腹腔镜在妇科急腹症诊治中的应用

目的探讨腹腔镜手术在妇科急腹症诊治中的应用价值。方法回顾分析应用腹腔镜诊断和治疗妇科急腹症353例(A组)的临床资料,并与同期开腹手术297例(B组)比较,分析腹腔镜手术应用于妇科急腹症的应用价值。结果 A组353例顺利完成手术,包括异位妊娠286例,黄体破裂29例,巧克力囊肿破裂18例,卵巢囊肿蒂扭转12例,盆腔炎性疾病8例;中转开腹3例,未出现并发症。与B组比较,A组的手术时间短、术中出血量少、术后疼痛程度轻、肠道功能恢复早、住院时间短,无切口感染病例。结论腹腔镜技术应用于妇科急腹症创伤小,在可明确诊断的同时,又能实施治疗。     

Torsion of a mesenchymal hamartoma of the liver in a 1-year-old boy

We report a case of a one-year-old boy who was referred to our clinic suspected of having acute abdomen. On physical examination, the abdomen was soft, diffusely tender with weak peristalsis. Ultrasonography and MRI of the right hemiabdomen demonstrated a well-defined, solid, expansive formation with slightly lobulated contours and an interspersed inhomogeneous structure with overall dimensions of 59?×?45?×?50?mm. After midline laparotomy was performed, a cystic tumor was found, twisted around a pedicle which was arising from the falciform ligament and it measured 5–6?cm in diameter. The tumor appeared to be necrotic. The mass was ligated and extirpated on the pedicle and sent for histopathological analysis. After the surgery, the boy was hemodynamically stable, without respiratory complications and all laboratory findings were within normal limits. Histopathological analysis showed that the tumor was composed of mesenchymal stroma with sparse glimpses of hepatocytes and bile ducts with partly cystic changes lined by orderly epithelium. Given the clinical data, histology and immunohistochemistry analysis (alpha-fetoprotein, CK8/18, hepatocyte, desmin and CD31) a diagnosis of a twisted mesenchymal hamartoma of the liver was made.     

Gastrointestinal perforation secondary to COVID-19: Case reports and literature review

Introduction:Corona virus disease-2019 (COVID-19) presents primarily with respiratory symptoms. However, extra respiratory manifestations are being frequently recognized including gastrointestinal involvement. The most common gastrointestinal symptoms are nausea, vomiting, diarrhoea and abdominal pain. Gastrointestinal perforation in association with COVID-19 is rarely reported in the literature.Patient concerns and diagnosis:In this series, we are reporting 3 cases with different presentations of gastrointestinal perforation in the setting of COVID-19. Two patients were admitted with critical COVID-19 pneumonia, both required intensive care, intubation and mechanical ventilation. The first one was an elderly gentleman who had difficult weaning from mechanical ventilation and required tracheostomy. During his stay in intensive care unit, he developed Candidemia without clear source. After transfer to the ward, he developed lower gastrointestinal bleeding and found by imaging to have sealed perforated cecal mass with radiological signs of peritonitis. The second one was an obese young gentleman who was found incidentally to have air under diaphragm. Computed tomography showed severe pneumoperitoneum with cecal and gastric wall perforation. The third case was an elderly gentleman who presented with severe COVID-19 pneumonia along with symptoms and signs of acute abdomen who was confirmed by imaging to have sigmoid diverticulitis with perforation and abscess collection.Interventions:The first 2 cases were treated conservatively. The third one was treated surgically.Outcome:Our cases had a variable hospital course but fortunately all were discharged in a good clinical condition.Conclusion:Our aim from this series is to highlight this fatal complication to clinicians in order to enrich our understanding of this pandemic and as a result improve patients’ outcome.     

Acute aortic dissection mimicking acute abdomen in a 14‐year‐old boy

Aortic dissection is extremely rare in children. Although it usually presents with severe chest pain, atypical clinical presentations mimicking various illnesses may cause misdiagnosis. In this report, the case of a 14‐year‐old boy with symptoms suggestive of acute abdomen, which was finally diagnosed as aortic dissection, is discussed.     

