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[Gastrointestinal stromal tumour in emergency surgery]. [急诊手术中的胃肠道间质瘤]。
Pub Date : 2009-01-01
Arrigo Spivach, Margherita Fezzia, Daniela Bonifacio, Carlo Pagani, Maria Assunta Cova, Alberto Zacchi, Fabrizio Zanconati

Although rare, gastrointestinal stromal tumours (GIST) are the most common mesenchymal neoplasms of the gastrointestinal tract. We present our experience with the treatment of 8 patients affected by gastrointestinal stromal tumours of the ileum and colon. These cases were characterised by acute bleeding, intestinal obstruction or diffuse abdominal pain, and all of them underwent an emergency surgical treatment. We performed six partial resections of the ileum, one right hemicolectomy and one left hemicolectomy. Three patients died after surgical procedures for disease relapse, one died 10 years later due to other complications, and the others are still alive.

胃肠道间质瘤(GIST)虽然罕见,但却是最常见的胃肠道间质肿瘤。我们报告了8例受回肠和结肠胃肠道间质瘤影响的患者的治疗经验。这些病例的特点是急性出血、肠梗阻或弥漫性腹痛,所有病例都接受了紧急手术治疗。我们进行了6次回肠部分切除术,1次右半结肠切除术和1次左半结肠切除术。3名患者因疾病复发手术后死亡,1名患者因其他并发症在10年后死亡,其余患者仍活着。
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引用次数: 0
[Benign retroperitoneal schwannoma: a case report and review of the literature]. 【良性腹膜后神经鞘瘤1例报告及文献复习】。
Pub Date : 2009-01-01
Alberto Mingione, Claudia Cirillo, Nicola Martucci, Stefano Mingione

Retroperitoneal schwannoma is a very rare benign tumour that accounts for only a small percentage of retroperitoneal tumours. The preoperative diagnosis is difficult and the only treatment is complete surgical excision. The authors report their experience with a case of a voluminous retroperitoneal mass in a 42-year- old male patient, incidentally discovered during a diagnostic search for a blunt abdominal trauma. Because of the unclear origin of this mass, the patient underwent periodic radiological and ultrasonographic examinations. Three years later, owing to a slight increase in this mass and vague abdominal discomfort reported by the patient, surgical excision was performed. Histological examination of the surgical specimen revealed an "ancient schwannoma". The patient is alive and well and has had no recurrence in the twenty months since surgery. The authors, after a short discussion of the subject, go on to examine the diagnostic and therapeutic treatments of this rare benign neoplasm, which always arouses lively clinical and scientific interest.

腹膜后神经鞘瘤是一种非常罕见的良性肿瘤,仅占腹膜后肿瘤的一小部分。术前诊断困难,唯一的治疗方法是完全手术切除。作者报告了一例42岁男性患者在钝性腹部创伤的诊断过程中偶然发现的腹膜后巨大肿块。由于肿块的来源不明,患者定期接受放射和超声检查。三年后,由于该肿块轻微增加和患者报告的腹部模糊不适,进行了手术切除。手术标本的组织学检查显示为“古神经鞘瘤”。手术后的20个月,患者活得很好,没有复发。作者对这一罕见的良性肿瘤作了简短的讨论,并对其诊断和治疗方法进行了探讨。
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引用次数: 0
[Surgical management of schwannoma of biliary tract]. 胆道神经鞘瘤的外科治疗。
Pub Date : 2009-01-01
Guido De Sena, Carlo Molino, Maria Rosaria De Riitis, Stefano Candela, Vincenzo Cifarelli, Vittorio Di Maio, Francesco Chianese, Davide Albino Rossetti, Massimo Rossi, Giuseppe Miranda

A borderline Schwann cell tumour with common bile duct compression and jaundice is extremely rare. This paper presents the first report in the Italian literature of a hepatojejunostomy for a symptomatic lesion midway between benign and malignant.

