非功能性甲状旁腺囊肿6例临床分析

目的探讨非功能性甲状旁腺囊肿的临床特点,总结其诊治经验。方法回顾性分析6例非功能性甲状旁腺囊肿临床资料,结合该病的临床症状、辅助检查、随诊情况,讨论其诊断、治疗与预后。结果6例患者均行手术治疗,术后病理确诊为非功能性甲状旁腺囊肿,术后均获得随访,随访时间6个月～5年,平均42个月,无复发。结论非功能性甲状旁腺囊肿术前诊断困难,确诊依靠病理检查,手术切除为主要治疗手段。     

无功能性甲状旁腺囊肿的外科诊治

目的:探讨无功能性甲状旁腺囊肿的临床特征、诊断及治疗方法 ,提高对无功能性甲状旁腺囊肿的诊治水平。方法:回顾性分析1995年4月至2014年8月期间我院收治的无功能性甲状旁腺囊肿8例病人的临床资料。结果:共有8例病人,中位年龄56(26~73)岁。肿瘤平均直径(3.4±0.4)(2.1~5.6)cm。术前甲状腺功能、血清钙检测均在正常范围。术前B超检查8例病人均提示囊性占位。术中行冷冻检查,7例提示囊肿为甲状旁腺来源。所有8例术后病理均证实为甲状旁腺囊肿。所有病例均完整切除囊肿。其中1例伴有结节性甲状腺肿行甲状腺大部切除术,1例因同时伴有甲状腺乳头状癌,行根治性切除手术。术后1例病人出现声音嘶哑,在术后3个月时恢复正常。中位随访时间8.4年,随访期间无囊肿复发。结论:术前超声和CT检查可初步诊断无功能性甲状旁腺囊肿,确诊需待病理检查。完整的囊肿切除是无功能性甲状旁腺囊肿的有效治疗方法。     

原发性甲状腺功能亢进症并发甲状腺癌分析

目的：探讨原发性甲状腺功能亢进症并发甲状腺癌患者诊治方法。方法对46例原发性甲状腺功能亢进症并发甲状腺癌患者行全甲状腺切除术。结果两种疾病的并存率为5．7％（46／810）。术前确诊率为10．8％（5／46）。对46例患者均行手术治疗,其中25例术中经快速冰冻切片病理学检查明确诊断,行全甲状腺切除术;21例术后病理学检查明确诊断,再次手术切除残余甲状腺。7例行颈淋巴结清扫术。术后随访6个月～10年无复发。结论原发性甲状腺功能亢进症患者需排除并发甲状腺癌可能,全甲状腺切除术治疗原发性甲状腺功能亢进症并发甲状腺癌效果良好。     

无功能性甲状旁腺囊肿的诊断和治疗

目的探讨无功能性甲状旁腺囊肿（NFPTC）的诊断和治疗方法。方法回顾性分析中国医科大学附属第一医院2008年3月至2012年10月期间手术治疗的6例NFPTC患者的临床资料。结果6例患者中术前明确诊断3例;术后病理学检查证实均为甲状旁腺囊肿。术后无并发症发生;随诊7个月～5年,平均32个月,无复发。结论NFPTC术前确诊困难,超声影像学特点对诊断有参考价值,手术切除是首选治疗方法。     

3D腔镜下左腋径路甲状旁腺囊肿切除1例报告

<正>甲状旁腺囊肿临床上少见,占甲状旁腺病变的0.5%～1%,仅占颈部肿块的<1%[1],有无功能性取决于能否分泌甲状旁腺激素,因其多为无功能性,误诊率高,常诊断为甲状腺囊肿而行手术治疗。我科采用3D腔镜技术,经腋径路悬吊建腔治疗无功能性甲状旁腺囊肿1例,现报道如下。患者女,35岁,因自觉左颈部肿块3个月,于2017年9月25日门诊拟诊为"左侧甲状     

非功能性甲状旁腺囊肿五例的临床分析

目的 了解非功能性甲状旁腺囊肿的特点，探讨其诊治方法。方法 回顾研究了1985～1999年收治的非功能性甲状腺囊肿5例患者的临床表现及血钙、B超和核素扫描等辅助检查的特点，以及病理学及免疫组织化学的特征。结果 本组5例患者均行手术切除治疗，病理学检查证实均为非功能性甲状旁腺囊肿，免疫组织化学检查嗜铬素（CgA）、突触素（Syn）、神经原特异性烯醇化酶（NSE）阳性支持本诊断。术后随访均无复发。结论 手术切除对非功能性甲状腺囊肿的治疗较为理想，而病理学检查是最可靠的诊断方法。     

