Four hundred and eighty two paients suffering from intrahepatic bile duct stone undergoing lobectomy and segmental resection (from 1975 to 1994,9) has reported. 63% of the patient in this group underwent 1-5 operations, including different types of biliary-intestinal anastomosis (21.6%). 482 cases underwent different types of hepatectomy, including left lateral-lobetomy 321 cases (66.6%),left hemihepatectomy 80 cases(16.6%), right hemihepatectomy 19 cases (3.9%), and multiple segmental resections 39 cases (8.1%, including Ⅴ+Ⅷ 11 cases, Ⅵ+Ⅶ 28 cases). Other type hepatectomy combined with guadrate lobectomy 20 cases (4.1%). Postoperative complication rate was 10.2%, including diliary fistula. hemobilia and subdiaphragmatic and resectional surface infectioin, 85% of the patients were followed up with an excellent result of 88%. The authors emphsize that hepatic lobectomy nad segmental resection is the core of treatment and selection of operative methods depends on clinical-patholigic types of the disease.
目的 分析原发性乳腺淋巴瘤（PBL）的临床病理特点、诊断、治疗及预后。 方法 回顾分析2000年12月－2011年10月收治的19例PBL患者的临床资料和治疗随访情况。 结果 19例PBL患者均为女性，年龄34～72岁。根据Ann Arbor临床分期，Ⅰ期患者9例，Ⅱ期7例，Ⅲ期3例，而病理类型以弥漫大B淋巴瘤为主（13/19）。全部患者随访时间为6～113个月，中位随访时间为45个月，5年生存率为36.8%。 结论 PBL其预后与病理类型、分期及治疗方式有关。手术联合放射化学疗法为主要治疗方式，腋窝淋巴结清扫有一定的意义，但对PBL预后的影响值得商榷。此外，PBL易出现中枢神经系统转移，应定期复查。
目的 探讨宫颈癌骨转移相关因素。 方法 回顾分析2008年6月－2011年8月收治的352例宫颈癌患者的临床资料，其中鳞癌326例，腺癌26例；临床分期Ⅰ期60例、Ⅱ期184例、Ⅲ期90例、Ⅳ期18例。比较不同期别、不同病理类型、不同组织分级患者的骨转移情况。 结果 352例宫颈癌中有18例发现骨转移，转移率为5.1%；转移时间为3～48个月，2例于骨转移后1年内死亡。鳞癌326例，骨转移率为5.2%；腺癌26例，骨转移率为3.8%。Ⅰ、Ⅱ、Ⅲ和Ⅳ期患者的骨转移率分别为0.0%、3.8%、5.6%和33.3%，晚期与早期相比有统计学意义（P＜0.05）；高、中和低分化患者骨转移率分别为3.1%、3.1%和6.3%，高分化与中分化相比，差异无统计学意义（P＞0.05），低分化与高中分化相比差异有统计学意义(P＜0.05)。 结论 宫颈癌骨转移与宫颈癌临床分期、病理类型、细胞分级密切相关。在宫颈癌的治疗过程中，做到早发现、早治疗，可提高患者的治疗效果，延长生存时间。
ObjectiveTo analyze the relative factors of lymph-nodes metastasis (LM) in patients with cervical cancer. MethodsThe clinico-pathological data of 136 patients with stageⅠ A-Ⅱ A of cervical cancer who underwent surgical therapy from January 2005 to December 2010 were retrospectively analyzed. The correlation between clinico-pathological parameters and LM was analyzed by univariable χ2 analysis and multivariable logistic analysis. ResultsThe total LM rate (LMR) was 14.0% (19/136). The rate of LM in obturator was the highest (63.2%), and then the rate between the external and internal iliac was 42.1%. The rate of deep inguinal lymph nodes and para-aortic lymph node was 0.0%. There was correlation between the clinic staging, depth of stromal invasion, histologic subtype, parametrial invasion, vaginal invasion and LM in univariable analysis (P<0.05). While in multivariable analysis, the correlation with LM was only existed between the clinic staging, histologic subtype, depth of stromal invasion and LM. ConclusionClinic staging, histologic subtype, depth of stromal invasion are high risk factors of LM.
