31例胰岛细胞瘤诊治的回顾性分析

目的 总结分析胰岛细胞瘤的临床特点,探讨其诊断治疗方法.方法 对湖北医药学院附属太和医院10年间收治的31例胰岛细胞瘤患者的临床特点、诊断和治疗方法进行回顾性分析总结.结果 31例患者中,功能性胰岛细胞瘤占26例,无功能性5例;前者的主要表现为各种各样的低血糖症状,均有典型的Whipple三联征;后者主要是腹部包块就诊...     

胰岛细胞瘤9例诊治体会

目的探讨胰岛细胞瘤的诊断和治疗。方法回顾性分析我院2002年6月至2008年10月收治的9例胰岛细胞瘤病例。结果9例均行手术治疗,其中6例功能胰岛细胞瘤术后血糖全部恢复正常;3例非功能性胰岛细胞瘤为恶性,手术后无复发或转移。结论胰岛细胞瘤早期诊断困难,容易误诊,手术切除是主要的治疗方法。     

胰岛细胞瘤的诊治体会

目的 探讨胰岛细胞瘤的定位诊断与外科治疗.方法 收集我院1996年至2009年收治的27例胰岛细胞瘤患者的临床资料,对其临床表现、检查手段和治疗结果进行回顾性分析.结果 功能性胰岛细胞瘤有明显的内分泌紊乱症状,瘤体较小,定位困难.无功能性胰岛细胞瘤多以腹部肿块、腹痛为首诊方式.B超、CT、MRI、彩色多普勒超声内镜、DSA的诊断率分别为30%、50%、57%、83%、90%.结论 胰岛β细胞瘤是胰岛细胞瘤中最常见的内分泌肿瘤,低血糖可以导致严重的中枢神经系统损伤,应尽早手术消除症状.肿瘤的准确定位可以减小手术创面,缩短手术时间,减少手术并发症的发生.选择合适的术式有助于避免术后并发症的发生和改善预后.     

无功能性胰岛细胞瘤诊治现状

无功能性胰岛细胞瘤(nonfunctional islet Cell tumors,NFIT)的发病率小于十万分之一,占全部胰岛细胞瘤的15％～53％。近年,随着影象诊断技术的提高,发现NFIT在胰岛细胞瘤中所占比例越来越高,而且术前确诊率也有所提高。1981年Kent等报道的168例胰岛细胞瘤中,有NFIT25例(15％),术前均未作出诊断。1996年Madura等报道44例胰岛细胞瘤,NFIT为14例(31.8％),术前确诊者有7例。1996年吴志勇等综合分析国内报道的NFIT76例,术前确诊者仅5例。NFIT虽属少见,但近年在诊断和治疗方面有所进展,在概念方面有所更新。     

超声引导下胰岛细胞瘤精细切除的临床研究

目的 探讨在术中B超引导下胰岛细胞瘤精确切除术的临床价值.方法 对我院2000.1-2013.9近13年间收治的22例胰岛细胞瘤患者的临床特点、诊断和治疗方法进行回顾性分析总结.结果 22例患者中功能性胰岛细胞瘤占17例,无功能性5例;前者的主要表现为各种各样的低血糖症状,均有典型的Whipple三联征;后者主要是腹部包块就诊.血清胰岛素测定对诊断功能性胰岛细胞瘤有重要价值.22例经腹B超发现10例（45.5％）,17例患者术前行CT检查,阳性率76.5％ （13/17）,而薄层CT扫描的敏感性可达91.7％ （11/12）.术中B超阳性率100％（19/19）,14例采用非精确切除发生胰瘘6例,8例采用术中在B超引导下对功能性胰岛细胞瘤患者实施精确切除胰瘘l例,超声引导下胰岛细胞瘤精确切除术可有效降低术后胰瘘发生率及胰瘘的严重程度（P＜0.05）.结论 典型的临床表现、CT薄层扫描、结合胰岛素水平测定是诊断胰岛细胞瘤诊断的有效方法;术中超声不仅有助于术中肿瘤的定位,超声引导下精确切除肿瘤,最大限度的保留正常胰腺组织可有效降低术后并发症.     