双侧甲状腺乳头状癌的临床诊治分析

目的探讨双侧甲状腺乳头状癌（PTC）的临床诊断及手术治疗的有关问题。方法回顾分析2005年1月至2010年6月收治的19例PTC患者的临床资料,总结其术前诊断、术中病理及手术治疗的特点。结果167例甲状腺癌患者中共发现PTC19例（11．4％）;术前通过超声造影和CT检查拟诊为双侧甲状腺癌仅1例（5．3％）;术中冰冻切片检查确诊为双侧乳头状癌17例（89．5％）。其中行双侧甲状腺切除术11例,行一侧腺叶切除加峡部及对侧甲状腺次全或部分切除7例,双侧甲状腺近全切除1例。同时行双侧中央区淋巴结清扫术5例,一侧中央区淋巴结清扫术7例,一侧功能性颈淋巴结清扫术1例。术后病理证实为中央区淋巴结转移共7例（36．8％）。结论双侧甲状腺乳头状癌的术前诊断较为困难,术前超声造影结合CT检查可提高甲状腺癌的诊断符合率。PTC手术时应以全甲状腺切除为主,并行双侧中央区淋巴结清扫。对明确有中央区淋巴结转移者,可同时行一侧功能性颈淋巴结清扫术。     

甲状旁腺癌的诊治：附6例报告

目的 总结甲状旁腺癌(PTC)的诊治经验.方法 回顾分析6例PTC的临床资料.结果 5例有原发性甲状旁腺功能亢进症的表现,3例可扪及颈部肿块,4例高钙血症[(3.62±0.56 )mmol/L],4例血甲状旁腺素(PTH)升高达正常上限的2倍以上.3例术中快速病检确诊,2例术后石蜡病检及免疫组化确诊,1例术后石蜡病检及免疫组化结合临床资料确诊.5例行甲状旁腺切除术 患侧甲状腺次全切除术,随访1~5年,其中1例术后复发;1例仅行甲状旁腺肿瘤切除术的甲状旁腺癌伴多发性骨转称患者,术后16 d死于多器官功能衰竭.结论 PTC术前诊断困难,术前血生化检查,PTH,99mTc-MIBI,超声、CT检查及术中大体标本观察和快速病检有利于明确诊断.手术方式以选择甲状旁腺切除术 患侧甲状腺次全切除术为宜.     

普通外科——甲状腺、甲状旁腺

甲状腺良性病变术中损伤喉返神经的原因及预防（附2266例分析）；腔镜乳晕径路甲状腺良性肿瘤手术101例分析；颈部非甲状腺肿块2236例临床分析；无功能性甲状旁腺囊肿：附15例报告；超声检查对钙化的甲状腺结节的诊断意义；甲状腺癌的外科治疗；甲状腺结节的诊治进展（综述）；乳晕入路腔镜甲状腺切除术安全可行性的探讨；     

原发性甲状旁腺肿瘤的诊断和外科治疗:附12例报告

目的探讨甲状旁腺肿瘤的诊断和外科治疗方法。方法回顾性分析近5年余中山大学附属第三医院手术确诊、年龄11～71岁的12例甲状旁腺肿瘤临床资料。包括甲状旁腺癌并甲状腺肿及多发性内分泌腺瘤I型（MEN-1）1例；甲状旁腺囊肿1例；甲状旁腺瘤10例，其中1例为双侧甲状旁腺瘤并MEN-1，1例合并甲状腺肿，1例为异位腺瘤。结果依靠血钙、血磷、B超、CT及99mTc-MIBI等检查10例在术前确诊（2例术后确诊）。8例腺瘤和1例囊肿行单侧探查及甲状旁腺瘤切除；行双侧探查3例，其中1例甲状旁腺瘤并甲状腺肿行双侧甲状腺大部分切除（包括旁腺瘤），1例甲状旁腺癌为MEN-1行根治性切除及切除垂体肿瘤手术，1例甲状旁腺瘤并MEN-1术前行胰岛素瘤和肾上腺皮质瘤切除。平均随访时间38个月。随访期间11例血钙正常，8例无症状生存；1例腺瘤术后对侧甲状旁腺增生，再次手术。结论定位明确的单发甲状旁腺瘤或囊肿可单侧探查，MEN-1和腺癌或伴结节甲状腺肿者应双侧探查。术后密切随访不仅可确定手术效果，而且有利于早期发现复发患者和MEN-I患者。     

Treatment of a nonfunctioning parathyroid cyst with tetracycline injection

Parathyroid cysts are uncommon: about 200 cases have been reported. They can be functional (i.e., accompanied by signs of primary hyperparathyroidism), or nonfunctional. Preoperative diagnosis is difficult, although it has become increasingly frequent with the use of ultrasound and fine-needle aspiration biopsy. Fluid of parathyroid cysts is almost invariably watery, colorless, and crystal clear, which should cause clinical suspicion. However, definitive diagnosis relies on the demonstration of high parathyroid hormone (PTH) levels in the fluid. Puncture may cure nonfunctioning cysts, but surgery is indicated when the lesion recurs after several fine-needle aspirations. We report a case of a nonfunctioning parathyroid cyst in a 17-year-old boy, which reappeared after two punctures made 6 months apart. On the third occasion, 1 mL of a sterile tetracycline solution injected into the cyst cured the lesion. Tetracycline and other sclerosants have been recommended as a treatment of recurring thyroid cysts. We suggest that injection of a sclerosant should be considered as an alternative to surgery in recurring, nonfunctional cysts of the parathyroid glands.     

