Search

双眼脉络膜转移癌一例

异基因造血干细胞移植后继发性纯红细胞再生障碍性贫血患者的护理

【摘要】 目的 总结异基因造血干细胞移植（allo-PBSCT）后发生继发性纯红细胞再生障碍性贫血（PRCA）的护理，以提高对此类患者的护理。 方法 对2007年1月-2008年12月收治的2例allo-PBSCT后发生PRCA患者的护理进行回顾性总结。 结果 allo-PBSCT后发生PRCA较少见，但在此过程中存在的严重贫血可能会危及患者生命。 结论 allo-PBSCT后发生PRCA的护理关键是针对贫血的各项护理措施。

Fundus angiography in metastatic carcinomas of choroid

Objective To evaluate the characteristics of two angiographic manifestation of ocular fundus in choroidal metastatic carcinomas. Methods Fundus fluoresein angiography (FFA) and indocyanine green angiography (ICGA) were performed on 17 patients (24 eyes) with choroidal metastatic carcinomas, and the characteristics of these two kinds of angiograms were analyzed and compared each other. Results According to various clinical features, e.g., locations of metastatic tumor in ocular fundus, disease course, and different kinds of original malignancy, the findings of ocular fundus were divided into (1) Isolation type: FFA showed pinpoint and mottled leaks against hypofluorescence background, increased and confluent fluoresecence in later stage. ICGA showed the similar images as in FFA, except later appearance of leaks and the choroidal vesseles could be seen beneath the thin metastatic tumor mass.(2) Diffusion type: Tumors showed hypofluorescence in early stage and uneven ill-defined hyperfluorescence both in FFA and in ICGA. (3) Small metastatic carcinomas: Hypofluorescence in early stage and mild mottled hyperfluorescence were found in FFA as well as in ICGA. Conclusion Both FFA and ICGA are helpful in the diagnosis of choroidal metastatic tumors and ICGA may be conducive if there are some troubles in diagnosing the tumors with FFA. (Chin J Ocul Fundus Dis, 2002, 18: 92-95)

Application of preoperative stereotactic localization in the operation of secondary hyperparathyroidism

ObjectiveTo explore the selection and application value of preoperative stereotactic localization in the surgical treatment of secondary hyperparathyroidism.MethodsThe preoperative ultrasound, CT, and methoxyisobutylisonitrile (MIBI) scan data of 54 patients with secondary hyperparathyroidism confirmed by pathological examination in the Department of General Surgery of the 900th Hospital of the Joint Logistics Team from September 2016 to January 2020 were retrospectively analyzed, to explore the localization accuracy of the three methods alone or in combination.ResultsIn this study, a total of 207 parathyroids were detected, 1 was misdiagnosed (ectopic thymus),9 were missed, and 216 parathyroids were removed. The preoperative localization accuracy of CT, ultrasound, and MIBI was the highest (95.39%, 207/217), followed by ultrasound and MIBI (93.55%, 203/217) and CT+MIBI (89.40%, 194/217), compared with other single or two methods, the differences were statistically significant (P<0.05). The accuracy of CT combined with ultrasound localization (82.49%, 179/217) was slightly higher than that of MIBI scan alone (78.80%, 171/217), but the difference was not statistically significant (P=0.060). Although the location accuracy of MIBI scan was slightly higher than that of ultrasound localization (77.88%, 169/217), the difference was not statistically significant (P=0.084).ConclusionIn order to maximize the accuracy of preoperative stereotactic localization of secondary hyperparathyroidism, ultrasound, CT, and MIBI should be combined.

