先天性胆管囊肿的外科治疗

目的探讨先天性胆管囊肿的手术方式、手术时机,进一步总结胆管囊肿的诊治经验.方法回顾性分析1990～2004年我院收治的43例先天性胆管囊肿的临床资料并复习文献.结果43例均手术治疗,其中行囊肿切除、肝总管空肠Roux-en-Y吻合术24例,囊肿大部切除、肝总管空肠Roux-en-Y吻合9例,囊肿空肠Roux-en-Y吻合内引流4例,囊肿外引流5例,左肝、尾状叶及胆管囊肿切除、肝总管空肠Roux-en-Y吻合术1例.32例获得随访,其中囊肿切除、肝总管空肠Roux-en-Y吻合术16例,偶发上腹隐痛1例;囊肿大部切除、肝总管空肠Roux-en-Y吻合7例,偶发胆管炎3例;囊肿空肠Roux-en-Y吻合内引流4例,频发胆管炎2例、胆瘘1例;囊肿外引流5例,经再手术获得治愈.结论先天性胆管囊肿一经明确诊断,应尽早治疗,避免急诊手术.囊肿外引流术只能作为急救措施,肝总管空肠Roux-en-Y吻合术伴抗反流术式,是囊肿切除术后重建胆道的理想术式.     

先天性胆总管囊肿的MRCP诊断

目的 探讨利用磁共振胰胆管成像(MRCP)的方法对先天性胆总管囊肿进行诊断。方法 对23例经手术及临床证实的,应用MRCP方法诊断先天性胆总管囊肿的病例进行回顾性分析。其中男性5例,女性18例。最大年龄15岁8个月,最小年龄5个月。用T2加权自旋回波序列,并应用MIP重建技术作MRCP检查,分析其扩张胆管的部位及程度,并应用Todani分型法进行分型。结果 23例用MRCP方法诊断为先天性胆总管囊肿并进行分型的病例,其检查结果与手术结果一致。其中,Ⅰ型10例,Ⅱ型1例,ⅣA型11例,V型1例。结论 MRCP检查胰胆管影像学诊断技术具有无创伤性、无需造影剂、快速简便的优点,是诊断先天性胆总管囊肿的一种理想方法。     

先天性胆总管囊肿的MRCP诊断

目的探讨利用磁共振胰胆管成像(MRCP)的方法对先天性胆总管囊肿进行诊断.方法对23例经手术及临床证实的,应用MRCP方法诊断先天性胆总管囊肿的病例进行回顾性分析.其中男性5例,女性18例.最大年龄15岁8个月,最小年龄5个月.用T2加权自旋回波序列,并应用MIP重建技术作MRCP检查,分析其扩张胆管的部位及程度,并应用Todani分型法进行分型.结果23例用MRCP方法诊断为先天性胆总管囊肿并进行分型的病例,其检查结果与手术结果一致.其中,Ⅰ型10例,Ⅱ型1例,ⅣA型11例,Ⅴ型1例.结论MRCP检查胰胆管影像学诊断技术具有无创伤性、无需造影剂、快速简便的优点,是诊断先天性胆总管囊肿的一种理想方法.     

手术治疗先天性胆总管囊肿临床研究

目的 总结胆总管囊肿切除、肝管空肠吻合治疗先天性胆总管囊肿的经验，以提高本病的疗效。方法 对1994年1月～2002年12月的30例行胆总管囊肿切除、肝管空肠吻合的先天性胆总管囊肿患者进行回顾性分析。结果 获得随访的22例，效果优良者17例，良者2例。差者3例。术中无死亡。结论 胆总管囊肿切除、胆道重建是治疗先天性胆总管囊肿的优选方式，附以适当的抗反流装置，提高手术操作技巧。能最大限度地为患者带来良好的术后效果。     

