目的:研究子宫腺肌病局部病灶切除术的可行性,方法及手术疗效的评价。方法:对2002年3月至2006年3月97例子宫腺肌病保留子宫仅作局部病灶切除术的患者进行随访观察。结果:97例子宫腺肌病手术后痛经治愈率:轻度,100%,中度37.8%,重度36%,痛经缓解率,中度及重度分别为62.2%及64%。月经过多治愈率为100%。妊娠分娩率原发不孕57.6%,继发不孕52.9%。结论:子宫腺肌病局部病灶切除术既治愈和改善了患者的临床症状又保留生殖器官的完整性及生理生殖功能可且有助于妊娠率的提高,是值得使用的方法。
ObjectiveTo investigate the short-term effectiveness of one-stage radical debridement and total hip arthroplasty (THA) in the treatment of active tuberculosis of the hip. MethodsBetween January 2006 and June 2011,one-stage radical debridement and THA were performed on 12 cases (12 hips) of active tuberculosis of the hip.There were 7 males and 5 females,aged 18-60 years (mean,46.3 years).The disease duration ranged from 6 to 24 months (mean,10.5 months).According to Babhulkar and Pande staging criteria,5 cases were at stage Ⅲ and 7 cases were at stage IV.One case had sinus,and 2 cases had previous pulmonary tuberculosis.Preoperative hip range of motion was (35.83±9.25)°; hip Harris score was 36.83±6.44.Erythrocyte sedimentation rate (ESR) was 45-90 mm/1 h (mean,62.4 mm/1h); C-reactive protein (CRP) was 19-50 mg/L (mean,33.6 mg/L).Perioperatively all the patients accepted the regular anti-tuberculous medication. ResultsThe results of histopathological examination and PCR detection were positive for tuberculosis bacillus.Postoperatively the incisions healed primarily.All the patients were followed up 25-60 months (mean,40.8 months).The ESR and CRP returned to normal level with no liver injury.Tuberculosis recurrence occurred in 1 patient at 4 months after operation,which was cured after revision.X-ray film showed no prosthesis shift,prosthesis loosening,or sinus tract.At 18-24 months after operation,the bilateral sides had the same bone density,which was similar to that at the final follow-up.Hip range of motion was significantly improved to (107.08±13.56)° (t=14.571,P=0.000).Hip Harris score was significantly increased to 88.00±10.78 (t=16.750,P=0.000). ConclusionA combination of one-stage radical debridement and THA is a safe method to treat active tuberculosis of the hip,which can relief symptoms and improve hip function,with low recurrence and satisfactory short-term effectiveness.
目的 探讨镰状韧带引起假性病灶的影像学表现，以提高对其的认识，减少误诊。 方法 对2010年1月－2012年1月收入的817例患者进行上腹部64排CT平扫加增强扫描，筛选出肝镰状韧带附近假病灶，详细记录其部位、大小、形状以及扫描各期图像的密度变化情况。 结果 有72例存在镰状韧带假病灶，绝大多数位于肝左叶内侧段（69例），并呈单发病灶（70例）。假病灶最大直径约5.1～22.0 mm，平均约13.1 mm，假病灶分别呈三角形43例、类圆形19例、结节状10例。CT扫描：平扫显示10例，动脉期显示63例，门脉期几乎全部显示清晰。 结论 镰状韧带形成假病灶比较少见，其发生部位特殊，在门脉期易于显示，可与肝内真性病灶鉴别，以免误诊。
ObjectiveTo summarize the therapeutic effect and clinical significance of reduced volume lesion resection combined with drug therapy for end-stage alveolar hepatic echinococcosis.MethodClinical data of 46 patients with end-stage alveolar hepatic echinococcosis who received treatment of reduced volume lesion resection combined with drug therapy at Department of General Surgery of Qinghai Provincial People’s Hospital from March 2013 to October 2019 were retrospectively analyzed.ResultsAmong the 46 patients, 3 patients were lost to follow-up and 43 patients received follow-up. The follow-up time ranged from 3 to 79 months, with the median of 40 months. Fifteen patients died during the follow-up period, of which 5 patients with cerebral hydatid disease died during 16–36 months due to acute seizures and cerebral edema, 4 patients with multiple systemic metastases died during 9–36 months due to multiple organ failure, 2 patients with pulmonary echinococcosis died due to acute pulmonary embolism, 4 patients died in 2 years after operation due to recurrent biliary tract infection, other patients survived during follow-up period without distant organ metastasis.ConclusionReduced volume lesion resection combined with drug therapy in treatment of end-stage alveolar hepatic echinococcosis can improve the patient’s quality of life, reduce the hospital cost, reduce the occurrence of postoperative complications, and shorten the length of hospital stay.
