食管平滑肌瘤的外科治疗

我院在1975年7月～1988年6月手术治疗食管平滑肌瘤18例。其中男12例,女6例;年龄在27岁～47岁之间。16例有临床症状,17例术前经X线钡剂造影或内窥镜作出诊断,除1例误断食管行对端吻合外均经开胸行肿瘤摘出术。本组病例中无手术死亡,随诊结果所有病例效果良好。     

食管平滑肌瘤X线诊断特点及误诊原因分析

我院１９８２年９月～１９９２年１２月，经食管胃肠钡餐Ｘ线检查诊断食管平滑肌瘤４２例，４２例经手术和／或行纤维内窥镜高频电凝摘除术活检病理证实。本文对其Ｘ线表现进行了分析，重点探讨了误诊原因及鉴别诊断，以提高对食管平滑肌瘤Ｘ线表现的认识。     

消化道平滑肌肿瘤的诊断和治疗（附26例报告）

１９８５年至１９９５年８月该院收治消化道平滑肌瘤２６例，均经手术切除及病理证实。平滑肌瘤１５例，平滑肌肉后１１例。主要表现为胸骨后及上腹不适、呕血黑便、腹部肿块及肠梗阻。内窥镜诊断率５０％，消化道钡剂诊断率６５．３％，未确诊６例，其中４例经ＣＴ检查证实。ＣＴ检查排除了２例误诊病例。本组均经手术治疗，平滑肌瘤术后无复发，平滑肌肉瘤术后存活５年以上５例，存活３年３例，存活１年３例。     

食管癌肉瘤五例报告

目的 探讨食管癌肉瘤的临床病理特征。方法 通过５例食管癌肉瘤术前Ｘ线钡餐造影术、纤维内窥镜观察,并术后病理检查、免疫组化学染色、随访。结果 ５例食管癌肉瘤术前仅１例确诊,４例诊断为鳞癌。肿瘤为带蒂的息肉型,癌的浸润限于粘膜层。癌与肉瘤成分相间混杂但无移行过渡,免疫组化染色各自表达相应抗体。术后随访：５年以上３例,２￣５年２例,患者健在。结论 食管癌内瘤术前Ｘ线钡餐造影和胃镜难以确诊。其组织学上有别     

食管平滑肌瘤10例临床治疗体会

我院１９７５年６月～１９９０年７月共收治食管平滑肌瘤１０例，占同期食管肿瘤总数的０．１９２％（１０／１０９２）。位于食管上段２例，中段５例，下段３例。Ｘ线食管钡餐造影是诊断本病的主要方法。行食管粘膜外肿瘤摘除９例，食管部分切除１例，效果良好。本文就其诊断与手术治疗进行了讨论。     

食管胃连接部平滑肌瘤：附10例临床报告

收集近３０年来手术治疗食管下段平滑肌瘤２８例，其中食管胃连接部平滑肌瘤１０例。该组术前误诊为贲门痉挛２例；纵隔肿瘤２例；贲门癌４例，其中术中探查后仍疑为贲门癌３例。ｘ线造影检查６例表现为贲门部不同程度的充盈缺损，２例表现为贲门部狭窄呈鸟嘴状．２例表现为纵隔肿块。胃镜下有５例贲门粘膜分别呈糜烂、出血、紊乱或中断等病理改变。食管胃连接部平滑肌瘤根据外科解剖结构，应归结为食管平滑肌瘤。     

脾脏肿瘤五例报告

我院于１９９１年１月至１９９６年３月收治脾脏肿瘤５例，均经手术治疗和病理证实，现报告如下。病例临床资料见附表。附表５例脾脏肿瘤临床资料例数性别年龄主诉体检Ｂ超、ＣＴ、Ｘ线检查血象术式病理１女３４左上腹肿物进行性增大伴胀痛、消瘦３个月左上腹肿块约２４ｃ...     

