摘要:目的:總結巨大垂體腺瘤水鈉代謝紊亂的圍手術期處理經驗。方法:對71例巨大垂體腺瘤患者術前及術后1周內每日檢測血、尿電解質水平,以及血、尿滲透壓,判斷失鈉及失水類型。總結不同瘤體大小與手術入路和水鈉紊亂發生率、程度、時間之間的關系。結果:71例巨大垂體腺瘤患者中,出現水鈉代謝紊亂52例,發生率73.2%。腫瘤大小與水鈉紊亂發生率、嚴重程度、發生時間成正比,而手術入路選擇與水鈉代謝紊亂發生無明顯相關。結論:巨大垂體腺瘤患者術后水鈉代謝紊亂的發生與瘤體大小成正相關,其出現時間和表現形式復雜。對水鈉代謝紊亂嚴重患者可適當予以預防性治療,以減少臨床癥狀和不良后果。Abstract: Objective: To summarize the preioperative management experience of metabolic disturbance of water and natrium for patients with giant pituitary adenomas. Methods: The electrolyte and osmotic pressure of blood and urine in patients with giant pituitary adenomas were detected within preoperative and postoperative one week and the type of the metabolic disturbance of water and natrium were determined. The correlation of the different tumor size and surgical approach with the incidence rate, extent and time of the metabolic disturbance was summarized. Results: There were 52 cases with different extent metabolic disturbance of water and natrium in 71 cases of giant pituitary adenomas(73.2%). There were a positive correlation of tumor size with the incidence rate, extent and time of the metabolic disturbance, and a negative correlation of surgical approach with that of the metabolic disturbance. Conclusion: The metabolic disturbance of water and natrium in giant pituitary adenomas was positive correlation with the tumor size, which. is various in emergence time and pattern of manifestation. To reduce the clinical symptoms and adverse consequences, prophylactic treatment may be used in patients with serious metabolic disorder of water and natrium.
ObjectiveTo evaluate the diagnostic value of 99Tcm-methoxy isobutyl isonitrile (MIBI) dual-time imaging for parathyroid adenoma (PA) and parathyroid hyperplasia (PH).MethodsClinical data of 187 patients with pathologically confirmed hyperparathyroidism (HPT) who admitted to the First Affiliated Hospital of Xi’an Jiaotong University School of Medicine from July 2011 to December 2018 were retrospectively collected. Taking postoperative pathology as the standard, the diagnostic value of preoperative 99Tcm-MIBI dual-time imaging was analyzed.ResultsThe serum PTH level of PH patients was higher than that of PA patients (Z=–3.23, P<0.01). Te/N (T: focal area radioactive count, N: the normal tissue radioactivity count of the corresponding thyroid gland on the opposite side of the lesion) in PA and PH patients were lower than Td/N (Z=–3.61, P<0.01; Z=–3.47, P<0.01). The positive rates of 99Tcm-MIBI dual-time imaging in the diagnosis of PA and PH lesions were 67.9% (36/53) and 20.6% (86/418), respectively, and the positive rate of PA were higher (χ2=52.51, P<0.01). The positive rate of 99Tcm-MIBI dual-time imaging in the diagnosis of PA and PH single lesions was higher than that of multiple lesions (χ2=15.79, P<0.01; χ2=64.73, P<0.01). Conclusions99Tcm-MIBI dual-time imaging shows a higher positive rate for PA and a lower positive rate for PH. When HPT is clinically suspected, but 99Tcm-MIBI dual-time imaging is negative and serum PTH is positive, PH should be considered, and B ultrasound and other examinations should be performed to determine the lesion site.
Objective To analyze the central visual fields and the ocular fundus changes of both eyes of patients with pituitary adenoma.Methods A total of 70 cases of pituitary adenoma received the examination of static central visual fields of all-liminal values by Humphrey instruments 750 cycloscope and the fundus exams by Topcon TRC-50X fundus photography before operations. Results There were 64.3% patients with decreased visual acuities, 80.7% with the defect of visual field, and 46 .4% with fundus changes. The decrease of the visual acuity was the first diagnostic symptom in 45.7% patients, among whom 28.6% were misdiagnosed as ocular diseases.Conclusions The misdiagnosed cause is that the first diagnostic symptom is the decrease of visual acuity without defect of visual field accompanied by ocular diseases. To avoid the misdiagnosis and the omitter of pituitary adenoma, general examination of visual field should be carried out in the patients with decreased visual acuity and optic atrophy with unknown reason in the clinical diagnosis of ophthalmology. (Chin J Ocul Fundus Dis，2003，19：18-19)
Objective
To compare the different surgical treatment methods of thymoma combined with myasthenia gravis (MG), and to discuss the clinical effectiveness of thoracoscopic combined mediastinoscopic extended thymectomy.
Methods
We retrospectively analyzed the clinical data of 58 patients of thymoma combined with myasthenia gravis in Northern Jiangsu People's Hospital between 2011 and 2016 year. According to the operation method, the patients were divided into three groups including a group A for thoracoscopic thymectomy (n=32), a group B for thoracoscopic combined mediastinoscopic thymectomy (n=15), and a group C for transsternal thymectomy (n=11). The clinical effects were observed and compared.
