Objective To observe an early result after the repair of the large upper thoracic wall defect by a combined use of the titaniumnet, reconstruction nickelclad, and latissimus dorsi myocutaneous flap in a patient who underwent a breast sarcomatoid caricinoma resection on the upper thoracic wall. Methods A breast sarcomatoid carcinoma in the upper thoracic wall was removed in 1 56yearold female patient in February 2006. After the tumorectomy, a large thoracic wall defect was left, which was 20cm×15cm in size. The defect was covered by the titanium net, the bilateral stumps of the clavicles were connected by the reconstruction nickelclad, and the soft tissue defect was repaired with the right latissimus dorsi myocutaneous flap(20cm×15cm). Results The patient depended on the breathing machine for 3 days after operation. When the breathing machine was discontinued, the patient developed a severe paradoxical breathing. Two weeks after operation when theblood circulation of the flap was stabilized, the paradoxical breathing disappeared with the help of the chest bandage for fixation of the chest cavity, and the blood supply of the flap was improved. The chest X-ray film showed that the titanium net and the reconstruction nickelclad were well positioned. The patient received chemotherapy 1 month after operation, The follow-up for 3 months revealed that the patient’s local condition and physical condition were good, and ROMof both the shoulders was improved, with AF 90° and ABD 90°. No recurrence ofthe tumor was found. Conclusion A large thoracic wall defect should be repaired with solid materials. The normal anatomic locations of the clavicles should be maintained with fixation by the reconstruction nickelclad for a good function of the shoulders. The latissimus dorsi myocutaneous flap can be properly enlarged.
【摘要】 目的 探讨子宫腺肉瘤早期的临床表现、影像学特征、组织病理学以及治疗和预后。 方法 对2006年—2010年病理诊断为子宫腺肉瘤的4例青年女性患者进行回顾性分析。 结果 子宫腺肉瘤占同期子宫肉瘤的6.8％（4/58），患者平均发病年龄为40岁，均未绝经。患者均有阴道不规则流血，B型超声示最大1例肿物直径为11 cm，其余结节直径平均约1.5 cm。1例患者的CA125水平高于正常。术后随访期间所有患者身体状态良好，无复发。 结论 子宫腺肉瘤恶性程度较低，如能及时治疗，预后较好。【Abstract】 Objective To investigate the clinical manifestations, imaging features, histopathology, treatment and prognosis of uterine adenosarcoma. Methods The clinical data of four young female patients with uterine adenosarcoma collected from 2006 to 2010 were analyzed retrospectively. Results Uterine adenosarcoma accounted for 6.8% in uterine sarcoma (4/58). All patients were not menopausal, with the average onset age of 40 years old. Abnormal vaginal bleeding were seen in all patients. The diameter of the largest nodule was 11 cm, and the average of the others was 1.5cm approximately in B-ultrasound image. The value of CA125 increased in one patient. During the follow-up period, all patients survived without tumor recurrence. Conclusion Uterine adenosarcoma is a low-grade malignancy. Timely treating may lead to a good prognosis.
目的探讨甲状腺肉瘤的诊断与治疗。 方法回顾性分析2008年1月至2013年8月期间贵阳医学院附属医院甲状腺外科和贵州肿瘤医院甲状腺外科收治的5例甲状腺肉瘤患者的临床资料。 结果5例患者均行根治性手术，3例行术后化疗及放疗。术后均未发生声音嘶哑、呼吸困难、呛咳、肺部感染等并发症，切口均甲级愈合。经病理学免疫组化检查，具体分型为甲状腺组织细胞肉瘤1例，甲状腺血管肉瘤2例，甲状腺平滑肌肉瘤1例，甲状腺未分化肉瘤1例；波形蛋白（Vimentin）阳性5例，角蛋白（CK）阳性2例，平滑肌肌动蛋白（SMA）、结蛋白（Des）及S-100各阳性1例，甲状腺球蛋白（TG）、上皮膜抗原（EMA）、甲状腺转录因子（TTF）及降钙素均为阴性。术后5例患者均经电话随访，随访时间3～9个月，中位数为6个月。随访期间，3例患者因复发和转移而死亡；余2例仍在化疗及放疗中，无复发及转移。 结论甲状腺肉瘤的恶性程度高，宜采用以手术为主的综合治疗方案。