食道贲门双原发癌（附6例报告）

本文报告食管癌并存贲门癌６例，全部病例均经手术病理证实，没有手术死亡和术后并发症发生。作者认为：由于术前漏诊率高，应提高对该病的警惕，Ｘ线钡检对确诊有重要价值。术中应常规检查食管和贲门部，并尽可能对所有肿瘤一次性切除。     

食管平滑肌瘤诊治体会(附9例报告)

我院近20年来收治9例食管平滑肌瘤病人，均经手术及病理证实。现结合文献总结如下。1临床资料一般资料本组男性6例，女性3例。年龄28～57岁，平均40岁。肿瘤位于食管中段者5例，下段4例。合并食管癌1例，多发性食管平滑肌瘤1例。临床表现6例表现为吞咽困难，程度较轻，3例表现为胸骨后及剑突下疼痛。病程4个月～1．5年，平均10个月。食管钡剂造影及内镜食管钡剂造影9例均表现为程度不同的充盈缺损。2例相应部位粘膜僵硬、紊乱、中断，7例粘膜完整光滑。内窥镜检查7例见圆形、椭圆形肿块突入食管腔，表面粘膜完整光滑，皱线消失。2例食管腔狭…     

甲状腺癌23例误诊误治分析

目的 减少甲状腺的误诊误治。方法 回顾误诊为良性病变的甲状腺癌２３例,对其诊治及再手术作探讨。术前诊断为甲状腺瘤２１例,结节性甲状腺肿２例。行Ｂ超检查２３例,针吸细胞学检查３例,术冰冻切片检查４例。首次行腺叶切除术６例,余作腺叶部分切除或肿瘤剜除术。结果 术后均经病理证实为甲状腺癌。予再手术１４例,术后示癌灶残留４例;随访６例,因１例复治。对误诊的部分病人须作相应的扩大手段。     

Leiomyoma of the esophagus

26 patients with leiomyoma of the esophagus treated by surgery from 1959 to 1983 are reported. 22 were men and 4 women. The ages ranged from 21 to 65 years old. 2 of them were asymptomatic, the other 24 had dysphagia and pain. The diagnosis was correctly made in 26 instances by esophagography before operation. The characteristic smooth, crescent type of defect in the contour of the esophageal lumen was present in all patients. 25 were treated by thoracotomy and enucleation. 1 was treated by esophageal resection. In our series, there was no operative death and the overall results were excellent.     

食管平滑肌瘤的外科治疗

目的　探讨食管平滑肌瘤的诊断方法、手术时机与手术方式的选择以及手术并发症的预防。方法总结 70例食管平滑肌瘤外科治疗的临床资料 ,结合文献复习 ,进行回顾分析。结果　全组病例术前经选择性地采用食管造影、食管镜、食管腔内超声、胸部CT扫描等方法检查 ;除因肿瘤 <1 0cm、无症状或症状轻微 ,合并症禁忌以及患者拒绝共 10例未手术外 ,手术治疗 6 0例 ;病理证实为平滑肌瘤 5 6例 ,平滑肌肉瘤 3例 ,平滑肌瘤合并食管鳞癌 1例 ;手术方式包括 :经胸前外或后外侧切口、腋窝S切口、不切断肌肉胸壁小切口、胸膜外及胸腔镜下粘膜外肿瘤摘除 ,食管部分切除、食管胃重建附加幽门成形术 ;术中食管粘膜破损 7例 ,术后声音嘶哑、食管狭窄各 1例 ,无围手术期死亡。结论　钡剂食管造影、食管镜检查仍为食管平滑肌瘤的基本、有效诊断方法。食管腔内超声探测、胸部CT扫描对于X线表现不典型、与恶性病变难以鉴别的病例 ,具有重要意义 ;基于食管平滑肌瘤系良性病变 ,提出对于病变小于 1 0cm、症状轻微、术中难以定位的患者 ,仅作追踪观察对象 ;对于体积较大、症状明显、或疑有恶性变者应根据肿瘤部位、大小、及性质确定手术入路及方案进行手术。强调术前如考虑为平滑肌瘤时 ,内镜下不宜咬取活检 ;术中剥离肿瘤时 ,应紧     

A resected case of thoracic esophageal cancer in which pCR was obtained using low-dose of nedaplatin (CDGP)/5-FU and radiotherapy

This is a report of a case with esophageal cancer in which pathological CR was obtained by neoadjvant chemoradiotherapy using a low-dose of nedaplatin (CDGP)/5-FU. The patient was a male aged 76. A protuberant lesion diagnosed as esophageal cancer was found in the middle thoracic esophagus by esophagography. Since another lesion in the upper thoracic esophagus was revealed by endoscopy, metastasis to the cervical lymph nodes was diagnosed by ultrasonography, and preoperative chemoradiotherapy combining a low dose of CDGP/5-FU with radiotherapy was performed. As side effects of this treatment, grade 2 stomatitis and granulocytopenia were observed. The main lesion of the esophagus was found to have significantly diminished through endoscopy after completion of the treatment, and with no malignant cells obtained by biopsy. No cervical lymph nodes were found. It was diagnosed as partial response (PR) through imaging diagnosis. Radical resection of esophageal cancer under right thoracotomy and laparotomy was performed. Operative findings were Ch x R-T3N0M0 Stage II R0 D2 Cur A. Pathological examination of resected specimens revealed no viable cancer cells in the esophagus or metastasis to the dissected lymph nodes. Neoadjuvant chemoradiotherapy using a low-dose of CDGP/5-FU is an effective treatment for esophageal cancer.     

