卵巢冠囊肿的病理类型及治疗

目的探讨卵巢冠囊肿的发病率、临床表现、病理类型及治疗。方法回顾性分析腹腔镜手术剔除的191例卵巢冠囊肿患者的临床资料。结果191例卵巢冠囊肿患者中有175例(91.62%)为单纯囊肿;15例(7.85%)为上皮性囊肿(其中13例为浆液性囊腺瘤,1例为浆液性乳头状囊腺瘤灶性交界,1例为副中肾管源囊腺瘤、腺体增生并中重度非典型性增生);1例(0.53%)为高分化乳头状间皮瘤。共有6例发生扭转,占3.1%,其中右侧4例,左侧2例。扭转囊肿直径为6~12.67 cm,平均(8.66±2.73)cm,扭转度为360°~720°。育龄妇女为主要发病人群,发病高发年龄为(34.0±11.4)岁。临床多无症状,肿瘤标记物CA125检查均正常,所有患者根据年龄选择相应的手术。结论卵巢冠囊肿并非单纯良性病变,亦有恶变可能,当囊肿直径超过5 cm时可能发生扭转。卵巢冠囊肿恶变绝大部分为浆液性,属低度恶性肿瘤,对恶变的卵巢冠囊肿应根据患者年龄及有无生育要求,采取与早期卵巢肿瘤治疗相同的分期手术方式。     

卵巢冠囊肿临床术式分析

目的探讨卵巢冠囊肿的临床治疗情况。方法回顾性分析我院住院治疗的273例卵巢冠囊肿患者的治疗情况,并比较各种疗法的效果及恢复情况等。结果卵巢冠囊肿腹腔镜手术组的手术时间、术后排气时间、术后住院时间均明显短于开腹手术组（P〈0.05）,术中出血量也明显少于开腹组（P〈0.05）。结论腹腔镜治疗卵巢冠囊肿损伤小、恢复快,可作为临床首选的一种理想术式。     

Paratubal cyst: a case report

Paratubal cyst can undergo torsion that can make it difficult to diagnose since tubal cysts mimic ovarian cysts. Most reported cases of paratubal cysts have occurred in pediatric patients, and this type of cyst rarely causes symptoms of lower abdominal pain mimicking appendicitis. We present the case of a 28-year-old female who was taking Carbergoline for hyperprolactinoma associated with a pituitary adenoma who came to the ER at Henry Ford Hospital in Detroit experiencing severe abdominal pain. Her pain was not accompanied by nausea, vomiting or other gastrointestinal symptoms. A transvaginal ultrasound revealed a normal uterus with the right ovary containing a cyst measuring 3 cm. x 2 cm. She was released on analgesics and seen at the clinic at Henry Ford Hospital three days later. She was still experiencing pain and was given antibiotics and Darvocet. When the pain had not subsided 48 hours later, a decision was made to perform diagnostic laparoscopy. Surgery was performed 10 days later and a paratubal cyst was removed that was twisted twice on its pedicle. This case illustrates the fact that torsion of paratubal cyst should be included in the differential diagnosis of adnexal pain.     

Solitary cyst of the liver presenting as an abdominal emergency

A case of torsion of a solitary non-parasitic cyst of the liver presenting as an acute abdominal emergency is described. Reference is made to the pathogenesis of such cysts, which occur infrequently and only rarely present with complications. A review of previous reports of complications in such cysts is presented.     

Upper genital schistosomiasis mimicking an ovarian tumour

Schistosomiasis is a widely prevalent disease in the world and usually involves the gastro-intestinal and urinary tract. The involvement of the female genital tract has been well-established in S. haematobium infections and is rare with S. japonicum infections. This case involves a Filipino female who was admitted to the University Hospital Kuala Lumpur for right iliac fossa pain and was diagnosed initially as acute appendicitis. Ultrasound showed a multi-septated pelvic cyst leading to a provisional diagnosis of ovarian torsion. Intraoperatively a right parovarian cyst was detected and removed. Histology revealed a congested cyst wall with areas of haemorrhage with several viable and calcified eggs of S. japonicum measuring 85 microns x 62 microns. Within the cystic cavity blood admixed with eggs were seen. Confirmation was carried out by using the indirect haemagglutination (IHA) test. This is a first report of upper genital schistosomiasis mimicking an ovarian tumour.     

