胰管结石的分型及外科治疗方式的选择

目的 探讨胰管结石的分型方法,并根据分型选择合理的外科治疗方式.方法 回顾性分析2000年1月至2010年12月89例接受手术治疗的胰管结石患者,男性57例,女性32例,平均年龄(52±23)岁.所有患者都经磁共振胰胆管成像确诊,根据结石的位置、胰管有无狭窄,将胰管结石分为3型:Ⅰ型43例,胰石位于主胰管,主要采用内镜取石或胰管切开取石+胰管空肠吻合术;Ⅱ型39例,胰石同时位于主胰管和分支胰管,主要采用胰管切开取石+胰管空肠吻合术和(或)胰腺区段切除;Ⅲ型7例,结石位于分支胰管,主要采用胰腺区段切除.结果 全组病例手术均获得成功,术后胰漏6例(6.7％),经非手术治疗后痊愈;吻合口出血2例(2.2％),其中1例死亡;结石残留6例(6.7％),均为分支胰管结石残留.78例获得随访,57例生存至今;5例患者有间隙性腹痛需要内科治疗,7例患糖尿病(2例为胰腺次全切除,5例为胰体尾切除),结石复发5例,其中3例行第2次手术.结论 根据结石在胰管内而不是在胰腺实质的部位提出的胰管结石分型方式,对于以“取尽结石并保留胰腺功能”为原则的胰管结石外科治疗具有一定的指导价值.     

胰管结石外科治疗体会

目的总结胰管结石的分型、外科治疗方式的合理选择。方法胰管结石病人21例,分析不同类型病人胰管结石分型、治疗方式、术后并发症和临床疗效。结果全组均采用影像学B超、CT或MRCP检查确诊。将胰管结石分为四型:Ⅰ型:结石主要位于胰头部,主要是采用内镜取石,内镜治疗失败后行胰头十二指肠切除(Whipple手术);Ⅱ型:结石主要位于胰体部,主要采用内镜取石,内镜治疗失败后采用胰管切开取石、胰肠吻合(Partington手术);Ⅲ型:结石主要位于胰尾部,主要采用胰尾部加脾切除;(4)Ⅳ型结石广泛分布于头、体和尾部,主要采用胰头切除,大口径胰管切开取石加胰管空肠Roux-en-Y吻合术。结论在胰管结石治疗中应根据胰管结石的类型采用不同的手术方式,遵循个体化治疗原则。     

胰管结石的外科分型及处理对策

目的 探讨胰管结石的外科分型并根据外科分型制定相应的有效处理对策。方法结合文献对33例胰管结石的诊断及处理进行回顾性分析。总结不同类型胰管结石治疗方法与结果,提出胰管结石的外科分型和处理对策。结果根据影像学(B超、ERCP、CT)检查结果和手术探查结果,将胰管结石分为四型：(1)I型：结石主要位于胰头部,主要处理方法是采用内镜取石,介入治疗失败或疗效不佳可行胰头十二指肠切除(Whipple手术);(2)Ⅱ型：结石主要位于胰体部,主要处理方法是采用胰管切开取石胰管空肠吻合(Puestow 手术);(3)Ⅲ型：结石主要位于胰尾部,主要处理方法是采用胰尾部加脾切除;(4)Ⅳ型：结石广泛分布于头、体和尾部主胰管,主要处理方法是采用Puestow．Gillesby和胰颈部离断,胰管探查取石加胰管两断端空肠Rous-en-Y吻合手术。结论正确的术前及术中诊断、分型,结合针对性的个体化处理对策在慢性胰腺炎导致的胰管结石治疗中具有重要意义。     