Objective To study the cl inical effects of modified Galveston technology in the treatment of lumbosacral tuberculosis. Methods From January 2001 to May 2008, 19 patients with lumbosacral tuberculosis were treated, including13 males and 6 females aged 21-58 years old (average 38 years old). The course of disease was 8-22 months. The tuberculosis was at the L4-S1 level in 3 cases, the L5, S1 level in 10 cases, the L5-S2 level in 5 cases, and the S1, 2 level in 1 case. Seven cases were compl icated with neural symptom of the lower l imbs, 3 cases of them were grade C and 4 cases were grade D according to the Frankel scale of nerve function. The preoperative JOA score of lower back pain was 5-22 (average 19). Six cases were compl icated with il iac abscess, 3 cases with psoas abscess, 3 cases with sacroil iac joint tuberculosis, and 2 cases with pulmonary tuberculosis. For 12 patients, the operation of modified Galveston internal fixation via the posterior approach, focus debridement via vertebral canal, and interbody fusion with autogeneous il iac bone fragment grafting was performed; for 7 cases, the operation of modified Galveston internal fixation via the posterior approach, vertebral lamina fusion with autogeneous il iac bone fragment grafting, and anterior focus debridement was performed. Results The incision of 18 cases was healed by first intention, and 1 case had sinus 3 weeks after operation and healed 3 months after operation. Nineteen patients were followed up for 12-82 months (average 21 months). There was no recurrence of the local tuberculosis, and the common toxic symptom of tuberculosis disappeared 6-12 months after operation. All the patients achieved bony fusion 4-6 months postoperatively, and 3 patients with sacroil iac joint tuberculosis achieved sacroil iac joint fusion. For those 7 patients with combinations of the neural symptomof the lower l imbs, the symptoms disappeared and their Frankel scales were improved to grade E. The JOA score of low back pain at the final follow-up was 22-29 (average 26). There was a significant difference between preoperation and postoperation (P lt; 0.05). Conclusion The modified Galveston technology is helpful to reconstruct the stabil ity of lumbosacral vertebrae, improve bony fusion rate, reduce the postoperative in-bed time.
摘要:目的:探讨晚期食管癌切除、纵隔淋巴结清扫及术中纵隔热灌注化疗对残留于气管、支气管、胸主动脉、奇静脉等器官的癌性肉眼微小病灶治疗效果。方法:选择食管癌病变浸润超过外膜层外侵至气管、支气管、胸主动脉、奇静脉等器官患者112例，随机分为两组:治疗组56例,术中42～43℃无菌蒸馏水2000～2500 mL加入顺铂(DDP)150 mg及氟尿嘧啶(5FU)1200 mg在体外循环下行纵隔热灌注化疗40 min;对照组56例,术中未进行纵隔热灌注化疗。结果:治疗组术后第一年有6例出现纵隔区域肿瘤复发及淋巴结转移,术后第二年有11例纵隔区域肿瘤复发及淋巴结转移;对照组术后第一年有14例出现纵隔区域肿瘤复发及淋巴结转移,术后第二年23例出现纵隔区域肿瘤复发及淋巴结转移。结论:晚期食管癌术中纵隔热灌注化疗可明显减少或延迟纵隔区域肿瘤复发及淋巴转移,提高术后第一至第二年生存率。