脾脏肿瘤的诊断及治疗

 目的　探讨脾脏肿瘤的诊断及治疗方法。方法　回顾分析我院 1978年 7月至 1999年 6月手术切除的 2 5例脾脏肿瘤的临床资料。结果　脾脏肿瘤男女发病率相似 ,临床表现以左上腹不适、疼痛及左季肋部肿物多见 ,辅助检查B超诊断率为 6 8% ,CT诊断率为 10 0 % ,良性肿瘤以脾囊肿最常见 ,恶性肿瘤以脾淋巴瘤最常见 ,良性肿瘤的治疗采用脾切除术或脾部分切除术 ,恶性肿瘤行脾切除或联合脏器切除辅以化疗。结论　脾脏肿瘤术前诊断依据CT、B超联合检查 ,最后确诊需手术切除及病理诊断 ,脾脏肿瘤无论良恶性均需手术治疗     

脾脏肿瘤31例临床分析

目的 通过临床病例分析,了解脾脏肿瘤的临床特点。方法 对1990年1月－2000年12月期间收治的31例脾脏肿瘤患者的临床表现、影像学特点和诊断依据、治疗情况进行了分析。结果 31例脾脏肿瘤中良性肿瘤居多（20／31）。临床表现无特异性。影像学特点为脾实质内单发或多发结节。全部患者均是先行B超检查发现脾脏占位,其中19例又行CT检查,7例行MRI检查。7例脾囊肿通过B超等影像学检查明确诊断,其中6例在手术后病理证实;9例脾脏转移性肿瘤通过影像学检查并结合病史在术前明确诊断,有5例经手术切除后病理证实;另外15例脾脏病变,除1例因术前CT检查明确为脾脏淋巴管瘤而放弃手术外,其余14例则以脾脏肿瘤而行脾脏切除手术,术后病理明确诊断。全组31例患者中,25例行脾切除术,术后恢复均较顺利,无手术死亡。结论 病史和影像学检查是诊断脾脏肿瘤的重要依据,术前不易鉴别良恶性肿瘤,手术效果佳。     

原发性脾脏肿瘤的诊治体会

目的：探讨脾脏原发性肿瘤的临床特点及治疗。方法：回顾性分析1990年3月至2008年3月我院收治的原发性脾脏肿瘤28例临床资料。结果：良性肿瘤24例，恶性肿瘤4例。行单纯性脾切除19例，脾部分切除2例，脾切除脾片移植5例，脾切除加胰尾切除2例。结论：影像学检查是脾脏肿瘤的主要诊断方法；良性肿瘤行个体化手术，尽力保留脾脏功能；恶性肿瘤应早期诊断、早期选择以手术为主的综合治疗。     

3459例卵巢肿瘤病理统计分析

全文统计分析近5年经病理检查证实的3 459例卵巢肿瘤,其中瘤样病变1 960例（56.66%）,良性肿瘤1 292例（37.35%）,交界性肿瘤64例（1.85%）,恶性肿瘤143例（4.13%）,瘤样病变、良性、恶性、交界性之比为30.63：20.19：2.33：1.发生部位以右侧卵巢较多,良性肿瘤发生在双侧卵巢的情况较恶性肿瘤多见.总平均发病年龄为36.25岁,良性肿瘤的发病年龄小于总平均年龄,交界性及恶性肿瘤的发病年龄大于总平均年龄.在良性肿瘤中以生殖细胞肿瘤最多见,占72.60%,其次为表面上皮-间质肿瘤（23.22%）、性索-间质肿瘤（3.95%）等;交界性肿瘤中,以黏液性肿瘤为多,占70.31%;恶性肿瘤中以表面上皮-间质肿瘤最多见,占69.23%,其次为性索-间质肿瘤（13.99%）、生殖细胞肿瘤（10.49%）等;瘤样病变中,以子宫内膜异位症最多,占33.78%.     