胰管结石40例诊治体会

目的探讨胰管结石合理的分型及个体化治疗方式。方法回顾性分析2004年10月至2014年5月我院收治的40例胰管结石患者的临床资料,男性20例,女性20例,平均年龄(37±12)岁。所有患者均术前确诊,其中确诊率B超88.6%(31/35),CT为77.4%(24/31),MRCP为92.6%(25/27)。手术治疗27例,内镜治疗13例,采用陈勇军等提出的胰管结石分型对其分型。结果根据结石的位置、胰管有无狭窄及术中探查结果,将胰管结石分为3型:Ⅰ型16例,胰管结石位于主胰管,7例行胰管切开取石+胰管空肠Roux-en-Y吻合,9例行ERCP取石,其中6例ERCP取石+支架,3例ERCP取石+ENPD;Ⅱ型20例,胰管结石位于主胰管和分支胰管,均行胰管切开取石+胰管空肠Roux-en-Y吻合,合并胰尾切除1例,胰十二指肠切除1例,Frey手术1例;Ⅲ型4例,胰管结石位于分支胰管,主要行ERCP胰管支架引流。全组无死亡病例,术后胰瘘1例(3.7%),内镜治疗后急性胰腺炎1例(7.7%),结石残留8例(20%),4例Ⅱ型结石,4例为分支胰管结石。38例获得随访,至今生存,疼痛症状均明显缓解。结论胰管结石处理复杂,正确的分型对其个体化治疗具有重要意义,胰管切开取石+胰管空肠Roux-en-Y吻合仍是外科治疗首选手术方式,内镜技术已然成为一种重要的治疗手段。     

胰管结石的外科治疗(附116例报告)

目的 总结胰管结石的外科治疗方式.方法 回顾性分析2007年1月至2012年12月间外科手术治疗胰管结石116例的临床资料.结果 胰十二指肠切除术者45例,胰管切开取石并行胰管空肠侧侧吻合者33例,Beger手术17例,Frey手术12例,胰体尾切除术9例.9例已发生胰腺癌变.全组无围手术期死亡,术后发生并发症12例,发生率为 10.3%.术后3个月,绝大多数患者症状有明显改善.105例术后全程随访发现:92例胰管结石患者存活至今,一般情况良好,6例胰腺癌患者因肿瘤复发病故,1例胰管结石患者因糖尿病及严重营养不良病故,6例因其他原因病故.结论 手术治疗是胰管结石达到根治性治疗的理想方法,按照胰管结石的治疗原则,依据结石及胰腺病变的具体情况选择合理的手术方式,是取得良好疗效的关键.     

慢性胰腺炎合并胰管结石的外科治疗

目的 探讨慢性胰腺炎合并胰管结石的外科治疗方法.方法 回顾性分析66例慢性胰腺炎合并胰管结石患者的临床资料,将其分为4型:Ⅰ型28例分布在胰头部;Ⅱ型30例在胰体部;Ⅲ型1例在胰尾部;Ⅳ型7例在胰头、胰体、胰尾部主胰管.10例(Ⅰ型4例,Ⅱ型5例,Ⅳ型1例)经镇痛、抑酸、应用生长抑素、抗感染等治疗.10例(Ⅰ型)行内镜取石术.Ⅰ型14例行胰头十二指肠切除术和保留十二指肠胰头部分切除术;Ⅱ型25例行胰管切开取石+胰管空肠吻合术;Ⅲ型1例行胰尾部+脾切除术;Ⅳ型6例行Puestow-Gillesby和胰颈部离断+胰管探查取石+胰管两断端空肠Roux-en-Y吻合术.结果 62例随访2个月至15年,Ⅰ型术后结石复发4例,Ⅱ型2例,Ⅲ型0例,Ⅳ型3例.结论 慢性胰腺炎合并胰管结石确诊后应争取早日手术治疗,根据结石分布范围选择相应的治疗方式.正确的术前及术中诊断、分型及个体化处理在预防慢性胰腺炎合并胰管结石外科治疗后结石复发中有重要意义.     

胰管结石的手术治疗

目的 探讨胰管结石的手术治疗方式.方法 对1997-2007年间24例胰管结石患者的手术治疗方式进行回顾性分析.结果 24例胰管结石中行胰管纵行切开取石、胰管空肠Roux-en-Y吻合17例,其中附加主胰管外引流2例,附加胆管空肠吻合3例,附加胰腺囊肿空肠吻合1例,1例术后并发胰肠吻合口出血,1例术后早期出现应激性溃疡,均经保守治疗治愈;胰十二指肠切除3例,1例并发吻合口出血,经保守治疗治愈;胰体尾切除2例,保留十二指肠胰头切除1例,胰管切开取石、Ⅰ期缝合1例,术后均无并发症.全组21例得到随访,17例效果优良.结论 胰管纵行切开取石、胰管空肠Roux-en-Y吻合是治疗胰管结石的合理术式,保留十二指肠的胰头切除和胰管切开取石、Ⅰ期缝合用于治疗胰管结石是可行的.     

