胬肉切除联合球结膜瓣转位术的疗效

目的:探讨胬肉切除联合球结膜瓣转位术技巧及其疗效分析。方法:胬肉切除联合球结膜瓣转位术操作要点:术眼在表麻和浸润麻醉下,彻底切除胬肉及受累及的球筋膜组织。于上方球结膜下注入20g/L利多卡因使球结膜与结膜下组织分离,并作一条与角膜缘平行的带蒂球结膜瓣,将其转位覆盖在巩膜裸露区,并予缝合固定。术后用氯霉素地塞米松眼液滴眼,6～7d拆线。采用此术式治疗翼状胬肉患者379例(386眼),其中原发性翼状胬肉患者373例(380眼),复发性翼状胬肉患者6例(6眼)。结果:手术治愈373例(380眼),治愈率为98.4%;复发6例(6眼),复发率为1.6%。术后复发者经再次作手术,全部治愈。结论:胬肉切除联合球结膜瓣转位术治疗翼状胬肉效果显著,此术式值得推广应用。     

Favorable outcome after radical excision of a 'Holocord' astrocytoma

We report a favorable outcome following a staged radical excision of an intramedullary low-grade astrocytoma involving the entire spinal cord in a pediatric patient. Although the preoperative neurological status was poor, the eventual outcome was good. This highlights the importance of a good tumor-cord interface that permitted a radical excision of an extensive tumor. Since partial excision followed by radiotherapy usually results in disease progression in patients with low-grade astrocytomas, radical excision and follow-up is probably the treatment of choice.     

宫颈上皮内瘤变阴道镜下活检与电环切除术后病理的对比分析

目的 对比分析宫颈上皮内瘤变（CIN）阴道镜下活检与电环切除术后病理，提高CIN诊断的准确性。方法 回顾性对比分析216例宫颈上皮内瘤变阴道镜下活检与电环切除术后病理，探讨影响两者符合率的相关因素。结果 两者对比，宫颈电环切除术（LEEP）后病理结果与阴道镜下活检相符的74例，升级的18例，降级的124例。阴道镜下检查不满意者活检与电环切除术后病理对比，升级率大于阴道镜下检查满意者，差异有显著性（P〈0．01）。结论 宫颈转化区向宫颈管上移者，要注意宫颈管内的病变。宫颈电环切除术可以部分弥补阴道镜下活检的缺陷，且有治疗作用。     

乳腺癌手术保留肋间臂神经的临床价值

目的探讨乳腺癌手术腋窝淋巴结清扫时保留肋间臂神经的临床价值。方法84例Ⅰ、Ⅱ、Ⅲa期乳腺癌患者,随机分为两组,试验组(36例)拟行乳腺癌腋窝淋巴结清扫术时保留肋间臂神经,对照组(48例)拟行常规手术切除肋间臂神经。术后对两组患者进行观察并随访。结果试验组术后发生上肢感觉障碍7例(19.4%),而对照组有35例(72.9%),二者比较差异有统计学意义(χ2=23.53,P<0.005);经3~48个月随访均未发现局部复发。结论Ⅰ、Ⅱ、Ⅲa期乳腺癌行腋窝淋巴结清扫术时保留肋间臂神经可以明显减少术后患侧上肢感觉障碍的发生,提高生存质量。     

宫颈环形电刀切除术治疗212例宫颈上皮内瘤变价值探讨

目的:探讨宫颈环形电刀切除术(LEEP)治疗宫颈上皮内瘤变(CIN)的价值。方法:回顾分析2000年3月至2004年10月212例CIN患者在阴道镜辅助下行宫颈环形电切术的治疗情况。结果:阴道镜下宫颈异常结构处取活检病理结果为CIN者212例行宫颈环形电切术(LEEP),LEEP术后病理检查:宫颈粘膜慢性炎症13例(6.1%)、CINⅠ90例(42.5%)、CINⅡ77例(36.3%)、CINⅢ24例(11.3%),原位癌累及腺体伴早期浸润癌8例(3.8%)。术后195例(92.0%)宫颈标本边缘病理学检查未见CIN病变;术后降级者70例(33.0%),等级者122例(57.5%),升级者20例(9.4%);治愈率达89.2%。结论:LEEP治疗CIN安全有效、简单易行、并发症少、避免了二次手术和过度治疗,能保留患者的生育能力,在治疗的同时能进行诊断。但术后仍需定期和规范的随访以防止宫颈癌的发生和发展。     

全直肠系膜切除术治疗中下段直肠癌

目的:探讨全直肠系膜切除术治疗中下段直肠癌的临床疗效。方法:回顾性分析采用保留植物神经的全直肠系膜切除术治疗86例中下段直肠癌的临床资料。结果:全组无手术死亡,平均手术时间为126±42min,术中失血平均235.30±189.50ml,发生吻合口瘘2例(2.33%)。术后拔尿管时间3~14d,平均6.23d。术后4周随访,保肛组67例中51例(76.1%)控便能力良好,术后勃起功能障碍发生率24.1%(14/58),射精功能障碍发生率为27.6%(16/58)。随访时间6个月~9年,平均46个月。发生局部复发2例(2.33%)。术后3、5年生存率分别为81.4%和63.2%。结论:全直肠系膜切除术是预防中低位直肠癌的局部复发,提高生活质量的有效措施。直肠癌根治性手术中采用TME手术方法是完全必要的。     