ObjectiveTo analyze the clinical manifestations and pathological patterns of renal diseases requiring percutaneous renopuncture, evaluate the clinical significance of renal biopsy and the value of clinical pathway for renal biopsy. MethodsWe retrospectively summarized and analyzed the clinical and pathological data, and the clinical pathway implementation of 224 patients who underwent renal biopsy between October 2009 and September 2014. ResultsIn the 224 patients, there were 62 cases of IgA nephropathy (27.68%), 50 cases of minimal change nephropathy (22.32%), 28 cases of lupus nephritis (12.5%), 26 cases of membrane nephropathy (11.6%), 26 cases of mesangial proliferative glomerulonephritis (11.6%), 6 cases of purpura nephritis (2.68%), 4 cases of focal segmental glomerular sclerosis (1.79%), 4 cases of hepatitis B virus-associated membrane nephropathy (1.79%), 4 cases of nodular diabetic glomerulosclerosis (1.79%), 4 cases of acute tubulointerstitial nephropathy (1.79%), 2 cases of hypertensive renal damage (0.89%), 2 cases of membrano-proliferative glomerulonephritis (0.89%), 1 case of lipoprotein kidney disease (0.45%), and 1 case of fibrillary glomerulopathy (0.45%). A total of 220 specimens in the 224 cases were qualified, accounting for 98.21%. Diagnosis of 70 patients in the qualified 220 cases were re-corrected according to their renal pathology reports, accounting for 31.81%. In the 224 cases, there were 16 cases of gross hematuria (7.14%) and 24 of peri-renal hematoma (10.71%) after renal biopsy. Patients who met the requirement of clinical pathway were divided into clinical pathway group and control group randomly. Average hospitalization time of the clinical pathway group was (7.6±1.2) days, and the average cost was (5 860±237) yuan, both lower than the control group [(11.8±2.3) days, (7 658±360) yuan)]. The difference was statistically significant. ConclusionsIgA nephropathy is the most common pathological type of primary glomerular diseases, and minimal change nephropathy the second. Lupus nephritis, membranous nephropathy, mesangial proliferative glomerulonephritis are still the most common types of glomerular diseases. Lupus nephritis becomes the first secondary glomerular disease. Ultrasound guided percutaneous renal biopsy is safe and has high success rate and high clinical application value. The implementation of clinical pathway can shorten the average length of hospital stay and reduce the average hospital cost.
ObjectiveTo summarize the clinical pathologic features of primary tonsil tumor, in order to provide reference for its diagnosis and treatment. MethodsWe retrospectively analyzed the clinical data from January 2002 to April 2012, and found 810 cases of malignant tumor and 113 cases of benign tumor. The pathologic patterns and clinical manifestations of these cases were recorded for analysis. ResultsMost tonsil tumors were unilateral, and the malignant types were much more than the benign. The most common malignant tonsil tumors were lymphoma (610 cases), followed by squamous cell carcinoma (172 cases); inverted papilloma was the most common benign tumor (87 cases). Paresthesia in the pharynx was the most common clinical manifestation that existed in almost all cases. ConclusionTonsil tumor pathological type is very important for its diagnosis, treatment and prognosis. Laying emphasis on pathological diagnosis and differential diagnosis could avoid missed diagnosis, misdiagnosis and improper treatment, which is particularly important for clinical physicians of the otolaryngology, head and neck surgery.
ObjectiveTo summarize the incidence, patterns and laws of perineural invasion, and explore the path and the influencing factors of perineural invasion in hilar cholangiocarcinoma. MethodsA clinicopathologic study was conducted on sections from 52 patients with hilar cholangiocarcinoma to summarize the incidence and patterns of perineural invasion. The relationship of perineural invasion to lymph node metastasis, serum CA19-9, CEA, total bilirubin (TBIL) level, Bismuth-Corllet classification, or tumor penetration depth of bile duct walls was analyzed by association analysis. ResultsThe overall incidence of perineural invasion was 90.38% (47/52). However, the incidences of perineural invasion had no significant differences among various differentiated adenocarcinoma groups (P > 0.05). The incidences of perineural invasion were not correlated with the lymph node metastasis, serum CA19-9, CEA, TBIL level, and Bismuth-Corlette classification (P > 0.05), which was correlated with the tumor penetration depth of bile duct walls (P < 0.01). There were four patterns of perineural invasion, sequenced them according their incidences from high to low as follows: typeⅡ> typeⅢ> typeⅣ> typeⅠ. The pattern of perineural invasion was correlated with the degree of tumor differentiation (χ2=31.04, P < 0.01). ConclusionsThe incidence of perineural invasion is very high in hilar cholangiocarcinoma. The patterns of perineural invasion are similar in the same patient, and a variety of invasion patterns might coexist. While the pattern of perineural invasion is correlated with the degree of tumor differentiation. The incidence of perineural invasion is correlated with the tumor penetration depth of bile duct walls.
ObjectiveBy applying the mutual corroboration in the diagnosis, we aimed to improve the accuracy of preoperative imaging diagnosis, select the appropriate timing of operation and guide the follow-up time for patients with pulmonary nodules.MethodsClinical data of 1 368 patients with pulmonary nodules undergoing surgical treatment in our department from July 2016 to October 2019 were summarized. There were 531 males and 837 females at age of 44 (21-67) years. The intraoperative findings, images and pathology were classified and analyzed. The imaging pathology and pathological changes of pulmonary nodules were shown as a dynamic process through mutual collaboration and interaction.ResultsOf 1 368 patients with pulmonary nodules, 376 (27.5%) were pure ground-glass nodules, 729 (53.3%) were mixed ground-glass nodules and 263 (19.2%) were solid nodules. Among the pure ground-glass nodules, adenocarcinoma in situ (AIS) accounted for the highest proportion (156 patients), followed by microinvasive adenocarcinoma (MIA, 90 patients), atypical adenomatous hyperplasia (AAH, 85 patients), and benign tumors (20 patients). Among mixed ground-glass nodules, 495 patients were invasive adenocarcinoma (IA) and 207 patients of MIA. In solid nodules, patients were characterized by pathology of either IA (213 patients) or benign tumors (50 patients), and no patient was featured by AAH, AIS or MIA.ConclusionThe mutual collaboration and interaction can improve the accuracy of preoperative diagnosis of pulmonary nodules, and it supports the choice of operation timing and the judgment of follow-up time.