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61.
经内镜胆管引流术在肝门部恶性胆管梗阻中的应用及其评价 总被引:9,自引:2,他引:7
肝门部恶性肿瘤手术切除率极低,临床处理十分棘手。作者采用内镜胆管引流术治疗此类肿瘤288例次(肝门部胆管癌184例、胆囊癌23例、肝细胞癌侵犯肝门部胆管47例、其他转移性肿瘤34例),其中行内镜鼻胆管引流162例次、塑料内置管引流80例次、放置可膨式金属胆道支架46例、4例患者接受同期双内置管引流。引流总有效率为67.0%,其中效果满意者43.1%;40例患者术后1个月内发生胆管炎,发生率为13.8%,3例死亡;长期随访病例的平均存活期5.3个月。我们观察到治疗的效果与Bismuth分型有密切关系,如果全肝40%以上的胆系得到引流,黄疸有望消退;左、右两侧胆管同时引流可扩大引流范围,提高疗效;应合理选择三种内镜胆管引流方法并适时灵活转换才能获得满意的疗效。结论:对于肝门部肿瘤,内镜胆管引流术是一种安全有效的治疗手段,可作为首选的姑息性治疗。 相似文献
62.
José I. Bilbao Manuel Ruza Jesús M. Longo Francisco Mansilla Antonio Picardi Vanessa de Villa Fernando Pardo Jesús Sola Jorge Quiroga 《Cardiovascular and interventional radiology》1994,17(4):210-213
Posttransplant lymphoproliferative disorders are infrequent tumors related to chronic immunosuppressive therapy. We present a liver transplant recipient who developed such a tumor in the porta hepatis that provoked obstruction of the entire portal triad. Treatment consisted of systemic chemotherapy, percutaneous dilatation, and placement of Wallstent endoprostheses across both biliary and portal vein stenoses. The patient died 3 weeks later of pneumonia and sepsis. At necropsy, the tumor was completely necrosed and the prostheses in both the common bile duct and the portal vein were patent. 相似文献
63.
From July 1989, to June 1996, 160 patients with congenital bile duct dilatation (CBD) were treated at our institution. The
incidence of CBD at our institution has increased annually. In approximately 90% of patients with CBD there was associated
anomalous arrangement of the pancreaticobiliary ductal system, and we concluded that this was one of the main causes of CBD.
Pediatric endoscopic retrograde cholangiopancreatography was first introduced to China in 1989, and has been successfully
performed in 90.2% of 92 patients at our institution. We found that age at diagnosis was closely related to the subtype, complications,
and mortality of CBD. The subtype also correlated with the presenting symptoms. One hundred and forty-seven of the 160 patients
underwent surgery. Of these 147 patients, 136 (92.5%) were cured with normal liver function and 9 (6.1%) improved with liver
impairment. Two patients died, one of postoperative pneumonia and one of liver failure. We conclude that early radical surgery
and careful postoperative follow-up are essential in the prevention of CBD complications such as cholangitis, pancreatitis,
biliary stones, and development of carcinoma.
This article is based on a special lecture delivered before the 19th meeting of the Japanese Society of Pancreatico-biliary
Maljunction, on September 14, 1996, in Tokyo 相似文献
64.
目的探讨急诊手术中胆总管末端狭窄的手术方法.方法回顾性分析553例急诊胆总管切开探查术中并发胆总管末端狭窄37例的临床资料.结果37例中行胆总管十二指肠吻合术29例;例出‘s括约肌切开成形术3例;单纯T管引流5例.随访27例,随访率75.7%,疗效满意.结论胆总管十二指肠吻合术及Oddi‘s括约肌成形术是治疗胆总管末端良性狭窄的良好术式,但各有利弊,而胆总管十二指肠吻合术更适于急诊手术及基层医院开展.严格掌握其适应症及手术原则是减少术后并发症的关键. 相似文献
65.
A stratified intraoperative surgical strategy is mandatory during laparoscopic common bile duct exploration for common bile duct stones 总被引:3,自引:0,他引:3
J. F. Gigot B. Navez J. Etienne E. Cambier P. Jadoul P. Guiot P. J. Kestens 《Surgical endoscopy》1997,11(7):722-728
Background: Open exploration and endoscopic sphincterotomy (ES) remain the preferred treatment of common bile duct stones (CBDS). The
recent spread of laparoscopy has worsened the dilemna of choosing between surgical and endoscopic treatment of CBDS. The aim
of this study was to critically evaluate the results of our preliminary experience with laparoscopic common bile duct exploration
(CBDE) for CBDS.
Methods: Ninety-two consecutive patients were prospectively submitted to laparoscopic CBDE. Surgical strategy included an initial
transcystic approach or laparoscopic choledochotomy. Failure of stone clearance was managed by conversion to open CBDE or
by postoperative ES. Electrohydraulic lithotripsy and papillary balloon dilatation were selectively used. Stone clearance
was assessed by choledochoscopy and control cholangiography.