Congenital choledochal cysts in adults: twenty-five-year experience

Background Choledochal cyst is rare in western countries. The relatively high incidence of coexistent hepatobiliary disease increases the difficulty of the surgical management of choledochal cyst. Here we analyze the diagnosis and treatment of congenital bile duct cyst in 122 Chinese adults. Methods The clinical data of 122 patients with congenital choledochal cysts admitted from 1981 to 2006 were analyzed. Results Clinical symptoms in most cases were nonspecific, resulting in delayed diagnosis. Sixty-one patients (50%) had coexistent pancreatobiliary disease. Among the 122 patients, 119 patients underwent ultrasonic examination; ERCP/MRCP was performed in 63 cases and CT in 102 cases. Abnormal pancreatobiliary duct junction was found in 48 patients. Sixteen patients had malignant lesions in the bile duct, arising in 11 of them from incomplete choledochal cyst that underwent various operations including cystenterostomy or cystojejunostomy. There was significant difference between the patients who underwent incomplete cyst resection and complete cyst resection in malignancy rate of bile duct (Chi square test, P= 0.000; odds ratio, 7.800; 95 % confidence interval, 2.450 to 24.836). Conclusions ERCP, CT and MRCP had proved their great values in the classification of the disease. Cyst excision with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice for patients with type I or type IV cysts. For type V cyst (Caroli’s disease) with recurrent cholangitis, liver transplantation should be considered.     

手术治疗先天性胆总管囊肿18例

0 引言 胆道重建术是目前治疗先天性胆总管囊肿的最主要方法之一,其治疗效果得到国内外一致公认,但术后的胆道逆行感染仍是研究的重点. 我院于1994/2002年以空肠间置.胆道重建为基础,在十二指肠内开口处制作内括约肌,以期达到预防逆行胆道感染的目的,通过对11例胆总管囊肿患儿的临床应用取得良好疗效.     

Surgical treatment of congenital choledochal cyst

20 cases of congenital choledochal cyst were operated by modified Lilly's method from 1980 to November 1985 in our Hospital. There were 4 males and 16 females. Their ages ranged from 50 days to 15 years with a mean of 5.1 years. All patients had preoperative ultrasonographic examination, barium meal radiography of the gastrointestinal tract or percutaneous transhepatic cholangiography. All had choledochal cystectomy with retention of the outer layer of the posterior wall of the cyst. We modified Lilly's method by injecting normal saline between the outer and inner layer of the choledochal cyst so that the outer layer could be isolated. Reconstruction of the biliary tract was then performed. 2 patients had choledochoduodenostomy and 18 patients had hepaticojejunostomy (1 end to end and 17 end to side). 19 patients had also had cholecystectomy. The post-operative course of the operation was found to be smooth and safe. Patients were followed up for a period from 6 months to 7 years. 3 patients had cirrhosis of liver, 2 of whom died within 8 months. The mortality rate in our series was 10%. The operative treatment and the problems of biliary reconstruction are discussed.     

儿童症状性松果体囊肿的手术治疗

目的研究和探讨儿童症状性松果体囊肿的手术治疗方法。方法症状性松果体囊肿的患儿3例，均经胼胝体-穹隆间入路。结果松果体囊肿均大部切除，有1例出现轻微的近期记忆力下降，另2例恢复良好。结论对儿童症状性松果体囊肿应采取手术治疗，经额胼胝体-穹隆间入路直接切除囊肿是最佳选择。     

成人先天性胆总管囊肿83例诊治分析

目的:探讨成人先天性胆总管囊肿的诊治。方法:分析2001年1月至2010年8月,我院83例成人先天性胆总管囊肿患者临床资料。结果:腹痛是其主要的临床表现(86.75%),其次为黄疸(56.63%)和发热(42.17%)。B超、CT和MRCP的诊断率分别为85.54%,92.86%和94.67%。83例患者中,72例接受手术治疗,术后随访51例(70.83%),中位随访时间38月(3月~100月)。患者术后恢复良好。5例随访的行胆管癌根治术患者中位生存时间为21月,4例行姑息手术治疗的患者中位生存时间为6月。结论:成人先天性胆总管囊肿的诊治应重视临床表现,MRCP有助于诊治。一旦确诊应早期手术治疗,以防癌变。囊肿切除和肝总管空肠Roux-en-Y吻合术应作为首选术式。     

Comparative Study on Two Surgical Procedures for Middle Cranial Fossa Arachnoid Cysts

In this study, we explored the operation options for middle cranial fossa arachnoid cysts （MCFAC）. One hundred and forty-nine patients who were operated for a symptomatic MCFAC between 1993 and 2006 in our hosptial were analyzed. Follow-up time ranged from 1 y to 14 y （mean=5.4 y）. All these patients were divided into three subgroups according to Galassi classification. Long-term outcome and complications were studied respectively. Fenestration （F） resulted in a more favorable long-term outcome and less complication for cysts of types I and Ⅱ, whereas a favorable outcome was noted in type Ⅲ patients who underwent cysto-peritoneal shunting （S）. We are led to conclude that Fenestration is suitable for cysts of types Ⅰ and Ⅱ （Galassi classification）, cysto-peritoneal shunting is better for cysts of type Ⅲ.     

