BACKGROUND Many patients have inadequate long-term analgesia,respiratory distress,and hypoxemia due to a long-standing substantial smoking history or the presence of primary pulmonary diseases;analgesic treatment is n...BACKGROUND Many patients have inadequate long-term analgesia,respiratory distress,and hypoxemia due to a long-standing substantial smoking history or the presence of primary pulmonary diseases;analgesic treatment is not valid in these patients.Even if the imaging findings of rib fractures are relatively mild,rib fractures may cause severe position limitation,respiratory distress,and hypoxemia.AIM To investigate the curative effect of surgical treatment for patients with severe non-flail chest rib fractures.METHODS A total of 78 patients from our hospital with severe noncontinuous thoracic rib fractures from September 2016 to September 2018 were enrolled in our study.Thirty-nine patients underwent surgical treatment,and 39 underwent conservative treatment.The surgical treatment group received surgery performed with titanium plates,and the screws were inserted with open reduction and internal fixation.The conservative treatment group received analgesia and symptomatic treatment.The pain scores at 72 h,1 wk,2 wk,4 wk,6 wk,3 mo,and 6 mo were compared,and the SF-36 quality of life scores were compared atthe 3rd and 6th months.RESULTS Pain relief in the surgical group was significantly better than that in the conservative group at each time point(72 h,1 wk,2 wk,4 wk,6 wk,3 mo,and 6 mo after surgery,P<0.001).The SF-36 scores were significantly higher in the surgical group than in the conservative group at 1 mo and 6 mo(P<0.05).CONCLUSION Patients with severe non-flail chest rib fractures have a better quality of life following surgical treatment than following conservative treatment,and surgical treatment is also useful for relieving pain.We should pay more attention to the physiological functions and clinical manifestations of patients with severe rib fractures.In patients with non-flail chest rib fractures,surgical treatment is feasible and effective.展开更多
A 64-year-old female had noticed an 11 × 6 cm mass growing on her left first rib. We performed a resection of the first and second ribs and a reconstruction of the chest wall. A thoracotomy was performed at the a...A 64-year-old female had noticed an 11 × 6 cm mass growing on her left first rib. We performed a resection of the first and second ribs and a reconstruction of the chest wall. A thoracotomy was performed at the anterolateral second intercostal space. The second rib cartilage was divided at the left parasternum. Based on a transmanubrial osteomuscular sparing approach, the left-upper part of the sternum and the first rib cartilage were both cut at the left clavicular-sternum joint. The posterior parts of the two ribs involving the tumor were resected at the transverse process of the vertebral bone by tearing off the anterior, middle, and posterior scalene muscles, subclavicular artery and vein. The defect size of the thorax was 15 × 9 cm, which was reconstructed by covering with a polytetrafluoroethylene dual mesh (Dual mesh, Gore tex, 2 mm). The major pectoral muscle flap was used to cover the mesh. The postoperative pathological examination diagnosed a poorly differentiated fibrosarcoma. Eventually, she had palliative therapy for the postoperative metastatic chest wall. She died 14 months after the operation.展开更多
