腹腔镜下卵巢畸胎瘤剥除术对患者生育力影响的临床研究

目的探讨腹腔镜下卵巢畸胎瘤剥除术的临床应用及其对患者生育力的影响。方法将随访到的222例已婚有生育要求但未产未育的卵巢畸胎瘤患者分为腹腔镜组和开腹手术组。每组的手术方式分别为单侧畸胎瘤剥除术、双侧畸胎瘤剥除术、单侧附件切除术和单侧附件切除＋对侧卵巢畸胎瘤剥除术。结果单侧畸胎瘤剥除术组,无论开腹手术还是腹腔镜下手术,其第一年的首次妊娠率、术后一年月经正常的比例、首次妊娠的活胎分娩率均分别高于双侧畸胎瘤剥除术组、单侧附件切除术组和单侧附件切除＋对侧畸胎瘤剥除术组,而其首次妊娠的平均时间、首次妊娠的自然流产率却低于其它各组。单侧畸胎瘤剥除术组患者的各项生育力指标与其它各组相比较,除术后一年月经正常比例的部分数据外（见表）,其余差异均具有显著（P〈0．05）或极显著（P〈0．01）意义。在单侧畸胎瘤剥除术组中,腹腔镜下手术其第一年的首次妊娠率、术后一年月经正常的比例、首次妊娠的活胎分娩率均高于开腹手术,但组间差异无统计学意义。而首次妊娠的平均时间、首次妊娠的自然流产率均低于开腹手术,但组间差异也无统计学意义。结论腹腔镜下卵巢畸胎瘤剥除术对患者生育力的影响较小,是年轻患者有生育要求的理想手术方式。     

Low-grade mucinous epithelial neoplasm (intestinal type) arising in a mature sacrococcygeal teratoma with late recurrence as pseudomyxoma peritonei

Mucinous epithelial neoplasms associated with mature teratomas are well described in the gonads, and some examples have presented with clinical pseudomyxoma peritonei. The association between pseudomyxoma peritonei and an extragonadal teratoma is limited to a single case report. We describe a mature teratoma in the sacrococcygeal region associated with an intestinal-type mucinous epithelial neoplasm that recurred with a disseminated intraperitoneal low-grade mucinous epithelial neoplasm and mucinous ascites. To our knowledge, this is the first reported case of a mature teratoma-associated mucinous epithelial neoplasm from any anatomical site with documented late recurrence as pseudomyxoma peritonei.     

腹腔镜下卵巢畸胎瘤剥除术中减少瘤体破裂的手术方法的临床探讨

目的探讨腹腔镜下剥除卵巢畸胎瘤术中减少瘤体破裂的手术方法。方法回顾性分析2006年1月～2009年12月间因卵巢畸胎瘤在杭州市第一人民医院妇科住院行腹腔镜下剥出术的患者254例,排除其中恶性2例,根据手术方法分成A组(施行改进的腹腔镜下畸胎瘤剥除手术:双极电凝畸胎瘤包膜,不带电电凝勾勾开电凝处包膜,然后利用双极电凝钳边剥离边凝血,遇到粘连剥离困难时电凝粘连带后剪开)51例,B组(施行传统的腹腔镜下畸胎瘤剥除手术)201例,对比分析两组的手术时间、术中出血量、畸胎瘤破裂率、术后肛门排气恢复时间、术后住院时间。结果手术时间分别为A组53.73±22.65min、B组84.62±38.71min,两组统计学有显著性差异(P<0.01);出血量分别为A组35.49±20.72ml、B组55.20±46.73ml,两组统计学有显著性差异(P<0.05),A组和B组的畸胎瘤破裂率分别为17.65%、46.77%,两组统计学有显著性差异(P<0.01);术后肛门排气恢复时间分别为A组48.47±11.25h、B组49.19±8.23h,两组统计学无显著性差异(P>0.05);术后住院时间分别为A组5.12±1.03天、B组5.68±1.14天,两组统计学有显著性差异(P<0.01)。结论改进的腹腔镜下畸胎瘤剥除手术中利用钩型器械打开瘤体包膜快捷有效,联合双极电凝钳的应用剥出瘤体破裂少、出血少、手术时间短、病人的住院时间短,改进的方法值得临床推广。     

Thymic teratoma masquerading as a thyroid lump

Teratomas are germ cell tumours commonly found in the sacrococcygeal region, ovary, testicle or, infrequently, the mediastinum. In very rare circumstances, these tumours are found in the neck. This case represents a thymic teratoma presenting as what appeared to be an intrathyroid lesion. This has not been described previously and demonstrates an unusual presentation of a neck lump necessitating two operations and a multidisciplinary approach for management. We would also like to highlight that while patients undergo imaging to guide surgery, the surgeon must always be prepared for the unexpected and recognise situations where the operation should be converted to an exploratory procedure instead of full resection. Often, combined surgical care is the best option for difficult congenital cases.     

