目的 探討乳腺葉狀囊肉瘤和巨纖維腺瘤的診斷和治療。方法 回顧分析我院1985～2002年期間外科收治的9例乳腺葉狀囊肉瘤和8例乳腺巨纖維腺瘤的臨床資料。結果 9例乳腺葉狀囊肉瘤中行單純乳房切除術4例，保留乳頭皮下乳房切除術1例，保留乳頭和部分壓縮腺體＋腫塊切除術1例，改良根治術3例; 術后恢復良好，僅1例復發。8例乳腺巨纖維腺瘤中行單純乳房切除術2例，保留乳頭皮下乳房切除術1例，保留乳頭和部分壓縮腺體＋腫塊切除術2例，單純乳腺腫塊切除術3例； 術后恢復良好，術后2例復發。結論 乳腺葉狀囊肉瘤和巨纖維腺瘤臨床上均表現為無痛性包塊，除乳腺葉狀囊肉瘤發病年齡較大、腫塊范圍大及易惡變外，二者主要依據病理檢查結果相鑒別； 均以手術治療為主，根據患者年齡、腫塊大小以及病理檢查結果選擇不同的手術方式。
Objective To analyze the clinicopathological characteristics of thymoma patients and the influencing factors for prognosis. Methods Thymoma patients who received treatment in Sichuan Cancer Hospital from March 2015 to March 2021 were collected. Clinical data of the patients were analyzed using Kaplan-Meier and Cox regression analyses. Results A total of 177 patients were included. There were 89 males and 88 females aged 17-88 (52.3±13.0) years, including 160 surgical patients and 17 non-surgical patients. There were 160 patients survived, 17 died of thymoma, and 5 had recurrence and metastasis. Overall, the 1-year, 3-year and 5-year progression-free survival rates were 94.4%, 88.7%, 88.1%, respectively; the 1-year, 3-year and 5-year overall survival rates were 94.9%, 91.5%, 91.0%, respectively. The Kaplan-Meier analysis showed that World Health Organization classification, clinical symptoms, Masaoka-Koga staging, treatment methods and surgery were statistically associated with progression-free survival; clinical symptoms, age, treatment methods and surgery were statistically associated with overall survival (P<0.05). Patients with younger age (P=0.018), without clinical symptoms (P=0.039), and with surgical treatment (P=0.004) had higher overall survival rates; those patients undergoing surgery had a higher progression-free survival rate (P=0.002). Conclusion Age, clinical symptoms and surgical treatment are independent factors influencing the prognosis of patients with thymoma.
【摘要】 目的 探討伽瑪刀治療垂體腺瘤遠期腫瘤控制及并發癥發生情況。 方法 2004年6月-2006年12月共158例垂體腺瘤患者接受伽瑪刀治療。伽瑪刀治療邊緣劑量12～30 Gy，以45%~70%等劑量曲線覆蓋腫瘤灶。術后定期對患者進行門診隨訪和鞍區增強MRI掃描，記錄腫瘤控制及并發癥發生情況。 結果 131例患者完成隨訪，平均隨訪時間49個月。至隨訪結束，共7例患者腫瘤增大復發。伽瑪刀治療后1、2、3、4及5年腫瘤控制率分別為95.8%、95.8%、95.8%、95.8%及93.9%。46例患者（35.1%）在治療后出現暫時性頭痛和感覺異常，對癥處理后緩解；4例患者（3.1%）出現垂體功能低下，接受激素替代治療。未觀察到其他顱神經和血管損害表現。 結論 伽瑪刀治療垂體瘤遠期療效肯定，并發癥輕微，是一種安全可靠的垂體瘤治療手段。【Abstract】 Objective To explore the long-term tumor control and side effects of gamma knife treatment for pituitary adenoma. Methods One hundred and fifty-eight patients with pituitary adenoma undergone gamma knife treatment were periodically followed up from June 2004 to December 2006. The prescript radiation dosage was 12-30 Gy. An enhanced MRI scan was scheduled every 6-12 months after the treatment. The tumor sizes of different scan were compared and the side effects were recorded. Results One hundred and thirty-one patients finished the follow-up procedure with an average time of 49 months. One hundred and twenty-four patients received good tumor control at the end of the research and recurrence was seen in seven patients. The 1-, 2-, 3-, 4-, and 5- year tumor control rates were 95.8%, 95.8%, 95.8%, 95.8%, and 93.9% respectively. Forty-six patients showed temporal and were relieved after treatment. Hypopituitarism was seen in four patients but no cranial nerve or vascular damage was detected. Conclusion The long-term effect of gamma knife therapy for pituitary adenoma remains good and the incidence of side effects is low. Gamma knife therapy could be a safe and effective choice for pituitary adenoma treatment.
