Cr32PO4胶体治疗腱鞘囊肿(附21例临床报告)

目的探讨Cr32PO4胶体治疗腱鞘囊肿的效果. 方法 40例腱鞘囊肿患者随机分为二组:核素治疗组(21例)予腱鞘囊肿粗针穿刺抽液后将Cr32PO4胶体注入囊腔内,加压包扎固定治疗;对照组(19例)予囊肿穿刺抽液后注入醋酸强的松龙常规治疗. 结果核素治疗组一次性治愈19例(90.4%),有效2例(9.5%);复发2例(9.5%).对照组一次治愈9例(47.4%), 有效3例(15.8%),无效7例(36.8%);复发8例(42.1%).两组术后治愈率和复发率均有显著性差异, 核素治疗组明显优于对照组. 结论 Cr32PO4胶体能显著提高腱鞘囊肿治愈率,减少其复发,有临床使用价值.     

Colloid cyst of the third ventricle

Summary The clinical and x-ray features of 28 cases of colloid cyst of the third ventricle are described. Colloid cyst is one of the most favourable space-occupying lesions of the brain for successful surgical removal, because an exact pre-operative diagnosis is possible. The surgical approach for colloid cyst of the third ventricle is discussed and the frequency of postoperative seizure is reviewed in 28 cases and compared with the literature.     

Colloid cysts of the third ventricle

Since computerized tomography scanning became available at the Division of Neurosurgery in July, 1979, 13 patients have undergone removal of colloid cysts of the third ventricle by transfrontal or transcallosal routes. Computerized tomography has increased the number of colloid cysts detected in the foramen of Monro during neurological diagnostic workups. The clinical and diagnostic aspects and changing concepts in the treatment of colloid cysts are reviewed.     

Management of Renal Cysts

Methods:A total of 184 patients with symptomatic simple renal cysts were treated with either laparoscopic decortication in 149 cases or percutaneous aspiration-sclerotherapy in 35 cases. The follow-up period was approximately 35 months, and the symptomatic and radiologic success rates of the 2 techniques were compared retrospectively.Results:Laparoscopic decortication was found to have high success rates, a low recurrence rate, and minimal morbidity. Percutaneous aspiration-sclerotherapy is an outpatient procedure with a minimally higher recurrence rate.Conclusion:When a symptomatic cyst is encountered and treatment of the cyst is indicated, laparoscopic decortication is a more efficient method that offers better results than percutaneous aspiration-sclerotherapy.     

Surgical Management of Intracranial Neuroenteric Cysts: The UCSF Experience

Objective Modern surgical experience with intracranial neuroenteric cysts is limited in the literature. We review our 15-year institutional experience with these rare lesions. Design Single-institution retrospective study. Setting Large North American tertiary care center. Participants Histologically confirmed cases of intracranial neuroenteric cyst from January 2000 to September 2014. Main Outcome Measures Pre- and postoperative modified Rankin Scale (mRS) scores, extent of resection, and postoperative complications are reported. Clinical presentation, imaging features, pathology, and operative approach are discussed. Results Five spinal and six intracranial neuroenteric cysts were surgically treated over a 15-year period. Median age at presentation for the intracranial cysts was 38.5 years. Mean cyst diameter was 3.8 cm. Five cysts were located in the pre-pontomedullary cistern, and one was located in the third ventricle. Gross total resection was achieved in four of the five posterior fossa cysts through a far lateral transcondylar approach. Postoperative complications included aseptic meningitis (one), transient abducens palsy (one), and pseudomeningocele requiring reoperation (three). Postoperative mRS scores improved to ≤1 by 6.5 months median follow-up. Conclusions Intracranial neuroenteric cysts are rare lesions with a variable imaging appearance. Complete surgical resection through a far lateral transcondylar approach is possible and usually results in symptom improvement or resolution.     