脾脏肿瘤的诊断和治疗(附22例报告)

目的:总结脾脏肿瘤的诊断治疗经验.方法:回顾性分析1997～2005年本院收集的22例脾脏肿瘤临床病例资料. 结果:22例中良性肿瘤8例,恶性肿瘤14例,其中15例行手术切除,无手术死亡.良性肿瘤预后良好,恶性肿瘤预后较差.结论 : 良、恶性脾脏肿瘤鉴别可根据CT、血管造影、病理活检.根治手术和综合治疗是改善脾脏恶性肿瘤预后的重要措施.     

原发性脾肿瘤：附112例综合分析

脾脏原发性肿瘤较少见,本院曾遇见3例,现收集国内文献94篇(1944～1986年)报告的109例,结合本组病例共112例作一综合分析。一、本组资料(见表1) 二、资料分析性别 112例中,男66(58.9％)例,女46(41.1％)例。脾恶性肿瘤男70.3％,女29.7％。男女之比为2.4:1。年龄 3～60岁,平均年龄38.2岁,以21～50岁为多,占72.3％。脾恶性肿瘤年龄7～66岁,平均38.8岁,以21～50岁为多,占77.6％。良性肿瘤3月～66岁,平均年龄37. 4岁,21～50岁占64. 4％。病理类型(见表2) 112例中,脾恶性肿瘤共67例,占59.8％;脾良性肿瘤共45例,占40.2％。按肿瘤组织     

胆道肿瘤25例报道

近6年来,我院经手术病理证实的胆道肿瘤25例,其中良性8例,恶性17例(均为晚期),术前诊断为良性肿瘤3例,恶性肿瘤5例,诊断率为32％,提示胆道肿瘤术前诊断率低,早期确诊更难。本文回顾25例手术及病理所见,对照临床表现及影像学检查,探讨胆道肿瘤的术前诊断和治疗。     

43例小肠肿瘤的临床诊断分析

[目的]探讨原发性小肠肿瘤的临床特点及其诊断。[方法]对1991年以来诊治的43例原发性小肠肿瘤的临床资料及随访结果进行回顾性分析。[结果]43例中 ,良性肿瘤11例 ,恶性肿瘤32例 ;肿瘤位于十二指肠者18例、空肠14例、回肠11例 ;最常见的临床表现为腹痛、腹块、消化道出血、肠梗阻、黄疸等 ;43例均经手术治疗 ,术前诊断率为55.80 %(24/43) ,32例恶性肿瘤根治性切除率为37.5 %(12/32) ,其中23例获随访 ,平均存活期(34±18.1)个月 ,存活9例。[结论]原发性小肠肿瘤临床表现不典型、恶性肿瘤早期诊断极为困难     

原发性脾脏肿瘤26例诊断和治疗

目的探讨原发性脾脏肿瘤的临床诊断和治疗。方法对26例原发性脾脏肿瘤的临床资料进行回顾性分析。结果26例中,良性11例,恶性15例。25例(良性11例,恶性14例)行脾切除术,其中1例行脾联合胰体尾切除术。恶性淋巴瘤8例术后辅以化疗和放疗。结论影像学检查是原发性脾肿瘤主要诊断手段,原发性脾肿瘤以手术治疗为主。良性肿瘤效果好,原发性恶性淋巴瘤预后好,肉瘤预后差。     

1342例泌尿系统肿瘤病理资料分析

目的:探讨泌尿系统肿瘤的发病趋势及构成情况。方法:选自2001年至2012年期间川北医学院附属医院病理科活检病理档案中泌尿系统各种类型的肿瘤病例,用Microsoft excel和SPSS 13.0统计软件进行数据录入和统计分析。结果:泌尿系统肿瘤1342例,在12年期间呈上升趋势。其中,男女患者之比为2.4∶1,恶性和良性肿瘤人数之比为5.5∶1,恶性肿瘤人数每年均高于良性肿瘤人数（P＜0.05）;在泌尿系恶性肿瘤中,女性发病高峰年龄为60-69岁,男性为≥70岁,女性患病较男性更趋于年轻（P＜0.05）;良性肿瘤中,女性好发部位为肾脏,男性为膀胱,恶性肿瘤中男女均以膀胱最多;膀胱恶性肿瘤以尿路上皮癌最多见,肾恶性肿瘤以肾细胞癌多见。结论:泌尿系统肿瘤患者呈上升趋势,且恶性肿瘤是良性肿瘤的五倍多,男性明显高于女性。     

