【摘要】 目的 探討超聲引導下導絲定位在不可觸及的乳腺病灶切除中的應用價值。 方法 對2005年1月－2010年9月127例女性患者的137個乳腺病灶（臨床捫診均為陰性），在超聲引導下進行導絲定位，后進行外科切除活檢，并對相關資料進行回顧性分析。 結果 137個病灶的組織學結果中，良性病灶101個（73.7%）、高風險病灶27個（19.7%）和癌9個（6.6%）。9個癌中3個為導管原位癌，6個為浸潤性導管癌（大小11～19 mm，平均14.2 mm）。超聲引導下導絲定位的時間為3～15 min，平均6 min；無血腫、導絲脫落及折斷等并發癥發生。外科手術切除時間20～40 min，平均30 min。 結論 超聲引導下進行導絲定位安全、迅速，能協助外科手術進行準確的活檢和切除。【Abstract】 Objective To determine the application value of ultrasound-guided wire localization in surgical excision of non-palpable breast lesions. Methods Between January 2005 and September 2010, 127 women with 137 non-palpable breast lesions underwent surgical excision at West China Hospital. Palpation results for all the lesions were negative. Wire localization guided by ultrasound was performed before operation and biopsy. Related imaging studies and medical records were reviewed retrospectively. Results Histological findings showed there were 101 benign lesions (73.7%), 27 high-risk lesions (19.7%), and 9 carcinomas (6.6%). Among the 9 carcinomas, 3 were ductal carcinoma in situ, and 6 were infiltrating carcinoma (with their size ranged from 11 to 19 mm averaging at 14.2 mm). The time of performing ultrasound-guided wire localization was from 3 to 15 minutes averaging at 6. No complications like hematoma, wire fragments, and wire breakage occurred in all cases. The surgical excision time ranged from 20 to 40 minutes averaging at 30. Conclusions Ultrasound-guided wire localization can be performed quickly and safely for the cases of non-palpable breast lesions. It is useful in assisting surgical excision and biopsy.
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.
Objective To investigate the surgical procedure selection, operation technique and safety of anatomic sublobar resection for pulmonary nodules. Methods The clinical data of 242 patients with clinical stage ⅠA lung cancer who underwent anatomic sublobar resection in our hospital between 2017 and 2020 were retrospectively analyzed. There were 81 males and 161 females with a median age of 57.0 (50.0, 65.0) years. They were divided into 4 groups according to the surgical methods, including a segmentectomy group (n=148), a combined segmentectomy group (n=31), an enlarged segmentectomy group (n=43) and an anatomic wedge resection group (n=20). The preoperative CT data, operation related indexes and early postoperative outcomes of each group were summarized. Results The median medical history of the patients was 4.0 months. The median maximum diameter of nodule on CT image was 1.1 cm, and the consolidation/tumor ratio (CTR) was ≤0.25 in 81.0% of the patients. A total of 240 patients were primary lung adenocarcinoma. The median operation time was 130.0 min, the median blood loss was 50.0 mL, the median chest drainage time was 3.0 d, and the hospitalization cost was (53.0±12.0) thousand yuan. The operation time of combined segmentectomy was longer than that of the segmentectomy group (P=0.001). The operation time (P=0.000), intraoperative blood loss (P=0.000), lymph nodes dissected (P=0.007) and cost of hospitalization (P=0.000) in the anatomic wedge resection group were shorter or less than those in the other three groups. There was no significant difference in the drainage time, total drainage volume, air leakage or postoperative hospital stay among the four groups (P>0.05). Conclusion The combined application of segmentectomy and wedge resection technique provides a more flexible surgical option for the surgical treatment of early lung cancer with ground glass opacity as the main component.
Objective To study the correlation of preoperative hemoglobin amount with venous thromboembolism (VTE) after surgical treatment of bronchiectasis and the clinical significance. Methods A retrospective study was performed on patients with bronchiectasis who underwent surgical treatment in our center from June 2017 to November 2021. The differences in blood parameters between the VTE patients and non-VTE patients were compared. The relationship between preoperative hemoglobin and VTE was confirmed by quartile grouping and receiver operating characteristic (ROC) curve. Results A total of 122 patients were enrolled, including 50 males and 72 females, with a mean age of 52.52±12.29 years. The overall incidence of VTE after bronchiectasis was 9.02% (11/122). Preoperative hemoglobin amount (OR=0.923, 95%CI 0.870-0.980, P=0.008) and D-dimer amount (OR=1.734, 95%CI 1.087-2.766, P=0.021) were independent influencing factors for VTE after bronchiectasis. The incidence of VTE after bronchiectasis decreased gradually with the increase of preoperative hemoglobin amount. The area under the ROC curve (AUC) of postoperative D-dimer alone was 0.757, whereas the AUC of postoperative D-dimer combined with preoperative hemoglobin amount was 0.878. Conclusion Low preoperative hemoglobin is an independent risk factor for postoperative VTE. Postoperative D-dimer combined with preoperative hemoglobin amount has a better predictive performance compared with postoperative D-dimer alone for postoperative VTE.