继发性抗磷脂抗体综合征合并肺栓塞一例

抗磷脂抗体综合征( antiphospholipid syndrome,APS) 是指由抗磷脂抗体( antiphospholipid antibody,APL) 引起的一组临床征象的总称。临床表现主要为血栓形成、习惯性流产、血小板减少等。APS 可分为原发性和继发性[ 1 ] 。如伴发系统性红斑狼疮或其他自身免疫性疾病, 称为继发性抗磷脂抗体综合征( secondary APS, SAPS) ; 如单独出现则称原发性抗磷脂抗体综合征( primary APS, PAPS) 。肺脏是APS 的主要受累器官, 可引起肺栓塞( pulmonary embolism, PE) 等严重并发症。现将我院收治的1 例SAPS合并PE 病例报告如下。

Clinical analysis of puncturing epigastrium subcutaneous tissue transplantation of parathyroid gland in treatment of secondary hyperparathyroidism

ObjectiveTo assess the clinical efficacy of percutaneous transplantation of parathyroid glands into the subcutaneous tissue of the epigastrium for treating malignant secondary hyperparathyroidism (SHPT). MethodsThe clinical data of the patients with SHPT who were treated by puncturing the subcutaneous tissue of the epigastrium and transplanting parathyroid glands in the Xuzhou Central Hospital from January 2020 to June 2022 were collected retrospectively. The preoperative and postoperative parathyroid hormone (PTH) level, calcium ion concentration, alkaline phosphatase (ALP) level, and phosphorus ion concentration, as well as postoperative follow-up results were analyzed. The data analysis was conducted using SPSS 23.0 software, with a testing level of 0.01. ResultsA total of 21 patients successfully underwent this surgery, including 12 males and 9 females, with a median age of 48 years old and a range of 32–71 years old. The dialysis time was (8.62±2.27) years, and 12 patients had hypertension, 9 patients had anemia, 17 patients had bone pain, and 11 patients had skin itching. On day 1 after treatment, the PTH level decreased from (1 893.23±539.30) ng/L to (5.99±3.50) ng/L (P<0.001), the calcium ion concentration decreased from (2.52±0.31) mmol/L to (2.24±0.35) mmol/L (P=0.003), and the phosphorus ion concentration decreased from (2.25±0.71) mmol/L to (1.76±0.38) mmol/L (P=0.006) as compared with the values before surgery. Although the ALP level decreased from (321.78±151.01) U/L to (229.32±89.32) U/L, there was no statistically significant difference (P=0.016). Among the 12 patients with hypertension before surgery, 6 patients improved and reduced the use of antihypertensive drugs after surgery; among the 9 patients with anemia, 3 patients improved before discharge; 17 patients with bone pain showed markedly relief before discharge; and 9 patients with skin itching improved before discharge. There were no complications such as hoarseness, choking cough when drinking water, or incision infection after the operation. All 21 patients were followed up for 6–12 months. The parathyroid hormone levels of the 21 patients all dropped to the normal level within 12 months after the operation. Among them, 3 patients recovered to the normal level at the 3rd month after the operation, 16 patients recovered to the normal level at the 6th month after the operation, and 2 patients recovered to the normal level at the 12th month after the operation. The time to return to the normal level was (5.86±2.70) months. No serious complications occurred in all patients, and there was no recurrent case during follow-up period. Conclusion From the analysis results of our study, parathyroid autotransplantation into the subcutaneous tissue of the epigastrium via puncture is a safe and effective method for patients with SHPT.

纵隔内异位甲状旁腺功能亢进症的诊治体会：附3例报道

目的分析纵隔内异位甲状旁腺功能亢进症2次手术的原因及防治策略。方法回顾性收集四川大学华西医院（简称“我院”）甲状腺外科2021年11月至2022年3月期间收治的三发性甲状旁腺功能亢进症患者的临床病理资料。结果共收集到3例患者即病例1~3，其中病例1和病例3为女性，病例2为男性，年龄分别为61、48及57岁。3例患者均因肾功能衰竭行维持性血液透析分别达13、10及9年。病例1和2初次均于外院经第1次行甲状旁腺切除+甲状旁腺自体移植术后甲状旁腺激素（parathyroid hormone，PTH）未持续下降而入我院治疗，发现纵隔内异位甲状旁腺，经评估后行机器人或胸腔镜下甲状旁腺瘤切除术，术后PTH显著下降，骨痛症状显著缓解。病例3初次因骨痛就诊于外院（具体不详）给予口服药物对症治疗后PTH仍持续偏高而入我院治疗，发现颈部及纵隔内异位甲状旁腺，经综合评估后行经颈甲状旁腺切除联合胸腔镜纵隔内甲状旁腺肿物切除，术后PTH下降显著，骨痛症状显著缓解。结论对于纵隔内异位甲状旁腺功能亢进症患者，术前联合多途径检查充分评估，选择合适的手术方式，若条件许可行微创治疗，必要时联合术中PTH检测，以减少再次手术风险。

