ObjectiveTo investigate diagnosis and treatment of rupture of pancreatic cystic disease. MethodThe clinical data of 20 patients who were diagnosed as pancreatic cystic disease combined with rupture in the First Affiliated Hospital of Harbin Medical University from June 2011 to December 2015 were analyzed retrospectively. Results① For the 5 patients with pancreatic cystic tumor, 3 patients of them received distal pancreatectomy and 2 patients of them received Whipple procedure. For the 15 patients with pancreatic pseudocyst, 2 patients received ultrasound-guided cyst puncture and drainage, 2 patients received endoscopic retrograde pancreatic drainage (ERPD), 2 patients received ERPD plus ultrasound-guided cyst puncture and drainage, 1 patient received pancreatic external drainage, 3 patients received pancreatic cyst-gastric anastomosis, 5 patients received pancreatic cyst-jejunal Roux-en-Y anastomosis. ② Pancreatic fistula occurred in 3 patients (Grade A 2 cases, Grade B 1 case), delayed gastric emptying was found in 1 patient, peritoneal effusion occurred in 1 patient. ③ Eighteen of them were followed up from 3 to 60 months with an average 25.6 months, 2 patients recurred and non-surgical treatments were taken. ConclusionsHow to correctly identify pancreatic cystic tumor with pancreatic pseudocyst is premise of treatment. Pancreatic cystic disease combined with rupture requires urgent therapy. Based on clinical manifestations, optimal selection might achieve a better prognosis.
ObjectiveTo explore the diagnostic value of exhaled volatile organic compounds (VOCs) for cystic fibrosis (CF). MethodsA systematic search was conducted in PubMed, EMbase, Web of Science, Cochrane Library, CNKI, Wanfang, VIP, and SinoMed databases up to August 7, 2024. Studies that met the inclusion criteria were selected for data extraction and quality assessment. The quality of included studies was assessed by the Newcastle-Ottawa Scale (NOS), and the risk of bias and applicability of included prediction model studies were assessed by the prediction model risk of bias assessment tool (PROBAST). ResultsA total of 10 studies were included, among which 5 studies only identified specific exhaled VOCs in CF patients, and another 5 developed 7 CF risk prediction models based on the identification of VOCs in CF. The included studies reported a total of 75 exhaled VOCs, most of which belonged to the categories of acylcarnitines, aldehydes, acids, and esters. Most models (n=6, 85.7%) only included exhaled VOCs as predictive factors, and only one model included factors other than VOCs, including forced expiratory flow at 75% of forced vital capacity (FEF75) and modified Medical Research Council scale for the assessment of dyspnea (mMRC). The accuracy of the models ranged from 77% to 100%, and the area under the receiver operating characteristic curve ranged from 0.771 to 0.988. None of the included studies provided information on the calibration of the models. The results of the Prediction Model Risk of Bias Assessment Tool (PROBAST) showed that the overall bias risk of all predictive model studies was high, and the overall applicability was unclear. ConclusionThe exhaled VOCs reported in the included studies showed significant heterogeneity, and more research is needed to explore specific compounds for CF. In addition, risk prediction models based on exhaled VOCs have certain value in the diagnosis of CF, but the overall bias risk is relatively high and needs further optimization from aspects such as model construction and validation.