经阴道超声诊断卵巢囊肿蒂扭转的价值

目的:探讨经阴道超声对卵巢囊肿蒂扭转的诊断价值。方法:36例住院病例术前均行经阴道腹部超声检查对照。结果:36例卵巢囊肿蒂扭转均经手术和病理证实,其中左侧22例,右侧14例,超声表现为单房囊肿19例,多房囊肿7例,囊肿内混杂回声10例。36例病例中经阴道超声发现扭转的蒂部27例,经腹部超声发现扭转蒂部22例,大部分为混杂回声团。经阴道超声诊断准确率75.0%,经腹部超声诊断准确率61.1%。结论:经阴道超声在对卵巢囊肿蒂扭转的诊断中有一定的优势。     

妊娠合并卵巢子宫内膜异位囊肿53例临床疗效分析

目的探讨妊娠合并卵巢子宫内膜异位囊肿的临床特点及诊治方案。方法回顾性分析53例均经病理证实妊娠合并卵巢子宫内膜异位囊肿患者的临床资料。结果术前诊断15例(28.30%),剖宫产术中诊断38例(71.70%);10例孕期囊肿直径无变化,5例明显缩小;6例发生并发症,5例异位囊肿破裂,1例异位囊肿扭转;8例行单侧附件切除,余45例行囊肿剥除、粘连分解及病灶电灼术。术后复发4例。结论妊娠合并卵巢子宫内膜异位囊肿早期诊断困难,并发症隐匿,应密切观察囊肿的变化,先行保守治疗,必要时手术,术后应定期随访。     

不孕症的腹腔镜检查及治疗

目的:探讨腹腔镜在不孕症诊断和治疗中的价值。方法:对57例女性不孕症患者进行了腹腔镜诊断,对其中45例施行了腹腔手术。结果:术中发现多囊卵巢综合征25例,占43.86%;输卵管阻塞24例,占42.11%;慢性盆腔炎22例,占38.60%;其它为盆腔子宫内膜异位症、卵巢囊肿、卵巢冠囊肿、子宫肌瘤等。结论:腹腔镜诊断及手术治疗是目前诊治女性不孕症最有效的方法。有条件的地区可将腹腔镜检查做为不孕症的常规检查。     

二孔法腹腔镜良性卵巢囊肿剥除术的临床分析

目的:总结二孔法腹腔镜卵巢良性肿瘤剥除术的适应症、手术技巧.方法:对我院进行的29例二孔法腹腔镜良性卵巢囊肿手术进行分析.结果:术后病理诊断巧克力囊肿8例,单纯滤泡囊肿10例,输卵管系膜囊肿(卵巢冠囊肿11例);手术均顺利完整剥除囊肿,保留了卵巢,手术历时平均65min;平均失血量约15ml;术中延长切口最多5mm.术后6h进流质饮食,嘱下床活动,无须术后镇痛,停留尿管12～24h,术后常规抗炎治疗3d,无伤口感染或腹膜炎等并发症;平均住院时间4～6d.术后随访患者满意率达100%,暂无复发病例.结论:严格掌握二孔法腹腔镜卵巢良性囊肿剥除术的适应症及手术技巧,能达到三孔法腹腔镜及开腹手术更好的治疗效果.     

卵巢冠囊肿90例分析

目的通过对卵巢冠囊肿的超声声像图特征及误诊原因的探讨,以提高超声对该病的诊断水平。方法回顾性分析了在我院经手术病理证实了的90例卵巢冠囊肿的超声声像图表现及临床资料。结果 90例卵巢冠囊肿,术前正确诊断30例,20例诊断为附件区囊肿,另外40例分别误诊为卵巢囊肿26例,合并蒂扭转1例,输卵管积水5例,巧克力囊肿5例,卵巢乳头状囊腺瘤2例,黄体囊肿1例。结论卵巢冠囊肿有其特征性的声像图表现,超声对其有一定的诊断及鉴别诊断价值。     