Abstract: Objective: To explore the advanced esophageal cancer resection, mediastinum, lymph node dissection, mediastinum, hot infusion chemoembolization and clinical observation of residual heat infusion chemoembolization and trachea, or the thoracic aorta, bronchus, eye cancer organs such as intravenous of tiny lesions therapeutic effect. Methods: Select esophageal lesions than the outer membrane layer of infiltrating the trachea and bronchus to the thoracic aorta, and 112 cases of patients with venous organs such as random points to two groups: treatment group treated with perfusion of 56 cases at 4243 degrees Celsius sterile 2000 mL distilled water 2500 mL ~ (DDP) joined cisplatin 150 mg, 5fluorouracil (5FU 1200 mg) in extracorporeal circulation downlink mediastinal hot perfusion 40 minutes, control group treated with perfusion of 56 cases without mediastinal hot perfusion chemotherapy. Results: Treatment group in 6 cases occured after first mediastinal tumor recurrence and regional lymph node metastases after 11 cases, the regional recurrence and lymphatic metastasis mediastinal, control group first fill after 14 cases mediastinal tumor recurrence and bureau of regional lymph node metastasis appeared in 23 cases, surgery between regional tumor locally recurrent lymph node metastases. Conclusion: Advanced esophageal intraoperative mediastinal hot perfusion chemotherapy can obviously reduce or delay mediastinal tumor recurrence and regional lymph node metastases, raise the firstsurial.
Objective To summarize the effect of one-stage anterior debridement of infection in function reconstruction of anterior and middle column for the treatment of thoracolumbar spinal tuberculosis. Methods From January 2001 to January 2007, 65 patients with thoracolumbar spinal tuberculosis were treated with one-stage anterior debridement, decompression, autogenous bone grafts and internal fixation. There were 43 males and 22 females with an average age of 40.2 years (range, 19-64 years), including 18 cases of thoracic tuberculosis (T4-10), 44 cases of thoracolumbar tuberculosis (T11-L2) and 3 cases of lumbar tuberculosis (L3-5). The disease course was 3 months to 10 years (median 10 months). One segment was involved in 7 cases, two segments in 54 cases and three segments in 4 cases. In 14 cases with spinalcord injury, there were 5 cases of grade C and 9 cases of grade D according to Frankel classification. The kyphotic Cobb angle was 20-65° (41° on average). Results The operative time was 120-210 minutes (170 minutes on average), and the blood loss was 300-1 500 mL (600 mL on average). Fifty-eight patients were followed up for 1-6 years (23 months on average). Abscess occurred in 2 cases at 40 days and 3 months, and healed after symptomatic management. The other incisions achieved heal ing by first intention. The X-ray films showed bony fusion 4-12 months (6 months on average) after operation. No tuberculosis recurred. At 12 months after operation, pain disappeared, and there were 7 cases of grade D and 7 cases of grade E according to Frankel classification. The kyphotic Cobb angle was 0-33° (24° on average), showing statistically significant difference (P lt; 0.05) when compared with preoperation. Conclusion Early reconstruction of load-bearing function and stabil ity of anterior and middle column in the treatment of spinal tuberculosis is great significant. The appl ication of one-stage anterior surgery with debridement, decompression, autogenous bone grafts and internal fixation in the operative treatment of thoracolumbar tuberculosis is safe and effective after a rigorous anti-tuberculosis treatment.
