目的 初步探討容易誤診為乳腺癌的乳腺良性疾病的病理類型和臨床特征，提高診斷準確率。方法 回顧性分析了1998年9月至2000年1月收治的50例術前診斷為乳腺癌的乳腺良性疾病。 結果 乳腺炎性疾病、纖維囊性增生或／和積乳囊腫、纖維腺病或／和某些纖維腺瘤均易誤診為乳腺癌；此類乳腺良性疾病捫診的準確性顯著低于乳腺鉬靶攝片和彩超檢查(P＜0.005)。 結論 乳腺良性疾病臨床診斷的準確性有賴于病史、乳腺捫診及乳腺X線攝片和彩超的綜合分析。
目的探索單操作孔電視胸腔鏡手術治療胸部良性疾病的有效性和安全性。 方法回顧性分析2008年3月至2013年4月德陽市人民醫院單操作孔電視胸腔鏡手術治療胸部良性疾病186例患者的臨床資料，其中男101例、女85例，年齡15～65（30.1±5.3）歲。 結果全組患者無圍手術期死亡。手術時間18～88（47.2±7.6）min，術中出血量5.0～110.0（49.8±9.4）ml，患者術后住院時間7～16（9.2±2.1）d。2例因致密粘連轉為輔助小切口手術。自發性氣胸肺大泡切除術后當日及術后1～2 d出現持續肺漏氣3例，1例肺漏氣持續9 d，1例肺漏氣持續10 d，1例肺漏氣持續11 d，均經保守治療治愈。切口脂肪液化4例，換藥后治愈。術后肺部感染3例，經加強抗感染后治愈。隨訪3～24（6.8±3.2）個月，失訪18例，總體隨訪率90.3%（168/186）。隨訪期間氣胸復發4例，氣胸壓縮肺組織10%～20%，觀察5～8 d自行吸收，未再次手術；肺及縱隔良性病變無復發；結核患者術后抗癆治療12～18個月治愈。 結論單操作孔電視胸腔鏡手術治療胸部良性疾病創傷小，切口美觀，患者恢復快，手術安全，對適應證患者可作為手術方式。
ObjectiveTo evaluate the safety and efficacy of single utility port video-assisted thoracoscopic lobec-tomy in the treatment of benign pulmonary diseases. MethodsFrom January 2011 to April 2014, 48 patients with benign pulmonary diseases underwent single utility port video-assisted thoracoscopic lobectomy in the First Affiliated Hospital of Soochow University. The patients included 21 males and 27 females, with their mean age of 47.4 years. There were 5 patients received right upper lobectomy, right middle lobectomy in 5 patients, right lower lobectomy in 5 patients, left upper lobectomy in 8 patients, and left lower lobectomy in 20 patients. the clinical outcomes included operation time, intraoperative blood loss, chest drainage duration, postoperative hospital stay and postoperative complications. ResultsThere were 2 patients conversion to open surgery. The average operation time was 147.2±50.4 min, intraopera-tive blood loss was 160.2±25.3 ml, postoperative chest drainage duration was 4.8±2.8 d, postoperative hospital stay was 7.4±1.9 d. There was no hospital death or serious postoperative complications. Postoperative pathological diagnosis showed bronchiectasis in 17 patients, inflammatory pseudotumor in 11 patients, tuberculosis in 9 patients, aspergillosis in 4 patients, pulmonary sequestration in 3 patients, bronchogenic cyst in 2 patients, pulmonary abscess in 1 patient, and hamartoma in 1 patient. No long-term complications were noticed in 48 patients during a mean follow-up of 6 months. ConclusionSingle utility port video-assisted thoracoscopic lobectomy is safe and feasible in the treatment of benign pulmonary diseases.
Objective To compare the clinicopathological features of hilar cholangiocarcinoma (HCCA) and hilar benign diseases, and then explore the value of carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) in the differential diagnosis between them. Methods Clinical data of 65 patients (54 patients with HCCA and 11 patients with hilar benign diseases) who were diagnosed as HCCA and received treatment from January 2011 to October 2015 in our hospital were retrospectively analyzed. Comparison of clinical data of HCCA patients and patients with hilar benign diseases in age, gender, disease duration, clinical manifestation, laboratory examination, and imaging examination was performed, and the receiver operating characteristic curve (ROC) was used to explore the value of CA19-9 and CEA in differential diagnosis between hilar benign diseases and HCCA. Results The age, levels of serum CA19-9, CEA, alanine aminotransferase (ALT), total bilirubin (BILT), and direct bilirubin (BILD) of HCCA group were significantly higher than that in benign group (P<0.05). However, the gender, disease duration, clinical manifestations (including jaundice, abdominal discomfort, fever, and weight loss), serum aspartate aminotransferase (AST), serum alkaline phosphatase (ALKP), and imaging findings (including hilar mass, intrahepatic bile duct dilatation, thickening of the bile duct wall, lymph node enlargement, vascular invasion, and gallbladder invasion) had no significant difference between the 2 groups (P>0.05). The ROC curve results showed that, when cut-off point for CA19-9 was 233.15 U/mL, the sensitivity was 56% and specificity was 91%; when cut-off point for CEA was 2.98 ng/mL, the sensitivity was 61% and specificity was 90%. Conclusions For the differential diagnosis between HCCA and hilar benign diseases, the elderly patients with high levels of serum transaminase and bilirubin were more likely to be malignant. It is more likely to be malignant when the serum CA19-9>233.15 U/mL or CEA>2.98 ng/mL.
