目的:分析經后腹腔鏡腎上腺囊腫去頂減壓術的療效,安全性和臨床價值。方法:我院2004年12月至2007年12月6例經后腹腔鏡腎上腺囊腫去頂減壓臨床資料進行回顧分析。結果:經后腹腔鏡5例腎上腺囊腫患者順利切除去頂,其中左側腎上腺囊腫3例,右側腎上腺囊腫3例。1例轉開放,為雙側腎上腺囊腫。平均手術時間(45.73±1.32)min,平均術中出血量(7.35±0.45)mL。平均住院天數(7.67±0.24)天,平均術后住院天數(5.0±0.11)天。結論:經后腹腔鏡腎上腺囊腫去頂減壓是一種安全,有效且可行的治療方式,必要時應及時轉開放。
【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.
ObjectiveTo investigate the effectiveness of retroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis. MethodsA retrospective analysis was made on the cl inical data of 22 patients with lumbar spine tuberculosis undergoing focus clearance, fusion, and internal fixation by retroperitoneal laparoscopic approach combined with anterolateral mini-incision between June 2006 and June 2012. There were 14 males and 8 females, with an average age of 42.6 years (range, 26-57 years) and with a mean disease duration of 7.3 months (range, 3-10 months). There were 17 patients with single-level spinal tuberculosis (L1, 2 in 3, L2, 3 in 6, L3, 4 in 4, L4, 5 in 2, and L5 in 2) and 5 patients with double-level spinal tuberculosis (L1-3 in 2 and L2-4 in 3). The preoperative Cobb's angle of lumbar spine was 5-28° (mean, 20°). In 6 patients having compression symptom, 4 cases were rated as grade D and 2 as grade C according to Frankel classification. The operative time, intraoperative blood loss, and postoperative complications were recorded. At last follow-up, the neurologic function was assessed according to Frankel grade, the Cobb's angle after operation was measured on lumbar lateral X-ray film; the efficacy was evaluated according to Nakai criteria, and the fusion was evaluated according to Suk criteria. ResultsAll operations were successfully completed. The operation time was 110-250 minutes (mean, 140 minutes), and intraoperative blood loss was 120-280 mL (mean, 180 mL). The symptoms of femoral nerve injury and sympathetic nerve injury occurred in 1 case respectively and was relieved at 1-3 weeks after operation. All incisions healed by first intention. The patients were followed up 16-50 months (mean, 21 months). During the follow-up period, no loosening or breakage of implants and no tuberculosis recurrence were found. At last follow-up, the nerve function was recovered to grade E in the others except 1 case at grade D. The Cobb's angle was 2-16° (mean, 7.8°). According to Nakai criteria for efficacy evaluation, the results were excellent in 9 cases, good in 10 cases, and fair in 3 cases, with an excellent and good rate of 86.4%. The bony fusion rate was 95.5% (21/22) according to Suk criteria. ConclusionRetroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis is a safe and effective approach with minimal invasion and less complications.
Objective To evaluate the real-time contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of retroperitoneal occupying lesions. Methods Thirty patients with retroperitoneal occupying lesions, including 10 benign and 20 malignant lesions, were performed with CEUS, thus describing the perfusion of contrast agent, the entering style of contrast agent and the vascular morphous. And the entering styles were divided into two patterns: peripheral type or central type while the vascular morphous were divided into 4 levels: level 0, level 1, level 2 and level 3. All of these were compared between benign and malignant lesions. Compared the results of diagnosis malignant lesions by common ultrasonography with CEUS. Results 1/5 case of benign substantive lesions presented as contrast agent perfusion defect, and 11/20 cases of substantive malignant lesions presented as contrast agent perfusion defect. 14/20 of malignant lesions were central type; 9/10 of benign lesions were peripheral type (P=0.005 2). In benign lesions, level 0 had 7/10， level 1 had 2/10 and level 3 had 1/10. In malignant lesions, level 0 had 1/20, level 1 had 3/20, level 2 had 8/20 and level 3 had 8/20, too (P=0.000 5). The rate of missed diagnosis was 40.00% and the accuracy was 66.67% by common ultrasonography, while the rate of missed diagnosis was 10.00% and the accuracy was 86.67% by CEUS combined with the entering style of contrast agent and the vascular morphous. Conclusion The CEUS applies a new way to discriminate malignant from benign in retroperitoneal occupying lesions.
