颈淋巴结结核病灶清除术并发淋巴漏的观察及护理

对60例颈淋巴结结核病灶清除术后并发淋巴漏的患者进行回顾性分析。 通过对淋巴漏患者严密观察,采取控制饮食、补充营养、负压吸引、碘伏纱布填塞、加压包扎等有效的医疗护理措施,60例患者均顺利治愈,无感染发生。针对性的护理有助于颈淋巴结结核病灶清除术后并发淋巴漏患者的康复。     

腹股沟淋巴结清扫术后淋巴漏的危险因素和治疗策略分析

目的探讨腹股沟淋巴结清扫手术后淋巴漏的危险因素和治疗策略。方法本研究共纳入56例在我院行腹股沟淋巴结清扫手术的阴茎癌患者。清扫手术的范围以腹股沟韧带上2cm为上界,缝匠肌内侧缘为外侧界,长收肌外侧缘为内侧界,股三角尖端为下界,清除该范围内的淋巴脂肪组织。淋巴漏在本研究中的定义：自术后第3天起,引流管引流〉100ml的淡黄色液体,连续2d。采用Logistic多因素回归分析找出淋巴漏的独立危险因素。结果 56例阴茎癌患者的中位年龄为51岁,腹股沟清扫区平均每天引流量为63.65ml,而淋巴漏的发生率为36.0%（40/111）,同时多因素分析结果显示,体重指数是淋巴漏的独立危险因素,OR值为1.03。经过适当处理后,出现淋巴漏的腹股沟伤口区的置管时间均〈4周。结论腹股沟淋巴结清扫术后淋巴漏的发生率较高,但术中对淋巴组织残端进行充分结扎,同时术后给予适当的治疗能减少淋巴漏的发生。     

超声诊断甲状腺癌颈部淋巴结转移的特点及其临床诊断价值

目的：分析超声对甲状腺癌颈部淋巴结转移的诊断价值及其转移特点。方法：选取2017年1月—2022年1月于广州医科大学附属中医医院就诊的60例甲状腺癌患者,均采取超声诊断,对比病理结果,分析超声在诊断甲状腺癌颈部淋巴结转移中的应用,分析对比甲状腺癌颈部淋巴结转移与未转移的超声特征。结果：60例患者经病理确诊颈部淋巴结转移的有26例,占比43.33%,未转移34例,占比56.67%;超声诊断甲状腺癌颈部淋巴结转移的准确率为90.00%（54/60）,特异度为88.24%（30/34）,灵敏度为92.31%（24/26）,阳性预测值为85.71%(24/28）,阴性预测值为93.75%（30/32）,误诊率为11.76%（4/34）,漏诊率为7.69%（2/26）。经受试者工作特征（ROC）曲线分析,超声诊断甲状腺癌颈部淋巴结转移的曲线下面积（AUC）为0.903,95%CI为0.816～0.990;甲状腺癌颈部转移淋巴结的门部回声不均匀、皮质增厚、微钙化、长短径比<2、淋巴门偏移、边界不清、血流丰富、淋巴结融合的发生率高于非转移淋巴结,差异有统计学意义（P<0.05）。结论：超...     

甲状腺微小癌临床特点及手术方式的探讨

目的探讨甲状腺微小癌的临床特点和合理的手术方式。方法对168例甲状腺微小癌进行回顾性分析。结果 168例甲状腺微小癌,单发病灶124例(73.8%),多发灶44例(26.2%)。预防性中央区淋巴结清除术68例,中央区淋巴结转移率44.1%(30/68)。中央区淋巴结转移行同侧III、IV区淋巴结清除术9例,颈侧区淋巴结转移率77.8%(7/9)。全组病人无声音嘶哑发生,暂时性甲状旁腺损伤发生率23.8%(40/168),术后出血1例。预防性中央区淋巴结清除术术后并发症发生率35.3%(24/68)高于未行中央区淋巴结清除术17.6%(13/74)。在84例行中央区淋巴结清除和改良式淋巴结清除术中,男性组颈部淋巴结转移率84.6%(11/13)高于女性47.9%(34/71),多灶甲状腺微小癌颈淋巴结转移率65.4%(17/26)高于单灶48.3%(28/58)。门诊随诊12~36个月无局部复发及远处转移发生。结论甲状腺微小癌具有多灶性和中央区淋巴结高转移率的特点,预防性中央区淋巴结清除术是必要的,特别是对于男性、多灶性、有包膜侵犯者。如中央区淋巴结查见转移癌建议行同侧III、IV区淋巴结清除术或功能性淋巴结清除术。     

