ObjectiveTo compare efficacy of laparoscopic or open hepatectomy in benign liver tumors patients with different difficult operations. MethodsAccording to the inclusion and exclusion criteria, the patients with benign liver tumors who underwent hepatectomy in the Affiliated Hospital of Xuzhou Medical University from September 2014 to March 2021 were collected. The enrolled patients were assigned into low, medium, and high difficulties by the Hasegawa liver resection surgical difficulty score model, then the patients were matched by propensity score matching. The liver function and inflammatory indexes, intraoperative bleeding, operative time, total hospital stay, postoperative complications, and hospitalization expenses of patients with benign liver tumors after laparoscopic (laparoscope group) or open (open group) hepatectomy were compared. ResultsA total of 209 patients who met the inclusion and exclusion criteria were enrolled in this study. According to the Hasegawa criteria, there were 59, 89, and 61 patients with low, medium, and high difficulties respectively. After 1∶1 propensity score matching, 18, 34, and 14 patients in the laparoscope group and open group were matched respectively. There were no statistic differences in the baseline data between the laparoscope group and open group (P>0.05). ① For the patients with low and medium difficulties, compared with the open group, the different values of alanine aminotransferase, aspartate aminotransferase, white blood cell count, and neutrophil percentage were lower (P<0.05), the intraoperative bleeding and total hospital stay were less or shorter (P<0.05), and the albumin were higher (P<0.05) in the laparoscope group. There were no statistic differences in these indexes among the patients with high difficulty (P>0.05). ② Compared with the open group, the operative time of the laparoscope group was shorter in the patients with low difficulty (P<0.05) and longer in the patients with high difficulty (P<0.05), and there was no statistic difference in patients with medium difficulty (P>0.05). ③ The postoperative complications had no statistic differences between the two groups for the patients with low and high difficulties (P>0.05), while which in the laparoscope group were lower than in the open group for the patients with medium difficulty (P<0.05). ④ The hospitalization expenses of the laparoscope group was higher than the open group for the patients with high difficulty (P<0.05), while which had no statistic differences between the two groups for the patients with low and medium difficulties (P>0.05). ⑤ The total hospital stay of the laparoscope group was shorter than the open group (P<0.05) no matter which difficult operation.ConclusionsAccording to results of this study, laparoscopic hepatectomy has more obvious advantages as compared with open hepatectomy for patients with low or medium difficulty, which could greatly shorten hospital stay and accelerate rehabilitation of patients. Even for patients with high difficulty, laparoscopic hepatectomy still shows an advantage of shortening hospital stay.
目的 探讨十二指肠良性肿瘤的诊断与治疗。方法 对1992~1998年间收治的10例患者的临床资料行回顾性总结分析。 结果术前经纤维十二指肠镜确诊7例 ，上消化道X线钡餐确诊3例。肿瘤位于十二指肠降部7例，球部3例。其中6例行手术治疗，4例因心肺脑等严重合并症行保守治疗。手术为十二指肠肿瘤局部切除连同周围肠壁组织部分切除。术后病理报告2例为平滑肌瘤，2例为布鲁氏纳氏腺瘤，2例为间质瘤。结论 十二指肠良性肿瘤可引发严重并发症，如出血、腹痛、肠梗阻、穿孔等，并约有15%的病例可发生恶变。一经诊断，应及早手术治疗，手术一般宜行局部切除。
Our clinical experiences in reconstruction of the defects from excision of benign tumors with expanded skin flap were reported. Since 1987 we have applied this method 23 cases with satisfactory results. When we decided to use this technique, the expander was placed in a pocket adjacent to a benign tumor planned to be excised. Once the skin flap was expanded fully, the tissue expanders were removed. After excision of the benign tumor, the defect was than be covered with the expanded skin flap. The problems related to treatment were discussed in detail.
From 1976 to 1991, 34 cases of benign tumors of femoral neck were received in our department and 29 cases were treated surgically with either free bone graft (18 cases) or vascularized bone graft (11 cases). Fibrous dysplasia of bone and bone cyst had a high incidence in this group (75%)and most of the patients were over 30 years old. Because the femoral neck had its own anatomical characteristics and was biomechanically important and in order to accelerate. The graft healing and prevent the occurrence of pathological fracture, the choice of operations should depend on the extent of the lesion, the thickness of the cortical bone of the affected past,and the presence or absence of complications.
