Symptomatic liver cyst: Special reference to surgical management

We conducted a retrospective study of 14 patients with symptomatic liver cysts to evaluate current therapeutic interventions for this condition. Abdominal pain (n = 7) or abdominal mass (n = 5) were the most frequent presentations. Three patients also had renal cyst. Percutaneous aspiration with ethanol sclerotheraphy was carried out in 4 patients and all cysts so treated diminished in size, with relief of the symptoms. One patient was treated by aspiration only and re-retension occurred. Cystectomy was performed in 2 patients, unroofing in 5, and fenestration in 2 patients. All patients gained relief of symptoms, with no recurrence of symptoms. Computed tomography revealed that the cysts were diminished or were no longer observable after all the treatments. Our experience indicates that unroofing, fenestration, and cystectomy are safe and suitable procedures for treatment of the condition. Ethanol sclerotherapy may be a feasible alternative to surgical intervention in selected patients. Received for publication on July 23, 1997; accepted on Dec. 25, 1997     

全主动脉弓替换术中顺行性脑灌注时血流变化观察

目的　利用前瞻性随机对照方法比较全主动脉弓替换术中单侧顺行性脑灌注 (ASCP)和双侧ASCP时视网膜中央动脉、球后血管血流变化和血S1 0 0蛋白浓度变化。方法　 1 6例全主动脉弓替换术患者随机分为单侧AS CP和双侧ASCP组 ,每组各 8例。两组均行术前术后颅脑计算机体层摄影 (CT)。术中采用经眼球超声监测视网膜中央动脉及球后血管血流。术中术后动态测定血S1 0 0蛋白浓度。结果　两组各有 1例出现短暂性神经功能异常。ASCP过程中单侧组右侧视网膜中央动脉可探及血流 ,左侧视网膜中央动脉不可探及 ,双侧组两侧视网膜中央动脉均可探及血流。所有患者球后动脉均可探及血流。两组间各阶段血S1 0 0蛋白浓度无显著性差异 (P >0 .0 5 )。结论　在基底动脉环完整 ,存在有效侧支循环条件下 ,单侧灌注操作较为简便 ,双侧灌注在ASCP期间两侧脑灌注较为均衡 ,但两种灌注方法对S1 0 0蛋白浓度的影响无显著性差异。     

Long-term results of the antegrade continent enema procedure for constipation in adults

OBJECTIVE: The aim of this study was to evaluate the long-term results of the Antegrade Continent Enema (ACE) procedure for treating severe constipation in adults. METHODS: Over 10 years 37 ACE conduits were created in 32 patients (median age 35 years, 26 women) with constipation caused by slow transit, obstructed defaecation or both. Conduits were created from the appendix (n = 20, 54%), ileum (n = 10, 27%), neoappendix caecostomy (n = 5, 14%) or colon (n = 2, 5%). Clinical records were retrospectively reviewed to determine outcome. RESULTS: After a median follow up of 36 (range 13-140) months, 28 (88%) required at least one further procedure on a primary conduit, including reversal in 19 (59%). Five patients had a second conduit fashioned, two successfully. Conduit type and constipation cause did not significantly influence the rates of ACE reversal or major revision. Ileal conduits were associated with fewer minor revision procedures for stenosis (1 in 7 patients) than appendix conduits (21 in 20 patients). There was one (3%) serious complication. Satisfactory ACE function was ultimately achieved in 47% of patients, at last follow up. After ACE reversal, 9 (28%) patients underwent formation of an end stoma and 3 patients had a colectomy. CONCLUSIONS: Revision procedures are common, but approximately half of patients can expect satisfactory long-term ACE function. ACE conduit reversal does not preclude subsequent alternative surgical strategies to treat this difficult condition.     