Gastric carcinoma is derived from epithelial cells in the gastric mucosa. We reported an extremely rare case of submucosal gastric carcinoma originating from the heterotopic submucosal gastric gland(HSG) that was safe...Gastric carcinoma is derived from epithelial cells in the gastric mucosa. We reported an extremely rare case of submucosal gastric carcinoma originating from the heterotopic submucosal gastric gland(HSG) that was safely diagnosed by laparoscopy and endoscopy cooperative surgery(LECS). A 66-year-old man underwent gastrointestinal endoscopy, which detected a submucosal tumor(SMT) of 1.5 cm in diameter on the lesser-anterior wall of the upper gastric body. The tumor could not be diagnosed histologically, even by endoscopic ultrasound-guided fine-needle aspiration biopsy. Local resection by LECS was performed to confirm a diagnosis. Pathologically, the tumor was an intra-submucosal well differentiated adenocarcinoma invading 5000 μm intothe submucosal layer. The resected tumor had negative lateral and vertical margins. Based on the Japanese treatment guidelines, additional laparoscopic proximal gastrectomy was curatively performed. LECS is a less invasive and safer approach for the diagnosis of SMT, even in submucosal gastric carcinoma originating from the HSG.展开更多
Pancreatic endocrine tumors are rare but are among the most common neuroendocrine neoplasms of the abdomen.At diagnosis many of them are already advanced and diff icult to treat.We report on an initially inoperable ma...Pancreatic endocrine tumors are rare but are among the most common neuroendocrine neoplasms of the abdomen.At diagnosis many of them are already advanced and diff icult to treat.We report on an initially inoperable malignant pancreatic endocrine tumor in a 33-year-old woman,who received neoadjuvant peptide receptor radionuclide therapy(PRRT)as firstline treatment.This resulted in a signif icant downstaging of the tumor and allowed its subsequent complete surgical removal.Follow-up for eighteen months revealed a complete remission.This is the first report on neoadjuvant PRRT in a neuroendocrine neoplasm with subsequent successful complete resection.展开更多
Liver transplantation is a major abdominal operation and the intimate anatomic relation of the liver with the right hemidiaphragm predisposes the patient to various manifestations in the chest cavity.Furthermore,chron...Liver transplantation is a major abdominal operation and the intimate anatomic relation of the liver with the right hemidiaphragm predisposes the patient to various manifestations in the chest cavity.Furthermore,chronic liver disease affects pulmonary function before and after liver transplantation resulting in a considerable percentage of patients presenting with morbidity related to chest complications.This review aims to identify the potential chest complications of surgical interest during or after liver transplantation.Complications of surgical interest are defined as those conditions that necessitate an invasive procedure(such as thoracocentesis or a chest tube placement)in the chest or a surgical intervention performed by a thoracic surgeon.These complications will be classified as perioperative and postoperative;the latter will be categorized as early and late.Although thoracocentesis or a chest tube placement is usually sufficient when invasive measures are deemed necessary,in some patients,thoracic surgical interventions are warranted.A high index of suspicion is needed to recognize and treat these conditions promptly.A close collaboration between abdominal surgeons,intensive care unit physicians and thoracic surgeons is of paramount importance.展开更多