Diagnosis and Management of Choledochal Cysts

Choledochal cysts are rare disease and of unknown etiology. They are typically a surgical problem of infancy and childhood, but in nearly 20% of the patients the diagnosis is delayed until adulthood. The presentation and therapeutic strategies for choledochal cysts in adult may differ from that of childhood. The surgical management of choledochal cysts in adults is complicated by associated hepatobiliary pathology. Despite the absence of clinical trials, a consensus for the management of choledochal cysts is excision. This review examines the spectrum of hepatobiliary pathology encountered with choledochal cysts and the surgical alternatives for managing choledochal cysts based on review of relevant literature in the English language indexed on MEDLINE.     

Combined Transoral and Endoscopic Approach for Total Maxillectomy: A Pioneering Report

Total maxillectomy is sometimes necessary especially for malignant tumors originating from the maxillary sinus. Here we describe a combined transoral and endoscopic approach for total maxillectomy for the treatment of malignant maxillary sinus tumors and evaluate its short-term outcome. This approach was evaluated in terms of the physiological function, aesthetic outcome, and complications. Six patients underwent the above-mentioned approach for resection of malignant maxillary sinus tumors from May 2010 to June 2011. This combined transoral and endoscopic approach includes five basic steps: total sphenoethmoidectomy, sublabial incision, incision of the frontal process of the maxilla, incision of the zygomaticomaxillary fissure, and hard palate osteotomy. All patients with malignant maxillary sinus tumors successfully underwent the planned total endoscopic maxillectomy without the need for facial incision or transfixion of the nasal septum; there were no significant complications. Five patients received preoperative radiation therapy. All patients were well and had no recurrence at follow-up from 13 to 27 months. The combined approach is feasible and can be performed in carefully selected patients. The benefit of the absence of facial incisions or transfixion of the nasal septum, potential improvement in hemostasis, and visual magnification may help to decrease the morbidity of traditional open approaches.     

Colloid cysts — a review including 19 own cases

Between 1974 and 1987 19 patients harbouring colloid cysts of the third ventricle have been treated in our department. There were 12 male and 7 female patients with an average age of 34 years (ranging from 17 to 58). Eighteen of the 19 patients underwent direct microsurgical removal of the space occupying lesion using the transcortical-transventricular approach. One patient had placement of a ventriculoperitoneal shunt and declined further treatment. There were no deaths in the entire series and no permanent neurological deficits were observed postoperatively. Surgery was successful in unblocking CSF pathways in 12 patients; six patients required permanent CSF diversion. Considering the advantages and disadvantages of various surgical modalities for the treatment of the lesions we recommend the microsurgical removal of the colloid cyst using the transcortical-transventricular approach.     

Diagnosis and Management of Choledochal Cysts

Choledochal cysts are rare disease and of unknown etiology. These are typically a surgical problem of infancy and childhood, but in nearly 20 % of the patients the diagnosis is delayed until adulthood. The presentation and therapeutic strategies for choledochal cysts in adult may differ from that of childhood. The surgical management of choledochal cysts in adults is complicated by associated hepatobiliary pathology. Despite the absence of clinical trials, a consensus for the management of choledochal cysts is excision. This review examines the spectrum of hepatobiliary pathology encountered with choledochal cysts and the surgical alternatives for managing choledochal cysts based on review of relevant literature in English language indexed on MEDLINE.     

Endoscopic Surgery for Hemorrhagic Pineal Cyst Following Antiplatelet Therapy: Case Report

Pineal cysts of the third ventricle presenting with acute obstructive hydrocephalus due to internal cystic hemorrhage are a rare clinical entity. The authors report a case of a 61-year-old man taking antiplatelet medication who suffered from a hemorrhagic pineal cyst and was treated with endoscopic surgery. One month prior to treatment, the patient was diagnosed with a brainstem infarction and received clopidogrel in addition to aspirin. A small incidental pineal cyst was concurrently diagnosed using magnetic resonance (MR) imaging which was intended to be followed conservatively. The patient presented with a sudden onset of headache and diplopia. On admission, the neurological examination revealed clouding of consciousness and Parinaud syndrome. Computerized tomography (CT) scans demonstrated a hemorrhagic mass lesion in the posterior third ventricle. The patient underwent emergency external ventricular drainage with staged endoscopic biopsy and third ventriculostomy using a flexible videoscope. Histological examination revealed pineal tissue with necrotic change and no evidence of tumor cells. One year later MR imaging demonstrated no evidence of cystic lesion and a flow void between third ventricle and prepontine cistern. In patients with asymptomatic pineal cysts who are treated with antiplatelet therapy, it is important to be aware of the risk of pineal apoplexy. Endoscopic management can be effective for treatment of hemorrhagic pineal cyst with obstructive hydrocephalus.     

