高强度聚焦超声消融治疗子宫肌瘤时妊娠一例报告并文献复习

高强度聚焦超声(high-intensity focused ultrasound,HIFU)消融治疗子宫肌瘤作为一种新的非侵入性的治疗方式,已越来越广泛地用于子宫肌瘤的治疗。但是对于HIFU治疗时妊娠的处理及妊娠结局鲜有文献报道。本文报道1例HIFU消融治疗子宫肌瘤时妊娠的病例,结合文献复习,探讨子宫平滑肌瘤对妊娠的影响、子宫平滑肌瘤不同处理方式对妊娠的影响、HIFU消融治疗子宫肌瘤时机选择的问题、HIFU消融治疗子宫肌瘤若同时合并妊娠时胎儿去留的问题以及近期HIFU消融治疗子宫肌瘤后对流产手术操作的影响等,以期对HIFU治疗子宫肌瘤的适应证、选择合适的治疗时间及术后选择合适的妊娠时机展开讨论。     

Laparoscopically assisted gastric surgery using Dexterity Pneumo Sleeve

Background: Laparoscopic surgery has been successfully applied to several gastrointestinal procedures. Although the totally laparoscopic gastrectomy is feasible, tactile sensation and manipulation of the organ as well as the lesion are decreased when compared to open surgery. The Dexterity Pneumo Sleeve is a new device which allows the surgeon to insert a hand into the abdominal cavity while preserving the pneumoperitoneum. This device was used for patients who underwent laparoscopic gastric surgery. Methods: The first patient presented with a non-Hodgkin's lymphoma of the stomach. A laparoscopically assisted distal gastrectomy was performed with Roux-en-Y reconstruction. The second patient had a 5-cm leiomyoma involving the greater curve of the stomach, and this device was used for manipulation of the tumor. The last patient suffered from morbid obesity with its associated medical complications and a ventral hernia. The Sleeve was applied at the hernia site and a laparoscopically assisted gastric bypass was performed. Results: The Pneumo Sleeve was useful in these cases for tactile localization of the tumor and for retraction and manipulation of the stomach and surrounding upper abdominal organs. Conclusions: The utilization of this device resulted in a more easily performed dissection, resection, and anastomosis and was felt to decrease operation time. Received: 18 September 1996/Accepted: 26 December 1996     

True smooth muscle neoplasms of the gastrointestinal tract: morphological spectrum and classification in a series of 85 cases from a single institute

BACKGROUND AND AIM: True smooth-muscle neoplasms of the GI tract have been only rarely studied in the KIT era. Their incidence among other GI mesenchymal tumours and their clinicopathological spectrum have not been sufficiently analysed. MATERIALS AND METHODS: We reviewed all GI mesenchymal lesions at the Pathology Institute of the Nuremberg Clinic Centre from 1994 through 2005. RESULTS: Among 262 lesions, there were 142 GISTs (54%) and 85 true smooth muscle neoplasms (32%). Smooth muscle neoplasms comprised 72 polypoid leiomyomas (78%, 5 oesophageal and 67 colorectal), 10 intramural leiomyomas (11%, 5 oesophageal, 4 gastric and one ileal), two intramural leiomyosarcomas in the sigmoid colon and ileum (2%) and one polypoid leiomyosarcoma involving the stomach, descending colon and the retroperitoneum concurrently. None of the leiomyomas with available follow-up have recurred or metastasised. CONCLUSION: Smooth muscle neoplasms are the second most common mesenchymal neoplasms in the GI tract after GISTs. They may arise either from the muscularis mucosae or proper muscle layer forming polypoid and intramural lesions, respectively. Polypoid leiomyomas are more common in the rectosigmoid, while intramural ones mainly arise in the vicinity of the oesophagogastric junction. Polypoid leiomyomas are sufficiently treated by endoscopic resection, and local surgical excision is the treatment of choice for intramural leiomyomas. Intramural leiomyosarcomas are rare high-grade sarcomas that commonly have infiltrated into the surrounding tissue or metastasised by the time of diagnosis.     