目的 了解胰十二指腸切除術中良性病例所占比例,分析其病變類型,探討術前、術中診斷及其它治療方式的可行性。方法 回顧性分析我院1996～2001年期間206例術前診斷為胰頭或壺腹周圍惡性腫瘤而作胰十二指腸切除術病例中，術后病理診斷為良性病變者23例的臨床、病理資料。結果 術后病理檢查發現慢性胰腺炎14例，胰頭囊腺瘤2例，十二指腸乳頭異位胰腺1例，十二指腸乳頭良性腺瘤4例，膽總管下段炎性狹窄2例。良性病變占整個胰十二指腸切除術病例的11.2%。結論 在作胰十二指腸切除術的良性病變中慢性胰腺炎占大多數。術中取活檢作冰凍切片病理檢查是鑒別良、惡性病變的最有效方法。對這些良性病變可選擇保守治療或行較小的局部切除術。
Objective To investigate clinical features of accidental parathyroid adenoma (APTA) and to explore diagnosis and treatment strategies of APTA. Methods From February 2009 to December 2016, the patients who would receive the thyroid surgery and were accidentally found the parathyroid adenoma by preoperative examination in the Department of Thyroid & Parathyroid Surgery, West China Hospital of Sichuan University were enrolled in the research. The clinical characteristics, surgical procedure, results of postoperative follow-up were analyzed retrospectively, and which were compared between the patients with APTA and the other patients diagnosed as primary parathyroid adenoma or received thyroid surgery (1 : 4 chosen randomly) in the same period. Results From February 2009 to December 2016, the patients who treated with thyroid surgery and were diagnosed as the primary parathyroid adenoma in our center were 5 881 and 251 respectively. Twenty-six patients with APTA were found in this research. The incidence rate of APTA was 0.44% (26/5 881), accounted for 10.4% (26/251) of the primary parathyroid adenoma. The positive rates of the ultrasound and the parathyroid scintigraphy were 69.2% (18/26) and 72.7% (8/11), respectively. The abnormal rate of the bone mineral density examination was 85.7% (6/7). The preoperative PTH was (38.17±40.69) pmol/L (3.40–181.20 pmol/L), and the serum calcium was (2.73±0.27) mmol/L (2.22–3.23 mmol/L). The number of detected parathyroid adenoma was 29, which were 55.2% (16/29) in the right-lower, 6.9% (2/29) in the right-upper, 27.6% (8/29) in the left-lower, and 10.3% (3/29) in the left-upper location. The rate of single parathyroid adenoma was 88.5% (23/26) and the maximum diameter of parathyroid adenoma was (21.72±9.65) mm. There was 13 cases (44.8%) of the A1 type and 16 cases (55.2%) of the B1 type in these 29 parathyroid adenomas. The rates of the recurrence, postoperative transient hypoparathyroidism, and permanent hypoparathyroidism were 7.7% (2/26), 30.8% (8/26), and 3.8% (1/26), respectively. Additionally, the preoperative PTH and serum calcium levels of the patients with APTA were significantly lower as compared with the primary parathyroid adenoma (P<0.001,P<0.001), which were significantly higher as compared with those of the patients received thyroid surgery without APTA in the same period (P=0.001, P<0.001). Conclusions APTA is a specific type of asymptomatic primary hyperparathyroidism. Examinations for PTH and serum calcium levels before thyroid surgery are important for finding APTA. For the patients with APTA, it is safe and effective to carry out exploratory parathyroidectomy with thyroid surgery at the same time.
FromJune1989toMarch1998,11casesofprimaryhyperparathyroidism(PHP)hadbeentreatedsurgicallyin .thishospital.Thepreoperativelocalizationof9caseswereachievedbyoneortwononinvasivetechniquesincludingultrasonography,computedtomography,colorDopplerimagingand99mTcMIBIscintigraphy.Parathyroidectomyweredonesuccessfullyin10of11caseswiththepathologicalresultsofadenomain10casesandonenormalparathyroid.Theauthorsemphasize①earlyrecognitionanddiagnosiswhichcanbehelpedbythenoninvasivetechniquesmentionedaboveforlocalization,②familiaritywiththelocalanatomyespeciallyfortheectopicparathyroidtogetherwithfrozensectionbiopsyduringoperation,and③intensivemedicalcareaftersurgeryandfollowupsoastoheightenthecapacityofdiagnosisandtreatmentofthisdisease.