Parenchyma-Preserving Surgery in the Management of Pulmonary Hydatid Cysts

Pulmonary hydatid cysts remain a significant health problem in endemic regions like Turkey. Here, we present our surgical experience in patients with pulmonary hydatid cysts. Between January 1985 and January 2001, 1118 operations were performed in 1032 patients (528 males, 504 females; mean age 32.7 years; range 1–87 years) with pulmonary hydatid cysts in our department. Posterolateral thoracotomy was performed in 1015 (98.3%), two-stage thoracotomy in 34 (3.3%), and median sternotomy in 17 (1.7%) patients. We preferred conservative surgical procedures. As a surgical procedure, cystotomy and capitonnage was performed in 626 (56%), cystotomy alone in 368 (33%), wedge resection in 81 (7%), enucleation in 29 (3%), and decortication in 11 (1%) patients. None of our patients were treated with anatomic resection. During surgery, 949 patients (92%) had unruptured and 83 patients (8%) had ruptured hydatid cyst. The morbidity ratio was 6.7%. Major complications were wound infection (2.3%), prolonged air leak (1.9%), atelectasis (1.2%), pleural effusion (0.8%), postoperative hemothorax (0.6%), and empyema (0.3%). Two patients (0.2%) died within the first month postoperatively. Mean follow-up was 31.2 months. Recurrence was detected in only 35 patients (3.3%). Treatment of pulmonary hydatid cyst is primarily surgical. Medical treatment is indicated for recurrent and multiple hydatid cysts postoperatively. Cystotomy alone, or cystotomy and capitonnage, as parenchyma-preserving surgery, is preferred. Radical surgery including pneumonectomy, lobectomy, and segmentectomy should be avoided.     

Symptomatic Pineal Cysts: Clinical Manifestations and Management

Summary.  Between 1991 and 2000, seven patients presented with symptomatic pineal cysts at our hospital (6 females, 1 male). Average age was 22 years (range 4–33 years). Headache was present in 6 patients, who were subsequently operated on. A scotoma and a transient inferior visual field deficit were minor signs in two patients respectively. A Parinaud syndrome with vertical gaze paralysis was found in none. In one child, paroxysmal pupillary dilatations and contractions (`springing pupils') constituted the only signs and a conservative policy was adopted. Four patients presented with hydrocephalus and were treated by an endoscopic resection of their pineal cysts (one stereotactically, three free-hand). Two other patients presented with a prolonged history of symptoms and signs: headache alone in one, headache with discrete neurological deficits in the other. Ventricles in these two patients were not dilated and therefore an open cyst resection by infratentorial supracerebellar approach was performed. Average follow-up in the six “operated” patients was 29 months (range 12–108 months). All four patients treated by endoscopy, are symptom-free at follow-up, whereas the two who were approached by open surgery, are not. Clinical presentation, radiological evaluation and treatment modalities of pineal cysts are discussed and compared with experiences reported in the literature. It is concluded that pineal cysts in the presence of obstructive hydrocephalus are a clear indication for endoscopy with a rigid endoscope.     

Complete Removal of Colloid Cyst via CT-Guided Stereotactic Biportal Neuroendoscopy

Four patients harbouring a colloid cyst of the 3rd ventricle were operated on endoscopically. With the "classical" monoportal technique, through a precoronal burr hole only partial removal could be achieved in the first case. As the crucial point of the procedure is the safe dissection of the cyst from the thela chorioidea and from the internal cerebral veins, adequate control of the posterior rim of the foramen of Monro and the roof of the 3rd ventricle is mandatory. Accordingly in other three cases a CT-guided biportal endoscopic technique was applied, which permitted radical removal of the entire cyst with maximum safety. CT-guidance is essential for optimal planning after careful study of the individual anatomy. In this way the rigid scopes are moved exclusively along their own axes throughout the procedure, the resulting brain damage thereby being minimal. With regard to all circumstances of the procedure, the use of flexible endoscopes appears to be inappropriate and biportal endoscopy offers itself as the method of choice.     

