十二指肠后壁穿透性溃疡致高位胆管梗阻1例报告

十二指肠后壁穿透性溃疡致高位胆管梗阻１例报告郑朝纪，张振寰，张文哲，张树友北京协和医院（１００７３０）患着男性，６５岁，因皮肤黄染２０天伴右上腹阵发性绞痛１０天，于１９９３年５月１１日入院。患者于１９９３年４月２０日出现巩膜及全身皮肤黄染，呈进行性加...     

OVERVIEW FOR THE DIAGNOSIS AND TREATMENT OF GALLBLADDER CARCINOMA

Objective. To improve the recognition of diagnosis and treatment of gallbladder cancer. Methods. Retrospective analysis of 52 cases of gallbladder carcinoma in our hospital from 1988 to 1998. Results. Preoperative diagnostic rate was 90.3%, of which 12 cases (23%) were early stage of carcinoma. The total operation resection rate was 55.8%, for which only 17.8% were advance stage of carcinoma. Conclution. The early diagnosis is the key factor of increasing treatment successful rate. The following are the symptoms that raise our special attention to carcinoma of gallbladder: ( 1 ) Age over 50 have recurrent eholecysfitis and with past history of gallstone; (2) Congenital malformation of bile duct; (3) Local thickening and irregularity of gallbladder,gall; (4) Polypoid lesion larger than lem inside gallbladder; (5) Atrophic gallbladder; (6) Intraluminal stone of gallbladder does not move when change in body position; (7) Regional lymph node enlargement.     

互联网在外科临床教学中的意义简

 分析在互联网时代,互联网给外科教学带来的影响,通过分析其在外科教学过程中的应用,以便充分合理地利用互联网资源,更好地提高外科教学效果。     

分化型甲状腺癌再次手术组织病理阴性的原因分析

  目的  分析分化型甲状腺癌再次手术组织病理阴性的可能原因。  方法  回顾性收集并分析2013年1月至2017年12月北京协和医院基本外科再次手术的分化型甲状腺癌患者临床资料。依据再次手术组织病理结果分为组织病理阴性组和组织病理阳性组。比较两组一般资料、首次手术临床资料、再次手术前超声声像特征及再次手术术式差异。  结果  共纳入218例符合纳入标准和排除标准的再次手术分化型甲状腺癌患者, 其中男性70例, 女性148例, 男女比例1:2.11;平均年龄(43.7±12.7)岁。所有患者均在术前临床诊断肿瘤复发转移, 其中组织病理阴性组27例, 组织病理阳性组191例。与组织病理阳性组相比, 组织病理阴性组患者年龄较大[(49.3±12.6)岁比(42.9±12.5)岁, P=0.013], 首次手术为多中心病灶的比率较低(7.4%比24.6%, P=0.045), 两组在性别、首次手术术式、肿瘤大小、再次手术前超声声像特征及再次手术术式方面无统计学差异(P均>0.05)。  结论  分化型甲状腺癌再次手术组织病理阴性病例并不少见。患者年龄及首次手术是否为多中心病灶可能与再次手术组织病理是否阴性有关。     

109例成人型胆管囊肿的诊治经验

Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment.     

109例成人型胆管囊肿的诊治经验

Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment.     

胆囊周围炎及粘连引起十二指肠不全梗阻一例

患者女,44岁。因间断性中上腹痛6个月,反复呕吐不能进食一个月于1986年4月21日入院。患者于1982年体检时B 超发现胆囊内有数个强光团,确诊为胆囊结石。但当时并无自觉症状。自1985年9月起多次出现右上腹剧烈绞痛,但不伴发热、寒战和黄疸。曾按胆结石服中药及熊去氧胆酸治厅,疼痛有所减轻。自1986年3月下旬起,中上腹痛较前加重,无规律性,伴胃脘部不适、胀满、有振水音,每于食后加重,大约6～7小时后即出现恶心呕吐,初为食物,继为胃液。虽有饥饿感但不能多进食,每天食量约一市两左     

90例原发性腹膜后肿瘤治疗分析

原发性腹膜后肿瘤起病隐匿，发现时肿瘤已生长巨大．完整切除率较低，术后复发率高，所以如何提高手术切除率、改善预后仍是临床急需解决的问题。我院基本外科于1996年1月-2004年12月共收治原发性腹膜后肿瘤病人113例，其中有完整病历资料记载者90例，本文对该组病人结合临床资料进行分析、探讨。     

脾脏占位性病变的临床诊治分析

目的 加强对脾脏占位性病变的鉴别诊断和治疗。方法 回顾性分析１９８３～１９９９年间,我院收治的脾脏占位性病变４０例的临床资料。结果 ４０例中脾脏良性病变２６例,其中脾结核７例、脾真性囊肿６例、脾脓肿３例、脾血管淋巴管瘤４例、脾动脉瘤３例、脾淋巴管瘤、脾表皮样囊肿和脾错构瘤各１例。脾脏恶性肿瘤１４例,其中脾脏原发非何杰金氏淋巴瘤和平滑肌肉瘤各２例、血管肉瘤１例。肝细胞转移癌３例、卵巢癌脾脏转移２例、胃癌、胰腺癌、绒毛膜上皮癌和右肾癌脾脏转移各１例。结论 应根据脾脏占位病变的临床表现和影像学特征,对不同性质的病变采用相应的治疗方法。     

109例成人型胆管囊肿的诊治经验

Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment.