损伤性肝外胆管狭窄45例临床分析

目的：分析损伤性肝外胆管狭窄发生的原因和损伤后狭窄的修复术式选择。方法：损伤性肝外胆管狭窄45例，诊断方法以B超，PTC、ERCP为主，全组分别行胆管空肠吻合术，胆管十二指肠吻合术，肝门胆管整形术等手术治疗。结果：随访36例，末次手术行胆管空肠吻合术33例，优良87.9%。结论：可见性损伤和隐性损伤所致的瘢痕收缩是胆道狭窄的主要原因，损伤性肝外胆管狭窄的治疗方法以胆管空肠Y形吻合术较为理想。     

老年重症急性胰腺炎手术治疗探讨

目的：讨论老年重症急性胰腺炎的手术治疗。方法：我院1984年1月－2000年10月共收治60岁以上手术证实的重症急性胰腺炎26例，本对其手术治疗的方法和时机以及相应的并发症和死亡率进行回顾性分析。结果：本组术后死亡6例，其中4例死于MOF，2例死于ARDS。在发病24小时内手术8例中无1例死亡，24－36小时内手术14例有2例死亡，36小时后手术4例均死亡。结论：老年重症胰腺炎患多伴有心、肺、肾等重要器官慢性疾病，脏器代偿功能差，较易出现MOF，因此如有手术指证或经短期非手术治疗效果不明显，应及时手术，并在术中和术后采用合理的治疗措施，有利于减少术后并发症，降低手术死亡率。     

The effect of prior back surgery on surgical outcome in patients operated on for lumbar spinal stenosis a matched-pair study

Summary It has been widely observed that the outcome after repeat lumbar surgery is rarely comparable to that of primary surgery. In particular, the results of repeat surgery for lumbar spinal stenosis (LSS) have not been favourable. We used a matched-pair format in an attempt to decrease the confounding factors so as to determine as exactly as possible the effect of prior back surgery on the LSS patients surgical outcome. The matching criteria were sex, age, myelographic findings, major symptom, and duration of symptoms. From one group of 251 patients without prior back surgery (SO patients) and another of fifty-three patients with one preceding back operation (RS patients), forty-one similar matched patients pairs (one SO and one RS-patient) were formed.There were 8 female and 33 male pairs. The mean age of the SO patients was 51.6 and of the RS patient 51.4 years, and the mean follow-up time was 4.6 and 4.4 years. The assessment of outcome was based on a subjective disability questionnaire. The SO patients fared significantly better than the RS patients (32.1 versus 41.3, P = 0.026). A short time interval between operations in the RS patients had a worsening effect on outcome, but this trend was not significant.We concluded that one preceding back operation had a worsening effect on the outcome of patients operated on for LSS. As a whole, the results of RS patients were unfavourable. The proper time for achieving good surgical results in LSS patients is the initial operation.     

应用抗凝剂的心脏瓣膜置换患者接受胆道手术的术前处理

目的总结瓣膜置换患者行胆道手术的术前用药方法。方法对38例瓣膜置换后在服用华法令过程中因胆道疾病需行择期手术治疗的患者随机分为2组,肝功能正常组(A组)23例、肝功能不正常组(B组)15例均于术前3d停服华法令,B组术前12h肌注VitK110mg。术前无应用华法令历史的患者115例做为对照组。结果38例患者停药2d后A组血浆凝血酶原时间与对照组差异无显著意义,B组于术前12h肌注VitK110mg后,血浆凝血酶原时间与对照组相比差异也无显著性意义。结论瓣膜置换患者在抗凝期间行胆道手术,只要准备充分,围手术期是安全的。     

年轻人腹主动脉瘤九例临床分析

目的探讨年轻人腹主动脉瘤(AAA)的临床特征、治疗和预后。方法回顾性分析244例AAA中9例(37%)年龄小于35岁的年轻患者的诊治经过。结果本组男7例,女2例,年龄21～35岁,临床表现腹部或腰背部痛、腹部搏动性肿物。瘤体直径(65±09)cm。4例行择期手术均成功,3例急诊手术1例成功,2例入院后未能手术治疗者均死亡。结论年轻人的AAA有病程短、瘤体较大且较多累及腹主动脉近端,症状重的特点,应尽早手术治疗。     

