腺癌的诊治方法.方法 对1998-2008年收治的均经手术和病理检查证实为胰腺囊腺瘤/囊腺癌的24例临床资料进行回顾分析.结果 本组术前、术中误诊率为12.5%;除1例胰头部浆液性囊腺瘤直径<3 cm,随访半年无进展.胰腺囊腺瘤除一例误诊拒绝再手术,切除率达100%;囊腺癌除1例腔镜下探查发现广泛转移、1例高龄患者合并阻塞性黄疸(家属拒绝探腹手术)仅行内镜逆行胆胰管造影术(endoscopic retrograde cholangiopancreatography,ERCP),切除率为71.4%.结论 虽有影像学、组织学、生化分析,正确诊断胰腺囊性肿瘤良恶性是很难的.要防止误诊为假性胰腺囊肿而行囊肿内外引流,不要轻易放弃手术切除.胰腺囊腺瘤、囊腺癌手术切除后疗效较满意.     

胰腺囊性肿瘤40例诊疗分析

目的探讨胰腺囊性肿瘤的诊治方法。方法对笔者所在医院科室2001年10月至2013年10月期间收治的40例胰腺囊性肿瘤患者的临床资料进行回顾性分析。结果胰腺囊性肿瘤无特殊临床表现,B超和CT检查对胰腺囊性肿瘤的诊断正确率分别为57．5％（23／40）和72．5％（29／40）,但不能准确区分其组织学类型。40例患者均行手术治疗,其中2例患者误诊为假性囊肿而行内引流术,另外38例行胰体尾切除术。术后病理学检查证实浆液性囊腺瘤23例,黏液性囊腺瘤9例,导管内乳头状黏液性腺瘤3例,黏液性囊腺癌5例。5例失访,35例患者获随访,随访时间为（74．2±12．8）个月（2个月～8年）;3例囊腺癌患者中1例肿瘤切除者至今存活（已随访8年）,2例肿瘤未切除者分别于术后4个月和7个月因肿瘤转移死亡;其余32例获访的囊腺瘤患者均存活至今。结论外科切除是治疗胰腺囊性肿瘤最有效的手段,即使是对于无任何症状的患者也应行积极的手术治疗。     

胰腺囊性肿瘤的诊断与治疗

胰腺囊性肿瘤（cystic tumors of the pancreas）是较少见的肿瘤,术前常难于确诊,常见的几种肿瘤为胰腺囊腺瘤和囊腺癌、胰腺实性假乳头肿瘤和胰腺导管内乳头状黏液性肿瘤。胰腺囊性肿瘤发病率以黏液性囊腺瘤或囊腺癌最高,浆液性囊腺瘤次之。近年来,胰腺实性假乳头状瘤（或称囊实性肿瘤）和导管内乳头状黏液瘤的文献报道增多。熟悉这几种肿瘤的临床特点,特别是影像学特征,能提高诊断准确率,确定正确的治疗方案,从而提高治疗效果。     

胰腺囊腺瘤和囊腺癌165例临床诊治分析

目的探讨胰腺囊腺瘤和囊腺癌的临床病理特点及其诊治方法。方法对我院2002年1月至2012年9月收治的165例胰腺囊性肿瘤患者的临床及病理资料进行回顾性分析。结果胰腺囊性肿瘤好发于中年女性,临床表现缺乏特异性,其中74例患者因体检时行B超或CT等影像学检查发现胰腺囊性占位来院就诊,影像学检查虽然是发现病灶的主要检查方法,但不能确定疾病病理类型。肿瘤位于胰腺头部40例,胰腺颈部34例,胰腺体尾部91例;行不同术式的肿瘤切除160例,剖腹探查、肿瘤活检3例,行胃空肠转流术2例。患者术前免疫学指标糖链抗原125(CA125)单项指标检测的特异度显著高于糖链抗原19-9(CA19-9)单项指标检测以及联合检测的特异度(P0.05)。结论在鉴别诊治胰腺囊腺瘤和囊腺癌患者中,结合患者术前影像学检查结果和免疫学肿瘤指标检测结果,有助于提高术前预判的准确性。由于CA19-9在良性疾病中也有升高现象,所以CA125检测有助于减少这种假阳性的结果。手术切除是胰腺囊腺瘤和囊腺癌的主要治疗手段。     

超声内镜及其介导的细针穿刺术对胰腺囊性疾病的诊断与治疗

虽然先进的影像学检查能提高胰腺囊性疾病的检出率 ,但在临床实践中胰腺囊性肿块常常在没有运用细胞学、囊肿肿瘤标志物及组织病理学检查的情况下不可避免地按良性假性囊肿来治疗。胰腺的囊性病变不仅有良性的假性囊肿 (90 % ) ,还包括恶性或潜在恶性的囊性肿瘤。囊性肿瘤可分为分泌性囊腺瘤、粘液性囊腺瘤及粘液性囊腺癌等。其中分泌性囊腺瘤恶变可能性较低 ,粘液性囊腺瘤恶变可能性较高。对胰腺粘液性肿瘤 ,包括粘液性囊腺瘤 (潜在恶性 )及粘液性囊腺癌 (恶性 ) ,一般主张立即切除 ,而对于非粘液性肿瘤 ,如分泌性囊腺瘤 ,除非已有临床症状…     

胰腺囊性肿瘤

胰腺囊性肿瘤包括胰腺囊腺瘤和胰腺囊腺癌,是较少见的肿瘤。自1930年Becourt首次报告以来,至1984年世界文献报告胰腺囊腺瘤只有300多例,囊腺癌100多例。近年来由于影像学诊断的进步,特别是腹部CT、B超的应用,使胰腺疾病的诊断水平有很大提高。但由于对胰腺囊性肿瘤认识不足,往往误诊为假性囊肿,如美国麻省总医院1977～1986年收治的13例胰腺囊性肿瘤中就有8例误诊为假性囊肿,国内也有类似报告。本文重点复习胰腺囊性肿瘤的病理和临床特点,以期提高对本病的认识。一、病理在胰腺囊性疾病中,绝大多数为胰腺囊肿,其内容物为胰腺的分泌物,由无上皮层的纤维壁所包绕,多因炎症或创伤所引起。覆盖上皮细胞的真性囊肿分为     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。