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目的 探讨腹部手术切口裂开的防治。方法 注意缝合技术和增加组织张力的强度。降低腹压,避免危险因素和对危险因素的围手术期处理。结果 有效地预防了腹部手术的切口一裂开。结论 减少腹部手术的切口裂开,能进一步提高手术的成功率和降低手术病死率。     

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目的 探讨胰腺实性假乳头状瘤（SPT）的诊断、治疗和预后。方法 回顾性分析中国协和医科大学肿瘤医院腹部外科1999年1月至2006年11月收治的29例实性假乳头状瘤的临床表现、影像学特征、病理结果、治疗和预后。结果 28例获得手术切除，术式包括Whipple术、胰体尾联合脾切除术、胰腺区段切除和肿瘤局部切除。术后出现胰漏4例，消化道出血1例，经治疗后恢复出院，1例味能切除者行化疗和介入治疗。术后随访2个月至7年，除未能切除的1例术后14个月死亡外，其他均未出现复发和转移。结论 SPT多见于年轻女性，临床表现无特异性。CT是最准确的影像检查方法，结合临床特点可以在术前作出准确诊断。SPT的恶性程度较低。以手术切除为主，完整切除后预后良好。     

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目的 总结无功能性胰岛细胞瘤的诊治经验.方法 应用中国医学科学院医学信息研究所"中国生物学医学文献数据库"光盘,检索无功能性胰岛细胞瘤1999年11月至2007年12月的文献报道.结果 获得有效文献29篇,共报道无功能性胰岛细胞瘤489例.结合中国医科大学附属第一医院普通外科2002-2007年间手术治疗的无功能胰岛细胞瘤15例,总结其临床表现、诊断、治疗方法及结果.结论 无功能胰岛细胞瘤症状缺乏特异性,超声和CT可作为首选的检查方法.外科手术是治疗该病、延长病人生存时间的有效手段.     

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乳腺导管内乳头状瘤是指发生在导管上皮的良性肿瘤,因其常合并上皮非典型增生,有继发浸润性癌危险[1]。营口市中心医院普外科2007年3月至2014年12月收治乳腺导管内乳头状瘤共100例,报告如下。1资料与方法1.1一般资料我院2007年3月至2014年6月期间收治因乳腺导管内乳头状瘤接受乳腺区段切除术病例100例。所有病人均经病理及术后免疫组化确定为乳腺导管内乳     

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目的 总结原发性腹膜后肿瘤(primary retroperitoneal tumor,PRT)的诊疗方法.方法 回顾性分析东南大学附属徐州医院1995年6月至2005年6月收治的60例PRT病人的临床资料.结果 60例病人肿瘤直径(13.5±6.5)cm,均经手术治疗,且经病理证实.其中16例良性肿瘤完整切除14例(87.5%);42例恶性肿瘤完整切除28例(66.7%);2例间质细胞潜在恶性肿瘤行完整切除,恶性肿瘤切除后切缘予以氩氦刀消融术20例.良、恶性肿瘤3年存活率分别为88.3%和21.6%.结论 完整切除肿瘤是治疗的关键和影响预后的重要因素.氩氦刀冷冻切缘有助于获得肿瘤的阴性切缘,改善预后.PRT的预后与手术的彻底性和病理类型相关.影像学检查对诊断有重要意义.     

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目的 总结原发性甲状旁腺功能亢进的诊治经验。方法 回顾分析中国医科大学附属第一医院普通外科1991—2005年经手术并经病理证实的48例原发性甲状旁腺功能亢进的诊治经验。结果 37例行超声检查的阳性准确率为81．1％（30／37）。35例行ECT检查的阳性准确率为91．4％（32／35）。38例甲状旁腺腺瘤均行单侧探查；6例甲状旁腺增生中4例行单侧探查，2例行双侧探查；3例甲状旁腺癌均参照甲状腺癌行根治性切除和颈部淋巴结功能性清扫术；1例甲状旁腺腺瘤恶变行患侧甲状腺和甲状旁腺全切除。手术后均发生不同程度的低钙血症，应用钙剂后症状缓解。结论 超声和ECT检查可做为诊断甲状旁腺疾病的首选定位诊断方法。定性诊断主要依据血钙和血甲状旁腺素的同步升高，一旦明确诊断即应手术治疗。定位明确的甲状旁腺腺瘤可行单侧探查。     