Results: The overall laparoscopic stone clearance in this series was 84% (transcystic route 63% and choledochotomy 93%). Conversion
to laparotomy was mandatory in 12% of the patients because of incomplete stone clearance and in 5% because of intraoperative
complications. Postoperative ES was required in 4% of the patients, giving an overall surgical success rate of 96%. When indicated
(small and limited number of stones located below the cysticocholedochal junction, with a dilated and patent cystic duct)
the transcystic route had the lower success rate, the higher complication rate, and the shorter operative time and postoperative
hospital stay. When indicated (accessible and dilated common bile duct over 7 mm), laparoscopic choledochotomy had the higher
success rate, the lower complication rate, the longer operative time, and the longer postoperative hospital stay, which is
related to associated external biliary drainage. The hospital mortality included two high-risk patients (2%) and the complications
rate was 15%.
Conclusions: Laparoscopic CBDE is safe in selected patients. A stratified intraoperative surgical strategy is mandatory in deciding between
a transcystic route and choledochotomy with specific indications for each approach. When feasible, laparoscopic choledochotomy
is more efficient and safe than the transcystic route, but it is associated with a longer postoperative hospital stay, which
is due to external biliary drainage.
Received: 7 May 1996/Accepted: 19 November 1996 相似文献
66.
肝硬化病人施行胆道手术35例分析 总被引:2,自引:0,他引:2
本文对我院近10年来收治的肝硬化病人施行胆道手术35例进行分析,术前漏诊肝硬化12例,占3O%以上,死亡5例,有3例死于胆囊床大出血与术前漏诊有关。作者就术前漏诊原因、术前准备和手术处理体会进行讨论。 相似文献
67.
目的总结近20年来孤立性左肝胆管结石并发左肝胆管狭窄的临床治疗体会.方法原发性肝胆管结石1018例,年龄27~72岁,其中孤立性左肝胆管结石133例,手术治疗112例,对其临床资料进行回顾性分析,包括各肝管狭窄并发率,术前各项检查确诊率,手术治疗方式,再狭窄率.结果左肝管狭窄的发生率为598%,左外肝管和左内肝管分别为840%和848%,均以重度狭窄为主.狭窄切开整形后高位胆肠吻合术是处理左肝管狭窄的常用手术方式(522%),远期再狭窄率为171%;左半肝切除术施实率为194%,再狭窄率为00%;狭窄整形术和狭窄扩张术的施实率分别为90%和194%,再狭窄率分别为500%和923%.左外肝管狭窄通常采用肝段或肝叶切除术(787%),而左内肝管狭窄的处理则通常采用非左半肝切除术(848%).左内肝管狭窄的术前/后影像学确诊率明显低于左肝管和左外肝管,平均确诊率依次259%,933%和879%.结论二级肝管狭窄是孤立性左肝管结石的常见并发症,肝叶或肝段切除术是其首选治疗原则.过多依赖非肝叶/段切除术和不适当的肝段切除术是遗留狭窄和远期疗效差的重要原因 相似文献
68.
49例梗阻性黄疸患者(实验组)和81例无黄疸的胆系疾病患者(对照组)围手术期外周血的内毒素(ET)检测结果表明,实验组:①术前ET阳性率明显高于对照组(P<0.001);②术后10~12d夹闭T/Y管后ET阳性率明显低于术前和夹管前(P<0.001);③伴急性化脓性胆管炎(ACST)的患者ET阳性率明显高于无ACST的患者(P<0.001);术前口服胆盐的患者ET阳性率则显著低于未口服胆盐者(P<0.001).作者认为,本组梗阻性黄疸患者中出现的肾功能障碍、胃肠道出血以及2例患者的死亡,至少部分地与内毒素血症有关。 相似文献
69.
低场强MRCP结合轴面T2WI对胆系结石的诊断价值 总被引:11,自引:0,他引:11
目的探讨低场强MRCP结合轴面T2WI对胆系结石的诊断价值。方法回顾性分析38例胆系结石患者的低强场(0.2T)MRCP,MRCP结合T2WI及US所见并进行对比分析。结果MRCP,MRCP结合T2WI及US对胆系结石的检出率分别为75.0%,95.9%,79.5%,MRCP结合T2WI对胆系结石的检出率明显高于单一MRCP(χ2=7.31,P<0.01)和US(χ2=5.09,P<0.05)。结论在低场强MR扫描环境下,MRCP结合轴面T2WI可以提高胆系结石的检出率。 相似文献
70.
医源性胆道损伤的外科治疗 总被引:2,自引:2,他引:0
目的:探讨医源性胆道损伤的原因、诊断、手术时机和手术方式的选择。方法:对28例胆道损伤进行分析总结:分别施行了胆管修补术3例、胆管端端吻合术2例和胆肠吻合术23例。结果:全组无围手术期死亡,4例术后出现胆管狭窄而再次手术,其余愈后良好。结论:尽早发现、及早正确处理对提高疗效和预防术后胆管狭窄起着决定性的作用。术中发现胆管损伤立即行端端吻合或修复加T管引流;术后数天发现或多次重建术失败,则宜行规范的胆肠Roux-en-Y吻合术。 相似文献