超声弹性成像诊断颈部淋巴结核的价值

目的：研究颈部淋巴结结核的超声弹性成像表现,评价超声弹性成像在其诊断中的价值。方法：采用弹性5分评分法对44例97个颈部淋巴结结核病灶进行分析。结果：有85.7%（30/35）结节型和83.7%（36/43）干酪坏死型颈部淋巴结结核的超声弹性成像评分和为1～2分,有57.8%（11/19）愈合钙化型的弹性成像评分为3～4分。结论：绝大多数颈部淋巴结结核病灶硬度较小,超声弹性成像评分较低,有助于诊断。     

多灶性甲状腺乳头状癌的临床病理特点及颈部淋巴结转移规律

目的探讨多灶性甲状腺乳头状癌（MPTC）的临床病理特点及颈部淋巴结转移规律分析,为多灶性甲状腺癌的治疗提供依据。方法回顾性分析2012~2016年788例于蚌埠医学院第一附属医院肿瘤外科行手术治疗且术后病理证实为多灶性甲状腺乳头状癌患者的临床资料。结果纳入的788例MPTC患者,年龄8~81岁（46.28±12.49岁）,其中男性138例（17.51%）,年龄43.58±13.62岁;女性650例（82.49%）,年龄46.86±12.17岁。≤45岁的287例（36.4%）,>45岁的501例（63.6%）。双侧多灶患者495例（62.8%）,单侧多灶293例（37.2%）。肿瘤直径>1 cm 377例（47.8%）,肿瘤直径≤1 cm 411例（52.2%）。病灶数为2个的524例（66.5%）,病灶数≥3个的264例（33.5%）。双侧多灶组合并桥本甲状腺炎、肿瘤直径>1 cm发生率明显高于单侧多灶组（P<0.01）。双侧多灶、包膜侵犯更倾向于发生颈部淋巴结转移,尤其是中央区淋巴结转移（P<0.01）。多灶组中随着癌灶数的增加,中央区及侧区淋巴结转移率明显增加（P<0 01=">1 cm发生淋巴转移的风险约是≤1 cm的3.805倍（P<0.01）;病灶数≥3个发生淋巴转移的风险是≤2的9.848倍。结论男性、肿瘤最大径>1 cm及合并桥本氏甲状腺炎的患者易发生双侧多灶性甲状腺癌,且随着癌灶数量的增加,双侧多灶性甲状腺癌的比例明显增高。男性、年龄≤45岁、肿瘤直径>1 cm、双侧多灶,包膜侵犯更倾向于发生颈部淋巴结转移,随着癌灶数的增加,中央区及侧区淋巴结转移率明显增加。性别、病灶数量、大小、双侧分布均为淋巴结转移的独立危险因素。      