BACKGROUND A vascular tumor is a benign tumor with unique clinical and pathological features.Perirenal vascular tumor is extremely rare and has not yet been reported.Clinically,it manifests as soreness and swelling.Co...BACKGROUND A vascular tumor is a benign tumor with unique clinical and pathological features.Perirenal vascular tumor is extremely rare and has not yet been reported.Clinically,it manifests as soreness and swelling.Color ultrasound and renal angiography illustrated the perirenal mass,which was closely connected with the kidney and the surrounding tissues and organs.Histology showed extensive embedded perirenal fat,and thin-walled vascular tissue displayed a pink stain due to red blood cells.CASE SUMMARY Herein,a case of robot-assisted retroperitoneal laparoscopic excision of a perirenal vascular tumor is reported.Analysis of the clinical,biological,and histological features of the perirenal vascular tumor can provide an in-depth understanding of the disease,which provides a theoretical and practical basis for better diagnosis and treatment.CONCLUSION This study contributes to a practical basis for the diagnosis and treatment of perirenal hemangiom.展开更多
BACKGROUND At present,cases of esophageal neuroendocrine tumors combined with cardia adenocarcinoma are extremely rare worldwide,and there are no clinical reports.Herein,we describe such a case for clinical reference....BACKGROUND At present,cases of esophageal neuroendocrine tumors combined with cardia adenocarcinoma are extremely rare worldwide,and there are no clinical reports.Herein,we describe such a case for clinical reference.CASE SUMMARY The presence of cardia cancer and esophageal neuroendocrine tumors in a single patient has not yet been reported.The patient in this case underwent prompt endoscopic treatment and additional surgical resection.Pathology revealed the following:The distance between the cardia cancer and the esophageal neuroendocrine tumors was small,approximately 3 mm.Vascular invasion was observed.The esophageal neuroendocrine tumor was determined to be grade G3.According to the treatment guidelines,after the patient received an explanation of their condition,additional surgical procedures were provided in a timely manner.Early detection and early treatment can successfully prolong survival and improve the quality of life of patients.CONCLUSION Early detection and early treatment can successfully prolong survival and improve the quality of life of such patients.展开更多
BACKGROUND Malignant peripheral nerve sheath tumor(MPNST)is a rare and aggressive soft tissue sarcoma that poses a major diagnostic and therapeutic challenge.CASE SUMMARY We retrospectively reviewed patients with head...BACKGROUND Malignant peripheral nerve sheath tumor(MPNST)is a rare and aggressive soft tissue sarcoma that poses a major diagnostic and therapeutic challenge.CASE SUMMARY We retrospectively reviewed patients with head and neck MPNSTs treated in our hospital from 2000 to 2021.The clinical features,pathological manifestations,treatments,and prognoses were summarized.We also reviewed the literature,focusing on MPNST in the mandible and maxilla.The study population consisted of five women and five men aged 22–75 years(mean age,49 years).Of the 10 patients,7 were initial cases and 3 were recurrent cases.All lesions were sporadic.The most common site was the mandible.The most frequently encountered symptoms were a progressive mass and local swelling.Complete or partial loss of trimethylation at lysine 27 of histone H3(H3K27me3)was evident on staining in four of nine cases(one case was excluded due to lack of tissue for evaluation of loss of H3K27me3).The 2-and 5-year disease-specific survival rates were 86%a nd 43%,respectively.The average survival time was 64 mo.CONCLUSION MPNST is a highly malignant tumor with a poor prognosis,prone to a high risk of recurrence and distant metastasis.Complete surgical resection is the main treatment.展开更多
近年随着脑肿瘤分子生物学的发展,具有不同组织形态的富含神经毡和真菊形团的胚胎性肿瘤、髓上皮瘤及室管膜母细胞瘤归属于同一分子实体,统称为多层菊花团的胚胎性肿瘤(embryonal tumor with multilayered rosettes,ETMR)。这些肿瘤的...近年随着脑肿瘤分子生物学的发展,具有不同组织形态的富含神经毡和真菊形团的胚胎性肿瘤、髓上皮瘤及室管膜母细胞瘤归属于同一分子实体,统称为多层菊花团的胚胎性肿瘤(embryonal tumor with multilayered rosettes,ETMR)。这些肿瘤的罕见性和更新给诊断和治疗带来了挑战。文章主要对ETMR的临床表现、影像特点、诊断及临床研究情况进行回顾分析,以期为临床管理提供指导帮助。对ETMR的临床特点及诊断治疗的研究情况进行文献综述。典型的组织学特点联合分子生物学改变,可以更好地诊断ETMR。目前ETMR的治疗建议主要基于小型、主要是回顾性患者队列的数据。普遍推荐最大安全切除,适应年龄和风险的放疗、化疗为ETMR主要治疗手段,早期放疗可能改善预后。展开更多
