非酒精性脂肪性肝炎相关肝细胞癌111例临床荟萃分析

目的总结非酒精性脂肪性肝炎（NASH）基础上肝癌的临床特征。方法对以＂fatty liver、NASH、liver cancer、HCC＂等为关键词,在Pubmed、Medline、OVID数据库检索得到的1990至2010年发表的22篇文献中111例NASH基础上肝癌患者的临床资料进行汇总分析。结果 （1）发现肝功能异常的年龄为60岁,诊断NASH的年龄为63.9岁,诊断肝细胞癌（HCC）的年龄66.7岁;（2）男性占62%,男女之比1.64：1;（3）79%患者伴有肥胖,78%伴有糖尿病,33%伴有血脂异常,52%伴有高血压;（4）71%患者肿瘤为单发,肿瘤直径最小1.0 cm,最大13 cm（平均3.3 cm）;（5）大多数肿瘤发生在肝右叶;（6）67%HCC伴肝硬化,肿瘤组织以梁索型居多,分化程度多为良好～中分化;（7）多数患者无任何症状,常规体检时发现肿瘤;（8）65%病例AFP和/或PIVKAII升高;（9）大多数病例经手术切除治疗,术后平均随访24个月,21%患者死亡,15%复发。结论 NASH基础上HCC多见于男性,这类患者往往伴有代谢性疾病,尽管肿瘤分化程度较高,根治性切除率高,NASH无痛性进展使得大多患者发现肝癌已属晚期,导致预后相对较差。有必要对合并多元代谢紊乱的NASH患者,尤其是男性和年老患者进行定期HCC筛检。     

进展期胃癌腹腔内游离癌细胞的灭活与预防(附149例报告)

进展期胃癌腹腔内游离癌细胞的灭活与预防（附１４９例报告）青州市人民医院（２６２５００）潘忠清王广文杨卫军姜雨刚韩兴华夏友恒我院对１４９例胃癌手术患者做了腹腔内游离癌细胞检查，发现５６例腹腔内存在游离癌细胞，并进行了术中、术后灭活。现报告如下。资料与方...     

高龄腹腔-皮下细粒棘球蚴病诊疗1例报告

青海大学附属医院于2021年1月收治1例82岁男性“左腹壁下巨囊肿”患者,患者自述左上腹疼痛20余天,有40余年肝棘球蚴病史、牛羊等动物密切接触史和长期流行区生活史。入院后查体,左上腹可触及一大小约为10 cm×5 cm的实性包块,质韧,边界清,压痛阳性。实验室检查,棘球绦虫IgG抗体阳性。结合腹腔三期动态增强CT、腹部MRI等相关影像学检查后诊断为“腹腔-皮下细粒棘球蚴病”,排除相关手术禁忌症后行腹腔细粒棘球蚴包囊内囊摘除术,术中探查发现病灶沿左侧第9～10前肋间突破腹壁向外生长至皮下,与腹腔棘球蚴包囊相通。术后第7天,患者好转出院。患者口服阿苯达唑15 mg/（kg·d）,早晚餐后分服,继续治疗6月。术后1月复诊,患者未诉特殊不适,行腹部、盆腔CT平扫后提示术后改变,余未见明显异常。     

多种技术联合应用对肺癌诊断的临床价值

目的评价多种技术联合应用对肺癌诊断的临床价值。方法 884例痰脱落细胞学、细菌学、常规支气管镜等检查均无阳性发现的疑似肺癌的患者行经支气管镜针吸活检术（TBNA）和活检刷检、经支气管镜超声引导针吸活检术（EBUS-TB-NA）、纵隔镜、超声或CT引导经皮肺穿刺活检术、PET-CT和内科电子胸腔镜胸膜活检术。结果 215例患者TBNA、刷检、活检的阳性率分别为81.58%、29.47%和16.84%。15例EBUS-TBNA的阳性率为91.67%,20例超声或CT引导经皮肺穿刺活检术阳性率为65%,10例PET-CT阳性率为80%,628例患者胸腔镜检查的总体阳性率为94.6%。结论多种技术联合应用可明显提高肺癌的早期诊断率。     