Objective To study the clinical and CT findings of bronchiolar adenoma. Methods Patients diagnosed with bronchiolar adenoma confirmed by surgical pathology at Linyi People's Hospital and Yantai Yuhuangding Hospital from 2016 to 2021 were collected. Their clinical and CT imaging features were retrospectively analyzed. ResultsFinally, 25 patients were collected, including 6 males and 19 females, aged 32-73 (58.6±10.1) years. The immunohistochemical Ki-67 (MIB1) of all lesions was <5%. The lesions were located in the upper and middle lobe of both lungs in 9 patients, lower lobes in 16 patients, extrapulmonary zone in 22 patients, intrapulmonary middle zone in 3 patients, round in 11 patients, irregular in 14 patients, well-defined in 22 patients, pure ground-glass/mixed ground-glass nodules in 6 patients, solid nodules in 19 patients. There were 11 patients with central small cavity, 18 patients with single bronchioles sign, 19 patients without adhesion with adjacent pleura, and 24 patients without mediastinal lymph node enlargement. ConclusionBronchiolar adenomas usually occur in the middle-aged and elderly, mostly in the lower lobe of both lungs and the distribution of the peripheral lung field, most of the patients do not have any clinical symptoms, and the postoperative prognosis is good. CT may show large nodules or masses, pure ground-glass/mixed ground-glass nodules, irregular solid nodules and central small cavities. Irregular stellate nodules, central small cavity shadow, and single bronchiolar vascular bundle connected with the lesions are relatively specific imaging findings of bronchiolar adenoma.
目的 探讨十二指肠良性肿瘤的手术治疗方式及术后早期营养管理的效果。方法 回顾性分析2009年1月至2011年12月期间我科收治的15例十二指肠良性肿瘤患者的临床资料，根据肿瘤的生长部位及肿瘤大小实施不同的手术方式，术后早期给予肠内营养治疗及消化液回输，观察术后患者并发症发生率及术后2个月内的返院情况。结果 15例患者中2例患者肿瘤位于十二指肠乳头下、直径2.5cm和2.0cm，2例位于降部与水平部交界处、直径2.3cm和2.5cm，1例位于十二指肠升部、直径3.5cm，该5例患者行十二指肠节段切除并空肠吻合术。4例患者肿瘤位于十二指肠乳头、直径1.0～2.0cm，3例位于乳头上缘、直径1.5～1.8cm，2例位于球部与降部交界处、直径2.0cm和1.8cm，1例位于十二指肠乳头下、直径1.2cm，该10例患者均行肿瘤局部切除术（位于乳头部的肿瘤同时行乳头成形术）。围手术期无死亡病例。1例（1/15）发生胃排空障碍，经禁食、减压及营养支持治愈出院。术后住院时间为7～10d，平均8d。术后2个月患者均接受随访，恢复良好，无返院患者。结论 手术切除是十二指肠良性肿瘤的首选治疗手段，手术方式取决于肿瘤的生长部位和大小，术后早期营养管理安全、有效。
ObjectiveTo investigate the role of local pancreatectomy for benign and low-grade malignant pancreatic tumors.MethodThe clinical data of 45 patients with benign and low-grade malignant pancreatic tumors who underwent local pancreatectomy from January 2014 to June 2019 in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were analyzed.ResultsForty-five patients underwent the local enucleation or resection with negative margin. The pathological results showed that there were 17 cases of solid pseudopapilloma, 5 cases of mucinous cystadenoma, 4 cases of serous cystadenoma, 10 cases of islet cell tumor, 5 cases of nonfunctional neuroendocrine tumor, 4 cases of congenital cyst. There were 6 cases of head of pancreas, 26 cases of body of pancreas, 8 cases of tail of pancreas, 5 cases of uncinate process. The tumor was 1.2 to 9.0 cm in diameter with an average of 3.2 cm. Among them, the diameter was more than 5.0 cm in 9 cases. The incidence of pancreatic fistula after operation was 57.8%, 65.4% was grade A fistula, 34.6% was grade B fistula, and no grade C fistula occurred. The incidence of abdominal infection was 13.3%, incidence of abdominal hemorrhage was 6.7%. There was no secondary diabetes mellitus and pancreatic endo- and exocrine dysfunction, and no death case.ConclusionsPancreatic enucleation for benign and low-grade malignant pancreatic tumors after strict preoperative evaluation can effectively preserve the pancreatic endocrine function of patients. Although the incidence of pancreatic fistula is high, it is mostly biochemical fistula, and the incidence of serious complications is low.