Laparoscopic Management of Adnexal Masses

Retrospective study of 121 cases of adnexal masses which were managed laparoscopically was carried out. The aim of study was to evaluate the safety and effectiveness of laparoscopic management of adnexal masses. In 120 cases, procedure was completed safely with minimum morbidity. In one case laparotomy had to be done to complete the procedure. In 76 cases cystectomy was done, 26 required salpingo-oophorectomy and 19 required only salpingectomy. Histologic evaluation revealed 30 functional cysts, 36 endometriotic cysts, 11 dermoids, 9 serous cystadenomas, 3 mucinous cystadenomas, 11 parovarian cysts, 19 cases of hydrosalpinx and 2 cases of tuberculosis.Key Words: Adnexal mass, Laparoscopy, Ovarian cyst     

苗勒氏管囊肿蒂扭转并发膀胱癌1例

回顾分析江苏省中医院收治的1例苗勒氏管囊肿蒂扭转并发膀胱癌患者的诊治过程，患者在全麻下行“经腹右侧附件切除+盆腔粘连松解+膀胱镜检术 ”，术后病理诊断为苗勒氏管源性囊肿、(膀胱)乳头状尿路上皮癌，低级别。术后予进一步化疗，后期随访患者各项指标均正常，未诉明显不适。B超、CT及MRI均可发现苗勒氏管囊性包块，确诊需依据组织病理学检查，囊肿多为良性，手术切除安全有效。     

Treatment of intracranial hydatid cysts

Background  Echinococcosis is still endemic in many countries, including China, where it is especially prevalent in the northwest. The aim of this study was to enrich the international literature about the treatment of intracranial hydatid cysts.

Methods  We retrospectively reviewed the clinical features, radiological manifestations, and surgical outcome of 97 patients with intracranial hydatid cysts, who received surgical treatment at the Neurosurgical Department of First Affiliated Hospital of Xinjiang Medical University from 1985 to 2010 and followed up the patient via sending a questionnaire or telephone contact. Clinical outcome was evaluated using the Karnofsky Performance Scale Index.

Results  Headache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases. On the X-ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round-shaped and thin-walled homogeneous low-density cystic lesions without surrounding edema and enhancement were the main findings on computerized tomography (CT) in 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts presented as a heterodensity lesions. On magnetic resonance imaging (MRI), hydatid cyst presented as a round-shaped low signal lesion in T1-weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts presented as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulting in two surgery-related mortalities. There was no other additional neurological deficit caused directly by surgery. In 97.2% of the patients, the Karnofsky Performance Scale score was 80 to 90 at the last follow-up.

Conclusions  Intracranial hydatid cyst is still a main cause of increased intracranial pressure among the patients in endemic areas for echinococcosis. CT and MRI are the best diagnostic methods and surgery is the treatment of choice for intracranial hydatid cysts.

     

Dermoid cyst in a domestic shorthair cat

A 5-year-old neutered male domestic shorthair cat was presented for examination of a subcutaneous mass in his tail. The mass was firm, non-painful, oval, and approximately 2.5 × 3.5 cm. Surgical exploration revealed a well-circumscribed, encapsulated mass. The mass was removed and sectioned for histopathological examination. In gross section, it was filled with numerous dark hairs. Histologically the mass was consisted of haired skin with dermal cystic structures lined by stratified squamous epithelium. The cyst lumen contained squamous debris and filled with keratinous material. Numerous hair shafts were extended from the wall of the cyst. The sebaceous and apocrine gland adnexal structures were also observed which confirmed the diagnosis of dermoid cyst. No tumor recurrence was observed after surgery in fallowing checkups. Cutaneous or subcutaneous cysts of all types are considered rare in cats and to our knowledge this is the third reported case of cutaneous dermoid cyst of cats in veterinary literature which is different from the other cases because it occurred in dorsal midline in tail area whereas others occurred in flank area.     

