食管贲门癌术后食管胃吻合口瘘15例临床护理

对15例食管贲门癌术后食管胃吻合口瘘患者在早期诊断、控制感染的治疗基础上,给予加强心理护理、基础护理、呼吸道护理、引流管护理、空肠造瘘护理、肠内营养护理.结果本组吻合口瘘愈合12例,死亡3例.认为积极有效的治疗及精心护理是治疗成功的关键.     

食管贲门癌术后食管胃吻合口瘘15例临床护理

对15例食管贲门癌术后食管胃吻合口瘘患者在早期诊断、控制感染的治疗基础上,给予加强心理护理、基础护理、呼吸道护理、引流管护理、空肠造瘘护理、肠内营养护理。结果本组吻合口瘘愈合12例,死亡3例。认为积极有效的治疗及精心护理是治疗成功的关键。     

胰十二指肠切除术后早期肠内营养的疗效观察与护理

目的：探讨胰十二指肠切除术后早期采用肠内营养的疗效及护理措施。方法：总结分析2006年10月～2008年10月30例胰十二指肠切除术患者术后早期进行肠内营养疗效及护理方法。结果：26例术后吻合口愈合良好,3例出现胰瘘,其中1例死亡;1例不能耐受,改用肠外营养治疗。结论：胰十二指肠切除术后早期采用肠内营养,总体疗效满意。     

食管癌术后预防吻合口瘘的护理体会

总结了67例食管癌术后预防吻合口瘘的护理措施，包括术前给予患者调整饮食结构，改善全身营养状况，加强口腔护理，术后采取胃肠外营养与胃肠内营养相结合，保持有效的胃肠减压，以及胸腔闭式引流管的护理等，认为通过综合的、有针对性的预防护理可有效地预防食管癌术后吻合口瘘的发生。     

胰十二指肠切除术行胃空肠造瘘患者的术后管理

目的:总结分析胰十二指肠切除行胃空肠造瘘患者术后治疗及护理中的管理。方法:2005年7月~2010年2月实施的22例胰十二指肠切除术患者,术中行胃造瘘、空肠造瘘,术毕后即拔除胃管,术后24 h由空肠造瘘管输入营养液,对造瘘管进行合理管理。结果:9例术后吻合口愈合良好,未出现胰瘘、胆瘘、肠瘘等并发症,肠道功能均在4~6 d内恢复。11例出现不同程度的胃排空障碍,最短3周,最长7周。胰瘘2例,考虑术前黄疸重,术后分别于3、4个月胰瘘愈合。所有患者术后精神营养均恢复良好。结论:对胰十二指肠切除术行胃空肠造瘘管的患者,合理的术后管理、早期的肠内营养,可以改善患者营养,预防呼吸道并发症,治疗胃排空障碍,减轻患者的经济负担。     

经鼻瘘腔引流治疗食管癌术后胸内食管-胃吻合口瘘

目的回顾性分析及评价X线下经鼻放置瘘腔引流在食管癌术后胸内食管-胃吻合口瘘中的应用价值。方法在X线透视下用介入导丝引导,经一侧鼻腔放置引流管至瘘腔最佳位置,持续负压引流。配合鼻胃管减压、鼻肠管肠内营养支持、抗感染等治疗。结果 11例患者在X线透视下用介入导丝引导,均经瘘口放置瘘腔引流管成功,置管时间10~34分钟,引流管留置时间15~46天,未发生置管并发症,放置及留置导管过程中患者耐受性良好。其中10例患者吻合口瘘获得治愈。结论 X线透视下用介入导丝引导,经鼻放置瘘腔引流治疗胸内食管-胃吻合口瘘安全、有效。     

胰腺损伤术后腹腔大出血治疗分析

目的探讨Ⅲ～Ⅳ级胰腺损伤术后腹腔大出血的治疗方法及防范措施。方法40例Ⅲ～Ⅳ级胰腺损伤患者，其中21例行远端胰体尾切除和／或脾切除术，17例行胰头断端缝合＋胰体尾空肠Roux-Y式吻合术，2例行胰管吻合。结果行远端胰体尾部切除术和／或脾切除21例中，1例死于多器官功能衰竭，2例出现胰瘘；17例行胰头断端缝合＋胰体尾空肠Roux-Y式吻合术，10例发生胰肠吻合口瘘合并腹腔大出血；2例行胰管吻合者，术后均出现胰瘘及腹腔大出血；经再次开腹手术、三球压迫法止血及切除胰尾体，10例抢救成功，2例术中死亡；随访35例，无并发糖尿病及明显消化功能障碍者。结论远端胰腺和／或脾脏切除术可减少Ⅲ～Ⅳ级胰腺损伤术后腹腔大出血的发生，三球压迫止血法治疗胰腺损伤术后腹腔大出血安全、有效。     

食道癌术后并发吻合口瘘的护理

总结了8例食道癌术后吻合口瘘患者的护理措施,包括术前健康教育,心理护理,保持胸腔闭式引流管通畅,给氧,呼吸道、肠内营养的护理和出院宣教.认为重视术前健康教育,早期发现、早期治疗及精心护理,是治愈吻合口瘘的关键.     