功能性胰岛细胞瘤术中精准定位与切除

目的 探讨功能性胰岛细胞瘤术中B超引导下精准定位与切除的临床应用价值.方法 回顾性分析2005年1月至2011年12月新疆医科大学第一附属医院收治的20例功能性胰岛细胞瘤患者的临床资料,总结其精确定位诊断方法、精准手术方式及预后情况.结果 21例患者术前行CT、MRI、腹部B超检查定位诊断阳性率分别为12/18、2/6、7/13,诊断的肿瘤直径分别为(1.7 ±0.8)cm、(1.3±0.2)cm、(1.9±0.9)cm;选择性动脉钙刺激静脉采血检查11例、胰腺灌注CT定位检查2例,定位诊断均为阳性,两种方法检测肿瘤直径分别为(0.7 ±0.3)cm和(0.9 ±0.4) cm.患者术中行B超检查阳性率为14/14,肿瘤直径为(1.5 ±0.6)cm.功能性胰岛细胞瘤采用常规手术6例,术后发生C级胰瘘2例、A级胰瘘1例;功能性胰岛细胞瘤采用精准切除术14例,术后发生A级胰瘘4例.20例患者均获得随访,截至2012年4月,患者一般情况良好,无死亡、恶变、转移或复发等情况发生.结论 术前和术中多种定位方法结合能对功能性胰岛细胞瘤精确定位,对于病灶距离主胰管＞3 mm的患者建议采用胰岛细胞瘤的精准切除术.     

小儿非功能性胰岛细胞瘤的治疗体会

目的 报告小儿非功能性胰岛细胞瘤的症状、诊断及治疗。方法 对3例非功能性胰岛细胞瘤患儿的资料进行回顾性分析。结果 小儿非功能性胰岛细胞瘤生长缓慢。症状不典型，以腹部疼痛时轻时重、右上腹肿块为主，均手术摘除肿瘤。结论 小儿非功能性胰岛细胞瘤的临床表现以腹部肿块为主，B超、CT和X线钡餐透视是主要检查手段，治疗原则是将肿瘤完整切除。     

胰岛细胞瘤的诊治体会

目的：研究胰岛细胞瘤诊断和治疗。方法：回顾分析8例胰岛细胞瘤外科治疗的临床资料,功能性胰岛细胞瘤3例,无功能性胰岛细胞瘤5例。肿瘤位于胰头1例,胰颈与胰体交界处1例,胰体4例和胰尾2例。8例均施行手术,5例施行肿瘤部位胰腺部分切除术,3例施行胰体尾切除术。结果：8例均治愈出院,无手术并发症,3例功能性胰岛细胞瘤手术后血糖上升5．5mmol／L以上,无功能性胰岛细胞瘤术后腹部不适症状消失。结论：手术切除胰岛细胞瘤可取得满意的效果。     

非功能性胰岛细胞瘤的临床和病理

非功能性胰岛细胞瘤的临床和病理浙江医科大学附属第二医院（杭州，３１０００９）彭淑牖沈正荣非功能性胰岛细胞瘤为一组临床上无特异内分泌紊乱表现的胰岛细胞瘤。尽管在胚胎学和组织学上非功能性胰岛细胞瘤与功能性胰岛细胞瘤来源是一致的，然而二者临床表现和肿瘤所在...     

无功能性恶性胰岛细胞瘤

无功能性恶性胰岛细胞瘤为一组临床上无特异内分泌表现的胰岛恶性肿瘤。在胚胎学和组织学上无功能性恶性胰岛细胞瘤与功能性胰岛细胞瘤基本是一致的，均为内分泌细胞的肿瘤，但二者临床表现，肿瘤所在部位及大小却不尽相同。１流行病学无功能性恶性胰岛细胞瘤少见，因无症...     