目的 評價不同外科手術治療肝臟囊性占位的臨床療效以及不同外科治療策略的優缺點。 方法 對1998年1月－2011年12月收治的肝囊性占位患者的臨床資料進行回顧性分析。共納入148例患者，其中單純性肝囊腫患者86例（單發35例，多發51例），多囊肝病患者62例。43.9%（65/148）患者行腹腔鏡囊腫開窗治療，27.0%（40/148）患者行開腹囊腫開窗術，21.6%（32/148）的患者行經皮囊腫穿刺及硬化劑注入術，另有7.4%（11/148）患者行開腹肝部分切除聯合囊腫開窗術。 結果 經過手術治療后，患者癥狀緩解率高達100.0%；術中患者出血量以經皮囊腫穿刺及硬化劑注入術最少，而以開腹肝部分切除聯合囊腫開窗術最多。對于單純性肝囊腫單發患者，不同手術治療后均未出現癥狀復發；對于單純性肝囊腫多發患者，肝部分切除聯合囊腫開窗術治療未出現癥狀復發，而經皮囊腫穿刺及硬化劑注入、腹腔鏡囊腫開窗和開腹囊腫開窗治療則分別有3、4、2例患者發生癥狀或影像學復發，總復發率為17.6%(9/51)；對于多囊肝病患者，經皮囊腫穿刺及硬化劑注入、腹腔鏡囊腫開窗、開腹開窗和肝部分切除聯合囊腫開窗治療則分別有2、7、3和2例患者發生癥狀或影像學復發，總復發率為22.6%（14/62）。 結論 目前常用治療方式對于單純性肝囊腫單發患者療效均理想，但對于單純性多發肝囊腫和多囊肝病患者遠期效果均尚不理想。
目的 全面介紹先天性囊性腺瘤樣畸形(CCAM)其可能的病因，臨床、病理特點及診斷手段，循證探討針對CCAM的治療方法及預后。 方法 對我院2011年11月收治的1例罕見的CCAM患者的臨床資料進行分析，并對相關文獻進行復習。 結果 患者數次誤診后最終診斷為CCAM，予手術治療后痊愈，隨訪1年無復發。 結論 CCAM是一種少見的、非遺傳性的、錯構瘤樣的肺發育異常，為一種良性的肺部畸形，其特點是局部肺終末呼吸性細支氣管過度生長。CCAM多通過產前影像學檢查、活組織檢查或術后病檢診斷。手術為治愈該病的最根本、最重要措施。
【摘要】 目的 探討CT對嬰幼兒腹部巨大囊性病變的診斷價值及其鑒別診斷。 方法 搜集2003年-2009年間經手術病理證實的2歲以內患兒腹部巨大囊性病變62例，分析其病變部位、大小、形態、分隔、密度和強化、囊壁及與周圍臟器關系等要素。 結果 62例中，先天性膽總管囊腫4例，重度腎積水36例，巨輸尿管2例，囊性腎母細胞瘤4例，大網膜囊腫4例，腸系膜囊腫3例，卵巢囊腫6例，囊性畸胎瘤3例。 各種囊性病變有其一定的發病部位和特征性的CT表現。 結論 CT是嬰幼兒腹部囊性病變定位、定性診斷的重要影像學方法。【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.
ObjectiveTo review the current clinical application of Beger procedure and Frey procedure for benign disease or low-grade malignant potential lesion of pancreas. MethodsRelevant literatures about current advance of clinical application of Beger procedure and Frey procedure published recently of domestic and abroad were collected and reviewed. ResultsWith the concept of organ-preserving operations was adopted in recent years, Beger procedure and Frey procedure were applied generally. Beger procedure and Frey procedure were associated with tolerable perioperative risk, postoperative complications, and good outcomes in the aspects of preservation of function and curability in these lesions compared to conventional pancreatectomy, with preservation of the physiological food passage, thus patients gained weight faster, had less pain, and demonstrated better exocrine and endocrine pancreatic function postoperatively and an improvement in the quality of life. Both procedures had reached an international position as a standard operation for the treatment of benign disease or low-grade malignant potential lesion of pancreas. But after long-term following-up early advantages were no longer present. ConclusionsBeger procedure and Frey procedure are safe and effective in providing good outcomes in the aspects of preservation of function and curability in benign disease or low-grade malignant potential lesion of pancreas. Organ-preserving pancreatectomy could become a new organ-preserving standard operation.
Objective To investigate the surgical technique of reduced sized liver transplantation. Methods A reduced size liver transplantation was successfully performed on a 11-year old girl with incurable caroli′s disease. Results The recovery of liver graft function was good after the operation in this patients without complications. Conclusion Reduced size liver transplantation is a safe and effective technique for pediatric liver transplantation to provide liver graft. Authors introduced their experiences of surgical technique in this patient.
目的 探討胰腺囊性腫瘤的診斷及外科治療方法。方法 對我院2003年4月至2012年4月期間收治的19例胰腺囊性腫瘤患者的臨床資料進行回顧性分析。結果 本組19例患者中漿液性囊腺瘤8例，黏液性囊腺瘤5例，導管內乳頭狀黏液瘤4例，實性假乳頭狀瘤1例，囊腺癌1例。行B超或CT發現胰腺占位病變。位于胰頭部5例，胰體部8例，胰尾部6例。行腫瘤摘除術4例，保留脾臟的胰體尾切除術5例，胰體尾＋脾臟切除手術3例，胰十二指腸切除術6例，1例囊腺癌患者因肝臟轉移伴腹腔廣泛轉移、侵犯大血管而腫瘤不能切除僅行胃空腸、膽腸吻合。術后發生胰瘺2例，腹腔感染1例，經保守治療后康復出院。無圍手術期死亡病例。19例患者均進行了隨訪，隨訪時間6～80個月，平均45.2個月。1例囊腺癌合并肝臟轉移患者于術后7個月死亡，其余良性腫瘤患者均未見復發，最長已存活5年。結論 胰腺囊性腫瘤主要靠影像學檢查發現，手術切除是理想的治療方法，選擇合適的術式有助于避免術后并發癥的發生和改善預后。