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Objective To study the early diagnosis and treatment of liver trauma.Methods Retrospective(analysis) of the clinical data of different therapeutic means for liver trauma was made on 124 cases of liver trauma.Of these, 99 patients underwent operative treatment and 25 patients nonoperative treatment .Results In nonoperative treatment group ,22 patients were cured and 3 patients changed to operation.In operative treatment group, including 3 non-opcrative treatment patients changed to opcration,95 patients were cured ,7 patients died.In this series,the cure rate was 94.4%(117/124); mortality rate was 5.6%(7/124),including 5 patients who died of major blood vessel injury ,and 2 patients who died of multiple organ failure. All patients with postoperative(complications) were cured, including subphrenic infection in 3(cases), hepatic(abscess) in 6 cases , pleural(hydrops) in 8 cases, incisional infection in 7 cases,and(intraabdominal)(abscess) in 2 cases. Conclutions Type I liver trauma can be treated by(nonoperation) ; type II～IV blunt liver trauma can be treated by(nonoperation) under the condition of hemodynamic stability and(intensive)(monitoring) .Type II～VI liver trauma accompanied by massive intra-abdominal bleeding and(injury) of other(organs) should be (operated) (emergently .)
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Objective To study the clinical characteristics and treatment of primary appendicular tumor. Methods The clinical data of 13 patients with primary appendicular tumor treated in our hospital from 1979 to 1999 were retrospectively analyzed. Results The primary appendicular tumors included 4 cases of mucinous tumor, 5 cases of carcinoid, 3 cases of adenocarcinoma and 1 case of leiomyosarcoma. None was diagnosed correctly before operation. All 13 cases were treated by operation. Right hemicolectomy was performed in carcinoid, diameter of which was longer than 1cm, right hemicolectomy and regional lymphadenectomy were performed in adenocarcinoma, and the other five cases were only received appendectomy. The patients were in good general condition after operation. Conclusions Primary appendicular tumor lacked particular symptoms, and the rate of misdiagnosis was extremely high. Barium radiography and ultrasonography were helpful for diagnosis. Intraoperative frozen section detection was very important for diagnosis. Operation is a principle therapy, and suitable operation plan may be key factor for improving the prognosis of the patients with appendicular tumor.
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Objective To study the experience in surgical treatment of gastric mucosa-associated lymphoid tissue lymphoma (GMALTL). Methods The clinical data of 69 cases of GMALTL from 1984 to 1996 were reviewed. Results In this series, there were 26 cases in stage Ⅰ, 21 in stageⅡ, 13 in stage Ⅲ and 9 in stage Ⅳ. Diagnosis was proved by both surgery and pathology in all the cases. 61 cases underwent curative resection, 4 incomplete resect and 4 unresectable. Among them, 5 cases were treated by surgery only, surgery plus postoperative radiotherapy used in 25 cases, 19 received surgery plus postoperative chemotherapy, and 20 cases received surgery plus chemotherapy and radiotherapy. 57 cases (82.6%) were following up for 1 to 12 years.The 5,10-year survival rate was 71%(49/69)and 31.9%(22/69) respectively. Conclusions Clinical stage and therapeutic modality adopted do the major prognostic foctors ,while age and gender do not count much to the recovery. Surgery remains to be the most important treatment model.
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Objective To analyze the reason of the misdiagnosis on carcinoma of gallbladder and to search the measure of prevention. Methods The clinical data of 91 cases of gallbladder carcinoma with misdiagnosis(from 1998 to 1999 operation) was retrospectively analyzed.Results There were 48(52.7%) patients who had been misdiagnosed before operation,major cause was gallbaldder other complication,of them,gallstones was commonest reason 26/54 cases,54.2%.The following misdignosed causes were the acute attack of chronic cholecystitis,gallbladder sandpaper and polypoid lesions of gallbadder.Conclusions On clinic,for those patients ⑴aged-women with chronic cholecystitis for a long term and their gallbladder become atrophy.⑵Local symptom aggravation and/or with complication of gastricism recently. ⑶Imaging inspections such as B ultrasongraphy or CT suggest that somatopleure of gallbladder intensified irreguarly or the cubic capacity of solely tuberculum in gallbladder expands obviously in short term. Prophylactic cholecystectomy should be perfomed,and dissect the sample of the gallbladder as routine operation,so it can elevate the precuse diagnosis rate on carcinoma of gallbladder.
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Objective To investigate the causes of clinical misdiagnosis for gastric mucosa associated lymphoid tissue lymphoma (GMALT). Methods The clinical manifestations of and accessory examination for GMALT in 32 cases were retrospectively analyzed. Results Clinical misdiagnosis was made on 32 out of 78 cases (41%) of GMALT for a period of 5 days to 13 months. Radiographic misdiagnosis rate was 40% and endoscopic misdiagnosis rate was 37%. Conclusion The preoperative diagnosis of GMALT was difficult because the incidence of GMALT is low, the symptoms are nonspecific, and radiologic and fibergastroscopic features were very similar to those of gastric carcinoma and peptic ulcer.
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ObjectiveTo determine the clinicopathological characteristics, the diagnosis, treatment and prognosis of anorectal malignant melanoma. MethodsRetrospective analysis was unducted for the clinical manifestation,treatment and prognosis of11 cases of anorectal malignant melanoma confirmed by surgery and pathology from 1978 to 1999. Results Of the 11 patients,7 had hematochezia of various degrees and suffered pain surrounding the auns.Seven patients had been misdiagnosed before the operation.The median survival time was 18 months,the longest survivor 39 months.ConclusionsAnorectal malignant melanoma is a highly malignant with early metastasis and poor prognosis.Radical surgery combined with chemotherapy,immunotherapy and biotherapy may be more effective.