Objective To improve the knowledge of pulmonary sclerosing hemangioma ( PSH)especially with bilateral multiple lesions of the lung. Methods The clinical data of 3 cases of PSH ( 1 case with bilateral multiple lesions in the lung) were analyzed, and the related literatures were reviewed. Results All of the 3 cases were females. A 22-year-old female patientwith bilateral multiple nodules in the lungs was complicated with thyroid multiple nodular goiter ( with hypothyroidism) , dysfunctional uterine bleeding ( with anemia) , nodular hyperplasia of the breast, and arteriovenous malformation over forearm. Thoracoscopicbiopsy of left lung and resection of the right pulmonary mass were performed and both the lesions were confirmed as PSH. The clinical manifestations of multiorgan diseases and the presence of PSH suggested Cowden syndrome in this patient. The other 2 cases aged 50 and 53 were asymptomatic with solitary pulmonary nodules identified incidentally. The accessory examinations for malignancies, infections, and autoimmune diseases showed no specific findings. Resection of the lesions were performed by thoracoscopic surgery and thoracotomy respectively, and the histopathological results proved to be PSH. Literature review showed that PSH typically occurred in middle-aged women without clinical symptoms and signs, often presenting as a pulmonary solitary nodule/mass identified incidentally. The differential diagnosis should include peripheral carcinoma, hamartoma, inflammatory pseudotumor and tuberculoma. Multiple PSH, which mainly presented as multiple well-defined nodules /masses of different size in the lungs, was rather rare, but easily confused with metastatic neoplasm. Lung biopsy by surgical operation was a common way to confirm the diagnosis, while FDP-PET and fine needle aspiration biopsy showed some defects. Surgical resection was an effective method of treatment, the residual lesions of multiple PSH should be monitored. Cowden syndrome may be considered if a PSH coexisting with abnormity of multiple organs such as thyoid, breast and vessels. Conclusions PSH should be considered during the differential diagnosis for solitary or multiple nodules /masses in the lung. Surgical biopsy is a common way to confirm the diagnosis. Local excision andnecessary follow-up are effective methods of treatment.
Objective To evaluate the therapeutic effect and complications of modified surgical treatment for parotid benign tumors. Methods Forty-nine patients with parotid tumors treated between February 2007 and February 2013 were randomly divided improved surgery group (trial group,n=24) and traditional surgery group (control group,n=25). Follow-up lasted from two months to two years after surgery. Postoperative complications (facial paralysis, Fery’s syndrome, local deformity, and salivary fistula) and recurrence were observed and compared between the two groups. Results All the 49 patients were followed up from two months to one year after surgery. Two years after surgery, three patients in the trial group and four in the control group were missing during the follow-up. No recurrence occurred in all the patients. There were no permanent facial paralysis cases in both groups. No temporary facial paralysis occurred in the trial group, while there were five such cases in the control group with an incidence rate of 20.0%. The trial group had one case of Fery’s syndrome with an incidence rate of 4.2%, and the control group had 4 such cases with an incidence rate of 16.0%. After surgery, the 24 patients in the trail group achieved general facial symmetry without any facial depression deformity, while there were 3 cases of mild facial depression and 1 obvious facial depression in the control group with an incidence rate of 16.0%. Five patients in the control group had saliva fistula with an incidence rate of 24.0% while one in the trail group (4.2%). The differences in the total rate of complications occurrence between the two groups were statistically significant (P<0.05). Conclusion The improved surgical treatment can effectively reduce complications after surgery for parotid benign tumors, which is worthy of clinical promotion.