原发性甲状腺恶性淋巴瘤诊治分析

目的提高原发性甲状腺恶性淋巴瘤的诊断与治疗水平。方法回顾性分析1990—2005年收治的14例原发性甲状腺恶性淋巴瘤患者的临床资料。结果12例患者以颈部肿块就诊,2例以声音嘶哑就诊,病程2周至4年。9例行患侧甲状腺全切及对侧大部分切除术,3例行双侧甲状腺全切除术,2例行患侧甲状腺及峡部切除术。术后病理诊断为弥漫性大B细胞淋巴瘤9例;滤泡性淋巴瘤4例;淋巴母细胞性淋巴瘤1例。术后联合放、化疗7例,4例行单纯局部放疗,另外3例未行辅助治疗。随访13例(92.8%),1例淋巴母细胞性淋巴瘤术后10个月死亡,2例术后未行任何治疗的患者分别于术后18,31个月死于肿瘤转移,其余10例随访6-122个月,平均43.2个月,均健在。结论原发性甲状腺恶性淋巴瘤临床及病理易误诊。手术是首选治疗方法,其预后与病理类型、综合治疗方案密切相关,术后辅助化疗对本病的治疗甚为重要。     

甲状腺原发性恶性淋巴瘤的诊断与治疗(附7例报告)

目的 了解甲状腺原发性恶性淋巴瘤的特点，探讨其诊治方法。方法 回顾分析我院收治的7例甲状腺原发性恶性淋巴瘤患者的临床表现．血清抗甲状腺球蛋白抗体(TGA)．抗甲状腺微粒体抗体(TMA)，B超，核素扫描．病理组织学及免疫组织化学染色特点。结果 7例患者均行手术切除和术后化疗，病理石蜡切片证实为甲状腺原发性恶性淋巴瘤，免疫组化染色显示白细胞共同抗原阳性．细胞角蛋白阴性．支持本诊断。治疗后随访4个月～11年患者均生存。结论 病理检查是明确诊断的可靠依据，手术应尽可能切除肿瘤．术后予以化疗．治疗效果较为满意。     

原发性乳腺恶性淋巴瘤的诊断及外科治疗探讨

目的探讨原发性乳腺恶性淋巴瘤的诊断与治疗. 方法回顾性分析我院1992～2004年5例原发性乳腺恶性淋巴瘤的临床资料.5例均为术后组织学病理诊断.4例行乳腺癌改良根治术,1例行乳房单纯切除术.5例均行化疗及放疗. 结果乳腺癌改良根治术手术时间60～120 min,平均80 min;乳房单纯切除术加乳腔镜腋窝淋巴结清扫术手术时间75 min.术中出血量150～250 ml,平均200 ml.术后病理组织诊断均为弥漫性非霍奇金氏淋巴瘤,为B细胞来源.且均有腋窝淋巴结转移.全组病例随访6个月～12年,平均4.5年.2例II期,均死于肿瘤多器官转移;3例I期,肿瘤无复发. 结论原发性乳腺恶性淋巴瘤无明显特异性表现,术前诊断困难.钼靶X线照相,对诊断有帮助. 治疗可选择手术、放疗、化疗或单纯给予化疗和放疗.     

原发性乳腺恶性淋巴瘤九例诊治体会

目的总结原发性乳腺恶性淋巴瘤临床特征及诊疗方法。方法回顾性分析9例原发性乳腺恶性淋巴瘤患者的临床资料。结果 9例患者中,6例患者术前行粗针穿刺活检,仅2例术前诊断为乳腺恶性淋巴瘤;9例患者均行手术治疗,其中6例行乳腺癌改良根治术,1例行单纯乳房切除术,2例因术前诊断为乳腺恶性淋巴瘤仅行肿瘤切除术;9例患者术后均给予环磷酰胺+阿霉素+长春新碱+泼尼松(CHOP)方案化疗,2例患者后续行局部放疗;9例患者初治后均获得完全缓解,随访期间死亡2例,分别死于脑转移和骨髓转移。结论手术切除是乳腺恶性淋巴瘤主要治疗手段,术后辅助化疗及局部放疗可提高治疗效果。     

原发性直肠恶性淋巴瘤7例诊治分析

目的:探讨提高对原发性直肠恶性淋巴瘤的诊断和治疗最佳方法。方法:回顾性总结1990~2005年我院原发性直肠恶性淋巴瘤诊断、治疗及随访结果。结果:本组7例均获随访,其中1例仅作化疗,未作手术和放疗的病人仅生存3个月;1例行Dixon手术仅生存8个月;5例行Miles手术中,2例联合化疗的病人生存2·5~5年,3例联合放、化疗的病人均生存5年以上。结论:早期诊断并手术切除,加规范的化、放疗,可明显延长生存期。     