胃肠神经内分泌肿瘤内镜表现及内镜下治疗效果分析

目的 探讨胃肠神经内分泌肿瘤的超声内镜表现及内镜下治疗效果。 方法 纳入在西安交通大学第一附属医院行内镜下治疗的27例胃肠神经内分泌肿瘤患者资料，回顾性分析其临床特征、超声内镜表现、病理特征及内镜下治疗效果。 结果 27例患者的病变内镜下表现为黏膜下隆起，超声内镜检查示病变长径（0.69±0.44）cm（0.32~2.00 cm），来源于黏膜下层14例（51.9%）、黏膜肌层8例（29.6%）、黏膜层5例（18.5%），诊断准确率92.0%。行内镜黏膜切除术（endoscopic mucosal resection,EMR）6例，内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）21例，ESD术后出血发生率4.8%。术后病理为G1级20例（74.1%），G2级6例（22.2%），G3级伴淋巴管癌栓1例（3.7%）。术后随访3~36个月总生存率96.3%，对于局限于黏膜下层以内、无脉管浸润的G1、G2级神经内分泌瘤患者，EMR术后复发率较ESD高（33.3%比0，P=0.042）；EMR与ESD术后出血、穿孔并发症及患者生存率差异无统计学意义。 结论 超声内镜可用于胃肠神经内分泌肿瘤的术前诊断，对2 cm以内、黏膜下层以内、无脉管浸润的G1、G2级胃肠神经内分泌瘤ESD治疗复发率低于EMR。     

UCAM和Maria诊断标准用于评估1352例中国人药物性肝损伤文献分析

目的 分析文献应用RUCAM标准和Maria标准诊断中国人药物性肝损伤情况。方法 以“药物性肝损伤、诊断标准、诊断评分系统或drug-induced liver injury,diagnostic criteria, diagnostic scale, RUCAM scale, Maria scale”为关键词检索中国期刊全文数据库、万方数据库、pubmed数据库,排除文献综述、重复文献、病例报道、未使用诊断标准或诊断评分系统进行诊断的文献,对文献中患者年龄、性别、诊断标准的诊断评估情况进行总结和描述。结果 在检索到的7篇文献中,共有1352例药物性肝损伤患者,年龄2~91岁。采用RUCAM诊断标准者6篇,共1027例病例,诊断DILI 997例（97.1%）,不能诊断DILI者有30例（2.9%）;采用Maria诊断标准诊断者4篇,共736例病例,诊断DILI者433例（58.8%）,不能诊断DILI者303例（41.2%）。结论 应用RUCAM诊断标准或Maria诊断标准诊断中国人药物性肝损伤的结果存在不一致性。     

腹腔脏器淋巴管瘤的诊断和治疗20例

目的:探讨腹腔脏器淋巴管瘤(LA)的诊断和治疗.方法:回顾分析我院1995-01/2007-01诊治的腹腔脏器LA患者20例临床资料.结果:20例均行手术,肿瘤最小为2 cm×4 cm,最大29 cm×12 cm.其中15例呈囊性,4例呈息肉融合成一片,1例呈脓肿样;单房性5例,多房性15例.病理检查示肿瘤由形状不规则的,扩张的淋巴管构成.20例患者随访8-400(平均210) mo;除行肿瘤活检术1例经随访45 mo尚带瘤生存外,其他11例均未发现复发.结论:腹腔脏器LA是一种少见特殊类型的疾病,一经诊断应积极手术治疗,术中冰冻切片、术后病理检查,LA完整切除是关键.     

