【摘要】 目的 分析胃肠道间质瘤（gastrointestinal stromal tumors，GIST）的螺旋CT（multi-detector row spiral computeel Tomography，MSCT）表现，评价其对该病的诊断价值。 方法 回顾性分析2000年3月—2010年10月经手术病理证实的32例GIST的MSCT表现，并将其与病理的生物学危险性进行对比研究。 结果 病理高、中、低及极低危险性GIST依次为15、6、7、4例。GIST主要CT表现，肿块腔外生长为主，大部分病灶边界清楚，呈类圆形或分叶状，密度均匀或不均匀，3例可见钙化，GIST增强静脉期强化较动脉期更明显，局部均无淋巴结转移，转移到肝脏的4例，同时伴前腹壁转移1例。15例肿块长径≥5 cm，密度多不均匀，可有囊变、坏死、出血等，增强不均匀强化，其中11例病理为高风险性；17例肿块长径lt;5 cm的病灶中，大多中度均匀强化，其中13例为中度及以下危险性。 结论 GIST患者的MSCT表现具有一定的特征性，MSCT对准确定位、术前估计肿瘤的风险级别、术后随访有重要价值。【Abstract】 Objective To investigate the imaging features of multi-slice spiral CT (MSCT) for gastrointestinal stromal tumors (GIST) and its diagnostic value. Methods We retrospectively analyzed the MSCT manifestations of 32 cases of GIST confirmed by operation and pathology between March 2000 and October 2010. Comparative study was then carried out between MSCT manifestations and patho-physiological risks. Results Of the 32 GIST lesions, 15 presented with high biological risks, six moderate risks, seven low risks and four very low risks. The MSCT results manifested the following main features. Exophytic growth was predominating; Most lesions were with well-defined margins, and were rotund or lobular in shape with homogeneous or heterogeneous density. Three lesions manifested calcification. The enhancement degree of GIST in portal vein phase was more obvious than in arterial phase. There was no metastasis to local lymph nodes. Hepatic metastasis occurred in four cases, one of which was accompanied with anterior abdominal wall metastasis. Of the 15 lesions with maximal diameter longer than 5 cm, MSCT showed obvious cystic changes, necrosis or hemorrhage within the mass most of which was in heterogeneous density, and heterogeneous enhancement; Eleven out of the 15 lesions were at high risk. Among the 17 lesions with maximal diameter shorter than 5 cm, MSCT showed homogeneous enhancement, and 13 of them were at moderate risk or below. Conclusion The MSCT imaging of GIST manifests some certain characteristics. It is valuable in locating the lesion precisely, estimating the risk level of the tumor, and postoperative follow-up for patients with GIST.
ObjectiveTo investigate the risk factors for hypoparathyroidism following radical surgery for patients with thyroid papillary carcinoma (PTC).MethodsA retrospective analysis was made on 192 patients with PTC who underwent radical thyroidectomy in the Department of Head Neck and Thyroid Surgery of Henan Cancer Hospital from January 2019 to January 2020. There were 52 males and 140 females with a median age of 48 years. The risk factors of hypocalcemia and hypoparathyroidism syndrome were screened by χ2 test and binary logistic regression analysis.ResultsIn 192 patients the proportion of patients with normal or hypoparathyroidism after operation were 62.5% (120/192) and 37.5% (72/192), respectively. Univariate analysis showed that complications, Hashimoto’s thyroiditis (HT), total thyroidectomy, N1a staging, Ⅵ lymph node dissection and parathyroid not planted were risk factors for postoperative hypoparathyroidism in patients with PTC. Binary logistic regression analysis showed that: ① HT, N1a staging and Ⅵ lymph node dissection were independent risk factors for postoperative hypocalcemia [without HT: OR=0.313, 95%CI (0.129, 0.760), P=0.010; N1a staging: OR=3.457, 95%CI (1.637, 7.301), P=0.001; without Ⅵ lymph node dissection: OR=0.115, 95%CI (0.041, 0.323), P<0.001]. ② HT, N1a staging, Ⅵ lymph node dissection and parathyroid not planted were independent risk factors for postoperative low parathyroid hormone [without HT: OR=0.285, 95%CI (0.117, 0.698), P=0.006; N1a staging: OR=3.747, 95%CI (1.762, 7.968), P=0.001; without Ⅵ lymph node dissection: OR=0.112, 95%CI (0.039, 0.317), P<0.010; planted parathyroid: OR=0.464, 95%CI (0.221, 0.978), P=0.043].ConclusionHT, N1a staging, Ⅵ lymph node dissection and parathyroid not planted are vital risk factors for hypoparathyroidism in patients with PTC after radical thyroidectomy.
ObjectiveTo analyze the incidence of and prevention strategies for bone cement leakage after percutaneous vertebroplasty (PVP) or kyphoplasty (PKP) for treatment of osteoporotic vertebral compression fractures. MethodsA retrospective analysis was carried out on the clinical data of 178 patients who had 268 thoracolumbar osteoporotic compressions and underwent PVP or PKP from January 2010 to January 2013 in our hospital. We analyzed the causes of and prevention strategies for bone cement leakage. The therapeutic effect was observed after operation. We summarized the causes and prevention strategies for the bone cement leakage. ResultsStatistics showed that 51 vertebrae (19.0%) had bone cement leakage, including 31 vertebrae (29.2%) after PVP and 20 vertebrae (12.3%) after PKP. All patients had back pain relief after operation. One patient with bone cement leakage had the nerve root injured, which was relieved by decompression. Other patients had no reaction. ConclusionThe causes of cement leakage were related to the patients' own factors, but were more related to the operations. Adequate preparation before operation, correct surgical technology during operation, taking necessary precautions and X-ray monitoring are the key to the prevention of cement leakage.