原发性直肠恶性淋巴瘤诊治分析

目的探讨原发性直肠恶性淋巴瘤的诊断和治疗方法。方法回顾性分析1994～2011年我院收治的7例原发性直肠恶性淋巴瘤诊断、治疗的临床资料。结果ⅡE期1例因患有肾功能衰竭放弃治疗并于1个月后死于急性肾衰外。ⅠE期2例经肛门手术,ⅡE期2例行根治手术,其无病生存期均达5年以上。ⅡE期1例仅做化疗,生存43个月。ⅣE期1例行姑息性手术加化疗,生存20个月。结论原发性直肠恶性淋巴瘤误诊率高、早期诊断对改善预后十分重要,手术切除加规范放、化疗,可明显延长生存期。     

原发性甲状腺淋巴瘤10例诊治体会

目的讨论原发性甲状腺淋巴瘤的诊断及治疗原则。方法回顾分析10例原发性甲状腺淋巴瘤的临床、病理特点和治疗、预后情况。结果病理诊断为黏膜相关淋巴组织B细胞淋巴瘤（MALT型）3例,黏膜相关淋巴组织B细胞淋巴瘤伴大细胞转化型（MALT伴大细胞转化型）3例,弥漫性大B细胞淋巴瘤（DLBCL型）4例。ⅠE期4例,ⅡE期2例,ⅢE期2例,ⅣE期2例。本组2例行手术切取活检术,8例行甲状腺腺体切除术,1例同时行气管切开造口术。8例术后明确行CHOP方案化疗等治疗。10例平均随诊30个月,10例平均存活36个月。结论对于原发性甲状腺淋巴瘤,手术主要起明确诊断的作用,放、化疗是其主要的治疗手段,MALT型、Ⅰ-Ⅱ期病例预后较好。     

原发性甲状腺淋巴瘤的诊断和治疗分析

目的:探讨原发性甲状腺淋巴瘤(primary lymphoma of thyroid,PLT)的诊断和治疗。方法:回顾性分析我院2005~2010年间住院治疗5例PLT的临床治疗资料。结果:5例中仅1例术前经甲状腺穿刺活检倾向淋巴瘤可能,其余4例均未能在术前明确。5例病人都行手术治疗,其中4例经病理检查而明确诊断,3例术后长期生存。结论:PLT术前诊断较困难,手术是治疗PLT的主要方法,术后标本病理学检查,结合免疫组化能明确诊断PLT。     

原发性睾丸恶性淋巴瘤7例报告

目的探讨原发性睾丸恶性淋巴瘤的临床规律。方法回顾分析本院诊治的7例原发性睾丸恶性淋巴瘤患的临床资料。结果全组7例均施行根治性睾丸切除，术后5例行化疗和放疗，2例单纯化疗。6例获随访，4例死于肿瘤复发和转移，3例仍存活，生存3年以上2例。结论原发性睾丸恶性淋巴瘤应采用积极综合治疗以提高生存率。     

原发性胃淋巴瘤的临床特点和外科治疗

目的:探讨原发性胃淋巴瘤的诊断及治疗方法。方法:对26例原发性胃淋巴瘤病人的临床资料进行回顾性的分析。25例进行了手术治疗,其中D1根治术5例,D2根治术8例,行全胃切除术者3例,行姑息性切除术者7例,仅作剖腹探查术者2例。结果:原发性胃淋巴瘤好发于胃窦、胃体部,肿块>5cm者占68%。3年和5年生存率分别为72.7%和61.1%。低度恶性和Ⅰ、Ⅱ期的原发性胃淋巴瘤预后较好.结论:原发性胃淋巴瘤的术前诊断主要依靠纤维胃镜;手术治疗和术后化疗是治疗原发性胃淋巴瘤的重要手段。     

