与肺动脉吊带关系密切的气管憩室一例

临床资料患者,男,6个月。因“反复气喘2^＋个月”入院。入院查体可于胸骨左缘第2～3肋间闻及轻微连续性杂音,肺部听诊可闻喘鸣。入院后心脏彩色超声心动图提示“先天性心脏病：动脉导管未闭”,但彩色超声心动图检查未能清楚显示左肺动脉开口。结合患儿临床表现,行胸部血管增强CT扫描后发现“左肺动脉开口于右肺动脉中段后侧壁,包绕气管走行于其后方,致气道局部狭窄”,遂补充诊断“肺动脉吊带”。患儿胸部CT同时意外发现“左肺动脉包绕气管”处见“气管壁局部呈指状突出形成约3mm×4mm憩室”（图1、图2）。术中充分游离主肺动脉、右肺动脉及开口于右肺动脉后壁的左肺动脉。可触及左肺动脉包绕处突起憩室。自左肺动脉开口离断左肺动脉,将其重新置于气管前方,于主肺动脉左侧壁行端．侧吻合完成重建。结扎动脉导管。因患儿并无反复呼吸道感染表现,故未处理气管憩室。患儿术后恢复顺利,随访6个月无明显症状。     

胸腔镜手术治疗食管癌合并气管憩室9例报告北大核心CSCD

目的 总结胸腔镜手术治疗食管癌合并气管憩室的经验。方法 2015年6月~2021年3月我们对7例食管癌合并气管憩室行腔镜颈胸腹三切口食管癌根治术,经右胸游离食管、腹游离胃及左颈部吻合;2例食管癌合并气管憩室行腔镜胸腹两切口食管癌根治术,经腹游离胃,右胸游离食管及胸内吻合。结果 9例顺利行单腔气管插管全麻,未发生因麻醉插管导致气管憩室的损伤。3例气管憩室在胸腔镜手术中探查诊断,其中1例在游离食管过程中发生憩室损伤,经缝合修补术后未发生与气管损伤相关的并发症。7例腔镜颈胸腹三切口手术时间(237.9±18.7)min,术中出血量(154.3±12.7)ml,清扫淋巴结(23.4±3.5)枚,术后住院时间(11.0±1.4)d;2例腔镜胸腹两切口手术时间分别为195、240 min,术中出血量160、150 ml,清扫淋巴结20、23枚,术后住院时间11、10 d。9例术后随访4~62个月,中位时间28个月,1例转移,1例因肿瘤复发死亡,余7例无复发和转移。结论 食管癌合并气管憩室罕见,术前应仔细阅片及术中精细操作,对安全实施食管癌手术具有临床指导意义。     

外伤性胸段气管膜壁破裂保守治疗12例诊疗分析

目的探讨外伤性胸段气管膜壁破裂保守治疗患者的诊断及治疗。方法回顾性分析笔者所在医院2006年8月～2010年10月收治的12例外伤性胸段气管膜壁破裂保守治疗患者的临床资料。对其临床特点、诊断方法及治疗措施进行分析。结果行保守治疗9例,行胸腔闭式引流2例,均痊愈出院。出院后随访半年,患者恢复良好。结论外伤性胸段气管膜壁破裂,行螺旋CT薄层扫描基本可明确诊断,保守治疗效果满意。     

多层螺旋CT轴位薄层重建与斜矢状位多平面重建图像对腰椎峡部裂的诊断价值

腰椎峡部裂是指椎弓上下关节突之间的狭细部分断裂．是椎体滑脱的主要病因之一。传统X线平片是诊断腰椎峡部裂的常规检查方法，但其获得的信息有限。CT特别是多层螺旋CT及其图像后处理软件的开发和应用为诊断腰椎峡部裂提供了更多更全面的影像信息。笔者对40例腰椎峡部裂患者的多层螺旋CT扫描轴位薄层重建图像及斜矢状位多平面重建（MPR）图像的特点进行分析，旨在探讨该技术在腰椎峡部裂中的临床应用价值。     

Meckel's diverticulum: report of two cases and review of the literature

Meckel's diverticulum is considered the most common diverticulum of the small intestine. Of the various complications associated with this condition, intestinal obstruction is one of the most common. Rapid diagnosis and treatment are essential. Resection of the obstructing element is the treatment of choice. The authors report on their recent experience with two patients with Meckel's diverticulum, both of whom had intestinal obstruction as the presenting complication. The authors discuss the etiology and various complications of Meckel's diverticulum and present information on the frequency of associated mortality and morbidity.     

