肝囊型包虫破裂的外科治疗110例

目的 分析肝囊型包虫破裂外科手术治疗方式的演变及其对患者预后的影响.方法 回顾性分析1990年1月至2008年12月外科手术治疗的肝囊型包虫破裂110例,按不同手术综合处理方法分为3组;A组22例:内囊摘除+甲醛或双氧水局部杀虫+残腔锁边缝合或大网膜填塞或残腔内翻缝合引流;B组65例:内囊摘除+高渗盐水局部杀虫+外囊肝外部分切除+残腔胆漏缝合+残腔开放引流;C组23例:外囊全部或次全剥除+高渗盐水局部杀虫+术区引流.分析3种外科综合手术治疗方式的效果.结果术后A组、B组、C组残腔并发症发生率分别为40.9%、16.9%、0.0%(P<0.05),复发率分别为18.2%、4.6%、0.0%(P<0.05);带管引流时间A组>B组>C组;手术耗时及术中出血量,A组、B组均低于C组,B组与A组相比无明显差别;高渗盐水腹腔处理后包虫腹腔种植率低于单纯生理盐水处理组,差异无统计学意义.结论 外囊全部或次全剥除+高渗盐水局部杀虫+术区引流的处理方式是目前最佳的治疗肝囊型包虫破裂的外科方法.     

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??EUS-guided internal drainage through the stomach in the treatment of postoperative infection of huge pancreatic pseudocyst: A report of 5 cases YUAN Hai-cheng, QIN Ming-fang, WU Yu, et al. Minimally Invasive Surgery Center, Tianjin Nankai Hospital, Tianjin 300070, China
Corresponding author: YUAN Hai-cheng, E-mail: ironyhc2002@163.com
Abstract Objective To explore treatment experience of EUS-guided internal drainage through the stomach in the treatment of infection after surgery of huge pancreatic pseudocyst. Methods The clinical data of 7 cases of huge pancreatic pseudocyst treated by EUS-guided internal drainage through the stomach between March 2010 and October 2013 in Minimally Invasive Surgery Center of Tianjin Nankai Hospital were analyzed retrospectively. Results Seven cases were drainaged successfully. Five cases were with postoperative infection. Among them, 2 cases were performed BD duct cyst external drainage; 2 cases were performed counterpart drainage with BD duct cyst drainage and CT guided cyst puncture; 1 case performed BD duct cyst external drainage was still unable to control, then cured by cyst infection tissue removal and abdominal drainage. The mean follow-up period was 21 (3-30) months without recurrence. Conclusion Huge pancreatic pseudocyst cured by EUS-guided internal drainage through the stomach is feasible, but postoperative infection is common. The preferred treatment is EUS-guided through the stomach cyst double stent drainage combined BD duct cyst external drainage .     

Internal drainage of infected pancreatic pseudocysts: safe or sorry?

BACKGROUND: External drainage is the traditional surgical therapy for infected pancreatic pseudocyst, although associated with high morbidity and mortality rates. In this study it was determined whether internal drainage is feasible with acceptable postoperative morbidity and recurrence rates. METHODS: A retrospective comparison was made of the outcome of internal versus external drainage of infected pseudocysts in 15 patients. All patients were known to have a (sterile) pseudocyst and presented with symptoms suggestive of infection of the cyst, proven by positive cultures and Gram staining. RESULTS: Internal drainage was performed in 8 and external drainage in 7 patients. Patient characteristics appeared comparable, as was the time of sterile cyst presence before infection occurred (6 and 9 weeks, respectively). No major complications occurred, although hospital stay was prolonged after external drainage due to development of pancreaticocutaneous fistulas along the drain tract in 4 patients. Enteric microorganisms were cultured in 11 patients, of whom 10 had undergone ERCP just prior to infection. During follow-up no pseudocyst recurred. CONCLUSION: Surgical internal drainage of an infected pseudocyst is safe and effective and, in selected patients, is first-choice treatment. ERCP seems to play an important role in the secondary infection of pseudocysts.     

Diagnosis and treatment tactics of postoperative bile peritonitis

Complex method of diagnosis and surgical treatment of 131 patients with postoperative bile peritonitis are analyzed. The main causes of peritonitis were technical and tactical medical errors and low functional reserve of liver. Laparoscopic, ultrasonic examinations and detection of endogenous intoxication degree are used for early diagnosis of this complication. Urgent relaparotomy with liquidation of peritonitis source, external drainage of bile ducts and small intestine, sanation and drainage of abdominal cavity is the main method of postoperative peritonitis treatment.     