LONG-TERM EXPERIENCE WITH SCLEROTHERAPY FOR TREATMENT OF EPIDIDYMAL CYST AND HYDROCELE

Background: Symptomatic testicular hydrocele and cyst of the epididymis may be treated with either operation or sclerotherapy. Methods: The current report presents the experience of a 9 year prospective study using sodium tetradecyl sulphate (STD) sclerotherapy for the treatment of symptomatic hydrocele and/or epididymal cyst. Results: A total of 102 lesions were treated during the study period, with an initial success rate of 76% which improved to 94% with multiple treatments. The overall median follow up during the study was 30 months (range 2–100). Conclusions: Sclerotherapy offers a cost-effective outpatient method for the treatment of symptomatic scrotal cysts.     

泌尿生殖系罕见病3例报告并文献复习

目的：探讨泌尿男生殖系罕见病的诊断与治疗方法。方法：回顾性分析3例精阜纤维上皮性息肉、先天性膀胱颈挛缩以及阴囊皮样囊肿患者的临床资料，术前采用排尿性膀胱尿道造影、膀胱尿道镜、尿动力学检查诊断；手术采用经尿道电切、钦激光内切开以及开放手术。结果：3例患者均于术前获得正确诊断，经手术治疗均得到满意疗效。结论：提高泌尿外科医生对罕见病的诊断及治疗水平十分重要。     

经皮顺行交锁钉治疗股骨干骨折

目的:评价经皮顺行交锁钉治疗股骨干骨折的临床疗效.方法:对79例82处股骨干骨折采用髋部小切口经皮顺行交锁钉治疗,观察疗效.结果:75例(92%)获得了良好的解剖对位并达到一期愈合,6例(8%)迟缓愈合.另外,由于再次手术1例(1%)发生了深部感染.失血量较少(平均小于100 mL),切口平均长25 mm.1年后随访只有10%髋部疼痛.结论:与传统手术方式相比,经皮技术术中出血少、对周围组织创伤少,是一个安全又有效的方法.     

放射性核素阴囊血池显像技术诊断精索静脉曲张的临床研究

目的:探讨放射性核素阴囊血池显像(RSI)技术诊断精索静脉曲张(VC)的价值。方法:本组126例有男性不育1年以上病史、精液分析异常的患者分别接受临床体格检查(PE);RSI技术检查,计算两侧阴囊血池指数值(SBPI),并观察是否有精索静脉血液返流;以及彩色双功能多普勒显像(CDFI)检查,对VC进行分型、定度。将PE,RSI结果分别与CDFI结果对比。结果:PE、RSI诊断VC的灵敏度分别为:71.7%、96.5%,特异度分别为:69.1%、97.1%。RSI诊断VC的灵敏度、特异度均高于PE。结论:RSI技术是诊断临床型、亚临床型VC的简单、安全、有效的无创诊断方法,也是一种非侵袭性,更加客观、准确地诊断VC的有效方法。     

经内镜注射硬化剂治疗食管静脉曲张(附15例报告)

经内镜注射5％鱼肝油酸钠治疗食管静脉曲张15例,共注射45次。其肝功能按Child分级,A级1例,B级8例,C级6例。曾经作过脾切除,分流或断流术者7例。8例急症出血患者经用硬化疗法获得了止血成功。1例急症患者死亡。6例作了择期预防出血的注射,治疗后均得到改善。治疗出血方面,硬化疗法在15例患者中14例有效,随访6～12月无再出血。     

Percutaneous aspiration and ethanol sclerotherapy of symptomatic hepatic cysts

Nineteen patients with 49 symptomatic non-neoplastic non-parasitic simple hepatic cysts were subjected to ultrasonographically guided percutaneous aspiration and temporary injection of 99% ethanol into the cyst. Small cysts were treated twice, the large ones three times at the same sitting. The volume of alcohol per injection varied from 20 to 100 ml, depending on the size of the cyst. A cure was usually achieved with one ethanol sclerotherapy treatment. Only minor side effects such as transient pain and temperature elevation occurred. Forty-seven of the 49 cysts could be treated adequately, and did not recur during a follow-up period af 12–40 months. The results indicate that aspiration an and ethanol sclerotherapy is the treatment of choice in patients with symptomatic non-neoplastic simple hepatic cysts or polycystic liver disease. Correspondence to: A. Leinonen