交界性雪旺细胞瘤合并胆总管压迫和黄疸是极为罕见的。本文提出了第一份报告在意大利文献肝空肠吻合术的症状病变之间的良性和恶性。
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引用次数: 0
[Ileal intussusception due to a voluminous inflammatory fibroid polyp. A case report and review of the literature]. 大体积炎性肌瘤息肉引起的回肠肠套叠。病例报告及文献综述]。
Pub Date : 2009-01-01
Lorenzo Sofia, Cesare Lorenzini, Francesca Pia Pergolizzi, Agata Foti, Eugenio Cucinotta

An inflammatory fibroid polyp is a rare benign submucosal lesion frequently located in the gastric antrum but it may be found anywhere in the gastrointestinal tract with maximal incidence in the fifth and sixth decades of life. The main histological characteristics are diffuse inflammatory infiltrate with eosinophils, high vascularisation and a myofibroblastic component. Its localisation in the small bowel can cause intestinal invagination in adults, a condition, that occurs most frequently in childhood where, however, it is generally not related to a pathological lesion. The diagnosis may often be delayed because of its non-specific symptoms and most cases are diagnosed at emergency laparotomy, although CT scans can furnish useful preoperative information. In the majority of cases, the treatment of choice is surgical resection. Reduction performed prior to resection proves controversial in patients with colic intussusception because of the high incidence of malignancy. We report a case of a 37-year-old man who had undergone emergency surgery for acute ileum intussusception associated with a voluminous inflammatory fibroid polyp. The case described emphasises that patients with bowel obstruction pose a complex and difficult challenge to surgeons as regards the choice of the correct diagnostic work-up and optimal therapeutic management.

炎症性肌瘤息肉是一种罕见的良性粘膜下病变,通常位于胃窦,但它可以在胃肠道的任何地方发现,发病率最高的是在五六十岁。主要组织学特征为弥漫性炎症浸润,伴嗜酸性粒细胞,高血管化和肌成纤维细胞成分。它定位于小肠可引起成人肠内陷,这种情况最常见于儿童,但通常与病理病变无关。尽管CT扫描可以提供有用的术前信息,但由于其非特异性症状,大多数病例在紧急剖腹手术时诊断往往会延迟。在大多数情况下,治疗的选择是手术切除。由于恶性肿瘤的高发病率,在肠套叠患者切除前进行复位是有争议的。我们报告一位37岁的男性,因急性回肠肠套叠合并大量炎性肌瘤息肉而接受紧急手术。病例描述强调,肠梗阻患者对外科医生提出了一个复杂而困难的挑战,即选择正确的诊断检查和最佳的治疗管理。
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引用次数: 0
[Laparoscopic wedge resection for gastrointestinal stromal tumour: a case report]. 腹腔镜楔形切除术治疗胃肠道间质瘤1例。
Pub Date : 2009-01-01
Marco Milone, Osvaldo Micera, Francesco Milone

Surgical resection is the main and most effective treatment for gastrointestinal stromal tumours (GISTs) and for all benign gastric tumours. All such tumours should be approached with the intention of performing complete en bloc removal of the tumour, achieving microscopically tumour-free pathological resection margins. More extensive surgery fails to guarantee better results over time. Consequently, wedge resection of the stomach ensures adequate therapy. Our personal experience with laparoscopic wedge resection for a gastrointestinal stromal tumour is described, demonstrating equivalent efficacy, greater safety, and applicability, and better postoperative results with this surgical approach.

手术切除是胃肠道间质瘤(gist)和所有良性胃肿瘤的主要和最有效的治疗方法。所有这样的肿瘤都应该进行完全的整体切除,以达到显微镜下无肿瘤的病理切除边缘。随着时间的推移,更广泛的手术并不能保证更好的结果。因此,楔形胃切除术确保了充分的治疗。我们描述了腹腔镜楔形切除术治疗胃肠道间质瘤的个人经验,证明了这种手术方法的同等疗效,更大的安全性和适用性,以及更好的术后效果。
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引用次数: 0
Abdominal aortic endograft infection: report of two cases and review of the literature. 腹主动脉内移植物感染2例报告并文献复习。
Pub Date : 2009-01-01
Gian Franco Veraldi, Bruno Genco, Annamaria Minicozzi, Marco Paolo Zecchinelli, Christian Segattini, Rostand Emmanuel Momo, Rosario Pacca

