腰交感神经节切除术手术方式的临床对比研究

目的 比较研究腹腔镜与开腹行腰交感神经节切除术的手术及术后并发症等情况.方法 2002年6月～2006年5月,采用腹腔镜腰交感神经节切除术(VALLS)治疗Buerger's病21例,在手术时间、出血量及术后并发症等方面与同期27例开腹手术进行对比.结果 VALLS组174±14.84min,明显高于开腹组132±32.81min(P＜0.05).VALLS组出血量为70±29.2ml,明显少于开腹组117±15.7ml(P＜0.05).VALLS组术后住院时间为3.7±1.3天,明显少于开腹组7.3±1.9天(P＜0.05).两组手术术后并发症发生率无明显差异,但并发症组成并不相同.两组手术的术后效果无明显差异.结论 腹腔镜腰交感神经节切除是治疗Buerger's病的安全、有效的手术方法,手术创伤小,并发症少,术后恢复快,值得临床推广.     

子宫恶性肿瘤腹腔镜手术体会

探讨子宫恶性肿瘤腹腔镜广泛全子宫切除加盆腔淋巴结清扫的可行性及临床效果。方法:回顾性分析2013年1月至2016年2月本院子宫恶性肿瘤Ia^IIIc期腹腔镜根治术33例以及30例子宫恶性肿瘤行开腹手术临床资料,比较两组的术中、术后情况。结果:与开腹组相比,腹腔镜组术中出血量少[(150±50)mlvs.(400±220.5)ml,t=3.132,p<0.05];术后肛门排气时间早[(2.0±1.2)dvs.(4.0±1.5)d,t=2.382,p<0.05];术后切口感染[(0,0%)vs.(4,18.18%),t=3.196,p<0.05];结论:腹腔镜下治疗子宫恶性肿瘤是安全有效的手术方法。     

开腹与腔镜手术用于胃穿孔对比分析

目的:观察分析开腹与腔镜手术用于胃穿孔对比的临床疗效.方法:选取我院从2012年3月到2013年3月收治的胃溃疡并发胃穿孔患者共100例.随机将患者分为两组,分为腹腔镜组和开腹组.结果:腹腔镜组患者的手术时间以及术中的出血量等均明显少于开腹组患者,两组患者对比有显著性差异(P＜0.01);而两组患者的术后恢复,腹腔镜组患者也明显要好于开腹组患者,两组患者在肠鸣音恢复时间以及排气时间恢复上有显著性差异(P＜0.01);另外,开腹组患者的术后并发症也明显要多于腹腔镜组患者,两组患者对比有显著性差异(P＜0.01).结论:开腹手术和腹腔镜手术均能有效治疗胃穿孔,但腹腔镜手术治疗对于患者的创伤较少,有利于患者术后的恢复.     

早期子宫颈癌腹腔镜与开腹下广泛性子宫切除术及淋巴清扫术的疗效研究

目的探讨腹腔镜及开腹下广泛性子宫切除术及淋巴结清扫术对早期子宫颈癌的疗效。方法回顾性分析83例确诊为早期宫颈癌并分别行腹腔镜及开腹下广泛性子宫切除及淋巴清扫术患者的临床资料,37例采用腹腔镜下手术为腹腔镜组,46例采用开腹手术为开腹组。比较2组患者的手术时间、术中出血量、宫旁及阴道切除长度、淋巴结切除数目、肛门排气时间、尿管拔除时间、住院时间、并发症发生率等指标。结果相比开腹组,腹腔镜组手术时间长、术中出血量少、术后肛门排气时间快及住院时间短,差异均有统计学意义（P值分别为0.000、0.003、0.000、0.037,P均〈0.05）;而淋巴结切除数、切除范围（宫旁、阴道）、盆腔引流量、术后尿管拔除时间这几个指标的比较,差异均无统计学意义（P值分别为0.178、0.105、0.097、0.551、0.74,P均〉0.05）。较开腹组,腹腔镜组术后尿潴留发生率明显低于开腹组,分别为37.0%和16.2%,差异有统计学意义（P=0.036〈0.05）。而脏器损伤、大出血、淋巴囊肿无统计学意义（P值分别为0.582、0.453、0.332,P均〉0.05）。结论腹腔镜下广泛性子宫切除及淋巴清扫术可以达到与开腹手术治疗早期宫颈癌的疗效,并具备了术中出血量少、术后恢复快、并发症少的优点。因此,腹腔镜下广泛性子宫切除及淋巴清扫术是一种理想术式。     

