胰腺假性囊肿15例诊治分析

目的总结胰腺假性囊肿（PPC）的诊治经验。方法对某医院2002年3月—2010年3月收治的15例胰腺假性囊肿的临床资料进行回顾性分析。结果保守治疗治愈2例,彩超引导下经皮置管引流5例,囊肿胰尾切除术2例,其余6例均行囊肿与空肠Roux-en-Y吻合内引流术,均获一次性治愈,无近期、远期并发症发生。结论应采用个体化的治疗原则,根据囊肿形成的大小、时问、部位选择保守疗法、非手术引流（经皮置管引流）,胃囊肿吻合、十二指肠囊肿吻合、空肠囊肿吻合、囊肿切除术。     

胰腺假性囊肿18例治疗体会

目的 探讨胰腺假性囊肿(pancreatic pseudocysts,PPC)治疗方法 及治疗效果.方法 对18例胰腺假性囊肿治疗进行回顾性分析并随访.结果 本组2例经保守后治愈;5例B超引导下经皮置管外引流,4例治愈、1例治疗后复发;4例经胃内镜超声引导下胰腺囊肿进行电切造瘘,3例治愈、1例复发.手术治疗共9例(含其他治疗复发2例),其中胃囊肿吻合内引流术3例,囊肿空肠Roux-en-Y内引流术6例,均治愈.结论 胰腺假性囊肿的治疗方法 各有其不同的优势,对PPC患者进行干预,要根据具体情况选择个体化的方案.     

胰腺假性囊肿18例治疗体会

目的 探讨胰腺假性囊肿(pancreatic pseudocysts,PPC)治疗方法 及治疗效果.方法 对18例胰腺假性囊肿治疗进行回顾性分析并随访.结果 本组2例经保守后治愈;5例B超引导下经皮置管外引流,4例治愈、1例治疗后复发;4例经胃内镜超声引导下胰腺囊肿进行电切造瘘,3例治愈、1例复发.手术治疗共9例(含其他治疗复发2例),其中胃囊肿吻合内引流术3例,囊肿空肠Roux-en-Y内引流术6例,均治愈.结论 胰腺假性囊肿的治疗方法 各有其不同的优势,对PPC患者进行干预,要根据具体情况选择个体化的方案.     

胰腺假性囊肿18例治疗体会

目的 探讨胰腺假性囊肿（pancreatic pseudocysts,PPC）治疗方法 及治疗效果.方法 对18例胰腺假性囊肿治疗进行回顾性分析并随访.结果 本组2例经保守后治愈;5例B超引导下经皮置管外引流,4例治愈、1例治疗后复发;4例经胃内镜超声引导下胰腺囊肿进行电切造瘘,3例治愈、1例复发.手术治疗共9例（含其他治疗复发2例）,其中胃囊肿吻合内引流术3例,囊肿空肠Roux-en-Y内引流术6例,均治愈.结论 胰腺假性囊肿的治疗方法 各有其不同的优势,对PPC患者进行干预,要根据具体情况选择个体化的方案.     

儿童颅内蛛网膜囊肿的手术治疗探讨

目的 探讨儿童颅内蛛网膜囊肿的手术适应证、手术方法和手术效果.方法 对手术治疗的82例儿童颅内蛛网膜囊肿的临床资料进行回顾性的分析总结.所采用的手术方法有四种,囊肿切除术19例,囊肿切除加脑池开放术23例,囊肿-腹腔分流术28例,囊肿-腹腔引流术16例.结果 术后随访6个月至5年,整体症状改善率为89.0%,CT或MRI证实囊肿消失明显缩小72例.四种术式比较,囊肿切除术在症状改善和囊肿缩小方面均不优于其他三种术式.结论 手术治疗明显改善儿童颅内蛛网膜囊肿的症状,并可使囊肿缩小.手术方法以囊肿切除加脑池开放术、囊肿-腹腔分流或引流术为佳.     

