探讨立体定向囊内放射治疗囊性和囊实性颅咽管瘤的方法和疗效。方法:对12例囊性和囊实性颅咽管瘤的囊性部分行CT、MRI 引导立体定向吸除囊液、注入胶体磷酸铬,待瘤囊缩小远离视神经等重要结构后,施行伽玛刀治疗。结果:全部病例经手术排出囊液后临床症状迅速改善。经囊内放疗后2-36个月随访12例患者,CT、MRI扫描显示5例患者瘤囊持续消失,临床症状消失,恢复正常的生活和学习;5例患者肿瘤显著缩小,症状持续改善;2例肿瘤无明显改变;无死亡病例。结论:CT、MRI引导立体定向放射治疗囊性颅咽管瘤安全、有效。
【摘要】目的探讨乳腺囊性肿块的临床特点及诊治经验。方法对我院1988年4月至2003年5月期间收治的220例乳腺囊性肿块患者的临床资料进行回顾性分析。结果经均手术切除及病理学检查，本组病例中乳腺囊性上皮增生症162例，积乳性乳腺囊肿26例，单纯性乳腺囊肿23例，乳腺叶状囊肉瘤5例，大导管内乳头状瘤4例。结论乳腺囊性肿块具有一定的共性和个性特点，术前B超检查和诊断性穿刺对乳腺囊性肿块的诊断和鉴别诊断有一定价值，但确诊有赖于病理学检查，手术可以明确诊断和治愈疾病。
Fibropolycystic liver diseases (FLDs) is a rare genetic disorder, including bile duct hamartomas, congenital hepatic fibrosis, polycystic liver disease, Caroli’s disease, and choledochal cysts. Fibropolycystic liver diseases has received little clinical attention and exhibits a variety of imaging manifestations, leading to a high likelihood of missed diagnosis and misdiagnosis. Through this case, we delineate the characteristic imaging manifestations of the disease and its underlying pathological mechanisms. Our objective is to enhance readers' comprehension of the disease and thereby reduce the rate of missed diagnosis and misdiagnosis of the disease.
ObjectiveTo investigate the diagnosis and treatment of pancreatic cystic neoplasm. MethodsThe clinical data of 40 cases of pancreatic cystic neoplasm from October 2001 to October 2013 in our hospital were retrospec-tively analyzed. ResultsPatients with pancreatic cystic neoplasm had no specific clinical feature. Ultrasonography and computed tomography displayed a cystic tumor in 57.5%(23/40) and 72.5%(29/40) of all patients, respectively, but could not distinguish the histological types. All of the patients had been operated, among them 2 cases were misdia-gnosed as pseudocysts and internal drainage; another 38 patients were undergoing the distal pancreatectomy. Pathologic examination results after operation showed 23 cases of serous cystadenoma, 9 cases of mucinous cystadenoma, 3 cases of intraductal papillary mucinous adenoma, and 5 cases of mutinous cystadenocarcinoma. Thirty five patients were followed-up. The followed-up time range from 2 months to 8 years, verage(74.2±12.8) months. Among the 3 patients with mucinous cystadenocarcinoma, 1 patient alived with no evidence of recurrence, the other 2 patients died of tumor invasion and metastasis in 4 months and 7months after operation. The others were still alive now with no evidence of recurrence. ConclusionSurgical resection is the most effective treatment for pancreatic cystic tumor, even if the patients with no any symptoms.