经阴道纯NOTES肾囊肿去顶术1例报告并文献复习

目的：报告1例经阴道纯自然腔道内镜手术（NOTES）肾囊肿去顶术的临床经验和体会。方法：采用经阴道纯NOTES肾囊肿去顶术治疗右肾囊肿患者l例。患者取截石位,患侧垫高约30°,头低脚高约25°。剪开阴道后穹窿黏膜约3cm,在5mm无损伤分离钳的引导下置人5mmTrocar,插入5mmO°远端可弯曲（四方向）腹腔镜,证实无肠管损伤。扩大阴道后穹窿切口至3cm,置入Triport。改头高脚低约25°,患侧抬高约60°。游离右肾囊肿,切除外露囊壁并取出,彻底止血后留置盆腔引流管,关闭切口。结果：手术顺利完成。手术时间75min,术中失血量约为20m1。患者于术后第1天拔除尿管和盆腔引流管并下床活动,第2天肛门通气并进饮食。术后第4天出院。结论：经阴道纯NOTES肾囊肿去顶术临床应用可行,其美容优势明显。该手术的成功实施,为经阴道纯NOTES其它术式的探索提供了借鉴。     

内镜黏膜下剥离术在中低位直肠肿瘤中的应用

早期直肠癌的内镜下切除存在一定的争议,文章就内镜下切除技术的发展、适应证、操作方法及在中低位直肠肿瘤中的应用做一综述。重点介绍了内镜黏膜下剥离术（ESD）的器械、技术要点、术后处理和疗效评价。     

Surgical Management of Life Threatening Bleeding after Endoscopic Cystogastrostomy

ABSTRACT

Postprocedural bleeding is a rare but life threatening complication of endoscopic cystogastrostomy which may require surgical management in some patients. The presence of adhesions and inflammation due to antecedent acute pancreatitis, difficult location of the bleeding site and breach in the posterior wall of stomach pose significant challenges during the surgical management. Here we have described the surgical approach and technique that we used to manage three patients who required surgery for life threatening bleeding after endoscopic cystogastrostomy.     

Colloid cysts with and without ventriculomegaly: Role of intraoperative real-time ultrasound

Intraoperative real-time ultrasound was used to assist localization and surgical removal of colloid cysts in patients without ventriculomegaly. In the most commonly used surgical approach for removal of colloid cysts, dilated lateral ventricles can expedite the localization of lesions because, once entered surgically, a dilated ventricle offers more space near the foramen of Monro in which to work. Additionally, the enlargement of the foramen of Monro, seen with hydrocephalus, provides greater accessibility to the colloid cyst. In patients with symptoms related to intermittent obstruction of cerebral fluid flow but with normal-sized ventricles, the precise localization of the foramen of Monro and colloid cyst is more difficult and may result in unnecessary exploration/resection of brain. Using intraoperative ultrasound, the colloid cyst and adjacent anatomic structures can be clearly visualized regardless of ventricular size. Intraoperative ultrasonography has a unique role in the operative treatment of patients with colloid cysts and nondilated ventricles.     

Transanal Endoscopic Microsurgery (TEM) Resection of Rectal Tumors

Local excision of rectal cancer is an attractive alternative to avoid the morbidity associated with radical rectal surgery. Oncologic concerns, specifically the inability to fully assess the status of the perirectal lymph nodes and the risk of local recurrence after local excision remain significant barriers to widespread adoption of this technique. Transanal endoscopic microsurgery is an alternative minimally invasive technique used for transanal excision of rectal polyps and tumors. It offers the advantage of better exposure, magnified stereoscopic view, and greater reach into the middle and upper rectum. This technique, combined with careful patient selection, has demonstrated optimistic results compared to standard transanal techniques and even total mesorectal excision when utilized for certain early rectal cancers. This study was presented at the Society for Surgery of the Alimentary Tract meeting, May 23, 2006, Los Angeles, CA, USA