机器人辅助腹腔镜下儿童肾脏异物取出1例报告

目的 报道1例机器人辅助腹腔镜下儿童肾脏异物取出病例的手术过程，为儿童内脏异物取出提供参考。方法和结果 1例2岁女性患儿因"X线平片检查发现右肾异物1个月"入院。曾误诊为消化道异物，保守观察3周余未排出，就诊于我院后进一步完善检查，腹部CT提示右肾异物。应患儿家长要求行机器人辅助腹腔镜探查，术中探查见异物位于右肾下极，完整取出一针形金属异物。术中出血及损伤小，定位准确。术后随访44个月无异常。结论 机器人辅助腹腔镜技术可应用于儿童肾脏异物取出，为儿童内脏异物的取出提供了一种新的手段。     

An omental abscess mimicking an intra-abdominal tumor

Here, we report the case of a 12-year-old boy who presented with intermittent lower abdominal pain; subsequently, an intra-abdominal mass found by abdominal ultrasound. Initially, an intra-abdominal tumor was suspected according to the results of the physical examinations, laboratory data, and imaging studies. A surgical excision was performed, and pathological examination revealed an omental abscess without evidence of intestinal perforation or a residual foreign body. The patient’s history consisted solely of receiving an open appendectomy for a ruptured appendicitis 2 years prior. This is an extremely rare case of a post-appendectomy omental abscess forming after such a long interval, but no evidence of residual appendiceal tissue or foreign bodies could be identified.     

肝下巨大卵巢成熟性囊性畸胎瘤并发对侧卵巢子宫内膜异位囊肿1例报告及文献复习

目的：探讨肝下巨大卵巢成熟性囊性畸胎瘤并发对侧卵巢子宫内膜异位囊肿患者的临床特点,分析诊断经验和治疗过程。方法：回顾性分析1例肝下巨大卵巢成熟性囊性畸胎瘤并发对侧卵巢子宫内膜异位囊肿患者的临床资料,并进行相关文献复习。结果：患者体检时发现腹腔巨大肿物。妇科超声提示腹部巨大囊肿,左卵巢内见61mm×48mm囊性光团回声,内液稠。腹部CT平扫提示右腹部巨大团块状混杂密度影,其内可见脂肪密度、钙化密度及软组织密度影,临近肝脏呈受压状态改变。术中探查,右侧卵巢肿瘤大小约40cm×35cm×30cm,上达膈下,下至盆腔,肿瘤后壁与肝左叶粘连,并将肝脏挤向右上方。左侧卵巢子宫内膜异位囊肿大小约7cm×6cm×6cm。手术剥除右侧卵巢肿瘤及左侧卵巢子宫内膜异位囊肿并重建双侧卵巢。病理诊断,右侧卵巢成熟性囊性畸胎瘤、左侧卵巢子宫内膜异位囊肿。术后随访已超过2年,未发现肿瘤复发,并经体外受精-冻融胚胎移植（IVF-ET）受孕。结论：巨大卵巢成熟性畸胎瘤粘连于肝脏下方同时并发对侧卵巢子宫内膜异位囊肿临床上罕见,手术治疗预后良好,如术后不孕,应及早行IVF-ET助孕。     

Uterus didelphys with fibroid uterus and ovarian cyst--rare Muellerian malformation

Persistent Muellerian duct syndrome is a very rare anomaly. A woman of 46-year-old was admitted with the history of lower abdominal pain, bleeding per vaginum and irregular menstrual cycles for last 6 months. An irregular non-tender mass of 16 x 10cm in size was palpable in suprapubic region. Per vaginal examination revealed two cervices and an incomplete vaginal septum. Ultrasound abdomen showed one uterus with endometrial cavity clearly delineated with a fibroid and an ovarian cyst in the left lumbar region. On laparotomy, 2 uterii along with a fibroid from the anterior wall of left uterus and a left ovarian cyst was seen. Patient had undergone total abdominal hysterectomy and adnexa removal. The specimen showed florid adenomyosis with leiomyoma of fibroid.     

A huge epiglottic cyst causing airway obstruction in an adult

An epiglottic cyst causing airway obstruction is rare in an adult. Early definitive diagnosis and management obviate an unnecessary tracheostomy. We report a case of a 64-year-old woman who arrived at our hospital with progressive stridor and foreign body sensation when swallowing for 6 weeks. A hot potato voice and biphasic stridor were remarkable upon physical examination. Indirect mirror and fibroscopic examination revealed a huge epiglottic cyst. The neck lateral X-ray and computed tomography scan demonstrated a huge cystic mass over the epiglottis. A 2.5 x 3.0 cm cystic mass was removed with endoscopic CO2 laser after needle decompression. The patient was discharged on the third day after surgery without complications. An epiglottic cyst in an adult seldom causes upper airway obstruction and is easily ignored by clinicians. We emphasize that complete airway evaluation including routine check-up of the larynx is mandatory for patients with intractable obstructive airway disease. Endoscopic laser surgery is effective in the surgical removal of an epiglottic cyst.     

