Recurrent gastric neuroendocrine tumors treated with total gastrectomy

Gastric neuroendocrine tumors are rare; however,the incidence has recently increased due to the increasing use of upper endoscopy. Neuroendocrine tumors arise from the excess proliferation of enterochromaffinlike(ECL) cells. The proliferative changes of enterochromaffin cells evolve through a hyperplasiadysplasia-neoplasia sequence that is believed to underlie the pathogenesis of gastric neuroendocrine tumors. Endoscopic resection is recommended as the initial treatment if the tumor is not in an advanced stage. However,there is no definite guideline for the treatment of recurrent gastric neuroendocrine tumors following endoscopic resection. Here,we report a rare case of gastric neuroendocrine tumors in a 56-yearold male who experienced two recurrences within 11 years after endoscopic resection. The patient finally underwent a total gastrectomy. The pathological features of the resected stomach exhibited the full hyperplasia-dysplasia-neoplasia sequence of the ECL cells in a single specimen.

上睑皱褶入路修复眶内侧壁爆裂性骨折

背景眶内侧壁入路的手术方法有很多。然而，许多方法有限制术区显露范围、术后瘢痕形成及术后眼部发生炎症反应的问题。作者利用上睑皱褶入路解决这些问题，并且探讨该方法的有效性。方法自2009—2011年，作者采用上睑皱褶入路对22例眶内侧壁骨折的患者进行治疗。在皱褶的内侧1／3做切口，沿松弛的皮肤张力线向上内侧延伸2～3mm。结果术后计算机断层扫描显示，所有患者的骨缺损重建完好。2例患者需要再次调整种植体的位置。对所有患者随访8～28个月，平均随访12个月。均未出现并发症。多数患者的复视和眼运动受限都已恢复。2例患者在术后6个月后，仍有复视，但逐渐得到缓解。在眶部未出现2mm以上的眼球内陷。手术瘢痕不明显。结论该入路方法有很多优点，如易于显露术区，而且相比结膜入路，医师更易进行操作。几乎无需将眼球向侧面缩进，可减少术后眼部炎症反应的发生。因此，眶内侧壁爆裂性骨折采用下睑皱褶入路是一种自然有效的方法。