原发性肺滑膜肉瘤2例并文献复习

目的阐述原发性肺滑膜肉瘤的相关内容并复习文献。方法结合我院收治的2例原发性肺滑膜肉瘤患者的临床资料,分析该病的临床特征、诊断、治疗和预后的相关情况。结果与结论原发性肺滑膜肉瘤预后差,总的5年生存率为50%。但因其为罕见病,症状无特异性且组织结构复杂,易误诊为其他软组织肉瘤或炎症。而加强多中心协助,对于明确其病因、发病率、提高其诊断水平、制定标准、治疗方案等方面有所帮助。     

左锁骨下动脉闭塞行腔内再通术中医源性B型主动脉夹层1例

<正>患者男,51岁,半月前出现左上肢无力,活动后头晕;既往无特殊病史。查体:左挠动脉、肱动脉搏动明显减弱,双上肢收缩压差45 mmHg。经颅多普勒检查:左椎动脉血流反向;CTA:左锁骨下动脉起始部闭塞伴明显纡曲,闭塞段长约14mm(图1)。入院后双联抗血小板治疗3天后,经股动脉穿刺入路行闭塞段开通、球囊扩张及支架成形术。将8F导引导     

肠系膜上静脉血栓合并多部位血栓复发致死1例

患者女,24岁．无明显诱因上腹部疼痛伴血便,逐渐加重7天;外院CTA示肠系膜上静脉血栓．行肠系膜上动脉插管溶栓治疗后症状稍缓解,但出现左下肢肿胀,静脉超声示左下肢深静脉血栓形成。入院后查体及实验室检查均无阳性发现,遂给予低分子肝素加华法林抗凝。     

中主动脉综合征合并去分化脂肪肉瘤1例

<正>患者女,70岁,4年前出现高血压,服用降压药物,血压控制在110mmHg/70mmHg左右。半年前腰部发沉、双下肢无力,但不影响活动;40余天前血压高达180mmHg/100mmHg,伴双上肢及面颈部充血肿胀,联合服用3种降压药物(硝苯地平30mg,2次/日;缬沙坦80mg,1次/日、酒石酸美托洛尔25mg,2次/日)后血压控制不理想;10天前上述症状加重,行走10米左右即出现间歇性跛行。查体:左侧锁骨上下窝、左肩甲下区及左上腹部闻及吹风样杂     

angiosome理念在重症下肢缺血膝下病变血运重建中的意义

angiosome是一个解剖单元,包括皮肤、皮下组织、筋膜、肌肉、骨骼以及供应其血液的源动脉和特定的引流静脉。按照angiosome理念,不管是采取腔内还是外科旁路手术,重建膝下动脉病变的源动脉血运对重症肢体缺血患者可能产生更好的伤口愈合率及更高的保肢率。笔者就angiosome理念及其在下肢重症缺血膝下血管病变血运重建治疗策略制定方面的作用作一综述。     

胆囊腹壁瘘误诊一例

【病例】男，58岁。主因反复右上腹肿胀、溢脓并疼痛1年半入院。患者于1年半前无明显诱因出现右上腹肋缘下红肿、胀痛，疼痛可以耐受，伴发热，最高体温38℃，当地县医院诊断：腹壁脓肿。行切开引流并抗感染治愈。之后上述症状反复发作2次，均经换药和抗感染治疗缓解。患者为进一步治疗来我院就诊。门诊以腹壁窦道收入院。     

腹腔镜胆囊切除术中出血的原因与处理

腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）具有创伤小、痛苦轻、恢复快等优点，已成为治疗胆囊良性疾病的首选术式，目前已广泛开展。但术中出血是临床较为常见的并发症，如处理不当，往往导致手术中转，甚至胆道损伤等严重并发症。故LC术中出血应得到越来越多的重视。我院近6年来行腹腔镜胆囊切除术360例，其中28例LC术中出血（吸引出血液量〉100ml），术中出血的发生率为0．77％。现将28例患者的出血原因及处理办法报道如下。     

非小细胞肺癌循环肿瘤细胞的定量检测意义

Objective To investigate the sensitivity, specificity and clinical significance of detecting circulating tomor cells (CTCs) in NSCLC. Methods Twenty-five patients who undetwent surgical resection for NSCLC form Jan 2007 to Apr 2007 were in- cluded in this study. Control group included 10 patients with benign pulmonary diseses (2 case of hamartoma and 8 case of pulmonary tu berculosis) and 10 healthy volunteers. The pulmonary veins blood and peripheral vein blood were collected respectively. The CD326 immunomagnetic beads and CK-fluorescein isothiocyanate (CK-FITC) were served as the marker antibodies of CTCs. Firstly mononu- clear cell marked by minibeads conjugated with CD326, the mononuclear cells were enriched and separated though Magnetic-activated cell separation(MACS), then the positive separtion cells were marked by anti-CK-FTTC and anti-leukocyte antibody CD45-phyco- erythrine (anti-CD45-PE), finally those cells detected and analyzed by flow cytometry . Results For stage Ⅰ and stage Ⅱ patients (n= 16), CTCs were detected from peripheral vein blood of in 5 (5/16, 31.25%) and from pulmonary veins blood in 9 (9/16, 56.25%). For stage Ⅲ and stage Ⅳ, CTCs were detected from peripheral vein blood in 5 (5/9, 55.56%) and from pulmonary veins blood in 9(7/9,77.78%).For stage Ⅰ,CTCs were detected from peripheral vein blood in 3(3/13,23%)and from pulmo- nery veins blood in 8(8/13,61.54%).The whole CTCs positive detection rate from pilmonary veins blood was 64%(16/25)which higher than feom peripheral vein blood(40%,10/25)(P<0.05).Conclusion The method was set up by MACS combined with FCM to detect the CTCs of pulmonary veins blood and peripheral vein blood of patients.with NSCLC,MACS combined with FCM may improve detection rate of CTCs.This technique appears to be an efficient to detect circulating tumor cells and may be important for dinical practice in the future.     

闭合性十二指肠损伤诊治体会

十二指肠损伤临床少见,约占腹部闭合性损伤的3．5％～5％。由于其生理及解剖部位的特殊性,损伤后缺乏特异性体征和症状,并且多合并有周围组织器官和血管的损伤,伤情复杂,术前诊断困难,术中容易漏诊,术后并发症多,病死率高。其并发症的发生率和死亡率分别高达65％和15％～20％左右。近年来,外伤性十二指肠损伤有逐年增多的趋势,因此必须引起重视。     

伞形滤器回收钩包埋和支柱断裂成功回收1例并导丝成襻技术要点总结

<正>1临床资料患者女，56岁。3个月前因右膝关节术后右下肢深静脉血栓形成，为预防肺栓塞行下腔静脉滤器（IVCF）置入术（伞形），手术顺利，术后恢复良好。1周前于外院2次行下腔静脉滤器取出术，均未获成功，最近一次术中造影发现滤器一支柱变形，随呼吸运动上下摆动（见图1(1)）。