单发少脂肪性肾血管平滑肌脂肪瘤的比较影像学评价

目的分析肾脏单发少脂肪性血管平滑肌脂肪瘤（RAML）的影像学表现,探讨B超、CT及MRI在鉴别诊断中的价值。方法回顾性分析11例经手术病理证实的RAML影像学表现。结果11例患者11个病灶均表现为实质性肿块,边界清楚、形态不一,其中7例为类圆形,4例不规则形;B超8例示低回声、3例稍高回声,CDFI示内部无或少许血流信号;CT平扫6例呈略高密度,5例呈等密度,其中5例内见小灶性低密度;所有病灶CT动态增强肾皮质期明显强化,实质期呈相对低密度;MRI显示所有病灶T2WI呈低信号,均未见假包膜,8例反相位病灶内部可观察到较同相位减低,MRI动态增强表现和CT相仿。结论B超与CT在RAML的诊断和鉴别诊断中具有一定特征性,MRI检查可进一步提供诊断依据。     

AML并对侧无功能肾上腺皮质腺瘤的诊断与治疗(附4例报告)

回顾性分析4例肾上腺髓性脂肪瘤（AML）并对侧无功能肾上腺皮质腺瘤患者的临床资料。本组2例临床表现为腰部或肋部不适、隐痛或胀痛,2例于查体发现。伴血压高1例。内分泌检查均在正常范围;B超、CT、MR I检查示AML并对侧肾上腺皮质腺瘤。4例均在全麻下行AML切除术,同期切除对侧腺瘤。随访9-60个月,临床症状均消失,无肿瘤复发。认为影像学检查和内分泌功能检查是AML并对侧无功能肾上腺腺瘤的主要诊断方法。手术切除是治疗本病的首选。     

B超对膀胱癌的诊断价值

1995～ 1998年 ,我们应用 B超对 84例膀胱肿瘤患者进行诊断 ,效果满意。现报告如下。临床资料 :本组 84例均为我院住院患者 ,其中男 6 0例 ,女 2 4例 ;年龄 35～ 78岁 ,平均 5 7岁 ;均经手术病理证实。 84例均行 B超并同时行 X线尿路造影摄片检查。B超检查显示 :84例患者中有 82例膀胱癌。肿瘤位于膀胱三角区 32例 ,两侧壁 5 0例 ,显示率 10 0 %。其中单发肿瘤72例。肿块直径 0 .4～ 6 .8cm ;多发肿瘤仅 10例。膀胱顶部肿瘤显示率极低。 B超显示向膀胱内突出呈中等强回声或低回声。有蒂 8例 ,均为乳头状癌 ,内部回声不均质 ,其它显示广基…     

恶性脑膜瘤的诊断与治疗

目的探讨恶性脑膜瘤的诊断与治疗方法。方法对21例恶性脑膜瘤患者的临床资料作回顾性分析。结果本组颅脑CT、MRI示肿瘤周围明显水肿,多为等密度或高密度块影,多见囊变或坏死区域;瘤组织呈非均一强化;肿瘤边缘不规则或边界不清。17例初治者首选手术全切除治疗,4例复发者均行γ刀治疗。其中15例行化疗,3例行放疗。随访5～84个月,完全缓解12例,部分缓解3例,无变化2例,进展3例,死亡1例。结论CT、MRI影像学检查有助于恶性脑膜瘤诊断;治疗方法是以手术切除为主,术后配合放化疗。     

胃肠道外间质瘤的MSCT和MRI诊断

目的:探讨MSCT和MRI对胃肠道外间质瘤(extra-gastrointestinal stromal tumors,EGIST)的诊断价值.方法:回顾性分析22例经免疫组织化学证实的EGIST的MSCT和MRI表现.16例患者行CT检查,6例行MRI检查.结果:22例EGIST中,中度危险5例,高度危险17例.肿瘤位于肠系膜6例,网膜5例,盆腔5例,腹腔3例,腹膜后2例,腹壁1例.肿瘤最大直径5.7-19.5cm.肿瘤呈分叶状4例,不规则形7例,类圆形或椭圆形11例.16例行CT检查中,肿瘤密度均匀4例,不均匀12例;增强后均匀强化2例,不均匀强化14例.6例行MRI检查中,T1WI肿瘤呈稍低信号4例,呈稍低、高混杂信号2例;T2WI呈等、高混杂信号6例;DWI肿瘤实性部分呈高信号6例;增强后肿瘤实性部分明显强化.22例EGIST中,13例在动脉期肿瘤实性成分内可见条状强化的血管影,9例伴有远处转移,其中肝转移(5例)最多见.结论:EGIST的MSCT和MRI表现有一定的特征性,MSCT和MRI是目前诊断EGIST的有效检查方法之一,MRI在早期发现肿瘤有无肠系膜、网膜、腹膜和骨骼的转移方面有一定优势.     

