目的探討經胸鎖乳突肌前緣入路行甲狀腺良性腫瘤切除術的體會。方法2002年10月至2010年10月期間我院對128例甲狀腺良性腫瘤患者行經胸鎖乳突肌前緣入路甲狀腺手術，手術切口采取皮內縫合。結果所有患者均順利完成手術。手術時間45~130 min（平均65 min），術中出血10~100 ml（平均40 ml）； 引流管均在術后第2天拔除，引流量15~30 ml（平均20 ml）； 手術切口長3~7 cm（平均5 cm），均一期愈合； 住院時間3~6 d（平均4.5 d）。術后無出血，無神經、甲狀旁腺損傷及其他并發癥。術后隨訪0.5~8年（平均5.5年），12例患者（9%）復發，復發時間為術后1~3年（平均1.5年）; 8例患者結節lt;1 cm，給予臨床觀察; 其余4例患者經相同入路經二次手術治愈，隨訪無復發，未發現甲狀腺癌。結論經胸鎖乳突肌前緣入路行甲狀腺良性腫瘤切除術不損傷或橫斷舌骨下肌群，術中出血少，無頸部肌肉瘢痕粘連影響外觀之慮。
目的 介紹胸部良性疾病經單孔胸腔鏡切除術后免胸腔引流管的臨床經驗。 方法 回顧性分析 2015 年 10 月至 2016 年 10 月我院胸外科 17 例行單孔胸腔鏡手術患者的臨床資料，其中男 9 例、女 8 例，年齡 33.8（17～58）歲。行肺大皰切除術 7 例，肺楔形切除術 9 例，交感神經烙斷術 1 例。 結果 所有患者均經單孔胸腔鏡手術有效切除，期間無中轉開胸或再次開操作孔，術后不放置胸腔引流管，手術時間為（60.3±8.2）min，術中出血量為（15.2±5.1）ml，術后第 1 d、2 d、3 d 疼痛視覺模擬評分（VAS） 為 6.5±2.2，5.8±2.1，3.5±1.3，術后舒適度評分分別為 8.6±1.3，術后早期下床活動時間為（1.0±0.3）d，切口甲級愈合率 100.0%。17 例患者均無心律失常、肺部感染等并發癥，術后隨訪 6 個月氣胸均無復發。 結論 合理選擇及嚴格基線評估，胸部良性疾病經單孔胸腔鏡切除術后免胸腔引流管是安全可行的，可能有利于患者術后快速康復。
Objective To improve accuracy of clinical diagnosis through analyzing the CT characteristics and clinical manifestations of patients with benign lung diseases whose CT manifestations initially led to a suspicion of lung cancer. Methods This study collected 2 239 patients of benign lung disease verified by postoperative pathology in the Department of Thoracic Surgery, Beijing Chao-yang Hospital from June 2006 to December 2016. Lesions of 173 patients (101 males and 72 females with a mean age of 56.0 years) were considered very likely to be malignant on preoperative contrast CT scan, which were sorted to 20 types of lung diseases, and the 20 types of diseases contained 907 patients diagnosed or misdiagnosed. Statistical analyses were performed using the CT and clinical characteristics of the 173 patients. Results Among the 907 patients with benign lung disease, the benign pathologies that were most commonly misdiagnosed by preoperative enhanced CT were pulmonary leiomyoma (100.0%), pulmonary actinomycosis (75.0%), pulmonary cryptococcosis (71.4%), sclerosing hemangioma (50.0%) and organizing pneumonia (44.2%). Among the 173 patients with benign diseases, the most common diseases were tuberculosis (29.5%), organizing pneumonia (28.9%), pulmonary hamartoma (6.4%) and pulmonary abscess (6.4%). In the 173 patients, 17.3% had fever, 56.6% coughing, 8.7% yellow sputum, 28.9% hemoptysis, 16.2% chest pain, 18.5% elevated leukocyte counts and 4.6% elevated carcinoembryonic antigen levels. Most of the CT manifestations consisted of nodular or mass shadows, 70.5% of which had foci≤3 cm and manifestations were similar to those of lung cancer, such as a spiculated margin (49.1%), lobulation (33.5%), pleural indentation (27.2%) and significant enhancement (39.3%). Furthermore, some patients had uncommon tumor signs, such as calcification (12.7%), central liquefactive necrosis (18.5%), satellite foci (9.8%) and multiple pulmonary nodules (42.2%). Moreover, 24.3% of the patients had enlarged lymph nodes of the mediastinum or hilum. Conclusion As the CT manifestations of some benign lung conditions are similar to those of lung cancer, careful differential diagnosis is necessary to identify the basic characteristics of the disease when the imaging results are ambiguous, and the diagnosis of a lung disease need incorporate the patients' clinical characteristics and a comprehensive analysis.
