先天性胆管囊肿的外科治疗（附131例分析）

本文报告先天性胆管囊肿１３１例，其中Ⅰ型８９例，Ⅱ型２例，Ⅲ型４例，ＩＶ．型２５例，Ｖ型１１例。１１９例施行手术治疗。作者认为：对先天性胆管囊肿的手术治疗，首次手术时应尽可能切除肝外胆管囊肿，有困难时可大部切除，行高位大口胆肠吻合。对局限于肝段或一侧肝叶的胆管囊肿，可行肝段或一侧肝叶切除。对左右肝叶均有胆管囊肿者，可切除病变较重的肝叶或部分肝组织，解除主要肝管的狭窄与扩张，行肝管空肠吻合术。     

成人胆总管囊肿的诊治

目的 进一步探讨成人胆总管囊肿的诊断和治疗。方法 回顾性分析１９９５年１月至１９９９年１月手术室治疗成人胆总管囊肿４２例资料,术后随访平均为３５个月,随访率为８０％。结果 行囊肿十二指肠吻合术２例,囊肿空肠Ｒｏ７ｕｘ－Ｙ吻合术１０例,行囊肿切除加肝总管空肠Ｒｏｕｘ－Ｙ吻合术３０例;术后胆瘘２例,腹腔出血、胰瘘各１例,无手术死亡。结论 囊肿切除加肝总管空肠Ｒｏｕｘ－Ｙ吻合术应为肝外胆管囊肿治疗的首选     

成人先天性胆总管囊肿的诊断与治疗体会

目的总结成人先天性胆总管囊肿的诊断和治疗方法。方法回顾分析我院2000年1月至2009年10月19例经手术治疗的成人先天性胆总管囊肿患者的临床资料,全组病例均行囊肿切除、肝总管空肠Roux．Y吻合术,其中有二次胆道手术史的1例合并肝内胆管扩张及肝内胆管结石加行左肝外叶切除术．另一例因肝总管狭窄加行高位胆管成型术。结果术后并发胆漏1例．经非手术治疗治疗效果欠佳,再次手术引流治愈,本组无死亡病例。结论囊肿切除加肝总管空肠Roux-Y吻合术是肝外胆管囊肿治疗的首选方法,局限性肝内胆管囊肿可行肝叶切除术。     

成人先天性胆管囊状扩张症的临床分析

目的:探讨成人先天性胆管囊状扩张症的诊断及治疗。方法:回顾性分析1996年1月—2012年5月收治的53例成人先天性胆管囊状扩张症患者的临床资料。结果:53例患者均行手术治疗,Ia,Ib,Ic型39例和II型4例行囊肿完整切除、肝总管空肠Roux-en-Y吻合术,另3例Ia型行囊肿大部分切除、肝总管空肠Roux-en-Y吻合术;IVa型1例行肝左外叶切除、囊肿完整切除、胆管成形、肝总管空肠Roux-en-Y吻合术,另1例行囊肿完整切除、肝总管空肠Roux-en-Y吻合术;V型1例行左肝内胆管囊肿切除术;2例癌变患者,其中1例行癌变囊肿切除、局部转移淋巴结清扫术,1例行囊肿切除、左肝内胆管肿瘤切除术。53例手术患者中获随访42例,随访时间为6个月至3年,良性患者情况良好;2例癌变患者,1例术后生存26个月,死于肿瘤复发,多系统器官功能衰竭,1例术后26个月肿瘤复发,肝转移,再次手术行左半肝切除、S5(第V段肝脏)切除、肝肠吻合术,术后2个月出现肿瘤进展,死于多系统器官功能衰竭。结论:成人先天性胆管囊状扩张症的手术方式选择与治疗效果密切相关,不同的临床分型应选择不同的手术方式。     

成人先天性胆总管囊肿的诊断及治疗

目的探讨成人先天性胆总管囊肿的诊断和治疗。方法对我科收治的37例成人先天性胆总管囊肿患者的资料进行回顾性分析。术前B超诊断正确率为91．9％(34／37)。36例行囊肿切除和肝总管空肠Roux-Y吻合术．1例因癌变行胰十二指肠切除术。结果共随访29例，随访率为78．4％，平均随访43个月，未发现恶变者。结论B超应作为先天性胆总管囊肿的首选检查．囊肿切除和肝总管空肠Roux-Y吻合术应作为首选术式，早期诊断，早期根治性治疗，是先天性胆总管囊肿诊治的关键。     

