腮腺肿瘤手术围手术期护理干预的临床应用研究

目的探讨对腮腺肿瘤手术进行围手术期护理干预临床疗效。方法对25例腮腺肿瘤手术患者进行心理干预、专科术前准备、伤口疼痛护理、并发症的预见性护理和重点加强负压引流观察。结果通过对腮腺肿瘤患者进行一系列的护理干预,为手术提供了安全保障。结论腮腺手术围手术期护理干预可以稳定患者情绪,促进术后康复,是提高手术质量的重要辅助环节。     

47例内镜甲状腺手术与传统手术的疗效比较

目的汇报经胸前壁乳晕径路的内镜甲状腺手术47例,对其安全可行性和治疗效果进行分析探讨。方法对2005年8月至2008年8月术前诊断为良性甲状腺疾病的47例患者采用内镜甲状腺手术治疗。结果内镜手术组手术时间为（82.2±22.3）min,术中出血量为（37±17）mL,术后住院天数为（4.5±1.2）d,对手术后美容效果的满意度为91.5%。患者术后出现皮下瘀斑2例,其后自行消褪,无一例中转开放手术。颈部引流管术后24～36h拔除。结论经胸前壁径路具有较好的美容效果,术式可根据患者病情来自主选择术式。     

前列腺增生患者住院费用影响因素分析

目的分析前列腺增生患者住院费用影响因素,探讨控制医疗费用不合理增长的有效途径。方法以主要诊断为前列腺增生的296例住院患者为例,采用多元逐步回归分析方法及相关性检验对可能影响因素进行筛选。结果影响前列腺增生患者住院费用的因素有：药品费、化验费、检查费、住院天数、年龄等。结论控制住院费用增长的途径：降低药品价格、合理检查、缩短患者住院日、做好老龄人口的保健工作。     

彩色多普勒超声对甲状腺微小癌诊断价值的研究

[目的]探讨彩色多普勒超声对甲状腺微小癌的诊断价值,误诊分析及如何提高对甲状腺微小癌的早期诊断水平。[方法]分析36例经手术和病理证实的甲状腺微小癌的彩色多普勒超声诊断及临床治疗资料。[结果]彩色多普勒超声诊断与病理诊断符合率为47．22％（17／36）,病变性质待定11例（30．56％）,误诊为良性病变8例（22．22％）。超声引导下行细针穿刺抽吸细胞学检查阳性率为95％（19／20）。[结论]甲状腺微小癌起病隐匿,术前较难确诊,虽然彩色多普勒超声对甲状腺微小癌诊断有其局限性,但对甲状腺微小癌病灶的声像图进行综合分析,选择恰当的手段可提高甲状腺微小癌的早期诊断率。     

肾上腺皮质髓质混合性病变的诊治研究

目的：提高对肾上腺皮质髓质混合性病变的诊治水平。方法：总结1987-2007年29例肾上腺皮质髓质混合性病变患者的临床资料。临床表现高血压29例,伴头痛16例、心悸10例和肌无力10例。10例血清钾2.4-3.2mmol／L,平均2.87mmol／L。血皮质醇9例增高,节律异常2例。24h尿香草基杏仁酸8例增高。2004年后8例24h尿甲氧基去甲肾上腺素中1例增高;24h尿甲氧基肾上腺素中2例增高。24例中血浆肾素：卧位中9例增高,2例降低。立位中7例增高,6例降低。血管紧张素：卧位中7例增高;2例降低。立位中6例增高,4例降低。醛固酮：卧位中5例增高,立位中3例增高。CT扫描检查：7例。肾上腺增生,14例肾上腺结节状增生,8例腺瘤,平扫CT值2.6-41.0Hu,平均21.0Hu;增强CT值26.0-74.3Hu,平均57.0Hu。结果：开放手术8例,后腹腔镜手术21例,手术时间：开放90-180min,平均110min;后腹腔镜25-70min,平均45min。术中血压变化6例〉50mmHg,23例〈50mmHg。术后7-10天出院。29例中26例随防时间1-5年手术部位未见增生、结节及肿瘤复发。18例患者血压正常,8例仍需服用降压药控制血压,但药物种类和剂量减少。病理诊断：13例肾上腺皮质髓质增生,3例肾上腺皮质髓质增生,皮质增生为主,4例肾上腺皮质髓质增生,髓质增生为主,1例。肾上腺皮质髓质增生伴嗜铬细胞瘤,1例肾上腺皮质结节状增生伴髓质增生,3例肾上腺皮质腺瘤伴皮质髓质增生,4例肾上腺皮质腺瘤伴髓质增生。结论：肾上腺皮质髓质混合性病变临床少见,确诊靠病理诊断。手术是治疗的主要方法,腹腔镜下手术值得推荐。     

Recurrent salivary gland carcinomas treated by surgery with or without intraoperative radiation therapy

BACKGROUND: The optimal treatment for patients with locally recurrent carcinomas of the salivary glands is unclear. METHODS: Ninety-nine patients underwent salvage surgery for locally recurrent salivary gland carcinomas. Eighty-one (82%) had previously received radiation. Thirty-seven patients (37%) received intraoperative radiation therapy (IORT) to a median dose of 15 Gy (range, 12-18 Gy) at the time of salvage. RESULTS: The 1-, 3-, and 5-year estimates of local control after salvage surgery were 88%, 75%, and 69%, respectively. A Cox proportional hazard model identified positive margins (0.01) and the omission of IORT (p = .001) as independent predictors of local failure. The 5-year overall survival was 34%. Distant metastasis was the most common site of subsequent failure, occurring in 42% of patients. CONCLUSIONS: IORT significantly improves disease control for patients with locally recurrent carcinomas of the salivary glands. The high rate of distant metastasis emphasizes the need for effective systemic therapies.     