儿童原发性睾丸肿瘤47例诊治分析

目的:探讨小儿原发性睾丸肿瘤的诊断及治疗经验.方法:回顾性分析2000年1月至2010年12月间手术治疗的47例原发性睾丸肿瘤患儿临床资料,包括患儿B超检查、血清AFP、病理类型、治疗、肿瘤分期和生存情况.结果:小儿睾丸恶性肿瘤血清AFP明显高于良性肿瘤(P＜0.05).小儿睾丸恶性肿瘤B超检查特征多表现为实质性占位,睾丸良性肿瘤多表现为囊实混合性占位,睾丸良恶性肿瘤间肿块性质差异有统计学意义(P＜0.05).31例卵黄囊瘤中,Ⅱ、Ⅲ期2年生存率为75％,5年生存率接近50％.结论:小儿睾丸肿瘤以卵黄囊瘤多见,血清AFP、超声检查在术前小儿睾丸肿瘤良恶性的鉴别、预后评估及术后随访中具有重要的参考价值.     

Primary tumor of the small intestine--analysis of 102 patients

102 patients with primary tumors of the small intestine proved by pathology in our hospital from 1964 to 1983 are reported. It made up 4% of primary gastrointestinal (GI) neoplasms during this period. Of the 102 patients, 32 were benign tumors, comprising 11.3% of all benign tumors of the GI tract. There were 70 malignant tumors, constituting 3.1% of all malignant tumors of the GI tract. Leiomyomas were very common in benign tumors while malignant lymphomas and carcinomas were predominant in malignant neoplasms. The main clinical manifestations were abdominal pain, mass, obstruction and GI hemorrhage. Eight patients were complicated with perforation, 6 of them were malignant tumors. Multiple lesions were found in 22 and 16 of them were malignant tumors. Only 29.3% of primary tumors of the small intestine could be demonstrated by barium X-ray examination. Correct diagnosis was made preoperatively in 13.7% of all patients. Resectability and operative mortality rates in malignant tumors were 70% and 12.9%, respectively, 62.3% of the patients were followed with an overall 5-year survival rate of 36.9% (malignant lymphoma 62.5% and leiomyosarcoma or carcinoma (18.2%). The 5-year survival rate was 43.8% after radical operation and 38.9% after palliative operation. The overall 10-year survival rate was 16.2%. One patient with lymphosarcoma is alive 21.5 years after operation. The reasons of the low incidence, the high misdiagnosis rate and the related aspects of diagnosis and treatment of this tumor are discussed.     

Diagnosis and surgical treatment of primary mediastinal tumors

This paper presents the diagnosis and surgical treatment of 60 patients with mediastinal tumors proven by pathology. The pathological types were: 36.7% teratodermoid tumor, 33.3% thymoma, 10% mediastinal cyst, 8.3% neurogenic tumor, 5% intrathoracic goiter and 6.7% other rare tumors. Fourty two of the 44 patients with benign tumors underwent resection. Of the 16 patients with malignant tumors, only 7 had the tumor removed, and the rest 9 were given exploration and biopsy. The majority of teratodermoid tumors was benign but perforation and infection added the difficulties to operation. The most common complication of thymoma was myasthenia gravis which comprised 35% in this study. The relation between thymoma and myasthenia gravis is intricate. The benign thymoma was much better in the resectability and survival rate than the malignant thymoma. Finally, the differential diagnosis between the benign and malignant thymomas is discussed. A rare case of malignant thymoma complicated by hypertrophic osteoarthropathy is reported in detail.     