先天性胆总管囊肿的外科治疗

目的 比较先天性胆总管囊肿不同术式的治疗效果。方法 对1985年1月-1998年12月57例先天性胆总管囊肿的术式及疗效进行分析。结果 以I型为主(44例)占77．2％。B超确诊率为84．2％。57例中,囊肿切除、肝总管空肠Roux—Y吻合37例,囊肿大部切除,胆管与空肠Roux—Y吻合12例。其中有14例行囊肿引流术后再次行囊肿切除术。囊肿切除术明显降低胆管炎的复发,术后随访治疗效果优良占89．1％。结论 囊肿切除、胆管与空肠Roux-y吻合术应作为胆总管囊肿的首选术式,囊肿切除困难时应尽量大部分切除,并行大口胆管肠吻合。     

姑息性手术治疗不能切除的胰头癌

本文报告我院１０年间姑息性手术治疗不能切除的胰头癌１００例。最常见的症状为黄疸（８１％），腹痛或背痛（５２％），体重减轻（４３％）。手术方法：肝总管空肠Ｒｏｕｘ－Ｙ形吻合术４７例，肝总管空肠Ｒｏｕｘ－Ｙ形吻合和胃空肠吻合术３７例，胆囊空肠Ｒｏｕｘ－Ｙ形吻合术８例，肝内或肝外胆管置管外引流术８例。手术死亡率为６％，胆肠吻合和预防性胃空肠吻合术的手术死亡率为５．４％。近期并发症为３９％，其中伤口感染多见。远期并发症为２３％，其中以胆囊空肠吻合术后的胆管炎和黄疸多见。我们认为姑息性手术治疗不能切除的胰头癌应尽量选择肝总管空肠Ｒｏｕｘ－Ｙ形吻合术，同时作预防性胃空肠吻合。     

成人先天性胆管囊肿的诊断与治疗

目的 分析成人先天性胆管囊肿的诊断和治疗。方法 自1991年9月至1998年11月共收治33例先天性胆管囊肿，B超诊断正确率26例（78.78%)，31例行囊肿切除和肝总管空肠Roux-en-Y吻合术，2例因癌变分别行肝门胆管癌根治术和保留幽门的胰十二指肠切除术，手术死亡率3.03%。结果 随访26例，随访率78.78%，平均随访34个月，约80％的病人能从事一般体力劳动，未观察到恶变。结论 B超应作为先天性胆管囊肿的首选检查，囊肿切除和肝总和肠Roux-en-Y吻合术应作为首选术式，早期诊断，早期治疗，控制囊肿发展，减少并发症是改善先天性胆管囊肿预后的关键。     

成人先天性胆总管囊肿的诊断及治疗

目的 探讨成人先天性胆总管囊肿的诊断和治疗。方法 对收治的53例成人先天性胆总管囊肿病人进行分析。B超诊断正确率90．57％(48／53)。49例行囊肿切除和肝总管空肠Roux-Y吻合术。2例因癌变分别行肝门胆管癌根治术和胰十二指肠切除术。手术死亡率1．89％。结果 随访43例，随访率81．13％，平均随访32个月，约90％的病人能从事一般体力劳动，未观察到恶变者。结论 B超应作为先天性胆总管囊肿的首选检查，囊肿切除和肝总管空肠Roux-Y吻合术应作为首选术式，早期诊断，早期治疗，控制囊肿发展，减少并发症是改善先天性胆总管囊肿的关键。     

不同类型胆管囊肿的手术治疗

目的　总结各种类型胆管囊肿手术治疗的经验。方法　对 5 2例手术治疗的 5种类型胆管囊肿进行回顾性分析。 5 2例中行胆总管囊肿切除、肝管空肠吻合 3 8例 ;囊肿部分切除、残余囊肿空肠吻合 2例 ;憩室型胆总管囊肿切除、T管支撑引流术 2例 ;胆总管末端囊肿行囊肿空肠吻合 1例 ;肝内科胆管囊肿行肝外胆管囊肿切除、肝管空肠Y型吻合 4例 ;肝叶或肝方叶切除、肝管空肠吻合 5例 ;结果　 5 2例均治愈出院。 45例随访 4个月～ 17年 ,42例恢复良好。结论　胆管囊肿切除、肝管空肠Roux en Y吻合术为治疗胆管囊肿的首选术式。掌握各类型囊肿切除的适应证、切除方法和胆道重建内引流的原则是提高手术疗效的关键。     

