胆道蛔虫症伴发胰腺炎一例

患者男性,28岁,广西博白县农民。诉2000年8月中旬出现上腹部阵发性疼痛,多呈绞痛,偶感钻痛,并向背部、右肩胛部及两侧腰部放射,每次持续1-2 h,伴恶心、呕吐、吐出胃内容物。9月21日因腹痛、恶心、呕吐加重,至广西医科大学第一附属医院急诊。体检:痛苦病容,中上腹及左上腹部有压痛,无反跳痛,余无特殊。实验室检查:Hb 118 g/L,WBC 16.3×     

选择性脾动脉阻断下行保脾术23例疗效观察

采用解剖脾门选择性脾叶、段动脉阻断手术方法行脾部分切除23例。手术均成功。术后均无脾萎缩及缺血坏死等情况发生。术后体液免疫指标无明显变化,手术前后体液免疫指标无明显变化,无血小板增多及免疫力下降发生。认为本术式保脾成功率高。     

电子胃镜下取出十二指肠乳头内三条蛔虫一例

目前,在电子胃镜下取出胃内、食管内异物很常见,其中上消化道内蛔虫的成功取出临床中也很多。但3条长度均10cm以上的蛔虫嵌顿在十二指肠乳头内的病例却很少见。现报道我院1例行电子胃镜成功取出3条嵌顿于十二指肠乳头内蛔虫患者的诊疗过程。     

脾动脉栓塞治疗肝硬化脾功能亢进15例临床观察

脾功能亢进 (脾亢 )是肝硬化失代偿期的严重并发症之一 ,患者可因脾亢导致血小板、白细胞及血红蛋白减少 ,从而引起出血倾向、抵抗力下降及重症感染 ,危及患者生命。目前有手术脾切除、脾动脉栓塞、超声引导脾内注射硬化剂等方法治疗肝硬化脾功能亢进。我院对 15例患者行部分脾动脉栓塞术 ,经临床观察效果满意 ,现报告如下。1　资料和方法1.1　临床资料　男 13例 ,女 2例 ,年龄 35～ 66岁 ,平均 4 6.3岁。 15例均诊断为肝炎后肝硬化 ,按 Child分级法 ,肝功能属 A级 2例 ,B级 13例。 15例患者白细胞均低于 4 .0× 10 9/L,血小板低于 10 0×…     

脾动脉栓塞术治疗脾机能亢进30例临床观察

脾机能亢进成因复杂,临床上多见于肝硬化的合并症。主要表现为一种或多种血液有型成分减少,骨髓细胞增生活跃伴有脾肿大、门静脉高压等。2000年1月至2004年8月,我们以脾动脉栓塞术治疗30例脾机能亢进患者,效果满意。现报告如下。     

脾动脉栓塞治疗肝硬化脾功能亢进20例报告

我院于 1995年 3月至 1999年 10月 ,采用明胶海绵行部份脾动脉栓塞治疗肝硬化脾功能亢进 (脾亢 )患者 ,取得满意疗效。材料和方法住院肝硬化脾亢患者 2 0例 ,男 17例 ,女 3例 ,年龄为 30～ 6 2岁。经血常规、骨髓象、Ｂ超或ＣＴ检查确诊。临床Ｃｈｉｌｄ Ｐｕｇｈ分级 :Ａ级 7例 ,Ｂ级 13例。栓塞前先行脾动脉造影 ,根据脾实质显影计算其栓塞面积 ,了解脾动脉走向 ,然后将导管插入脾动脉远端 3～ 4级分支注入明胶海绵微粒 (2ｍｍ× 2ｍｍ× 2ｍｍ) 30～ 40粒 76 %的泛影葡胺 4～ 5ｍｌ,在电视透视下 ,缓慢沿导管注入 ,栓塞后再摄片 ,了解梗…     

门静脉高压症脾动脉灌注48例临床分析

门静脉高压症脾动脉灌注４８例临床分析聊城地区人民医院（２５２０００）隋永领，王银龙，姚玉民，池金风，孙桂珍１９９０～１９９５年，我们对４８例门静脉高压症患者于脾切除前行脾动脉灌注，将脾脏内储存的血液回输入体循环，收到了良好效果。１资料与方法本组男２１...     

部分脾动脉栓塞治疗脾功能亢进的疗效

脾功能亢进简称脾亢,其主要临床特征是各种原因造成的脾脏肿大伴血细胞过多消耗,引起患者出现各种相应的临床表现〔1〕。因此,脾功能亢进并非单一疾病,而是一种临床综合征。脾脏增大、门静脉出现高压、血细胞及血小板显著减少,引起严重出血事件的发生,尤其是消化道出血,严重者危及患者生命,因此对于这类患者积极进行干预具有非常重要的临床意义〔2〕。尽管对原发疾病进行有效干预可显著改善患者症状,但是对于增大的脾脏并不具有多大的意义。脾动脉栓塞术是近年来广泛应用于临床上治疗脾功能亢进的有效手段,其可以显著降低门静脉压力,进而增加肝动脉的血液供应,减少由于脾亢引起的血液有效成分的减少〔3,4〕。本研究旨在探讨部分脾动脉栓塞治疗脾功能亢进的临床疗效。     

脾切除术中脾动脉加压灌注自体脾血回输46例体会

1998年8月～2003年8月，我院共对46例患者于脾切除术中采用脾动脉加压灌注自体脾血回输，效果满意。现报告如下。     

部分脾动脉栓塞术治疗肝硬化脾功能亢进26例临床观察

肝炎后肝硬化脾功能亢进症是肝硬化失代偿期的严重并发症之一,可导致血小板、白细胞减少,出血倾向,抵抗力下降及重症感染;以往对其主要采用脾切除的方法治疗。2002年5月至2004年5月,我们采取部分性脾动脉栓塞术(PSE)治疗肝炎后肝硬化脾功能亢进症患者26例,取得满意效果。现报告如下。     