妇科恶性肿瘤腹腔镜淋巴结清扫术后淋巴漏的影响因素及治疗方法

目的分析妇科恶性肿瘤腹腔镜下淋巴结清扫术后淋巴漏的发生危险因素及治疗方法。方法回顾性分析2016年4月-2017年8月190例在该院妇瘤科诊断为妇科恶性肿瘤并接受腹腔镜下腹膜后淋巴结清扫术的患者的临床资料,分析患者术后淋巴漏发生的相关因素及治疗方法,并总结归纳出预防措施。结果 22例(11.58%)患者术后发生淋巴漏,16例为淡黄色引流液,6例为乳糜样引流液。单因素分析显示,淋巴漏组与非淋巴漏组的患者在术前、术后血红蛋白(Hb)、术后血清白蛋白(ALB)水平、淋巴结清扫范围及淋巴结清扫数量这5个因素中存在差异(P 0.05),而Logistic多元回归分析显示,淋巴结清扫范围及术后血清ALB水平是导致术后淋巴漏的影响因素。16例单纯淋巴漏患者经过调整饮食、纠正电解质紊乱、静脉营养及持续引流等保守治疗后治愈。6例伴乳糜漏患者给予禁食、肠外营养、皮下注射生长抑素处理,5例患者治愈,1例患者保守治疗效果不佳行手术结扎后治愈。结论淋巴结清扫范围及术后血清ALB水平是导致术后淋巴漏发生的危险因素。保守治疗及充分引流可获得满意效果,术中选择合适的能量器械并熟练地掌握操作技巧、熟悉解剖和仔细操作可预防淋巴漏发生。     

病灶清除术治疗腹部淋巴结结核50例疗效分析

目的探讨病灶清除术治疗腹部淋巴结结核的可行性。方法对药物治疗无效的50例腹部淋巴结结核患者采用病灶清除术治疗。结果 50例患者均治愈。1例出现胆总管瘘,经T管引流后治愈;1例损伤肠管,修补破口术后无肠瘘;1例出现淋巴漏,保守治疗后治愈;1例出现局限性结核性脓腹,经冲洗引流后治愈;1例出现粘连性肠梗阻,再手术治愈。随访2年无复发。结论对药物治疗无效的腹部淋巴结结核采用病灶清除术治疗,疗效好,手术并发症发生率低,预后好。     

颈淋巴结清扫术后并发乳糜漏的观察及护理

总结896例颈部淋巴结清扫术后13例并发乳糜漏的护理,13例乳糜漏均先采用限制饮食、持续负压吸引、局部压迫保守治疗,其中12例经保守治疗获得治愈,愈合时间4~10天。1例保守治疗10天后无效,改为手术缝扎治愈。     

甲状腺乳头状癌的外科治疗探讨

目的探讨甲状腺乳头状癌(PTC)的外科治疗相关问题。方法对100例PTC手术治疗病例临床资料进行回顾性分析。结果对100例患者中发现124个癌灶,多灶性甲状腺癌17例(占17.0%),颈部淋巴结转移40例(40.0%);合并结节性甲状腺肿﹑桥本病﹑滤泡型腺瘤36例(36.0%)。手术方式包括:甲状腺患侧叶切除术52例,患侧全切加对侧大部分切除术33例,甲状腺全切15例,中央区淋巴清扫术100例,侧颈部淋巴清扫术37例。术后并发症发生率7.0%;术后1例同侧颈淋巴结转移,1例对侧甲状腺出现癌灶。结论应根据PTC患者病变的不同部位及数目(单发/多发)及有无淋巴结转移采用相应的手术方式。     

浅表器官结核的超声声像图特征分析

目的 :探讨浅表器官结核的超声图像特点,并评估超声在其诊断中的价值。方法 :回顾性分析75例经病理证实为浅表器官结核患者的超声图像,其中附睾或(和)睾丸结核34例,颈淋巴结结核23例,腮腺或(和)腮腺淋巴结结核8例,胸壁结核5例,甲状腺结核2例,乳房结核3例。对75例患者进行进行灰阶超声和彩色多普勒超声成像。结果:75例浅表器官结核患者病灶的超声图像表现为实块型11例,脓肿型13例,混合型28例,弥漫型16例,溃疡窦道型7例。彩色多普勒图像显示,多数病灶血供不丰富(68/75)。结论:浅表器官结核的超声表现有一定特征性,提示超声检查是浅表器官结核诊断的重要手段。     