Clinical statistics on testicular tumors in the Japanese during the 1970's

A statistical analysis was made by computer on 511 cases of testicular tumor experienced at 14 facilities in Japan between 1970 and 1979. The age distribution of the patients had two peaks, one under 3 years (15%) and the other between 25 and 34 years (32%). Forty percent of the patients were office workers and 76% were college graduates. Fifty percent of the patients had 0 to 1 sibs. The blood type distribution was similar to that for the whole Japanese population. Six percent of the patients had a past history of trauma, and no relation with cell type was detected. Sixty nine percent of the patients were married and 31% were not married. Sixty seven percent of the patients over 30 had seminoma, and 78% of the patients under 29 years old had non-seminoma. Seminoma was rare in patients under 9 years old. Histologically, 75% were simple type, and 25% were mixed type. Forty three percent of the cases were seminoma and 57% were non-seminoma. Of the stage I cases, 78% and 57%, and of the stage III cases 7 and 28%, respectively, were seminoma and non-seminoma, many of the non-seminoma being at high stage. The 5-year survival rate for the 75 patients under 9 years old was 96%, and that for the 341 patients over 15 years was 70%, the survival rate for the patients under 9 years being significantly higher. The 5-year survival rate for stage I, II and III seminoma was 100, 65 and 0%, respectively, while that for non-seminoma was 93, 56 and 8%, respectively. The survival rate for stage I was higher for seminoma cases than for non-seminoma cases. No difference was detected between survival rate for stage II or III between seminoma and non-seminoma. The survival rate for seminoma did not differ with the time when the surgery was performed, but for the patients with non-seminomatous tumors, the survival rate was higher for the patients operated within one month than those operated later. The survival rate was not related to the weight of the extracted testicle. The 5-year survival rate for the patients with normal body temperature was 78% whereas that for the patients who had fevers was 32%. The 5-year survival rate for the patients not accompanied by abdominal tumors was about 80%, whereas that for the patients with palpated abdominal tumors was 42%.(ABSTRACT TRUNCATED AT 400 WORDS)     

铜离子电化学疗法治疗痔出血及痔脱出的临床研究

目的　利用铜离子电化学疗法治疗痔出血及痔脱出。方法　 3 73例痔出血患者按查随机数字表的方法随机分为实验组与对照组。实验组 2 0 2例 ,年龄 3 6～ 76岁 ,其中单纯内痔 79例 (一期 2 8例 ,二期 3 3例 ,三期 18例 ) ,混合痔 12 3例 ;对照组 171例 ,其中单纯内痔 64例 (一期 3 2例 ,二期 2 8例 ,三期 4例 ) ,混合痔 10 7例。痔脱出患者 5 6例 ,未设对照组。痔出血患者实验组及痔脱出患者进行铜离子电化学疗法治疗 ,常规肠腔内消毒后 ,将特制的铜针刺入出血及脱出的痔核 ,深约 8～ 15mm ,按照设置好的参数用铜离子电化学治疗仪进行治疗 4min 40s ,以同一方法逐一治疗各个痔核。对照组使用痔疮宁栓及九华膏治疗。结果　痔出血实验组治愈率为 98.0 % ,显效率为 1.5 % ,有效率为 0 .5 % ,无效率为 0。对照组治愈率为 11.1% ,显效率为 2 4.6% ,有效率为 2 8.1% ,无效率为 3 6.3 %。两组比较实验组疗效好于对照组 (U =44 .6,P<0 .0 0 1)。痔脱出治愈率为 48.2 % ,显效率为 3 3 .9% ,有效率为 17.9%。治疗中患者无明显疼痛感 ,治疗后 4h可恢复工作。结论　铜离子电化学疗法治疗痔出血优于痔疮宁栓及九华膏 ,前者可以有效地治疗痔疮出血和痔脱出 ,避免了激光、注射等方法的不安全因素 ,简便、安全 ,不影响正常     