腹腔镜下子宫切除术72例分析

目的评估腹腔镜下子宫切除术的可行性、安全性及优越性。方法对72例腹腔镜下子宫切除术及75例开腹子宫切除术的平均手术时间、术中出血量、术后输液日数、术后肛门排气时间、术后住院时间进行对比分析。结果腹腔镜组平均手术时间较开腹组长,但术中出血量、术后输液日数、术后肛门排气时间、术后住院时间腹腔镜组均明显优于开腹组,差异有显著性(P<0.01)。结论腹腔镜下子宫切除术与开腹子宫切除术相比,具有切口小、损伤小、术中术后并发症发生率低、恢复快、住院时间短等优势。     

腹腔镜下结直肠癌根治术的临床应用研究

 目的 比较腹腔镜下结直肠癌根治术与同期开腹手术的临床疗效.方法 行腹腔镜下结直肠癌根治术43例,传统开腹根治术59例,观察两组的手术安全性、术后恢复情况、肿瘤根治性、医疗费用和随访.结果 与开腹根治术组比,腹腔镜组前 25 例手术时间较长(175.4 vs. 124.8 min,P=0.038),后18例与开腹手术时间相当(136.3 vs. 124.8 min,P=0.110),术中出血量较少(72.5 vs. 158 ml,P=0.030),术后肠功能恢复快(48.7 vs. 63.4 h,P=0.043)、术后住院时间短(9.1 vs. 11.2 d,P=0.030),手术并发症无明显差异(4/43 vs. 15/59,P=0.929),清扫淋巴结阳性数及总数相近(6.3 vs.7.0,P=0.090;13.9 vs.14.2,P=0.475).腹腔镜组43例随访平均(36.2±7.4) 个月,开腹组随访平均(39.1±5.8)个月,两组短期(≤5年)累计生存率差异无统计学意义(P>0.05).结论 腹腔镜下结直肠癌根治术创伤小、恢复快、根治效果好、生活质量高,值得临床推广应用.     

经阴道根治性子宫切除联合腹腔镜下淋巴结清扫在子宫恶性肿瘤中的应用

目的评估经阴道广泛或次广泛子宫切除联合腹腔镜下淋巴结清扫(LARVH)治疗子宫恶性肿瘤的可行性及疗效。方法对2006年10月-2010年4月收治的38例子宫颈癌6、例子宫内膜癌行经阴道广泛或次广泛子宫切除,并联合LARVH,分析术中、术后及随访情况。结果 44例患者均完成阴道手术及腹腔镜手术,平均手术时间210(146~460)min,平均术中出血量300(100~800)ml,平均手术清除淋巴结13(2~29)枚。术中发生副损伤3例,均为泌尿系损伤。术后排气时间2(1~2)d,膀胱恢复时间12(8~38)d,术后住院时间14(9~32)d。术后随访4~49个月,2例复发。结论经阴道广泛子宫切除联合腹腔镜下淋巴结清扫治疗子宫恶性肿瘤切除范围满意,疗效可靠,创伤小,恢复快,值得临床推广。     

后腹腔镜下肾输尿管全切除术(附36例报告)

目的 比较上尿路移行细胞癌患者行后腹腔镜肾输尿管全切除术与开放手术的临床疗效.方法 36例上尿路移行细胞癌患者行后腹腔镜下肾输尿管全切除术(A组),并与同期29例开放手术病例(B组)进行对比.对两组患者的手术时间、术中失血量、肠功能恢复时间、止痛剂使用量和住院时间等进行统计分析,并对患者进行4～36个月随访,比较两组的生存率、膀胱肿瘤复发情况等.结果 所有手术均成功完成,无死亡病例,A组无中转开放手术病例.A组手术时间(156±28min)略长于B组(138±19 min,P<0.05),而术中出血量(120±30ml)、术后止痛药物用量(38.6±15.1mg)均少于B组(分别为180±29ml、50.9±19.7mg,P<0.05).两组术后肠道功能恢复时间(36.7±8.2、37.2±7.2h)、术后住院天数(8.7±1.3、9.2±1.8d)无显著性差异(P>0.05).随访4～36个月,两组术后膀胱癌发生率无显著性差异(P>0.05).结论 后腹腔镜下肾输尿管全切除术具有创伤小、出血少、并发症少、切除标本完全、恢复快、符合肿瘤根治外科学原则等优点,是治疗上尿路移行细胞癌较理想的手术方法.     