Sonographic findings in two cases of lymphangioma of the mesocolon in adults

Lymphangioma of the mesocolon is very rare. We report two cases of surgically resected and histologically proven mesocolic lymphangioma in adults. In both cases, ultrasound revealed a large cystic mass with multiple thin septa in the lower abdomen. A peculiar finding was the large craniocaudal sliding movement of the mass synchronized with the patient's respiration, which was a clue to the diagnosis of mesenteric lymphangioma. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46 :78–81, 2018;     

Effect of somatostatin on postoperative gastrointestinal function and stress level in children with acute abdomen: a prospective randomized controlled study北大核心CSCD

目的 探讨生长抑素对急腹症患儿术后胃肠功能及应激水平的影响。 方法 选取2019年8月至2021年6月徐州市儿童医院收治的行手术治疗的102例急腹症患儿为研究对象。将患儿随机分为观察组和对照组,每组各51例。对照组患儿术后给予止血、抗感染等常规治疗,观察组在常规治疗的基础上加用生长抑素。术前、术后第1天及术后第5天采集两组患儿外周血,比较两组患儿血清血管内皮素-1（endothelin-1,ET-1）、促肾上腺皮质激素（adrenocorticotropic hormone,ACTH）、皮质醇（cortisol,Cor）及胃泌素、胃动素水平,以及两组患儿术后恢复情况及并发症发生率。 结果 术前两组患儿血清ET-1、ACTH、Cor、胃动素及胃泌素水平差异无统计学意义（P>0.05）。术后第1天、第5天,观察组患儿血清ET-1、ACTH、Cor水平均显著低于对照组（P<0.05）;术后第5天,观察组患儿胃动素与胃泌素水平均高于对照组（P<0.05）。术后观察组患儿首次肛门排气时间、肠鸣音恢复时间、首次排便时间、住院时间均较对照组缩短（P<0.05）。观察组并发症发生率（6%）显著低于对照组（24%,P<0.05）。 结论 生长抑素可显著降低急腹症患儿术后应激反应,改善胃肠功能,降低并发症发生率,有益于疾病预后。     

腹部超声在诊断老年非均匀性脂肪肝中的应用价值

目的探讨腹部超声辅以彩色多普勒检查在诊断老年非均匀性脂肪肝中的应用价值.方法收集23例最终被其他方法确诊为非均匀性脂肪肝的老年患者的肝脏超声图像,回顾性分析这些患者腹部超声以及彩色多普勒的数字和图象资料,找出其内在规律并评价其在诊断老年非均匀性脂肪肝中的应用价值.结果所有23例老年患者腹部超声图象中没有一例患者的腹部超声图象表现为占位效应,其中Ⅰ型局限浸润型2例,Ⅱ型多灶浸润型1例,Ⅲ型叶段浸润型1例,Ⅳ型弥漫非均匀浸润,残存小片正常区19例;彩色多普勒检查示有7例肝内异常强回声或弱回声区（直径均＞3.0cm）,内部或周边可见正常血管分支走行.结论非占位效应也是老年非均匀性脂肪肝的最重要特征,在诊断老年非均匀性脂肪肝中具有同样高的应用价值.     

不同MYCN基因扩增状态腹部神经母细胞瘤CT表现

目的 观察不同MYCN基因扩增状态的腹部神经母细胞瘤（NB）CT表现。方法 纳入172例腹部NB患儿,根据MYCN基因拷贝数分为MYCN组（n=47）及未扩增组（n=125）。比较组间肿瘤分布部位、大小、形态、密度、边界、钙化、囊变及坏死等CT征象差异;比较组间肿瘤实质的平均CT值及其与同一层面背部肌肉平均CT值差值的差异。结果 组间肿瘤大小、分布部位、形态、钙化、囊变及坏死、跨越中线生长情况差异均有统计学意义（P均<0.05）,而静脉期强化方式差异无统计学意义（P>0.05）;组间肿瘤与血管关系及邻近脏器侵犯情况差异均有统计学意义（P均<0.05）;未扩增组静脉期肿瘤实质平均CT值及与同一层面背部肌肉平均CT值差值均显著高于MYCN组（P均<0.05）。结论 MYCN基因不同扩增状态的腹部NB肿瘤CT表现存在一定差异。     

基于模型及自适应统计迭代重建优化儿童腹部低剂量CT血管造影图像质量

目的 评价基于模型的迭代重建（MBIR）及自适应统计迭代重建（ASIR）优化100 kV儿童腹部CT血管造影（CTA）图像质量的价值。方法 对55例患儿行100 kV低剂量腹部CTA,分别采用MBIR、100% ASIR、80% ASIR、60% ASIR、40% ASIR及滤过反向投影（FBP）算法重建为6组图像,评价图像质量,包括图像噪声、大动脉（LA）及小动脉（SA）显示能力;对比各级动脉CT值及标准差（SD）,计算信噪比（SNR）及对比噪声比（CNR）。结果 图像噪声主观评分及LA评分以MBIR图像最高,ASIR次之,FBP图像质量最差;SA评分以MBIR图像最佳,FBP次之;随权重提升,ASIR图像评分逐渐降低,100% ASIR最低（P均<0.05）。MBIR图像SD最低,其SNR及CNR明显高于其他图像（P均<0.05）。结论 MBIR可明显提高儿童低剂量CTA图像质量,100% ASIR仅可提高图像显示LA能力。