腮腺结核病的CT表现

目的分析腮腺结核病的CT征象,提高对该病的认识与诊断水平。方法搜集2009年8月-2012年12月期间经手术病理及实验室检查证实的腮腺结核病患者9例,回顾性分析其CT表现并与病理检查结果对照。结果 9例患者均单侧发病,其中左侧7例,右侧2例。腮腺淋巴结结核病8例,均位于浅叶,3例单发,5例多发,共30枚病灶,直径约0.5~4.5 cm;平扫呈均匀稍低密度,增强后呈中等密度均匀实性强化25枚,环状强化4枚,花边状强化1枚,其中6例临近颈阔肌、皮下脂肪及皮肤不同程度增厚,6例伴颈部淋巴结增大。腮腺实质结核病1例,为弥漫性实质受累,累及深浅叶,平扫呈不均匀稍低密度,内见斑片状低密度影及结节状钙化灶,增强后整个腮腺实质弥漫性强化,局部见不规则液化、坏死,临近颈阔肌及脂肪层稍肿胀,不伴颈部淋巴结增大。结论腮腺结核病的CT征象与其病理改变密切相关,对于单侧腮腺浅叶占位病变,呈均匀实性强化、环状强化或花边状强化,临近颈阔肌、皮肤及皮下脂肪层增厚,伴颈部淋巴结增大,应考虑到腮腺淋巴结结核病的诊断。     

肾移植后淋巴漏的原因分析

背景：近年来,肾移植后并发症明显降低,但移植后淋巴漏仍有很多报道。目的：探讨肾移植后淋巴漏的原因。方法：分析396例肾移植患者的临床资料,根据移植中髂血管周围有无肿大淋巴结分为淋巴结肿大组（n=21）和无肿大组（n=375）,分析两组移植后淋巴漏的原因。结果与结论：两组共发生淋巴漏27例,总发生率为6.82%。淋巴结肿大组5例,发生率为23.81%,移植后3d出现淋巴漏,平均持续时间为23d,淋巴液引流量日均为191mL;无肿大组22例,发生率为5.87%,移植后8d出现淋巴漏,平均持续时间为11d,淋巴液引流量日均为96mL。两组比较差异有显著性意义（P〈0.01）。淋巴结肿大组移植后病理诊断淋巴结结核1例,出现淋巴漏1例;反应性淋巴结肿大9例,出现淋巴漏1例;慢性淋巴结炎11例,出现淋巴漏3例;无淋巴结肿大组1例移植肾功能丢失,1例死亡。说明肾移植后淋巴漏与肿大淋巴结性质、手术操作、排斥及感染等因素有关,影响人肾存活。     

超声引导下穿刺活检对儿童浅表淋巴结的诊断价值

目的探讨超声引导下穿刺活检对儿童浅表淋巴结的诊断价值。方法选取195例浅表淋巴结肿大患儿,均行超声引导下浅表淋巴结穿刺活检,以术后病理结果为标准,计算超声引导下穿刺活检的取材满意度,以及其诊断颈部淋巴结病变的敏感性、特异性;分析免疫组化对诊断准确率的影响和颈部淋巴结病变与分区的情况。结果①195例患儿中,经穿刺活检病理诊断为良性166例,误诊1例淋巴结结核;恶性21例;未做出诊断8例,漏诊1例霍奇金淋巴瘤,以术后病理诊断结果为标准,超声引导下穿刺活检诊断儿童浅表淋巴结的准确率为95.4%,敏感性为95.5%,特异性为100%,阳性预测值为100%,阴性预测值为99.4%。195例患儿均未见大出血或其他严重并发症。②取材满意者穿刺活检的诊断准确率为99.4%,取材不满意者穿刺活检的准确率为75.8%,两者比较差异有统计学意义(χ²=29.5988,P<0.05)。加做免疫组化者诊断准确率为99.0%,未加做免疫组化者诊断准确率为91.6%,两者比较差异有统计学意义(χ²=4.5253,P<0.05)。③颈部淋巴结病变中恶性、良性病例累及Ⅱ区者最多,分别为72.7%、81.6%。结论超声引导下穿刺活检对儿童浅表淋巴结有较高的诊断价值,且操作简单、价廉、安全、患者耐受良好,具有广阔的应用前景。     

