细胞增殖特性与良性脑膜瘤复发的关系

目的 :探索良性脑膜瘤的复发与肿瘤细胞增殖能力的关系 ,并寻找能预测其复发的指标。　方法 :对 1 5例复发的良性脑膜瘤和 2 2例非复发的良性脑膜瘤共 4 9份标本分别进行增殖细胞核抗原 (PCNA)和Ki 6 7的免疫组化染色 ,计数阳性细胞数的比率即标记指数 (LI) ,比较各组间的PCNALI和Ki 6 7LI。　结果 :复发的良性脑膜瘤的PCNALI和Ki 6 7LI均显著高于未复发组 (P <0 .0 5 ) ;复发组中同一患者前后两次手术标本的PCNALI和Ki 6 7LI均无显著差异 (P >0 .0 5 )。　结论 :复发的良性脑膜瘤的细胞增殖性高于未复发组 ,当PCNALI>2 .0 %时 ,提示肿瘤有复发倾向。良性脑膜瘤复发后其增殖特性无明显改变     

Solitary lucent epiphyseal lesions in children

We evaluated retrospectively the varying radiographic appearances of 15 solitary lucent epiphyseal lesions occurring in children. Imaging modalities used included plain films, conventional tomography, nuclear scintigraphy, and computed tomography. Forty percent of the lesions (6) were due to osteomyelitis. The remaining lesions included tuberculosis (1), foreign body granuloma (1), chondroblastoma (2), chondromyxoid fibroma (1), enchondroma (1), osteoid osteoma (2), and eosinophilic granuloma (1). Although the radiographic appearances of such lesions may be particularly characteristic, pathologic correlation is frequently necessary. The high incidence of osteomyelitis in our cases emphasizes its importance as a cause for a lucent epiphyseal lesion.     

经尿道前列腺电汽化联合撬拨术治疗高龄前列腺增生症

目的探索微创手术治疗高龄前列腺增生症(benign prostatic hyperlasia,BPH)的安全有效新方法. 方法采用经尿道前列腺电汽化(transurethal vaporiyation of prostate,TUVP)联合撬拨术治疗80岁以上BPH 68例. 结果手术时间30～160 min,平均60 min,切除腺体重量12.5～98.5 g,平均37.6 g,术中出血量30～120 ml,平均65 ml,术后住院5～7 d,平均6 d.术后随访0.5～2年,国际前列腺症状评分由(23.5±4.2)分降至(6.5±2.1)分,生活质量评分由(4.6±0.6)分降至(2.2±0.2)分,最大尿流率由(8.7±4.3)ml/s升至(18.0±2.2)ml/s,剩余尿由(176.0±86.7)ml降至(12.2±2.4)ml.与术前相比,术后6个月均得到显著改善(P＜0.01). 结论 TUVP加撬拨术治疗高龄BPH安全有效,并发症少.     

电视硬质气管镜治疗大气道良性肿瘤

目的探讨电视硬质气管镜在大气道良性肿瘤治疗中的价值.方法2002年9月～2005年4月,我院应用电视硬质气管镜治疗大气道良性肿瘤7例,其中气管1例,隆突1例,左主支气管3例,右主支气管2例.手术采用静脉全身麻醉,喷射通气供氧,探查评估气道后,首先冷冻或电凝肿瘤,破坏肿瘤血供,再以活检钳分块取出,蒂部采用冷冻或氩气凝固处理;对于宽蒂肿瘤,内镜下将肿瘤主体清除后中转开胸行气管局部切除吻合术.结果7例手术均顺利,无一例死亡和严重并发症发生.6例气管窄蒂良性肿瘤镜下完整摘除,1例气管膜部宽蒂平滑肌瘤先内镜清除肿瘤主体后中转开胸行气管局部切除.术后病理为错构瘤2例,平滑肌瘤3例,嗜酸性肉芽肿性腺瘤1例,炎症组织1例.7例随访3～36个月,平均17.3月,无肿瘤复发.结论电视硬质气管镜治疗大气道良性肿瘤安全可靠.     

经阴道行良性卵巢囊肿剥离术195例报告

目的探讨经阴道行良性卵巢囊肿剥离术的临床实用价值.方法2001年1月2004年6月对有手术指征的良性卵巢囊肿195例实施阴式手术,并观察有关手术指标.结果经阴道完成手术190例,5例因盆腔广泛粘连中转开腹.手术时间45～83 min,平均50 min.术中出血30～90 ml,平均45 ml.术后排气时间4～24 h,平均8.5 h.术后病率18.4%(35/190).183例随访2周内恢复日常家务及工作者分别为72.1%(132/183)、48.1%(88/183).结论经阴道行良性卵巢囊肿剥离术是一种安全、微创的手术.     