Survival of European patients with central nervous system tumors

We present estimates of population-based 5-year relative survival for adult Europeans diagnosed with central nervous system tumors, by morphology (14 categories based on cell lineage and malignancy grade), sex, age at diagnosis and region (UK and Ireland, Northern, Central, Eastern and Southern Europe) for the most recent period with available data (2000-2002). Sources were 39 EUROCARE cancer registries with continuous data from 1996 to 2002. Survival time trends (1988 to 2002) were estimated from 24 cancer registries with continuous data from 1988. Overall 5-year relative survival was 85.0% for benign, 19.9% for malignant tumors. Benign tumor survival ranged from 90.6% (Northern Europe) to 77.4% (UK and Ireland); for malignant tumors the range was 25.1% (Northern Europe) to 15.6% (UK and Ireland). Survival decreased with age at diagnosis and was slightly better for women (malignant tumors only). For glial tumors, survival varied from 83.5% (ependymoma and choroid plexus) to 2.7% (glioblastoma); and for non-glioma tumors from 96.5% (neurinoma) to 44.9% (primitive neuroectoderm tumor/medulloblastoma). Survival differences between regions narrowed after adjustment for morphology and age, and were mainly attributable to differences in morphology mix; however UK and Ireland and Eastern Europe patients still had 40% and 30% higher excess risk of death, respectively, than Northern Europe patients (reference). Survival for benign tumors increased from 69.3% (1988-1990) to 77.1% (2000-2002); but survival for malignant tumors did not improve indicating no useful advances in treatment over the 14-year study period, notwithstanding major improvement in the diagnosis and treatment of other solid cancers.     

Phyllodes tumors of the breast diagnostic and therapeutic dilemmas

BACKGROUND: This article compares experiences in the diagnosis and treatment of phyllodes tumors from 2 regional institutions with the relevant literature. PATIENTS AND METHODS: From 1991 to 2005, 2,848 breast cancer patients were treated in our institutions, 36 (1.44%) for phyllodes tumors. The average tumor size was 5.1 cm (range 1.4-19.6). Triple assessment was the standard diagnostic algorithm. Wide excision with tumor-free margins was carried out in 29 (80.5%) cases and mastectomy in 7 (19.4%) cases. Axillary lymphadenectomy was performed in patients with positive lymph nodes. RESULTS: Histology showed the phyllodes tumors to be benign in 27 (75.0%), malignant in 6 (16.6%), and borderline in 3 (8.3%) cases. Follow-up was from 5 months to 16 years. In this period, recurrences of 3 (8.3%) malignant and 2 (5.6%) benign phyllodes tumors were diagnosed and treated. 10 (27.7%) patients treated with wide local excision showed deformities in the form of scarring. The steroid receptor status was of no prognostic value in our patients, and chemotherapy was used in only 1 (2.7%) patient. 5-year survival was 86.2%. CONCLUSION: Our study shows that tumor size, margin infiltration, mitotic activity and degree of cellular atypia are important prognostic factors. Problems in diagnosing this condition arise from its similarity to fibroadenoma. Although wide local excision is usually the treatment of choice, tumor recurrence is common. Axillary lymphadenectomy in malignant phyllodes tumors is, in our opinion, still controversial.     

脾脏肿瘤的诊断和治疗（附22例报告）

目的：总结脾脏肿瘤的诊断治疗经验。方法：回顾性分析1997～2005年本院收集的22例脾脏肿瘤临床病例资料。结果．22例中良性肿瘤8例，恶性肿瘤14例，其中15例行手术切除，无手术死亡。良性肿瘤预后良好，恶性肿瘤预后较差。结论：良、恶性脾脏肿瘤鉴别可根据CT、血管造影、病理活检。根治手术和综合治疗是改善脾脏恶性肿瘤预后的重要措施。     