ObjectiveTo evaluate the safety to perform 23G vitrectomy with scleral incisions at 5.0 mm behind the limbus.MethodsThis is a prospective uncontrolled case study. The data of 140 consecutive primary 23G vitrectomy patients (145 eyes) were enrolled in this study. There were 56 males (59 eyes) and 84 females (86 eyes), with the mean age of (56.34±9.98) years and axial length of (23.99±2.57) mm. There were 139 phakic eye and 6 aphakic eyes. All the eyes received 23G pars plana vitrectomy with scleral incisions at 5.0 mm behind the limbus. To measure the normal Chinese adult parameters of anteroposterior axis of the eyeball, lens thickness and scleral distances from the limbus to the plane passing through the lens posterior apex, the head CT scans of 105 patients without eye diseases in our hospital were studied during the same period of time for these vitrectomy surgeries. Pearson correlation analysis was used to analyze the relationship between age, anteroposterior axis of eyeball, lens thickness and scleral distances from the limbus to the plane passing through the lens posterior apex.ResultsSurgical related complications included retinal tears close to the scleral incision sites (3/145 eyes, 2.1%) and lens injury (3/121 eyes, 2.5%). No other surgical complications occurred, such as retinal hemorrhage, supra-choroidal expulsive hemorrhage and iatrogenic retinal detachment. Based on CT images, the average scleral distance from limbus to the plane passing through the lens posterior apex, anteroposterior axis of eyeball and lens thickness was (6.72±0.81), (24.39±0.97), (4.22±0.47) mm, respectively. The results of Pearson correlation analysis showed that age and lens thickness had statistically significant correlation (r=0.328 9, P=0.000 6).ConclusionPrimary 23G pars plana vitrectomy with incisions at 5.0 mm posterior to the limbus is safe.
ObjectiveTo observe the outcomes of 23G pars plana vitrectomy (PPV) and air tamponade for non-inferior rhegmatognous retinal detachment (RRD).MethodsA prospective case series study. From August 2017 to April 2018, 39 consecutive RRD patients (39 eyes) in Department of Ophthalmology of Subei People’s Hospital Affiliated to Yangzhou University were enrolled in this study. There were 20 males (20 eyes) and 19 females (19 eyes), 23 right eyes and 16 left eyes, with the mean age of 55±11 years. There were 30 eyes with lens and 9 eyes without lens or IOL. There were 21, 14 and 4 eyes with 1, 2 and equal or greater than 3 retinal tear respectively. All patients underwent 23G PPV which performed preretinal proliferative membranes and vitreous cortex removal, photocoagulation around the breaks with 3-5 rows, and filtered air tamponade. The follow-up was more than 2 months. The retinal reattachment, visual acuity and complications were observed. Pearson correlation analysis was used to analyze the correlation between BCVA and disease course. Chi-square test was performed for comparison among retinal reattachment rate and different clinical factors before operation.ResultsAt 2 months after the PPV, 35 eyes’ retina reattached, the rate of reattachment was 89.8%. In 2-3 weeks, 4 eyes were re-detached, all of them performed silicone oil tamponade. One eye was secondary to pre-macular membrane. The logMAR BCVA before and after PPV were 1.15±0.78 and 0.41±0.31, respectively (t=6.589, P=0.0001). Correlation analysis results showed that BCVA after surgery was positively correlated with BCVA before surgery (r=0.544, P=0.001). Twelve of 30 eyes with crystalline lens suffered cataract. The rate of reattachment vary in the number of the breaks (χ2=9.181, P=0.010).ConclusionPPV with air tamponade may be an optimal treatment of non-inferior RRD with better success rate and security.
ObjectiveTo investigate the lens and ora serrata safety during 23G vitrectomy with sclera incisions at 5.0 mm or 4.0 mm posterior to the limbus.MethodsA prospective case-controlled study was adopted. From April 2016 to January 2018, 290 consecutive primary 23G vitrectomy patients (300 eyes) with vitreoretinal disease in Department of Ophthalmology of Subei People’s Hospital Affiliated to Yangzhou University were enrolled in this study. Among them, 146 patients (150 eyes) received 23G pars plana vitrectomy (PPV) with scleral incisions at 5.0 mm posterior to the limbus (5.0 mm group), and 144 patients (150 eyes) at 4.0 mm (4.0 mm group). No statistically significant difference was found in age, axial length(t=−1.324, 0.867; P=0.186, 0.387) and in gender, right/left eyes, proportion of indications (χ2=1.366, 2.615, 10.195; P=0.242, 0.106, 0.070) between the two groups. The incidence rate of complications between the two groups were comparatively observed, such as lens injury, retinal tears close to the scleral incision, retinal hemorrhage, supra-choroidal expulsive hemorrhage and iatrogenic retinal detachment. Independent sample t test and χ2 test were performed for comparison between the two groups.ResultsLens injury was observed in 4 eyes (2.67%) and 14 eyes (9.33%) respectively in the 5.0 mm and 4.0 mm group during surgery (χ2=5.910, P=0.015). Retinal tears close to the scleral incision sites were observed in 5 eyes (3.33%) and 6 eyes (4.00%) respectively in the 5.0 mm and 4.0 mm group during surgery (χ2=0.094, P=0.759). The mean time of removing the vitreous base was 6.17±2.76 min and 10.03±5.56 min respectively in the 5.0 mm and 4.0 mm group (t=7.599, P＜0.01). No other surgical complications occurred in any group, such as retinal hemorrhage, supra-choroidal expulsive hemorrhage and iatrogenic retinal detachment, etc.ConclusionIn primary 23G PPV, the safety of ora serrata with incisions at 5.0 mm posterior to limbus is similar to that at 4.0 mm, but the safety of lens and the efficiency of vitreous resection is higher with incisions at 5.0 mm.