Objective To investigate the operative procedure and the effectiveness of eosinophil ic granuloma (EG) of long bones in children. Methods Between January 2005 and December 2009, 14 patients with EG of long bones were treated. There were 9 boys and 5 girls, aged from 1 to 13 years (mean, 6.5 years). The locations were femur in 5 cases, humerus in 4 cases, tibia in 2 cases, fibula in 1 case, and femur compl icated with tibia in 2 cases. The disease duration was7 days to 10 months (median, 2 months). X-ray films showed that osteolytic destruction had clear boundary, which did notinvolve the epi physeal plate. Of 14 cases, 12 cases of tumor were treated by curettage, autologous il iac bone or combined artificial bone graft repair, and 2 cases were treated by resection, autologous il iac reconstruction, plate and screw fixation. Five cases compl icated with pathological fracture underwent reduction and fixation. Results All cases were diagnosed pathologically as having EG. All incisions healed by first intention. A total of 12 patients were followed up 1 to 4 years (mean, 2 years). The X-ray films showed tumor focus and pathological fracture healed within 3 to 4 months (mean, 3.5 months). Tibial lesion was found in 1 case of femoral tumor after 8 months, and was curred after reoperation. No recurrence occurred in other 11 cases. According to comprehensive assessing standard of X-ray film and joint function, the results of all cases were excellent. Conclusion EG of long bones in children is more common in the femur and humerus. Tumor curettage and autologous il iac bone graft repair is an effective method, and postoperative prognosis is good. There may be multiple lesions, so long-term follow-up is needed.
ObjectiveTo construct a prediction model for the postoperative recurrence risk of granulomatous lobular mastitis (GM) based on multiple systemic inflammatory indicators and clinicopathologic characteristics, with the aim of guiding clinical treatment. MethodsThe GM patients who underwent lesion resection at Sichuan Provincial Hospital for Women and Children from January 2017 to March 2024 were retrospectively collected. The univariate and multivariate logistic regression analyses were used to screen the risk factors for recurrence after GM lesion resection, and a nomogram prediction model was constructed based on the risk factors. The test level was set at α=0.05. ResultsA total of 533 patients with GM were included in this study, of whom 118 cases (22.1%) developed postoperative recurrence. The results of multivariate analysis showed that the not taking oral bromocriptine, having microabscess formation in postoperative pathological examination, systemic immune inflammation index (SII) >789.0×109/L, and immunoglobulin E (IgE) >64.4 U/mL were the independent risk factors for recurrence after GM lesion resection. Based on the risk factors, the nomogram predicting recurrence risk was constructed. The area under the receiver operating characteristic curve (95%CI) was 0.913 (0.895, 0.932), and its sensitivity and specificity were 90.5% and 88.9%, respectively. The calibration curve showed that the probability of recurrence after GM lesion resection predicted by using the nomogram was highly consistent with the actual recurrence probability. The decision curve analysis showed that the nomogram had a good clinical net benefit. ConclusionsThe findings of this study suggest that close postoperative monitoring for recurrence is warranted in patients who did not receive oral bromocriptine treatment, presented with microabscess formation on pathological examination, and exhibited elevated SII and IgE level. The postoperative GM recurrence prediction nomogram model constructed based on risk factors demonstrates a good predictive performance, providing a valuable reference for early treatment and management strategies of GM.
ObjectiveTo investigate the research progress of etiology, pathogenesis, diagnosis, differential diagnosis, and treatment of granulomatous lobular mastitis (GLM). MethodA comprehensive analysis was conducted by reviewing the domestic and foreign literatures on GLM and combining with clinical experience. ResultsGLM was a relatively rare chronic inflammatory disease of the breast, and the number of patients had been increasing in recent years. It mainly occured in multiparous women of childbearing age. Clinically, it was characterized by a hard breast mass with or without redness and pain, and severe cases might be accompanied by nodular erythema and arthritis. Bacterial infection, especially Corynebacterium kroppenstedtii and autoimmunity were considered to be the main causes of GLM. The diagnosis of GLM needed to combine with medical history, clinical manifestations, histopathological findings, imaging findings, and laboratory tests. A multidisciplinary team for diagnosis and treatment of GLM should be established to improve the diagnostic accuracy and reduce misdiagnosis. At present, the treatment methods for GLM were mainly conservative treatment and surgical treatment, including follow-up observation, antibiotic treatment, glucocorticoid treatment, immunosuppressive therapy, surgical treatment, traditional Chinese medicine treatment, and combined treatment. ConclusionsAt present, the incidence of GLM is on the rise, but its etiology and pathogenesis are still unclear. The diagnosis needs to combine with many aspects, and it is recommended that the multidisciplinary team could improve the accuracy of diagnosis. There is still no unified standard for the selection and timing of treatment. Clinicians’ experience and patients’ wishes should be taken into account when choosing treatment options in clinical practice. Prospective and high-quality multicenter clinical trials and evidence-based medicine practice are still needed to further improve diagnosis and treatment of GLM.
目的 探討面部燒傷后肉芽創面移植自體大張中厚皮的可行性。 方法 回顧性分析2002年1月－2012年4月收治的27例面部燒傷后肉芽創面進行自體大張中厚皮移植手術患者的臨床資料。術中用手術刀刮除肉芽組織至基底層，用取皮鼓或電動取皮刀取患者大腿或者腹部大張中厚皮，移植于受皮區，術后5 d左右打開敷料半暴露或暴露。 結果 27例手術患者中24例大張中厚皮全部成活，3例大部分成活，再次補植皮后愈合。患者創面愈合后外形豐滿，皮膚彈性較好，表情豐富。20例隨訪1～5年，患者面部外觀良好，2例發生小口畸形，2例眼瞼輕中度外翻，分別行整形手術后改善。 結論 面部燒傷后肉芽創面移植大張中厚皮可獲得較滿意的治療效果，可在臨床推廣使用。
目的 探討胃嗜酸性肉芽腫的診斷、誤診原因和治療方法。方法 對14例胃嗜酸性肉芽腫的臨床資料進行回顧性分析。結果 全部病例均有上腹疼痛和返酸史； 伴潰瘍形成11例，穿孔4例，上消化道出血3例； 術前行胃鏡檢查2例，X線鋇餐透視檢查6例，無1例獲確診； 其余病例亦全部誤診為胃潰瘍或癌腫。結論 胃鏡多部位取材，特別是在潰瘍與周邊粘膜移行處，采取挖掘式取材，能減少誤診率； 胃大部切除術是主要的治療方法。
目的 分析黃色肉芽腫性膽囊炎（XGC）誤診為膽囊癌的原因，探討XGC的診斷和治療策略。方法 回顧性分析2012年我科收治的2例XGC誤診為膽囊癌患者的臨床病理資料。結果 2例患者術前及術中均誤診為膽囊癌，均行膽囊切除＋肝臟Ⅳ、Ⅴ段切除＋膽道鏡下膽總管探查術，其中1例還行肝門周圍淋巴結清掃。術后病理回報均為XGC。2例患者術后均恢復良好，無手術并發癥發生；均隨訪3個月，生活質量好。結論 臨床上根據XGC的癥狀和影像學表現極易誤診為膽囊癌，建議術中冰凍病理明確診斷后選擇合適的術式，防止盲目擴大手術范圍，減少機體損傷和術后并發癥的發生。