CT引导下经皮穿刺活检食管占位性病变的有效性及安全性

目的 观察CT引导下经皮穿刺活检食管占位性病变的有效性及安全性。方法 回顾性分析37例接受CT引导下经皮穿刺活检的食管占位性病变患者（37个病灶）,统计取材成功率、穿刺病理诊断率及诊断准确率（以术后病理诊断或随访诊断为最终诊断）和术中、术后并发症。结果 37个病灶均穿刺取材成功并获明确病理诊断,32个病理结果为阳性（肿瘤性病变）、5个为阴性（炎性病变或正常组织）,穿刺病理诊断率100%。32个阳性病变穿刺病理诊断与最终诊断结果均一致;5个穿刺阴性病变中,3个与最终诊断一致,2个术后病理均为胃肠间质瘤,穿刺诊断准确率为94.59%（35/37）,假阴性率40.00%（2/5）。术后2例出现少量气胸、3例穿刺针道少量出血,1周后均自然吸收,并发症发生率13.51%（5/37）。结论 CT引导下经皮穿刺食管占位性病变安全、有效。     

CT引导下经皮穿刺活检胃肠道占位性病变的有效性及安全性

目的 观察CT引导下经皮穿刺活检胃肠道占位性病变的有效性及安全性。方法 回顾性分析116例接受CT引导下经皮穿刺活检的胃、小肠或结直肠占位性病变患者（共116个病变）,统计穿刺取材成功率,以手术病理或随访结果为标准评估活检有效性,包括敏感度、特异度、准确率及假阴性率,并观察病变腔壁厚度（＜1 cm与≥1 cm）、穿刺进针深度（＜5 cm或≥5 cm）、穿刺针有无经胃肠道的影响,记录相关并发症。结果 对所有病变均取材成功。穿刺活检诊断敏感度为88.07%（96/109）,特异度为100%（7/7）,准确率为88.79%（103/116）,假阴性率为11.93%（13/109）。腔壁厚度≥1 cm及进针深度＜5 cm时活检敏感度及准确率较高（P均＜0.05）,而穿刺针有无经胃肠道的敏感度及准确率差异均无统计学意义（P均＞0.05）。12例（12/116,10.34%）病变周围少量出血;未见其他并发症。结论 CT引导下经皮穿刺活检胃肠道占位性病变有效且安全。     

妊娠期外科急腹症的诊治

目的 探讨妊娠期外科急症的诊断与治疗。方法 回顾性分析近上治的妊娠期外科急腹症４８例的诊治情况。结果 急性阑尾炎２９例，急性胆囊炎１６例，急性胰腺炎３例，全组手术治疗４１例，其中阑尾切除２７例，胆囊切除１２例（其中加胆总探查５例），胰腺手术２例。术后切口感染８例，早产２例，胎儿死亡２例，母体死亡２例。结论 对妊娠各期的外科急症应取积极和手术治疗。合理的剖腹手术不会增加流产、早产、胎儿死亡生率。发生     

Results in 104 patients undergoing bronchoplastic procedures for bronchial lesions

Bronchoplastic procedures were used in 104 patients with various bronchial disorders. Ten had benign lesions and 94, malignant tumors. The principal operative procedures were sleeve lobectomy and sleeve pneumonectomy for bronchogenic carcinoma, but 11 limited bronchial resections were performed in patients with benign lesions, minute bronchogenic carcinomas, and low-grade malignant tumors. Of the 94 patients with malignant tumors, 79 underwent a bronchoplastic procedure without carinal resection (sleeve lobectomy in 75 and limited bronchial resection in 4), and there was one operative death (1.3%). The overall 5-year survival rate for the patients with bronchogenic carcinoma in this group was 45% and that for patients undergoing curative resection, 57% (survival of patients in stages I, II, and IIIA was 79%, 55%, and 30%, respectively). A bronchoplastic procedure with carinal resection was performed in 15 patients. Twelve in this group underwent sleeve pneumonectomy. There were two operative deaths, and 1 patient has survived for longer than 4 years. Two patients with low-grade malignant tumors underwent carinal resection without lung resection and are still alive. We believe that bronchoplasty is a safe and valuable procedure and that limited bronchial resection appears to be the procedure of choice for localized bronchial lesions.     