胰腺假性囊肿45例诊治分析

目的 总结胰腺假性囊肿的诊治体会.方法 回顾性分析45例胰腺假性囊肿患者的临床资料.10例保守治疗,行内引流术30例,外引流术3例,胰腺部分切除术2例.结果 保守治疗者均痊愈,无复发;行内引流术者中2例术后出现吻合口出血,2例术后出现感染,1例术后出现肠瘘,其余25例恢复良好,无复发;行外引流术者中1例术后出现胰瘘,1例死亡,1例恢复良好;行胰腺部分切除术者中1例术后复发,1例恢复良好.结论 根据囊肿形成的原因、位置、大小等特点选择正确的治疗时机和治疗方案,是治疗胰腺假性囊肿成功的关键.     

急性胰腺炎的手术时机与手术方法

目的：探讨急性胰腺炎的手术时机、手术方法。方法：回顾性分析笔者所在医院收治的236例急性胰腺炎行手术治疗病例,其中重症急性胰腺炎有59例。手术方法有单纯胰腺周围引流术、胰腺被膜切开减压加胰腺周围引流术、胰腺坏死病灶切除清创术、脓肿引流术、囊肿引流或切除术、胆囊切除术、胆总管探查引流术加胆囊切除术、胰腺周围引流术加胆囊切除术加胆总管探查引流术等。结果：236例手术者治愈226例,治愈率95.8%（226/236）,其中SAP手术的治愈率为83.1%（49/59）;10例因病情恶化自动出院死亡,死亡率为4.2%（10/236）。结论：对于急性胰腺炎治疗应在病程的各个阶段采取＂个体化＂的防治措施。对合并胆石者,应根据胰腺炎不同的病理类型,积极选择适当的手术时机。胰腺假性囊肿多在急性期后行引流术。胰腺周围血管破裂可行经导管出血动脉栓塞术或破裂血管缝扎止血术。对重症急性胰腺炎合并腹腔间室隔综合症或感染者,应及时行开腹减压、胰腺周围感染坏死组织清创术及引流术。     

儿童颅内蛛网膜囊肿的手术治疗探讨

目的探讨儿童颅内蛛网膜囊肿的手术适应证、手术方法和手术效果。方法对手术治疗的82例儿童颅内蛛网膜囊肿的临床资料进行回顾性的分析总结。所采用的手术方法有四种，囊肿切除术19例，囊肿切除加脑池开放术23例，囊肿-腹腔分流术28例，囊肿-腹腔引流术16例。结果术后随访6个月至5年，整体症状改善率为89．0％，CT或MRI证实囊肿消失明显缩小72例。四种术式比较，囊肿切除术在症状改善和囊肿缩小方面均不优于其他三种术式。结论手术治疗明显改善儿童颅内蛛网膜囊肿的症状，并可使囊肿缩小。手术方法以囊肿切除加脑池开放术、囊肿-腹腔分流或引流术为佳。     

经输尿管镜下囊肿内切开引流术对肾囊肿的治疗作用研究

目的:探讨肾囊肿应用输尿管镜下囊肿内切开引流术治疗的效果。方法:将肾囊肿患者76例随机分为试验组(38例)与对照组(38例),分别行输尿管镜下囊肿内切开引流术治疗与常规腹腔镜囊肿去顶术治疗,对比两组的疗效。结果:试验组的手术时间、术中出血量、术后首次下床活动时间以及止痛药使用率均显著少于对照组(P0.05);两组临床疗效及复发率无明显差异(P0.05)。结论:肾囊肿应用输尿管镜下囊肿内切开引流术治疗可获得与腹腔镜手术相当的疗效,但其创伤更小且并发症更少,具有良好的应用价值。     

外伤性胰腺假性囊肿的处理方式18例报告

目的 探讨外伤性胰腺假性囊肿的处理方式.方法 回顾性分析18例外伤性胰腺假性囊肿的临床资料.结果 18例患者中2例合并胰管断裂者先行外引流后,再行内引流治疗,4例行内引流治疗,余12例未行手术治疗,所有患者均治疗成功.结论 外伤性胰腺假性囊肿手术可行.     

