【摘要】 目的 评价大分割适形放射治疗对腹膜后软组织肿瘤术后患者的治疗作用。 方法 对1998年10月-2003年4月收治的16例腹膜后软组织急性肿瘤术后患者行大分割适形放射治疗，设计临床靶区等效生物剂量为55～62 Gy，观察放疗后2、5年局部控制率、生存率和无病生存情况。 结果 2、5年局部控制率较未行放疗患者明显提高并和其他放射治疗方式达到较高治疗剂量者近似；远期生存无改善，无病生存率较未行放疗患者有提高。 结论 大分割适形放射治疗方式对腹膜后软组织急性肿瘤术后患者有较好的局部控制作用，无瘤生存率有提高，远期生存无改善，无严重的远期放疗后遗症。【Abstract】 Objective To observe the effect of high-dose three-dimensional conformal radiotherapy combined with surgery on primary retroperitoneal soft tissue sarcoma. Methods A total of 16 patients with primary retroperitoneal soft tissue sarcoma underwent high-dose three-dimensional conformal radiotherapy after sarcoma excision from October 1998 to April 2003. The biologically effective dose was 55-62 Gy for CTV. The local control rate and long-term survival rate and disease free survival after 2 and 5 years were observed. Results The local control rate obviously raised in these patients after 2 and 5 years; but the long-term survival rate didn’t improve and the disease free survival improved in these patients compared with those wasn’t radiated. Conclusion High-dose three-dinensional comfomal radiotherapy is effective on the patients with retroperitoneal soft tissue sarcoma in local control rate and disease free survival, but long-term survival rate is not improved and the side-effect is not serious.
目的 总结原发性腹膜后脂肪肉瘤（primary retroperitoneal liposarcoma，PRL）的临床病理特征、诊断及治疗方法。 方法 回顾性分析经手术和活检证实的23例PRL患者的临床病理资料。结果 首发症状及体征表现为腹部肿块（91.3%，21/23），腹胀（56.5%，13/23）及腹痛（30.4%，7/23）。B超及CT的定位诊断准确率分别为66.7%（12/18）和85.7%（12/14）。首次手术肿瘤完整切除16例（69.6%），其中8例联合脏器切除； 部分切除3例（13.0%）； 仅行活检4例（17.4%）。PRL肿瘤完整切除术后复发率为75.0%（12/16）,该12例中再次手术8例（66.7%）可完全切除肿瘤。结论 CT是诊断PRL的重要手段，优于B超； 手术以完整切除肿瘤为主，对侵犯脏器者采用累及脏器一并切除； 术后复发者可再次手术。
【Abstract】ObjectiveBy using multidetectorrow spiral CT (MDCT), to investigate the CT imaging features of inflammatory diseases in retroperitoneal space with correlation of radiological anatomy.MethodsThe clinical and laboratory dada of 30 patients with proven inflammatory diseases of retroperitoneal space were collected. All patients underwent MDCT plain scanning and portal venous acquisition. CT imaging data generated at portal venous phase were processed with coronal, sagittal and oblique multiplanar reformation (MPR) technique.ResultsAcute pancreatitis and various types of renal infection were the two main sources of retroperitoneal inflammation. Depending on the specific anatomic locations, retroperitoneal inflammation of different subspaces demonstrated characteristic imaging features. Spreading of inflammatory process across subspaces was also quite common.ConclusionMDCT is the imaging method of choice to depict comprehensively and clearly the inflammatory diseases of various retroperitoneal spaces.
目的 探讨急性胰腺炎继发感染的治疗方法。方法 分析总结我院1998～1999年收治的20例胰腺感染患者，采用经后上腰腹膜后引流及灌洗方法治疗的资料。结果 术后并发症： 残余脓肿2例，消化道出血1例，肠瘘4例，胰瘘6例，经治疗后患者全部治愈。结论 该治疗方法残余感染及死亡率低。
目的 总结1例腹膜后神经鞘瘤合并胃神经鞘瘤的临床诊疗方法。 方法 2010年12月收治1例女性患者，因呕血行CT检查发现胃体前壁及右肾上腺区占位入院，行胃楔形切除术及右肾上腺肿瘤切除术治疗。 结果 术后病理证实为腹膜后神经鞘瘤合并胃神经鞘瘤，随访半年无复发。 结论 腹膜后神经鞘瘤合并胃神经鞘瘤病例罕见且诊断困难，影像学检查缺乏特异性，可依靠术后病理检查确诊；外科手术完整切除肿瘤是有效的治疗方法，预后较好。