Uncommon abdominal sites of hydatid disease. Our experience with the surgical treatment of 15 cases

The aim of this retrospective study is to report on a series of 15 patients with abdominal hydatid disease in uncommon sites submitted to surgery in our unit over the period 1974-2003. Eight women and 7 men (mean age: 48.4 years) were included in the study. The hydatid cysts were located in the peritoneum in 8 patients, in the spleen in 5, in the kidney in 1 and in the retroperitoneum in 1. In 4 cases the peritoneal cysts were solitary, while 4 patients in this subgroup presented multiple cysts and 2 had concomitant liver hydatidosis. The splenic cysts were solitary in 2 cases, associated with a hepatic cyst in 2 and with a lung cyst in 1. The renal and retroperitoneal cysts were both solitary. The diagnosis was made at operation in 3 cases, while in 12 patients it was made by serological tests, ultrasonography and/or CT. All patients were operated on: we performed a total cystectomy in 7 patients with peritoneal cysts and in the patient with a retroperitoneal location, splenectomy in the 5 splenic cysts and a partial cystectomy with external drainage of the residual cavity in 1 peritoneal cyst and in the renal location. The postoperative course was regular with no mortality and no major morbidity in 14 patients, while 1 patient submitted to splenectomy developed a subphrenic abscess that required surgical drainage. Two recurrences occurred in patients with peritoneal cysts 71 and 20 months, respectively, after the first operation and these were managed by total cystectomy. The diagnosis of uncommon abdominal sites of hydatid disease is more accurate today because of the new imaging techniques, which are often able to show specific radiological signs of hydatid disease. The treatment of choice is surgical and complete removal of the cyst is the gold standard, but its feasibility is related to the location of the cyst.     

经脐单切口腹腔镜辅助小儿输卵管系膜囊肿剔除术

目的:探讨经脐单切口腹腔镜辅助手术治疗小儿输卵管系膜囊肿的可行性及安全性。方法:回顾分析2013年1月至2016年1月为8例输卵管系膜囊肿患儿行经脐单切口腹腔镜囊肿剔除术的临床疗效。腹腔镜下明确诊断为输卵管系膜囊肿后,用无损伤抓钳钳夹固定囊肿蒂部,扩大脐部切口至约2 cm,牵拉囊肿至切口下,行囊肿穿刺减压,缩小至能从脐部提出,体外常规行囊肿剔除术。结果:8例均顺利完成手术,术后病理证实为输卵管系膜单纯性囊肿。手术时间平均(40±16)min,术后住院4~6 d,无并发症发生,术后随访6个月~3年,未见复发。结论:经脐单切口腹腔镜辅助治疗小儿输卵管系膜囊肿是安全、可行的,具有创伤小、手术时间短、术后康复快、并发症少、美观等优点。     

Our experience in the surgical treatment of peritoneal hydatid disease

The Authors report on a series of 9 patients with peritoneal hydatidosis submitted to surgery during the period between 1974 and 2003. In 5 cases the cyst was solitary, while in 3 patients the cysts were multiple, in 1 spread and in 2 there was a concomitant liver hydatidosis. In 2 patients the disease was asymptomatic, while 4 cases were revealed by pain and 3 by an abdominal mass. The diagnosis was made at the operation in 3 patients, while it was performed by ultrasonography in 1 case, by CT scan in 4 and by both methods in 1. All patients were operated on: 7 underwent total cystectomy and partial cystectomy with external drainage of residual cavity was performed in one; the spread disease was managed by omentectomy, ovariectomy and appendectomy. Postoperative course was regular without mortality and major morbidity in all patients. Two recurrences occurred 71 and 20 months after removal of the primary cysts and they were managed by total cystectomy. The Authors believe that the diagnosis of peritoneal hydatid disease is today more accurate because of the new image techniques and the surgical procedure should be tailored to each patient depending on size, location and complications of the cyst, although the results of radical treatment are better.     