Pancreatic injury in abdominal trauma in children: difficult to diagnose and treat

Traumatic injury of the pancreas is rare in children. It is often difficult to diagnose due to the lack of signs and symptoms, and shortly after trauma laboratory values may be normal. In addition, ultrasound and CT are often not specific. The treatment of grade 1 and 2 injury is non-operative. Although there seems to be a shift towards non-operative management of grade 3-5 injuries (with injury of the pancreatic duct), this is still a matter of debate. We describe 3 children, a girl of 2.5 years-old and a boy of 7 years-old, with grade 3 pancreatic injuries and an 8-year-old boy with a grade 2 injury. We demonstrate that the diagnosis is hard to establish, while the consequences of this injury can be serious. Thinking of pancreatic injury is most important to its diagnosis. We advocate referral to or consultation of specialized centres in these cases.     

膀胱嗜铬细胞瘤的诊断和治疗

目的了解膀胱嗜铬细胞瘤患者诊治情况,提高膀胱嗜铬细胞瘤的诊断和治疗水平.方法对5例膀胱嗜铬细胞癌的临床资料进行回顾性分析.4例行膀胱部分切除术,1例行膀胱全切除术.结果术前确诊4例,术后5例均经病理证实为膀胱嗜铬细胞瘤.随访10个月～12 a,1例术后16个月转移,死于脑出血,其他4例血压正常,无肿瘤复发.结论血尿、高血压、排尿时典型发作三联征为膀胱嗜铬细胞瘤的主要症状.B超、CT、MRI、131I-MIBG作定位诊断,尿4-羟-3甲氧扁桃酸(VMA)和尿儿茶酚胺作定性诊断.手术切除是最有效的治疗方法,术后密切监测尿儿茶酚胺含量,可以了解有无转移和复发.     

后腹腔镜肾囊肿去顶术治疗肾囊肿16例体会

目的：探讨后腹腔镜手术治疗肾囊肿的方法及疗效。方法：16例肾囊肿患者均在全麻下行后腹腔镜肾囊肿去顶减压术,1例术中改开放手术。结果：16例手术均获成功。手术时间30～100min,术中失血量10～50ml,术后住院时间3～5d,无并发症。随访1～12个月无囊肿复发。结论：后腹腔镜肾囊肿去顶术疗效确切,创伤小,安全,有效,痛苦小,康复快。     

卵巢子宫内膜异位囊肿的腹腔镜手术治疗

目的探讨电视腹腔镜手术对卵巢子宫内膜异位囊肿患者的治疗效果。方法收集我院2003年1月~2004年12月在我院接受腹腔镜手术治疗的卵巢子宫内膜异位囊肿患者共46例进行回顾性分析。结果46例患者均行腹腔镜下卵巢子宫内膜异位囊肿剔除术,其中合并不孕症10例,术后随访40例,时间1~12个月,未见复发。10例不孕患者1例妊娠。结论腹腔镜手术治疗卵巢子宫内膜异位囊肿是一种安全有效的方法。     

腹腔镜诊治妇科急腹症156例分析

目的:探讨腹腔镜诊断和治疗妇科急腹症的价值。方法:回顾分析应用腹腔镜诊断和治疗妇科急腹症156例的临床资料。结果:腹腔镜诊断并对109例异位妊娠、23例黄体破裂、3例巧克力囊肿破裂、21例卵巢肿瘤蒂扭转成功进行手术治疗,其中输卵管切除术92例、附件切除术20例、卵巢囊肿剥除术4例、卵巢楔形切除术2例、保守性手术如输卵管线形切开取胚术和卵巢电凝止血术38例。术后3～5d均痊愈出院。结论:运用腹腔镜诊断和治疗妇科急腹症有效、实用。对于休克型的内出血者有可行性。     