Endovascular prosthesis infection after exclusion of an abdominal aortic aneurysm is a rare, dramatic event and its diagnosis and treatment are extremely complex. This particular complication has been less well explored in the literature than others such as endoleaks, migration or stent rupture. The incidence of aorto-iliac stent-graft infection is almost 0.7%, while the infection rate in open surgery varies from 0.6% to 3%. Moreover, the infection can be early when it arises within 4 months of the implant or late when it arises after 4 months. Since 1991 only 94 cases of endograft infections have been reported in the world literature, to which our two cases need to be added, making a total of 96 cases. The first of our patients was diagnosed with an early infection that was successfully treated by explanting the infected graft followed by aortic reconstruction with a homograft. Six months after the operation the patient died of cardiac failure. The second case was a late infection which developed 8 years after the first intervention in a patient with chronic renal failure treated with dialytic therapy. After aneurysmectomy and stent-graft removal, a bifurcated dacron silver graft was implanted. The patient died of cardiogenic shock 40 days after surgery. The surgical treatment of this serious complication is associated with high perioperative morbidity and mortality rates and requires very careful planning of the operation.

腹主动脉瘤排除后血管内假体感染是一种罕见的、戏剧性的事件,其诊断和治疗非常复杂。这种特殊的并发症在文献中没有像其他并发症如内漏、移位或支架破裂那样得到很好的探讨。主动脉-髂支架移植感染的发生率几乎为0.7%,而开放手术的感染率从0.6%到3%不等。此外,在种植体4个月内出现的感染可能是早期的,或在4个月后出现的感染可能是晚期的。自1991年以来,世界文献仅报道了94例移植物感染,加上我们的2例,共计96例。我们的第一位患者被诊断为早期感染,通过移植感染的移植物,然后用同种移植物重建主动脉,成功地治疗了感染的移植物。手术后6个月,病人死于心力衰竭。第二个病例是在第一次干预后8年发生的晚期感染,患者患有慢性肾衰竭并接受透析治疗。在动脉瘤切除术和支架移植物移除后,植入分岔的涤纶银移植物。术后40天,患者死于心源性休克。这种严重并发症的手术治疗与高围手术期发病率和死亡率相关,需要非常仔细的手术计划。
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引用次数: 0
Gastro-oesophageal reflux and "epileptic" attacks: casually associated or related? Efficiency of antireflux surgery: a case report. 胃食管反流与“癫痫”发作:偶然关联还是相关?抗反流手术疗效1例报告。
Pub Date : 2009-01-01
Eugenio Fiorentino, Gianni Pantuso, Alessia Cusimano, Stefania Latteri, Achille Mastrosimone, Calogero Cipolla

Although a possible link between gastro-oesophageal reflux disease (GORD) and obstructive sleeping apnoea has already been reported in the literature, there has never been any suggestion of an association with epilepsy, and epileptic attacks have not so far been included among gastro-oesophageal reflux disease symptoms. We report the case of a patient with gastro-oesophageal reflux disease associated with a sliding hiatus hernia, a short oesophagus and oesophagitis, who for the last ten years had not only presented the typical symptoms of gastrooesophageal reflux, but also symptoms of obstructive sleep apnoea and epileptic-like attacks occurring occasionally and only during sleep. Partial posterior fundoplication was performed and considerably reduced the reflux symptoms, and in addition brought about a drastic decrease in the number of epileptic-like attacks. Our case suggests that epileptic-like episodes in patients with obstructive sleeping apnoea may well be linked to the simultaneous presence of GORD associated with hiatus hernia, and surgical treatment of GORD may bring about an improvement of the neurological problems.

