脾大部切除后胸腔残脾形态和功能的远期疗效评价

目的评价门静脉高压症巨脾大部切除后胸腔残脾的形态与功能。方法门静脉高压症巨脾行脾大部切除40例,采用外周血细胞计数,免疫指标检测,99mTc同位素扫描,DSA造影及CT扫描进行评价。结果外周血细胞计数术后明显改善,血清Tuftsin和IgM水平无变化,残脾形态和吞噬功能正常,残脾显像良好,脾肺间形成侧支循环。结论胸腔残脾可长期存活,脾吞噬功能和免疫功能正常。门静脉高压症巨脾保脾术比脾外伤更有临床意义。     

Laparoscopic splenectomy: a personal series of 140 consecutive cases

Introduction

Laparoscopic splenectomy has emerged as a safe and effective treatment for a variety of haematological conditions. The objective was to review the results from a large personal series from the perspective of outcomes according to operative time, conversion to open operation, complications and mortality. The application of laparoscopic splenectomy to cases of splenomegaly without hand assistance is examined.

Patients and Methods

A retrospective review of 140 patients undergoing laparoscopic splenectomy at a single university hospital by one surgeon during 1994-2006. Case notes were reviewed and data collected on operative time, conversion to open procedure, morbidity and mortality. Particular reference was made towards the results of cases of splenomegaly.

Results

In total 140 laparoscopic splenectomies were performed with a complication rate of 15% and no mortality. The median operative time was 100 min and conversion to open procedure was necessary in 2.1%. Conversion for cases of splenomegaly was only 5.7%. The median hospital stay was 3 days.

Conclusions

Laparoscopic splenectomy is a safe procedure with acceptable morbidity. A laparoscopic approach for splenomegaly is feasible.     

一氧化氮、一氧化氮合酶在肝硬化门静脉高压症中的研究进展

一氧化氮(NO)具有重要的生物活性,与肝硬化门静脉高压症的发生、发展密切相关。一氧化氮合酶(NOS)是NO合成的关键酶,目前一些通过干预NOS来调整局部(如肝脏、内脏血管)NO浓度进行治疗的研究已取得一定的进展,本文就NO、NOS在肝硬化门静脉高压症中的相关研究予以综述,为研究其发病机制和治疗提供新的切入点。     

Laparoscopic splenectomy for lymphoproliferative disease

Background: Elective laparoscopic splenectomy (LS) achieves excellent results for benign hematologic diseases. The role of LS for hematologic malignancies is harder to define owing to associated splenomegaly and patient disease that may alter outcome. Methods: Retrospective review of single institution experience 1996 through 2002. To limit variability of disease processes, only patients with immune thrombocytopenic purpura (ITP) and lymphoproliferative disease (LPD) were studied. Results: A total of 211 LS have been performed, including 73 for LPD and 86 for ITP. Patients with LPD were significantly older, 61 vs 46 years p<0.001; male, 45 (62%) vs 33 (38%), p<0.001; and larger splenic weight, 680 vs 162 g, p<0.001. Fifty-nine patients (81%) with LPD were operated with standard LS with a conversion rate of 15%. Hand-assisted LS was performed in 14 patients (19%), and three were converted to open. Compared to ITP, patients with LPD had longer operative time, 148 vs 126 min, p<0001, and higher blood loss, 200 vs 100 cc, p = 0.004. There was one mortality (0.6%), and morbidity occurred in six patients (8%) with LPD and seven (8%) with ITP. The median length of stay was 3 days for LPD and 2 days for ITP, p = 0.03. Forty-six patients were principally operated for a diagnosis, and 27 (60%) were found to have lymphoma. Conclusions: LS can be performed safely in patients with LPD, and when used judiciously with hand-assisted techniques can be performed with low conversion and morbidity rates. Splenectomy plays an important role in establishing the diagnosis of lymphoma in LPD.     

重型β地中海贫血患者肝脾肿大原因探析

目的 探讨重型β地中海贫血(thalassemia major,TM)患者肝脾肿大的影响因素.方法 2008-07/2010-03月,171例TM患者接受腹部超声检查,观察其肝脾肿大情况及胆囊结石的发生,并记录一般情况、输血和去铁状况,测量血清铁蛋白浓度.结果 171例患者中113例肝脏增大,89例脾脏增大,15例曾行...     

Trichobezoar masquerading as massive splenomegaly: Rapunzel's syndrome revisited

Trichobezoars are usually formed due to ingestion of hair or hair-like fibres and present with a wide spectrum of clinical manifestations. We report a case of Rapunzel''s syndrome associated with trichotillomania in a 16-year-old girl who presented to our Haematology unit with complaints of fatigue, abdominal distention, and early satiety. Initial evaluation demonstrated anaemia, thrombocytosis, and a left hypochondrial mass suggestive of splenomegaly. However, ultrasound of the abdomen showed no hepatosplenomegaly and blood investigations were not suggestive of haematological malignancy. Not long after, the patient presented to the emergency department with suspected acute abdomen. Computed tomography of the abdomen revealed intraluminal gastric and jejunal masses causing small bowel obstruction. Emergency laparotomy confirmed gastric and jejunal trichobezoars, and subsequent psychiatric evaluation confirmed trichotillomania. Clinicians should consider trichobezoar in the differential diagnosis of abdominal pain and a non-tender ‘spleen-like’ abdominal mass.