联合手术方式治疗退行性下睑内翻的疗效

目的 探讨联合手术方式治疗退行性下睑内翻的疗效。方法 退行性下睑内翻52例(65眼)行皮肤轮匝肌切除联合眼轮匝肌缩短下睑缩肌复位术,手术经下睑皮肤入路,打开眶隔,切除部分眶脂肪,将下睑缩肌缝合固定于睑板下缘,分离出5 mm 的睑板前轮匝肌条,剪除部分睑板前眼轮匝肌,褥式缝合于外侧眶骨膜上。术后随访12～16个月,观察手术效果。结果 符合纳入标准65眼,61眼下睑内翻矫正良好,治愈率93.85%。2例复发患者行皮肤轮匝肌切除联合外侧睑板条悬吊术,术后效果良好;1例患者术后出现下睑外翻伴下睑退缩,行双眼下睑缩肌后徙联合外侧睑板缩短术治愈。结论 联合手术方式治疗退行性下睑内翻,手术成功率高,复发率低,对于保持下眼睑稳定性有更持久的效果。     

甲状腺结节外科治疗112例临床分析

目的:总结甲状腺结节的外科治疗经验。方法:对行外科手术治疗的112例甲状腺结节患者的临床资料及随访结果进行回顾性分析。结果:112例均治愈。术后出现暂时性手足麻木6例;出现声音嘶哑4例,其中暂时性声音嘶哑3例;术后皮下出血1例;术后复发4例。结论:术前应明确甲状腺结节的手术指征,术中根据患者具体情况合理选择手术方式并遵循甲状腺结节外科治疗原则,能有效减少甲状腺疾病患者的手术并发症和复发,改善预后。     

大鼠胰十二指肠移植模型制作的手术技巧

目的：探索建立大鼠胰腺移植模型的手术技巧。方法：采用经肠道引流全胰十二指肠移植术式;带腹腔动脉和肠系膜上动脉的供者腹主动脉与受者腹主动脉端侧吻合,供者门静脉与受者左肾静脉袖套法吻合,供者十二指肠与受者十二指肠端侧吻合。结果：9例次手术中51例次手术成功,术后移植胰腺具有内分泌功能。结论：这种胰腺移植模型制作切实可行,其成功的关键在于预防和治疗血管并发症。     

持续组织扩张手术方法及扩张期临床管理

目的：研究持恒压皮肤软扩张的手术方法及扩张期管理技术。方法：皮肤瘢痕患者你例,在局部肿胀麻醉下经病变内重直小切口埋植扩张器４５个,术后１天～３天开始进行持续恒压扩张（１０例）和持续恒速扩张（１１例）,观察手术效果和患者对扩张的反应。结果：局部肿胀麻醉具有良好的止血作用,扩张器植入术可在无血条件下完成,手术时间少于常规方法。垂直切口有良好的抗张能力,术中可以向扩张器内大量注水,术后１天～３天即可进行     

硬脊膜外囊肿的诊断与手术治疗

目的探讨硬脊膜外囊肿的临床表现、诊断、手术治疗效果,方法分别对硬脊膜外囊肿的部位、临床表现、影像学检查和手术治疗方法进行描述。结果7例均采用手术冶疗,术后运动及感觉障碍获得满意恢复,无任何并发症。结论根据临床表现、影像学特征结合病理检查能确立诊断,手术切除囊肿是行之有效的治疗方法。     

下肢动脉闭塞性疾病的外科治疗

目的:探讨下肢动脉闭塞性疾病外科手术方案的选择及其对移植血管远期通畅率的影响。方法:自1998年12月至2002年12月手术患者中,有80例得到完整随访,按照不同手术方案分组,结合随访结果,统计远期通畅率。结果:移植血管近期通畅率98.5%;1年、3年、5年远期通畅率分别为82%、71%、57%。腹股沟以上动脉旁路术中,移植血管5年通畅率85%;腹股沟以下动脉旁路术血管5年通畅率54%。腹股沟以下动脉旁路术中,移植血管采用自体大隐静脉5年通畅率66%,而采用PTFE人工血管5年通畅率41%(P=0.022)。结论:术前详细评估,结合患者状况制订个体化手术方案,选择适宜的移植物,完善围手术期处理,才能降低手术并发症及死亡率,提高远期治疗效果。