MRI and conservative treatment of locally advanced breast cancer

AIMS: The objectives of this study were to compare the efficacy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing the response of primary breast carcinoma to neoadjuvant chemotherapy compared to conventional imaging modalities, and to see how surgical outcome was influenced as a result of these findings. METHODS: Thirty-four patients with locally advanced primary breast cancer underwent conventional imaging and DCE-MRI following six cycles of neoadjuvant chemotherapy prior to surgery. Changes in surgical management based on the post-chemotherapy DCE-MRI findings were recorded. RESULTS: Prior to neoadjuvant chemotherapy, 22 of the 34 patients were assessed as requiring mastectomy and the remaining 12 were considered inoperable. Following chemotherapy two patients were still considered inoperable. In 11 of the 34 patients, the final decision to proceed to either mastectomy or non-surgical management was based primarily on pre-treatment disease status or patient choice. DCE-MRI findings, therefore, contributed to the operative decision in 21 of 34 patients. Two of these 21 patients were spared surgery as DCE-MRI demonstrated complete response to chemotherapy and one declined surgery. The remaining 18 were able to undergo wide local excision, with only two patients subsequently requiring mastectomy for involved margins. CONCLUSIONS: DCE-MRI is able to accurately predict those patients suitable for breast conserving surgery following neoadjuvant chemotherapy and should be the imaging modality of choice in assessing the response of patients with primary breast carcinoma to neoadjuvant chemotherapy.     

Arthroscopic Management of Giant Meniscal Cysts Among Young Patients: An Average Three‐Year MRI Follow‐Up

ObjectiveTo describe an arthroscopic technique for giant meniscal cyst excision with preservation of the functional meniscus, report the short‐ and medium‐term outcomes, and assess magnetic resonance imaging (MRI) for follow‐up imaging evaluations.MethodsA total of 54 consecutive patients with symptomatic meniscal cysts were admitted to the Second Xiangya Hospital of Central South University between 2014 and 2019. Nine patients with giant meniscus cysts (six females and three males) were included in this study. The age range of the patients was 6–34 years. All patients underwent a complete physical examination, X‐ray, Doppler ultrasound, and MRI of the knee preoperatively. After an arthroscopic diagnosis of a meniscal rupture with a giant meniscal cyst, partial meniscectomy, ablation of the cyst, and suturing of the retainable meniscus were performed. Lysholm and International Knee Documentation Committee (IKDC) scores were used preoperatively and at the most recent follow‐up. Clinical outcomes were classified into four categories: excellent, good, fair, and poor. During the last visit, all patients underwent MRI to assess the recurrence of the cyst and meniscal suture healing.ResultsPreoperative MRI and arthroscopic examination revealed giant meniscal cysts combined with meniscal tears and congenital discoid meniscus, and all giant meniscal cysts occurred in the lateral meniscus. The main types of meniscal tears were horizontal and complex tears. The cysts were unicystic in one case and multicystic in eight cases. The mean size of the cysts on the MRI was 5.86 cm × 2.24 cm × 2.48 cm. The mean follow‐up periods were 37.5 (19–60) months. Clinical outcomes were excellent in six patients and good in three patients. The postoperative scores were significantly improved compared to the preoperative scores (Lysholm: 90.78 ± 4.60 vs. 54.56 ± 7.25; IKDC: 96.2 ± 3.46 vs. 61.69 ± 3.36; p <0.01). No recurrence of the cyst was indicated on the MRI, and there was good healing of the torn meniscus.ConclusionsArthroscopic cystectomy combined with the meniscus suture technique was effective to eradicate residual cyst cavities, and traffic orifices be highly recommended.     

Fibrin glue assisted amniotic membrane graft reconstruction of conjunctival fornix and canthus following excision of conjunctival tumours

Conjunctival tumors involving non-limbal locations, such as the fornix and canthus, are typically excised using a “non-touch” technique, often with a wide surgical margin. Reconstruction of these large defects can be difficult due to the contour of the ocular surface and are often complicated by shortening of the fornix, symblepharon formation, and restriction of eye movements. In our experience, the use of amniotic membrane grafts combined with the sealant properties of fibrin glue such as Tisseel® has improved our surgical outcomes during the reconstruction phase. We would like to highlight and describe our surgical technique using fibrin glue and squint hooks to aid amniotic membrane graft reconstruction for surgically challenging locations in the fornix and canthus following excision of conjunctival lesions, with excellent surgical outcomes.     

云南白药联合宫颈环形电切术治疗慢性宫颈炎82例

目的:观察云南白药联合宫颈环形电切术治疗难治性慢性宫颈炎的临床疗效.方法:选取本院2012年5.月-2014年5月收治的164例难治性慢性宫颈炎患者,随机分为治疗组与对照组各82例,对照组给予宫颈环形电切术治疗,治疗组在对照组治疗的基础上配合云南白药治疗,观察两组阴道排液、出血及宫颈创面的愈合情况及治愈率.结果:治疗组患者的阴道排液时间及出血量均少于对照组,创面的愈合时间也较对照组短(P＜0.01);治疗组治愈率97.56％明显高于对照组的79.27％(P＜0.01).结论:云南白药联合宫颈环形电切术治疗难治性慢性宫颈炎疗效显著.