Acinic cell carcinoma of the parotid gland: Auckland experience and literature review

Acinic cell carcinoma is an uncommon malignancy of the salivary glands and as such it has been difficult to accurately delineate its natural history. The aim of this study is to assess the behaviour of acinic cell salivary cancer of the parotid gland presenting to a single head and neck surgical unit in Auckland. The study is a structured review of cases of acinic cell carcinoma of the parotid gland presenting from 2000 to 2006 to the Head and Neck Unit at Auckland Hospital, those identified from the pathology database and the Otobase head and neck database. Case records and pathology reports were reviewed. Fifteen patients were identified, 9 men and 6 women. The mean age was 67.2 years, with range 50-85 years. The mean follow up was 4.4 years and range 1.1-7 years. There was one case of local recurrence during study period and no deaths. Five of 15 patients received postoperative radiotherapy. Postoperative complications consisted of one wound haematoma and two cases of marginal mandibular weakness (one transient and one permanent). Current management strategies are obtaining appropriate rates of recurrence and postoperative complications within the Auckland population.     

Surgical management of large adrenal tumours: the University of Miami experience using liver transplantation techniques

OBJECTIVE

To report our experience in the surgical management of patients with large adrenal masses and describe the key steps in performing radical resections, which are especially demanding where thrombi extend into the inferior vena cava (IVC).

PATIENTS AND METHODS

From 2003 to 2007, 14 patients presented with large adrenal mass, and underwent surgical extirpation. In five patients thrombi extended into the IVC, causing Budd–Chiari syndrome in one.

RESULTS

The median (range) patient age was 48 (40–58) years. The excision was radical with negative tumour margins in all cases. Cardiopulmonary bypass (CPB) was required in one case with adherent intra‐atrial thrombus. The mean blood loss was 500 (250–1500) mL except in the patient who required CPB. Morbidity included pleural effusion (three patients) and postoperative pneumonia (two), which responded to conservative management. All patients were alive and free of disease at a median follow‐up of 12 (5–42) months.

CONCLUSIONS

Surgical extirpation of large adrenal masses requires technical experience to optimize outcome. Total tumour excision is the only therapeutic option in such cases and provides acceptable results in survival and quality of life.     

The Utility of Metaiodobenzylguanidine (MIBG) Scintigraphy in Patients with Pheochromocytoma

Background Radiolabeled metaiodobenzylguanidine scintigraphy (MIBG) can be used to image pheochromocytomas. While cross-sectional imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) usually localize the tumor, MIBG is often obtained to rule out multifocal and metastatic disease, and to corroborate anatomic imaging with functional data. We questioned the utility of MIBG in the diagnosis and management of pheochromocytoma. Methods All patients who received MIBG at one academic center from 1999 to 2004 were identified. For the subset of patients who received MIBG in the work-up of possible pheochromocytoma, the following data were reviewed: demographics, symptoms, results of biochemical and imaging studies, histopathological diagnosis, and management. Results A total of 60 patients received MIBG, including 27 patients for the evaluation of a possible pheochromocytoma. Biochemical testing was performed in all patients. Fourteen patients received MIBG despite normal biochemistry and an absence of risk factors such as a hereditary syndrome or prior history of pheochromocytoma. None of these 14 low-risk patients with negative biochemistry had a final diagnosis of pheochromocytoma. In the ten patients with pheochromocytoma, all tumors were localized by CT and/or MRI. Importantly, MIBG did not identify any foci of disease not seen on cross sectional imaging, and MIBG did not alter the surgical management of any patient in this series. Conclusions In patients with clinical findings suggestive of pheochromocytoma, biochemical testing should be used to confirm the diagnosis, and cross-sectional imaging is sufficient for tumor localization. In the absence of hereditary disease or a past history of pheochromocytoma, MIBG does not alter the treatment plan and therefore should not be routinely performed. Instead, MIBG should be used selectively, such as for the rare patient with a biochemical diagnosis of pheochromocytoma and no tumor seen on exhaustive anatomical imaging. Presented at the 60th Annual Cancer Symposium of the Society of Surgical Oncology, Washington, D.C., March 15–18, 2007.     

Adrenal Schwannoma Treated With Laparoscopic Surgery

Objective:

We report a case of left adrenal schwannoma in a 62-year-old man, incidentally discovered on an abdominal computed tomography. It was successfully treated with laparoscopic adrenalectomy.

Methods:

On admission, no remarkable findings were recognized in the patient''s blood and urine examination, including adrenal function. Laparoscopic left adrenalectomy was performed with the diagnosis of a nonfunctioning adrenal tumor.

Results:

Macroscopically, the tumor (45 mm × 30 mm, 60 g) arose from the medulla of the adrenal gland with a clear border distinguishing it from surrounding tissues. Histologically, the tumor consisted uniformly of spindle cells that were positive for S-100. The cortex was compressed but showed no atrophy. The diagnosis of adrenal schwannoma was made.

Conclusion:

Although an increasing number of adrenal incidentaloma have been identified with the recent advances in imaging techniques, only a few cases of schwannoma of the adrenal gland have been reported. We reviewed the cases reported previously in an attempt to reveal the characteristic features of this rare disease.