目的 探讨先天性胆总管囊肿(congenital choledochal cyst,CCC)术式选择与疗效的关系。方法 对1989年至1998年间38例CCC手术治疗病例进行回顾性研究。结果 38例中行胆肠Roux-Y吻合术20例，肝总管十二指肠高位大口吻合术18例。术后随机获随访31例。13例胆肠Roux-Y吻合术后随访3～7年，发现5例并发十二指肠溃疡，3例并发胆道逆行感染。18例肝总管十二指肠高位大口吻合术后随访2～5年，发现1例并发胆道逆行感染，无1例并发十二指肠溃疡。结论 由于肝总管十二指肠高位大口吻合术后远期并发十二指肠溃疡发生率较低，其与胆肠Roux-Y吻合术相比，是提高CCC患儿术后远期生活质量较理想的术式。
Objective To explore the diagnosis and treatment of anterior cruciate l igament (ACL) cysts of the knees. Methods The cl inical data were retrospectively analysed from 13 patients with ACL cysts between December 2000 and August 2007. The patients included 7 males and 6 females with an average age of 46.3 years (range, 32-55 years). The locationswere the left knee in 6 cases and the right knee in 7 cases. Seven cases had an obvious history of trauma, 4 cases had a history of chronic injury, and 2 cases had no obvious incentive factor. The disease duration was from 6 to 29 months (mean, 20 months). Anterior drawer test was positive in 1 case, pivot shift test was positive in 1 case, and McMurray test was positive in 3 cases. Six cases were preoperatively diagnosed by MRI. The cysts located near the tibial insertion in 6 cases, between the ACL and the posterior cruciate l igament in 3 cases, and near the femoral attachment in 4 cases. All cysts were arthroscopically resected and had the pathohistological examination. Results The pathohistological examination showed mucoid degeneration of collagen and connective tissues, and the diagnosis result was ACL cyst. All incisions healed by first intention, and no compl ication occurred. Thirteen patients were followed up 2 to 5 years (mean, 2 years and 6 months). The symptoms of arthralgia, swell ing, and interlocking of the affected knees disappeared. At 24 months postoperatively, the anterior drawer test was positive in 1 case, the pivot shift test was positive in 1 case, and McMurray test was positive in 4 cases. There was no recurrence during the follow-up. There were significant differences in the range of motion and Lysholm score between pre- and post-operation (P lt; 0.01). Conclusion ACL cysts may be indicated by simple knee pain, especially when accompanied by l imitation of joint motion without imaging evidence of osteoarthritis. The MRI finding is very important in the diagnosis of ACL cysts, and arthroscopic resection and debridement is the first choice in the treatment of ACL cysts.
ObjectiveTo emphasize the important role of video-assisted thoracoscopic surgery (VATS) in treatment of mediastinal bronchogenic cysts (MBCs).MethodsWe retrospectively reviewed the clinical data of 112 patients (53 males and 59 females) of mediastinal bronchogenic cysts who underwent VATS in our institution between April 2001 and Aprial 2016. Median age was 4–75 (45.6±15.0) years. All patients underwent chest CT preoperatively. The patients were divided into two groups: an anterior mediastinum group, 47 patients; a middle and posterior mediastinum group, 65 patients including 35 patients in the middle mediastinum, 30 patients in the posterior mediastinum. The average diameter was 0.5–22.0 (3.50±2.33) cm. The average CT attenuation was 0–67 (35.5±15.3) Hu on unenhanced CT. We began each operation with the VATS technique.ResultsThe CT diagnostic accuracy for group middle and posterior mediastinum with CT value≤20 Hu was higher than others (61.5% vs. 13.1%, χ2=17.675, P<0.001). A total of 111 patients underwent VATS, only one patient converted to open thoracotomy. Cyst resection and thymectomy were conducted in 45 patients, cyst resection and extended thymectomy were conducted in 2 patients in the anterior mediastinum group. Simply cyst resection were performed in the middle and posterior mediastinum group (n=65). The average operative time was 40–360 (104.5±43.1) min. The average intraoperative blood loss was 5–600 (57.9±88.9) mL. The intraoperative complication rate was 3.6% and the incomplete resection rate was 6.3%. The main reason for these was severe adhesion between the cyst and mediastinal structure. No serious postoperative complication was found. Follow-up was done in 99 patients, and the mean follow-up time was 42 (12–191) months. There was no local recurrence.ConclusionVATS resection of MBCs is a safe and efficacious procedure, and minimally invasive and surgical resection should be performed as early as possible for MBCs.
Abstract To restore the bone defect after curettage of bone cyst, hydroxyapatite bioactive microcrystal glass (HBG) was used. From 1990 to 1995, HBG was applied in 17 cases. The bone involved were humerus, femur, tibia and fibula. Among them, 6 were complicated with pathological fracture. After eradication of the focus, the cyst was filled in ZnCl2 powder and irrigated with saline, then particles or segments of HBG were implanted into the cavity. The fracture were fixed with Enders rod. All the extremities were immobilized with plaster splint for about 6 to 8 weeks. Three months later, the lower limbs began to have functional exercises. By X-ray examination, the border between HBG and bone was clear in 2 weeks, after 1 month the clear border become blurred, and 2 months after operation, HBG was intermingled with bone. After 1 year there was neither absorption of bone nor HBG. No recurrence of the aptic lesion occurred in 1 year. HBG was a kind of artificial bone composed of hydroxyapatite and bioactive microcrystal glass, the latter contained silicon.It was characterized by its bioactivity, osteoinductivity and good tissue compatibility. The microcrystal would facilitate the growth of osseous tissues, which caused HBG intermingled with the surrounding bone. The source of HBG was abundant. It might be an ideal artificial bone.