胰管结石的治疗：附37例报告

目的:探讨胰管结石的外科处理方法。方法:回顾性分析近13年我院收治的37例胰管结石临床资料。结果:将胰管结石分为3型:Ⅰ型，结石主要位于胰头部,以采用胰头十二指肠切除为主;Ⅱ型， 结石主要位于胰体尾部,以采用胰尾部或加脾切除为主;Ⅲ型， 结石广泛分布于头、体和尾部,主要采用胰头切除，大口径胰管切开取石加胰管空肠Roux-en-Y吻合术。全组病例无死亡。治疗后2周内症状不同程度缓解。随诊31例（83.8 %），随诊时间为6～72个月，效果满意。结论:在胰管结石治疗中应根据胰管结石的类型采用不同的手术方式，其外科治疗关键是清除胰石、切除病胰、通畅引流。     

胰管结石的诊断与治疗:附25例报告

目的探讨胰管结石的诊断与治疗方式。方法回顾分析2005年~2012年收治的25例胰管结石患者的临床资料。结果根据临床表现及影像学检查结果将胰管结石分为不同类型。根据不同类型病例特点,采用保守治疗、内镜治疗、手术治疗等不同的治疗方式。全组无与手术相关的死亡病人。3例合并胰腺癌患者术后5~11个月死亡。随访23(92%)例,随访时间12~36个月,效果满意。结论正确的诊断与分型对胰管结石的治疗有重要意义,治疗应遵循个体化的原则。     

胰管结石慢性胰腺炎的诊断和外科治疗

目的探讨胰管结石慢性胰腺的诊断和外科治疗。方法收集我院2000年9月至2006年10月间经手术治疗的胰管结石慢性胰腺炎患者6例的临床资料进行回顾性分析。结果全组病例均经B超、CT和磁共振胆胰管成像MRCP检查确诊及手术治疗。手术方式采用胰管切开取石,胰管空肠Roux-Y吻合术,其中同时行胆胰Roux-Y吻合术2例,行胆囊切除术1例。治愈5例,缓解1例,无手术死亡。结论影像学检查是诊断本病的重要手段,准确率高。胰管空肠Roux-Y吻合术是治疗胰管结石慢性胰腺炎的有效方式,可取得良好的治疗效果。     

Anterior decompressive surgery after cervical laminoplasty in patients with ossification of the posterior longitudinal ligament

Background contextTwo surgical procedures, posterior decompressive surgery (PDS) and anterior decompressive surgery (ADS), are the treatment options for cervical ossification of the posterior longitudinal ligament (OPLL). Each procedure has advantages and disadvantages. Cervical laminoplasty, a type of PDS, is relatively easy to perform and can be used for patients with multilevel cord compression. ADS can often be more technically demanding.ObjectiveThe purpose of this study was to clarify the clinical characteristics and surgical results of the patients for whom ADS was necessary after PDS.Study designRetrospective study.MethodsA total of 144 patients, followed for more than 3 years after cervical laminoplasty, were included. The neurologic status was graded using the Japanese Orthopedic Association (JOA score). Eleven patients underwent ADS after PDS. The clinical background and surgical outcomes were evaluated. Radiological findings of the 11 patients requiring ADS after PDS (PA group) and the 133 PDS patients not requiring ADS (P group) were compared.ResultsIn the PA group, the JOA score was slightly deteriorated during follow-up after cervical laminoplasty. Severe pain in the unilateral upper extremity and deterioration of cervical myelopathy were the most typical symptoms necessitating ADS. The incidence of the mixed type of OPLL was significantly higher in this group. The JOA score improved in all patients after ADS as a second surgery.ConclusionsIn our strategy for the surgical treatment of cervical OPLL, PDS with laminoplasty remains as the initial treatment, and in patients with neurological deterioration and newly developed clinical symptoms during follow-up, ADS is considered as a salvage procedure.     