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??Perioperative management of gastrointestinal neoplasms complicated with coronary artery disease: an analysis of 52 cases ZHA Yong*, CUN Ying-li, HUANG Yun-chao, et al. *Department of Abdominal Surgery, Affiliated Tumor Hospital of Kunming Medical College, Kunming 650118, China Corresponding author??HUANG Yun-chao, E-mail: huangych@yahoo.com.cn Abstract Objective To study the strategies of the perioperative management of gastrointestinal neoplasms complicated with coronary artery disease. Methods The clinical data of 52 cases of gastrointestinal neoplasms complicated with coronary artery disease admitted from July 2007 to August 2008 at the Affiliated Tumor Hospital of Kunming Medical College were analyzed retrospectively. All the cases had been assessed and managed according to ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery. Results Perioperative managements included revascularization with stents in 5 cases, revascularization with only balloon in 15 cases, systemic medical therapy in 32 cases. Postoperative 30 day complications occurred in 8 cases (15.4%), including acute congestive heart failure in 1 case ??1.9%??, acute myocardial infarction and death in 2 cases (3.8%), relapsing angina in 3 cases ??5.8%), intractable cardiac arrhythmia in 2 cases ??3.8%??. Conclusion Successful perioperative evaluation and management of high risk cardiac cases undergoing noncardiac surgery requires careful teamwork and communication between surgeon, anesthesiologist, cardiologist according to ACC/AHA 2007 Guidelines.     

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??Diagnosis and treatment of Hurthle cell tumors of thyroid:an analysis of 15 casesDI Zhong??min??YANG Qiu??meng,YAN Min.Department of General Surgery,Ruijin Hospital,Medical School of Shanghai Jiaotong University??Shanghai 200025,China Corresponding author:DI Zhong??min,E??mail??dzmhz2006@163.com AbstractObjectiveTo investigate the diagnosis and treatment of Hurthle cell tumors (HCT) of the thyroid.MethodsThe clinical data of 15 cases of HCT admitted between 2001 and 2007 at Ruijin Hospital of Medical School of Shanghai Jiaotong University were analyzed.ResultsForteen cases of Hurthle cell adenomas were diagnosed by pathology.One case of Hurthle cell adenomas were complicated with Hurthle cell follicular carcinoma on the opposited side of thyroid.Only 6 cases were diagnosed by frozen section examination during the operation,the others could only be confirmed by paraffin section examination finally.Surgical procedure:3 cases of total or near total thyroidectomy and 12 cases of sub??total desection were performed.The follow??up periods varied from 1 year to 7 years,and median follow??up time was 38 months.No recurrence and death were observed during the follow??up periods.ConclusionThere are evidences that HCT is a potential malignant neoplasm. Surgery is the effective way for HCT.     

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??Diagnosis and treatment of solid-pseudopapillary tumor of pancreas ZHANG Ren-chao*, MOU Yi-ping, JIANG Chao-hui, et al??*Department of General Surgery, the 117th Hospital of PLA, Hangzhou 310013, China Corresponding author??MOU Yi-ping??E-mail??mouyiping@yahoo.com.cn Abstract Objective To analyze the diagnosis and treatment of solid-pseudopapillary tumor of pancreas??SPT????Methods The clinical data of 13 cases of SPT admitted from January 1999 to October 2007 in the Department of General Surgery of Sir Run Run Shaw Hospital (Medical College of Zhejiang University) and Department of General Surgery of the 117th Hospital of the PLA were analyzed retrospectively??Results All the cases were female with the mean age of 32 years old??SPT had no specific clinical symptoms??Abdominal pain and space occupying symptoms were the mostly symptoms??All the cases received operation??Operative procedure included pancreaticoduodenectomy in 6 cases, pancreatic neck segmentectomy in 1 case, distal pancreatectomy in 1 case, distal pancreatectomy with splenectomy in 2 cases, laparoscopic distal pancreatectomy with splenectomy in 2 cases , distal pancreatectomy, sigmoid colectomy and ethanol injection of liver nodulars in 1 case??Twelve cases recovered successfully after the operation. One case received distal pancreatectomy suffered from postoperative biliary and pancreatic fistula??Ten cases were followed up without tumor recurrence??Conclusion SPT is a special type of pancreatic tumor with low degree malignancy, affecting in young women predominantly??Aggressive surgery could get good prognosis??     