虽然已有文献报道胃食管反流病(GORD)与阻塞性睡眠呼吸暂停之间可能存在联系,但从未有任何迹象表明其与癫痫有关,并且癫痫发作迄今未被纳入胃食管反流病症状。我们报告一例胃食管反流病合并滑动裂孔疝、短食管和食管炎的患者,在过去的十年中,他不仅表现出典型的胃食管反流症状,而且还表现出阻塞性睡眠呼吸暂停和癫痫样发作的症状,偶尔发生且仅在睡眠中发生。部分后侧基底部复制术大大减轻了反流症状,并大大减少了癫痫样发作的次数。我们的病例表明,阻塞性睡眠呼吸暂停患者的癫痫样发作可能与同时存在的裂孔疝相关的GORD有关,GORD的手术治疗可能会改善神经系统问题。
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引用次数: 0
[Use of an evaluation score for rectal mucosal prolapse]. [直肠粘膜脱垂评估评分的使用]。
Pub Date : 2009-01-01
Fabio Gaj, Antonello Trecca, Pietro Crispino

Rectal mucosal prolapse is characterised by the protrusion of the mucosa alone in the rectal lumen. The authors, after an experience conducted in ambulatory patients, have produced a score to classify the extent of rectal mucosal prolapse based on evaluation of qualitative and quantitative factors that should help in the correct management of proctological patients. A total of 30 patients with proctological symptoms during outpatient visits were submitted to a minimally invasive test in comparison to the traditional ones, using a simple gauze plug connected to the end of a suture thread, inserted in the rectal lumen and removed via the anus. The score designed by the authors made it possible to classify 96.6% of patients accurately. In 4 patients the score was equal to zero. In 12 patients there was a mucosal prolapse of less than 25% with a reduction score equal to 2.4 and therefore these were treated with a single rubber ligature (7 patients with classes a and b) and 5 patients were treated with the transfixed stitch technique (TST) (class c). In 10 patients a 50% mucosal prolapse of the anal circumference and a mean reduction score of 5.6 were found. In 5 of these patients (classes a and b) it was possible to perform a multiple ligature while the other 5 (class c) were treated with TST. In 3 patients a prolapse ranging from 50 to 75% with a mean reduction index of 8.1 was found. The therapeutic procedure preferred for these patients was TST. In one patient a circumferential prolapse was diagnosed with a reduction score of 11 treated with Longo's surgical technique. The mucosal prolapse score seems to be useful to stratify patients more precisely in the choice of surgical intervention and during follow-up. The plug test is a minimally invasive test, useful for the application of the rectal mucosal prolapse score.

直肠粘膜脱垂的特征是直肠腔内粘膜的突出。作者根据门诊病人的经验,根据定性和定量因素的评估,产生了一个评分来分类直肠粘膜脱垂的程度,这应该有助于直肠病人的正确管理。与传统的微创检查相比,共有30例门诊期间出现直肠症状的患者接受了微创检查,使用简单的纱布塞连接缝线末端,插入直肠管腔并通过肛门取出。作者设计的评分可以准确地对96.6%的患者进行分类。4例患者得分为零。在12例患者中,粘膜脱垂小于25%,复位评分为2.4,因此采用单一橡胶结扎治疗(7例患者为a级和b级),5例患者采用穿刺缝合技术(TST)治疗(c级)。在10例患者中,发现肛门周围粘膜脱垂50%,平均复位评分为5.6。其中5例患者(a类和b类)可以进行多次结扎,而其他5例患者(c类)接受TST治疗。3例患者脱垂50% ~ 75%,平均复位指数8.1。这些患者首选的治疗方法是TST。其中一名患者被诊断为圆周脱垂,采用Longo手术技术治疗,复位评分为11分。粘膜脱垂评分似乎有助于在手术干预的选择和随访期间更准确地对患者进行分层。栓试验是一种微创试验,对直肠粘膜脱垂评分有用。
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引用次数: 0
[Integrated multidisciplinary treatment of colorectal neoplasms]. 【结直肠肿瘤多学科综合治疗】。
Pub Date : 2009-01-01
Fabio Procacciante, Fabiana Caciolo, Giulia Diamantini, Donato Flati, Franca Pitasi, Valmira Abilaliaj, Alfredo Covotta, Enzo Banelli, Marisa Di Seri, Giorgio Citone