锐性去表皮层包皮环切术138例临床分析

目的探讨去表皮层包皮环切术治疗包皮过长及包茎的方法和效果。方法标记包皮切除长度,在利多卡因局部浸润麻醉下于包皮内、外板作两个互相平行的环形表皮层切口,用15#刀锐性切除两切口间包皮的表皮层,保留真皮下微血管、阴茎浅筋膜、阴茎背浅静脉及淋巴管完整,并保留完整的包皮系带。结果去表皮层包皮环切术138例,术中出血极少,术后龟头及黏膜无水肿,无继发性出血及感染,均一期愈合。84例随诊2~24个月,切口无增生性瘢痕,不损害阴茎外观及功能。结论去表皮层包皮环切术对包皮过长及包茎患者治疗效果满意。     

Esophageal tuberculosis complicated with intestinal tuberculosis: A case report

BACKGROUND Although the overall incidence of tuberculosis in underdeveloped areas has increased in recent years, esophageal tuberculosis(ET) is still rare. Intestinal tuberculosis(ITB) is relatively more common, but there are few reports of ET complicated with ITB. We report a case of secondary ET complicated with ITB in a previously healthy patient.CASE SUMMARY A 27-year-old female was hospitalized for progressive dysphagia, retrosternal pain, acid regurgitation, belching, heartburn, and nausea. Upper gastrointestinal endoscopy showed a mid-esophageal ulcerative hyperplastic lesion. Endoscopic ultrasonography showed a homogeneous hypoechoic lesion, with adjacent enlarged lymph nodes. Biopsy histopathology showed inflammatory exudation,exfoliated epithelial cells and interstitial granulation tissue proliferation.Colonoscopy revealed a rat-bite ulcer in the terminal ileum and a superficial ulcer in the ascending colon, near the ileocecal region. The ileum lesion biopsy showed focal granulomas with caseous necrosis. Polymerase chain reaction for Mycobacterium tuberculosis was positive in the esophageal and ileum lesion biopsies. The T-cell spot tuberculosis test was also positive. The patient was diagnosed with secondary ET infiltrated by mediastinal lymphadenopathy and complicated with ITB, possibly from the Mycobacterium tuberculosis-infected esophageal lesion. After 2 mo of anti-tuberculosis therapy, her symptoms improved significantly, and upper gastrointestinal endoscopy showed healing ulcers.CONCLUSION When dysphagia or odynophagia occurs in patients at high-risk for tuberculosis,ET should be considered.     

肝结核的病理特征与临床相关问题探讨

目的 探讨肝结核的病理特征与临床表现、诊断和治疗的关系。方法 对经手术与病理证实的肝结棱患者的临床资料进行回顾分析。结果 肝结核病理改变以粟粒样和结节瘤样病灶为主，临床表现和影像学表现多样，且无特异性，误诊误治率高。结论 了解肝结核的病理特征，有助于理解分析肝结核的临床表现和影像学检查结果，有助于治疗方法的选择，从而降低误诊误治率。     

腹主动脉旁孤立结节性病变的CT诊断价值分析

目的：分析腹主动脉周围孤立结节（最大径≤30mm影像特征，以提高诊断正确率。材料与方法：收集经手术病例证实结节病变19例，试验性治疗有显著疗效的结节病变6例，共计25例。对其CT表现进行回顾性分析，并提出各种结节病变的诊断标准及鉴别诊断要点。结果：肾上腺肿瘤11例，淋巴结转移癌3例，淋巴结核1例，淋巴瘤2例，肝外生肿瘤2例，副脾1例，肝硬化致侧枝血管团2例，未充盈小肠2例，膈肌脚1例。25例均呈实性结节影，并各具一定特征。结论：通过CT各种征象的综合分析，可以埘腹主动脉旁周围孤立结节性病变做到正确的定位及定性诊断。     

细针穿刺细胞学与抗酸染色检验在淋巴结核诊断中的比较

目的比较细针穿刺细胞学与抗酸染色在淋巴结核临床诊断中的应用价值。方法对100例淋巴结病变患者穿刺物标本应用细针穿刺细胞学和涂片抗酸染色法检测,对2种检测方法的结果进行比较分析。结果 100例淋巴结核细胞学分型不同时期,抗酸染色阳性例数不同,其中结核结节期44例中抗酸染色阳性2例;干酪样坏死期38例中抗酸染色阳性36例,其他各期抗酸染色阳性几乎为0。结论细针穿刺细胞学诊断淋巴结核不同时期抗酸染色阳性率不同,其中干酪样坏死期抗酸染色阳性率最高,细针穿刺细胞学和抗酸染色相结合在临床上有重要的应用价值。     