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??Adult lower gastrointestinal hemorrhage caused by Meckel’s diverticulum??A clinical analysis of 37 cases QU Feng-zhi??CAO Cheng-liang??WANG Gang??et al. Department of Hepatobiliary and Pancreatic Surgery??the First Affiliated Hospital??Harbin Medical University??Harbin 150001??China
Corresponding author??WANG Gang, E-mail??wgilu79@163.com
Abstract Objective To summarize and analyze the clinical characteristics??diagnosis and treatment principle of adult lower gastrointestinal bleeding caused by Meckel’s diverticulum. Methods The clinical data of 37 cases of adult lower gastrointestinal hemorrhage caused by Meckel’s diverticulum admitted from January 2007 to January 2016 in the First Affiliated Hospital of Harbin Medical University were analyzed retrospectively. Single diverticulum resection was performed in four cases, and diverticulum resection combined with partial small intestine resection and anastomosis was performed in thirty-three cases. Results The lower gastrointestinal bleeding of all the patients who performed surgical treatment had been salved effectively. Postoperative hospital stay was 11.6 (8 to 15) day??without death and serious complication??and all the cases were recovered. All the cases were diagnosed Meckel’s diverticulum by pathological examination postoperatively. Eight cases lost the follow up, and 29 cases were followed up for 4 to 111 months with good general condition??had not been bleeding again. Conclusion Meckel’s diverticulum is a rare cause of adult lower gastrointestinal bleeding. Clinical manifestations and preoperative diagnosis methods of Meckel’s diverticulum are lack of specificity??and therefore it leads to misdiagnosis and missed diagnosis easily. Surgery is the only effective way to its diagnosis and treatment.     

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??Diagnosis and treatment of fulminant liver abscess??A report of 12 cases YIN Da-long??LIU Lian-xin??JIANG Hong-chi. Department of Hepatic Surgery??the First Affiliated Hospital of Harbin Medical University??Key Laboratory of Hepatosplenic Surgery??Ministry of Education????Harbin150001??China
Corresponding author??LIU Lian-xin??E-mail??liulianxin@medmail.com.cn
Abstract Objective To investigate the characteristics??clinical manifestations and prognosis of fulminant liver abscess (FLA)??provide useful references for its diagnosis and treatment. Methods The clinical characteristics??laboratory tests??imaging studies and treatment of 12 cases of FLA in 500 consecutive cases of liver abscess admitted from January 2007 to December 2014 in the First Affiliated Hospital of Harbin Medical University were analyzed retrospectively. Results The incidence of FLA was 2.4% with first misdiagnosis rate of 67%??and the mortality rate was 25%. Fever??abdominal pain and jaundice were the most common clinical manifestations??accompanied by multiple organ dysfunction syndrome (firstly respiratory system dysfunction). Half of cases of FLA have diabetes??and 91.7% of the pathogen were Klebsiellapneumoniae. Support treatment was employed in the first phase due to insufficient liquefaction abscesses and percutaneous drainage guided by ultrasound in the second stage as soon as possible. Conclusion FLA has the characteristics of overwhelming progress??high first misdiagnosis rate, high complication incidence and high mortality. Klebsiellapneumoniae is the main pathogen of FLA and percutaneous drainage guided by ultrasound should be employed as soon as possible.     

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??Surgical treatment of giant cavernous hemangioma of the liver closely attached to porta hepatis: an analysis of 51 cases XU Feng??DAI Chao-liu??JIA Chang-jun??et al. Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004??China Corresponding author:DAI Chao-liu, E-mail:daicl-sy@tom.com Abstract Objective To analyze the surgical treatment for giant cavernous hemangima of the liver closely attached to porta hepatis. Methods The clinical data of 51 cases of giant hepatic cavernous hemangioma closely attached to porta hepatis performed surgical treatment between March 1997 and October 2007at Shengjing Hospital of China Medical University were analyzed retrospectively. Results Enucleation procedure was performed in 29 cases. Liver resection was performed in 19 cases. Suture and ligation was performed in 3 cases. The mean blood loss during intraoperative period was (1085±1539) mL, and complications occurred in 22 cases. There was no mortality. Conclusion Surgical management is safe and feasible for cavernous hemangioma of the liver. It recommend enucleation as the surgical procedure of choice for the treatment of hepatic hemangiomas. Limited to a half or caudate lobe of the liver cases can be performed hemihepatectomy or caudate lobe resection respectively.     

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??Interpretation of consensus statements and guidelines on the surgical management of inflammatory bowel disease in China and abroard ZHONG Min-er, WU Bin.Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Corresponding author: WU Bin, E-mail??wubin0279@hotmail.com
Abstract Recently, a brunch of consensus statements and guidelines on the treatment of inflammatory bowel disease (IBD) were published. The consensus statements and guidelines included European Evidence-based Consensus on Surgery for Ulcerative Colitis??2015???? European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease??2016???? World Gastroenterology Organization Global Guidelines Inflammatory Bowel Disease??2015???? Asia-Pacific Consensus Statements on Crohn's Disease??2016???? Clinical Practice Guideline for the Surgical Management of Crohn's Disease??2015?? and Chinese Consensus Statements on the Treatment of Inflammatory Bowel Disease??2012??. The paper makes interpretation for consensus and guidelines mentioned above with the aim to provide reference for surgeons to select appropriate treatment for patients with IBD.     

