CT引导下带钩钢丝术前定位在胸腔镜下孤立性肺小结节切除术中的应用

Objective Video-assisted thoracoscopic surgery (VATS) provides a minimally invasive approach to resect small solitary pulmonary nodules (SSPN). The aim of this study is to evaluate the efficacy and safety of preoperative CT-guided hookwire localization for SSPN in VATS. Methods Hookwire was used to localize 26 SSPN under CT guidance in 24 patients (14 male, 10 female, age range 21-61 years, mean 52.3 years), preoperatively, and wedge resection was performed through VATS. The lesion size, distance from the lesion to parietal pleura, the time of localization and complications were evaluated. Results All the 26 pulmonary nodules were preoperatively detected and localized with hookwire under CT-guidance. The mean lesion size was 10.05 ± 3.08 nun in diameter, and the mean distance from lesion to parietal pleura was 10.09±2. 62 mm. The mean localization time was 20. 18±7.16 min, and then the nodules were removed by VATS within 18 ± 6. 65 min. The major complication of CT-guided hookwire localization was mild pneumothorax in 6 patients (25.0%), but no one needed chest tube drainage. The dislodgment of hookwire was found in only one patient (4.2%) during the operation, but the lesion was still successfully resected under VATS. Of those patients, 8 were confirmed to have a primary NSCLC by rapid pathologic diagnosis during VATS wedge resection, and then VATS lobectomies were performed. Condusion The preoperative CT-guided hookwire localization for small solitary pulmonary nodules is an effective and safe technique to assist VATS resection of the nodules.     

GC-MS分析川产余甘子挥发油中的化学成分

目的 研究四川余甘子挥发油中的化学成分.方法 采用水蒸气蒸馏法提取挥发油,以GC-MS结合计算机技术对其化学成分进行分离和鉴定,用面积归一化法测定各组分的相对含量.结果 从四川余甘子挥发油中共分离到47个峰,鉴定了其中的43种化合物,其含量占总峰面积的97.42%.其中,含量较高的组分为α-糠醛(17.93%)、2-氯-二环[2.2.2]-5-烯-2-辛腈(7.69%)、水杨酸甲酯(7.25%)、反-2-癸烯醛(5.05%)、六氢法呢基内酮(5.03%).结论 鉴定结果与文献报道的其他余甘子挥发油中的化学成分存在显著性差异.     

间接喉镜下摘除声带息肉146例报告

声带息肉是喉部常见病,大部份病例较易诊断。我们对在间接喉镜下声门暴露困难的部份病例,借助纤维喉镜检查,明确了诊断并及时进行了手术治疗。现将我院自1978年至1984年在间接喉镜下摘除声带息肉146例,报告如下。     

喉腔巨大纤维瘤切除后行T型硅胶管喉成型术一例报告

患儿李某,男,4岁。1984年6月13日因持续性呼吸不畅,伴有喉鸣,声嘶,咳嗽,以喉源性呼吸困难入院。全身检查未见明显异常,X线摄片示喉部肿物性质待查。急行常规气管切开术。直接喉镜检查,左侧杓状软骨前上有一光滑球形肿物,有弹性,约1.5×1.2×1.0cm,与会厌喉面有空隙,与食管入口前壁不粘连。病理诊断为喉纤维瘤。时年两岁,暂时带气管套管出院。同年12月14日再次住院。瘤体增大至2.2×2.0×1.5cm。食管钡透肿物压迫食管前壁。拟定喉裂开肿物切除术,因术中出现颈交感迷走综合征,手术中止,未治出院。患儿于1986年4月24日,第三次住院。喉腔肿瘤明显增大,充满前庭,上部超出会反游离缘,压迫舌根时可窥及肿瘤。食管口前壁受压进食困难。纤维喉镜检查,肿瘤填满喉前庭,超出会厌游     

乳腺癌患者肺内孤立性结节CT征象：肺原发性腺癌和转移性乳腺癌的鉴别

背景与目的：乳腺癌患者CT上表现为孤立性的肺结节（solitary pulmonary nodule,SPN）可能是原发性肺癌（primary lung cancer,PLC）也可能是乳腺癌肺转移（metastatic pulmonary breast cancer,MBC）,明确诊断对于患者的个性化诊疗具有重要意义。该研究回顾性分析CT上表现为SPN的PLC和MBC的高分辨率CT（high resolution CT,HRCT）特征,探讨其诊断价值。方法：回顾性分析2007年10月—2013年9月经胸外科手术获得病理证实的116例乳腺癌患者的孤立性肺结节,通过Logistic回归模型和受试者工作特征（receiver operating characteristic,ROC）曲线分析结节CT征象鉴别MBC和PLC。结果：116例结节中,PLC为77例（66.4%）,MBC为39例（33.6%）。MBCs与PLCs在圆形或椭圆形、亚实性结节、分叶征、毛刺征、空泡征、支气管充气征、胸膜凹陷征、结节最大径及实性成分体积比等征象上差异有统计学意义。多变量分析显示,毛刺征、支气管充气征和非实性成分体积比≥24%是PLC的独立预测因子,相应的比值比（odds ratio,OR）分别为0.219（95%CI：0.069~0.638）、0.061（95%CI：0.009~0.240）和0.972（95%CI：0.951~0.990）。该多因素回归模型对PLC与MBC的鉴别具有良好的性能,ROC曲线的曲线下面积（area under curve,AUC）为0.903（95%CI：0.838~0.969）,准确率为86.2%,灵敏度为88.3%,特异度为82.1%。结论：乳腺癌患者孤立性肺结节中原发性肺腺癌概率高。实性成份体积比＜24%、有支气管充气征和有毛刺征等CT征象提示原发性肺癌的可能大。     