Quadrizeps- und Patellasehnenrupturen

Ruptures of the quadriceps or patellar tendon are uncommon but extremely relevant injuries. Early diagnosis and surgical treatment with a stable suture construction are mandatory for a good postoperative clinical outcome. The standard methods of repair for quadriceps and patellar tendon injuries include the placement of suture loops through transpatellar tunnels. Reinforcement with either a wire cerclage or a PDS cord is used in patellar tendon repair. The PDS cord can also be applied as augmentation in quadriceps tendon repair. In secondary patellar tendon repair an autologous semitendinosus graft can be used. For chronic quadriceps tendon defects a V-shaped tendon flap with a distal footing is recommended. The different methods of repair should lead to early functional postoperative treatment. The clinical outcome after surgical treatment of patellar and quadriceps tendon ruptures is mainly good.     

Olecranon fracture fixation utilizing a bioabsorbable tension band construct: analysis of stability with motion in a cadaveric model

This study was performed to determine if tension band suturing with bioabsorbable materials can maintain fracture (osteotomy) reduction when subjected to an early motion protocol. Olecranon osteotomies were created in 13 cadaveric upper extremities and then sequentially fixed with axial Kirschner wires, and tension band wiring/suturing utilizing: musical #1 PDS (Ethicon Inc., Somerville, New Jersey, USA), musical #1 Panacryl (Ethicon Inc.), musical #2 Panacryl (Ethicon Inc.), and 18 gauge surgical wire. Specimens were cycled through a range of motion in a continuous passive motion machine. Specimens fixed with K-wires only, musical #1PDS and musical #1 Panacryl tension band suturing failed to maintain osteotomy reduction. Only surgical steel and musical #2 Panacryl maintained osteotomy reduction; both were superior to the other fixation methods (P<0.001). The musical #2 Panacryl suture is an excellent choice for a tension band suture construct; it retains 80% of its breaking strength at 3 months, is fully absorbed, and maintains osteotomy reduction throughout a passive motion protocol.     

Spinal cord stimulation (SCS) using an 8-pole electrode and double-electrode system as minimally invasive therapy of the post-discotomy and post-fusion syndrome--prospective study results in 34 patients

AIM: Therapy of a pronounced post-discotomy (PDS) and post-fusion syndrome (PFS) is often unsatisfactory because of the complexity and multifactorial pain genesis. If surgical interventions cannot promise relief and if the entire interdisciplinary spectrum of conservative treatment measures is inadequate, the area of neuromodulative procedures offers spinal cord stimulation (SCS). The objective of this study was to examine the therapeutic possibilities of SCS using an 8-pole electrode and double electrode system in PDS and PFS with extensive back-leg pain areas. METHOD: An appropriate SCS system was implanted in 34 patients with PDS and PFS. Follow-up examinations were made prospectively over a period of 24 months using general criteria and psychometric test measuring instruments validated for German-language use. RESULTS: An 8-pole double electrode system was implanted 23 times, a single electrode sufficed in 11 cases. The area of pain was covered in all patients. This required special technical capabilities of the SCS system. The results remained constant over 24 months. The morphine dose could be reduced by at least 50 %. All measuring instruments confirmed a clear reduction in pain and improvement in quality of life as a result of SCS implantation. CONCLUSION: The SCS is an minimally invasive surgical procedure which can enlarge the therapeutical possibilities of pronounced PDS and PFS resistant to other modes of treatment. Special technical possibilities of parameter setting are required to cover the pain areas.     