THE RELATION OF APICAL TUBERCULOSIS OF ADULTS TO THE FOCAL TUBERCULOSIS OF CHILDREN

The age incidence of focal tuberculous lesions of the lungs demonstrates that they have their origin in most instances in childhood. Focal lesions which heal have been found at all ages after the 2nd year of life, but in more than half of all individuals these lesions are acquired between the ages of 10 and 18 years. In the period between 18 and 30 years at least 85 per cent of all individuals have ''acquired focal tuberculous lesions. The occurrence of tuberculous infection in the lungs, in regional lymphatic nodes, or in some other organs of the body such as the gastrointestinal tract and its lymphatic system, is nearly universal but doubtless a few individuals escape. That focal tuberculous lesions of the lung are occasionally acquired during adult life is shown by the slight increase in the proportion of those with these lesions as age increases from 18 years to old age. Apical lesions of the lung make their appearance in later childhood and occur with increasing frequency from adolescence to old age (50 per cent). After the 2nd year of life focal tuberculous lesions occurring in situations other than the apices of the lungs tend to heal and after the 10th year focal lesions are almost invariably encapsulated and latent or healed. Fatal tuberculosis after the 10th year is with few exceptions apical in origin. The apices are not only more susceptible to infection in later life but once infected afford less resistance to the extension of the lesion. The present series of cases has furnished opportunity to observe the character of the apical lesion in lungs of individuals previously infected with tuberculosis. With one exception the apical lesion (in eight instances) has pursued a chronic course and, encapsulated by fibrous tissue, has remained limited to the extreme apex of the lung. In one instance in a woman with advanced malignant disease chronic pulmonary tuberculosis has been progressive. Tuberculosis of the apices in those who have previously acquired a focal tuberculous lesion has pursued a chronic course and in most instances has remained latent or has completely healed. A very small group of instances of fatal pulmonary tuberculosis suggests that apical lesions in those who have not undergone previous infection may assume an unusually severe character. One instance of apical tuberculosis unaccompanied by focal lesions and followed by tuberculosis of the thoracic duct and disseminated miliary tuberculosis has been especially significant. Apical tuberculosis unaccompanied by evidence of preexisting tuberculosis may be accompanied by tuberculosis of the regional lymphatic nodes, whereas apical tuberculosis in an individual with a preexistent focal tuberculous lesion is not followed by tuberculosis of adjacent lymphatic nodes. It is well known that tuberculosis in previously uninfected animals is followed by tuberculosis of adjacent lymphatic nodes, whereas a second infection fails to implicate the regional lymphatic nodes. This relation has been well illustrated by the lungs of a monkey which acquired in confinement acute tuberculous pneumonia limited to the left lung; the lymphatic nodes on this side were greatly enlarged and caseous. The following observations indicate that apical tuberculosis of adults is not the result of infantile tuberculosis but is caused by subsequent infection: (a) Apical tuberculosis does not have its highest incidence, in accordance with common belief, in early adult life when focal infections acquired in childhood are relatively fresh and active but is more common in later life when the focal lesions of childhood have in most instances completely healed. It is noteworthy that most of these apical lesions of later life pursue a chronic course and are discovered at autopsy in individuals who have died from other causes. (b) The well characterized lesions of tuberculosis acquired in childhood and found in adults with apical lesions are almost invariably calcified and healed. The apical lesion is in most instances relatively fresh and caseous whereas the focal pulmonary lesion and associated lesions of regional lymphatic nodes exhibit no evidence of activity. (c) In a large proportion of instances of associated focal and apical tuberculosis the focal lesion is in one lung, whereas the apical lesion is limited to the opposite apex. This relation affords no support to the view that tuberculous lesions may be transmitted to the apex by way of the lymphatics.