REOPERATION OF 81 CASES AFTER CHOLECYSTECTOMY

目的探讨胆囊切除术后再次手术的原因及其防治措施。方法对近6年我院收治的胆囊切除术后仍有症状，经B超、ERCP、MRCP、腹部X线平片及十二指肠低张造影等检查发现需再次手术的81例患者的临床资料进行回顾性分析，并结合文献，对其常见原因及其预防治疗措施进行了讨论。结果81例患者根据不同病因予以了相应的手术，如残株胆囊切除术、胆总管切开取石术、十二指肠憩室手术等。再次手术均取得良好效果，无手术死亡。结论对胆囊切除术后仍有症状者应作全面检查，部分患者可找出原因进行相应治疗，能取得良好效果； 而且绝大部分的再次手术，通过术前评估及术中各种技巧的应用是可以防范的。

超声辅加绘图技术在继发性甲状旁腺功能亢进手术前定位中的应用价值

目的探讨超声辅加绘图技术对继发性甲状旁腺功能亢进甲状旁腺术前定位的效果。方法前瞻性收集 2017 年 6 月至 2018 年 6 月期间在吉林大学中日联谊医院甲状腺外科行手术治疗的继发性甲状旁腺功能亢进患者 20 例，术前由术者亲自操作超声检查。前 5 例（超声组）仅行超声检查，后 15 例（超声辅加绘图组）采取超声辅加手绘标记技术，记录术前定位与术中甲状旁腺位置的符合率。结果超声组的超声识别率为 77.78%（14/18），病理诊断符合率为 100%（18/18）；超声辅加绘图组的超声识别率为 93.85%（61/65），病理诊断符合率为 100%（65/65）。2 组的超声识别率比较差异有统计学意义（χ2=0.850，P<0.05），超声辅加绘图组的超声识别率较高。超声组患者的手术时间长于超声辅加绘图组（t=0.876，P=0.041）。2 组患者术后均未出现喉返神经损伤，术后复查喉镜均未出现声带麻痹。结论对继发性甲状旁腺功能亢进患者，术前超声辅加绘图技术定位甲状旁腺快速而准确，在临床制定手术方案、术中精准切除甲状旁腺及缩短手术时间方面有一定的应用价值。

Penile Corpus Cavernosum Metastasis Secondary to Rectal Adenocarcinoma Undergone Miles’ Operation (A Case Report and Literature Review)

目的探讨继发性阴茎癌的临床特点及诊治方法。方法 回顾性分析成都军区总医院全军普外中心收治的1例直肠癌术后36个月发生阴茎转移患者的临床资料，并结合国内、外46例文献报道的资料(1988~2010年)，对其发病情况、临床表现、转移途径、诊断、治疗和预后进行总结。 结果阴茎转移癌以泌尿系来源最多见（51.05%），其次为消化系统来源（36.17%）； 多发生在原发肿瘤术后5~18个月，部分表现为首发症状； 转移灶多位于阴茎体部或根部（87.23%），多表现于单发结节（48.94%），部分为多发结节（29.97%）； 25.53%伴有异常阴茎勃起； 常伴有其他部位转移（55.32%）。对单纯继发性阴茎癌不伴其他脏器转移者行部分或全部阴茎切除，术后辅以放疗、化疗和内分泌治疗能够提高治疗效果，延长生存期； 非手术治疗的患者，多因其他部位转移不能手术，绝大多数生存期在1年内。结论对阴茎出现单个或多个结节或伴有异常勃起的肿瘤患者，要考虑阴茎继发性转移的可能； 活检可明确诊断； 手术切除、辅以放化疗及内分泌治疗可延长患者的生存期。