腮腺乳头状淋巴囊腺瘤的临床研究

目的探讨腮腺乳头状淋巴囊腺瘤的临床特点及治疗方法。方法总结分析8例腮腺Warthin＇s瘤患者的临床表现及诊治情况。结果超声检查显示Warthin＇s瘤呈圆形或椭圆形、界清、低回声结节,血供丰富。MRI检查示肿物为类圆形稍高T1高T2异常信号,囊壁不均匀强化。7例患者行肿物及周围部分腺体切除术,1例行单纯肿瘤切除术,随访6～16个月,无复发。结论Warthin＇s瘤好发于老年男性,吸烟增加其患病率,手术可采用肿瘤及部分腺体切除术。     

胰岛素瘤的诊断和治疗

目的 总结胰岛素瘤的诊断和治疗经验,以期提高手术成功率和改善预后.方法 回顾性分析1966年至2007年收治的138例胰岛素瘤患者的临床资料.结果 全组病例均有不同程度的低血糖症状和Whipple三联征表现;64例有不同程度的精神神经症状,12例术后血糖恢复正常,但仍遗留精神神经症状.检测空腹血胰岛素88例,胰岛素释放指数均>0.3.术前B超检查75例,检出肿瘤8例;腹部CT 68例,检出17例;腹部MRI检查10例,检出5例;术中B超44例,检出肿瘤43例,另1例病理证实为胰岛细胞增生症.135例行手术治疗,其中肿瘤摘除术88例,胰体尾切除44例,胰十二指肠切除2例,活检1例.132例术后血糖恢复正常.术后血糖反跳性升高110例,多于术后2周内恢复正常;术后胰瘘20例,急性胰腺炎32例.结论 根据whipple三联征和胰岛素释放指数对胰岛素瘤作出定性诊断.手术探查联合术中B超是简单有效的定位诊断方法.手术是治愈胰岛素瘤的惟一方法.术中B超引导下切除肿瘤可有效避免主胰管和血管的损伤,降低手术并发症.     

胰岛素瘤17例临床诊治分析

目的探讨胰岛素瘤的诊断和治疗方法.方法回顾性地分析我院自1966年～2000年收治的17例胰岛素瘤.结果胰腺B超、腹部CT、选择性腹腔动脉造影检查准确率分别为82.4%、72.7%、60%.2例未手术,15例肿瘤切除.肿瘤位于胰头钩突3例,胰颈1例,胰体尾11例;80%肿瘤直径＜3 cm;行单纯肿瘤摘除术8例,胰体尾切除术4例,胰体尾加脾脏切除者2例,胰腺节段性切除(捆绑式胰体尾空肠吻合空肠端侧吻合术)1例.结论血糖、血胰岛素水平测定结合胰腺B超、CT检查能有效提高功能性胰岛素瘤的诊断.治疗多为单纯性肿瘤切除,恶性肿瘤应行根治性切除,腹腔镜微创手术正处于尝试阶段,药物治疗仍然在探讨阶段.     