骶前持续低负压冲洗引流在骶前囊肿切除术后促进骶前残腔及会阴切口恢复价值研究

目的 探讨骶前持续低负压冲洗引流在骶前囊肿切除术后促进骶前残腔及会阴切口恢复的临床效果及价值。方法 回顾性分析2014年1月至2021年1月郑州大学附属肿瘤医院收治的130例接受骶前囊肿切除术病人的临床资料,根据骶前引流方式不同,分为骶前持续低负压冲洗引流组（67例）和传统骶前引流组（63例）,比较两组病人术后骶前残腔、会阴部切口并发症及治疗效果,骶前残腔、会阴部切口感染的处理及效果等。结果 骶前持续低负压冲洗引流组会阴部切口感染、骶前积液并感染的发生率均显著低于传统骶前引流组［3例（4.5%）vs 10例（15.9%）,1例（1.5% ）vs 7例（11.9%）;P均＜0.05］;骶前持续低负压冲洗引流组骶前残腔恢复时间及会阴部切口愈合时间均短于传统骶前引流组［14（12,24）vs.16（14,40）d,12（10,28）vs. 14（12,48）d;P均＜0.05］。两组共21例术后骶前残腔及会阴部感染,骶前持续低负压冲洗引流组切口拆开引流处理低于传统骶前引流组［0 vs.10例（58.8%）,P＜0.05］;其骶前残腔及会阴部切口感染症状转归时间短于传统骶前引流组［（5.0±1.4）d vs.（7.2±2.6）d,P＜0.05］。结论 骶前持续负压冲洗引流可降低骶前积液及会阴部切口感染的发生率,加速骶前囊肿切除术后骶前残腔及会阴部切口恢复,促进病人快速康复。     

腹腔镜阑尾切除术后预防性置管引流的再认识

目的：探讨腹腔镜阑尾切除术（1aparoscopicappendectomy,LA）后预防性置管引流的指征及位置。方法：将146例LA患者随机分为预防性置管引流组（n=71,对照组）与未预防性置管引流组（n=75,实验组）,对比两组患者下床活动时间、肛门恢复排气时间、WBC恢复正常时间、腹腔残余感染率、术后炎性肠梗阻发生率及住院时间。并将预防性置管引流组患者随机分为经右中腹切口髂窝引流组（n=39,A组）与经左下腹切口盆腔引流组（n=32,B组）,对比两组引流切口感染率、术后24h疼痛评分、总引流量及腹腔残余感染率。结果：实验组下床活动时间、肛门恢复排气时间、住院时间均短于对照组,差异有统计学意义（P〈0．05）;两组患者WBC恢复正常时间、腹腔残余感染率、术后炎性肠梗阻发生率差异无统计学意义（P〉0．05）。B组切1：7感染率、引流切口疼痛程度明显减轻（P〈0．05）,总引流量明显多于A组（P〈0．05）;A、B两组腹腔残余感染率差异无统计学意义（P〉0．05）。结论：化脓性阑尾炎合并局限性腹膜炎、甚至弥漫性腹膜炎的患者,术中阑尾根部处理满意,腹腔冲洗干净彻底,不主张常规放置引流。如果放置引流,建议引流管经左下腹部切口放置于盆腔内。     

Relationship of postoperative residual air and recurrence in chronic subdural hematoma

The possibility exists that residual air after surgery is one cause of recurrence of chronic subdural hematoma. We have devised a new simple method which decreases postoperative residual air, using external drainage and an endoscope. First, we make endoscopic observations of the inner aspect of the hematoma cavity. Then, we insert external drainage apparatus into the most frontal area of the hematoma cavity, we regard this location as the most appropriate place to ensure most effective drainage. The present study included 37 chronic subdural hematomas in 32 patients who had been treated between January and December, 1999. Their ages ranged from 48 to 86 years old, with an average of 72 years. Insertion of external drainage in the most frontal area of the hematoma cavity was successfully achieved in 27 (73%, Group I) out of 37 cases and resulted in no recurrence. In the remaining 10 hematomas (27%, Group II), external drainage was not able to be inserted in the most frontal area, and four hematomas (40%) had recurrence (p < 0.01 vs Group I). Insertion in the most frontal area of the hematoma cavity decreases residual air after surgery, and may be effective for the prevention of recurrence of chronic subdural hematoma.     