外科治疗纵隔原发神经源性肿瘤的手术径路评价

目的　探讨外科治疗原发纵隔神经源性肿瘤的手术径路。方法　 1963年 3月至2 0 0 3年 9月外科治疗原发纵隔神经源性肿瘤 91例。所有病例均于术前行X线胸片检查 ,其中 65例行CT或磁共振检查。根据肿瘤的大小、部位及其是否向椎管内延伸选择不同的手术入路 ,其中胸后外侧切口 84例 ,半哈壳状切口 2例 ,高位胸后侧切口 4例 ,胸后外侧加脊柱旁切口 1例。所有病例均经病理证实并行 6个月～ 15年的术后随访。结果　本组手术切除率 97.8% ( 89/91) ,术后并发症发生率 4.4% ( 4 /91) ,无手术死亡病例。术后病理诊断良性肿瘤 79例 ( 86.8% ) ,恶性肿瘤12例 ( 13 .4% )。 1例神经纤维瘤 2年后复发经再次手术切除治愈 ;恶性肿瘤平均生存 3 8.1个月。结论　适当的手术径路是提高纵隔原发神经源性肿瘤切除率的关键。     

自发性食管破裂的诊断和外科治疗

目的:探讨自发性食管破裂的诊断和外科治疗。方法 :对 14例自发性食管破裂患者的诊断、治疗方法及治疗结果进行回顾性分析。结果:本组确诊时间 2 4 h以内者仅 2例 ,确诊时间大于 2 4 h者 12例 ;一期食管修补、带蒂胸膜覆盖术 3例 ,治愈 1例 ,治疗失败 2例 (其中 1例死亡 ,1例延期行结肠代食管术后治愈 ) ;行破裂段食管切除、胃 -食管吻合术的 5例全部治愈 ;保守治疗 6例 ,治愈及死亡各 3例。结论:早期诊断自发性食管破裂是提高疗效、降低病死率的关键。发病 2 4 h以上者 ,如全身情况允许 ,破裂段食管切除、胃 -食管吻合术的疗效较好。     

SURGICAL TREATMENT OF GYNECOLOGIC MALIGNANCES IN PATIENTS 70 YEARS OF AGE AND OLDER

Accordingtothedatafromepidemiology,thein-cidenceofcancerrisessteadilywithadvancingage.Age?specificincidenceratesfromtheThirdNationalCancerSurveyoftheUnitedStatesrevealedthattheriskofcancerdevelopmentinthe6thdecadeoflifeisapproximately1%,whichincreasesto2%inthe81styearoflife(1).Theincidencesofmostgyneco-logiccancersincludingcervicalcancer,endometrialcancer,ovariancancerandvulvarcancerpeakaftertheageof60years(2-4).Surgeryisoneofthemaintreatmentoptionsforgynecologiccancerandmaybringaboutsomeeff…     

眼眶巨大肿瘤的诊断与治疗对策

目的探讨和分析眼眶内巨大肿瘤术前定性诊断和有关手术治疗方案的制定原则。方法2001.1-2005.1月共32例,其中,男14例,女18例,年龄5岁-80岁,平均38.40岁。眼球突出两眼差3cm-15cm,平均6.0cm,病程6m至30y,平均5.5y。入选标准：眼眶巨大肿瘤为医学影像学或术中测量肿瘤直径〉2.5cm,范围2.5cm-4.5cm,平均2.95cm,甚至充满眶腔（4例）。术前确诊者27例;其中,海绵状血管瘤12例,神经鞘瘤4例,静脉性血管瘤4例,脑膜瘤4例,视神经胶质瘤、皮样囊肿和骨瘤各1例。术中操作：海绵状血管瘤行穿刺或切开放血减少体积,神经鞘瘤行囊内切除,皮样囊肿切开吸出内容物再切除囊膜,静脉性血管瘤放出血液后紧贴瘤组织切除。注意因肿瘤巨大使正常结构移位,解剖不清造成意外出现并发症。结果术前确诊的27例经病理诊断符合率为100%,其他为横纹肌肉瘤、间叶软组织肉瘤、纤维肉瘤、恶性血管外皮瘤和神经纤维瘤。术后视力提高者7例,不变者16例,视力下降者9例;上睑下垂6例,眼球运动障碍5例,眼球内陷4例。结论对于大部分眼眶肿瘤（27/31）术前均得到定性诊断,有利于术前制定的治疗方案,保证术中操作安全,避免盲目手术带来的各种并发症,提高了手术的成功率和病人的生活质量。     

Structured training of ENT Specialist Registrars in the out‐patient clinic and theatre

The aims of this paper are to evaluate the training in out‐patients and in theatre after the recent changes in SpR training. A postal questionnaire was sent to 191 Specialist Registrars (SpRs) in England and Wales and 57 were returned (30%). There were temporal bone facilities within the hospital for 53 SpRs but only three used them because there were no temporal bones. Surgical training was more satisfactory than out‐patient training. Fewer general clinics and more specialized clinics are required, and consultant supervision is still patchy and needs attention.