腹腔镜手术与开腹手术治疗早期胃癌近期疗效分析

目的:探讨开腹手术与腹腔镜手术对早期胃癌治疗的近期疗效,并对两种手术方式进行对比及分析.方法:回顾性分析2013年1月-2014年12月期间在本院行胃癌根治术的89例早期胃癌患者,42例行腹腔镜胃癌根治术;47例行传统开腹胃癌根治术.观察并比较分析两组病例手术近期临床疗效.结果:两组患者术后疗效较好,腹腔镜组术中出血量、术后胃肠功能恢复时间、术后免疫功能恢复情况等指标优于开腹组,差异有统计学意义(P.＜0.05);手术时间腹腔镜组比开腹组长,差异有统计学意义(P＜0.05),术中淋巴结清除数、术后1周内WBC计数两组差异无统计学意义(P＞0.05).结论:腹腔镜胃癌根治术和开腹胃癌根治术治疗早期胃癌均是安全、可行的,相对传统开腹手术,腹腔镜手术具有术后恢复快,创伤小等优势,具有良好的应用前景.     

非脱垂子宫阴式与改良腹式切除术的临床效果比较

目的：比较阴式子宫切除术与开腹子宫切除术临床疗效。方法将我院2009年1月-2012年10月收治的106例需要切除子宫的非脱垂子宫患者按入院时间顺序分为阴式切除术组（n=54例）和腹式手术组（n=52例）,患者治疗结束后对两组患者的手术效果进行对比分析。结果两组患者手术均获成功,未发生膀胱、输尿管直肠损伤及大出血等并发症,手术时间、术中出血量及住院时间比较,差异无显著性（P＞0.05）;两组术后排气时间、下床活动时间比较,差异非常显著（P＜0.01）,阴式切除术组明显优于开腹手术组。结论阴式非脱垂子宫切除术具有创伤小、并发症少等微创手术的优点,其手术方法可以提高腹式子宫切除术的手术技巧。     

Oral and oropharyngeal tumors

There is a large variability of tumors and tumor-like lesions, which are located in the oral cavity and oropharynx. But more than 90% of all tumors in this area are squamous cell carcinomas (SCCs). Other malignancies in this location are rare. About 10% of all oral and oropharyngeal tumors are benign. Congenital lesions, like vascular malformations, lingual thyroid or (epi-)dermoid cyst, usually become present in youth or childhood. Acquired lesions can be inflammatory (abscess) or neoplastic (pleomorphic adenoma and hemangioma). Preferred imaging in childhood are ultrasound and magnetic resonance imaging (MRI), while in adults usually computed tomography (CT) and MRI are more frequently used.     

原发性结外淋巴瘤在耳鼻及咽部的临床特点

目的 总结原发性结外淋巴瘤在耳、鼻及咽部的临床表现,以提高及时确诊率。方法 回顾性分析16例原发性结外淋巴瘤在耳、鼻及咽部的临床表现特点,特别是罕见的中耳淋巴瘤和少见的副鼻窦淋巴瘤的临床表现。结果 中耳淋巴瘤1例,以伴有疼痛的慢性分泌性中耳炎(传导性聋)、轻度面瘫为特点;扁桃体淋巴瘤7例,以咽异物感及单侧扁桃体肿大为特点;鼻及副鼻窦淋巴瘤2例,以血涕、鼻臭、下鼻甲黏膜粗糙,增厚为特点;鼻咽部淋巴瘤以血涕、头痛为特点;口咽部淋巴瘤以咽痛、发热、软腭溃疡、口臭为特点。结论 在发现耳、鼻及咽部病变时,掌握原发性结外淋巴瘤在耳、鼻及咽部的临床表现特点,及时行病理检查,是及时确诊的关键。     