Acute abdomen masquerading as acute retention

Urologists should remain constantly alert for patients with acute abdominal emergencies who may be admitted under their care with the erroneous diagnosis of acute retention.These cases are not uncommon. The patients may be suffering from suppression of urine, or their inability to pass urine may be the predominant symptom of their intra-abdominal catastrophe.When catheterization has yielded only a small amount of concentrated urine and has failed to relieve the patient's discomfort, think of an acute abdomen, investigate this possibility and treat the patient accordingly.We must look and see, know and act! —not wait and see!Lord Moynihan of Leeds     

Amebiasis presenting as an acute abdomen

Eight cases of amebiasis complicated by an acute surgical abdomen and treated surgically are presented. An uncomplicated postoperative course followed early diagnosis and treatment whereas delayed diagnosis resulted in marked morbidity but no fatalities. Amebiasis, therefore, is not a contraindication to early surgery, but, if unrecognized, will result in marked morbidity and mortality.     

Pathology of space-occupying lesions of the CNS

The brain and spinal cord are enclosed by bone, hence expansion of their contents by a space-occupying lesion (SOL) leads to compression and distortion of the tissues of the CNS. Slowly enlarging SOLs can be accommodated by atrophy of adjacent brain or spinal tissue. More rapid enlargement causes a rise in pressure in the affected compartment from the normal level of < 2 kPa (< 15 mmHg), and herniation of the soft CNS tissue into adjacent compartments where the pressure is lower. This has potentially fatal consequences. There are several types of SOL within the CNS (Figure 1) and individual examples are discussed in this contribution.     

Tumors as a cause of acute abdomen in children

The authors share their experience in treating children aged 1 day to 14 years with acute processes in the abdomen induced by various tumors. During 10 years 51 patients have been observed. "Acute abdomen" was induced by tumors and cysts of ovaries (16 patients), lymphangiomas, cysts and tumors of the mesentery, greater and lesser omentum, retroperitoneal cavity (14 patients), intestinal tumors (7), small pelvis tumors (6), tumors of kidneys (4), liver (3), cyst of the pancreatic gland (1). The clinical picture of the disease, possible timely diagnosing and tactics are presented. All the patients were operated urgently. After operation 44 patients recovered and were discharged from the hospital, 7 patients died.     

Carcinoma urinary bladder presenting as acute abdomen

Bladder perforation presenting as acute peritonitis is a rare and dramatic event in the course of carcinoma urinary bladder. We present one such case and discuss the presentation, management and brief follow-up.     

Liver cell adenoma presenting as acute abdomen

A 31-year-old female presented with a sudden onset of acute abdominal pain in the right hypochondrium. Two days later, the patient was in shock and suffering from severe intra-abdominal bleeding. Investigations showed that the bleeding originated in the right lobe of the liver. The patient had been taking oral contraceptives for seven years. She underwent a laparotomy and right lobectomy of the liver which was performed successfully for bleeding cell adenoma. The patient made a full recovery.     

Management of the acute abdomen complicating oral anticoagulation therapy

Acute abdominal pain in the patient receiving oral anticoagulants poses a difficult diagnostic and therapeutic challenge. We describe two cases of peritonitis requiring laparotomy in anticoagulated patients, and review 49 similar case reports from the world literature. These patients were usually explored for signs of bowel obstruction. At operation, the intestine often appeared infarcted, but pathologic examination commonly revealed intramural hematomata. In contrast, we present microscopic evidence of hemorrhagic cecal infarction complicating oral anticoagulation therapy in one patient. Intramural intestinal hemorrhage is the most common cause of acute abdominal pain in the anticoagulated patient who undergoes laparotomy. In addition to intramural hemorrhage, 14 per cent of patients had coexistent volvulus, appendicitis, intestinal wall disruption or intestinal infarction. We conclude that anticoagulated patients with suspected intramural intestinal hemorrhage may have severe intraabdominal pathology requiring operation. Therefore, operation is mandatory for patients who fail to improve after a short course of expectant management.     

脾脏占位性病变的诊治

目的探讨脾脏占位性病变的临床特点和诊治原则。方法回顾性分析2004年1月至2013年12月收治我院的47例肝脏占位性病变的临床资料。结果47例均行手术治疗,并经病理证实。其中良性病变26例,恶性肿瘤21例。开腹行脾脏切除术30例,腹腔镜下行脾脏切除术17例。结论脾脏占位性病变的诊断主要依靠临床表现和影像学检查,治疗以手术治疗为主的综合性治疗。