Aplasia cutis congenita: report of four cases and literature review

Aplasia cutis congenita (ACC) is a defect of cutaneous development, most commonly on the scalp. The incidence is between 0.5–1/10,000 of newborns. It can be associated with other congenital syndromic anomalies. Different aetiological theories exist about ACC. The defects are probably not attributable to one single factor. Management of the less severe forms is relatively simple and treatment can be either conservative or operative. More severe cases involving the skull are associated with a 20–55% mortality rate, due to massive haemorrhage or infection. Four new cases are reported; three were treated conservatively, one patient had a severe form which was associated with other congenital anomalies and died 1 month after birth. This small series confirms the effectiveness of conservative therapy in the treatment of limited areas of ACC.     

Adenoacanthoma of the pancreas: report of four cases and literature review

Cases of 20 patients with adenoacenthoma of the pancreas with clinicopathologic data, including the four added, are reviewed. The clinical manifestations, sites of metastases, survival and gross pathology appear to be similar to the usual adenocarcinoma of the pancreas. Adenoacanthoma of the pancreas most probably represents squamous metaplasia of an adenocarcinoma or arises from an undifferentiated cell in the pancreatic duct system. The metastases are typically an admixture of both elements but in four cases, pure squamous or adenocarcinoma metastases were encountered. It is suggested that the pancreas should be included as a possible source in those patients with an unknown primary who have a metastasis consisting of either an admixture of squamous and glandular elements or a pure squamous type and in those instances in which a pure squamous and a pure adenocarcinoma are encountered in different metastases.     

Gallbladder torsion: report of four cases and review of the literature

Gallbladder torsion is a rare cause of acute acalculous cholecystitis. Preoperative diagnosis is difficult. The treatment of choice remains immediate cholecystectomy. We present four cases of gallbladder torsion and review the literature.     

Adenocarcinoma in Meckel's diverticulum: case report and literature review

A case of adenocarcinoma arising in Meckel's diverticulum in a 55 year old man is reported, and a brief review of the literature is presented. The patient developed low abdominal pain and showed elevation of serum carcinoembryonic antigen (CEA) level. The tumour was located in the apical portion of the diverticulum and extended into the mesenterium. Histologically, the tumour was a well-differentiated adenocarcinoma arising in the Meckel's diverticulum. Immunohistochemical study showed that malignant cells were positive for CEA. The noteworthy feature of this case is the pre-operative elevation of serum CEA level and the immunohistochemical demonstration of CEA in the cancer cells.     

Glomerular disease in patients with malignant disease: four cases and review of literature

Renal involvement may occur in cases with malignant disorders. Glomerular injury may be the first sign of these diseases and may predict the overall survival. In some cases, glomerular injury may be associated with tumor antigens, and in some others, viruses cause renal injury together with underlying malignant disease. Here we report four cases with malignant diseases and accompanying glomerular injury and review the literature.     

儿童溶血尿毒综合征4例报道并文献回顾

溶血尿毒综合征(hemolytic uremic syndrome,HUS)是小儿急性肾衰竭常见原因之一,死亡率高。本文通过分析总结4例HUS患儿临床特点及诊治经过,为提高诊疗水平提供参考。方法将湖北省妇幼保健院PICU收治的4例HUS患儿临床表现、辅助检查、治疗及转归进行回顾性分析。结果4例患儿均进行血液净化治疗,2例患儿恢复良好;1例患儿出院后10个月复发,再次住院好转出院,随访5个月身体健康。1例患儿住院治疗68 d,间断透析治疗,因预后差放弃治疗后死亡。结论HUS为儿童致命性疾病,血浆置换能够缓解病情、改善预后,为HUS一线治疗。婴儿期发生非典型HUS可出现血浆置换治疗不敏感,建议尽早采用其他治疗如依库珠单抗。