目的对比经胸乳途径腔镜下甲状腺手术与传统甲状腺手术的疗效,观察患者对两种术式的认可度。方法回顾本院2019年9月-2021年1月收治的74例甲状腺良性肿瘤患者的临床资料,按手术入路分传统组(30例)和经胸乳组(44例),传统组均按传统术式完...目的对比经胸乳途径腔镜下甲状腺手术与传统甲状腺手术的疗效,观察患者对两种术式的认可度。方法回顾本院2019年9月-2021年1月收治的74例甲状腺良性肿瘤患者的临床资料,按手术入路分传统组(30例)和经胸乳组(44例),传统组均按传统术式完成甲状腺切除,经胸乳组均经胸乳入路行腔镜下甲状腺切除。比较2组手术耗时、术中出血量、术后引流量、住院天数、疼痛程度、并发症发生情况和手术满意度。结果2组患者均顺利完成既定手术,除术后引流量2组间无统计学差异外,经胸乳组患者的手术耗时、术中出血量、住院天数、VAS评分均优于传统组,差异有统计学意义(74.40±9.35min VS 112.20±12.45min,35±5mL VS 70±9mL,4.75±1.23d VS 10.20±1.78d,3.25±0.56 VS 6.42±1.22,P均<0.05)。传统组并发症发生率高于经胸乳组,差异有统计学意义(20.00%VS 4.55%,P<0.05)。经胸乳组患者的满意度明显高于传统组,差异有统计学意义(72.73%VS 60.00%,P<0.05)。结论与传统甲状腺切除手术比较,经胸乳组胸乳入路腔镜下甲状腺切除术式具有手术时间短、出血量少、患者恢复快、切口美观、患者满意度高等优点,值得推广应用。展开更多
文摘BACKGROUND Many patients have inadequate long-term analgesia,respiratory distress,and hypoxemia due to a long-standing substantial smoking history or the presence of primary pulmonary diseases;analgesic treatment is not valid in these patients.Even if the imaging findings of rib fractures are relatively mild,rib fractures may cause severe position limitation,respiratory distress,and hypoxemia.AIM To investigate the curative effect of surgical treatment for patients with severe non-flail chest rib fractures.METHODS A total of 78 patients from our hospital with severe noncontinuous thoracic rib fractures from September 2016 to September 2018 were enrolled in our study.Thirty-nine patients underwent surgical treatment,and 39 underwent conservative treatment.The surgical treatment group received surgery performed with titanium plates,and the screws were inserted with open reduction and internal fixation.The conservative treatment group received analgesia and symptomatic treatment.The pain scores at 72 h,1 wk,2 wk,4 wk,6 wk,3 mo,and 6 mo were compared,and the SF-36 quality of life scores were compared atthe 3rd and 6th months.RESULTS Pain relief in the surgical group was significantly better than that in the conservative group at each time point(72 h,1 wk,2 wk,4 wk,6 wk,3 mo,and 6 mo after surgery,P<0.001).The SF-36 scores were significantly higher in the surgical group than in the conservative group at 1 mo and 6 mo(P<0.05).CONCLUSION Patients with severe non-flail chest rib fractures have a better quality of life following surgical treatment than following conservative treatment,and surgical treatment is also useful for relieving pain.We should pay more attention to the physiological functions and clinical manifestations of patients with severe rib fractures.In patients with non-flail chest rib fractures,surgical treatment is feasible and effective.
文摘A 64-year-old female had noticed an 11 × 6 cm mass growing on her left first rib. We performed a resection of the first and second ribs and a reconstruction of the chest wall. A thoracotomy was performed at the anterolateral second intercostal space. The second rib cartilage was divided at the left parasternum. Based on a transmanubrial osteomuscular sparing approach, the left-upper part of the sternum and the first rib cartilage were both cut at the left clavicular-sternum joint. The posterior parts of the two ribs involving the tumor were resected at the transverse process of the vertebral bone by tearing off the anterior, middle, and posterior scalene muscles, subclavicular artery and vein. The defect size of the thorax was 15 × 9 cm, which was reconstructed by covering with a polytetrafluoroethylene dual mesh (Dual mesh, Gore tex, 2 mm). The major pectoral muscle flap was used to cover the mesh. The postoperative pathological examination diagnosed a poorly differentiated fibrosarcoma. Eventually, she had palliative therapy for the postoperative metastatic chest wall. She died 14 months after the operation.
