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??The clinical applicaion analysis of taken radiofrequency assisted partial splenectomy operations on patients with benign splenic space-occupying lesions XIAO Chang-wu*??QIU Rong??ZHANG Wei??LI Ning. *Department of Hepatobiliary Surgery??Suining Central Hospital??Suining 629000??China
Corresponding author??ZHANG Wei??E-mail??zw68229@sina.com
Abstract Objective To assess the feasibility??safty and clinical practicalty value of taken radiofrequency assisted partial splenectomy operations on patients with benign splenic space-occupying lesions. Methods The clinical data of 21 cases of taken radiofrequency assisted partial splenectomy operations on patients with benign splenic space-occupying lesions from September 2010 to February 2012 were retrospectively analyzed in Suining Central Hospital. These patients were the follows??Splenic non parasitic cysts in 11 cases??splenic hemangioma in 3 cases??splenic hematoma 5 cases??splenic epidermoid cyst in 1 cases??splenic abscess in 1 cases respectively. Results All of operations were completed smoothly??The average operative time was ??67.0±17.5??min and the average of intraoperative blood was ??55.7±10.3??ml. Patients in this group had a transient increase of temperature??but the conventional treatment or observation decreased to normal level a few days later. The complication rate in this group was 9.5% (2/21)??which 1 case of left pleural effusion??1 cases of splenic fossa effusion was observed after a few days??self absorption. The average duration of hospitalization was ??10.0±3.5??d. All patients were followed up and the period of following-up were 1~24 months. During hospitalization and follow-up??no serious complications such as bleeding, abdominal abscess, and thrombosis occurred. No overwhelming postsplenectomy infection (OPSI) occurred??immunological examination showed normal spleen function in All patients. Conclusion Taken radiofrequency assisted partial splenectomy operations on patients with benign splenic space-occupying lesions is feasible??safe and practical which should be developed extensively in clinic.     

41例成人先天性胆管扩张症的诊治分析

目的:探讨成人先天性胆管扩张症的诊断和外科治疗。方法:对我科1997~2006年期间共收治41例成人先天性胆管扩张症患者的诊断和治疗进行回顾性分析。结果:术前B超诊断正确率为92.7%(38/41),磁共振胰胆管造影术(magnetic resonance cholangiopancreatography,MRCP)检查13例均确诊。39例行囊肿切除和肝总管空肠Roux-en-y吻合术(其中包括2例急诊手术后再行该手术和5例合并肝左外叶切除术),1例行肝右叶切除术,1例因癌变行胰十二指肠切除术。共随访35例,随访率为80.5%,平均随访45个月,未发现恶变者。结论:B超应作为先天性胆管扩张症的首选检查,MRCP有助于临床分型及术式的选择,囊肿切除和肝总管空肠Roux-en-y吻合术应作为首选术式。早期诊断,早期根治性治疗,是成人先天性胆管扩张症的关键。     

12例肺结核误诊为肺炎临床探讨分析

加强对不典型性肺结核的认识,提高对肺结核的诊断治疗,减少漏诊、误诊。对12例我院不典型性肺结核患者进行临床综合分析,12例不典型性肺结核的临床表现及检查结果缺乏特异性。不典型肺结核临床上易误诊为肺炎,提高其认识可为正确及时的治疗奠定基础。     

面肌痉挛责任血管压迫面神经根的解剖特点

目的探讨特发性面肌痉挛（idiopathic hemi facial spasm,IHFS）的面神经根部责任血管的临床解剖特点。方法选择IHFS 160例,在神经根血管减压术中采用显微镜或鼻内镜观察面神经根周围病变。结果可见责任血管154例（96.2%）,依次为小脑前下动脉、小脑后下动脉、小脑上动脉、椎动脉以及两支血管压迫。压迫部位在面神经根入脑桥处151例（98%）,且多居前方,同时伴蛛网膜粘连（107/154,69.5%）。未见血管压迫及占位病变者6例（3.8%）。结论 IHFS责任血管多为一支,也可为两支;压迫部位在面神经根入脑桥处前方,位置隐蔽。因此,神经根血管减压术（micro vascular decompression,MVD）术中应该仔细寻找,以免遗漏责任血管。     

经脐单孔腹腔镜保胆取石术的应用体会(附8例报告)

目的:探讨经脐单孔腹腔镜保胆取石术治疗胆囊结石的可行性、手术方法及应用价值.方法:回顾分析为8例胆囊结石患者行经脐单孔腹腔镜保胆取石术的临床资料.结果:8例手术均顺利完成,患者均恢复良好,手术时间45～90 min,平均62 min;术中出血量10～20 ml,平均15 ml,术后住院2～3 d.术后均未使用止痛药,无...     