非酒精性脂肪性肝病患者动脉僵硬度的变化及其影响因素分析*

目的 研究不同年龄段非酒精性脂肪性肝病（NAFLD）患者外周动脉僵硬度的变化,探讨影响动脉僵硬度增高的相关危险因素。方法 根据超声检查是否存在脂肪肝将2382例健康体检者分为NAFLD组和无NAFLD组,分析各年龄段两组间肱踝脉搏波传导速度（baPWV）的变化特点。以baPWV≥1400 cm/s为动脉僵硬度增高,采用Logistic回归分析影响动脉僵硬度增高的危险因素。结果 在2382例体检者中,发现NAFLD患者935例（39.3%）,在1595例男性中,检出NAFLD 患者726例（45.5%）,在787例女性中,检出NAFLD患者209例（26.6%,P<0.001）;在616例20~39岁、1463例40~59岁和303例>60岁人群中,分别发现NAFLD188例（30.5%）、623例（42.6%）和124例（40.9%）; 20～39岁年龄段NAFLD组baPWV水平为（1340.0±180.7） cm/s,显著高于无NAFLD组［（1203.9±155.2） cm/s,P<0.001］,40～59岁年龄段NAFLD组baPWV水平为（1437.1±232.6） cm/s,显著高于无NAFLD组［（1355.8±217.9） cm/s,P<0.001］,大于60岁年龄段NAFLD组baPWV水平为（1885.8±404.0） cm/s,与无NAFLD组的baPWV水平［（1830.2±430.6） cm/s］无统计学差别（P>0.05）;在1643例血压正常者,二分类Logistic回归分析发现,年龄、性别、NAFLD、血清总胆固醇为baPWV升高的独立危险因素。结论 NAFLD患者较无NAFLD人群动脉僵硬度增高,以青中年NAFLD患者增高更为明显。NAFLD为动脉僵硬度增高的独立危险因素。     

彩色多普勒超声在腹主动脉瘤破裂诊断中的应用价值

目的探讨彩色多普勒超声在腹主动脉瘤破裂诊治中的价值。方法回顾性分析14例腹主动脉瘤破裂患者的灰阶和彩色多普勒超声图像,从腹主动脉瘤发生部位、瘤体大小、瘤壁厚度、瘤体破裂部位、瘤体破裂时血管内异常回声、血管周边形成血肿、出现腹腔游离液及瘤体内彩色多普勒表现等方面进行分析,并与手术结果、CT血管成像或磁共振检查结果进行对比。结果腹主动脉瘤超声检出率100%,肾上型2例,肾下型12例,瘤体最大直径6.1～1 3.2 cm,超声诊断腹主动脉瘤壁破裂处显示率14.3%,腹主动脉瘤旁腹腔血肿显示率66.7%,腹腔积液显示率80.0%,腹膜后血肿显示率12.5%。结论超声作为可移动简便无损伤的检查方法 ,可以快速的对腹主动脉瘤破裂和其他腹腔器官肿物引起的急腹症进行鉴别,在腹主动脉瘤的发现、随访监测、腹主动脉瘤破裂急诊入院有较高的临床应用价值。     

无腹腔镜辅助的内镜全层切除术治疗源于固有肌层的胃黏膜下肿瘤

目的探讨无腹腔镜辅助的内镜全层切除术（EFR）治疗源于固有肌层的胃黏膜下肿瘤（SMT）的疗效和可行性。方法2007年7月至2009年8月经辅助检查和前期治疗明确诊断为起源于固有肌层的胃SMT患者20例,择期行全麻下EFR治疗：（1）黏膜下注射生理盐水,预切开肿瘤周围黏膜和黏膜下层,显露肿瘤;（2）采用内镜黏膜下剥离术（ESD）技术沿肿瘤周围分离固有肌层至浆膜层;（3）应用Hook刀沿肿瘤边缘切开浆膜;（4）胃镜直视下应用Hook、IT刀或圈套器完整切除包括浆膜在内的肿瘤;（5）应用金属夹缝合胃创面。结果20例源于固有肌层的胃SMT中,病灶位于胃底9例、胃体11例。EFR成功切除所有病变,完整切除率为100％,未使用腹腔镜辅助;EFR时间为60—145min,平均85min。切除肿瘤最大直径1．8～3．5cm,平均2．6cm;病理诊断为问质瘤13例、平滑肌瘤4例、血管球瘤2例、神经鞘瘤1例。术后无一例出现胃出血、腹膜炎体征及腹腔脓肿,术后3d造影无一例造影剂外漏和胃排空障碍。住院天数3～8d,平均5．5d。术后随访1～12个月,平均7个月,无一例病变残留或复发。结论EFR治疗源于固有肌层的胃SMT是安全、有效的,可以切除更深的胃壁肿瘤,并提供准确的病理诊断资料,它的开展可进一步扩大内镜治疗的适应证。     

Peritoneal mice implicated in intestinal obstruction: report of a case and review of the literature

BACKGROUND: Peritoneal loose bodies or "peritoneal mice" are asymptomatic and mostly found as "incidentalomas" during intraperitoneal surgery or at autopsy. Implication of these concretions in an acute abdomen is a rare clinical entity. CASE REPORT: We report the case of a 63-year-old man who presented with small bowel obstruction and two calcified concretions in his pelvis. A computerized tomography scan demonstrated two oval stones near the terminal ileal loop with lumenal compression of the distal small bowel. During laparotomy, two extralumenal glistening stones, measuring 5.8 x 4.5 x 3.7 cm and 5.2 x 4.5 x 3.7 cm, were recovered from the peritoneal cavity. Histologically, the wall showed concentric lamellar fibrosis and calcification, whereas the nucleus displayed the vestiges of membranous fat necrosis; all consistent with diagnosis of peritoneal loose body. All symptoms of bowel obstruction were relieved postoperatively, and the patient had an uneventful recovery. DISCUSSION: Peritoneal loose body is a histopathologic diagnosis, and most other differentials for calcified intraperitoneal masses can be ruled out during the histologic examination. Surgical removal is recommended because conventional cross-sectional imaging cannot accurately establish the diagnosis.     

Prognostic significance of hemoperitoneum in peritoneal dialysis

According to previous reviews, hemoperitoneum episodes appear in 6.1-8.4% of the peritoneal dialysis patients, and they are severe in a 20% of them. Due to the absence of severe hemoperitoneum in our peritoneal dialysis program, we retrospectively reviewed hemoperitoneum non-related with abdominal surgery or catheter placing. We analyzed its incidence, etiology, prognostic and clinical outcome, as well as the possible effect of recurrent hemoperitoneum on peritoneal function. A total of 132 patients were treated in our centre during a period of 173 months. Mean age at the beginning of peritoneal dialysis was 59+/-17.1 years, 43.2% were females, and 22.8% of them were menstruating women. Twenty-two patients had at least one hemoperitoneum episode during follow-up, with an incidence of 17%. The mean time interval between the start of peritoneal dialysis and the first hemoperitoneum episode was 0.66+/-0.94 years (range: 0.01-3.20 years). 73% were women. Most cases (59%) were due to menstruation. Remarkably, all the menstruating women presented hemoperitoneum at least once with a high incidence of recurrent episodes. The other hemoperitoneum episodes were mainly of unknown etiology (32% of patients), being this one the main cause in males. We only observed two more cases: a male who presented hemoperitoneum related to dicumarinic overdose and a female who presented hemoperitoneum due to mesenteric ischemia. All the 22 patients had a favourable outcome, except for the woman with mesenteric ischemia, what represented an incidence of 4.5% of severe hemoperitoneum. No significant association was found between episodes of hemoperitoneum and aspirin treatment, dicumarinic treatment or the presence of coagulopathy. There was no association either between recurrent hemoperitoneum and the number of peritonitis episodes, peritoneal function or technique survival. In conclusion, hemoperitoneum is a common and usually benign problem in peritoneal dialysis patients, frequently due to retrograde menstruation, and no deleterious long-term effects were found in patients with recurrent hemoperitoneum.     

Pathophysiology and prevention of postoperative peritoneal adhesions

Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part of healing following any peritoneal injury, particularly due to abdominal surgery. The balance between fi brin deposition and degradation is critical in determining normal peritoneal healing or adhesion formation. Postoperative peritoneal adhesions are a major cause of morbid...     

