目的 分析新型冠状病毒肺炎(COVID-19)患者的薄层CT特征.方法 回顾性分析51例确诊的COVID-19患者,对其发病后的薄层CT表现进行分析总结.结果 51例患者中,病变累及双肺38例(74.51％),累及单肺12例(23.53％),胸部CT无明显异常1例(1.96％).病变累及肺下叶48例(94.12％),仅累及肺上叶2例(3.92％),病变主要沿支气管血管束及胸膜下分布.病变形态学表现为磨玻璃密度影48例(94.12％),实变影42例(82.35％),实变影伴磨玻璃密度影41例(80.39％),细网格影或"铺路石样"改变23例(45.10％),空气支气管征30例(58.82％),血管增粗征13例(25.49％).31例CT随访病例中,16例(51.61％)经抗病毒、抗感染等积极治疗后病变范围缩小,密度减低,12例(38.71％)治疗效果不佳,肺内病变范围扩大,密度增高,由局限性进展为多发、弥漫性,3例(9.68％)治疗后肺部病灶变化不明显.结论 COVID-19患者薄层CT最主要特征是下叶胸膜下分布磨玻璃密度影伴间质性改变.

由2019新型冠状病毒感染引起的肺炎目前正在我国肆虐.新型冠状病毒肺炎可以在人际间传播已经证实.普外科急腹症是人群常见病、多发病,有急诊手术可能.在新型冠状病毒肺炎流行的形势下,外科医生应该按照指南和诊疗常规,顺应形势,根据不同的风险等级做好自身防护措施的同时,做好普外科急腹症的分类诊疗,合理选择诊疗方式.

目的:探讨腹股沟疝术后下肢深静脉血栓形成(lower extremity deep venous thrombosis,LEDVT)的治疗经验.方法:2012年1月至2017年12月我院收治的2 835例腹股沟疝病人,其中7例(0.25％)病人术后发生LEDVT.结果:7例腹股沟疝病人术后发生LEDVT,其中l例双下肢,4例左下肢,2例右下肢.经抗凝和对症支持治疗,均顺利出院.未发生肺栓塞和死亡.结论:腹股沟疝围术期,要高度重视LEDVT的发生.积极预防、迅速诊断和治疗是防治LEDVT的关键.

患者女,52岁,咳嗽、咳痰、发现肺部占位1月余,抗感染治疗无效;无石棉接触史。查体:右肺呼吸音稍减弱,闻及少许湿啰音。CT:右肺中叶约4.5cm×3.9cm、边界尚清类圆形肿块,密度不均匀;增强后呈中度强化,内见坏死区（图1）。诊断:右肺中叶占位性病变,不除外肺癌。行开胸肿瘤切除术,术中见6cm×5cm×4cm质硬肿块,未侵及脏层胸膜及膈肌。病理:光镜下肿瘤组织与周边肺组织分界模糊,未见包膜,肿瘤细

患者男,20岁,4个月前发现右侧阴囊内黄豆大小肿物,质硬,后逐渐增大,偶感持续性隐痛,加重10余天,伴同侧阴囊皮肤红热.查体:右侧阴囊可触及约10 cm肿块,质硬,活动度较差,触压痛不明显.超声:右侧阴囊探及巨大异常回声的肿块,内部回声不均匀,可见线状血流信号(图1A).超声提示:右侧阴囊内占位性病变,考虑精原细胞瘤.CT:右侧睾丸明显增大,可见巨大类圆形软组织肿块,约12.71 cm×6.83 cm×7.04 cm,其内密度不均匀,可见不规则坏死区及点状钙化影,边界尚清;增强扫描肿块实性成分呈中度强化(图1B),肿块由粗大纡曲的睾丸动脉供血,供血动脉起自腹主动脉(图1C).

Kummell病(创伤后椎体迟发性骨坏死)是一种发病机制及诊断方法尚不完全明确的少见疾病,其主要特征为轻微外伤导致脊柱疼痛,经过长短不一的无症状期后再次出现相同部位疼痛不适,后逐渐进展为脊柱后凸畸形.因该病报道时X线检查设备尚未应用于临床,无影像学证据,未引起临床医师的重视.从而造成骨科医师对于Kum-mell病的认识不足,导致了疾病的漏诊或误诊,这也是其低报道率的原因之一.随着影像学技术的发展,近年来对于Kummell病的研究报道日益增多,似乎表明Kummell病并非罕见.为了提高人们对Kummell病的进一步认识,现对Kummell病的相关研究作一综述.

Objective To investigate the clinical application of traditional suture and tension-free repair in treating adult umbilical hernia .Methods Clinical data of 58 patients with adult umbilical hernia were analyzed retrospectively .This series of patients included 15 patients who underwent traditional suture repair ( traditional suture group ) and 43 patients who underwent tension-free repair ( tension-free repair group).Statistical analysis was made using SPSS 13.0 software.Curative effect was compared between the two groups using Student ’ st test, and complications were compared between the two groups using the chi-square test.P<0.05 was considered statistically significant .Results Mean operation time was 48.5 minutes and 62.3 minutes in the conventional suture group and the tension-free repair group , respectively (t=2.058, P<0.05), whereas mean postoperative hospital stay was 4.5 days and 3.8 days respectively, with no differences between the 2 groups (t=1.137, P>0.05).Hospitalization expenses of the tension-free repair group was higher than that of the traditional suture group (t=3.465, P=0.001).Follow-up time (72.4%) ranged from 4 to 54 months.Postoperative complications between the two groups showed no significant difference .There was one case of subcutaneous fluid in the tension-free repair group , one case of postoperative chronic pain in each group , and no postoperative wound infection and hernia recurrence in both groups.Conclusion Good clinical outcomes were achieved by traditional suture or tension-free repair in treating adult umbilical hernia;however different indications should be followed for individualized treatment .

目的:初步探讨腹腔淋巴管瘤的临床表现、影像学特点及诊断治疗方法.方法:回顾分析我院2008-01/2012-12收治的18例腹腔淋巴管瘤患者的临床资料.结果:腹腔淋巴管瘤形状多规则,界限大多清晰,成圆形、椭圆形或分叶状,直径7-19 cm不等.18例患者均行手术治疗,病理检查示肿瘤由形态不规则的、扩张的淋巴管构成,术后恢复良好,均无复发.结论:腹腔淋巴管瘤是临床少见的腹腔疾病,术前需借助体检、影像学检查综合分析,手术治疗预后较好.

目的探讨腹壁切口疝的病因、手术治疗的方式与效果,总结腹壁切口疝的治疗经验。方法对128例腹壁切口疝患者的临床资料进行回顾性分析。结果 128例患者术后恢复良好,平均住院9.5d,无严重并发症。其中有11例发生切口内积液,经穿刺抽吸、加压包扎及理疗后消失,无切口感染;1例患者有窦道形成,经取出补片后治愈。128例患者平均随访33个月,无复发。结论应根据切口疝患者的机体状况、腹壁缺损大小、腹内压升高情况等合理采用人工合成材料修补或直接缝合修补;加强围术期处理并尽量避免腹壁切口疝的诱发因素,可以获得良好的治疗效果。