一线化疗方案联合血管生成抑制剂治疗四肢成骨肉瘤随机、对照、多中心研究的初步报告

 目的 评价一线化疗方案联合重组人血管内皮抑制素治疗四肢骨肉瘤的疗效及安全性,为寻找骨肉瘤化疗新的药物和评价化疗方案提供依据。方法 采用随机、对照和多中心的研究方法,将63例确诊为骨肉瘤的患者随机分为试验组(32例)和对照组(31例),剔除和脱落9例,有效病例54例(试验组29例、对照组25例)。试验组采用阿霉素、顺铂、氨甲喋呤、异环磷酰胺联合重组人血管内皮抑制素方案,对照组使用阿霉素、顺铂、氨甲喋呤、异环磷酰胺方案。采用中位无进展生存时间、临床受益率、无进展生存率、保肢率、生存率等指标来评价两组疗效。通过比较两组不良事件发生率来评价重组人血管内皮抑制剂的安全性。结果 试验组中位无进展生存时间18.9个月,对照组为13.1个月,两者差异无统计学意义。试验组临床受益率89.7%、无进展生存率37.9%、生存率65.5%、保肢率89.7%,对照组分别为88.0%、36%、68%和96.0%,上述四项指标两组间差异均无统计学意义。结论　在目前随访期内采用重组人血管内皮抑制剂治疗在控制肿瘤进展和患者生存方面与对照组比较尚未见明显差异。使用重组人血管内皮抑制剂未发现相关的毒性反应,也未有因其而增加基础化疗毒性反应的报告。     

Adenocarcinoma of the extrahepatic biliary tree.

Increasing survival rates for carcinoma of the biliary tree could reflect the selection of patients for referral to a specialist centre as well as modern improvements in diagnosis and treatment. To determine the true incidence and outcome of biliary cancer, the records of 243 unselected Bristol patients were reviewed retrospectively over a 15-year period. Mean age was 64 years. Gallstones were associated in 38% of cases. Sixty-nine of 87 patients with gallbladder carcinoma were submitted to laparotomy. The operative (30-day) mortality rate was 56% and the one-year survival rate was 7%; one patient with an unexpected carcinoma is alive 7 years after cholecystectomy (1% five-year survival rate). Among 31 patients with carcinoma of the ampulla the operative mortality rate was 27%; one-year and five-year survival rates were 46% and 15%. Bile duct cancers (n = 125) arose proximal to the entry of the cystic duct (n = 63), distal to that point (n = 46) or diffusely (n = 16). For proximal cholangiocarcinoma the operative mortality rate was 38% and 1-year survival rate 17%; no patient lived for 2 years. For distal cholangiocarcinoma the operative mortality rate was 45% and one-year survival rate 26%; no patient lived for 3 years. Only palliative procedures were undertaken for diffuse cholangiocarcinoma; 2 patients survived 1 year (13%). Overall 5 patients with carcinoma of the extrahepatic biliary tree appear to have been cured (2%).     

Ependymomas of the spinal cord and cauda equina: An analysis of 26 cases and a review of the literature

STUDY DESIGN: Retrospective review. OBJECTIVES: To clarify the clinical features of patients with spinal ependymomas and to compare the clinical results between the patients in whom microsurgical technique and spinal cord monitoring were used intraoperatively and the patients in whom they were not used. SETTING: Keio University Hospital, Tokyo, Japan. METHODS: Twenty-six consecutive patients with spinal ependymomas were treated surgically between 1958 and 1995. All patients underwent tumor resection through a posterior approach. Complete tumor resection was possible in 15 patients (57. 7%), and subtotal tumor resection (more than 90%) was done in two patients (7.7%). Only a partial tumor resection (less than 90%) was performed in the remainder of the patients (34.6%). The operative results of the patients were evaluated by the Japanese Orthopaedic Association Scoring System (JOA score) and its recovery rate. RESULTS: The overall average recovery rate was 18.3%. The mean recovery rate was 14.4% in cervical lesion, 11.1% in thoracic lesion and 40% in lumbar lesion. The recovery rate of eight patients with cervical ependymomas who underwent tumor resection under both microscopic surgical procedure and intraoperative spinal cord monitoring was 37.1% although the recovery rate of the rest of the patients was -1.6%. There was a statistical difference between the two groups (P<0.02). The survival rate of patients following complete excision was statistically better compared to that of patients after incomplete resection. CONCLUSION: Both microsurgical technique and spinal cord monitoring are indispensable to achieve total removal of ependymomas and to obtain improvement of neurological recovery.     