Objective To investigate the effectiveness of bundled multi-segment autologous rib graft reconstruction for bone defects after thoracic spinal tuberculosis debridement. Methods The anterior debridement, multi-segment autologous rib interbody fusion, anterior or posterior internal fixation were used for treating the bone defect after thoracic spinal tuberculosis debridement in 36 cases between January 2006 and December 2013. There were 20 males and 16 females with an average age of 50.5 years (range, 21-60 years), and an average disease duration of 6.8 months (range, 5-11 months). The thoracic vertebral tuberculosis located at T4, 5 in 1 case, T5, 6 in 4 cases, T6, 7 in 4 cases, T7, 8 in 4 cases, T8, 9 in 9 cases, T9, 10 in 8 cases, T10, 11 in 5 cases, and T11, 12 in 1 case. Neurological impairment of 34 patients was assessed as grade B in 2 cases, grade C in 8 cases, and grade D in 24 cases according to Frankel classification. The pre- and post-operative erythrocyte sedimentation rate (ESR), C reactive protein (CRP), visual analogue scale (VAS) score, and kyphosis Cobb angle were evaluated. The fusion rate was analysed based on CT three-dimensional reconstruction. Results The cross-sectional area of the bundled multi-segment rib graft was 136.8-231.2 mm2 (mean, 197.1 mm2); the endplate surface area of adjacent upper and lower vertebral bodies was 425.0-677.6 mm2 (mean, 550.6 mm2); and the cross-sectional area of rib graft accounted for 29%-50% (mean, 33.6%) of the endplate surface area. The operation time was 95-160 minutes (mean, 125 minutes) and the intraopeartive blood loss was 280-850 mL (mean, 450 mL). All the patients were followed up 2-8 years (mean, 4.4 years). The postoperative complications included intercostals neuralgia in 2 cases, pleural effusion in 1 case, and liver function damage caused by antituberculosis drugs in 2 cases, who were all cured after symptomatic treatment. The rest patients had no respiratory complications and wound infection; and there was no fracture, displacement, absorption of rib support, tuberculosis recurrence, internal fixation loosening, and kyphosis occurred in all patients. CT three-dimensional reconstruction showed that the fusion rate was 86.1 (31/36) at 6 months after operation and was 97.2% (35/36) at 12 months after operation. The ESR, CRP, VAS scores, and kyphosis Cobb angle at 3 months after operation and last follow-up were significantly improved when compared with preoperative values (P<0.05), but there was no significant difference between at 3 months after operation and last follow-up (P>0.05). Neurological deficits were all improved at last follow-up according to Frankel classificaiton, including 2 cases with grade B recovered to grade D, 8 cases with grade C to grade D in 1 case and to grade E in 7 cases, 24 cases with grade D all to grade E. Conclusion Bundled multi-segment autologous rib graft reconstruction is an alternative method for less than 2 discs and vertebral bone defect created by radical debridement for thoracic spinal tuberculosis.
【摘要】 目的 探讨超声引导下导丝定位在不可触及的乳腺病灶切除中的应用价值。 方法 对2005年1月－2010年9月127例女性患者的137个乳腺病灶（临床扪诊均为阴性），在超声引导下进行导丝定位，后进行外科切除活检，并对相关资料进行回顾性分析。 结果 137个病灶的组织学结果中，良性病灶101个（73.7%）、高风险病灶27个（19.7%）和癌9个（6.6%）。9个癌中3个为导管原位癌，6个为浸润性导管癌（大小11～19 mm，平均14.2 mm）。超声引导下导丝定位的时间为3～15 min，平均6 min；无血肿、导丝脱落及折断等并发症发生。外科手术切除时间20～40 min，平均30 min。 结论 超声引导下进行导丝定位安全、迅速，能协助外科手术进行准确的活检和切除。【Abstract】 Objective To determine the application value of ultrasound-guided wire localization in surgical excision of non-palpable breast lesions. Methods Between January 2005 and September 2010, 127 women with 137 non-palpable breast lesions underwent surgical excision at West China Hospital. Palpation results for all the lesions were negative. Wire localization guided by ultrasound was performed before operation and biopsy. Related imaging studies and medical records were reviewed retrospectively. Results Histological findings showed there were 101 benign lesions (73.7%), 27 high-risk lesions (19.7%), and 9 carcinomas (6.6%). Among the 9 carcinomas, 3 were ductal carcinoma in situ, and 6 were infiltrating carcinoma (with their size ranged from 11 to 19 mm averaging at 14.2 mm). The time of performing ultrasound-guided wire localization was from 3 to 15 minutes averaging at 6. No complications like hematoma, wire fragments, and wire breakage occurred in all cases. The surgical excision time ranged from 20 to 40 minutes averaging at 30. Conclusions Ultrasound-guided wire localization can be performed quickly and safely for the cases of non-palpable breast lesions. It is useful in assisting surgical excision and biopsy.