胰腺假性囊肿内引流术式的研究

目的：探讨胰腺假性囊肿内引流术的术式选择。
方法：回顾性分析13余年收治且行囊肿内引流治疗的胰腺假性囊肿62例的临床资料,着重探讨手术方法以及效果。
结果：全组均经B超或/和CT以及术后病理学检查明确胰腺假性囊肿的诊断。行囊肿空肠Roux-en-Y型吻合术的31例,术后囊肿感染发生率为9.7%（3/31）,消化道出血发生率为3.2%（1/31）,无死亡病例。行囊肿胃吻合术的16例,术后囊肿感染发生率为12.5%（2/16）,消化道出血发生率为37.5%（6/16）,病死率为6.25%（1/16）。行序贯式囊肿外、内引流术的15例,术后囊肿感染发生率为6.7%（1/15）,消化道出血发生率为13.3%（2/15）,无死亡者。
结论：囊肿空肠Roux-en-Y型吻合术是安全有效的术式;对适宜行囊肿胃吻合术的囊肿,建议行序贯式囊肿外、内引流术。     

输血器改制的脑室引流装置的疗效分析

目的评价输血器改制的脑室引流装置在脑室外引流中的临床疗效及经济效果。方法对于脑室出血需行脑室外引流的患者,选用输血器改制的脑室引流装置40例作为治疗组,选用成型产品40例作为对照组,比较两组引流效果,颅内感染发生情况及预后,并应用药物经济学方法对两组患者进行成本效益分析。结果两组患者术后引流效果、颅内感染发生及预后,均无显著性差异(P>0.05);成本效益比为,治疗组每单位效益成本(48)较对照组每单位效益成本(3161.3)显著降低。结论输血器改制的脑室引流装置效果确切,实用价廉,适于基层医院推广使用。     

Method of the surgical treatment of nonspeciphic extrasphincteric rectal fistula

The method of treatment of nonspeciphic extrasphincteric rectal fistula was proposed, which consists of the fistula channel excision en bloc with external and internal (the anal sinus, which bears the fistula) apertures on perineum, subsequent layer by layer restoration of the rectal wall, as well as the sphincters and the anal levators muscles integrity (if necessary) and the formed cavity drainage. The operation was performed in 25 patients. Its performance have guaranteed the recurrences rate lowering as well as the postoperative incontinence occurrence.     

Laparoscopic surgery for hepatic hydatid cyst--possibilities and limitations

Laparoscopy in hydatid liver disease, is not addressing only to simple but to complicated cases, although the rate of complications registered a significant decrease because of the modem means (ultrasonography, TC) and the precocity of the diagnostic. We made a retrospective study on 76 patients with liver hydatid cysts admitted and operated in two Surgery Clinics of Sibiu and Braila, between January 2002 and January 2007. On 52 cases we performed laparoscopic interventions and 24 where operated in open surgery, decided by the option and the experience of the surgeon. Our laparoscopic technique is based on specific and original instruments, two patented inventions which increase the security of the primary approach of the liver hydatid cyst. This specific set of instruments, uses extraperitoneal work tunnels for treatment and exploration inside the cyst. The limits of laparoscopy are represented by the cases which presume difficulties and require the conversion. We had one patient who needed conversion to open surgery with a "mercedes" incision, because of the huges dimensions of the liver cyst (25 cm), which did not allowed the induction of a suitable work camera, and because of it's central position (IV-V-VI segments) and numerous adherences to adjacent organs. At three or our cases, the cyst position and the peri-cystic adherences, required the cysto-phrenic dissection, ended with diaphragm perforation, solved by laparoscopic suture without thoracic drainage, but with intra-operatory aspiration of the pneumothorax. The advantages of the laparoscopy are numerous, from the excellent visibility inside abdomen and inside the hydatid cyst cavity, the protection of the abdominal wall and peritoneal cavity, to a relevant shortening of hospitalisation period and convalescence.     

腰大池置管持续引流治疗胸椎黄韧带骨化术后脑脊液漏

目的探讨腰大池置管持续引流治疗胸椎黄韧带骨化术后脑脊液漏的效果。方法2003年3月～2011年3月对15例胸椎黄韧带骨化术后脑脊液漏应用一次性颅脑外引流器从L3-4椎间隙行硬膜外穿刺,置管于蛛网膜下腔引流脑脊液。结果切口引流时间2～8d,平均4d;腰大池置管时间3～10d,平均6d。15例术后随访6个月,无一例出现脑脊液复发、切口感染和颅内感染并发症。结论腰大池置管持续引流治疗胸椎黄韧带骨化术后脑脊液漏安全、有效。     

