急性结石性胆囊炎腹腔镜胆囊切除术148例临床探讨

目的:总结急性结石性胆囊炎LC手术的应用.方法:总结2009-10~2012-01本院收治的148例急性结石性胆囊患者行腹腔镜胆囊切除手术的经验.结果:148例中有143例完成腹腔镜手术,5例中转开腹,无胆管损伤,患者恢复快,无并发症发生.结论:具备熟练腹腔镜操作技术前提下,急性结石性胆囊炎早期行腹腔镜胆囊切除术在基层医院大有前景.     

腹腔镜治疗急性结石性胆囊炎145例

目的：总结腹腔镜胆囊切除术（LC）治疗急性结石性胆囊炎的体会。方法：对我院145例急性结石性胆囊炎患者采取LC进行治疗。结果：平均发作时间82.3 h,手术平均时间64 min,出血量平均23 mL,平均引流量36.3 mL。中转开腹4例（占2.7%）,发生胆漏2例,膈下感染1例,无手术死亡。患者均痊愈出院,平均住院时间12.96 d。结论：准确掌握胆囊结石并发急性胆囊炎腹腔镜切除术的适应证,手术是安全可行的。     

PTGD联合LC治疗高龄高危急性结石性胆囊炎32例

目的 总结经皮肝胆囊穿刺引流(PTGD)联合腹腔镜胆囊切除术(LC)对高龄高危急性结石性胆囊炎患者的治疗经验.方法 回顾分析我中心2008年5月～2010年5月采用PTGD联合LC序贯治疗32例高龄高危结石性胆囊炎患者的临床资料.结果 32例均穿刺置管,全部获得有效引流,1 w～3个月后行LC,中转开腹4例;无出血及漏...     

47例阑尾切除术同时胆囊切除术治疗体会

目的 探讨阑尾炎合并结石性胆囊炎或胆囊息肉手术治疗体会.方法 对手术治疗的47例急慢性阑尾炎合并结石性胆囊炎或胆囊息肉患者进行回顾性分析.结果 阑尾炎合并结石性胆囊炎35例,合并胆囊息肉12例,其中急性阑尾炎37例,慢性阑尾炎10例 开腹手术31例,腹腔镜手术16例.开腹手术后切口感染2例 腹腔镜手术后发生胆漏1例,发生阑尾残端瘘1例.结论 单纯急慢性阑尾炎合并结石性胆囊炎或胆囊息肉患者可以选择性同时进行胆囊切除术和阑尾切除术.     

胆囊结石嵌顿和胆囊萎缩腹腔镜85例手术治疗

胆囊结石嵌顿及胆囊萎缩的腹腔镜手术(LC)难度大,稍有不慎会出现严重的并发症。我院自2000年7月～2003年1月,应用腹腔镜治疗结石性胆囊炎623例,其中胆囊结石嵌顿及萎缩性胆囊炎85例,占13.6%。现报告如下。     

腹腔镜胆囊切除术31例严重并发症分析

腹腔镜胆囊切除术 ( LC)已广泛应用于临床 ,实践证明 ,LC因其独特的微创外科优点 ,为广大患者所接受。现将我院开展 LC的情况向大家汇报如下。1　临床资料我院 1 991年 1 0月至 2 0 0 2年 4月施行腹腔镜胆囊切除术 ( LC) 1 1 0 0 0例 ,发生严重并发症 31例。其中死亡 2例。1 .1　一般资料　　男 2 85 6例 ,女 81 44例 ,年龄 1 6～ 91岁。其中慢性结石性胆囊炎 9663例 ,急性胆囊炎或胆囊积脓 986例 ,胆囊息肉样病变 31 9例 ,慢性非结石性胆囊炎 32例 ,全部病例均经手术和病理证实。1 .2　严重并发症及原因分析1 .2 .1　胆管损伤 1 1例 :…     

腹腔镜胆囊切除治疗急性结石性胆囊炎的临床效果观察

目的 探讨急性结石性胆囊炎应用腹腔镜手术的治疗效果及对患者C反应蛋白(CRP)水平的影响.方法 纳入诊治的急性结石性胆囊炎患者78例,随机分为对照组和研究组,对照组35例采用传统开腹手术治疗,研究组43例采用腹腔镜手术治疗,比较两组临床疗效及CRP水平.结果 研究组手术切口、术中出血量明显短于/少于对照组,肝功能和肠蠕...     

腹腔镜下行急性胆囊炎切除56例临床分析

目的总结腹腔镜下行急性胆囊炎切除术的临床经验。方法对本院2003年7月—2005年6月的56例急性胆囊炎病人施行腹腔镜胆囊切除术(LC)的临床资料进行回顾分析。结果51例成功完成LC,中转开腹手术5例,其中因Calot三角解剖不清,周围致密粘连2例,结石嵌顿于胆囊管1例,胆囊动脉出血2例。术后无严重并发症发生。结论只要能把握住手术时机并注重手术技巧,急性胆囊炎患者行腹腔镜下胆囊切除术是安全可行的。     

腹腔镜手术严重并发症15例的预防与处理

我院自1992年9月至1995年3月行电视腹腔镜胆囊切除术（LC）650例，作者对其中发生三大损伤和与之相关的并发症15例的原因进行了分析，提出了预防与处理措施。1临床资料本组LC手术650例，发生术中及术后并发症15例，罹息率为2．3％，其原发病为慢性结石性胆囊炎10例，慢性结石性胆囊炎急性发作3例，胆囊结石并胆囊管嵌顿结石1例，慢性非结石性胆囊炎1例，平均术后住院14．5d，比无并发症者多住院11d.1．1LC手术并发症的分布情况：血管损伤3例，胆管损伤7例，十二指肠前壁损伤1例，隔下及盆腔积脓2例，穿刺孔疝2例。1．2胆管损伤的部位与类…     

腹腔镜胆囊切除手术前后护理

腹腔镜手术 (LC)是上个世纪九十年代引进的新术式 ,这是胆道外科的一次飞跃 ,也是外科发展史上的一个新的里程碑。具有切口小 ,创伤小 ,疼痛轻 ,术后恢复快 ,住院时间短 ,切口美观 ,符合美容的要求。自 1997年 11月～ 2 0 0 2年 11月我科用腹腔镜手术治疗结石性胆囊炎 2 0 8例 ,取得良好效果 ,在手术前后护理中 ,腹腔镜手术确有比开腹胆囊术不少优点 ,现将护理体会介绍如下 :1　临床资料2 0 8例结石性胆囊炎患者 ,男性 76例 ,女性 13 2例年龄最大 76岁 ,最小 16岁 ,平均年龄 46岁 ,全部病例均经B超确诊为胆囊结石 ,其中“中转开腹”只有 2…     

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.