【摘要】 目的 探讨子宫颈巨大平滑肌瘤在其诊断及治疗上的特殊性。 方法 对2007年10月-2010年3月收治的11例子宫颈巨大平滑肌瘤患者的临床资料进行分析，对其发病率，诊断和手术治疗进行评价。 结果 11例子宫颈巨大平滑肌瘤中黏膜下2例，腹膜后9例。术前9例出现误诊，其中误诊为盆腔包块5例，子宫体肌瘤3例，子宫肉瘤1例。6例行经腹子宫全切加双附件切除，2例行经腹子宫切除术，1例行经腹肌瘤挖除术，1例行经阴道肌瘤摘除术，1例行经腹肌瘤挖出加宫颈残端切除术。 结论 子宫颈巨大平滑肌瘤由于其位置的特殊性，尤其是凸向腹膜后的肌瘤，由于盆腔器官被挤压，使盆腔解剖结构发生改变，术前易被误诊。且手术过程中易出现损伤及出血，因此术前估计充分，术中仔细认清各器官解剖关系，可有效地减少术中损伤和控制出血。【Abstract】 Objective To investigate the particularity of diagnosis and treatment for giant uterine cervical leiomyoma. Methods We analyzed the clinical data of 11 patients with giant uterine cervical leiomyoma who were admitted in our hospital from October 2007 to March 2010. The incidence, diagnosis and surgical treatment of the disease were evaluated. Results Of the 11 cases, nine were retroperitoneal leiomyoma and two were submucous leiomyoma. There were nine misdiagnosed cases before operation, including five diagnosed as pelvic mass, one as uterine sarcoma and three as uterine corpus leiomyoma. Six patients underwent abdominal hysterectomy and bilateral salpingo-oophorectomy; two underwent abdominal hysterectomy; one underwent abdominal myomectomy; one underwent transvaginal myomectomy; and one underwent abdominal myomectomy with excision of cervical stump. Conclusion The giant uterine cervical leiomyoma is easily misdiagnosed preoperatively due to its special anatomic site. A good example is the retroperitoneal leiomyoma in which the pelvic anatomic structure is changed because of the extrusion of the tumor on other pelvic organs. Furthermore, injuries and bleeding often happen during the operation. Consequently, sufficient preoperative assessment and clearly identifying regional anatomical relations can effectively reduce the damage and bleeding during the operation.
【摘要】 目的 探讨外科手术治疗原发性腹膜后肿瘤的方法和影响患者预后的因素。 方法 回顾分析2002年5月-2008年5月收治的70例原发性腹膜后肿瘤患者的临床表现、影像学检查、手术治疗及随访情况。 结果 70例患者均进行了手术治疗，其中良性肿瘤20例（28.57%），恶性肿瘤50例（72.43%），良恶之比为1∶2.5；完整切除肿瘤者58例（82.86%），肿瘤部分切除者7例（10%），肿瘤广泛转移行组织活检者5例（7.14%），联合器官切除者18例（25.71%）。术后随访1~5年恶性肿瘤患者45例，其中肿瘤完全切除组1、3、5年的生存率分别为91.67%、66.67%、22.22%，肿瘤部分切除组分别为66.67%、33.33%、0%。两组比较差异有统计学（Plt;0.01）。研究发现肿瘤的大小、病理类型、是否完整切除是影响肿瘤局部复发、患者生存率的重要因素。 结论 早期诊断、充分的术前准备、肿瘤的全切除率能显著改善患者术后远期生存率。【Abstract】 Objective To investigate the surgical management for primary retroperitoneal tumors (PRT) and the factors influencing the prognosis after operation. Methods The clinical manifestation, image data, treatment and prognosis of 70 patients with primary retroperitoneal tumor from May 2002 to May 2008 were retrospectively analyzed. Results All of the patients with PRT had undergone the operations, in whom 20 (28.57%) had benign tumors and 50 (72.43%) had malignant tumors with a ratio of 1:2.5. Among these patients, 58 (82.86%) had complete resection, 7 (10%) had incomplete resection, five (7.14%) had surgical biopsies and 18 (25.71%) had combined resection of the organs. A total of 45 patients with malignant tumors were followed up for one month to five years. The one-, three-, and five-year survival rates of the patients in complete resection group was 91.67%, 66.67% and 22.22%, respectively; and was 66.67%, 33.33%, and 0%, respectively in incomplete resection group. The differences between the two groups were significant (Plt;0.001). The results showed that the completeness of tumor, sizes, and histological type were associated closely with local recurrence and prognosis. Conclusion Early diagnosis, sufficient preoperative preparation and complete tumor resection play important roles in reducing the recurrence and improving the long-term survival rate.
目的:分析经后腹腔镜肾上腺囊肿去顶减压术的疗效,安全性和临床价值。方法:我院2004年12月至2007年12月6例经后腹腔镜肾上腺囊肿去顶减压临床资料进行回顾分析。结果:经后腹腔镜5例肾上腺囊肿患者顺利切除去顶,其中左侧肾上腺囊肿3例,右侧肾上腺囊肿3例。1例转开放,为双侧肾上腺囊肿。平均手术时间(45.73±1.32)min,平均术中出血量(7.35±0.45)mL。平均住院天数(7.67±0.24)天,平均术后住院天数(5.0±0.11)天。结论:经后腹腔镜肾上腺囊肿去顶减压是一种安全,有效且可行的治疗方式,必要时应及时转开放。