An Unusual Cervical Penetrating Wound Extended to the Right Pleural Dome

The solution of continuity of the tissues of the neck with rupture of the platysma muscle is called a cervical penetrating wound. The authors report a case of an unusual penetrating neck wound extended to the pleural dome by stabbing a psychiatric patient. They describe the diagnostic circumstances, the therapeutic approach and discuss data from the literature. It was a 26-year-old young woman, who was received in ENT for a penetrating neck wound with a stab wound following a suicide attempt. The diagnosis of a penetrating stab wound to the neck extending to the right pleural dome was retained. The exploratory cervicotomy with the extraction of the foreign body found a knife blade penetrating the anterior base of the right side of the neck to the right pleural dome, sparing the noble vasculo-nervous and aero-digestive organs of the neck. The postoperative course was simple and the evolution was favourable. This unusual penetrating wound of the neck is spectacular and remarkable for the absence of involvement of noble organs despite the involvement of the pleural dome. However, it remains a concern in psychiatric patients and requires multidisciplinary management and systemic management in order to avoid recurrence.

人工胸腔积液协助经皮微波消融肝脏穹窿部肝癌的临床价值

目的：探讨人工胸腔积液协助经皮微波消融位于肝脏穹窿部肝癌的临床价值。方法：28例患者共34个病灶,所有病灶均因位于肝脏穹窿部受肺气遮挡而显示不清。采用超声实时引导下人工注入适量胸腔积液,并行经皮微波肝癌消融治疗。观察人工注入胸腔积液的量及其成功率、病灶显示率、肿瘤完全消融率、相关并发症等。结果：人工注入胸腔积液200-1 000 mL[（388±107）mL],成功率为100.0%（28/28）;病灶显示率85.3%（29/34）,另外5个病灶因其回声与肝组织相近常规超声显示不清,行超声造影后可清晰显示。肿瘤完全消融率100%（34/34）;消融术后,1例患者出现少量腹腔出血,相关并发症发生率2.9%（1/34）。结论：人工胸腔积液协助经皮微波消融肝脏穹窿部肝癌是一种安全、有效的治疗方法,拓宽了经皮微波消融的治疗范围,值得临床进一步推广应用。

人工胸腔积液超声引导经皮射频消融治疗膈顶部肝癌

目的：经皮超声引导射频消融是治疗肝脏肿瘤的一种有效的微创方法。但当肿瘤位于肝膈顶部时，由于肺脏气体的干扰肿瘤难以显示，治疗受到了限制。本文将评估射频结合人工胸腔积液治疗肝膈顶部肿瘤的安全性与可行性，并初步探讨其临床应用价值。方法：15例原发性肝细胞肝癌患者，男性12例，女性3例，肿瘤均位于肝膈顶部。采用超声引导下冷循环射频结合人工胸腔积液的方法对肿瘤进行治疗。术后1月对所有治疗患者均进行增强CT或磁共振检查。结果：所有病例均安全完成射频治疗，未发生手术相关的并发症。随访时间2-18个月，11例患者存活。结论：人工胸腔积液结合经皮射频消融术可能是治疗肝脏膈顶部肿瘤一种安全可行的方法，值得进一步研究。