目的 探讨肝细胞腺瘤的诊断与外科治疗方法。方法 对5例肝细胞腺瘤患者进行回顾性分析。结果 术前行B超检查4例，行CT检查2例及行MRI检查2例均未确诊。术前4例成人均误诊为原发性肝癌； 1例幼儿误诊为肝母细胞瘤。全部病例均做了肝叶或联合肝段切除术。结论 成人肝细胞腺瘤须与原发性肝癌相鉴别； 幼儿肝细胞腺瘤须与肝母细胞瘤相鉴别。肝细胞腺瘤误诊原因与其发病率低，缺乏典型的临床表现、生化检查指标和影像学特征有关。肝叶或联合肝段切除是肝细胞腺瘤的主要外科治疗方法。
Ｔｈｉｒｔｅｅｎ ｃａｓｅｓ ｏｆ ｐａｎｃｒｅａｔｉｃ ｃｙｓｔ ｗｅｒｅ ａｎａｌｙｓｅｄ，ｉｎｃｌｕｄｉｎｇ ６ ｃａｓｅｓ ｏｆ ｒｅｔｅｎｔｉｏｎ ｃｙｓｔ，４ ｃａｓｅｓ ｏｆ ｃｙｓｔａｄｅｎｏｍａ ａｎｄ ３ ｃａｓｅｓ ｏｆ ｃｙｓｔａｄｅｎｏｃａｒｃｉｎｏｍａ．Ｔｈｅ ｄｉｓｅａｓｅ ｈａｓ ｎｏ ｓｐｅｃｉａｌｉｔｙ ｉｎ ｃｌｉｎｉｃａｌ ｓｙｍｐｔｏｍｓ ｕｌｔｒａｓｏｎｏｇｒａｐｈｙ ａｎｄ ＣＴ ｈａｖｅ ｈｉｇｈ ｖａｌｉｄｉｔｙ ｉｎ ｌｏｃａｔｉｎｇ ｔｈｅ ｃｙｓｔ，ｂｕｔ ｎｏ ｖａｌｕｅ ｉｎ ｄｅｔｅｒｍｉｎｇ ｉｔｓ ｐａｔｈｏｌｏｇｉｃａｌ ｎａｔｕｒｅ．Ｍｕｌｔｉｐｌｅ ｃｏｍｐａｒｔｍｅｎｔ ｏｆ ｔｈｅ ｃｙｓｔ ｗｅｒｅ ｏｆｔｅｎ ｓｅｅｎ．Ｓｅｒｏｕｓ ｆｌｕｉｄ ａｎｄ ｆｌａｔ ｅｐｉｔｈｅｌｉａｌ ｃｅｌｌ ｅｘｉｓｔｅｄ ｍａｉｎｌｙ ｉｎ ｒｅｔｅｎｔｉｏｎ ｃｙｓｔ．Ｍｕｃｉｎｏｕｓ ｆｌｕｉｄ ａｎｄ ｃｕｂｉｃ／ｃｏｌｕｍｎ ｅｐｉｔｈｅｌｉａｌ ｃｅｌｌｓ ｗｅｒｅ ａｌｗａｙｓ ｓｅｅｎ ｉｎ ｃｙｓｔａｄｅｎｏｍａ ａｎｄ ｃｙｓｔａｄｅｎｏｃａｒｃｉｎｏｍａ．Ｃｙｓｔｅｃｔｏｍｙ ｉｓ ａｎ ａｐｐｒｏｐｒｉａｔｅ ｏｐｅｒａｔｉｏｎ ｆｏｒ ｔｈｅ ｄｉｓｅａｓｅ．
Objective To compare the different surgical treatment methods of thymoma combined with myasthenia gravis (MG), and to discuss the clinical effectiveness of thoracoscopic combined mediastinoscopic extended thymectomy. Methods We retrospectively analyzed the clinical data of 58 patients of thymoma combined with myasthenia gravis in Northern Jiangsu People's Hospital between 2011 and 2016 year. According to the operation method, the patients were divided into three groups including a group A for thoracoscopic thymectomy (n=32), a group B for thoracoscopic combined mediastinoscopic thymectomy (n=15), and a group C for transsternal thymectomy (n=11). The clinical effects were observed and compared. Results In the group A and the group B, the bleeding volume, postoperative hospital stay and other complications were significantly lower than those in the group C with statistical differences (P<0.05). The incidence of myasthenic crisis in the group B (6.7%) was less than that in the group C (36.4 %), but the difference was not statistically different (P=0.058). The operation time of the three groups was 122.0 ± 39.4 min, 130.3 ± 42.5 min, and 142.3 ± 40.8 min respectively with no statistical difference between the two groups (P>0.05). The rate of dissection grade in the group B (grade 1, 12 patients, 80%) was significantly greater than that in the group A (grade 1, 14 patients, 43.8%,P<0.05). The effective rate of the group A, the group B, the group C was 84.4%, 93.3% and 90.9%, respectively with no statistical difference between groups (P>0.05). Conclusion The thoracoscopy combined mediastinoscopic thymectomy not only has the advantages of less trauma, quicker recovery and fewer complications, but also can more thoroughly clean the thymus and adipose tissue, which can achieve the same therapeutic effect as the transsternal thymectomy.
