胆道镜检查在胆道疾患术式选择中的价值

目的 探讨胆道镜检查在胆道疾患术式选择中的价值。方法 收集术中或联合术后应用胆道镜治疗的胆道疾患１８２例临床资料,进行分析及总结。结果 １３４例胆管胆石症患者胆道残留结石率从３５．２％降至９．７％;３０例术中胆道镜发现合并胆管狭窄,其中１５例肝胆管膜状狭窄者在胆道镜指导与实施了有效扩张治疗;１３列术后残留结石取尽１２例;胆总管下希梗阻病史中２４例肿瘤依据形态学检查,结合术中扪诊及活检组织学检查得到     

胆道镜在胆道术中应用的体会

自1987年至1998年8月间,我院应用纤维胆道镜(下称胆道镜)在胆道手术中诊治胆道疾病98例,取得较好效果。现总结如下。临床资料一、一般资料:本组经临床和影像学诊断胆道疾病98例,其中梗阻性黄疸疑诊胆道肿瘤5例,肝内外胆管结石93例。男41例,女57例;年龄16～78岁。急诊手术应用19例,择期手术应用79例。二、胆道镜检查和治疗方法:我们使用ＯｌｙｍｐｕｓＣＨＦＢ3Ｒ,4Ｂ,Ｐ10型纤维胆道镜,按常规行胆总管切开后,先用传统器械探查,如为胆道结石先用传统器械尽量取石,然后行术中胆道镜检查,先肝内胆管,最后检查胆总管远端。遇结石逐一采用取石网…     

纤维胆道镜检700例次操作并发症防治体会

胆道镜经各种入路在直视下对胆道手术后早期残余病变和远期复发病变进行处理,有效果迅速、确切、安全,可降低再手术率等优点,另一方面,胆道镜检查即使由有经验的医师操作,仍有腹痛、发热、胆道出血和腹壁窦道穿孔等并发症发生,有的并发症还需要外科手术治疗。八年来,我科经T管窦     

纵隔肿瘤的手术方法及手术入路探讨

1970～1996年,我们收治原发性纵隔肿瘤患者228例。其中男149例,女79例;年龄10～68岁,平均31.8岁。良性肿瘤185例,占84.86％;恶性肿瘤33例,占15.14％。肿瘤体积最大约35cm×25cm×25cm。行肿瘤完全切除217例(占95.17％),部分切除4例,探查活检7例;死亡3例。现结合临床资料对其手术方法及手术入路探讨如下。 选择手术切口的原则为显露好、创伤小、便于采取应急处理措施。我们对前上纵隔肿瘤多采取前外侧胸部切口;后纵隔肿瘤多采取后外侧胸部切口;位置较高的前上纵隔肿瘤及累及双侧的采用胸骨正中切口;胸骨后甲状腺采用颈部切口,必要时部分劈开胸骨;累及胸廓出口部位的较大肿瘤采用颈胸联合或双切口。对后纵隔神经源性肿瘤(特别是椎管内肿瘤)者,可采用背部脊柱旁路切口胸膜外切除肿瘤。对部分肿瘤较小者,可于电视胸腔镜下行纵隔肿瘤切除或电视胸腔镜辅助下的小切口纵隔肿瘤切     

下消化道出血患者术中内镜入路的选择

我院自 1993年以来对术前及术中未能明确诊断的下消化道出血 25例,采用经回肠末端 入路紧急内镜检查,取得了良好的效果,现报告如下。 1.资料： 25例中男 16例,女 9例,年龄 17～ 68岁,平均 45.3岁。全组患者均以大 量鲜血便为主诉而入院,术前均经胃镜肠镜检查,除 1例发现回肠末端多发性息肉外,余均 未能发现明确的病变。该患者经止血、扩容、输血,血压仍不能稳定,或经综合治疗止血后 ,住院期间再次出血,采用急诊手术。 2.方法：常规剖腹,因肠腔积血等原因术中探查未能找到出血原因,即再铺一条剖腹单 ,将回肠末端拉出体外作一…     

