Objective: To evaluate the procedures and timing of operation as well as long-term postoperative effect of congenital choledochal cysts (CCC) in adults. Methods: The procedures and timing of operation, effective rate,...Objective: To evaluate the procedures and timing of operation as well as long-term postoperative effect of congenital choledochal cysts (CCC) in adults. Methods: The procedures and timing of operation, effective rate, re-operation rate and incidence of car- cinoma after operation for 70 adult patients with CCC from January 1980 to June 1999 were analyzed retrospectively. Results: The re-operation rate of external drainage was 86% (6/7). The effective rate of internal drain- age was significantly lower than that of cyst resection (3/10 vs 45/49, X^2=20. 94, P<0.001). The re-op- eration rate and incidence of carcinoma of internal drainage were higher than those of cyst resection (5/ 10 vs 3/49, X^2=13. 64, P<0. 001 and 3/10 vs 3/49, X^2=5. 18, P<0. 025). The reoperation rate of e- mergency surgery was higher than that of selective operation (8/10 vs 6/56, X^2=24. 37, P<0.001). Conclusions: External drainage should be the first- aid measure and the therapy of choice on emergency basis. Internal drainage should never be attempted. Cyst resection with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice in selective operation.展开更多
Background Choledochal cyst excision and biliary enteric reconstruction constitute the best therapy for choledochal cyst. And laparoscopy is currently used to cure this disease now. Methods We retrospectively analyzed...Background Choledochal cyst excision and biliary enteric reconstruction constitute the best therapy for choledochal cyst. And laparoscopy is currently used to cure this disease now. Methods We retrospectively analyzed the clinical data of 34 cases of total laparoscopic choledochal cyst excision between January 2007 and August 2011. All patients underwent in vitro Roux-en-Y hepatoenterostomy. Results All 34 patients underwent successful total laparoscopic choledochal cyst excision. The operation time was 200-360 minutes. The duration of hospital stay was 3-7 days. Follow-up observations lasted 1-56 months. One patient developed an anastomotic stoma stricture, but no other cases had postoperative complications. No patients died. Conclusion Total laparoscopic choledochal cyst excision is safe and feasible.展开更多
Choledochocele （also known as type？Ⅲ？ choledochal cyst according to Todani’s classifcation） is a cystic dilation of the distal segment of the common bile duct protru-ding into the duodenal lumen. Cases are rare ...Choledochocele （also known as type？Ⅲ？ choledochal cyst according to Todani’s classifcation） is a cystic dilation of the distal segment of the common bile duct protru-ding into the duodenal lumen. Cases are rare and the etiology remains unclear. It is usually misdiagnosed as peptic ulcer, as in the patient whose case is described here. Multislice spiral computed tomography and magnetic resonance cholangiopancreatography may be comparable to endoscopic retrograde cholangiogra-phy for diagnosis of choledochocele. Both endoscopic therapy and open surgical management are safe options, and size of the cyst plays a role in the decision-making for which approach to apply. A 50-year-old woman admitted to our hospital with upper abdominal pain caused by choledochocele with large size was successfully treated by open surgical management. We present the details of her case in this case report and discuss the recent literature on such cases and their therapeutic management.展开更多
BACKGROUND Spinal extradural arachnoid cysts(SEACs)are a rare cause of spinal cord compression.Typically,these cysts communicate with the intradural subarachnoid space through a small defect in the dural sac.For sympt...BACKGROUND Spinal extradural arachnoid cysts(SEACs)are a rare cause of spinal cord compression.Typically,these cysts communicate with the intradural subarachnoid space through a small defect in the dural sac.For symptomatic SEACs,the standard treatment is to remove the cyst in total with a(hemi)laminectomy or laminoplasty.We present a rare case of bi-segmental non-communicating SEACs and describe our experience of using an endoscopic minimal access technique to remove bi-segmental non-communicating SEACs.CASE SUMMARY A 79-year-old female presented with pain related to bi-segmental SEACs at the T11-L1 segments.She underwent sequential