肝局限性结节性增生二例报告

例1 男性,23岁,右上腹隐痛不适半年入院。B 超示肝右前叶有1个6. 5×5. 4cm相对强回声光团,形态不规则,内部回声不均匀。CT 示肝右叶顶部有6. 9×6. 5cm 圆形低密度占位,血管丰富,注入造影剂后,肿块密度迅速增高。化验:肝功正常,HBsAg(-),AFP(-),否认肝炎史以及特殊用药史。手术发现肿块位于肝右前叶上部,呈卵圆形,质较硬,表面欠光滑,逐将肿块切除。     

胰腺实性假乳头状瘤的诊治

目的 探讨胰腺实性假乳头状瘤的临床诊治.方法 回顾性分析2005年10月至2008年12月间收治的10例胰腺实性假乳头状瘤患者的临床资料.结果 10例患者均为女性,年龄11～39岁,平均24岁.中上腹部不适或疼痛为主要症状,4例体检触及腹部包块.B超、CT及MRI检查显示胰腺实性或囊实性占位.术前实验室检查无明显异常,肿瘤标记物正常.所有病例均接受手术治疗,胰腺头颈部肿块6例,胰体尾部肿块4例.手术方式:肿块切除3例,胰体尾切除3例(2例保留脾脏,1例联合脾脏、远端胃及部分结肠切除),节段性胰腺切除3例,胰十二指肠切除1例.术后2例发生胰瘘,经非手术治疗治愈,无其他外科并发症.切除的肿块长径约5.9 cm.平均随访时间19.2个月(8～42个月),所有患者均存活,无肿瘤复发转移迹象.结论 胰腺实性假乳头状瘤是临床少见的低度恶性胰腺肿瘤,手术切除预后良好.     

Natural history of minute hepatocellular carcinoma smaller than three centimeters complicating cirrhosis. A study in 22 patients

Twenty-two patients with cirrhosis and minute hepatocellular carcinoma less than 3 cm in diameter were followed for periods of 6-37 mo without specific treatment. The survival curve drawn by the Kaplan-Meier method showed a 1-yr survival of 90.7%, a 2-yr survival of 55.0%, and a 3-yr survival of 12.8%. The ultrasonic patterns of these masses in the liver were correlated with the size and showed a tendency to change from a low echo pattern to a low periphery and, finally, to a massive pattern. The growth speed calculated from the doubling time for tumor volume varied considerably from case to case with an average of 6.5 +/- 5.7 mo; it also changed in some cases during the observation period. Serum alpha-fetoprotein levels were generally low, rarely assisted in diagnosis, but tended to increase when the mass attained a diameter of greater than 3 cm; sudden acceleration in the rate of increase in alpha-fetoprotein level often coincided with a change of ultrasonic pattern to the massive one.     

隐原性机化性肺炎的CT影像学特征及激素治疗后的改变

目的 了解隐原性机化性肺炎（COP）治疗后CT影像学的变化.方法 回顾分析我院2001至2005年有临床表现、实验室检查、经病理活检证实、影像学表现支持的COP患者21例,男2例,女19例,平均年龄39～74岁.追踪检查85次,平均4次,最多8次;最短复查间隔时间为5 d,最长2.5个月;随访最短时间为3个月,最长43个月.结果 CT表现为多发性斑片状、含气实变影,主要分布在胸膜下区和双肺下叶.多数伴有磨玻璃影、小支气管扩张及条索状影.部分有病灶游走的表现.肾上腺皮质激素治疗21例,20例有显著疗效,治疗后病灶完全吸收4例,大部分吸收16例,无明显变化1例,治疗后出现反复2例.结论 COP应结合临床表现、影像学、病理检查综合诊断,治疗中CT追踪检查有利于了解治疗效果.     

Long-Term Survival Following Pancreatectomy and S-1 Chemotherapy for Pancreatic Acinar Cell Carcinoma With Peritoneal Dissemination: A Case Report and Literature Review

Current case is the third report of S-1 chemotherapy against acinar cell carcinoma (ACC) of pancreas, and our patient has achieved the longest reported recurrence-free survival, longer than 6 years, despite the presence of disseminated nodules at laparotomy.A 77-year-old man presented with abdominal discomfort. Computed tomography showed a low-density tumor in the pancreas tail and the patient was referred for surgery. A 3-cm sized pancreatic tumor, with localized disseminated nodules, was detected on laparotomy. Distal pancreatectomy with concomitant resection of disseminated nodules was performed, and histopathological examination revealed an ACC. Oral S-1 chemotherapy was administered postsurgery, and the patient showed no sign of recurrence during 73 months of follow-up. This is the first report of long-term survivor of pancreatic ACC with peritoneal dissemination, following pancreatectomy and S-1 chemotherapy.Current case suggests a beneficial effect of S-1 chemotherapy in cases of ACC.     