下鼻道后穹窿鼻出血的临床特点及综合治疗

目的：总结下鼻道后穹窿鼻出血的临床特点并分析其综合治疗措施。方法：212例鼻出血住院患者中23例（10．8％）确诊为下鼻道后穹窿鼻出血,1例在全身麻醉下行鼻内镜鼻腔探查＋电凝止血术,其余22例在局部麻醉下行鼻腔探查＋电凝止血术。所有患者在术中排除了嗅裂、蝶筛隐窝及中鼻道出血,术中行下鼻甲骨折内移位后见下鼻道后穹窿活动性出血,立即给予双极电凝止血。术后电凝区域及鼻黏膜糜烂处填塞少量纳吸棉组织。结果：所有患者术中均发现明确的出血点并成功止血;术后1周内未再出血。随访6～12个月患侧鼻腔无再发鼻出血,无鼻腔粘连。结论：难治性鼻出血如排除嗅裂、蝶筛隐窝及中鼻道出血,则应考虑下鼻道后穹窿出血的可能。术中将下鼻甲往内侧骨折移位彻底暴露下鼻道后穹窿并仔细探查是发现和治疗下鼻道后穹窿鼻出血的关键。     

经脐单孔腹腔镜胆囊切除术临床分析

目的探讨经脐单孔腹腔镜胆囊切除的可行性、安全性及实用性。方法回顾分析2010年11月-2011年2月27例行经脐单孔腹腔镜胆囊切除术患者的临床资料。其中男15例,女12例;年龄19～53岁,平均39.5岁。胆囊息肉样病变12例,病程6个月～8年;胆囊结石17例,结石数量1～9个,大小0.5～1.5 cm,均为非急性期患者,病程1个月～13年。结果 27例手术均顺利完成,无1例中转开腹或转为传统三孔腹腔镜胆囊切除术,术中生命体征平稳。手术时间35～149 min,平均63 min;术中出血10～20 mL,平均15 mL。所有患者术后2～3 d出院。患者均获随访,随访时间6～24个月,平均13个月。术中及术后随访期间未发生任何并发症。脐部瘢痕不明显,患者满意度高。结论经脐单孔腹腔镜胆囊切除安全可行,具有创伤小、瘢痕不明显等优点。     

Mirizzi综合征的临床诊断与治疗探讨分析

目的：探讨Mirizzi综合症的诊断治疗特点,以提高其诊断和治疗水平。方法：对35例经手术证实为Mirizzi综合症的临床资料进行回顾性分析。结果：35例Mirizzi综合症患者中仅4例（11．4％）术前确诊。Ⅰ型7例,Ⅱ型17例,Ⅲ型9例,Ⅳ型2例。5例行胆囊切除术,2例行胆囊大部分切除术;胆囊切除、胆囊瓣瘘口修补6例,12例行胆囊切除、胆总管探查、瘘口修补、T管引流术;胆囊切除、胆肠吻合术lO例。术后恢复好,随访结果,无严重并发症．结论：Mirizzi综合症术前确诊困难,B超结合MRCP／ERCP检查可以提高Mirizzi综合症的术前确诊率,手术容易损伤胆管,手术方式应据病理损伤程度决定。     

吲哚菁绿荧光显像技术在复杂腹腔镜胆囊切除术中的临床应用

目的 探讨吲哚菁绿（indocyanine green，ICG）荧光显像技术在复杂腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）中的临床应用。方法 对2019年7月至2020年1月期间遂宁市中心医院肝胆外科收治的31例在ICG荧光显像技术辅助下完成复杂LC的患者临床资料进行回顾性分析。术前ICG皮试阴性，于术前60 min注射ICG，术中利用近红外光三维显像肝外胆管结构。在ICG显像引导下行LC。结果 31例患者均顺利完成LC手术，其中26例患者胆总管和胆囊管ICG显像；5例胆囊管未显像，但胆总管显像。手术时间41（25～89）min，术中出血量7（3～15）mL，术后住院时间3.5（2～6）d。所有患者术后恢复顺利，1例切口感染，1例剑突下伤口红肿，无胆漏等并发症发生，术后随访1～7个月无并发症发生。结论 利用ICG荧光显像技术优势，可以对肝外管道系统进行显像，辅助复杂腹腔镜胆囊切除术的顺利完成，避免医源性肝外胆管损伤，值得临床推广应用。