小肠平滑肌肿瘤的血管研究

目的：观察小肠平滑肌肿瘤血管形态。方法：对８例正常小肠标本及１０例（１５个瘤体）经病理证实的平滑肌瘤手术切除标本，采用血管造影、解剖镜观察、石蜡切片光镜观察及图像分析。结果：小肠平滑肌肿瘤血管丰富，共同特征是：供血动脉增粗，沿瘤蒂进入瘤中心，呈放射状分布、簇状增生、丰富吻合，形似“蜘蛛网”状。血管扭曲、中断，瘤体内造影剂池明显者提示平滑肌肉瘤。结论：小肠平滑肌肿瘤属多血供肿瘤，良、恶性之间血管存在一定特点。这有助于介入诊断及螺旋ＣＴ诊断。     

壁间型膀胱平滑肌瘤十例患者诊治经验的初步探讨

目的通过对壁间型膀胱平滑肌瘤的诊疗进行回顾性分析,初步探讨其临床诊疗方式。方法回顾性分析2010年1月至2019年1月于徐州医科大学附属医院泌尿外科行手术治疗壁间型膀胱平滑肌瘤10例患者资料。其中男性1例,女性9例,年龄33~51(44±6)岁。其中5例患者以膀胱刺激症状为主要临床表现,1例患者以下腹痛为主要表现,还有4例患者无明显临床症状,患者发病时间1周至2年,平均4.9个月。患者泌尿系彩超检查发现膀胱壁上形态规则、表面覆盖黏膜高回声的低回声包块。CTU检查为膀胱壁均质样实性肿块,边界清楚、光滑,无侵蚀表现,膀胱壁走形自然,且壁周脂肪间隙清晰,膀胱内可见充盈缺损。膀胱镜检查可见瘤体表面黏膜常完整连续,可见局部稍向膀胱内隆起。根据患者肿瘤部位、大小,10例患者分别采用经尿道平滑肌瘤剜除术和腹腔镜下平滑肌瘤剜除术,3例患者术中冰冻切片示:膀胱平滑肌瘤。结果10例患者中有临床症状者:其中5例以膀胱刺激症状为主诉的患者术后症状明显缓解,表现为下腹部疼痛症状的患者术后腹痛症状消失,所有患者术后均未发生并发症,术后随访4~24个月(平均16个月)均未见肿瘤复发且未诉漏尿等常见并发症。结论泌尿系彩超,CTU等影像学检查与膀胱镜相结合是诊断壁间型膀胱平滑肌瘤的主要手段,经尿道肿瘤剜除术、腹腔镜下肿瘤剜除术是治疗壁间型膀胱平滑肌瘤安全有效的手术方式且预后较好。     

子宫平滑肌肿瘤的病理组织学观察

目的 探讨子宫平滑肌肿瘤的病理诊断标准及其预后。方法 对病例进行病理组织学观察,并用ｄｅｓｍｉｎ,ａｃｔｉｎ免疫组织化学染色。结果 多数子宫平滑肌内瘤核分裂像增多同时伴细胞特异性及凝固性坏死,子宫平滑肌瘤则无以上病理变化。子宫平滑肌肉瘤的ｄｅｓｍｉｎ和ａｃｔｉｎ阳性细胞显著低于子宫平滑肌瘤。结论 尽管核分裂诊断是子宫平滑肌肉瘤的重要指标,但不是唯一指标,应综合细胞异型,边界浸润,凝固性坏死这些改变     

11例食管平滑肌瘤临床病理X线分析

本文对11例食管平肌瘤的临床病理X线表现进行分析,本病临床症状轻微,具有典型粘膜下良性肿瘤膨胀性生长的病理特征,X线检查能充分反映其病理基础．除边线光滑的腔内充盈缺损或范围一致的腔内外肿块、“环形征”、粘膜不同程度挤压等固有X线特征外,作者认为“扇形增宽皱襞”、“肿瘤移动征”等特异征象,对诊断也很有帮助．术前诊断主要依靠食管钡餐检查．文中并讨论了鉴别诊断．     

食管平滑肌瘤诊断的新征象

本文报告2例食管平滑肌瘤,经食管钡透检查,发现两种新的征象,我们称之为“粘膜折叠征”和“粘膜外凸征”。经食管镜检查与术中观察分析可印证:这两种征象的出现是食管粘膜深陷于肿瘤表面的凹陷处,或深陷于两个肿瘤挤压在一起的间隙中而形成的,而食管壁以外的任何肿瘤压迫食管壁都不可能出现的征象。出现上述两种征象,可以作为食管平滑肌瘤与纵隔肿瘤鉴别诊断的依据,也可以作为多发性食管平滑肌瘤挤压在一起的征象。     

Quadruplet in vitro fertilization pregnancy complicated by fetal reduction and leiomyoma

A woman had a quadruplet IVF pregnancy with a leiomyomatous uterus. Pregnancy resulted in the birth of one baby after missed abortion of one fetus and selective reduction of two others. The woman had a left deep calf vein thrombosis in the first half of pregnancy.