胸腔内留置导管注入羟基喜树碱卡铂及IL-2治疗恶性胸腔积液临床分析

目的比较胸腔内静脉导管留置注入羟基喜树碱联合卡铂及白细胞介素-2（IL-2）和卡铂及白细胞介素-2（IL-2）治疗恶性胸腔积液的临床疗效及不良反应。方法46例经病理组织学或细胞学确诊的恶性胸腔积液患者，随机分为两组：两组均采用改良的Seldinger法经皮穿刺，将一次性单腔中心静脉导管置人胸腔并保留，在胸腔积液引流干净后。治疗组24例：由导管注入羟基喜树碱和卡铂和IL-2；对照组22例：由导管注入卡铂和IL-2。注药后两组均夹管5天后再引流，无积液引出后再注入上述药物，夹管保留5天，一般注药2～4次。4～6周后复查B超、胸片，评价疗效。结果治疗组恶性胸腔积液治疗有效率91．7％（22／24）；对照组恶性胸腔积液治疗有效率63．6％（14／22），差异有显著性（P〈0．05）；两组不良反应均较轻微，差异无显著性（P〉0．05）。结论羟基喜树碱联合卡铂及白细胞介素-2较卡铂及白细胞介素-2胸腔内注入治疗恶性胸腔积液有效率较高且不良反应轻微，值得进一步推广应用。     

胰腺腺泡细胞癌的病理特点及治疗方法临床分析

目的 探讨胰腺腺泡细胞癌（PACC）的临床病理特点及治疗方法,以提高对此疾病的诊断水平和治疗效果.方法 回顾性分析第二军医大学附属长海医院胰腺外科2005年11月至2014年3月收治的17例经病理证实的PACC病例,分析其临床病理特征及治疗方法.结果 本组男性10例,女性7例.年龄37 ～ 77岁,平均59岁.11例主诉腹痛或腹胀;3例主诉皮肤及巩膜黄染;3例为体检发现.术前4例血清CA19-9、1例CEA、1例AFP超过正常参考值范围.B超检查见实性或囊实性低回声占位,内部回声欠均匀;CT和（或）MR、MRCP检查示多为边界较清的乏血供肿块,伴或不伴有胆管或胰管的扩张.肿块位于胰头6例、胰颈2例、胰体尾9例.肿块大小为1.5～7.3 cm,平均3.7 cm.实性肿块13例（76.5％）,伴有囊性变4例（23.5％）.免疫组化检查α1-抗胰凝乳蛋白酶（α1-ACT）和极低分子量细胞角蛋白（CAM5.2）均为阳性.3例行药物敏感性试验,其中抑制率均＞70％的有紫杉醇（TAX）和5-氟脲嘧啶.2例（14.3％）于术后第10和第17个月复发,5例（35.7％）于术后3 ～19个月出现肝脏转移伴或不伴腹膜后淋巴结转移.14例获得随访,其中3例死亡,术后生存时间分别为19、43和49个月,平均生存37个月;其余11例均健在,平均已生存31.5个月.结论 胰腺腺泡细胞癌是胰腺少见肿瘤,临床表现无特异性,肿瘤α1-ACT阳性表达率高达100％.局部PACC的治疗以手术切除为主,化疗主要采用紫杉醇、5-氟脲嘧啶.PACC总体预后较差.     