Anomalies of the urinary tract associated with congenital heart diseases

Due to the frequent association of congenital heart disease and urinary tract malformations we studied 434 patients undergoing angiocardiograms for diagnosis of their congenital heart disease. In every patient a plain abdominal X-ray film was made in order to observe urinary elimination of the contrast material. We found 70 patients with urinary tract malformations, the most frequent of which was pyelo-chaliceal dilatation, accounting for 47.1% of all the malformations found. A double pyelo-chaliceal system was found in 25.7%, kidney hypoplasia in 10% and in lower frequencies double urethers, kidney agenesia, pelvic kidneys, horseshoe-shaped kidney and others. Patients were usually urologically asymptomatic. In view of the frequent association of congenital heart disease and urinary tract malformations a plain abdominal X-ray film should always be performed postangiographically. In some cases a contrast urography is recommended.     

Localization and extent of peritoneal calcification in three uremic patients on continuous ambulatory peritoneal dialysis

Peritoneal calcification in three patients on continuous ambulatory peritoneal dialysis (CAPD) was reviewed, and the relation between the localization and extent of calcium deposits detected by abdominal computed tomography (CT) and clinical signs was evaluated. Case 1 was a 48-year-old man with abdominal pain, hemoperitoneum and secondary hyperparathyroidism after receiving CAPD for seven years. An abdominal CT revealed linear peritoneal calcification in the pelvic cavity and liver surface, and his symptoms resolved after switching to hemodialysis. His clinical course and pathological findings were compatible with those in progressive calcifying peritonitis. Case 2 was a 26-year-old man presenting with abdominal pain, vomiting and fullness two years after switching to hemodialysis, because of uncontrolled overhydration following 13 years of CAPD. Plaque-like calcification outlining the small intestine and parietal peritoneum was noted on CT. Case 3 was a 59-year-old man who had abdominal distention, vomiting and diarrhea three months after switching to hemodialysis due to loss of peritoneal function following 10 years of CAPD. CT revealed diffuse sheet-like calcification surrounding the bowel and mesentery, adherent dilated bowel loops and ascites. These CT findings suggested the existence of encapsulating peritoneal sclerosis (EPS) in cases 2 and 3. Findings from our three patients indicate that peritoneal calcification is not always accompanied by EPS; however, monitoring peritoneal calcification and other findings by abdominal CT, even after cessation of CAPD, is crucial to maintain vigilance on whether the subclinical signs, which are temporally diagnosed as progressive calcifying peritonitis, advance to EPS.     

Peritoneal surface oncology: review of a personal experience with colorectal and appendiceal malignancy

Peritoneal surface malignancy usually results from implantation of gastrointestinal cancer. In the past, this clinical situation was treated with palliative intent. A definitive approach to peritoneal surface malignancy involves peritonectomy procedures, visceral resections, perioperative intraperitoneal chemotherapy and knowledgeable patient selection. The quantitative prognostic indicators necessary for valid clinical judgements include the cancer histopathology (invasive vs. expansive progression), the preoperative abdominal and pelvic CT, the peritoneal cancer index and the completeness of cytoreduction score. Proper patient selection is mandatory for optimizing the results of treatment. In a series of phase II studies, appendiceal tumors with peritoneal seeding became the paradigm for success with an 85% long–term survival in selected patients. Carcinomatosis from colon cancer had an overall 5–year survival of 45% with selected patients. In all malignancies, early aggressive treatment of minimal peritoneal surface dissemination showed the greatest benefit. The definitive prognostic indicator was the complete cytoreduction. Oncologists must seek new knowledge regarding the management of peritoneal surface dissemination of cancer because a curative approach has been demonstrated in large phase II studies; in contrast all historical controls show 0% long–term survival. Additional adjuvant phase III studies with perioperative intraperitoneal chemotherapy in diseases where peritoneal surface spread occurs are indicated.     