Factors affecting early and long-term outcomes after completion pneumonectomy

Objective: To identify factors that affect operative mortality and morbidity and long-term survival after completion pneumonectomy. Methods: We retrospectively reviewed the charts of consecutive patients who underwent completion pneumonectomy at our cardiothoracic surgery department from January 1996 to December 2005. Results: We identified 69 patients, who accounted for 17.8% of all pneumonectomies during the study period; 22 had benign disease and 47 malignant disease (second primary lung cancer, n = 19; local recurrence, n = 17; or metastasis, n = 11). There were 50 males and 19 females with a mean age of 60 years (range, 29–80 years). Postoperative mortality was 12% and postoperative morbidity 41%. Factors associated with postoperative mortality included obesity (p = 0.005), coronary artery disease (p = 0.03), removal of the right lung (p = 0.02), advanced age (p = 0.02), and renal failure (p < 0.0001). Preoperative renal failure was the only significant risk factor for mortality by multivariate analysis (p = 0.036). Bronchopleural fistula developed in seven patients (10%), with risk factors being removal of the right lung (p = 0.04) and mechanical stump closure (p = 0.03). Overall survival was 65% after 3 years and 46% after 5 years. Long-term survival was not affected by the reason for completion pneumonectomy. Conclusion: Although long-term survival was acceptable, postoperative mortality and morbidity rates remained high, confirming the reputation of completion pneumonectomy as a challenging procedure. Significant comorbidities and removal of the right lung were the main risk factors for postoperative mortality. Improved patient selection and better management of preoperative renal failure may improve the postoperative outcomes of this procedure, which offers a chance for prolonged survival.     

腮腺间隙良性肿瘤的MRI诊断

目的探讨腮腺间隙常见良性肿瘤的影像特征及其诊断与鉴别诊断。方法良性肿瘤20例，包括多形性腺瘤13例、乳头状淋巴囊腺瘤3例、淋巴管瘤2例、血管瘤1例、脂肪瘤1例。经手术病理证实15例，穿刺活检证实4例，典型MR特征结合病史确诊1例。结果13例多形性腺瘤中有11例位于腮腺浅叶，2例位于深叶；9例表现为均匀等T1长T2信号．4例在T2WI上信号明显不均匀；静脉注射Gd—UIPA后3例瘤实质均匀强化，4例增强后明显不均匀强化。3例Warthin瘤中2例发生于一侧，1例累及双侧腮腺，在T1WI上呈低信号，T2WI上信号等于或低于正常腺实质，增强后无明显强化。2例淋巴管瘤呈明显长T1长T2信号，并有多房现象。1例血管瘤信号不均质，呈明显长T1长T2信号，静1脉注射Gd—DTPA后病变往往显著异常强化。1例脂肪瘤在T1WI及T2WI上均表现为明显高信号强度。结论运用MR成像研究腮腺间隙的良性肿瘤，有利于疾病的定位，有助于病变的诊断与鉴别诊断。     

同时性后半规管与水平半规管性良性位置性眩晕

目的：探讨同时性后半规管与水平半规管性良性位置性眩晕（混合性良性位置性眩晕）的诊治方法。方法：联合应用Epley手法和Barbecue翻滚法对4例患者进行治疗，两次治疗间隔1d。结果：4例患者眩晕症状完全消失，随访至今无复发。结论：混合性良性位置性眩晕兼有后半规管与水平半规管性良性位置性眩晕的临床表现，联合采用Epley手法和Barbecue翻滚法治疗该病是可行的。     

侧脑室－头静脉分流术治疗梗阻性脑积水

通过对２５例成人尸体的解剖学调查及应用＂侧脑室─头静脉分流术＂治疗２３例梗阻性脑积水的临床疗效观察，旨在确立一种脑积水症手术分流的新途径。２３例手术病人显效率９２％（２１／２３）。１８例（７８％）基本恢复正常。３例（１３％）明显好转。２例轻度改善。分析表明：头静脉具备位置浅表恒定、管径适宜、瓣膜可防止血液返流等解剖学特点。是一条可供选择的较为理想的脑积水症分流途径。     

良性淋巴上皮病、淋巴上皮癌、MALT淋巴瘤的关系

良性淋巴上皮病(benign lymphoepithelial lesion)、淋巴上皮癌(lymphoepithelial carcinoma)、黏膜相关淋巴组织型结外边缘区B细胞淋巴瘤(MALT淋巴瘤)(extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue,MALT lymphoma)是3种性质不同但又存在某些关联的病变,本文对3种病变的病因、组织病理学表现及三者之间的关系进行了介绍,并结合叶为民等论文中的一些内容进行了简要探讨。