1例全胃、脾及胰尾切除术后引流管的护理

全胃切除,因手术侵袭大,术后易出现各种并发症,各管道护理极为重要,有利于早期发现并发症,给予有效的治疗.我院于2001年6月收治1例"胃底癌",行"全胃、脾及胰尾切除术",共置腹腔引流管4根,空肠造瘘、十二指肠造瘘管各1根,术后先后出现胰瘘、吻合口瘘,经精心护理及治疗,于术后96d痊愈出院.现将各引流管护理体会报告如下.     

食管癌术后并发胸内吻合口瘘5例的护理

目的：探讨食管癌根治术后并发吻合口瘘的护理方法及经验。方法：总结2006/2009年行食管癌手术后5例并发吻合口瘘患者的护理经验。对5例患者严格执行胸腔闭式引流管及胃肠减压管护理,加强肠内营养支持,纠正营养不良,维持水电解质平衡,做好基础护理及心理护理。结果：5例患者均好转出院。结论：吻合口瘘是食管癌术后的严重的并发症之一,重视食管癌术后护理,加强术后监测,做好心理护理及引流管护理可以降低患者病死率。     

胰腺闭合性损伤合并主胰管断裂23例诊治分析

目的：分析严重胰腺外伤患者的临床表现及处理方法,探讨严重胰腺外伤的诊治对策。方法：回顾性分析23例严重胰腺闭合性损伤并同时合并主胰管断裂患者的临床资料及救治经过,根据胰腺损伤的严重程度而选择不同的手术方式。结果：CT检查对胰腺闭合性损伤确诊率可高达100％。本组患者均行手术治疗,其中远端胰（或加脾）切除术9例,远端胰腺空肠吻合术9例,主胰管端端吻合加胰管内支撑术1例,改良十二指肠憩室化手术4例。23例患者经救治均痊愈出院。结论：胰腺闭合性损伤临床表现隐晦,CT可明显提高术前确诊率。及时和合理的手术是提高严重胰腺外伤患者生存率的关键。     

Evaluation of pancreatic carcinoma with FDG PET

Background: To assess the diagnostic usefulness and clinical impact of positron emission tomography with [F-18]fluorodeoxyglucose (FDG PET) on the management of patients with known or suspected pancreatic carcinoma. Methods: Attenuation-corrected FDG PET was performed in 20 patients (12 male, eight female) with pancreatic carcinoma at the time of initial diagnosis (n = 7), for tumor surveillance after Whipple surgery (n = 11), and for reevaluation after chemoradiation therapy (n = 2). Visual analysis of PET images were correlated with the results of abdominal computed tomography (CT) and carbohydrate antigen (CA) 19-9 serum tumor marker level that were obtained within 1 month of the PET study. Diagnostic validation was by histology in nine patients and by clinical or radiologic follow-up (5–48 months) in 11 patients. Changes in therapeutic management that were prompted by PET were tabulated. Results: PET was concordant with the findings of abdominal CT in 14 patients (13 true positive, 1 true negative). PET detected clinically unsuspected lung lesions, confirmed subsequently by a chest CT, in one of these 14 patients. PET was discordant with CT in six patients. PET detected tumor recurrence in three patients in this group (15% of total) with nondiagnostic CT findings and elevated CA 19-9 serology. In two of these three patients, chemotherapy with gemcitabine was initiated based on PET localization of disease. Tumor was confirmed in the remaining one of the three patients at autopsy shortly after the PET study. FDG localization in a displaced loop of bowel resulted in an apparent false-positive hepatic lesion in one of six patients in the discordant group. PET underestimated the extent of metastatic disease in the remaining two of six patients due to hyperglycemia. Conclusion: In patients with suspected pancreatic carcinoma at the time of initial presentation, PET is complementary to abdominal CT and allows detection of unsuspected distant metastases. In patients with suspected recurrent pancreatic carcinoma, based on elevated or rising CA 19-9 serology, PET can localize the disease when abdominal CT is nondiagnostic as a result of posttherapy anatomic alteration. Imaging evaluation with PET may impact the clinical management of patients with pancreatic carcinoma. Received: 1 August 2000/Accepted: 20 September 2000     