In this retrospective study, the modality and advantages of the multidisciplinary diagnostic work-up and therapy regarding colorectal neoplasm were analysed. Over the period 2004-2008, 63 patients underwent multidisciplinary treatment for colorectal cancer. All patients underwent surgery (laparoscopic/open). Exeresis was supplemented by adjuvant chemotherapy in those cases beyond IIA stage; all cases of extraperitoneal rectal and anal canal neoplasms plus one case of carcinoma of the transverse colon, initially inoperable, underwent neoadjuvant radiotherapy plus chemotherapy. The treatment was initiated approximately 3 weeks after the diagnosis. Fifty-four percent of patients with colonic and upper rectal neoplasms were given adjuvant chemotherapy, starting around 4 weeks after surgery. Exeresis was performed in those patients with extraperitoneal rectal and anal canal neoplasms (12.7%) about 6-8 weeks after they had completed neoadjuvant therapy. At the end of the treatment, 76% of the overall total numbers of patients were in good condition (follow-up 4-50 months). The remaining 24% suffered recurrences about 13 months after the treatment for colonic and upper rectal neoplasm, and 8 1/2 months after treatment for extraperitoneal rectal/anal canal neoplasms. Seventy-five percent of the recurring cases underwent treatment again, with 50% success; the others are still undergoing treatment. The best therapeutic results were obtained by programmed integration of the various diagnostic-therapeutic steps according to an algorithm which we elaborated to evaluate all types of neoplasm at any stage of illness.

本文回顾性分析了结直肠肿瘤多学科诊断、检查和治疗的方式及优势。在2004-2008年期间,63名患者接受了结直肠癌的多学科治疗。所有患者均接受手术(腹腔镜/开放)。超过IIA期的患者行辅助化疗;所有腹膜外直肠肛管肿瘤加1例横结肠癌,最初不能手术,均行新辅助放疗加化疗。诊断后约3周开始治疗。54%的结肠和上直肠肿瘤患者在手术后4周左右开始接受辅助化疗。腹腔外直肠肛管肿瘤患者(12.7%)在完成新辅助治疗后约6-8周进行运动。治疗结束时,76%的患者状态良好(随访4-50个月)。其余24%的患者在结肠和上直肠肿瘤治疗后约13个月复发,在腹腔外直肠/肛管肿瘤治疗后约8个半月复发。75%的复发病例再次接受治疗,成功率为50%;其他人仍在接受治疗。根据我们制定的一种算法,将各种诊断-治疗步骤程序化整合,以评估疾病任何阶段的所有类型的肿瘤,从而获得最佳的治疗结果。
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引用次数: 0
Perineal hernia: a case of outlet dysfunction. 会阴疝:出口功能障碍1例。
Pub Date : 2009-01-01
Lino Succi, Nnawuihe Luca Ohazuruike, Conchita Emanuela Oliveri, Antonino Carlo Privitera, Serafina Prumeri, Antonino Politi, Antonio Garufi, Giuseppe Randazzo

This article describes and discusses a successfully treated case of a primary posterior perineal hernia which is a rare cause of outlet dysfunction. A 46-year-old female patient had a 6 cm left para-anal protrusion and a 7-year history of outlet dysfunction. The perineal hernia orifice was closed via an abdominal approach using both a polypropylene mesh and a Parietex Composite Net. A rectopexy to the promontory of the sacrum was then performed. Moreover, after 6 months' follow-up, the patient presented a sense of incomplete evacuation and underwent a prolassectomy to treat a hidden rectal prolapse. This clinical case shows that the surgical treatment of a pelvic pathology can be successful for the correction of a serious functional defect such as outlet dysfunction.

本文描述并讨论了一例成功治疗的原发性会阴后疝,这是一种罕见的出口功能障碍的原因。46岁女性,左侧肛旁突出6厘米,出口处功能障碍7年。会阴疝口经腹部入路闭合,使用聚丙烯网和Parietex复合网。然后行骶骨角直肠置换术。随访6个月后,患者出现排空不完全感,行隐蔽性直肠脱垂切除术。这个临床病例表明,手术治疗盆腔病理可以成功地纠正严重的功能缺陷,如出口功能障碍。
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引用次数: 0
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Chirurgia italiana
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