【摘要】 目的 探讨治疗肝尾状叶巨大海绵状血管瘤的外科手术方法。方法 通过1 例肝尾状叶巨大海绵状血管瘤外科手术治疗体会并结合文献复习,分析肝尾状叶解剖及影像学特点,探讨外科手术方法。结果 肝尾状叶巨大海绵状血管瘤因肝尾状叶特殊的解剖特点,安全并有效的肝全尾叶血管瘤切除是治疗这类疾病的有效治疗方法。结论 选择合适的手术径路是关键,熟练并精细地解剖、默契的手术配合可以安全切除肝尾状叶巨大海绵状血管瘤。
【摘要】 目的 探讨CT对婴幼儿腹部巨大囊性病变的诊断价值及其鉴别诊断。 方法 搜集2003年-2009年间经手术病理证实的2岁以内患儿腹部巨大囊性病变62例，分析其病变部位、大小、形态、分隔、密度和强化、囊壁及与周围脏器关系等要素。 结果 62例中，先天性胆总管囊肿4例，重度肾积水36例，巨输尿管2例，囊性肾母细胞瘤4例，大网膜囊肿4例，肠系膜囊肿3例，卵巢囊肿6例，囊性畸胎瘤3例。 各种囊性病变有其一定的发病部位和特征性的CT表现。 结论 CT是婴幼儿腹部囊性病变定位、定性诊断的重要影像学方法。【Abstract】 Objective To explore the value of CT diagnosis and differential diagnosis of the giant cystic lesions in abdomen of the infants. Methods A total of 62 infants younger than 2 years old with the giant cystic lesions in abdomen confirmed by surgery and histopathology from 2003 to 2009 were collected. The location of the lesion, range, configuration, thickness of cystic wall and septa, density, contrast enhancement, and adjacent organs were observed and analyzed. Results In 62 infants, there were congenital cyst of common bile duct in 4, giant hydronephrosis in 36, primary megaureter in 2, cystic Wilms tumor in 4, greater omentum cyst in 4, mesenteric cyst in 3, ovarian cystic in 6, and cystic teratoma in 3. Each disease had its own lesions location and features of CT images. Conclusion CT is very effective on the localized and qualitative diagnosis of the giant cystic lesions in abdomen of infants.
Giant thoracic tumor is currently one of the diagnostic and therapeutic challenges of thoracic surgery, with no established guideline or standard for diagnosis and treatment. The quality control of individualized surgical strategy and perioperative management with multi-disciplinary participation is the key to ensure the safety and improve the prognosis of patients. Based on the clinical experience of our institution and others, we hereby discussed and summarized the basic principles, surgical strategies and perioperative management of giant thoracic tumor, aiming to provide a reference of quality control.
Objective To explore the results of repairing widespread traumatic soft tissue defects in the heels and adjacent regions with free latissimus dorsi muscle-skin flaps. Methods From March 1998 to May 2005, 10 cases of widespread traumatic soft tissue defects in the heels and adjacent regions were repaired with free latissimus dorsi muscleskin flaps. Of the 10 patients, 9 were male and 1 was female, whose ages ranged from 32 to 60years, and the disease course was 2 hours to 2 months. The defect was by ploughmachine injury in 5 cases, by crush injury in 2 cases, by snake injury in 2 cases, and electricity injury in 1 case. Eight cases of defects involved in the posteriorof heel and leg, the defect area ranged from 21 cm×12 cm to 35 cm×15 cm; 2 cases had widespread soft tissue defects on heel, ankle, sole and dorsal foot, and the defect area was 27 cm×14 cm and 30 cm×21 cm respectively. All cases were accompanied by the exposure of bone; 6 cases by fracture; 4 cases by openinfection of ankle joint; and 2 cases by injuries of the posterior tibial vessel and the tibial nerve. The sizes of the dissected flap ranged from 25 cm×14 cm to 33 cm×24 cm. The donor sites were covered by large mid-thickness flap. Results There were no postoperative complication of vascular crisis and infection. Ten flaps survived completely and the wounds healed by first intention. After a follow-up of 3 to 24 months, five cases received twostageplastic operation because bulky flaps bring some trouble in wearing shoes. In 5cases of reconstructed sensation, two cases recovered pain and temperature sensation. All cases recovered the abilities to stand and walk without ulcer complication. Conclusion The free latissimus dorsi muscle-skin flap is an ideal flap for repairing widespread traumatic soft tissue defects and infectious wounds with muscle defects and bone exposure in the heel and adjacent regions, because it has such advantages as adequate blood supply, big dermatomic area, and excellent ability to resist infection.
Objective To review the emergency management and perioperative strategies for ruptured neurofibromatosis type 1 (NF1)-related giant plexiform neurofibroma (PNF), providing a systematic treatment protocol to improve the therapeutic outcomes and quality of life for patients with giant PNF. Methods The literature on the management of giant PNF rupture and hemorrhage was reviewed, and the diagnosis, treatment, and perioperative management were summarized based on clinical experiences. Results By implementing an integrated diagnostic and treatment strategy that includes early diagnosis, imaging evaluation, emergency ultra-selective arterial embolization combined with surgical excision, acute hemorrhage can be effectively controlled while also reducing the risk of major intraoperative bleeding and minimizing postoperative complications. As a result, this approach significantly improves treatment success rates and patient quality of life. Conclusion For ruptured NF1-related giant PNF, employing emergency ultra-selective arterial embolization combined with surgical excision, under the collaboration of a multidisciplinary team, can effectively improve treatment success rates, rapidly control bleeding, reduce tumor size, and lower mortality. Future research should focus on assessing the long-term quality of life of patients treated for ruptured and hemorrhaging giant PNF and on further optimizing treatment protocols.
【摘要】 目的 探讨多层螺旋CT血管造影（MSCTA）对腹部巨大肿块定位定性的诊断价值。 方法 收集2005年6月-2009年12月98例腹部巨大肿块，作MSCTA检查，观察供血动脉来源和肿块与血管关系。 结果 98例肿块发现有主要供血动脉76例，其中恶性肿块69例，血管受侵改变51例。 结论 由于MSCTA快捷、无创、经济、方便、空间分辨率高等优点，对腹部巨大肿块定位定性有较高诊断价值。【Abstract】 Objective To investigate the diagnostic value of multislice CT angiography (MSCTA) to abdominal huge mass from June 2005 to December 2009. The relation among blood vessel and supply origin and tumor was analyzed. Methods MSCTA was performed in 98 cases with abdomenial huge mass. Results The feeding artery of mass was discovered in 76 cases, in which malignant tumors were confirmed in 69 cases, the vessels were encroached on in 51 cases. Conclusion MSCTA may be of high value to diagnose abdominal huge mass because of noninvasiveness, convenience, and high resolution.