ObjectiveTo summarize the predictive factors of recurrence of retroperitoneal sarcoma.MethodsThe literatures on the recurrence of retroperitoneal sarcoma at home and abroad were reviewed and analyzed.ResultsTumor size, margin negative resection, tumor grade, multifocal, and histological types were important predictors of the recurrence of retroperitoneal sarcoma. In addition, combined organ resection, diversity of tumor growth patterns, and tumor-free surgical techniques could also affect the recurrence of retroperitoneal sarcoma.ConclusionUnderstanding the predictive factors of the recurrence of retroperitoneal sarcoma is of great significance to guide surgeons to understand and recognize the disease, to reduce the recurrence of retroperitoneal sarcoma.
【Abstract】ObjectiveTo inquire the therapeutic effect of retroperitoneal splenic autotransplantation combined with lower esophageal transection in the treatment of hepatic cirrhosis induced portal hypertension with randomized comparasion.MethodsThe hepatic cirrhosis induced portal hypertension patients with Child A or B grade of liver function were randomly divided into splenic autotransplantation group and splenectomy group.In the splenic autotransplantation group, retroperitoneal transplantation of pedicled autosplenic tissue combined with modified lower esophageal transection was performed,while in the splenectomy group, splenectomy combined with modified lower esophageal transection was conducted.The general conduction, splenic scanning, liver function, serum tuftsin and IgM levels in patients were observed 2 to 6 months after operation, and compared with those before operation. ResultsOne patient died in the splenectomy group on the 6th postoperative day, rebleeding occurred in one case of the splenic autotransplantation group. The levels of tuftsin and IgM in splenic autotransplantation group were higher than those of splenectomy group after operation, with significant difference (P＜0.01). The liver function between two groups showed no difference (Pgt;0.05).ConclusionSpleen autografts could maintain the basic immune function of spleen and survive for a long time.
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。
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.
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。
【摘要】 目的 評價大分割適形放射治療對腹膜后軟組織腫瘤術后患者的治療作用。 方法 對1998年10月-2003年4月收治的16例腹膜后軟組織急性腫瘤術后患者行大分割適形放射治療，設計臨床靶區等效生物劑量為55～62 Gy，觀察放療后2、5年局部控制率、生存率和無病生存情況。 結果 2、5年局部控制率較未行放療患者明顯提高并和其他放射治療方式達到較高治療劑量者近似；遠期生存無改善，無病生存率較未行放療患者有提高。 結論 大分割適形放射治療方式對腹膜后軟組織急性腫瘤術后患者有較好的局部控制作用，無瘤生存率有提高，遠期生存無改善，無嚴重的遠期放療后遺癥。【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 探討微波固化在腹膜后腫瘤手術中止血的可行性。方法 對我院2008年7月至2009年8月期間收治的9例腹膜后腫瘤患者手術中應用微波固化止血。手術暴露瘤體后，應用微波治療儀多點固化瘤體。手術切除腫瘤，不能完整切除者則再次應用微波治療儀固化瘤床創面，盡量滅活殘余腫瘤。結果 9例患者腫瘤切除后創面幾乎無滲血，術中失血量（275.56±81.26） ml，手術時間（150.56±36.18） min，住院時間（14.67±2.30） d，無術后并發癥發生。術后隨訪（10±3.97)個月，9例患者均未見復發。結論 腹膜后腫瘤手術過程中應用微波固化止血效果良好。
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。
【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.