Results
In the group A and the group B, the bleeding volume, postoperative hospital stay and other complications were significantly lower than those in the group C with statistical differences (P<0.05). The incidence of myasthenic crisis in the group B (6.7%) was less than that in the group C (36.4 %), but the difference was not statistically different (P=0.058). The operation time of the three groups was 122.0 ± 39.4 min, 130.3 ± 42.5 min, and 142.3 ± 40.8 min respectively with no statistical difference between the two groups (P>0.05). The rate of dissection grade in the group B (grade 1, 12 patients, 80%) was significantly greater than that in the group A (grade 1, 14 patients, 43.8%,P<0.05). The effective rate of the group A, the group B, the group C was 84.4%, 93.3% and 90.9%, respectively with no statistical difference between groups (P>0.05).
Conclusion
The thoracoscopy combined mediastinoscopic thymectomy not only has the advantages of less trauma, quicker recovery and fewer complications, but also can more thoroughly clean the thymus and adipose tissue, which can achieve the same therapeutic effect as the transsternal thymectomy.
摘要:目的:探討神經內鏡經單鼻腔蝶竇入路在切除垂體腺瘤中的臨床應用。 方法:對58例垂體腺瘤患者進行手術切除。應用神經內鏡直接自單鼻腔進入,暴露雙側蝶竇開口,打開蝶竇前壁進入蝶竇腔切除腫瘤。 結果: 腫瘤全部切除42例,約占 72%;次全切除16例,約占28%,無嚴重并發癥。結論:神經內鏡經單鼻腔蝶竇入路切除垂體腺瘤是一種更微創、暴露更好、并發癥少的手術方式。Abstract: Objective: To investigate the clinic application of endoscopic end nasal transsphenoidal surgery for pituitary tumors. Methods: 58 patients were treated. A endoscope was used to open the anterior wall of the sphenoid sinus and resected tumors. Results: 42 cases (72%) underwent total resection, 16 cases (28%) underwent subtotal resection. No severe complications was found. Conclusion: Endoscopic end nasal transsphenoidal surgery for pituitary tumors can reduce the tissue trauma, improved visualization, more complete tumor removal, and reduce complications.
Objective To discuss the molecular structures and functions of βCatenin and APC (Adenomatous polyposis coli) genes, as well as the roles they played during the carcinogenesis and progression of tumors. MethodsAdvances in molecular biology and oncology of βCatenin and APC genes in recent years has been reviewed. ResultsHigh expression of βCatenin and APC genes was an early event during the carcinogenesis due to the abnormal regulation of βCatenin and APC genes. But on the contrary, the low expression of these two genes was probably associated with the progression of tumors. Moreover, βCatenin and APC genes could also regulate the expression of p53,cmyc genes and cyclin D1. Conclusion βCatenin and APC genes may play a key role during the carcinogenesis and progression of tumors and modulate other oncogen/suppressor gene and factors.
ObjectiveTo analysis the clinical symptoms, diagnosis, and treatment of primary hyperparathyroidism (PHPT).
MethodsA retrospective study was made in consecutive patients with PHPT who performed operation and had integral data between January 2004 to December 2012 in West China Hospital.
ResultsThe 136 cases were composed of 52 cases (38.23%) bone types, 17 cases (12.50%) nephrocalcinosis, 7 cases (5.15%) skeletal and renal involvements, 24 cases (17.65%) asymptomatic primary hyperparathyroidism, and 36 cases (26.47%) combined with other clinical symptoms. The preoperative parathyroid hormone (PTH) levels were (106.20±88.88) pmol/L (6.91-390 pmol/L) and serum calcium were (3.12±0.66) mmol/L (2.15-5.77 mmol/L). The coincidence rate between the examinations preoperation and pathology:B type ultrasound was 75.00%, 99Tcm-MIBI scan was 85.29%, ultrasound and 99Tcm-MIBI combined with computerized tomography (CT) scan was 86.76%. Pathology presentation:129 patients (94.85%) were benign lesions, 7 cases (5.15%) were parathyroid carcinoma. Of the 129 patients, 114 cases (95.80%) were single parathyroid adenoma, 5 cases (4.20%) were multiple parathyroid adenoma or combined parathyroid hyperplasia, 10 cases (7.75%) were parathyroid hyperplasia. Of the patients, the PTH level decreased to below normal upper limit within 3 days after surgery in 124 cases (91.18%). One hundred and twenty-four cases (91.18%) were followed-up. The follow-up time was 6-112 months, a median follow-up time was 49 months. Twelve patients (8.82%) were lost to follow-up, 2 patients (1.47%) with carcinoma recurrence, the rest patients without recurrence and metastasis. Three patients (2.20%) with parathyroid carcinoma died. Of the 3 patients, 2 died of systemic metastasis of parathyroid carcinoma in 18 and 23 months after surgery, 1 died of cardiovascular accident in 19 months after surgery.
ConclusionSurgical excision of the lesion parathyroid tissue is the most effective treatment for PHPT.