胰腺浆液性囊腺瘤的超声诊断价值

目的探讨胰腺浆液性囊腺瘤的超声表现与诊断。方法对2000年1月至2008年5月中山医院外科手术病理证实的36例胰腺浆液性囊腺瘤的超声表现进行回顾性分析。结果36例37个病灶，超声显示34个，检出率91．9％（34／37），其中4个超声定位错误，定位诊断符合率81．1％（3N37）。超声表现囊实性17例，囊性8例，实性9例；超声诊断良性病变28例，良恶性诊断符合率82．4％（28／34），但仅8例诊断正确，诊断正确率仅23．5％。结论胰腺浆液性囊腺瘤的典型超声声像图表现是由无数个小囊组成的多房囊性病灶，根据典型声像图可作出正确诊断，表现不典型时需结合其他影像学检查。     

腹腔镜胰管切开取石+胰管T管引流术在慢性胰腺炎合并胰管结石中的应用价值

目的 探讨腹腔镜胰管切开取石+胰管T管引流术在慢性胰腺炎合并胰管结石中的应用价值。方法 回顾性分析2017年1月－2020年6月浙江大学医学院附属金华医院5例行腹腔镜胰管切开取石+胰管T管引流术治疗胰管结石的患者的临床资料。结果 5例患者均顺利完成手术。其中,1例Ⅳ_b型胰管结石予以EMS碎石清石系统碎石。手术时间120～180 min,平均145 min;术中出血量15～50 mL,平均29 mL;术后胃肠道功能恢复时间1.0～2.0 d,平均1.6 d;术后住院时间4.0～11.0 d,平均7.0 d;T管拔除时间32.0～60.0 d,平均42.4 d。术后无胰瘘、出血和腹腔感染等并发症发生。5例患者疗效均为优良。术后随访27.0～55.0个月,平均40.8个月。1例糖尿病患者胰岛素用量较术前减少;1例T管造影示胰管残余结石,行胆道镜检查术取出残余结石。患者均未见结石复发,无恶变。结论 腹腔镜胰管切开取石+胰管T管引流术创伤小,恢复快,疗效满意,操作简单,是一种安全有效的术式。     

腹部超声对胰腺肿瘤的诊断价值

目的 评价腹部超声对于临床怀疑为胰腺肿瘤病人的术前诊断价值。方法 术前，用腹部超声评价了98例临床怀疑为胰腺肿瘤的病人的声像图特征，以及它们与周围主要血管的关系(包括腹腔动脉、门静脉、肠系膜上动脉、肝动脉、脾血管及下腔静脉)，并将声像图结果与病人的临床资料、术中所见及术后病理作对照。结果 在90例接受外科手术治疗的病人中，腹部超声诊断胰腺肿瘤的敏感性为91．0％，诊断良恶性的准确率分别为94％(恶性)及54．5％(良性)。超声在发现肿瘤对周围血管的侵犯上．准确率为77．5％，在发现肿瘤的腹腔转移上，准确率87．5％。超声的准确率与CT相比，没有显著性差异。结论 对于临床怀疑为胰腺肿瘤的病人，腹部超声是一项首要的检查方法。不仅可以确立诊断，而且可以判断肿瘤是否可行切除术。     

State of anxiety may be associated with exocrine pancreatic insufficiency in functional dyspepsia patients with pancreatic enzyme abnormalities

We have reported that refractory functional dyspepsia patients with pancreatic enzyme abnormalities (FD-P). We tried to analyze the prevalence of exocrine pancreatic insufficiency (EPI) in FD-P patients to clarify whether the pathophysiology of FD patients including clinical symptoms and quality of life were associated with EPI. We enrolled forty-nine patients presenting with typical symptoms of FD-P patients (n = 20) and asymptomatic patients with pancreatic enzyme abnormalities (AP-P) (n = 29). Five pancreatic enzymes (p-amylase, lipase, elastase-1, trypsin, and PLA2) were measured and STAI-state/-trait and SF-8 were evaluated. Pancreatic exocrine function was analyzed using N-benzoyl-l-tyrosyl-p-aminobenzoic acid (BT-PABA). There were no significant differences in patient background between FD-P and AP-P patients. BT-PABA test scores for FD-P patients (61.67 ± 5.55) were significantly (p = 0.01) lower than in AP-P patients (95.38 ± 2.36). Physical component scale (PCS) in FD-P patients was significantly (p = 0.002) lower than that in AP-P patients. STAI-state was relatively (p = 0.054) associated with BT-PABA test in FD-P and AP-P patients by multiple logistic regression analysis. The prevalence of EPI in FD-P patients was significantly higher than that in AP-P patients and was relatively associated with state of anxiety. Further studies will be needed to clarify how EPI or pancreatic enzyme abnormalities are associated with the pathophysiology of FD-P patients.