大脑中动脉瘤的手术入路

文章介绍了大脑中动脉瘤的手术入路，重点描述了经外侧裂入路、颞上回入路的手术方法及段缺点，并对术前入路的造反作了分析和总结。     

胆道术中使用胆道镜的几点体会

自采用术中胆道造影之后,纤维胆道镜相继问世14年以来,使胆道残余病变、残石明显减少,并杜绝了医源性十二指肠及其憩室损伤的发生,进而提高了一次性完成胆道手术的效果。现将我们对39例术中使用胆道镜的几点体会总结如下。临床资料本组142例胆道手术,除常规采用金属探条、取石钳和刮匙探查胆管外,同时行术中胆道造影65例共70例次(45.7％),应用纤维胆道镜检查39例(27.4％)。其中有3例胆道造影疑为胆道残石(4.61％),同时作胆道镜证实仅有1例残石(1.53％)。7例术中胆道残石,经胆道镜完全取净者4例,部分取除者2例,取石成功率达85.7％(6/7)。其     

大脑中动脉瘤的手术入路

文章介绍了大脑中动脉瘤的手术入路,重点描述了经外侧裂入路、颞上回入路的手术方法及优缺点,并对术前入路的选择作了分析和总结。     

髋臼骨折手术入路选择的研究现状

髋臼骨折属于最大负重关节内的骨折,因其解剖位置深在、显露困难、周围血管神经密集且治疗往往要求对其解剖复位和坚强固定,因此成为创伤骨科最具难度的手术之一。该文就髋臼骨折手术经典入路及近几年提出的各种改良入路的研究现状作一综述。     

选择性术中胆道造影在胆系手术中的应用价值

目的探讨选择性术中胆道造影(IOC)在胆系手术中的应用价值。方法回顾性分析2010年5月-2015年5月于平顶山市第一人民医院住院的112例行选择性IOC患者的临床资料及随访情况;另选取同期或早期符合选择性IOC标准但未行IOC或造影失败的84例患者作为对照。比较两组患者的临床资料及随访情况。计量资料组间比较采用t检验,计数资料组间比较采用χ~2检验。结果选择性IOC组中,腹腔镜下IOC 82例(造影后中转开腹手术19例),开腹IOC 30例;其中IOC阳性40例,包括胆道结石24例,胆道狭窄4例,胆管下端占位1例,胆道损伤5例,胆道阴性探查6例。对照组中,术中胆道探查53例,其中胆道结石26例,胆总管下端炎性狭窄2例,阴性探查25例。选择性IOC组胆道阴性探查率为15.00%(6/40),对照组为47.17%(25/53),两组比较差异有统计学意义(χ~2=10.616,P=0.001)。选择性IOC组中胆管损伤致术后胆漏1例(0.89%),术中及时发现并行一期胆管修补T管引流,2周后自愈;对照组中术后发现胆道损伤7例(8.33%),均需短期内再次手术或内镜下治疗,两组间胆道损伤发生率差异有统计学意义(χ~2=6.787,P=0.009)。选择性IOC组患者术后半年内发现胆道结石2例(1.79%),对照组术后半年内发现12例(14.29%),两者比较差异有统计学意义(χ~2=11.308,P=0.001)。结论选择性IOC能有效减少不必要的胆道探查,降低胆道损伤几率,减少术后残石的发生,并可在术中帮助术者较早地发现胆管损伤,减少再次手术的几率,减轻患者的痛苦及花费,为胆道探查手术提供有力的帮助。     

