甲状腺外科手术中喉不返神经的解剖研究

目的 探讨甲状腺手术中如何识别和避免误伤喉不返神经.方法回顾性分析1998年1月至2008年12月3078例甲状腺手术患者的临床资料.结果 3078例患者接受了显露喉返神经的甲状腺手术,共解剖喉返神经4241根.发现喉不返神经12根(0.28%,12/4241),全部位于右侧;其中男性1例,女性11例.12根中Ⅰ型有2根(16.67%,2/12),Ⅱ型有6根(50%,6/12),Ⅲ型有4根(33.33%,4/12).有1根Ⅰ型喉不返神经术中被误伤(8.33%,1/12).结论 甲状腺手术中只要采取正确的解剖方法常规全程显露喉返神经,就可以尽可能的识别和避免误伤喉不返神经.     

Fiberoptic Ductoscopy-Guided Intraductal Biopsy Improve the Diagnosis of Nipple Discharge

Abstract:  Fiberoptic ductoscopy (FDS)-guided intraductal biopsy is a minimally invasive technique developed to obtain pathologic diagnoses for patients with spontaneous nipple discharge. We performed biopsies of 53 intraductal lesions from March 2006 to April 2007 followed by surgical microdochectomy. FDS-guided intraductal biopsy was shown to be a minimally invasive, safe, and convenient technique with a high ability (90.6%) to get adequate samples. Twenty-seven solitary papillomas, 12 multiple intraductal papilloma, five ductal hyperplasia, three ductal carcinoma in situ, and one invasive ductal carcinoma were diagnosed. Compared with conventional microdochectomy, FDS-guided intraductal biopsy can significantly increase the detection rate of solitary papilloma (40.7% versus 92.6%, p < 0.05). It should be a routine procedure after intraductal lesion found by screening FDS. Since it would underestimate all multiple intraductal papilloma and some (50%) cancer, microdochectomy is inevitable if biopsies show atypical ductal hyperplasia.     

胸段食管鳞癌患者的喉返神经旁淋巴结转移特点

目的探究胸段食管鳞癌患者的喉返神经旁淋巴结转移特点。 方法回顾性分析福建协和医院胸外科2012年1月至2015年12月间收治的行胸腹腔镜联合食管癌切除术的294例胸段食管鳞癌患者的喉返神经旁淋巴结清扫及转移情况,并分析喉返神经旁淋巴结转移特点。 结果294例行喉返神经旁淋巴结清扫的患者中,有88例患者有喉返神经旁淋巴结转移,转移率为29.93%;共清扫喉返神经旁淋巴结1 899枚,转移淋巴结145枚,转移度为7.64%。胸段食管鳞癌患者左、右喉返神经旁淋巴结转移与肿瘤浸润深度、分化程度、脉管瘤栓均有显著相关性(P<0.05),但与性别、年龄、肿瘤部位无显著相关性(P>0.05)。 结论胸段食管鳞癌患者易发生喉返神经旁淋巴结转移。对于肿瘤浸润程度大、分化程度差、有脉管瘤栓的胸段食管鳞癌患者,应重视左、右两侧喉返神经旁淋巴结清扫。     

乳腺导管内乳头状瘤术前评估与术式选择

正乳腺导管内乳头状瘤(breast intraductal papilloma)约占乳腺良性疾病的10%,表现为乳管内的乳头状新生物[1]。该病多数是单发病灶,少数为多发病灶,因溢液、肿块而就诊。外科手术是治疗该疾病的惟一手段。1病因及分型乳腺导管内乳头状瘤的病因不明。该病可以分为孤立的导管内乳头状瘤(solitary papilloma)和多发导管内乳头状瘤(multiple papillomas)。孤立的导管内乳头状瘤是起源于     

甲状腺乳头状癌右侧喉返神经背侧中央区淋巴结转移及清扫临床研究进展

正由于超声和超声引导下细针穿刺活检技术的广泛应用,甲状腺癌检出率急剧上升。甲状腺乳头状癌(PTC)是其中最常见的病理学类型,其分化良好,具有生长缓慢、恶性程度低、侵袭性弱、预后良好等特点,恰当的手术方式能有效提高病人存活率,甚至达到临床治愈。PTC最常见的转移方式为颈部淋巴结转移,尤其是中央区淋巴结,转移率高达40%~60%~([1])。常规行中央区淋巴结清扫(CCD)对降低局部复发率、减少二次手术有重要意义,有利于PTC的根     

上尿路内翻性乳头状瘤7例报告

目的：探讨上尿路内翻性乳头状瘤(IP)的临床特征。方法：回顾分析7例上尿路IP患者的临床资料。患者多以无痛性肉眼血尿就诊,影像学检查提示上尿路占位性病变。术中冷冻切片确诊。5例行肾、输尿管全长切除,2例输尿管肿瘤分别作局部及节段切除。结果：术后病理检查均证实为上尿路IP。7例随访19～85个月,无肿瘤复发、恶变。结论：上尿路IP是良性肿瘤,诊断主要依据影像学及内镜检查;治疗主要开放手术及内镜手术。其有易同时或异时并发泌尿系恶性肿瘤可能,术后随访十分重要。     

Clinical value of serum squamous cell carcinoma antigen in the management of sinonasal inverted papilloma

BACKGROUND: Although sinonasal inverted papilloma (IP) is a rare benign tumor, it has a tendency to recur and is sometimes associated with squamous cell carcinoma (SCC). Therefore, postoperative long-term follow-up of these patients is recommended. We previously reported that serum SCC antigen might be a useful tumor marker for sinonasal IP. In this study, we investigated whether serum SCC antigen level has a correlation with disease status and is useful in the early detection of recurrent disease. METHODS: Blood samples for the analysis of serum SCC antigen were taken from 28 IP patients before and after surgical treatment. RESULTS: Twenty-five (89%) of 28 cases showed evaluated serum SCC antigen levels above the upper limit. This marker level decreased in all cases after surgical resection. Four of these patients had a recurrence. None of the patients with recurrent tumor showed symptoms at the time of detection of their recurrent tumor, and recurrence was discovered from elevated levels of SCC antigen. CONCLUSIONS: Serum SCC antigen level has a correlation with disease status of IP and has a potential to serve as a useful tool for monitoring the course of disease. SCC antigen is a reliable tumor marker in the management of sinonasal IPs.     

鼻腔鼻窦内翻性乳头状瘤比较CT与MRI在诊断中的作用

【摘要】目的：分析鼻腔鼻窦内翻性乳头状瘤应用CT和MRI的诊断价值。方法：以102例病理检查确诊为鼻腔鼻窦内翻性乳头状瘤患者为研究对象,分别使用CT和MRI检查,对比CT和MRI检查结果与病理检查结果。结果：CT扫描可清晰显示NIP边界、NIP与鼻腔和鼻窦关系;MRI扫描可观察鼻腔鼻窦内黏膜及潴留分泌物,可清晰显示肿瘤及周边软组织关系。97例（95.1%）患者的CT检查分期符合病理检查结果,100例（98%）患者的MRI检查分期结果符合的病理检查结果,CT和MRI扫描分期符合率差异无统计学意义（P＞0.05）。结论：CT和MRI诊断NIP的价值较高,联合CT和MRI检查可提高疾病诊断率。