2017年 · 第55卷第10期

Urachal mass is a rare clinical disease^[1]Early diagnosis is difficult, easy to delay treatment due to misdiagnosis, and poor prognosis; Moreover, the differentiation between benign urachal lesions and urachal carcinoma is relatively difficult. Therefore, improving the awareness of urachal tumors, especially urachal carcinoma, is helpful to improve the diagnosis rate and improve the prognosis. We retrospectively analyzed the data of 19 patients with urachal tumors diagnosed and treated in the urology department of our hospital, and now report the clinical characteristics, treatment methods and prognosis of patients with benign and malignant urachal tumors as follows.

At present, mitral valvuloplasty can successfully repair anatomically appropriate mitral valve lesions^[1]。 However, the indications, timing and methods of surgery in children with anatomically inappropriate mitral valve disease are still controversial^[2]。 We retrospectively analyzed the early and middle-term efficacy of patients with congenital heart disease complicated with mitral valve disease treated in the cardiac center of our hospital who underwent mitral valvuloplasty at the same time as the correction of cardiac malformations.

The patient was a 42-year-old male. He was admitted to our hospital in May 2016 due to the physical examination of a cystic mass in his right upper abdomen. He had no fever, abdominal pain and distension, no history of going out, and no positive findings in the physical examination. Since the onset of the disease, the patient's mental appetite and sleep are acceptable, the defecation and defecation are normal, and the weight has not changed significantly. Has a history of hepatitis B for more than 10 years and has not taken medication; History of hyperglycemia, coronary heart disease, diabetes, no history of surgical trauma, no history of blood transfusion and blood products, and unknown history of vaccination were denied. Upper abdominal CT scan: 9.4 cm ×7.6 cm ×9.2 cm massive low-density shadow was seen in the right upper abdomen, with clear boundary, but no enhancement was seen in enhanced CT (Figure 1)； Three-dimensional reconstruction showed that the cyst had a clear border, adhered to the lower pole of the right kidney, and part of the ascending colon was compressed and displaced to the left. Preoperative diagnosis: Retroperitoneal cyst, considering lymphatic cyst. Laparoscopic exploration: A cystic mass with a size of 10 cm ×8 cm ×10 cm was observed at the root of the right renal vein and mesenteric vessel, which was tightly adhered to the renal fat sac. Laparoscopic resection of the retroperitoneal cyst was performed, and the root of the cyst was found to be connected to a duct. Intraoperative rapid pathological examination was performed, and it was confirmed that it was ureter. Considering the shortened ureter and the difficulty of laparoscopic anastomosis, it was decided after discussion with the urologist to perform an open ureterostomy with an indwelling 6F double J tube. Postoperative pathological report: sparganosis mansoni (Figure 1)。 Immunohistochemical results: Smooth muscle actin (+), S-100 (-), vimentin (+), HMB 45 (-), CD 68 (-). Treatment with oral pyroquinone tablets at discharge. After re-examination 1 month later, the patient did not complain of any discomfort, and the double J tube was extracted by cystoscopy. The blood image and urine routine were normal, and the serum antibody to Sparganus mansoni was negative. No abnormalities were found in pelvic and abdominal ultrasound.

The patient was a 56-year-old male. He was admitted to the hospital on January 5, 2015 due to "gross hematuria for 1 d". The patient developed full-course macroscopic hematuria without obvious trigger 1 day ago, with small blood clots and blood strips discharged, no frequent urination, urgency, painful urination, no waist and abdominal pain, no fever, and stool as usual. No previous special medical history. Physical examination: body temperature 36.6 ℃, heart rate 70 beats/min, 20 breaths/min, blood pressure 135/80 mmHg (1 mmHg =0.133 kPa). Abdominal and urological specialist examination showed no abnormalities. Laboratory tests: urinary occult blood (+ + +), urinary white blood cells (-), urinary protein (+). The results of urinary system ultrasound and enhanced CT scan showed no abnormalities in bilateral kidney and bladder. No tumor cells were revealed on urine exfoliation cytology. Cystoscopy was performed on the second day after admission. There were no new organisms in the bladder, and there was intermittent ejection of bloody urine from the right ureter (Figure 1), no new organism in the right ureter was found in hard ureteroscopy, and a protruding mass in the renal pelvis was found in flexible ureteroscopy, with a wide base, clear boundary, smooth surface and visible strip structure, and local active bleeding. Biopsy of renal pelvic tumor, pathological results showed: fibrous tissue in renal pelvis (Figure 2)。 Because the possibility of malignant lesions could not be excluded, laparoscopic resection of the right kidney, right ureter and bladder sleeve was performed after communication with the patient and family members. The postoperative pathological results showed: right pelvic cavernous hemangioma (Figure 3)。