Metastatic mediastinal mature teratoma with malignant transformation in a young man with an adenocarcinoma in a Klinefelter's syndrome: Case report and review of the literature

Malignant transformation of mediastinal mature teratoma is extremely rare and worsens the prognosis of the disease. Transformation can appear synchronously to or several years after the initial diagnosis. Clinical and radiological signs can orientate the clinician but the definitive diagnosis is obtained thanks to histology. An 11 year-old boy presented with a mediastinal mature teratoma and bone and pulmonary metastases. He received six cycles of chemotherapy combining etoposide, ifosfamide, cisplatin, followed by resection of a 16 × 14 × 9 cm mediastinal mass. Karyotype analysis revealed the presence of an additional sex chromosome X (47 XXY) pathognomonic of Klinefelter's syndrome. Ten years later, sciatalgia revealed malignant transformation of a pre-existing sacral bone metastasis into gastrointestinal adenocarcinoma. The patient received four cycles of chemotherapy combining oxaliplatin, 5-fluorouracil and cetuximab. This treatment was followed by a complete resection of the sacral metastasis and completed with adjuvant irradiation of 54 Gy in 30 daily fractions. Twelve months after the diagnosis of relapse, the patient remained alive without disease. To our knowledge, this is the first case of adenocarcinoma developed in bone metastases of a mediastinal mature teratoma in a boy with a Klinefelter's syndrome. We propose a review of the literature and an analysis of 20 others published cases of mediastinal teratoma with malignant transformation into adenocarcinoma.     

RNAi沉默PCDGF基因对喉鳞癌Hep-2细胞生物学特性的影响

目的 研究RNAi沉默畸胎瘤细胞源性生长因子(PCDGF)表达对喉鳞癌Hep-2细胞增殖、凋亡及侵袭能力的影响.方法 RT-PCR检测喉鳞癌组织中PCDGF的mRNA表达水平;Hep-2细胞分为空白对照组、阴性对照组和PCDGF-siRNA组,Western blot检测转染效果及Bcl-2、Bax、E-cadherin和MUC1蛋白表达;CCK8实验检测细胞增殖;流式细胞仪检测细胞凋亡;Transwell 小室检测细胞侵袭能力.结果 喉鳞癌组织中的PCDGF mRNA表达水平显著高于声带息肉组织(t=6.88,P=0.005).PCDGF在喉鳞癌组织中高表达.PCDGF-siRNA组喉鳞癌Hep-2细胞中PCDGF、Bcl-2、MUCI蛋白表达显著低于空白对照组(P<0.05),Bax、E-cadherin蛋白表达显著高于空白对照组(P<0.05),细胞增殖率显著低于空白对照组(P<0.05),细胞侵袭数显著低与空白对照组(P<0.05),细胞凋亡率显著高于空白对照组(P<0.05).结论 抑制PCDGF的表达能够抑制喉鳞癌Hep-2细胞的增殖和侵袭能力,诱导细胞发生凋亡.     

胎儿巨大骶尾部畸胎瘤破裂后足月分娩1例

本文报告了1例妊娠14周经超声发现胎儿骶尾部畸胎瘤,超声联合MRI提示肿瘤分型为Ⅰ型。妊娠26周前肿瘤囊性部分占比>60%,妊娠28周肿瘤囊性部分自行破裂。妊娠期密切监测,妊娠36周 +5时,肿瘤体积增至12.8 cm×9.7 cm×12.3 cm。孕妇于妊娠37周行剖宫产术分娩。新生儿生后4 d于小儿外科...     

Congenital hairy polyp of the soft palate

Hairy polyp is an unusual developmental malformation that is most frequently seen as a pedunculated tumor in the neonate. They are benign lesions containing elements of both ectodermal and mesodermal origin. The symptoms of hairy polyps relate both to their location and their size. Larger lesions produce symptoms due to feeding difficulties and airway obstruction while smaller lesions cause intermittent symptoms resulting from a ball-valve type of obstruction.We present two cases of a soft palate hairy polyp causing respiratory and feeding difficulties and review the literature.     

纵隔生殖细胞肿瘤的MSCT诊断

目的:分析纵隔生殖细胞肿瘤MSCT的表现,提高对本病的诊断水平。方法:共64例,采用GE Lightspeed 16层CT进行胸部平扫及增强扫描。结果:53例畸胎瘤,11例恶性生殖细胞瘤。53例畸胎瘤CT显示都含有脂肪,位于前纵膈。11例恶性生殖细胞瘤,肿瘤直径范围为7.0~28.0cm,均偏于纵隔一侧生长,位于中上前纵隔,平扫密度较低,CT值约20~30HU,增强扫描呈斑片状、边缘轻度强化;与周围大血管分界不清,肿瘤具有钻隙生长的趋势,肿瘤内部多发囊变。结论:CT对纵隔生殖细胞肿瘤,具有一定的诊断及鉴别诊断价值。