原发性小肠肿瘤305例临床分析

目的总结原发性小肠肿瘤的诊断与治疗经验。方法回顾性分析经手术及病理证实的305例原发性小肠肿瘤的诊断与治疗。结果良性肿瘤42例,恶性肿瘤263例;良、恶性之比为1:6.26。恶性肿瘤主要包括腺癌(135例)、恶性间质瘤(57例)、恶性淋巴瘤(37例)和类癌(20例)等,其临床表现大多为非特异性及症状不典型。慢性隐匿性失血、隐匿体重下降及脐周隐痛(三隐症状)是小肠肿瘤的常见症状,也是小肠肿瘤早期诊断的警示信号。小肠肿瘤术前确诊率为57.0%(174/305),其中十二指肠肿瘤的确诊率为67.2%(92/137);空、回肠为51.9%(82/168)。42例良性肿瘤患者行局部或肠段切除;263例恶性肿瘤患者中,153例行根治术,34例行姑息性切除或减瘤荷手术,76例行捷径及取活组织检查手术。153例根治性切除术的患者,中位生存时间为92个月,明显优于姑息性切除术或减瘤荷手术者。结论全消化道钡剂造影和内窥镜检查及肠系膜上动脉造影是诊断和定位原发性小肠肿瘤的主要手段,早期治疗是提高小肠恶性肿瘤预后的关键,凡无远处转移的患者,应积极施行根治手术。     

三维超声联合ROMA指数在卵巢良恶性肿瘤鉴别中的应用价值

目的:探讨三维超声联合卵巢恶性肿瘤风险预测模型（ROMA）指数在卵巢良恶性肿瘤鉴别中的应用价值。方法:选取2017年10月至2018年10月在本院接受外科手术治疗的152例卵巢肿瘤患者作为受试对象,术后按照病理学检查结果分为卵巢良性肿瘤组84例、卵巢恶性肿瘤组68例。术前采用Voluson E8超声诊断仪进行三维超声检查;应用酶联免疫吸附试验（ELISA）检测血清人附睾蛋白4（HE4）、糖类抗原125（CA125）水平,由两者水平计算ROMA指数,并采用ROC曲线分析三者对卵巢良恶性肿瘤的诊断价值。结果:卵巢恶性肿瘤组患者三维超声诊断符合率明显低于卵巢良性肿瘤组（P＜0.05）。卵巢恶性肿瘤组患者血清HE4、CA125水平及ROMA指数均显著高于卵巢良性肿瘤组（P＜0.05）。血清HE4、CA125水平及ROMA指数诊断卵巢良恶性肿瘤的ROC曲线下面积分别为0.849、0.871、0.933,最佳截断值分别为132.46 pmol/L、150.27 U/mL、40.21%,且三维超声联合ROMA指数诊断灵敏度、特异度、准确度均高于单项指标检测。结论:应用三维超声联合ROMA指数能明显提高鉴别诊断卵巢良恶性肿瘤的灵敏度、特异度及准确度。     

正电子发射断层显像在心脏恶性肿瘤诊断中的临床应用价值

目的:探讨正电子发射断层显像(PET/CT)在心脏肿瘤诊断中的临床应用价值。方法:回顾性分析2011年1月-2018年12月,在我中心行PET/CT检查的23例心脏肿瘤患者的全身PET/CT的诊断结果,确诊依据为术后病理结果、临床随诊结果证实,评价PET/CT对心脏肿瘤诊断效能。结合影像学特征及SUVmax得到PET/CT的诊断结果,与确定诊断进行比较,采用两样本t检验分析数据,分析PET/CT对心脏恶性肿瘤的诊断能力。结果:23例心脏肿瘤患者中,恶性肿瘤19例,原发恶性肿瘤6例,转移瘤13例;良性病例4例。 PET/CT显像在心脏良恶性肿瘤诊断灵敏度、特异性、准确率分别为89.5%（17/19）、75.0%（3/4）、87.0%（20/23）;恶性肿瘤平均SUVmax为14.5±9.7,良性肿瘤SUVmax为3.0±2.4,两者比较差异有统计学意义（t=-1.95,P＜0.05）。恶性肿瘤PET/CT显像发现全身多部位、多器官转移的16人,改变了临床分期及治疗方案。结论:PET/CT显像对心脏恶性肿瘤的诊断,具有较高的灵敏度和特异性,可为鉴别诊断心脏占位性病变良恶性提供帮助,对肿瘤临床分期及治疗方案的确定具有非常大的指导意义。