Objective To present the surgical treatment experiences of congenital choledochal cyst (CCC). MethodsOne hundred and fortyfive patients in 152 CCC were analyzed retrospectively and followed in west China hospital of Sichuan university from 1964 to 1999. ResultsOne hundred and fortyfive cases underwent operation and 6 of them died after operation. The incidence of hepatocirrhosis within first year after birth is higher than those over one year old （P＜0.05）. Thirtynine cases underwent cystoduodenostomy or cystojejunostomy. One hundred and six children underwent cyst resection and biliary tract reconstruction (with single RouxY hepaticojejunostomy 48 cases, intussusceptive valve and rectangular valve to the line of RouxY hepaticojejunostomy 37 and 21 cases respectively). Seventyseven patients were followedup (means 4.68 years). Two of 3 cases with ascending cholangitis after single RouxY hepaticojejunostomy underwent reoperations with an intussusceptive valve added to the line of RouxY hepaticojejunostomy and the symptoms disappeared. All of them have a good outcome. Conclusion The younger the patients, the less severe the liver damaged, and its prognosis are better. The procedure that cyst resection totally and an intussusceptive valve added to the line of RouxY hepaticojejunostomy should be carried out early as soon as possible.
ObjectiveTo observe apoptosis and proliferation of choledochus wall epithelial cell and fibrocyte, to understand the effects of apoptosis and proliferation on choledochal cyst development.MethodsThirty two cases of cystic dilatation,35 cases of cylindrical dilatation，and 25 cases of cholangiectasis caused by choledocholith were collected. All specimens were offered by department of hepatobiliarypediatric surgery. The apoptosis related index (bcl2 and bax) and cell proliferation index (PCNA) were detected by the immunohistochemical technique; Apoptosis was detected by TUNEL method. ResultsThere was serious mucosal epithelial cell damage in cystic dilatation group. In cylindrical dilatation group there was a damage similar to that of the cystis dilatation group, but the damage was not serious. In control group there was little damage in the duct wall, but there was a low positive rate of apoptosis of 〔epithelium cell (2.74±1.00)% and fibroblast (2.95±0.87）%〕, and a low bcl2 and bax’s expression rate, and a high PCNA’s expression rate 〔epithelium cell (3.74±1.00)%, fibroblast (3.71±1.77)%〕. There was no obvious difference between cylindrical dilatation group and cystic dilatation group (Pgt;0.05): the PCNA’s expression rate was low 〔(0.99±0.51)% and (0.90±0.38)% respectively〕, the bax expression rate was high in remaining epithelial cell, and the positive rate of bax was apparently higher than that of bcl2 (P＜0.05), the positive rate of the apoptosis cell was high 〔(13.94±4.77)%, (7.51±3.46)%〕; the expression rate PCNA were high 〔(9.91±2.91)%,(9.70±3.18)%〕, and expression rate of bax’s was low in the fibre tissue, the positive rate of bcl2 was markedly higher than that of bax, and the positive rate of the apoptosis cell was low 〔(3.74±2.12)%,(4.46±2.41)%〕. There were no marked difference between the two groups (Pgt;0.05). The expression of bcl2 and bax had marked difference both in cylindrical dilatation group and cystic dilatation group and as compared to control group (P＜0.05). ConclusionApoptosis has certain promoting effect in the course of choledochal cyst formation.
Objective To investigate the clinical result of treatment of bonecyst by transplantation of the autologous bone marrow combined with the allograft bone. Methods From February 2004 to March 2006, 13 patients withbone cyst were treated by transplantation of the autologous bone marrow combined the the allograft bone. Among the 13 patients, 6 were males and 7 were females, ranging in age from 5 to 16 years, averaged 11.5 years. In the patients, 5 lesions were located inthe proximal humerus, 2 in the femoral neck, 3 in the femoral shaft, 2 in the proximal tibia, and 1 in the distal tibia. Among the patients, 5 had a complication of pathologic fracture. All the patients underwent an erasion of the bone cyst, and then the transplantation of the autologous bone marrow combined with the allograft bone, and 8 of them were also given an instrument fixation. Results The follow-up for 6 months to 2 years after operation revealed that 5 of the patients had an incision healing by the first intention, 5 had an effusion in the incision site, and 3 had a delayed healing of the incision. According to the Capanne criteria, the postoperative X-ray findings indicated that 10 patients had Grade Ⅰ healing, and 3 had Grade Ⅱ healing. The complete healing took 3.5-8 months,averaged 5.2 months. There was no recurrence. When the fixation instrument was removed, no pathologic fracture occurred. The function of the upper and lower limbs recovered. Conclusion Transplantation of the autologous bone marrow combined with the allograft bone is an effective and safe procedure for treatment of bone cyst.
目的 探讨无功能性甲状旁腺囊肿（NFPTC）的诊断和治疗方法。方法 回顾性分析中国医科大学附属第一医院2008年3月至2012年10月期间手术治疗的6例NFPTC患者的临床资料。结果 6例患者中术前明确诊断3例；术后病理学检查证实均为甲状旁腺囊肿。术后无并发症发生；随诊7个月～5年，平均32个月，无复发。结论 NFPTC术前确诊困难，超声影像学特点对诊断有参考价值，手术切除是首选治疗方法。