Rheumatoid lung nodulosis and osteopathy associated with leflunomide therapy

Background Leflunomide (LEF) is indicated in adults for the treatment of active rheumatoid arthritis (RA). LEF inhibits dehydroorotate dehydrogenase, a key enzyme of the pyrimidine synthesis in activated lymphocytes. Among rare adverse effects, fatal interstitial lung disease has been recently reported during treatment of RA with LEF in Japan. Clinical trials outside Japan do not suggest that LEF causes an excess of pulmonary adverse effects. Development and increase of peripheral rheumatoid nodules in typical sites of RA patients following LEF therapy has been recently reported. Objectives Two cases with new and accelerated development of rheumatoid lung nodulosis during LEF therapy were described in this study. Methods LEF treatment was administered to two male patients (77 and 66 years old) with long-standing active seropositive nodular RA with failure of multiple second line drugs and without lung involvement. Clinical and laboratory assessment using the American College of Rheumatology response criteria, chest computed tomography (CT), quantification of serum rheumatoid factor (RF), and monocyte count of peripheral blood along with routine laboratory follow up were performed on both patients before and during therapy. In case 1, a bone scan was performed due to sustained limbs pain. Open lung biopsy was performed in case 1 and core lung biopsy in case 2. Results Both patients achieved full clinical remission during 2 months of LEF therapy. In case 1, the first complaints were limbs pain after 10 months of treatment associated with intensive bone uptake on a bone scan consistent with hypertrophic pulmonary osteopathy. Productive cough developed after 3 months of the therapy in case 2. Initially, these complaints were not attributed to therapy. New lung disease was present on CT with cherry-like progressive cavitary nodules, predominantly involving the basal segments of the right lung. The first lung lesions were found by CT 13 months (case 1) and 7 months (case 2) after the beginning of therapy and were erroneously related to bronchiectasia in case 2. In both cases, the lung biopsy showed necrosis surrounded by epithelioid mononuclear inflammation with giant cells, consistent with rheumatoid lung node. The time that elapsed between the beginning of the first symptoms to LEF discontinuation was very long: 13 months in case 1 and 24 months in case 2. Discontinuation of LEF therapy was followed by an arrest in growth of lung nodules, resolution of limb pain, and gradual improvement of bone scan. A significant decrease of monocyte count and RF level in peripheral blood was observed during LEF therapy in both cases. Conclusion For the first time, we described rheumatoid lung nodulosis as complication of successful LEF therapy for RA. Hypertrophic pulmonary osteopathy with severe limbs pain and dry cough were the first manifestations of the lung nodulosis. Monocytopenia during LEF therapy is proposed to be involved in pathogenesis of this rare complication of LEF therapy.     

消化系统和腹膜腔炎性肌纤维母细胞瘤的CT表现与病理对照

目的探讨消化系统和腹膜腔炎性肌纤维母细胞瘤(IMT)的临床病理特点及CT影像特征，以提高对该病的认识。 方法回顾性收集并分析2012年2月至2021年2月郑州大学第一附属医院14例经病理组织学确诊的IMT患者的临床、病理及CT影像资料，观察并评估病灶的部位、形态、生长方式、最长直径、边缘、密度、包膜是否完整、表面有无溃疡，分析病灶增强方式及强化程度等，结合文献分析总结IMT的CT特征并与病理结果相对照。 结果14例IMT位于肠系膜3例，胃窦2例，结肠2例，胃体、回肠、回盲部、腹膜后、胆囊、肝脏、胰腺各1例。病灶最长径为2~9(4.90±2.20)cm，6例形态不规则呈分叶状，7例为单发类圆形，1例为多发类圆形；9例有完整包膜，5例包膜不完整；8例瘤内见迂曲血管，11例瘤周见供血血管；12例病灶内见坏死囊变，3例内见钙化，2例内见脂肪，1例合并出血。增强后13例强化不均，7例为全瘤填充样强化，6例为边缘环形强化，1例为中心分隔样强化；9例呈明显强化，4例呈轻度强化，1例呈中度强化。 结论IMT可来源于消化道和腹膜腔各区域，临床表现不典型，CT影像表现有一定特征性，对提示IMT的诊断有一定的价值，可辅助临床制定手术方案和治疗后随访，确诊依赖于病理及免疫组织化学检查。     