ObjectiveTo study the clinical features,pathogenesis and differential diagnosis,and explore the imaging characteristics of congenital cystic adenomatoid malformation of the lung (CCAM) in children,in order to improve the knowledge of imaging findings of the disease. MethodsWe retrospectively analyzed the clinical data and imaging characteristics of three patients proven to have CCAM of the lung both by surgery and pathology between March 2011 and March 2013.Related literature was also reviewed,and two out of the three patients were followed up for two years. ResultsAll CCAM lesions in this study involved unilateral lower lobe,including two left lung and one right.Two patients had multiple large cysts containing gas,and one had multiple honeycomb-shaped vesicles.Histopathological examination showed that two cases were classified as Stocker type I and one as type Ⅱ,without type Ⅲ cases.Surgeries proved that the malformation was unilateral in all patients without connection with the bronchia.All patients with CCAM got complete cure by operation.The two-year postoperative follow-up showed an excellent recovery in all the patients. ConclusionImaging examination is the main basis for discovery and diagnosis of CCAM.The CT manifestations of CCAM are featured,and according to CT examination,pathological subtypes of the disease can be predicted.Being familiar with these characteristics is helpful for its diagnosis.
Objective To summary the experience in diagnosis and managements for primary hyperparathyroidism（PHPT）. Methods The clinical data of 73 patients with PHPT who underwent parathyroidectomy in our hospital from Jan. 2003 to Dec. 2010 were analyzed retrospectively. Results There were 1 case of hyperplasia （1.4%）， 67 cases of adenoma （91.8%）， and 5 cases of adenocarcinoma （6.8%） among the 73 cases of PHPT. The common presentations involved with pain in bones and joints in 63 cases （86.3%）， pathologic fractures in 17 cases （23.3%）， osteoporosis in 59 cases （80.8%）， fatigue in 28 cases （38.4%）， abdominal pain in 4 cases （5.5%）， urolithiasis in 17 cases （23.3%）， malignant hypertension in 1 case （1.4%） who suffered multi-endocrine neoplasm （MEN）Ⅱa， and so on. The preoperativeserum parathyroid hormone （PTH） abnormally elevated in all 73 patients， and serum calcium abnormally elevated in 59 patients （80.8%）， and alkaline phosphatase abnormally elevated in 62 patients （84.9%） before operation. The positive rate of lesion locations by ultrasonography， CT， 99Tcm-sestamibi （MIBI） scan， and the combination of 3 kinds of tests were 82.8% （53/64）， 83.3% （20/24）， 90.2% （46/51）， and 91.8% （67/73） respectively， but 6 cases were not traced preop-eratively. Parathyroidectomy was conducted to all the cases， besides， regional neck lymphadenectomy was performed for those 5 adenocarcinoma cases. Tetany in 16 cases， hoarseness in 2 cases， acute pancreatitis in 1 case， acute left heart failure in 1 case were observed after operation. Sixty nine cases were follow-up for 3-72 months （average 17.3 months）. During the followed-up period， most of them were alleviated from bone pain （43 cases） and fatigue （18 cases）within 1 month. However， the recovery of PTH and serum calcium back to normality were relatively slow. One case ofadenoma recurred， 1 case of adenocarcinoma suffered lung metastasis， 1 case of adenocarcinoma survived for 37 monthsprior to death for postoperative lung and bone metastasis， the other cases （including 1 case of adenocarcinoma developed from adenoma） were still alive and had no metastasis or recurrence by the end of follow-up. Conclusions The symptoms of PHPT vary and lack of specificity， hence， the enhancement of knowledge to this disease and screenings conducted for parathyroid function and serum calcium will increase the rate of diagnosis. Parathyroidectomy is the effective management for PHPT， and preoperatively accurate position contribute to minimal exploration.
Objective To assess the long-term results and relevant influencing factors of extended thymectomy and medicine-alone treatment of non-thymomatous myasthenia gravis (MG) patients. Methods We retrospectively analyzed the clinical data of 174 patients with non-thymomatous MG diagnosed and treated in our department from December 2009 to April 2017, including 81 males and 93 females, aged 13-88 (47.1±17.8) years. According to the different treatment methods, the patients were divided into two groups: an operation group (91 patients receiving extended thymectomy) and a medicine-alone group (83 patients receiving medical therapy alone). The efficacy was evaluated according to the Myasthenia Gravis Foundation of America (MGFA). Survival curves of the patients were plotted using the Kaplan-Meier method to evaluate the remission rate and survival rate. Cox regression analysis was used to assess the influencing factors of the outcomes. Results The patients were followed up for 3 to 94 (39.1±26.9) months. As a result, 29 patients (31.9%) achieved complete remission in the surgery group and 13 patients (15.7%) were completely relieved in the medicine-alone group (P=0.014). Further analysis showed that treatment pattern (P=0.018) and MG type (P=0.021) were the main factors related to the efficacy. Conclusion For patients with non-thymomatous MG, extended thymectomy is superior to the medicine-alone in terms of complete remission rate and the postoperative immunosuppression ratio.