纤维支气管镜对成年患者下呼吸道异物的临床诊治

目的探讨纤支镜诊治成年患者下呼吸道异物的临床价值。方法回顾分析我院2001年4月~2011年4月间140例成年患者下呼吸道异物病例的相关资料,其中80例采用纤支镜手术,60例采用支气管镜手术。结果本组纤支镜一次性治愈率明显高于支气管镜一次性治愈率,异物多位于右支气管。均成功钳取异物,122例异物位于右支气管,18例位于左支气管。术中79例直接窥见异物并直接取出;61例表面覆盖分泌物,其中21例肉芽组织增生明显,仅51例一次性取出。均无严重并发症。结论纤支镜是诊治成年患者下呼吸道异物的有效方法。     

Unusual perforating foreign body in the neck

Penetrating injury in the neck is not an uncommon condition, but a perforating foreign body like bamboo in the neck is uncommon. A 36 years old young man was admitted in Otolaryngology and Head Neck surgery department, Mymensingh Medical College hospital, with a history of accidental perforating injury in the neck with a bamboo, while driving a vehicle (tempo). Clinical examination revealed a bamboo measuring 4.6 X 0.09 ft. perforated in his neck from left to right. Surprisingly great vessels and air way spared. Due to difficult intubation, elective tracheostomy was done. Neck was explored and foreign body removed under general anesthesia. Haemostasis ensured and wound closed in layers after putting drain tubes. Recovery was uneventful and was discharged after three weeks.     

A prospective evaluation of foreign bodies presenting to the Ear,Nose and Throat Clinic,Hospital Kuala Lumpur

The results of a prospective study of 94 patients with history of ear, nose or aerodigestive tract foreign bodies were analysed. Sixty six to 94% of patients presented within 24 hours to a primary care doctor, 80 to 94% was referred to the ENT Department within 24 hours and 89 to 93% of patients had their foreign bodies removed within 24 hours. Overall, 58% of aural foreign bodies, 67% nasal foreign bodies and 94% of aerodigestive tract foreign bodies were removed within 48 hours of insertion. As a result of the prompt removal of foreign bodies in the majority of patients, no significant complications occurred. Foreign bodies in the aerodigestive tract tend to present earlier and more promptly removed compared with ear and nose foreign bodies. There was a significantly higher proportion of foreign body in the right ear and nostril compared to the left.     

Sonographic appearances of mesenteric cysts--report of 2 cases]

Mesenteric cyst is defined as a cystic mass located in the mesentery, and has rarely been reported. Before the clinical use of ultrasound (US), the imaging diagnosis of the abdominal mass depended on plain X-ray films and contrast examinations to delineate the space occupying lesion. The later use of US enables us to readily identify mass character. For example, whether it is cystic or solid, with or without septum, or whether there is sediment in the cyst. US examination is the method of choice in evaluating abdominal masses. Two cases of pediatric mesenteric cysts were brought to our hospital on account of complication. US of the first patient revealed a huge cystic mass with sediment and septae in central abdomen. Mild hydronephrotic change of the right kidney was found. The pathology showed nonepithelial lining multiloculated cyst surrounded by a thick, fibrotic granulomatous wall with suppurative cell infiltration and some calcifications. The histopathological diagnosis was an infected pseudocyst. The other patient had a cyst which twisted the jejunum and resulted in intestinal obstruction. US found dilated intestinal loops and a septate cystic mass in epigastrium. The pathology showed a multiloculated cyst with mesothelial lining, representing a mesothelial cyst. Both patients were treated surgically and had an uneventful recovery. In this article we described and explained the findings on US, discussed the differential diagnoses and compared different imaging modalities.     