文摘Gastric carcinoma is derived from epithelial cells in the gastric mucosa. We reported an extremely rare case of submucosal gastric carcinoma originating from the heterotopic submucosal gastric gland(HSG) that was safely diagnosed by laparoscopy and endoscopy cooperative surgery(LECS). A 66-year-old man underwent gastrointestinal endoscopy, which detected a submucosal tumor(SMT) of 1.5 cm in diameter on the lesser-anterior wall of the upper gastric body. The tumor could not be diagnosed histologically, even by endoscopic ultrasound-guided fine-needle aspiration biopsy. Local resection by LECS was performed to confirm a diagnosis. Pathologically, the tumor was an intra-submucosal well differentiated adenocarcinoma invading 5000 μm intothe submucosal layer. The resected tumor had negative lateral and vertical margins. Based on the Japanese treatment guidelines, additional laparoscopic proximal gastrectomy was curatively performed. LECS is a less invasive and safer approach for the diagnosis of SMT, even in submucosal gastric carcinoma originating from the HSG.
文摘Pancreatic endocrine tumors are rare but are among the most common neuroendocrine neoplasms of the abdomen.At diagnosis many of them are already advanced and diff icult to treat.We report on an initially inoperable malignant pancreatic endocrine tumor in a 33-year-old woman,who received neoadjuvant peptide receptor radionuclide therapy(PRRT)as firstline treatment.This resulted in a signif icant downstaging of the tumor and allowed its subsequent complete surgical removal.Follow-up for eighteen months revealed a complete remission.This is the first report on neoadjuvant PRRT in a neuroendocrine neoplasm with subsequent successful complete resection.
文摘Liver transplantation is a major abdominal operation and the intimate anatomic relation of the liver with the right hemidiaphragm predisposes the patient to various manifestations in the chest cavity.Furthermore,chronic liver disease affects pulmonary function before and after liver transplantation resulting in a considerable percentage of patients presenting with morbidity related to chest complications.This review aims to identify the potential chest complications of surgical interest during or after liver transplantation.Complications of surgical interest are defined as those conditions that necessitate an invasive procedure(such as thoracocentesis or a chest tube placement)in the chest or a surgical intervention performed by a thoracic surgeon.These complications will be classified as perioperative and postoperative;the latter will be categorized as early and late.Although thoracocentesis or a chest tube placement is usually sufficient when invasive measures are deemed necessary,in some patients,thoracic surgical interventions are warranted.A high index of suspicion is needed to recognize and treat these conditions promptly.A close collaboration between abdominal surgeons,intensive care unit physicians and thoracic surgeons is of paramount importance.
文摘BACKGROUND A vascular tumor is a benign tumor with unique clinical and pathological features.Perirenal vascular tumor is extremely rare and has not yet been reported.Clinically,it manifests as soreness and swelling.Color ultrasound and renal angiography illustrated the perirenal mass,which was closely connected with the kidney and the surrounding tissues and organs.Histology showed extensive embedded perirenal fat,and thin-walled vascular tissue displayed a pink stain due to red blood cells.CASE SUMMARY Herein,a case of robot-assisted retroperitoneal laparoscopic excision of a perirenal vascular tumor is reported.Analysis of the clinical,biological,and histological features of the perirenal vascular tumor can provide an in-depth understanding of the disease,which provides a theoretical and practical basis for better diagnosis and treatment.CONCLUSION This study contributes to a practical basis for the diagnosis and treatment of perirenal hemangiom.
基金Supported by Zhejiang Provincial Department of Health Clinical Research Application Project,No.2022KY924General Project of Zhejiang Provincial Department of Health,No.2021KY835。
文摘BACKGROUND At present,cases of esophageal neuroendocrine tumors combined with cardia adenocarcinoma are extremely rare worldwide,and there are no clinical reports.Herein,we describe such a case for clinical reference.CASE SUMMARY The presence of cardia cancer and esophageal neuroendocrine tumors in a single patient has not yet been reported.The patient in this case underwent prompt endoscopic treatment and additional surgical resection.Pathology revealed the following:The distance between the cardia cancer and the esophageal neuroendocrine tumors was small,approximately 3 mm.Vascular invasion was observed.The esophageal neuroendocrine tumor was determined to be grade G3.According to the treatment guidelines,after the patient received an explanation of their condition,additional surgical procedures were provided in a timely manner.Early detection and early treatment can successfully prolong survival and improve the quality of life of patients.CONCLUSION Early detection and early treatment can successfully prolong survival and improve the quality of life of such patients.