肝臟移植作為終末期肝病的治療，自上個世紀80年代在歐美國家獲得公認以來，已在世界各國得到迅速開展。我國自90年代后期以來，在全國掀起了第二個肝移植的熱潮，迄今已完成1 000余例肝移植，在圍手術期處理、手術技術、介入放射、移植免疫、抗感染治療等各個方面均獲得豐富的經驗，我國肝移植的效果及長期生存率亦逐步趕上國際先進水平。總的來講，適合進行肝移植的病種可分為良性及惡性肝病，鑒于惡性肝病行肝移植后復發率高，長期生存率低，因而其作為肝移植的指征長期以來存在爭議，而良性終末期肝病則是肝移植的主要指征。我院自1999年2月以來連續施行肝移植114例，其中良性肝病為69例，占60.5%。本文僅針對良性肝病肝移植的一些特點談談我們的經驗和體會。
【Abstract】Objective To investigate the safety and clinical significance of total thyroidectomy performed for benign thyroid disease. Methods Eighty-eight patients with benign thyroid disease were treated with total thyroidectomy. The postoperative complications were analyzed. Results With primary total thyroidectomy, the incidences of transient hypocalcemia and transient recurrent laryngeal nerve paralysis were 2.5% and 1.2% respectively. The incidences after reoperation were 28.6%（P＜0.05）and 28.6%（P＜0.01）respectively. No patients had permanent hypoparathyroidism and permanent recurrent laryngeal nerve injury. Conclusion Total thyroidectomy can be performed safely. It can avoid reoperation for the recurrence caused by the remainder thyroid.
Objective To compare the clinicopathological features of hilar cholangiocarcinoma (HCCA) and hilar benign diseases, and then explore the value of carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) in the differential diagnosis between them. Methods Clinical data of 65 patients (54 patients with HCCA and 11 patients with hilar benign diseases) who were diagnosed as HCCA and received treatment from January 2011 to October 2015 in our hospital were retrospectively analyzed. Comparison of clinical data of HCCA patients and patients with hilar benign diseases in age, gender, disease duration, clinical manifestation, laboratory examination, and imaging examination was performed, and the receiver operating characteristic curve (ROC) was used to explore the value of CA19-9 and CEA in differential diagnosis between hilar benign diseases and HCCA. Results The age, levels of serum CA19-9, CEA, alanine aminotransferase (ALT), total bilirubin (BILT), and direct bilirubin (BILD) of HCCA group were significantly higher than that in benign group (P<0.05). However, the gender, disease duration, clinical manifestations (including jaundice, abdominal discomfort, fever, and weight loss), serum aspartate aminotransferase (AST), serum alkaline phosphatase (ALKP), and imaging findings (including hilar mass, intrahepatic bile duct dilatation, thickening of the bile duct wall, lymph node enlargement, vascular invasion, and gallbladder invasion) had no significant difference between the 2 groups (P>0.05). The ROC curve results showed that, when cut-off point for CA19-9 was 233.15 U/mL, the sensitivity was 56% and specificity was 91%; when cut-off point for CEA was 2.98 ng/mL, the sensitivity was 61% and specificity was 90%. Conclusions For the differential diagnosis between HCCA and hilar benign diseases, the elderly patients with high levels of serum transaminase and bilirubin were more likely to be malignant. It is more likely to be malignant when the serum CA19-9>233.15 U/mL or CEA>2.98 ng/mL.
Prostate disease is one of the most common urological disease. A large number of studies have shown that prostate disease is related to changes in the local microenvironment. Periodontitis is a chronic inflammatory disease characterized by the destruction of periodontal tissue caused by a variety of pathogenic microorganisms. Its pathogenesis may involve many factors. Periodontitis may have adverse effects on cardiovascular, respiratory, digestive and endocrine systems. Recent studies have found that chronic periodontitis is associated with the occurrence and development of benign prostatic hyperplasia and prostatitis, but the relationship is not clear. Therefore, further research is needed. This article elaborates on inflammation and benign prostatic hyperplasia and prostatitis, periodontitis and prostatitis, and periodontitis and benign prostatic hyperplasia, aiming to provide certain ideas for clinical research and diagnosis and treatment.
Objective To evaluate the correlation between benign prostatic hyperplasia (BPH) and metabolic syndrome (MS). Methods Total 666 elderly male patients admitted to West China Hospital for routine physical examination in May, 2010 were included in this study. The related laboratory tests of BPH and MS were taken. The correlation among BPH, lower urinary tract Symptoms (LUTS), prostate volume (PV), MS and its component diseases were analyzed. Results Hypertension was an important risk factor for BPH (OR=1.309, 95%CI 1.033 to 1.661), low HDL-C hyperlipidemia was a risk factor for IPSS scored over 7 points (OR=1.573, 95%CI 0.330 to 0.997), and the score of PV was positively correlated to obesity, hypertension, low HDL-C hyperlipidemia and MS (all Plt;0.05). Conclusion For the patient with BPH, MS and its component diseases mainly exert their effects on PV changes rather than LUTS.