Co-existence of early esophageal carcinoma and leiomyoma: a case report

There have been several reports of co-existing esophageal squamous cell carcinoma and esophageal submucosal tumor. However, there is no previous report describing a submucosal tumor located within an area of early esophageal cancer. This report presents the case of a 64-year-old man who developed early esophageal cancer with leiomyoma situated within the lesion in the upper third of the esophagus. Since leiomyoma existed within the area of the esophageal cancer, it was misdiagnosed as a component of esophageal cancer and the depth of esophageal cancer invasion was overdiagnosed by endoscopic ultrasonography. Therefore, surgery was chosen as treatment for esophageal cancer. If the leiomyoma had been diagnosed correctly as a submucosal tumor by endoscopy and endoscopic ultrasonography, an endoscopic mucosal resection would have been the therapeutic procedure of choice for an esophageal tumor.     

膀胱平滑肌瘤的诊断和治疗的探讨

目的 对膀胱平滑肌瘤临床诊治进行回顾性分析,以提高其诊断和治疗水平。方法：2004-2005年连续诊治3例膀胱平滑肌瘤患者,临床有血尿症状2例,体检发现1例。行B超、KUB＋IVP、CT等检查示1例膀胱与子宫间占位,1例示膀胱内病灶生长,1例早期B超无明显异常。膀胱镜下3例均见膀胱内局部隆起,黏膜表面光整。3例均在连续硬膜外麻醉下行膀胱部分切除术治疗。结果 3例病灶均完整切除,术后随访4～5年无复发。结论 膀胱平滑肌瘤是少见的膀胱良性肿瘤,对其诊断主要依靠影像学及膀胱镜检查,必要时可取病理活检以防误诊,外科手术可获得良好的治疗效果。     

外科治疗43例高龄食管癌贲门癌

目的：探讨高龄食管癌贲门癌病人围手术期的处理和手术方式的选择。方法：43例肿瘤患者中,食管癌26例,根治手术23例,探查3例,贲门癌17例,根治手术13例,探查4例,对食管癌贲门癌的术前准备、营养支持及手术方式进行总结分析。结果：本组手术切除率93．0％、并发症发生率41．9％、手术死亡率4．7％,获得了较满意的治疗结果。结论：对高龄食管癌和贲门癌病人,应严格掌握适应证及正确处理围手术期并发症。     

肺炎性假瘤诊断及外科治疗71例

目的：总结肺炎性假瘤诊断及外科治疗体会，方法：对1970年12月－2000年12月71例肺炎性假瘤的临床资料进行回顾性分析。女49例，男22例，年龄23－72岁，平均45．2岁，肺叶切除44例，楔形切除18例，肺段切除8例，探查活检1例，术中冰冻病理切片13例，肺炎性假瘤11例，错构瘤1例，可疑腺癌1例，术后病理考虑恶性变5例。结果：5例恶性变者，3例已生存5年，2例术后5年内死于复发，转移，余66例预后良好，结论：术前诊断较困难，治疗以手术切除为主，术中冰冻病理切片检查对决定术式有帮助。     

Multicentric carcinoma of the esophagus and double primary malignant neoplasm of the upper alimentary tract--report on 44 patients

During the past fifteen years, 44 patients with multicentric carcinoma of the esophagus or double primary malignant neoplasm of the upper alimentary tract, collected from 5316 patients with cancer of esophagus or gastric cardia in the same period, were treated in our hospital. The incidence was 0.83%. All were proven by pathology. Exploratory thoracotomy was done in 32 patients and 26 lesions were resected with a resection rate of 81.3%. All patients with cancer resected survived over 1 year, 6 out of 9 survived over 3 years and 2 out of 3, over 5 years. In the 18 patients who received chemotherapy alone, 12 were followed and all died within 1 year. It is shown that multicentric carcinoma of the esophagus or double malignant neoplasm of the upper alimentary tract should be given energetic treatment. Finally, the incidence, diagnosis criteria, diagnosis method, etiology and management are discussed with a review of literature.