尿出蛔虫1例报道

患者 ,男 ,47岁 ,工人 ,因 1997年 4月 8日尿出虫体 1条而就诊。 10 d前患者骑自行车时突然感到会阴部胀痛 ,继而尿频、尿急 ,无尿痛 ,出现肉眼血尿 ,持续 5 d,无发烧。尿化验 :血尿。口服环丙沙星、甲硝唑 3d后血尿消失 ,但尿道有管状物及爬的感觉 ,排尿时 ,尿出一条 10 cm长的虫体 ,仍在蠕动 ,放置酒精中保存待检。后经天津医科大学寄生虫学教研室鉴定为雄性蛔虫幼虫。自尿出虫体后 ,尿有粪臭味 ,尿色深黄、混浊 ,肛门排气有异样感 ,无力、无声 ,有漏气感觉。每天可见自尿道口及肛门有黄色分泌物排出 ,持续 8个月 ,消瘦、乏力。检查治疗经…     

A case of splenic artery aneurysm simulating a pancreas tumor

A 46-year-old man was admitted to our hospital for further evaluation of a hypoechogenic mass in the pancreatic body. He had no history of hypertension, pancreatitis, abdominal trauma, or portal hypertension. He had no abdominal symptoms. A contrast-enhanced CT scan demonstrated a hypodense, round shaped mass. EUS and MRI also showed it to be a pancreatic mass. Because of the tumor size of more than 30mm and the possibility of malignancy, distal pancreatectomy was performed. Microscopic findings showed the mass was the dissection of the proximal splenic artery. The true lumen of the dissecting aneurysm was occluded and the false lumen developed fusiform dilatation. Moreover, microscopic findings revealed the rupture of the false lumen complicated by pseudoaneurysm. We finally diagnosed the lesion simulating a pancreatic tumor as the pseudoaneurysm of the splenic artery.     

Laparoscopic distal pancreatectomy in a patient with aberrant splenic artery originating from the superior mesenteric artery: A case report

Rationale:Splenic artery originating from the superior mesenteric artery is extremely rare. Because of this, its significance in laparoscopic distal pancreatectomy has never been reported. Here, we present the first case of laparoscopic distal pancreatectomy in a patient with a splenic artery arising from the superior mesenteric artery.Patient concerns:A 46-year-old Japanese woman with type 2 diabetes mellitus presented with worsening glycemic control. Abdominal ultrasonography revealed a pancreatic tail mass.Diagnoses:The patient was diagnosed with pancreatic neuroendocrine tumor by endoscopic ultrasound-guided fine needle aspiration. Preoperative computed tomography showed that the splenic artery with branches of dorsal pancreatic artery originated from the superior mesenteric artery.Interventions:The patient underwent laparoscopic distal pancreatectomy. Prior to pancreatectomy, the splenic artery and its dorsal pancreatic branches were clamped using the superior and inferior approaches, respectively, to avoid bleeding and congestion.Outcomes:The postoperative course was uneventful.Lessons:Preoperative evaluation of anatomical variants and development of strategies are important to avoid intraoperative complications in pancreatic surgery. Our results revealed that laparoscopic distal pancreatectomy can be performed safely by strategic approach even in a patient with a rare aberrant splenic artery.     

A case of the ruptured splenic artery aneurysm treated with transcatheter embolization]

Splenic artery aneurysms are the most common visceral artery aneurysms, which are usually found incidentally. The most common complication of splenic artery aneurysms is spontaneous rupture into the peritoneal cavity, which leads to acute peritonitis and shock. Less commonly, it may rupture directly into the stomach, small bowel or pancreatic duct and may present with acute gastrointestinal hemorrhage. We report a rare case of the ruptured splenic artery aneurysm, presenting as acute massive hematochezia which was treated with transcatheter embolization.     

Spontaneous splenic artery hemorrhage with secondary antiphospholipid syndrome in lupus: a case report

Spontaneous hemorrhage is a rare complication of lupus. We describe a 36-year old female with lupus who suffered spontaneous, nontraumatic hemorrhage from branches of the splenic artery with massive blood loss while being treated for a lupus flare. We compare this to the two other reported cases of similar lupus-associated splenic artery hemorrhage documented in the literature, both of which had significant pre-existing hemorrhagic risk factors. Spontaneous, nontraumatic hemorrhage of the splenic artery in the absence of risk factors, and in a patient with secondary antiphospholipid syndrome, has been previously undescribed in lupus.     

Laparoscopic resection of splenic artery aneurysm; a case report

We report a case of a patient who underwent three-dimensional arterial computed tomography, color Doppler sonography and laparoscopic splenectomy for splenic artery aneurysm. Helical computed tomography revealed a splenic artery aneurysm, 3.0 x 1.8 cm in diameter. Color Doppler sonography reveals a weak pulsatile flow from the aneurysm. Surgical treatment is indicated for such cases since approximately 10% of these aneurysms tend to rupture which thus results in fatal hemorrhaging. As a result, a laparoscopic splenectomy was performed. According to our experience, three-dimensional computed tomography and color Doppler sonography can be performed for the arterial and venous information with less invasion than angiography and a laparoscopic splenectomy for splenic aneurysm can be performed which is safer and less invasive than conventional open procedure.