急性非梗阻性胆源性胰腺炎的腹腔镜手术时机探讨

目的探讨急性非梗阻性胆源性胰腺炎的实施腹腔镜胆囊切除术(LC)的可行性及手术时机。方法回顾性分析2004年4月—2008年2月,我院收治37例急性非梗阻性胆源性胰腺炎患者的实施LC治疗的临床资料。结果37例经非手术治疗2~11 d后,血、尿淀粉酶恢复正常,成功实施LC,术后37例均恢复顺利,当日或次日下床活动,36~72 h后进食,无并发症。住院10~24 d,平均13 d。37例随访3个月~1年,均无复发。结论急性非梗阻性胆源性胰腺炎经非手术治疗病情控制后如能慎重选择病例,做好必要的围术处理,实施LC是安全的。     

胆囊结石合并胆源性胰腺炎行微创治疗时机

<正>近年来,随着腹腔镜技术的成熟以及药物的发展,急性胆源性胰腺炎在胰腺炎控制后行腹腔镜胆囊切除术(LC)已成为趋势,但手术时机及手术方式仍有争议。现回顾分析1998年10月—2009年4月我院行LC和腹腔镜联合胆道镜胆总管切开取石术治疗胆源性胰腺炎52例的临床资料,就手术时机选择分析报告如下。     

急性胆源性胰腺炎68例临床诊治分析

目的：探讨急性胆源性胰腺炎临床诊治方法。方法：回顾性分析68例急性胆源性胰腺炎的临床资料。结果：本组5例进行非手术治疗,3例在胰腺炎控制后复查B超或CT示结石消失,2例为重症急性胰腺炎早期出现多器官功能衰竭,最终死亡;63例进行手术治疗,7例行急诊手术,余56例经非手术治疗胰腺炎症状控制后进行延期手术（41例）或择期手术（15例）;急诊手术中,术后3例发生并发症;延期手术中2例术后发生并发症胆瘘,经保守治疗治愈;择期手术均未发生并发症。结论：ABP的治疗应视患者胆道有无梗阻、具体分型及患者的身体状况而制定不同的治疗方案,才能取得满意的效果。     

急性胆源性胰腺炎伴梗阻性黄疸的手术时机探讨

急性胆源性胰腺炎 (Acutegallstonepancreatitis,AGP)伴梗阻性黄疸时临床多主张早期手术治疗。 1998年～ 2 0 0 4年我院收治AGP 10 4例 ,其中伴梗阻性黄疸 36例 ,5例早期 (起病3d内 )手术 ,5例非手术治疗 3～ 7d中转手术 ,2 6例经积极非手术治疗胰腺炎治愈后择期手术。现报告如     

急性胆源性胰腺炎61例的治疗分析

目的总结分析急性胆源性胰腺炎的治疗经验。方法对1997年4月—2004年4月收治的61例急性胆源性胰腺炎的临床治疗资料进行回顾性分析。结果入院后经非手术治疗症状缓解,延期手术27例(44.3%),非手术治疗未能使症状缓解,急诊手术34例(55.7%)。所有病例均痊愈出院,无死亡病例。结论对病情不重的急性胆源性胰腺炎,可先行非手术治疗后,再行手术治疗。但在强调非手术治疗的同时,对某些急性胆源性胰腺炎病例,应积极进行外科手术治疗,并重视术后非手术处理。     

内镜乳头括约肌切开在胆胰疾病治疗中的应用

我院1987年10月—2008年12月,在十二指肠镜下行乳头括约肌切开（EST）治疗胰胆管疾病385例,取得满意效果,现报告如下。1资料与方法1.1一般资料本组385例,男208例,女177例,年龄16～77岁,平均46.8岁。术前诊断：胆道蛔虫症124例,急性胆源性胰腺炎65例,胆道手术后胆漏34例,急性梗阻性胆管炎58例,胆总管结石92例,缩窄性乳头炎9例,胆总管下端癌3例（为高龄不能耐受手术切除患者）。术前详细了解有否心、     

腹腔镜联合胆道镜微创治疗老年人胆总管结石及胆囊结石的临床研究

目的：研究腹腔镜胆总管探查术（LCBDE）及腹腔镜胆囊切除术（LC）联合胆道镜检查取石术治疗老年人胆总管结石（CBDS）合并胆囊结石的可行性及安全性。方法：2011-01-2014-04,53例CBDS及胆囊结石的老年患者实施LCBDE、LC及胆道镜检查取石术。梗阻性黄疸27例,急性胆管炎13例,急性胆囊炎32例,急性胰腺炎2例,肝脓肿1例。肝硬化3例,肝细胞癌1例,慢性阻塞性肺疾病19例,高血压17例,糖尿病13例。术中放置T管及腹腔引流管,观察并分析术后临床病理数据。结果：51例老年患者成功实施腹腔镜及胆道镜联合手术,2例中转开腹。1例因原发性肝癌同时行腹腔镜肝切除术,另1例行十二指肠瘘修补术。平均手术时间（87.9±20.2）min。平均出血量（47.1±51.8）ml。继发性胆总管结石45例,原发性结石6例。发现意外胆囊癌2例。平均术后住院时间（6.6±2.3）d。术后胆漏2例,肺部感染3例,胆道感染2例。未发生胆总管残余结石。结论：腹腔镜联合胆道镜微创治疗老年人CBDS及胆囊结石安全可行,治疗效果良好。     

急性非结石性胆囊炎临床特点及治疗方法探讨

目的探讨急性非结石性胆囊炎的病因、临床特点及诊治经验。方法对我院2000年～2007年间收治的25例急性非结石性胆囊炎患者的临床资料进行回顾性分析。结果24例行手术治疗，其中胆囊切除18例，胆囊造瘘3例，胆囊大部分切除2例，胆囊切除＋胆总管探查T管引流术1例。治愈23例，死亡1例，放弃治疗1例（其家属放弃治疗，追踪结果，病人回家后24小时内死亡）。结论急性非结石性胆囊炎起病急、进展快，病因复杂。提高对该病的认识有重要的临床意义，早期诊断和及时治疗是提高其治愈率和降低病死率的关键。     

急性胆源性胰腺炎的内镜下诊治进展

急性胆源性胰腺炎是因各种胆道疾病引起的胰腺炎。对高度怀疑或已证实为胆源性胰腺炎应立即采用内镜下治疗。目前内镜下治疗包括内镜逆行胰胆管造影（endoscopic retrograde cholangiopancreatography,ERCP）、内镜括约肌切开术（endo-scopic sphincteropapillotomy,EST）和内镜鼻胆管引流术（endoscopic naso-biliary drainage,ENBD）,其已成为治疗急性胆源性胰腺炎的重要手段之一。本文综述了近年来胆源性胰腺炎内镜下诊治情况。     

二镜联合经胆囊管治疗肝外胆管结石12例

目的　总结应用腹腔镜与胆道镜联合微创治疗继发性胆总管结石病人的治疗经验。方法　从 2 0 0 2年 2月至今 ,应用腹腔镜联合胆道镜手术方式经胆囊管途径对 12例继发性胆总管结石病人进行了微创治疗。结果　 10例手术获成功 ,2例改为腹腔镜胆总管探查术及术中胆道镜取石 ,无中转开腹手术 ,无残留结石及严重并发症 ,手术时间稍长 ,但术后住院时间明显缩短。结论　二镜联合行胆囊切除经胆囊管途径治疗继发性胆总管结石对有较高内镜及腹腔镜技术水平的医疗单位是切实可行和安全可靠的     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.