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??A method of pancreatieojejunostomy in pancreaticoduodenectomy??An analysis of 83 cases ZHANG Jian, WANG Jian-ming, MA Chao-qun, et al. Department of General Surgery, Tongji Hospital??Tongji Medical College, Huazhong University of Science and Technology??Wuhan 430030??China
Corresponding author: WANG Jian-ming, E-mail??kangaroozj@yahoo.com.cn
Abstract Objective To explore a method of pancreaticojejunostomy in pancreaticoduodenectomy. Methods The clinical data of 83 cases of pancreaticoduodenectomy using the modified technique of duct to mucosa pancreaticojejunostomy from July 2009 to December 2012 in Department of General Surgery, Tongji Hospital??Tongji Medical College, Huazhong University of Science and Technology were analyzed retrospectively. Results The average time was 20±2 min for the anastomosis in the 83 cases. There were only two cases of pancreatic leakage postoperatively with the incidence of 2.4%??2/83??. Conclusion The pancreaticojejunostomy is easy to perform and time-saving with obviously reducing incidence of pancreatic fistula??It is proved to be a kind of safe and efficient anastomosis.     

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??Endovascular repair of abdominal aortic aneurysms: an analysis of 84 cases LIU Chang-wei, LIU Bao, WU Wei-wei??et al. Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China Corresponding author??LIU Chang-wei, E-mail??liucw@vip.sina.com Abstract Objective To summarize experiences of endovascular treatment on 84 patients with abdominal aortic aneurysms. Methods From September 2001 to December 2008, 84 cases of abdominal aortic aneurysm were treated with endovascular repair in Peking Union Medical College Hospital. Results Eighty-four cases of abdominal aortic aneurysm were performed endovascular repair successfully??include 8 emergency procedures??. Seventy-seven bifurcated stent grafts and 7 tubular stent grafts, including two fenestrated stent grafts, were deployed. Two cases died within 30 days after the procedures. Among them, one died of acute myocardial infarction and another died of septic shock. Conclusion Endovascular repair of abdominal aortic aneurysm is safe and feasible. The indications of endovascular repair of aortic aneurysms, skills of interventional procedure, management of complications and treatment of concomitant disease are the key factors of successful operation.     

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??Preperitoneal inguinal hernia repair via midline incision with 3D-max patch: A study of 115 cases WANG Tong-sheng??DING Lei??ZHAO Ai-min??et al. Department of General Surgery??Beijing Shijitan Hospital Affiliated of Capital Medical University??Beijing 100038??China
Corresponding author??GAO Hong??E-mail: gaohongdoctor@sina.com
Abstract Objective To explore the value of preperitoneal inguinal hernia repair via midline incision with 3D-max patch. Methods The clinical data of 115 cases of inguinal hernia underwent preperitoneal hernia repair via midline incision with 3D-Max patch from January 2012 to December 2014 in Department of General Surgery??Beijing Shijitan Hospital Affiliated of Capital Medical University were analyzed retrospectively. Among them??there were 89 cases of unilateral hernia??26 cases of bilateral hernia; 73 cases of indirect hernia??22 cases of direct hernia??20 cases of composite hernia??11 cases of recurrent hernia. Operative time??length of hospital stay??complications and recurrence rate were recorded. The postoperative follow-up ranged from 4 months to 2 years. Results The mean operative time was 51.2 min in the cases of unilateral hernia and 76.6 min in the cases of both sides. The length of hospital stay were 6.1 days. Seroma occurred in 5 cases; fat liquefaction and incision split occurred in 4 cases; they were cured by drainage and dressing respectively. No recurrence occurred during follow-up for 3 to 24 months. Conclusion Preperitoneal inguinal hernia repair via midline incision with 3D-max patch is suitable for complicated hernia and recurrent hernia??but difficult to use??has no obvious advantages for incipient inguinal hernia.