HBV重叠HIV感染患者细胞免疫功能及临床特征的研究

目的：探讨HBV（乙肝病毒）重叠HIV（人类免疫缺陷病毒）感染患者的临床特征，以及细胞免疫功能损害情况。方法：回顾性分析我院2004—2007年收治的HBV重叠HIV感染的AIDS（获得性免疫缺陷综合征）患者30例的临床资料、免疫状态和转归，分析30例HBV重叠HIV感染者、50例单纯AIDS患者以及20例正常对照者的CD3、CIM、CD8细胞百分比以及CD4／CD8比值。结果：在30例HBV重叠HIV感染者中，6例死亡，均死于肝功能衰竭或肝硬化并发症。实验检查发现其肝功能以低蛋白血症为主要表现，转氨酶、胆红素轻度升高，透明质酸（HA）升高明显，HBV复制异常高拷贝。CIM、CD3的检测值，在3组之间两两比较差异有统计学意义，CD3及CIM细胞计数表现为HBV／HIV重叠感染组〈AIDS组〈正常对照组（P〈0．01），CD8细胞计数3组间两两比较差异无统计学意义。CD4／CD8比值降低，HBV／HIV重叠感染组、AIDS感染组均〈正常对照组（P〈0．01）。B超均显示肝回声增粗，弥漫性肝损害6例、腹水5例、肝肿大10例、脾大10例。结论：HBV重叠HIV感染者临床表现肝脏炎症反应较轻，但全身情况差，并发症多，增强了与HBV感染相关的终末期肝病风险，病死率也明显升高，同时CD4淋巴细胞衰减明显，细胞免疫损害明显。     

Idiopathic sustained ventricular tachycardia responsive to verapamil: clinical electrocardiographic and electrophysiologic considerations

Fifteen cases of idiopathic VT responsive to verapamil were studied to examine its clinical, electrocardiographic and electrophysiologic features. All patients were male, aged 15-49, average age 28. Initial onset of VT occurred at ages 9-48 (average 21). Time from onset of VT to first admission was 1-20 years (average 8.2 years), and patients had been followed for 17-40 months (average 27 months). 13 cases had palpitations, 5 had faintness, 1 had syncope, but no deaths were reported. ECG's at time of VT exhibited CRBBB + LAD pattern in 12 cases, CRBBB + RAD pattern in 1, and LBBB in 2. VT rate was 130-200 bpm (average 163 bpm), with QRS width of 0.11 - 0.16 sec (average 0.14 sec). ECG's during sinus rhythm revealed no ST/T abnormalities, although in 6 cases they were found post-VT. 5 cases had recognizable H waves during VT, and HV intervals were shorter than that during sinus rhythm. VT could be induced by programmed electrical stimulation in 14 cases. VT or RVR could be induced by atrial pacing in 6 of 14, single RV extra-stimuli in 12 of 14, paired pulses in 5 of 12, RV overdrive pacing in 7 of 14, and burst pacing in 6 of 14 cases. VT could be terminated by RV burst pacing in 14 of the 15 cases, while single RV stimuli were effective in 5 out of 12 cases. Among the 12 cases in which VT could be induced by single RV extra-stimuli, the relationship between changes in premature interval for the induction of VT and the echo interval of VT (extrastimulus to first VT complex) was examined. 8 showed an inverse relationship, 3 showed a concordant relationship and 1 case could not be assessed. An inverse relationship was found between changes in paced cycle length and echo interval for the 2 cases in which VT could be induced by rapid pacing. Verapamil terminated sustained VT in 12 out of 13 cases, and in another case had a pronounced decelerating effect. Prior to termination, VT rate was drastically reduced (from 163 +/- 29 bpm to 128 +/- 29 bpm). Verapamil was able to prevent the induction of VT in 6 out of 14 cases, while in 6 cases the VT zone was expanded and in 2 cases the VT zone was narrowed.(ABSTRACT TRUNCATED AT 400 WORDS)     

28例结核性缩窄性心包炎临床诊疗分析

目的 通过分析结核性缩窄性心包炎（CTP）的临床特点、治疗与转归，以期提高CTP的诊疗水平。方法 对手术后病理证实为CTP的28例病人临床资料进行分析与总结。结果 CTP主要症状为气促、心悸、胸闷及腹胀，体征主要为颈静脉怒张与下肢水肿；多合并心包外结核病：心脏超声及CT检查均示心包膜增厚伴有钙化；手术后症状及心功能均有缓解而全部出院。术后随访4-24个月无需二次手术。结论 CTP临床症状无特异性，心包外结核病是CTP初步诊断依据；心脏超声和胸部cT是判断结核性心包炎是否已发生缩窄的可靠指标；手术是解除CTP心脏机械性压迫有效而又比较安全的治疗手段；加强围手术期的治疗是降低手术风险的关键。