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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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??Re-operation for papillary thyroid carcinoma after radiofrequency ablation therapy: A clinical analysis of 5 cases DONG Wen-wu??ZHANG Hao??ZHANG Ping??et al. Department of Thyroid Surgery??the First Affiliated Hospital of China Medical University??Shenyang 110001??China
Corresponding author??ZHANG Hao??E-mail??haozhang@mail.cmu.edu.cn
Abstract Objective To investigate the treatment of papillary thyroid carcinoma (PTC) after radiofrequency ablation (RFA). Methods The clinical data of 5 cases of PTC after RFA from November 2014 to January 2015 in the Department of Thyroid Surgery??the First Affiliated Hospital of China Medical University were studied retrospectively. Results There were 3 cases of single lesion and 2 cases of multiple lesions in bilateral lobes. The mean tumor size was 1.76 cm (range 0.4??3.0 cm). Two cases received unilateral thyroid lobectomy plus isthmusectomy with ipsilateral central lymph node dissection (CLND). One case received total thyroidectomy with unilateral CLND. One case received total thyroidectomy with bilateral CLND and 1 case received total thyroidectomy with bilateral CLND and unilateral modified lateral lymph node dissection. All cases were diagnosed as PTC by routine histopathology. There were 4 cases of central lymph node metastasis in which 1 case of lateral lymph node metastasis. There was no complications??but temporary hypoparathyroidism in 1 case. Conclusion The indications for RFA should be grasped strictly. Early operations for PTC after RFA should be performed by an experienced surgeon??given that local tissue adhesion was obvious.     

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??CT features of primary thyroid malignant lymphoma WANG Zhi-hong??DONG Wen-wu??HE Liang??et al. Department of General Surgery??the First Hospital??China Medical University??Shenyang 110001??China
Corresponding author: ZHANG Hao, E-mail??haozhang@mail.cmu.edu.cn
Abstract Objective To evaluate the CT features of primary thyroid malignant lymphoma (PTML). Methods The CT features of 14 cases of PTML admitted between January 2000 and June 2011 at the First Hospital of China Medical University were analyzed retrospectively and compared with surgical and pathological results. Results The common CT appearances were that the density of the enlarged thyroid mass was lower than that of the muscle nearby, unconspicuous enhancement in contrast-enhanced CT scan and calcification and necrosis were rare. The CT features were classified into three types??3 cases of solitary nodule (type 1)??which was a solitary nodule surrounded by normal thyroid tissue??8 cases of massive mass (type 2)??which were usually in homogeneous hypodense with integrated capsule??and 3 cases of pervasive mass (type 3)??which were manifested as unconspicuous enhancement mass with narrow cordlike hyperdense thyroid tissue around or inside in it. Conclusion The CT appearance of PTML is usually manifested as massive type. The pervasive type has its characteristic. The CT features combine with the history of rapidly growing thyroid mass and the increased thyroid antibody titer are helpful for preoperative diagnosis.     

改良胸前壁入路腔镜手术治疗甲状腺疾病：附66例报告

目的 探讨腔镜技术在甲状腺疾病治疗中的临床应用价值.方法 采用胸前壁入路行腔镜甲状腺切除66例,其中甲状腺腺瘤7例,结节性甲状腺肿55例,甲状腺癌3例,继发性甲亢1例.结果 成功完成手术65例,1例因术中出血中转开放.行单侧次全切除术42例,双侧次全切除术21例,甲状腺癌3例中行单侧腺叶加峡部切除2例,甲状腺全切1例.手术时间94(50～180)min,术中出血量21(10～200)mL,住院天数9(5～19)d.无神经损伤及甲状旁腺误切等严重并发症.随访1～11个月,均无复发(包括3例甲状腺癌).结论 腔镜甲状腺手术具有安全有效、创伤小、恢复快的优点,可作为甲状腺良性病变治疗的首选治疗手段.     

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目的 探讨腔镜甲状腺手术的简便方法,促进腔镜甲状腺手术的应用.方法 第三军医大学西南医院乳腺中心自2004年6月至2007年5月采用前胸壁径路完成55例腔镜甲状腺手术,其中甲状腺腺瘤40例(双侧15例、单侧25例、峡部1例),结节性甲状腺肿15例(双侧10例,单侧5例),肿块直径0.5～6.0cm.采用颈丛阻滞加局部浸润麻醉,在胸骨上窝下方约12cm处置入trocar,于颈前肌群浅面采用电凝钩游离皮瓣,切开颈白线后游离并悬吊颈前肌群,用无损伤抓钳提抓肿块表面组织,超声刀沿肿块周围切割即可将肿块完整切除或将腺叶部分切除.结果 55例中,53例颈丛麻醉加局麻后效果良好.双侧手术25例,单侧29例,峡部肿瘤切除1例.手术时间平均95 min.结论 颈丛麻醉加局麻可以作为腔镜甲状腺手术麻醉方式;采用经胸壁径路及合适长度的皮下隧道(12cm左右)有利于简化手术操作;电刀和超声刀的配合使用可缩短手术时间.     