多层螺旋CT诊断食管异物及对临床治疗的价值

目的探讨多层螺旋CT对诊断食管异物的优越性和临床治疗价值。方法对38例食管异物在多层螺旋CT多平面成像的表现以及对临床治疗的价值进行总结。结果 38例有异物病史患者,确诊有异物32例(8例开胸的手术取出,24例食道镜下取出),排除异物6例(胃镜排除后抗炎治疗并连续观察1年无不适),诊断符合率100%。32例异物中,各种形态大小的鱼刺17例,鸡骨头或肉骨头10例,部分假牙套2例,硬钱币1例,鱼钩1例,螺钉1例。结论多层螺旋CT对食管异物的诊断准确、直观,对临床治疗指导意义重大。多层螺旋CT是诊断食道异物的一种方便可靠的检查方法,值得临床推广。     

应用螺旋CT诊断不典型气管异物病例的价值探讨

目的探讨螺旋CT在不典型小儿支气管异物中的诊断价值。方法对11例没有明确异物吸入史,长期误诊为“支气管哮喘”和“支气管炎”的患儿进行支气管螺旋CT的冠扫和轴扫诊断,并与气管镜检查结果相比较。结果11例患儿螺旋CT显示右侧支气管异物4例,左侧支气管异物6例,主气管异物1例。11例患儿在全麻下行支气管镜检查及异物取出术,其中右侧支气管花生米异物2例,西瓜子2例,左侧支气管西瓜子异物5例,葵瓜子1例,主气管异物1例完整西瓜子一枚。与螺旋CT结果一致。结论小儿支气管异物在螺旋CT扫描上有较为特征性表现,对不明原因的反复咳喘和呼吸道感染的患儿可首选支气管CT检查,排除有无气管异物。     

儿童支气管异物246例临床分析

目的 回顾性研究儿童支气管异物的临床特点以及电子支气管镜在诊断治疗儿童支气管异物中的作用.方法 2000年1月至2009年8月北京儿童医院经支气管镜诊断治疗的支气管异物患儿246例,应用Olympus电子支气管镜,在局部黏膜麻醉下经鼻插入支气管镜逐级观察支气管结构,使用篮状异物钳或齿状异物钳钳取异物.结果 246例患儿中,支气管异物以果仁或果壳类(230例,占93.5%)最为常见,异物嵌顿位置以右下叶支气管开口(98例,占39.8%)为最多.钳取异物手术次数平均为(1.9±1.3)次,一次取出率为58.5%(144例).阻塞于左右主支气管、右中叶和右下叶支气管的异物一次取出率较高,分别为91.1%、60.0%和55.1%.篮状异物钳钳取所需次数(1.4±0.9)明显低于齿状异物钳所需次数(2.1±1.4),差异有统计学意义(P=0.000).结论 儿童支气管异物种类以果仁或果壳类植物性异物为主,阻塞部位以右下支气管为多见.位于左右主支气管异物一次取出率明显高于其他部位.用篮状异物钳钳取异物所需手术次数明显少于使用齿状异物钳.     

9例肠系膜囊肿临床分析

通过回顾性地分析我院１９７０～１９９５年间收治的９例均经手术和病理证实肠系膜囊肿病例。临床表现以腹痛和腹部包块为主，部分包块活动度较大。腹部Ｂ超和ＣＴ检查有利确诊。治疗应完整切除包块，预后良好。     

Inhaled foreign bodies in a paediatric population at AKTH Kano-Nigeria

Background:

Inhaled foreign bodies are common paediatric emergencies and a major cause of accidental deaths at home among Nigerian children especially among children below the age of 5 years. Different types of foreign bodies have been reported from the ordinary to the most bizarre. We evaluated the types of foreign bodies and sites of possible impaction of these foreign bodies along the tracheobronchial tree.

Materials and Methods:

A 6-year case record of 35 patients with foreign body inhalation was reviewed from January 2005 to December 2010 at the Otorhinolaryngology Department of Bayero University/Aminu Kano Teaching Hospital, Kano — North-western Nigeria. Basic information such as date of birth, age groups, gender, indication for bronchoscopy, type of foreign bodies, sites of foreign body impaction and surgical outcome were extracted and analysed.

Results:

Thirty-five patients [18 (51.4%) males and 17 (48.6%) females, aged 6 months-10 years] with a mean age of 5.1 years and median of 5 years (+/- 3.0 Standard Deviation). The most affected age group with 31.4% is 3-5 years. Groundnuts and whistles were the most frequently inhaled foreign bodies with an equal frequency of 25.7%, respectively. Foreign bodies were preferentially lodged in the left main bronchus in 8 (22.9%) patients compared to the right main bronchus in 6 (17.1%) patients.

Conclusion:

Public enlightenment both in the news/print media on the risk of foreign body aspiration especially among the under-five''s is highly advocated. The left main bronchus may be a common site for impaction as well.     

