分化型甲状腺癌再次手术治疗分析

目的 探讨分化型甲状腺癌再次手术的原因、必要性和对策.方法 回顾性分析我院2000-2010年收治的124例分化型甲状腺癌患者再次手术的临床资料.结果 124例甲状腺癌再次手术病例中,75例甲状腺癌误诊为甲状腺良性病变,而行肿瘤局部切除或一侧腺叶次全切除术,手术切除范围不够;39例为首次手术方式选择不当,其中27例已有颈淋巴结转移,未行颈淋巴结清扫术,12例因颈淋巴结转移癌仅行淋巴结活检,忽视甲状腺肿瘤的诊断;10例因为快速病理检查未能诊断甲状腺癌而再次手术.最终病理检查证实肿瘤的残留率为50%(62/124),并发症发生率为4.03%(5/124).结论 甲状腺癌误诊为良性病变是造成再次手术的主要原因;不规范甲状腺癌手术后再次手术是必要的;提高术者对甲状腺癌的认识水平,强调术中快速冰冻切片病检在甲状腺手术中常规应用,选择恰当的手术方式,是避免甲状腺癌再次手术的关键.

Abstract：

Objective To discuss the main causes, necessity and strategy of reoperation in patients with differentiated thyroid cancer. Methods The clinical data of 124 patients with thyroid cancer who needed reoperation from 2000 to 2010 were analyzed retrospectively. Results In the 124 patients with thyroid cancer required for reoperation, 75 cases were misdiagnosed as benign thyroid tumor and previously received local nodulectomy or subtotal lobectomy, in which the extent of resection was not enough; in 39 cases, the first time surgical modality were unsuitable, of which 27 cases with cervical lymph node metastasis were not performed cervical lymph node dissection, and 12 cases with cervical lymph node metastasis cancer were only performed lymph node biopsy, and the diagnosis of thyroid cancer was ignored. 10 cases suffered reoperation because of failure to diagnosis thyroid cancer by quick pathologic diagnosis. The rate of residual cancer was 50% (62/124) by final pathologic diagnosis,and the rate of complication was 4.03% (5/124). Conclusion Misdiagnosis of thyroid cancer as benign thyroid tumor is the main cause of reoperation. Reoperation is necessary for those patients who received nonstandardized operation. The key points of avoiding reoperation are to improve cognitive level of operator for thyroid cancer, to emphasize the routine application of quick pathologic diagnosis during operation of thyroid and select the best suitable surgical modality.     

老年股骨转子间骨折的外科治疗

股骨转子间骨折是指发生于髋关节囊线以外至小转子下方区域内的骨折，好发于老年病人。随着社会人口老龄化，此类骨折的发生率不断增高。由于长期卧床带来的各种并发症严重威胁患者生命，使得保守治疗的死亡率要成倍高于手术治疗组。因而对于可以耐受手术的患者，绝大多数学者主张积极手术治疗。     

经尿道钬激光剜除术治疗前列腺增生症

目的探讨经尿道钬激光剜除术治疗前列腺增生症的效果。方法采用钬激光前列腺剜除术治疗前列腺增生症50例,并对患者术前、术后的国际前列腺症状评分、生活质量评分及最大尿流率进行比较。结果手术后第3个月,国际前列腺症状评分,从手术前(2280±120)分降至(560±060)分,生活质量评分从手术前(480±072)分降至(150±009)分,最大尿流率从手术前(610±091)m1/s增加至(1730±183)ml/s,疗效显著。结论经尿道钬激光前列腺剜除术治疗前列腺增生症具有损伤小、术后恢复快和住院时间短等优点,具有良好的临床应用前景。     

高功能孤独症患儿全脑白质纤维的弥散张量成像研究

Objectlve To analysis the changes of white matter fiber in autistic disorder.Methods Diffusion tensor imaging(DTI)data were obtained from 18 autistic children and 10 age-,sex-and intelligent quotient matched normal controls.Voxel-based analysis Was applied to assess the fractional anisotropy(FA)in cerebral tissues.Results Compared with the controls,the FA values in autistic children were significantly decreased in the white matter of right inferior frontal gyrus,left middle frontal gyrus and right inferior temporal gyms,and increased in the white matter of left superior parietal lobule(P＜0.001).Furthermore.the white matter changes on left middie frontal gyrus were significandy correlated with the scores of Childhond Autism Rming Scale(CARS)in autistic children(r=-0.63,P=0.005).Conclusion The white matter integrity is probably disconnected in many brain regions in children with autistic disorder.     

医学三维可视化技术在肝癌切除术中的应用现状及发展趋势

正肝癌是世界范围内最常见的恶性肿瘤之一,由于起病隐匿、早期诊断困难、疾病进展迅速,总体预后较差,是导致肿瘤死亡的重要原因之一~([1])。肝癌切除术是目前治疗肝癌最重要的方式之一,尤其是早期肝癌~([2-3])。肝癌的术前诊断及手术规划主要由超声、CT、MRI等传统二维影像学检查辅助完成,即手术医生利用其个人空间想像能力及诊治     

溶组织内阿米巴体外吞噬杀灭肿瘤细胞的显微动态特征

0 引言 溶组织内阿米巴(Entamoeba histolytica)可寄生人类大肠,属无性生殖.其滋养体侵犯宿主肠黏膜可以引起阿米巴病(amoebiasis),包括阿米巴性结肠炎和肠外脓肿.溶组织内阿米巴滋养体可以吸附、凝集、吞噬及溶解正常组织细胞,而棘阿米巴滋养体对HeLa细胞与黑色素瘤细胞有细胞毒及损伤作用[1-2],但是溶组织内阿米巴是否对肿瘤细胞有吸附、凝集、吞噬及溶解作用的研究较少.我们以KB细胞为靶细胞,采取混合培养方法,在显微镜下动态观察了不同时间段溶组织内阿米巴对KB细胞的吞噬杀灭过程,现将结果报道如下:     

微创经皮肾穿刺取石术和后腹腔镜下输尿管切开取石术治疗嵌顿性输尿管上段结石的疗效比较

目的比较微创经皮肾穿刺取石术（minimally invasive percutaneous nephrolithotomy,MPCNL）和后腹腔镜输尿管切开取石术（retroperitoneal laparoscopic ureterolithotomy,RLUL）治疗嵌顿性输尿管上段结石的疗效。方法对72例单侧嵌顿性输尿管上段结石采用MPCNL（45例）或RLUL（27例）治疗,对比2组手术时间、结石清除率和术后高热（〉38．5℃）率。结果72例手术全部成功,手术时间MPCNL组短于RLUL组[（43±9）min与（69±17）min,t=-11．564,P=0．000]。术后第2天结石清除率2组均为100％。术后高热率MPCNL组13．3％（6／45）,与RLUL组11．1％（3／27）比较差异无显著性（Χ^2=0．000,P=1．000）。术后随访1～24个月,平均8个月,2组均未发现有输尿管狭窄和结石复发。结论MPCNL和RLUL治疗输尿管上段嵌顿性结石均是安全、有效的,两者均可以选用。