Mediastinal parathyroid cyst with tracheal constriction

A 63-year-old man visiting a physician for slight dyspnea, attributed to a lump on his neck, was found in ultrasonography and computed tomography to have a cyst extending from the left lobe of the thyroid gland to the superior mediastinum. Radiography showed right deviation of the trachea. The cyst disappeared after fine-needle aspiration, but cyst fluid subsequently reaccumulated and he was admitted to our hospital. No abnormalities were detected in tests of thyroid and parathyroid function or blood chemical analysis. The cyst was surgically removed and diagnosed as a nonfunctioning parathyroid cyst, based on the high-intact parathyroid hormone in cyst fluid. The patient recovered fully and has shown no recurrence in the 11 months to data since surgery.     

Mediastinal parathyroid cyst with tracheal constriction.

A 63-year-old man visiting a physician for slight dyspnea, attributed to a lump on his neck, was found in ultrasonography and computed tomography to have a cyst extending from the left lobe of the thyroid gland to the superior mediastinum. Radiography showed right deviation of the trachea. The cyst disappeared after fine-needle aspiration, but cyst fluid subsequently reaccumulated and he was admitted to our hospital. No abnormalities were detected in tests of thyroid and parathyroid function or blood chemical analysis. The cyst was surgically removed and diagnosed as a nonfunctioning parathyroid cyst, based on the high-intact parathyroid hormone in cyst fluid. The patient recovered fully and has shown no recurrence in the 11 months to data since surgery.     

Parathyroid cysts of the neck and mediastinum. Case report

Five cases of parathyroid cyst are presented and the literature concerning this rare entity is reviewed. Three of the five cysts were located in the neck and were non-functioning. The other two were in the anterior mediastinum and functioning, and indeed were associated with hypercalcemic crisis. Four cases were treated surgically, and in one non-functioning parathyroid cyst both diagnosis and treatment were accomplished with fine-needle aspiration. The cystic appearance, color of the fluid contents, high content of parathyroid hormone and histologic features distinguish parathyroid cyst from the much commoner thyroid cyst. Non-functioning parathyroid cysts can be treated with fine-needle aspiration, whereas functioning cysts require surgical removal.     

脐尿管癌的临床病理学特点及手术疗效观察

目的 探讨脐尿管癌的临床病理学特点,提高诊疗水平. 方法脐尿管癌患者7例.男6例,女1例.平均年龄52(26～75)岁.临床表现间歇无痛肉眼血尿5例,血尿伴尿中有黏液1例,血尿伴下腹部疼痛1例.术前检查包括彩色多普勒超声、膀胱镜、尿脱落细胞、CT、IVU.肿瘤直径平均3.6(2.0～6.0)cm.7例中行扩大性膀胱部分切除6例,行膀胱部分切除术1例. 结果 病理报告黏液腺癌5例,肿瘤细胞呈柱状,胞质内见空泡状黏液分泌特征;未特殊分类腺癌1例,癌细胞呈腺样排列,腺腔大小不等,形态不规则,癌细胞核大,染色质深;小细胞型内分泌癌1例,癌组织主要位于肌层及脂肪组织中,呈片状分布,癌细胞核小呈短梭形或圆形,可见空心菊形团结构,免疫组化神经元特异性烯醇化酶阳性.Sheldon分期ⅢA期6例,ⅢC期1例.1例术后3个月死于多发骨转移,1例术后15个月和2年分别出现膀胱颈部及尿道复发接受经尿道肿瘤电切术,余5例随访2～30个月,肿瘤无复发. 结论脐尿管癌是一种少见类型的恶性肿瘤,预后差,早期扩大性膀胱部分切除术可以达到长期无瘤生存效果,脐尿管下端体积较小的肿瘤可行保留脐部手术,放化疗无肯定疗效.     

结节性甲状腺肿合并分化型甲状腺癌诊断与治疗

目的：探讨结节性甲状腺肿合并分化型甲状腺癌的临床特点及诊治原则。 方法：回顾性分析2003年10月—2011年10月收治的47例结节性甲状腺肿合并分化型甲状腺癌的临床资料。 结果：患者均表现为颈部包块或颈部增粗,术前B超显示结节伴细沙粒样钙化者19例（40.43%）。47例患者均行手术治疗,术后经病理学检查确诊为分化型甲状腺癌（其中乳头状癌36例,占76.60%;滤泡样癌11例,占23.40%）,手术方式包括：患侧腺叶+峡部全切术+VI区淋巴结清扫;两侧腺叶+峡部全切术+VI区淋巴结清扫;颈部淋巴结肿大、转移者加行改良颈清扫术。术后均给予左旋甲状腺素片治疗。47例患者术后随访6~36个月,平均为（15.6±8.9）个月,3例分别于术后16~33个月复发,再次手术,效果良好。全组无死亡病例。 结论：结节性甲状腺肿合并甲状腺癌术前诊断困难,术前超声检查可提供可考依据,术中快速冷冻切片病理学检查是提高甲状腺癌检出率的关键;个体化、精细规范的手术治疗对结节性甲状腺肿合并分化型甲状腺癌有良好的治疗效果。