同步辐射衍射增强成像技术检测人离体乳腺癌的实验研究

背景与目的：同步辐射衍射增强成像(diffraction-enhanced imaging,DEI)是近年来发展起来的新技术,具有极高的软组织分辨率,比传统X线吸收成像分辨率高1 000倍。该研究旨在探讨DEI技术在人离体乳腺癌标本中的应用。方法：15例乳腺癌标本经4%甲醛溶液固定后,在北京同步辐射装置（Beijing synchrotron radiation facility,BSRF）的4W1A束线X射线成像站进行同步辐射DEI,最后行病理学检查,将所得影像学资料与病理学资料进行对比研究。结果：15例标本均获得了良好的衍射增强图像,均可清晰地显示病变组织与正常组织,其中3例标本中可见钙化灶,同一样品在摇摆曲线不同位置获得不同的图像,所有的衍射增强图像均具有较高的空间分辨率和衬度分辨率。结论：同步辐射DEI技术具有很高的衬度分辨率和空间分辨率,可清晰观察肿瘤内部组织特征和空间分布,而且其采用的折射成像机制,可以有效地减少X射线对人体的辐射损伤,具有良好的基础医学应用前景。     

DSA引导下胸壁完全性植入式静脉输液港应用总结

完全性植入性输液港（totally implantable access port．TIAP）是一种由注射座和硅胶导管组成,可植入皮下、长期留置体内的闭合静脉或动脉输液系统。1982年首次报道应用此系统,临床最常用于中心静脉输液。这种系统可以提供长期、安全、方便的静脉通路,用于静脉化疗、抗生素治疗和全静脉营养等。我科自2006年06月起开始在数字减影血管造影（digital subtraction angiography,DSA）机引导下植入静脉输液港．     

CT引导下带钩钢丝术前定位在胸腔镜下孤立性肺小结节切除术中的应用

Objective Video-assisted thoracoscopic surgery (VATS) provides a minimally invasive approach to resect small solitary pulmonary nodules (SSPN). The aim of this study is to evaluate the efficacy and safety of preoperative CT-guided hookwire localization for SSPN in VATS. Methods Hookwire was used to localize 26 SSPN under CT guidance in 24 patients (14 male, 10 female, age range 21-61 years, mean 52.3 years), preoperatively, and wedge resection was performed through VATS. The lesion size, distance from the lesion to parietal pleura, the time of localization and complications were evaluated. Results All the 26 pulmonary nodules were preoperatively detected and localized with hookwire under CT-guidance. The mean lesion size was 10.05 ± 3.08 nun in diameter, and the mean distance from lesion to parietal pleura was 10.09±2. 62 mm. The mean localization time was 20. 18±7.16 min, and then the nodules were removed by VATS within 18 ± 6. 65 min. The major complication of CT-guided hookwire localization was mild pneumothorax in 6 patients (25.0%), but no one needed chest tube drainage. The dislodgment of hookwire was found in only one patient (4.2%) during the operation, but the lesion was still successfully resected under VATS. Of those patients, 8 were confirmed to have a primary NSCLC by rapid pathologic diagnosis during VATS wedge resection, and then VATS lobectomies were performed. Condusion The preoperative CT-guided hookwire localization for small solitary pulmonary nodules is an effective and safe technique to assist VATS resection of the nodules.     

腰椎间盘突出症合并马尾神经损伤手术矫治和康复训练

我们从1986年以来手术治疗且资料完整的腰椎间盘突出症52例，其中合并马尾神经损伤者6例，报告如下，并加以讨论。1 资料与方法本组6例，男4例，女2例，年龄28～58岁，平均42岁。病史1～6个月，平均2个月。有腰腿痛者5例。2例腰腿痛剧烈者夜不能寐，弯腰跪伏在床上；1例女性腰腿痛症状轻微，有假性尿失禁。全部病例均有会阴部麻木感，有大小便失禁者4例，男性病人有2例出现性功能障碍。2例行椎管造影，均显示病变间隙之硬膜囊有程度不同的凹形压迹，并与手术病变间隙相符合。其余4例行CT检查，3例手术病变间隙与CT检查相符合，1例CT检查…     

CT引导下带钩钢丝术前定位在胸腔镜下孤立性肺小结节切除术中的应用

Objective Video-assisted thoracoscopic surgery (VATS) provides a minimally invasive approach to resect small solitary pulmonary nodules (SSPN). The aim of this study is to evaluate the efficacy and safety of preoperative CT-guided hookwire localization for SSPN in VATS. Methods Hookwire was used to localize 26 SSPN under CT guidance in 24 patients (14 male, 10 female, age range 21-61 years, mean 52.3 years), preoperatively, and wedge resection was performed through VATS. The lesion size, distance from the lesion to parietal pleura, the time of localization and complications were evaluated. Results All the 26 pulmonary nodules were preoperatively detected and localized with hookwire under CT-guidance. The mean lesion size was 10.05 ± 3.08 nun in diameter, and the mean distance from lesion to parietal pleura was 10.09±2. 62 mm. The mean localization time was 20. 18±7.16 min, and then the nodules were removed by VATS within 18 ± 6. 65 min. The major complication of CT-guided hookwire localization was mild pneumothorax in 6 patients (25.0%), but no one needed chest tube drainage. The dislodgment of hookwire was found in only one patient (4.2%) during the operation, but the lesion was still successfully resected under VATS. Of those patients, 8 were confirmed to have a primary NSCLC by rapid pathologic diagnosis during VATS wedge resection, and then VATS lobectomies were performed. Condusion The preoperative CT-guided hookwire localization for small solitary pulmonary nodules is an effective and safe technique to assist VATS resection of the nodules.