乳腺癌术后肝转移癌的声像图特点

本文回顾性分析了１９８７－１１～１９９４－１１乳腺癌术后肝内占位性病变１２０例，其中９８例为转移癌，２２例为非均匀性脂肪肝、肝囊肿或血管瘤。采用针吸活检、诊断性化疗、综合影像学诊断及超声随访方法证实。乳腺癌术后出现脂肪肝的比例较高（４７％），肝转移伴脂肪肝者３５例（３６％），其声像图特点为内部呈低回声（６６％）及周围无低回声晕（６９％）；而不伴脂肪肝者６３例（６４％），其内部多呈等回声（５９％），常伴低回声晕（７６％）。脂肪肝的存在使肝脏回声衰减，可能导致占位显示不清而漏诊；脂肪肝的存在又往往使得一些占位病变表现不典型而误诊。当声像图不典型、鉴别诊断困难时，应做超声引导下穿刺活检予定性诊断。     

FDG PET/CT and Mediastinal Nodal Metastasis Detection in Stage T1 Non-Small Cell Lung Cancer: Prognostic Implications

Objective

We aimed to compare the prognoses of patients with pathologically true negative (P-TN) N2 and PET/CT false negative (FN) results in stage T1 non-small cell lung cancer (NSCLC).

Materials and Methods

Our institutional review board approved this retrospective study with a waiver of informed consent. The study included 184 patients (124 men and 60 women; mean age, 59 years) with stage T1 NSCLC who underwent an integrated PET/CT and surgery. After estimating the efficacy of PET/CT for detecting N2 disease, we determined and compared disease-free survival (DFS) rates in three groups (P-TN [n = 161], PET/CT FN [n = 12], and PET/CT true positive [TP, n = 11]) using the Kaplan-Meier analysis and log-rank test.

Results

Pathologic N2 disease was observed in 23 (12%) patients. PET/CT had an N2 disease detection sensitivity of 48% (11 of 23 patients), a specificity of 95% (153 of 161), and an accuracy of 89% (164 of 184). The 3-year DFS rate in the PET/CT FN group (31%, 95% confidence interval [CI]; 13.6-48.0%) was similar to that of the TP group (16%, 95% CI; 1.7-29.5%) (p = 0.649), but both groups had significantly shorter DFS rates than the P-TN group (77%, 95% CI; 72.0-81.2%) (p < 0.001).

Conclusion

The PET/CT shows a high specificity, but low sensitivity for detecting N2 disease in stage T1 NSCLC. Patients with PET/CT FN N2 disease have survival rates similar to PET/CT TP N2 disease patients, which are both substantially shorter than the survival rate of P-TN patients.     

Lung metastases

The lungs are among the most prominent target organs for metastatic disease. Most frequently, lung metastases originate from cancers of the head and neck, breast, stomach, pancreas, kidney, bladder, the male and female genitourinary tract, and sarcomas. Plain chest radiography is typically the modality used for detection and therapeutic monitoring; however, the use of CT for these purposes is becoming more frequent. Currently, spiral CT appears to be the most sensitive imaging technique in the identification of metastases, because it detects a higher number of pulmonary nodules compared to other techniques. Pulmonary metastatic disease manifests itself by the presence of pulmonary nodules, lymphangitic carcinomatosis, endobronchial tumors, and pleural involvement. Nevertheless, the differential diagnosis is an important consideration, particularly in patients with solitary pulmonary nodules, systemic disorders, and signs or symptoms indicative of infection. The role of the radiologist involves the identification of metastatic disease, monitoring of response to therapy, and the use of invasive procedures when the differential diagnosis indicates the need for biopsy and histopathologic proof. The radiologist must be aware of the impact of his diagnosis on patient management and should be familiar with oncologic strategies as well as the terminology used to characterize tumor response. In future, the role of imaging may further expand due to the increased sensitivity in lesion detection, increased specificity in lesion (tissue) characterization using MR imaging, and reduced radiation exposure. Correspondence to: Christian J. Herold     

Follow-up Results After Negative Findings on Unenhanced Hepatic MR Imaging for Hepatic Metastasis from Rectal Cancer

Objective

To assess the follow-up results after negative findings on unenhanced hepatic MR imaging in rectal cancer patients who have undergone locally curative surgery.

Materials and Methods

From all pertinent imaging reports and medical records, we selected 255 patients who had negative results on unenhanced hepatic MR imaging. When selecting patients who had undergone curative resection, the following patients were excluded from the study: 1) patients in whom extrahepatic metastases were detected on preoperative staging work-ups, 2) patients in whom the surgery was judged to be non-curative due to peritoneal seeding or local aggressiveness. Cases with follow-up periods of less than 18 months were also excluded, as these cases were considered insufficient to confirm the negative outcomes. Thus, a total of 149 patients were ultimately enrolled in our study. The follow-up results of unenhanced MR imagings were assessed according to the assumption that the newly developed hepatic metastases had been false-negative lesions on preoperative MR image.

