Objective To evaluate the diagnostic significance and to analyze reasons of false negative cases forpreoperative ultrasonography， 99Tcm-sestamibi scintigraphy （MIBI scintigraphy）， and CT in primary hyperparathyroidism（PHPT）. Methods Clinical data of 69 patients with PHPT， who underwent operation in Affiliated Shengjing Hospital of China Medical University between Jan. 2003 and Aug. 2012 were retrospectively analyzed. Results There were 76 parathyroid lesions in 69 PHPT patients proved by operation and pathology， including 58 cases of parathyroid adenoma with 60 lesions， 7 cases of parathyroid hyperplasia with 11 lesions， and 4 cases of parathyroid carcinoma with 5 lesions. The sensitivity of ultrasonography， CT， and 99Tcm-MIBI scintigraphy were 81.94% （59/72）， 61.76% （21/34）， and 69.57% （16/23）， the accuracy of 3 kinds of tests were 78.67% （59/75）， 61.76% （21/34）， and 66.67% （16/24）， the positive predictive value were 95.16% （59/62）， 100% （21/21）， and 94.12% （16/17） respectively. There was significant differ-ence only between ultrasonography and CT in sensitivity （P=0.03）， no other significant difference was found （P＞0.05）.Conclusions Ultrasonography is complementary to 99Tcm-MIBI scintigraphy， but CT has little significance in diagnosis of PHPT. Both of ultrasonography and 99Tcm-MIBI scintigraphy should be used before operation routinely to localize parathyroid lesions.
目的探讨腹腔镜微创手术治疗贲门失弛缓症的应用价值。 方法2007年11月至2009年12月期间，中国医科大学附属盛京医院微创外科对5例贲门失弛缓症患者实施腹腔镜改良Heller手术并胃底折叠术。 结果手术过程顺利，手术时间120～165 min，平均139 min； 术中失血50～200 ml，平均88 ml； 术后第1天进食，吞咽困难症状消失，无手术相关并发症。 5例患者均痊愈出院。术后随访8～31个月，平均19个月，无症状复发或出现返流症状。 结论腹腔镜手术治疗贲门失弛缓症安全、效果良好，值得进一步推广。
ObjectiveTo evaluate the differential diagnosis and treatment of nonfunctional parathyroid cyst. MethodsThe data of 6 patients with nonfunctional parathyroid cyst, who underwent operation in general surgical department of China Medical University Shengjing Hospital between January 2003 and April 2013 were retrospectively analized. ResultsNo patient got definite diagnosis before operation.Preoperative diagnosis were thyroid cyst in 4 patients, neck mass in 1 patient, and thyroid cancer in 1 patient.All patients received operation, included parathyroid cystectomy in 5 patients and thyroid cancer radical resection plus parathyroid cystectomy in 1 patient.Two patients were lost to follow-up, 4 patients were followed-up for 9-24 months, average 19 months, there were no parathyroid cyst and thyroid cancer recurrence or metastasis. ConclusionsNonfunctional parathyroid cyst is true cyst, it is rare lesion in neck, and preoperative definite diagnosis rate is low.The cystectomy is a safe and effective treatment method.
Objective To explore the effect of renal microcirculation following severity acute pancreatitis （SAP） on renal injury and to explore the protection effect of urokinase on them. Methods A total of 192 Wistar rats were randomized divided into normal control group， SAP group， and urokinase group， then rats of 3 groups were sub-divided into 2， 6， 12， and 24 hours group， each group enrolled 16 rats. Of the 16 rats in each subgroup， 8 rats underwent blood flow of renal test， other 8 rats were sacrificed to get blood samples and to perform histopathological examination. The rat models of SAP were established by retrograde injecting with 5% sodium taurocholate into the cholangiopancreatic duct. Radioactive biomicrosphere technique was used to measure the blood flow of renal， levels of plasma thromboxane B2（TXB2） and 6-keto-prostaglandin F1α （6-Keto-PGF1α） were tested by the TXB2 kit and 6-Keto-PGF1α kit， and histopa-thological changes of renal tissues were observed by using HE staining. Results Compared with normal control group at the same time point， the blood flow of renal were lower （P＜0.05）， activity ratio of TXB2 to 6-Keto-PGF1α were higher（P＜0.01）， and the histopathological injury were worse （P＜0.01） in rats of SAP group and urokinase group. Compared with SAP group， the blood flow of renal at 2， 6， and 12 hours in urokinase group were higher （P＜0.01）， the activity ratios of TXB2 to 6-Keto-PGF1α were lower （P＜0.01）， and the histopathological injury were lighter （P＜0.05） in all the 4 time points of urokinase group. Conclusions The renal microcirculation dysfunction and increase of activity ratio of TXB2 to 6-Keto-PGF1α may play an important role in renal injury following SAP in early stage. Urokinase can protect the renal from such injuries.