经原腹腔引流管腔置入自制管芯持续冲洗负压引流治疗胰十二指肠切除术后胰瘘

目的 探讨和总结经原腹腔引流管置入自制管芯持续冲洗负压引流治疗胰十二指肠切除术（PD）术后胰瘘（POPF）的临床效果和经验。方法 回顾性分析衢州市人民医院2016年7月至2022年4月57例PD术后确诊为B级及以上POPF的病例临床资料。患者分别采用经原腹腔引流管置入自制管芯持续冲洗负压引流（观察组,n=30）及彩超定位下经皮腹腔穿刺置管引流（对照组,n=27）进行POPF的治疗,比较两组治疗效果。结果 两组POPF均成功治愈。观察组与对照组比较,术后发热时间[8(5,14)d vs 12(7,19)d,P=0.004]、继发腹腔感染率[23.33%(7/30) vs 59.26%(16/27),P=0.006]、切口感染率[16.67%(5/30) vs 40.74%(11/27),P=0.042]、胰瘘治愈时间[（14(7,19)d vs 18(12,31)d,P=0.047]、拔管时间[（22(15,35)d vs 35(23,56)d,P=0.001]、术后住院时间[21(18,29)d vs 33(25,47)d,P=0.009]均降低。所有病例均未发生意外拔管、继发腹腔大出...     

中耳弥漫性炎性感染伴胆脂瘤行岩骨次全切除术的经验分析

目的 介绍中耳弥漫性炎性感染伴胆脂瘤行岩骨次全切除术中用带蒂颞肌瓣充填中耳乳突腔但不封闭外耳道的方法及观察术后效果。方法 对6例成人单侧中耳弥漫性炎性感染伴胆脂瘤患者行岩骨次全切除术,行耳甲腔成形,用带蒂颞肌瓣充填中耳乳突腔,同时封闭咽鼓管,但未封闭外耳道,观察术后并发症,干耳时间。结果 术后随访1年以上,所有6例患者术后均无脑脊液耳漏,无脑膜炎等颅内感染,4例患者术后3个月干耳,2例患者术后6个月干耳,其中1例患者在术后1年出现胆脂瘤局部复发,但无耳流脓,予定期耳内镜下清理。结论 岩骨次全切除术是治疗中耳弥漫性炎性感染伴胆脂瘤的有效方法,用带蒂颞肌瓣充填中耳乳突腔,封闭咽鼓管,可有效地防止相关并发症发生及中耳乳突再发感染,不封闭外耳道口有利于术后随访清理。     

Errors and complications in external drainage of the common bile duct

Errors and complications taking place in external drainage of the common bile duct were analyzed in 484 patients. They appear due to choice of a wrong drainage tube. The authors describe their method of fixation the drain when draining through the stump of the bladder duct. In the postoperative period it is necessary to perform intracholedochal therapy with antibiotics for treatment of purulent cholangitis and for preventing a secondary infection of the bile ducts. Time of the removal of the drain depends on the state of the pancreas and on the data of transdrainage cholangiography.     

肠瘘并腹腔感染16例诊治体会

目的　探讨肠瘘并腹腔感染的早期诊断及治疗。方法　对 1 6例肠瘘并腹腔感染的诊断及治疗进行回顾性分析。结果　本组死亡 1例 ,1 5例早期明确腹腔感染存在后及时作有效彻底的腹腔冲洗及引流 ,而使腹腔感染得到有效的控制。结论　对肠瘘并腹腔感染的病人 ,首先明确是否存在腹腔感染 ,早期彻底的腹腔冲洗及通畅有效的腹腔及脓肿引流 ,是控制感染治愈肠瘘的关键     

低位三管引流防治直肠癌保肛术后吻合口漏220例

目的研究低位三管引流预防直肠癌保肛术后吻合口漏的效果。方法 2006年1月至2010年12月共220例直肠癌患者进行保肛术（治疗组）,术中经肛门放置双管引流,经肛旁于骶前腔内放置双套引流管。选取2001年1月至2005年12月间205例经左下腹壁于盆腔放置引流管的患者作对照组。对照两组患者术后切口感染率及吻合口漏率进行对比分析。结果切口感染、吻合口漏发生率：治疗组分别为8.18%（18/220）、2.27%（5/220）;对照组分别为7.80%（16/205）、8.78%（18/205）。两组切口感染发生率差异无统计学意义（P〉0.05）,吻合口漏发生率治疗组显著低于对照组（P〈0.05）。结论低位三管引流可显著降低低位直肠癌保肛术后吻合口漏的发生。     

Contrast media radiography in patients with retrosternal irrigation drainage for severe sternal wound infection.