Analysis and treatment of pancreatic cystic diseases]

Owing to the spectacular progress in imaging techniques, cystic lesions of the pancreas are detected more often than previously, and this leads to therapeutic dilemmas. Of the cystic lesions of the pancreas, 80% are found to be pseudocysts and 10-15%, neoplastic cysts. The definition of a pseudocyst is: 'an accumulation of pancreatic juice surrounded by a wall of connective tissue or granulation tissue, developed as the result of acute pancreatitis, pancreatic injury or chronic pancreatitis'. In cases of asymptomatic pseudocyst, an expectative policy suffices; growth and symptomatic pseudocysts justify intervention. In addition to surgical internal drainage (cystojejunostomy) there are new therapeutic techniques: external drainage guided by ultrasonography or CT, and internal drainage guided by endoscopy. Endoscopic drainage is the treatment of choice, but it requires experienced hands. The cystic tumours are subdivided into two groups: serous and mucinous cystadenomas. The group of mucinous tumours is subdivided into mucinous cystadenomas and intraductal papillary mucinous tumours. The mucinous or macrocystic adenoma is potentially malignant and should be treated as a malignancy.     

50例胰腺损伤的临床诊疗分析

目的对50例胰腺损伤的临床诊疗进行分析。方法选择2002年1月～2010年3月在本院收治的50例胰腺损伤患者进行手术治疗,分析其临床诊疗。结果本组病例就诊后24h内即明确诊断者45例（90％）,就诊后2～4d内明确诊断者5例（10％）。50例胰腺损伤患者经过治疗之后,显效31例（62％）,有效18例（36％）,无效1例（2％）,总有效率98％。术后出现腹腔脓肿1例,并发胰瘘2例,胰腺假件囊肿1例,伤口感染1例,肺感染2例,1例V级胰腺损伤病例,合并肺感染及腹腔脓肿,于术后26d死亡。结论应把握好各级胰腺损伤的处理原则,在彻底止血、清创的前提下,充分引流,一般多条腹腔负压引流,根据损伤分级施行相应术式,并加强抗感染、营养等综合治疗。     

Treatment of Pancreatic Cyst by Gastrostomy and Internal Drainage

When chronic pancreatitis is accompanied by the presence of a mass in the pancreatic region, treatment must be surgical, but the choice of procedure is not always obvious; if the mass is a cyst, simple internal drainage is to be preferred. While the final decision is made at the table, ultrasonic scanning, as in the case presented, can be of great assistance in anticipating the operative findings.     

Case report: managing fractures in non-compliant alcoholic patients--a challenging task

AIMS: To investigate whether there are extractable conclusions for limb fracture management in dependent alcoholics. METHODS: We discuss four cases of dependent alcoholics who presented in our department over a 12-month period, and who developed significant complications owing to non-compliance with treatment. RESULTS: Initial treatment, although appropriate, failed because of non-compliance. This led to further admissions, wound infections and surgery to enable cure. CONCLUSIONS: Our case reports indicate that for upper limb fractures of the middle third of the humerus, non-operative treatment or internal fixation with out-patient detoxification is appropriate. Lower limb fractures, on the other hand, should be dealt with by external fixation and in-patient detoxification. It is imperative that the alcohol dependence is addressed if we are to decrease non-compliance.     

Late complications of pancreatic injuries following blunt abdominal trauma]

In connection with three successfully operated cases authors are treating the types of late pancreatic complications after blunt abdominal trauma. It is emphasized that the preoperative diagnosis is difficult. Many times weeks or months pass away after the trauma without any symptoms and only developed complication can be noticed first. The importance of the first provision and the need for a careful examination of the pancreas at operation is underlined. In the case of the less suspicion of pancreatic injury they suggest wide, adequate drainage. At last they call attention to the responsibility of the surgeon making the first operation.