多层螺旋CT对小儿气道异物的临床应用

目的:评价多层螺旋CT对小儿气道异物的临床应用。方法:总结经纤维支气管镜或临床证实的78例气道异物患儿的多层螺旋CT表现,结合处理图像分析。结果:78例检查结果均为阳性,74例直接显示异物,占94. 8%。其中气管异物2例,右主支气管68例,左主支气管4例,4例显示间接征象。结论:多层螺旋CT扫描及其后处理技术能很好的显示气道异物的部位、大小、形态及并发征象,是一种安全、有效、无创的气道异物检查方法。     

多层螺旋CT对小儿气道异物的临床应用

目的:评价多层螺旋CT对小儿气道异物的临床应用。方法:总结经纤维支气管镜或临床证实的78例气道异物患儿的多层螺旋CT表现,结合后处理图像分析。结果:78例检查结果均为阳性,74例直接显示异物,占94.8%。其中气管异物2例,右主支气管68例,左主支气管4例,4例显示间接征象。结论:多层螺旋CT扫描及其后处理技术能很好的显示气道异物的部位、大小、形态及并发征象,是一种安全、有效、无创的气道异物检查方法。     

Crohn’s disease of the terminal ileum: a cheap diagnosis

Background  A 29-year-old man was admitted with a 7-day history of progressive non-specific abdominal pain that progressed to small bowel obstruction following ingestion of a 20-pence coin 4-months previously. Colonoscopic retrieval was unsuccessful. A subsequent laparotomy revealed a chronically inflamed thickened terminal ileum with mesenteric fat encroachment necessitating a right hemicolectomy. Histopathological analysis confirmed Crohn’s disease with impaction of the 20-pence coin in a distal terminal ileum stricture near the ileo-caecal valve. Learning point  Gastrointestinal foreign body retention should alert the clinician to the presence of an undiagnosed bowel abnormality. Furthermore, failed endoscopic retrieval should be considered as a marker for potential underlying gastrointestinal pathology and a requirement for operative intervention. Conclusion  This case describes a rare presentation of Crohn’s disease and highlights the need to consider underlying gastrointestinal pathology in patients presenting with a deteriorating clinical condition in the presence of an incidental foreign body.     

多层螺旋CT重建技术对气管及支气管非金属异物的诊断价值

目的探讨多层螺旋CT重建技术对非金属气管及支气管异物的诊断价值。方法对25例疑为气管及支气管异物的患者行多层螺旋CT检查,原始图像重建采用最小密度投影（MinIp）、多平面重建（MPR）、曲面重建（CPR）和容积再现（VR）技术。结果异物位于主气管3例;右主支气管14例;左主支气管7例;左右主气管内均有1例。异物中花生米碎片12例,葵花籽及西瓜子5例,蚕豆及青豆各1例,软糖和碎糖各l例,栗子、塑料帽、苹果皮、米粒各1例。全部病例均经纤维支气管镜。重建后图像能明确显示异物的位置、形态及异物与气管壁的关系。结论多层螺旋CT是诊断气管及支气管非金属异物一种非常有价值的无创伤、定位准确的方法。     

Acute torsion of greater omentum. Report of a case mimicking acute appendicitis

Among a variety of acute abdomens, acute torsion of omentum, first reported by Marchett in 1851, is least suspected under the impression of, most commonly, acute appendicitis and then acute cholecystitis, mesenteric thrombosis, ovarian cyst, perforated peptic ulcer, etc. A 52-years-old woman was admitted on May 2, 1987 with anorexia, nausea and RLQ pain for 2 days. Physical examination revealed tenderness, guarding and rigidity over RLQ. White cell count was 12.100/mm3. A reducible hernia was found in the right inguinal region. The operation through McBurney's incision showed blood-stained fluid. Appendix was slightly congested. A solid, gangrenous mass was palpated at right iliac fossa that disclosed a completely tight torsion of omentum twisting 6 times counterclockwise with distal infarction. Segmental omentectomy, appendectomy and hernioplasty were done. The patient's recovery was uneventful. This case emphasizes the necessity of routine examination of the omentum during the course of abdominal exploration especially when serosanguinous fluid was encountered in the peritoneal cavity.     

腹膜腔游离体的X线诊断(附二例报告)

本文报导两例经 X 线诊断的腹膜腔游离体。并对其 X 线表现、鉴别诊断及检查方法进行讨论。对慢性间歇性转移性腹痛患者,腹部片显示圆形或卵圆形、边缘光滑、密度较均匀的明显游动性之致密影,必须警惕本病的可能性。