Results

During a median follow-up period of 29.3 months, 25 hepatic metastases were detected in 13 patients (8.7%), which indicated a negative predictive value of 91.3%.

Conclusion

Unenhanced hepatic MR imaging provides a high negative predictive value with regard to the detection of hepatic metastasis in the preoperative evaluation of rectal cancer.     

Carcinosarcoma of the Liver: A Case Report

Primary hepatic carcinosarcoma is a rare tumor comprised of a mixture of carcinomatous and sarcomatous elements. Less than 20 adequately documented cases have been reported, however the imaging features of two cases were briefly described. We present here a case of carcinosarcoma of the liver in a 46-year-old woman, which was confirmed based on pathology. Imaging showed a large mass with large necrotic portions, small cystic portions, calcifications and bone formations.     

高场MRI对喉及下咽癌术前分期价值的评价

目的评价高场MRI（1.5T）在喉、下咽癌术前分期中的价值。方法对36例喉、下咽癌患者的MRI资料进行回顾性分期，并与临床分期及手术病理分期相对照。结果MRI对各期喉、下咽癌的准确率分别是T192%，T286%，T386%，T4100%。临床分期准确率分别是T1100%，T286%，T357%，T422%。MRI和临床分期总准确率分别是92%，69%。二者之间有显著性差异。结论高场MRI通过不同加权像的对比和从多角度准确显示肿瘤的部位形态及浸润范围，因而显著性提高喉、下咽癌术前分期的准确性。     

MR Imaging of papillary renal neoplasms: potential application for characterization of small renal masses

The purpose of our study was to evaluate the role of MRI in demonstrating the precise nature of papillary renal tumors (P RCC) and its potential application to select patients for partial surgery. Ninety-seven tumors less than or equal to 3 cm in size [55 papillary renal cell carcinoma - 42 clear cell renal carcinoma (CC RCC)] were preoperatively evaluated by MRI. Imaging findings were assessed with a special focus on the aspect of the tumoral process. Correlations were performed with pathologic staging after surgery. At pathology, 92 tumors were established to be staged p T1 and 5 were p T3 ( 3 cases of CC RCC and 2 cases of P RCC). Ninety-four percent of papillary tumors exhibited low signal intensity with homogeneous pattern on T2-weighted images. All clear cell carcinoma were hyperintense and heterogeneous on T2-weighted sequence. Enhancement was lower and delayed in the papillary type in comparison with the clear cell type. MRI is accurate enough to predict the ‘histologic‘ nature of papillary renal carcinoma. It is an additional argument to propose that the tumor can be removed by partial surgery.     

Malignant liver lesions: Comparison of spiral CT arterial portography and MR imaging for diagnostic accuracy,cost, and effect on patient management

We compared two imaging techniques, spiral CT arterial portography (CTAP) and MR imaging, for diagnostic accuracy, procedural cost, and effect on management of 26 patients referred for hepatic surgery for suspected limited malignant liver disease. CTAP and MR imaging were done within a 1-week period (19 within 24 hours); the results of the studies were interpreted prospectively by separate reviewers. Surgical data were evaluated in conjunction with imaging data in 10 patients. Lesion detection and segmental involvement were determined and sensitivity and specificity were calculated. Procedural cost was determined from hospital billing codes. Effect on patient management was determined by the referring oncologic surgeon. CTAP and MR imaging showed 185 and 176 true-positive malignant lesions, 15 and zero false-positive malignant lesions, zero and 18 true-negative malignant lesions, and 13 and 22 falsenegative malignant lesions, respectively. CTAP and MR imaging showed 107 and 105 true-positive segments, 11 and zero false-positive segments, 80 and 91 true-negative segments, and four and six false-negative segments, respectively. There was a significant difference in specificity of segmental involvement between MR imaging (1.0 ± 0) compared with CTAP (0.88 ± 0.05), P=.03. Total procedural cost was $3,499 for CTAP and $1,224 for MR imaging. CTAP findings did not change patient management over MR imaging findings in any patient, whereas MR imaging findings resulted in a change in patient management over CTAP findings in seven patients (P=.015). The results of our study suggest that MR imaging has higher diagnostic accuracy and greater effect on patient management than CTAP does and is 64% less expensive.