包虫病(棘球绦虫病)临床分类的探讨

目的 研究包虫病的临床分类,旨在提出一个新的分类设想.方法 20年前,作者挑选20例包虫病病例,初步提出临床分类[1].近年作了进一步的研究,按寄生虫学、感染途径、症状、病理学和超声扫描等方法对多年收集的315例肝包虫病病例进行了分类.结果 按寄生虫学分类,有215例囊型包虫病和100例泡型包虫病病例.按感染途径分类,有186例原发型和29例继发型囊型肝包虫病病例,94例原发型和6例继发转移型泡型包虫病病例.按临床症状分类,有170例单纯型和45例复杂型囊型肝包虫病病例.泡型包虫病病例按病理大体肉眼观分为7例结节型、25例巨块型和12例混合型;泡型包虫病病例按光学显微镜下观察分为10例增殖型、2例衰退型和12例混合型.囊型肝包虫病患者按超声图像分型,有16例单纯性囊肿型、18例包虫特征型、82例囊内异常回声、18例钙化型和2例复合型;泡型肝包虫病患者包括65例异常强回声型、9例坏死液化型和8例钙化型.结论 包虫病临床分类不仅对选用手术或化疗,而且对评估患者疗效和预后均有意义,故实有必要将包虫病临床分类作为包虫病诊断的一部分.     

Cigarette abandonment: its significance

Two hundred and eight interviews with ex-cigarette-smokers in the street and 208 interviews with ex-cigarette-smoker chest patients, all over 45 years of age, gave a composite picture of people commonly smoking until their health is affected. Symptoms were much more important then tobacco tax or propaganda in stopping cigarette-smoking. Of continuing smokers 16% wished that they could stop because of symptoms. Fear of the presence of cigarette-induced disease was thought to explain why some patients gave unconvincing reasons for abandoning cigarettes or had become ex-smokers in the year preceding their examination and many of these had carcinoma of the bronchus. Cigarette abandonment should be accepted as part of the symptomatology of respiratory disease. It sometimes is the first identifiable event in the relevant medical history of chest patients.     

Definitions for haemophilia prophylaxis and its outcomes: The Canadian Consensus Study

The creation of acceptable standard definitions for terms used in the care and assessment of haemophilia patients has become increasingly important, as a growing number of international clinical studies have been initiated. The Delphi approach has been used in health research to reach consensus in large groups and can be used to develop definitions by using several iterations of surveys eliciting opinions from specialists in the field. Three consecutive surveys were designed based on the Delphi approach and distributed to specialist physicians, nurses and physiotherapists in order to develop definitions for seven haemophilia terms: 'primary prophylaxis', 'secondary prophylaxis', 'target joint', 'joint bleed', 'significant soft-tissue bleed', 'superficial soft-tissue bleed' and 'mucosal bleed'. Suggestions were solicited, compiled into a subsequent survey and fed back to the group to rank-order the importance of each suggested component of the definition. Final definitions were created using the top-ranked suggestions and sent back to the experts for approval. Five of the seven terms were highly endorsed with greater than 90% agreement. Some differences in agreement were found when analysed by profession. Haemophilia terms were successfully defined using the Delphi approach. Further refinement from members of the international haemophilia community will ensure that comprehensive standard definitions can be used in multicentre studies in the future.     

Angiotensin blockade: its clinical significance.

An understanding of the possible role of excessive angiotensin II activity in the pathogenesis of hypertension in every patient is therapeutically desirable, but it is frustrated by the lack of complete reliability of peripheral plasma measurements of renin activity. Observation of a clear-cut, supranormal decrease in blood pressure during the intravenous infusion of the angiotensin II antagonist, saralasin, has provided a far more reliable indication of the presence of an angiotensinogenic component in the hypertension. There is convincing evidence, however, that the presence of sodium-overload may prevent a decrease in blood pressure during saralasin infusion in persons known to have angiotensinogenic hypertension and that saralasin may cause a slight decrease in the blood pressure of normal subjects after natriuresis. For these reasons, it is important to study hypotensive responses to saralasin under standardized conditions after the administration of a potent diuretic and to compare the observations with those made on normal subjects under identical circumstances. This angiotensin antagonist may be used in the therapy of malignant or advanced hypertension and as an aid to therapeutic decisions in hypertensive patients who have known renal diseases, are taking oral contraceptives or have had severe trauma to the area of the kidneys. Side effects of saralasin are limited to excessive falls in blood pressure levels, mainly when vasodilators or ganglioplegic drugs are being taken at the time of the saralasin infusion, and excessive rises in blood pressure levels, especially in hypertensive subjects with "low renin" activity during high rates of saralasin infusion or after intravenous injections of large boluses. This safe and reliable drug is a valuable tool in the investigation and therapy of hypertension.