【摘要】 目的 探討外科手術治療原發性腹膜后腫瘤的方法和影響患者預后的因素。 方法 回顧分析2002年5月-2008年5月收治的70例原發性腹膜后腫瘤患者的臨床表現、影像學檢查、手術治療及隨訪情況。 結果 70例患者均進行了手術治療，其中良性腫瘤20例（28.57%），惡性腫瘤50例（72.43%），良惡之比為1∶2.5；完整切除腫瘤者58例（82.86%），腫瘤部分切除者7例（10%），腫瘤廣泛轉移行組織活檢者5例（7.14%），聯合器官切除者18例（25.71%）。術后隨訪1~5年惡性腫瘤患者45例，其中腫瘤完全切除組1、3、5年的生存率分別為91.67%、66.67%、22.22%，腫瘤部分切除組分別為66.67%、33.33%、0%。兩組比較差異有統計學（Plt;0.01）。研究發現腫瘤的大小、病理類型、是否完整切除是影響腫瘤局部復發、患者生存率的重要因素。 結論 早期診斷、充分的術前準備、腫瘤的全切除率能顯著改善患者術后遠期生存率。【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 探討急性胰腺炎繼發感染的治療方法。方法 分析總結我院1998～1999年收治的20例胰腺感染患者，采用經后上腰腹膜后引流及灌洗方法治療的資料。結果 術后并發癥： 殘余膿腫2例，消化道出血1例，腸瘺4例，胰瘺6例，經治療后患者全部治愈。結論 該治療方法殘余感染及死亡率低。
目的 總結1例腹膜后神經鞘瘤合并胃神經鞘瘤的臨床診療方法。 方法 2010年12月收治1例女性患者，因嘔血行CT檢查發現胃體前壁及右腎上腺區占位入院，行胃楔形切除術及右腎上腺腫瘤切除術治療。 結果 術后病理證實為腹膜后神經鞘瘤合并胃神經鞘瘤，隨訪半年無復發。 結論 腹膜后神經鞘瘤合并胃神經鞘瘤病例罕見且診斷困難，影像學檢查缺乏特異性，可依靠術后病理檢查確診；外科手術完整切除腫瘤是有效的治療方法，預后較好。
目的 總結原發性腹膜后脂肪肉瘤（primary retroperitoneal liposarcoma，PRL）的臨床病理特征、診斷及治療方法。 方法 回顧性分析經手術和活檢證實的23例PRL患者的臨床病理資料。結果 首發癥狀及體征表現為腹部腫塊（91.3%，21/23），腹脹（56.5%，13/23）及腹痛（30.4%，7/23）。B超及CT的定位診斷準確率分別為66.7%（12/18）和85.7%（12/14）。首次手術腫瘤完整切除16例（69.6%），其中8例聯合臟器切除； 部分切除3例（13.0%）； 僅行活檢4例（17.4%）。PRL腫瘤完整切除術后復發率為75.0%（12/16）,該12例中再次手術8例（66.7%）可完全切除腫瘤。結論 CT是診斷PRL的重要手段，優于B超； 手術以完整切除腫瘤為主，對侵犯臟器者采用累及臟器一并切除； 術后復發者可再次手術。
【摘要】 目的 探討子宮頸巨大平滑肌瘤在其診斷及治療上的特殊性。 方法 對2007年10月-2010年3月收治的11例子宮頸巨大平滑肌瘤患者的臨床資料進行分析，對其發病率，診斷和手術治療進行評價。 結果 11例子宮頸巨大平滑肌瘤中黏膜下2例，腹膜后9例。術前9例出現誤診，其中誤診為盆腔包塊5例，子宮體肌瘤3例，子宮肉瘤1例。6例行經腹子宮全切加雙附件切除，2例行經腹子宮切除術，1例行經腹肌瘤挖除術，1例行經陰道肌瘤摘除術，1例行經腹肌瘤挖出加宮頸殘端切除術。 結論 子宮頸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，由于盆腔器官被擠壓，使盆腔解剖結構發生改變，術前易被誤診。且手術過程中易出現損傷及出血，因此術前估計充分，術中仔細認清各器官解剖關系，可有效地減少術中損傷和控制出血。【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.