胰管结石的临床诊断与治疗

目的探讨胰管结石的诊断、分型及治疗方法选择。方法回顾性分析2010年1月至2019年12月间上海健康医学院附属周浦医院收治的32例胰管结石临床资料,总结不同类型胰管结石的处理方法。结果32例患者术前均通过超声、CT及磁共振胰胆管造影(MRCP)等明确诊断。其中超声诊断正确率81.3%(26/32),CT诊断正确率86.2%(25/29),MRCP诊断正确率90.4%(19/21),内镜逆行胰胆管造影(ERCP)诊断正确率100%(8/8)。根据结石的位置及术中探查将胰管结石分为3型:I型17例,结石位于主胰管;Ⅱ型11例,结石位于主胰管和分支胰管;Ⅲ型4例,结石位于分支胰管。依据不同类型采用不同的治疗方式。全组围术期无死亡病例。术后共有并发症11例(34.3%),术后残石率为9.3%(3/32)。32例均获得随访,随访时间6~60个月不等,术后腹痛、脂肪泻等症状消失或明显减轻。2例合并胰腺癌者于术后12~35个月后因胰腺癌复发转移死亡。结论胰管结石处理复杂,影像学检查是确诊胰管结石的主要方法。胰管结石分型对其个体化治疗方法选择具有重要意义。外科手术是治疗胰管结石常用的重要手段。     

Morphological and histological findings after typical surgical manipulations on growing septal cartilage in rabbits

One remaining problem of nose surgery is surgical correction of a prepubertal distortion of the septum. Unfortunately, the growing cartilage reacts differently upon a surgical intervention; in most cases this might cause iatrogenic disturbance of the development. Our clinical and histological studies with polydioxanone (PDS) foil in septal reconstruction showed that the PDS foil successfully prevented postoperative sequelae like dislocation of the reimplanted cartilage fragments and recurrent deviation caused by overlapping of the cartilage borders. Furthermore, it seemed to stimulate cartilage regeneration. The question occurs whether the same effect can be expected if growing septal cartilage is supported by the PDS foil. This animal study showed remarkable effects of the resorbable PDS foil in healing and regeneration of the growing septum up to complete resorption of the PDS, which coincidentally paralleled the outgrowth of the septal cartilage in rabbits, such as in cartilage regeneration and in prevention of secondary septal deviations due to bending of the newly formed cartilage or incomplete healing of cut edges.     

Die Rupturen der Amphiarthrosen am Beckenring

So-called over-bridging tension band fixations are presented with special respect to their surgical procedures, development to technique, operative approaches, experimental findings gathered from 83 human pelvises explanted postmortally and clinical results. PDS band fixation has shown to guarantee approximately the same stability as comparable procedures offering in any case an immediate ease of bedside care and the possibility of physical exercise in bed. A slight postoperative elongation of the PDS band is sometimes seen on the X-ray as a small step in the outlines of the symphysis, but so far has been of no importance in our cases of treatment.     

Surgical treatment of fractures of the distal clavicle with polydioxanone suture tension band wiring: an alternative osteosynthesis

 Fracture of the distal clavicle type II (Neer) is an indication for surgical intervention. We report our experience in 12 patients with acute clavicular fractures and operative treatment with polydioxanone suture (PDS) tension band wiring. The patients were assessed 6 and 12 weeks postoperatively by radiological and clinical evaluation and with the Constant Murley score. All 12 patients had an excellent functional result 12 weeks postoperatively. The Constant Murley score was excellent in all patients. The PDS band can be considered as an alternative osteosynthesis. In the context of the current literature, the advantages and disadvantages of this new procedure are discussed. Received: October 26, 2001 / Accepted: April 1, 2002     

超声回声灰阶直方图分析预测胆结石成分的研究

目的: 通过对胆石超声回声灰阶直方图分析,预测胆石的化学类型,为胆石症的治疗及其成因分析、预防提供指导和参考. 方法: 对78例胆石症病人进行术前超声检查,记录回声图像直方图及各项参量,术后对取出的胆结石进行红外光谱分析,将不同化学类型的胆石与直方图的类型相比较,预测胆石的化学类型. 结果: 不同化学类型胆石的直方图图形各有其特点,大致分六种图形:高峰型、尖峰型、底圆峰型、底平峰型、多峰型和高圆峰型. 结论: 回声灰阶直方图的图形与胆石类型之间有一定规律,可以测胆石化学类型.     

The surgical relief of transposition of the great vessels in infancy

The necessity for palliative surgery in transposition of the great vessels is indicated and the basic haemodynamics of the condition are outlined. The clinical picture of infants with transposition is divided into three types, and a method of surgical treatment is suggested for the two most common types. Our technique of investigation and treatment is described and the reasons for our choice of therapy are discussed. The results of cases operated upon are presented.