卵巢子宫内膜异位囊肿的介入性治疗及术前后用药

目的：探讨囊内注射无水酒精治疗卵巢子宫内膜异位囊肿及术前后服用达那唑的疗效。方法：按照随机分组的原则,试验组卵巢子宫内膜异位囊肿２６ 例,对照组卵巢子宫内膜异位囊肿２４ 例。试验组囊肿内注入无水酒精术前后服用达那唑３ 个月。对照组囊内单纯注入无水酒精。结果：穿刺术后追踪半年以上在试验组２６ 例中,２１ 例囊肿消失,４ 例囊肿明显缩小,１ 例囊肿复发。在对照组２４ 例中,９ 例囊肿消失,８ 例囊肿明显缩小,７ 例囊肿复发。经统计学处理,两组之间的差异有显著性意义。结论：囊内注射无水酒精术前后服用达那唑治疗卵巢子宫内膜异位囊肿比囊内单纯注入无水酒精疗效好     

人体细粒棘球蚴接种小鼠体早期发育观察

人体肺或肝内棘球蚴的生发囊或原头蚴接种杂交小白鼠腹腔,最初可见游离的原头蚴周围有大量中性细胞及少数嗜酸性细胞,原头蚴结构模糊,生发囊外有明显的细胞反应带。如系存活的原头蚴其内部结构多集聚于一处,并有少数顶突钩,原头蚴可向不同方向形成有角质层外被的突起,突起可脱离原头蚴,形成有角质层的新个体,但未见内侧有生发层存在。     

改良开窗减压术治疗大型颌骨囊肿疗效分析

【目的】评价患者配合程度对开窗减压术治疗大型颌骨囊肿的疗效影响。【方法】对在我院接受囊肿改良开窗减压术的45例颌骨囊肿患者（囊肿直径4.0-10.0 cm）于口腔内采用小切口或拔除囊肿区Ⅲ度松动牙作开窗,置固定引流管1根,视囊液流出的多少每日或隔日冲洗囊腔,并指导家属及患者如何进行冲洗操作。术后每1个月至1年内定期复诊,复查口腔全景片观察囊腔内颌骨骨质增生情况及观察囊腔内渗出物情况及囊肿腔大小的变化。【结果】45例患者中,定期复诊并坚持每日或及时冲洗,随诊1年后,无明显的继发感染症状,囊腔逐渐被新生骨完全替代者7例,占15.5%;囊腔由4.0-10.0 cm囊腔缩小至1.0-2.0 cm左右者35例,占77.8%;疗效显著为93.3%。3例囊腔4.0-6.0 cm左右的患者占6.7%,虽经过多次指导仍不能坚持执行冲洗操作,全景片显示囊腔减小不明显,并且仍有大量粘稠伴有脓液的囊液,实行了囊腔全刮治术。【结论】开窗减压术手术方法简单实用,并发症少;能最大限度保持颌骨的完整性,保护病变区的患牙,减少了患者的损伤和减轻了手术痛苦。但对患者配合度要求高,临床上患者不能认真很好的配合,会导致该方法的疗效的失败。     

Parovarian cystadenocarcinoma of low malignant potential.

Malignant parovarian tumors are rare, with only 20 cases previously reported. Only eight of these were cystadenocarcinomas of low malignant potential and only two had both mucinous and serous components. In this article, we report the third case of a parovarian cystadenocarcinoma with both serous and mucinous components--A 26-year-old female who was treated by conservative surgery and later carried a pregnancy to term. Prognosis and management of these lesions are discussed.     

Chronic hematic cyst of the temporomandibular joint

Hematic cyst refers to accumulation of blood or blood breakdown products in a non epithelium-lined fibrous tissue capsule. Hepatic cyst is a term often used for deeply placed, incompletely resorbed hematoma hemorrhagic cyst, which may remain unchanged and unidentified for long periods of time. Trauma is the major causative factor, although it is often vague or totally uncalled by the patient. Chronic hematic cysts are uncommon lesions those can present diagnostic challenge. In this article we report a first case of a chronic hematic cyst of the temporomandibular joint (TMJ).     

腮腺囊肿的临床病理观察——11例报告

本文报告了11例腮腺囊肿的临床病理观察。该囊肿约占我院治疗的1106例口腔颌面部囊肿的1％。9例男性,2例女性。就诊年龄3～64岁。大多数囊肿直径3～5 cm,仅1例最大直径超过10cm。组织学检查5例存在假复层柱状上皮或立方状上皮衬里,6例缺乏上皮衬里。鉴别诊断包括鳃裂囊肿、混合瘤及一些其它腮腺肿瘤。腮腺囊肿手术治疗的一个重要问题是保护面神经。