【Abstract】Objective To investigate the safety and clinical significance of total thyroidectomy performed for benign thyroid disease. Methods Eighty-eight patients with benign thyroid disease were treated with total thyroidectomy. The postoperative complications were analyzed. Results With primary total thyroidectomy, the incidences of transient hypocalcemia and transient recurrent laryngeal nerve paralysis were 2.5% and 1.2% respectively. The incidences after reoperation were 28.6%（P＜0.05）and 28.6%（P＜0.01）respectively. No patients had permanent hypoparathyroidism and permanent recurrent laryngeal nerve injury. Conclusion Total thyroidectomy can be performed safely. It can avoid reoperation for the recurrence caused by the remainder thyroid.
ObjectiveTo explore the advantages and disadvantages of duodenum-preserving pancreatic head resection (DPPHR) in the clinical application of pancreatic surgical diseases, and to summarize the progress of minimally invasive application of DPPHR combined with the current application of laparoscopy and robot surgery in pancreatic surgery. MethodThe related research literatures about DPPHR at home and abroad in recent years were searched and reviewed. ResultsThe effect of DPPHR compared with traditional pancreaticoduodenectomy (PD) for treatment of benign pancreatic diseases was still controversial, and the postoperative remission effect, perioperative period, occurrence of long-term complications and improvement of quality of life were not very advantageous compared with PD, and the prognosis of minimally invasive surgery was poor. ConclusionDPPHR remains highly controversial for surgical intervention in benign pancreatic disease and has enormous scope for advances in minimally invasive surgical applications in pancreatic surgery, but more clinical studies are needed to verify its clinical efficacy.
ObjectiveTo investigate the value of single incision laparoscopic cholecystectomy in the operation of benign diseases of the gallbladder in day surgery.MethodThe clinical data of 105 patients underwent the single incision laparoscopic cholecystectomy in the Day Operation Center of Zhengzhou Central Hospital of Zhengzhou University from March 2017 to December 2018 were retrospectively analyzed.ResultsThe single incision laparoscopic cholecystectomies were successfully performed in 105 patients with benign gallbladder diseases, including 65 cases of gallbladder stones, 26 cases of gallbladder polyps, 14 cases of gallbladder adenomyosis; 45 cases of men and 60 cases of women. In all cases, no incision was increased or no case was converted to laparotomy. No bile duct injury and intra-abdominal bleeding happened during the operation. All patients were discharged overnight (no more than 24 h) after the surgery and without delayed discharge and re-admission. The intraoperative blood loss was (10.3±3.5) mL, and the operation time was (55.0±25.5) min (from laparoscopy to gallbladder removal). The postoperative pain score was 1–2 and 0–1 on day 1 and on day 3 after the surgery, respectively. The postoperative incision cosmetic satisfaction score on month 6 after the operation was 4.5±0.5.ConclusionSingle incision laparoscopic cholecystectomy is safe and feasible for benign gallbladder disease during day surgery.
ObjectiveTo discuss the causes of esophageal benign diseases and how to prevent, diagnose and treat such diseases. MethodsWe reviewed and analyzed the clinical data of 162 patients with esophageal benign diseases treated in our hospital from March 1994 to July 2011. Causes, diagnosis, treatment and prognosis of this kind of diseases were analyzed and summarized. ResultsEighty-five patients had definite inducements. All patients were diagnosed through barium swallow radiography, CT, and gastroscopic inspection and underwent operation. A total of 155 patients were cured by positive treatment, but 7 patients died because of severe infection. ConclusionMost patients suffering from esophageal benign diseases have definite inducements. Therefore, many such diseases can be prevented. Once being confirmed, active surgery is the main treatment. Most patients can be cured if treatment is performed in time.
目的 報道10例血清CA19-9明顯升高的膽管良性疾病病例。方法 回顧性分析2004年1月至2006年3月期間我院收治并經手術證實的10例血清CA19-9明顯升高（gt;500 U/ml）的膽管良性病變病例。結果 患者中男4例，女6例，年齡30~85歲，CA19-9為532.32~12 000.00 U/ml，除1例患者CA125輕度升高外，其他患者血清CEA、CA125及AFP均正常。膽總管結石8例，肝內膽管結石1例，原發性硬化性膽管炎1例； 除1例外均存在不同程度阻塞性黃疸。經治療后8例CA19-9水平在30 d內降至正常，另2例分別于術后2個月和3個月內降至正常。結論 CA19-9在膽管惡性腫瘤診斷方面的意義仍需進一步研究。