文摘BACKGROUND Malignant peripheral nerve sheath tumor(MPNST)is a rare and aggressive soft tissue sarcoma that poses a major diagnostic and therapeutic challenge.CASE SUMMARY We retrospectively reviewed patients with head and neck MPNSTs treated in our hospital from 2000 to 2021.The clinical features,pathological manifestations,treatments,and prognoses were summarized.We also reviewed the literature,focusing on MPNST in the mandible and maxilla.The study population consisted of five women and five men aged 22–75 years(mean age,49 years).Of the 10 patients,7 were initial cases and 3 were recurrent cases.All lesions were sporadic.The most common site was the mandible.The most frequently encountered symptoms were a progressive mass and local swelling.Complete or partial loss of trimethylation at lysine 27 of histone H3(H3K27me3)was evident on staining in four of nine cases(one case was excluded due to lack of tissue for evaluation of loss of H3K27me3).The 2-and 5-year disease-specific survival rates were 86%a nd 43%,respectively.The average survival time was 64 mo.CONCLUSION MPNST is a highly malignant tumor with a poor prognosis,prone to a high risk of recurrence and distant metastasis.Complete surgical resection is the main treatment.
文摘近年随着脑肿瘤分子生物学的发展,具有不同组织形态的富含神经毡和真菊形团的胚胎性肿瘤、髓上皮瘤及室管膜母细胞瘤归属于同一分子实体,统称为多层菊花团的胚胎性肿瘤(embryonal tumor with multilayered rosettes,ETMR)。这些肿瘤的罕见性和更新给诊断和治疗带来了挑战。文章主要对ETMR的临床表现、影像特点、诊断及临床研究情况进行回顾分析,以期为临床管理提供指导帮助。对ETMR的临床特点及诊断治疗的研究情况进行文献综述。典型的组织学特点联合分子生物学改变,可以更好地诊断ETMR。目前ETMR的治疗建议主要基于小型、主要是回顾性患者队列的数据。普遍推荐最大安全切除,适应年龄和风险的放疗、化疗为ETMR主要治疗手段,早期放疗可能改善预后。
文摘目的对比经胸乳途径腔镜下甲状腺手术与传统甲状腺手术的疗效,观察患者对两种术式的认可度。方法回顾本院2019年9月-2021年1月收治的74例甲状腺良性肿瘤患者的临床资料,按手术入路分传统组(30例)和经胸乳组(44例),传统组均按传统术式完成甲状腺切除,经胸乳组均经胸乳入路行腔镜下甲状腺切除。比较2组手术耗时、术中出血量、术后引流量、住院天数、疼痛程度、并发症发生情况和手术满意度。结果2组患者均顺利完成既定手术,除术后引流量2组间无统计学差异外,经胸乳组患者的手术耗时、术中出血量、住院天数、VAS评分均优于传统组,差异有统计学意义(74.40±9.35min VS 112.20±12.45min,35±5mL VS 70±9mL,4.75±1.23d VS 10.20±1.78d,3.25±0.56 VS 6.42±1.22,P均<0.05)。传统组并发症发生率高于经胸乳组,差异有统计学意义(20.00%VS 4.55%,P<0.05)。经胸乳组患者的满意度明显高于传统组,差异有统计学意义(72.73%VS 60.00%,P<0.05)。结论与传统甲状腺切除手术比较,经胸乳组胸乳入路腔镜下甲状腺切除术式具有手术时间短、出血量少、患者恢复快、切口美观、患者满意度高等优点,值得推广应用。