不同微创方法治疗复杂性输尿管上段结石的比较

目的总结复杂性输尿管上段结石的有效治疗方法。方法回顾性分析经尿道输尿管镜碎石（URL）、微创经皮输尿管镜碎石（MPCNL）以及后腹腔镜输尿管切开取石术（RLU）治疗复杂性输尿管上段结石患者的临床效果,比较3种治疗方法的成功率及结石清除率。结果285例患者中,URL治疗121例,一次手术成功率70．1％,改开放手术5例,术后1个月结石清除率为79．3％。MPCNL治疗94例,一次手术成功率86．0％,改开放手术6例,术后1个月结石清除率为92．1％。RLU治疗70例,一次手术成功率97．0％,改开放手术2例,术后1个月结石的清除率为100％。结论．对于复杂性输尿管上段结石的微创治疗,应根据患者临床情况及实际要求制定治疗方案。     

CARCINOMA OF THE STOMACH: A REVIEW WITH SPECIAL REFERENCE TO TOTAL GASTRECTOMY

Five hundred and eleven patients with adenocarcinoma of the stomach were reviewed. Weight loss and abdominal pain were the most common symptoms. One-third of patients were found to have proximal gastric lesions with dysphagia being a major symptom in 23% of all patients. Laparotomy was performed on 88% of patients with 56% of the entire series undergoing gastric resection. The overall 5-year survival rate was 12.3% and for curative resection 43%. The 5-year survival rate of patients undergoing total gastrectomy was 53% and for patients undergoing subtotal or partial gastrectomy the 5-year survival rate was 42%. The operative mortality. similar in both groups. was 8.1% versus 5.6%. Palliation was better achieved by resection than bypass. Total gastrectomy for palliation was undertaken in 48 patients. This group of patients has achieved a good quality of life and a mean survival rate of 12.5 months.     

Carcinoma of the stomach: a review with special reference to total gastrectomy.

Five hundred and eleven patients with adenocarcinoma of the stomach were reviewed. Weight loss and abdominal pain were the most common symptoms. One-third of patients were found to have proximal gastric lesions with dysphagia being a major symptom in 23% of all patients. Laparotomy was performed on 88% of patients with 56% of the entire series undergoing gastric resection. The overall 5-year survival rate was 12.3% and for curative resection 43%. The 5-year survival rate of patients undergoing total gastrectomy was 53% and for patients undergoing subtotal or partial gastrectomy the 5-year survival rate was 42%. The operative mortality, similar in both groups, was 8.1% versus 5.6%. Palliation was better achieved by resection than bypass. Total gastrectomy for palliation was undertaken in 48 patients. This group of patients has achieved a good quality of life and a mean survival rate of 12.5 months.     

Midline anterior craniofacial approach for malignancy: results of en bloc versus piecemeal resections

Thirty consecutive cases of midline anterior craniofacial procedures for the treatment of malignant neoplasms arising from the paranasal sinuses were reviewed. Posterior and lateral base craniofacial procedures were specifically excluded. This review compares the results, in terms of survival and major complication rate, between en bloc and piecemeal resections. The average follow-up was 4 years and 3 months. Sixteen patients were treated with an en bloc resection. The major complication rate was 31%. One-year survival rate was 94% for the en bloc resection group, 67% for patients with positive margins, and 100% for patients with clear margins. Three-year survival for en bloc resection dropped to 56, 33, and 67%, respectively. Fourteen patients were treated with piecemeal resections. The major complication rate was 21%. One-year survival rate was 83% for the piecemeal resection group, 60% for patients with positive margins, and 100% for patients with clear margins. Three-year survival dropped to 70, 60, and 80%, respectively. Although it is considered desirable to obtain an en bloc resection in some craniofacial procedures, we conclude that a piecemeal resection is a viable alternative in situations where an en bloc procedure is difficult to obtain safely.     

Midline Anterior Craniofacial Approach for Malignancy: Results of En Bloc Versus Piecemeal Resections

Thirty consecutive cases of midline anterior craniofacial procedures for the treatment of malignant neoplasms arising from the paranasal sinuses were reviewed. Posterior and lateral base craniofacial procedures were specifically excluded. This review compares the results, in terms of survival and major complication rate, between en bloc and piecemeal resections. The average follow-up was 4 years and 3 months. Sixteen patients were treated with an en bloc resection. The major complication rate was 31%. One-year survival rate was 94% for the en bloc resection group, 67% for patients with positive margins, and 100% for patients with clear margins. Three-year survival for en bloc resection dropped to 56, 33, and 67%, respectively. Fourteen patients were treated with piecemeal resections. The major complication rate was 21%. One-year survival rate was 83% for the piecemeal resection group, 60% for patients with positive margins, and 100% for patients with clear margins. Three-year survival dropped to 70, 60, and 80%, respectively. Although it is considered desirable to obtain an en bloc resection in some craniofacial procedures, we conclude that a piecemeal resection is a viable alternative in situations where an en bloc procedure is difficult to obtain safely.