A 37-year-old male was admitted to the Department of Cardiac Surgery of the First Hospital of Jilin University on July 1, 2016 due to "cardiac murmur found during physical examination". No history of hypertension, diabetes and infectious diseases. Physical examination after admission: body temperature 36.6 ℃, pulse 66 beats/min, breathing 16 beats/min, blood pressure 126/75 mmHg (1 mmHg =0.133 kPa); In the recumbent position, no dry or wet rales were heard in both lungs, no bulge in the precordial area, the apical beat was located about 1 cm outside the midline of the left clavicle of the fifth intercostal area, and tremor was palpable at the apex, and the heart boundary was slightly enlarged to the left. The auscultation heart rate was 66 beats/min, the heart rhythm was uniform, and a grade 4/6 systolic jet-like murmur could be heard in the auscultation area of the aortic valve; The liver and spleen were not palpable, and there was no edema in both lower limbs. There were no abnormalities in laboratory tests and no abnormalities in chest X-rays after admission; Electrocardiogram revealed sinus bradycardia. Echocardiography showed: severe aortic stenosis with mild regurgitation; The peak supravalvular flow velocity was 509 cm/s, the pulmonary artery pressure was 103 mmHg, and the mean transvalvular pressure difference was 67 mmHg; The left ventricular end-diastolic diameter was 56 mm and ejection fraction was 61%. Preoperative diagnosis: Valvular heart disease, severe aortic stenosis with mild regurgitation, cardiac function (New York Heart Association) Class II. Aortic valve replacement was performed on 07 Jul 2016 under general anesthesia. The patient took the recumbent position, split the middle of the sternum, separated the excess tissue outside the pericardium, cut out the pericardium with a size of 8 cm ×9 cm longitudinally, fixed the pericardium in 0.6% glutaraldehyde solution for 10 min, and then washed in 0.9% sodium chloride solution three times for 6 min each time. After the routine establishment of cardiopulmonary bypass, when the nasopharyngeal temperature dropped to 35 ℃, the ascending aorta was blocked, the root of the aorta was perfused with arrest fluid, and the aorta was incised left and right transversely on the root of the aorta. Three leaflets of the aorta were removed, and the new leaflet size was measured with a surgical leaflet measuring instrument. The right coronary sinus, left coronary sinus and no coronary sinus were 27, 23 and 25 mm, respectively. The edge lines of each new leaflet were marked on the pericardium with a special template, and each valve was cut out separately. First, the right coronary sinus valve was reconstructed, and a 5-0 non-absorbable suture was applied to suture the midpoint of the pericardial slice to the cross-junction between the left coronary sinus and the non-coronary sinus, and the other half was sutured from the midpoint of the pericardial slice to the cross-junction between the left coronary sinus and the right coronary sinus. When the suture reached the cross-junction, it penetrated the aortic wall vertically. The suture method of the rest of the valve leaflets was the same as before. Then, two 4-0 non-absorbable suture double-ended needles were applied to penetrate the aorta vertically in an inverted trapezoid shape, and the valve angle tissue of the pericardium was fixed on the aortic wall. Felt pieces were tied and fixed outside the aortic wall, and the 5-0 non-absorbable suture stitched to the cross-junction was also tied and fixed on another hair gasket. After completion of leaflet reconstruction (Figure 1) Water injection experiment showed that the valve leaflets were well aligned. After cardiac rebeat, intraoperative transesophageal echocardiography showed good leaflet opening and closing (Figure 2), micro-regurgitation of the aortic valve. The time of surgical aortic occlusion and cardiopulmonary bypass were 165 min and 218 min, respectively. The patient recovered and was discharged 7 days after surgery. Echocardiography at the third month after surgery showed that the aortic valve was open and closed well, with minor regurgitation and a transvalvular pressure difference of 14 mmHg.

In the past ten years, the morbidity and mortality of colorectal cancer have shown an obvious upward trend, and the patients tend to be younger. The problems related to its diagnosis and treatment have gained keen attention from academic circles. On June 2-6, 2017, the 53rd Annual Meeting of the American Society of Clinical Oncology (ASCO) was held in Chicago. We briefly introduced several hot topics in the field of colorectal cancer diagnosis and treatment at this ASCO Annual Meeting, hoping to enlighten our colleagues to carry out related work.