Severe wound infection after open-heart surgery is a potentially life-threatening complication, which is mostly treated by re-operation with debridement, and insertion of closed irrigation drainage. Until now there is no consensus about the appropriate duration of irrigation therapy. Since the retrosternal irrigation cavity is likely to become continually smaller as the infection heals, this study was intended to answer the question, as to whether this process can be made visible by the use of contrast media radiography, and whether this information could be used to determine when an irrigation therapy can safely be discontinued. In 1997, 34 patients suffered from sternal wound healing disturbances which required re-operation at our institution (incidence = 0.97%). During the re-operation, a closed retrosternal irrigation drainage was inserted. Of the 34 patients contrast media radiography examinations were carried out on the first, 4th and 12th postoperative day (POD), which consisted of an antero-posterior x-ray of the chest after contrast media injection through each inlet tube. At POD 4 and 12 in the majority of cases, the retrosternal irrigation cavity became smaller when compared with the previous x-ray examination. Only in three of the non-survivors there was a huge irrigation cavity visible at the 12th POD, which sometimes even included the pleural cavity. We conclude that in patients with mediastinitis treated by insertion of a closed irrigation drainage, the retrosternally irrigated cavity seems to become smaller over the therapeutic course of treatment. This process can be visualized by contrast media radiography. Results from this examination should be included in decision making about the best time for discontinuation of the irrigation therapy.     

儿童阑尾穿孔的腹腔镜阑尾切除术

目的 :探讨儿童阑尾穿孔腹膜炎行腹腔镜阑尾切除术的优缺点。方法 :分析 30例阑尾穿孔并腹膜炎手术治疗患儿的临床资料 ,其中 15例行LA为腹腔镜组 ,15例开腹阑尾切除术为对照组。比较两组病例的手术时间、术后引流时间、住院时间、术后并发切口感染及腹腔残余感染等情况。结果 :15例LA手术时间 30～ 75min ,平均 5 2min ,几乎无出血 ,术中冲洗并吸尽腹腔内脓液后留置腹腔引流 2～ 3d ;切口感染 1例 ,平均住院 7d。对照组 15例手术时间 4 5～ 110min ,平均 6 4min ,腹腔残余感染 3例 ,切口感染 2例 ,肠粘连 1例。结论 :阑尾穿孔并腹膜炎患儿行LA比常规开腹术恢复快 ,住院时间短 ,切口感染及腹腔残余感染发生率明显降低 ,且切口疤痕小 ,美容效果好。阑尾脓肿形成早期不是LA的禁忌证 ,但阑尾脓肿并广泛包裹者不宜行LA。     

Guideline of surgical management based on diffusion of descending necrotizing mediastinitis.

BACKGROUND: Descending necrotizing mediastinitis resulting from oropharyngeal abscess, is a serious, life-threatening infection. Exisiting strategies for surgical management, such as transcervical mediastinal drainage or aggressive thoracotomic drainage, remain controversial. METHODS: Four patients, (three males and one female) were treated for descending necrotizing mediastinitis resulting from oropharyngeal infection. Two had peritonsillar abscesses, while the others experienced dental abscess and submaxillaritis. Descending necrotizing mediastinitis received its classification according to the degree of diffusion of infection diagnosed by computed tomography. Mediastinitis in two cases, (Localized descending necrotizing mediastinitis-Type I), was localized to the upper mediastinal space above the carina. In the others, infection extended to the lower anterior mediastinum (Diffuse descending necrotizing mediastinitis-Type IIA), and to both anterior and posterior lower mediastinum (Diffuse descending necrotizing mediastinitis-Type IIB). The spread of infection to the pleural cavity occurred in three cases. RESULTS: The surgical outcome concerning each of the patients was successful. Radical cervicotomy (unilateral in three patients, bilateral in the other) in conjunction with mechanical ventilation with continuous postoperative positive airway pressure, was performed in all cases. Tracheostomy was established in three patients and pharyngostomy in two. The two descending necrotizing mediastinitis-Type I cases were successfully managed with transcervical mediastinal drainage. The descending necrotizing mediastinitis-Type IIA case received treatment through transcervicotomy and anterior mediastinal drainage through a subxiphoidal incision. The patient with descending necrotizing mediastinitis-Type IIB required posterior mediastinal drainage through a right standard thoracotomy followed by left minimal thoracotomy. CONCLUSIONS: The mediastinal infection, the extent of which has been accurately determined by computed tomograms, necessitates radical cervicotomy followed by pleuromediastinal drainage. Situations where infection has spread to posterior medisatinum, particularly when it reaches in the level of the carina (descending necrotizing mediastinitis-type I), may not always require aggressive mediastinal drainage. In comparison, diffuse descending necrotizing mediastinitis-Type IIB demands complete mediastinal drainage with debridement via thoracotomy. Subxiphoidal mediastinal drainage without sternotomy may provide adequate drainage in diffuse descending necrotizing mediastinitis-Type IIA.