transforaminal percutaneous endoscopic thoracic cystectomy of the SEACs.Following her first procedure,spinal magnetic resonance imaging demonstrated complete excision of the cyst at the T12-L1 segment.However,the cyst at the T11-T12 segment was still present.Thus,a second procedure was performed to remove this lesion.The patient’s right-sided lumbar and abdominal pain improved significantly postoperatively.Her Japanese Orthopaedic Association score increased from 11 to 25,her visual analogue scale score was reduced from 8 to 1.The physical and mental component summary of the 36-item short-form health survey(SF-36)were 15.5 and 34.375 preoperatively,and had increased to 79.75 and 77.275 at the last follow-up visit,respectively.CONCLUSION Bi-segmental non-communicating SEACs are extremely rare.Endoscopic surgery is a safe,effective,and reliable method for treating these cysts.In the event of bisegmental SEACs,it is important to identify whether both cysts are communicating before surgery,and if not,to remove both cysts separately during the index surgery to avoid re-operation.展开更多
Dermoid cysts are uncommon congenital or acquired developmental cystic malformations that were usually seen in the midline of frontal region and the anterior fontanel. Congenital forms develop from the remnants of the...Dermoid cysts are uncommon congenital or acquired developmental cystic malformations that were usually seen in the midline of frontal region and the anterior fontanel. Congenital forms develop from the remnants of the epithelium or ectodermal membranous bone growth line. We report here a case of a congenital frontal dermoid cyst that should be considered in the differential diagnosis of lipoma and neurofibroma. Dermoid cysts should be considered in the differential diagnosis of all nodular cyst-like lesions in the head and neck region. Early recognition and accurate diagnosis by means of Computerized Tomography scan or Magnetic Resonance Imaging facilitate successful treatment.展开更多
目的:探讨加速康复外科(Enhanced Recovery After Surgery,ERAS)护理在儿童机器人先天性胆总管囊肿术围手术期的应用。方法:选取2015年6月1日—2020年9月30日在华中科技大学同济医学院附属协和医院行机器人辅助腹腔镜手术的儿童先天性...目的:探讨加速康复外科(Enhanced Recovery After Surgery,ERAS)护理在儿童机器人先天性胆总管囊肿术围手术期的应用。方法:选取2015年6月1日—2020年9月30日在华中科技大学同济医学院附属协和医院行机器人辅助腹腔镜手术的儿童先天性胆总管囊肿患者78例,将2018年3月31日前入院的手术患儿纳入对照组(47例),采用常规护理干预;将2018年4月1日后入院的手术患儿纳入观察组(31例),采用ERAS护理干预。观察两组患儿术后恢复情况及患儿家属心理状况。结果:观察组肠道恢复时间、住院时间及其家属心理状态均优于对照组。结论:在机器人辅助腹腔镜儿童先天性胆总管囊肿术的围手术期应用ERAS理念护理,有利于加快术后恢复,减少并发症,缩短住院时间,值得在临床中推广。展开更多
文摘Objective: To evaluate the procedures and timing of operation as well as long-term postoperative effect of congenital choledochal cysts (CCC) in adults. Methods: The procedures and timing of operation, effective rate, re-operation rate and incidence of car- cinoma after operation for 70 adult patients with CCC from January 1980 to June 1999 were analyzed retrospectively. Results: The re-operation rate of external drainage was 86% (6/7). The effective rate of internal drain- age was significantly lower than that of cyst resection (3/10 vs 45/49, X^2=20. 94, P<0.001). The re-op- eration rate and incidence of carcinoma of internal drainage were higher than those of cyst resection (5/ 10 vs 3/49, X^2=13. 64, P<0. 001 and 3/10 vs 3/49, X^2=5. 18, P<0. 025). The reoperation rate of e- mergency surgery was higher than that of selective operation (8/10 vs 6/56, X^2=24. 37, P<0.001). Conclusions: External drainage should be the first- aid measure and the therapy of choice on emergency basis. Internal drainage should never be attempted. Cyst resection with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice in selective operation.
文摘Background Choledochal cyst excision and biliary enteric reconstruction constitute the best therapy for choledochal cyst. And laparoscopy is currently used to cure this disease now. Methods We retrospectively analyzed the clinical data of 34 cases of total laparoscopic choledochal cyst excision between January 2007 and August 2011. All patients underwent in vitro Roux-en-Y hepatoenterostomy. Results All 34 patients underwent successful total laparoscopic choledochal cyst excision. The operation time was 200-360 minutes. The duration of hospital stay was 3-7 days. Follow-up observations lasted 1-56 months. One patient developed an anastomotic stoma stricture, but no other cases had postoperative complications. No patients died. Conclusion Total laparoscopic choledochal cyst excision is safe and feasible.