目的 全面介绍先天性囊性腺瘤样畸形(CCAM)其可能的病因，临床、病理特点及诊断手段，循证探讨针对CCAM的治疗方法及预后。 方法 对我院2011年11月收治的1例罕见的CCAM患者的临床资料进行分析，并对相关文献进行复习。 结果 患者数次误诊后最终诊断为CCAM，予手术治疗后痊愈，随访1年无复发。 结论 CCAM是一种少见的、非遗传性的、错构瘤样的肺发育异常，为一种良性的肺部畸形，其特点是局部肺终末呼吸性细支气管过度生长。CCAM多通过产前影像学检查、活组织检查或术后病检诊断。手术为治愈该病的最根本、最重要措施。
Objective To summarize ultrasonography, CT and (or) MRI imaging features of cystic liver lesions so as to improve its diagnostic accuracy. Methods The literatures relevant imaging studies of different types of cystic liver lesions at home and abroad were searched. Then with the etiology as clue, the imaging fetures of ultrasonography, CT and (or) MRI plain scan and enhancement scan were summarized. Results The cystic liver lesions had many types, their imaging findings were different and existed overlaps. The diagnosis and differential diagnosis of atypical cases were difficult. ① For the simple hepatic cyst, it was a round cystic mass with water-like echo, density and signal. The boundary was clear, and there was no separation in the cyst, without contrast enhancement. The sensitivity and specificity of diagnosing were higher by ultrasonography and MRI as compared with CT. ② For the bile duct hamartoma and Caroli diease, they were manifested as multiple cysts, widely distributed in the whole liver, without enhancement for the most lesions. The multiple cystic lesions without communicating with the bile duct was the key sign of differential diagnosis for these two dieases. ③ Enhancing mural nodules were more common in cystadenocarcinoma than cystadenoma. The accurate diagnosis of biliary cystadenoma depended on combination of ultrasonography, CT, and MRI findings. ④ For the cystic liver metastatic tumor, it was multiple cystic neoplasms in the liver parenchyma or around the liver. CT was the main method for the diagnosis, and which showed that the density was lower than that of the liver parenchyma, peripheral ring-enhanced lesion as enhanced scan. It was easy to distinguish with simple hepatic cyst by MRI. ⑤ For the cystic hepatocellular carcinoma, it presented as a multilocular cystic solid tumor. The presence of tumor thrombus in portal vein could help to the diagnosis. ⑥ For the undifferentiated embryonal sarcoma, CT plain scan showed the cystic low density mass with clear boundary, the edge with calcification, enhanced scan showed that the soft tissue composition presented continuous strengthening sign. There was no specific signal in MRI plain scan, and the periphery of the tumor was slowly strengthening. ⑦ For the liver abscess, it was easy to diagnose because it had different characteristic features in different pathological phase, but it was misdiagnosis of intrahepatic cholangiocarcinoma when its symptoms were atypical. ⑧ The ultrasonography and the CT were the optimal methods for the hepatic cystic echinococcosis and the hepatic alveolar echinococcosis respectively. The significances of imaging were to determine the activity of hydatid cyst and to identify anatomy structure among alveolar echinococcosis, bile duct and blood vessel, and judge invasion or not, MRCP was important for diagnosis. Conclusions Abdominal ultrasonography could be used as the first choice for diagnosis of cystic liver lesions, CT and MRI could be used as effective supplementary methods for it. A combination of various imaging techniques is key to diagnosis. Moreover, number and morphology of lesion, and solid component or not are important imaging features of diagnosis and differential diagnosis of cystic liver lesion.
Objective To summarize the research progress in the diagnosis and treatment of pancreatic cystic neoplasms (PCNs). Method The guidelines and literatures related to the diagnosis and treatment of PCNs were collected and reviewed. Results At present, there was still no clear method to distinguish the types of PCNs and their benign and malignant, and there was still a dispute between domestic and foreign guidelines on the diagnosis and treatment of PCNs. Conclusion Clinical researchers still need to carry out more research, provide higher quality evidence, resolve the disputes existing in different guidelines, standardize the diagnosis and treatment process of PCNs, thus, PCNs can be identified early, diagnosed accurately and intervened in time.
目的 探讨腹膜后囊性淋巴管瘤的CT诊断价值和治疗方法。方法 回顾性分析2004年6月至2010年5月期间我院收治的5例经病理检查证实的腹膜后囊性淋巴管瘤患者的临床表现、CT影像特征、手术治疗及术后随访的资料。结果 5例患者术前CT均诊断为囊性淋巴管瘤，均行手术完整切除肿瘤，术后病理结果均证实为囊性淋巴管瘤。术后7 d顺利出院，随访3个月～6年均无复发。结论 CT对腹膜后囊性淋巴管瘤的诊断具有重要意义，手术完整切除整个囊壁是治疗及预防术后复发的最好方法。