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??Surgical indication , key point and prevention of complication of total thyroidectomy ZENG Zhi-jun??OU Di-peng,??YANG Lian-yue. Department of Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
Corresponding author??YANG Lian-yue??E-mail:lianyueyang@hotmail.com
Abstract Objective To discuss the surgical indication, key point and prevention of complication of total thyroidectomy. Methods A retrospective analysis of the clinical records of 107 patients from March 2000 to March 2010 at Xiangya Hospital, Central South University undergoing total thyroidectomy was analyzed for the treatment for thyroid diseases. Results Total thyroidectomy was performed in 107 patients including 71 cases of thyroid carcinoma, 25 cases of giant nodular goiter, 6 cases of hyperthyroidism, 5 cases of Hashimoto thyroiditis. All patients discharged and postoperative complications incidence was 4.6%. Two patients had one-sided recurrent laryngeal nerve injury and temporary hypoparathyroidism occurred in 2 cases. One case had neck swelling in 24 hours. Conclusion Total thyroidectomy could be indicated as differentiated thyroid carcinoma. Precise operation is important to prevent the postoperative complication.     

经胸骨前径路腔镜甲状腺切除24例

目的 :探讨腔镜下甲状腺切除术的可行性及临床价值。方法 :甲状腺腺瘤 18例用腔镜下甲状腺腺瘤切除术 ,结节性甲状腺肿 2例用腔镜下甲状腺部分切除术 ,原发性甲状腺功能亢进 4例用腔镜下甲状腺大部分切除术。结果 :手术成功 2 3例 ,中转 1例。手术时间 4 5～ 310min ,平均 132min ,术中出血 5～ 30ml,术后当天患者即能下床活动 ,疼痛感轻 ,住院 3～ 7d。无神经损伤、皮下气肿 ,无术后出血、呼吸困难 ,原发性甲状腺功能亢进 4例无术后甲亢危象及甲状旁腺损伤。结论 :腔镜下甲状腺切除术安全可行 ,颈部无疤痕 ,有极佳的临床美容价值。     

内镜甲状腺切除术

目的 探讨内镜甲状腺切除术的手术难点和应对策略.方法 对169例患者施行内镜甲状腺切除术,总结本类手术难点、危险因素及防治措施.结果 内镜甲状腺切除手术成功167例,包括甲状腺腺瘤切除术37例,甲状腺单叶大部分切除术63例,甲状腺双叶大部分切除术42例,甲状腺功能亢进行甲状腺双叶次全切除术20例,甲状腺癌行甲状腺单叶并峡部全切除对侧次全切除术5例.无神经或甲状旁腺损伤等严重并发症.中转开放手术2例,术后切口脂肪液化2例,皮下气肿1例,皮肤淤斑1例,一过性声音嘶哑1例,随访1～4年,复发1例,无死亡病例.结论 内镜甲状腺切除术有其特殊的操作方法和手术难点,通过精细的术中操作和适当的围手术期处理可以降低副损伤的发生率.     

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??Da Vinci robotic surgical treatment of papillary thyroid carcinoma: A clinical analysis of 150 cases WANG Meng??ZHENG Lu-ming??YU Fang??et al. Department of Thyroid and Breast Surgery??the General Hospital of Jinan Military Command of PLA??Jinan 250031??China
Corresponding author??HE Qing-qing??E-mail:heqingqing@yeah.net
Abstract Objective To explore the technical safety of the operation??the oncology security and the feasibility of clinical application of Da Vinci robotic papillary thyroid microcarcinoma surgery. Methods The clinical and pathological datas of 150 cases of PTMC performed da vinci robotic thyroidectomy in the General Hospital of Jinan Military Command of PLA from February 2014 to January 2016 were analyzed retrospectively. The 150 cases underwent total robotic thyroidectomy (or lobectomy and isthmusectomy) and central neck dissection (CND). Result All the cases of robotic thyroidectomy were completed successfully??and no conversion to open operation. A total of 61 cases (40.7%), 8 cases??5.3%??and 3 cases ??2.0%?? had level ??, ?? and ?? lymph nodes metastasis, respectively. The total volume of drainage was??0.2±0.1??L . The time of drainage was ??5.5±1.4??days. Transient recurrent laryngeal nerve injury occurred in 3 cases. Transient hypoparathyroidism occurred in 19 cases. Intraoperative subcutaneous tunnel bleeding occurred in 1 case. All the cases had no permanent recurrent laryngeal nerve injury and hypoparathyroidism. All the cases were followed up for 1 to 24 months with the median follow-up time of 11 months. no tumor recurrence. The cosmetic results were satisfactory. The case of subcutaneous tunnel bleeding had no metastasis and recurrence. Conclusion Da Vinci robotic thyroid surgery is safe??feasible??and with good cosmetic results??suitable for PTMC cases who pay attention to the neck cosmetic effect.