文摘Choledochocele （also known as type？Ⅲ？ choledochal cyst according to Todani’s classifcation） is a cystic dilation of the distal segment of the common bile duct protru-ding into the duodenal lumen. Cases are rare and the etiology remains unclear. It is usually misdiagnosed as peptic ulcer, as in the patient whose case is described here. Multislice spiral computed tomography and magnetic resonance cholangiopancreatography may be comparable to endoscopic retrograde cholangiogra-phy for diagnosis of choledochocele. Both endoscopic therapy and open surgical management are safe options, and size of the cyst plays a role in the decision-making for which approach to apply. A 50-year-old woman admitted to our hospital with upper abdominal pain caused by choledochocele with large size was successfully treated by open surgical management. We present the details of her case in this case report and discuss the recent literature on such cases and their therapeutic management.
基金Supported by the Program of Scientific Development of Jilin Province,China,No.20190201066JCthe Health Appropriate Technology Poverty Alleviation Project of Jilin Province China,No.2018FP043.
文摘BACKGROUND Spinal extradural arachnoid cysts(SEACs)are a rare cause of spinal cord compression.Typically,these cysts communicate with the intradural subarachnoid space through a small defect in the dural sac.For symptomatic SEACs,the standard treatment is to remove the cyst in total with a(hemi)laminectomy or laminoplasty.We present a rare case of bi-segmental non-communicating SEACs and describe our experience of using an endoscopic minimal access technique to remove bi-segmental non-communicating SEACs.CASE SUMMARY A 79-year-old female presented with pain related to bi-segmental SEACs at the T11-L1 segments.She underwent sequential transforaminal percutaneous endoscopic thoracic cystectomy of the SEACs.Following her first procedure,spinal magnetic resonance imaging demonstrated complete excision of the cyst at the T12-L1 segment.However,the cyst at the T11-T12 segment was still present.Thus,a second procedure was performed to remove this lesion.The patient’s right-sided lumbar and abdominal pain improved significantly postoperatively.Her Japanese Orthopaedic Association score increased from 11 to 25,her visual analogue scale score was reduced from 8 to 1.The physical and mental component summary of the 36-item short-form health survey(SF-36)were 15.5 and 34.375 preoperatively,and had increased to 79.75 and 77.275 at the last follow-up visit,respectively.CONCLUSION Bi-segmental non-communicating SEACs are extremely rare.Endoscopic surgery is a safe,effective,and reliable method for treating these cysts.In the event of bisegmental SEACs,it is important to identify whether both cysts are communicating before surgery,and if not,to remove both cysts separately during the index surgery to avoid re-operation.
文摘Dermoid cysts are uncommon congenital or acquired developmental cystic malformations that were usually seen in the midline of frontal region and the anterior fontanel. Congenital forms develop from the remnants of the epithelium or ectodermal membranous bone growth line. We report here a case of a congenital frontal dermoid cyst that should be considered in the differential diagnosis of lipoma and neurofibroma. Dermoid cysts should be considered in the differential diagnosis of all nodular cyst-like lesions in the head and neck region. Early recognition and accurate diagnosis by means of Computerized Tomography scan or Magnetic Resonance Imaging facilitate successful treatment.
文摘目的:探讨加速康复外科(Enhanced Recovery After Surgery,ERAS)护理在儿童机器人先天性胆总管囊肿术围手术期的应用。方法:选取2015年6月1日—2020年9月30日在华中科技大学同济医学院附属协和医院行机器人辅助腹腔镜手术的儿童先天性胆总管囊肿患者78例,将2018年3月31日前入院的手术患儿纳入对照组(47例),采用常规护理干预;将2018年4月1日后入院的手术患儿纳入观察组(31例),采用ERAS护理干预。观察两组患儿术后恢复情况及患儿家属心理状况。结果:观察组肠道恢复时间、住院时间及其家属心理状态均优于对照组。结论:在机器人辅助腹腔镜儿童先天性胆总管囊肿术的围手术期应用ERAS理念护理,有利于加快术后恢复,减少并发症,缩短住院时间,值得在临床中推广。