疑似卵巢癌的盆腔结核20例分析

目的分析极易与卵巢癌相混淆的女性盆腔结核的临床特征，寻求两鉴别诊断的依据。方法对1994年3月～2002年5月间收治的20例确诊为盆腔结核的患进行回顾性分析。结果经济条件差、有结核病史或明确的结核接触史、发热是鉴别晚期卵巢癌与盆腔结核的重要依据。20例中有盆腹腔肿物20例，腹胀18例，腹痛12例，腹水20例，发热18例，消瘦13例，腹泻6例。血清CA125检测结果最小64U／L，最高1069U／L。术前经腹水细胞学检查16例，14例未发现癌细胞，1例见可疑癌细胞，1例见癌细胞(手术病理排除)。结论女性盆腔结核与晚期卵巢癌鉴别诊断极为困难，盆腔肿物、腹水、CA125升高的年轻妇女，若有结核史或结核接触史、发热，且腹水细胞学未发现癌细胞，则盆腔结核的可能性较大。     

Peritoneal tuberculosis in the Fes University Hospital (Morocco). Report of 123 cases

AIMS: Peritoneal tuberculosis is an important public health issue in Morocco. Our aim was to describe the clinical, biological, and therapeutic features of peritoneal tuberculosis treated in a University Hospital in Morocco. PATIENTS AND METHODS: We retrospectively included 123 patients with peritoneal tuberculosis diagnosed at the gastroenterology unit of the Fes University Hospital between January 2001 and August 2003. RESULTS: The mean age was 28 years with a clear female predominance (sex ratio 2.61). Ascites associated with fever were the most frequent signs found in 80.5% of patients. The ascitic fluid was exsudative in 90% of cases and lymphocytic in 88%. The diagnosis was based on laparoscopy or laparotomy with peritoneal biopsy demonstrating caseating granulomatous lesions in 92.4% of patients. Patients were given antituberculous therapy for 6 months, and the outcome was favourable in 90%. CONCLUSION: Peritoneal tuberculosis is very frequent in Morocco, where the diagnosis is based exclusively on peritoneal biopsies obtained during laparoscopy. With an adapted treatment, the course of the disease is favourable in most cases.     

Abdominal echinococcosis during pregnancy: clinical aspects and management of a series of cases in Chile

Twelve pregnant women with hydatid disease are presented with median age of 29; 11 (91.7%) had a liver cyst and one (8.3%) had a kidney cyst as the primary disease location. Four (33.3%) had additional cysts located in the pelvis, peritoneal cavity and/or spleen; eight (66.7%) had two or more abdominal cysts. Three patients (25.0%) had surgery at the 3rd month after delivery and nine (75.0%) during their pregnancy. There was no histological evidence of hydatid disease in placentas, and no serological evidence of echinococcosis in the newborns was confirmed. One patient died after surgery. After a mean follow-up time of 39.5 months, we found one recurrent case of pelvic hydatid disease. Management of abdominal echinococcosis during pregnancy is an uncommon and difficult problem owing to the serious potential risks for mother and child.     

Diagnostic and prognostic value of peritoneal cytology in biliary tract cancer

BACKGROUND/AIMS: Evaluation of peritoneal cytology provides valuable prognostic information in abdominal cancers. The aim of this study is to assess the incidence and the prognostic value of conventional peritoneal cytology in biliary tract cancers. METHODOLOGY: A total of consecutive 41 patients with biliary cancers (17 bile duct, 20 gallbladder, 4 ampulla of Vater) underwent surgery between July 2003 and July 2005. Peritoneal cytology was performed in these patients at the beginning of laparotomy. On opening the abdomen, 100mL of normal saline were instilled into the subhepatic space and retrieved. Cytologic analysis was performed using the Papanicolau technique. RESULTS: The overall incidence of positive cytology findings was 9.8% (4/41). When analyzed by disease factors or stage, the prevalence of positive cytology was 0% in T1/T2, 6% in T3, 38% in T4 (p=0.03), 0% in N0, 25% in N1 (p=.03), 3% in M0, 27% in M1 (p=0.02), 0% in Stage I/II and 27% in Stage III/IV cases (p<0.01), respectively. Although survival was worse in patients with positive peritoneal cytology, when adjusting TNM stage the positive peritoneal cytology did not have significant prognostic value. CONCLUSIONS: Peritoneal cytology associates positively with advanced disease but does not increase prognostic information in biliary tract cancers.