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目的 总结胰岛素瘤的诊断和治疗经验.方法 回顾性分析北京协和医院1953-2007年诊治404例胰岛素瘤的临床资料.结果 肿瘤直径＜2cm者占79.6%.36.2%的肿瘤位于胰头部,28.2%位于胰体部.35.6%位于胰尾部.18例(4.5%)为恶性胰岛素瘤,34例(9.0%)为多发性肿瘤.96.0%有典型的Whipple三联征.89.6%血胰岛素/血糖比值＞0.3.术前定位检查发现胰岛素瘤敏感性经腹超声检查36.8%,普通平扫CT24.7%,增强CT66.7%,多排螺旋CT胰腺灌注92.7%,MRI 31.6%,生长抑素受体显像33.3%,超声内镜(EUS)79.1%,选择性动脉造影(SAG)84.6%,经皮经肝门静脉置管取血(眦)测定胰岛素88.1%,动脉刺激静脉取血(ASVS)测定胰岛素87.0%.术中定位诊断方法的敏感性细针穿刺活检89.2%,术中超声(包括腹腔镜超声)检查90.0%.73.1%的病例可行肿瘤的局部摘除术.结论 多排螺旋CT胰腺灌注是目前胰岛素瘤术前定位诊断的首选方法.随着微创外科技术在胰腺外科中的应用,对部分条件适宜的病例可选用腹腔镜手术,但对多发胰岛素瘤仍应仔细开腹探查,避免遗漏病灶.     

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目的总结肝内胆管囊腺癌的临床特点及诊治经验。方法回顾性分析中国医学科学院肿瘤医院1999年1月至2011年10月手术切除并病理证实的肝内胆管囊腺癌6例病人的临床资料。结果病人主要临床表现为非特异性症状,如右上腹不适等或缺乏明显症状。4例出现血CA19-9升高。1例术后病理证实区域淋巴结转移,术后8个月发现肝内多发转移并于术后10个月死亡;另1例外科切缘不足5mm,术后6个月肝内多发转移及骨转移,在外院行全身化疗后疾病进展,术后21个月死亡;其余4例无瘤生存至今。结论 CA19-9升高、B超和增强CT扫描有助于鉴别肝内胆管囊腺癌和其他肝内囊性病变并提高诊断率。手术切除是其根治的首选治疗,保证充分的外科切缘可减少肝内复发并明显延长生存期,伴有区域淋巴结转移可能是影响预后的重要因素之一。     

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目的探讨胰腺癌的早期诊断、手术治疗的效果以及微创外科技术带来的新问题。方法回顾性分析1991年1月至2003年12月148例胰腺癌的外科治疗及随诊情况。结果施行手术148例,手术切除率38.5%,根治性切除率28.4%,姑息性切除率10.1%。根治性切除组1、3、5年存活率分别是52.6%、18.4%、7.9%;姑息性切除组1、3、5年存活率分别是23.1%、0、0。术后采取全身化疗。对复发或原发病变进行热疗,姑息旁路引流组1、3年存活率达到16.7%、3.3%。结论重视高危人群的监测,胰腺癌应采取以手术为主的综合治疗模式。     

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感染性心内膜炎合并下肢动脉栓塞较少见,但下肢动脉栓塞易造成病人截肢或死亡等严重后果。我科自2001年9月至2010年9月收治9例此类病人。报告如下。1资料与方法1.1一般资料本组9例,男4例,女5例。年龄21～67岁,平均37岁,均为单下肢栓塞。     

Computed tomography and nonoperative treatment for blunt abdominal trauma

Studies were undertaken to determine if computed tomography (CT) could reliably assist physical examination in the initial assessment of blunt abdominal trauma, and also to examine how various abdominal injuries were managed with the guidance of CT. A total of 255 patients underwent emergency abdominal CT following blunt abdominal trauma over a period of seven years. One hundred and fifty two patients had abnormal CT scans, including 58 hepatic, 36 renal, 25 splenic and 9 pancreatic injuries as well as 67 patients with intra-abdominal hemorrhage and 21 patients with free abdominal air. A comparative study on the detection of pneumoperitoneum revealed CT to be far superior to plain radiography. One hundred and three patients had normal CT scans, all of whom were managed nonoperatively, except for three false-negative cases and two nontherapeutic cases. The patients with injury to the parenchymal organs were given nonoperative treatment if they had stable vital signs and no evidence of associated injuries demanding immediate surgery and the majority of these patients were managed well nonoperatively. CT was thus found to be a useful adjunct in the management of victims of blunt abdominal trauma, since in a rapid and noninvasive fashion, CT accurately defined the extent of parenchymal organ injury and also disclosed any other abdominal injuries.     

Delayed manifestation of aortic stenosis after blunt abdominal trauma: Report of a case

Delayed manifestation of aortic stenosis caused by abdominal blunt trauma is rare. We report herein the case of a 67-year-old man who was taken to a nearby hospital after being crushed between a heavy truck and a wall. An emergency laparotomy was performed, revealing only a mesenteric tear which was repaired. He was discharged after an uneventful postoperative course; however, 1 month later he began to experience intermittent claudication, and presented to our hospital in December 1994, 1 year after the first operation. Angiography and enhanced computed tomography (CT) demonstrated infrarenal abdominal aortic dilatation with distal stenosis. Both the dilated and stenotic lesions were resected and bypass surgery was performed. Pathologic examination demonstrated that the intima had been lacerated circumferentially and everted distally, causing the aortic stenosis. To our knowledge, this is the first case of the delayed manifestation of traumatic aortic stenosis to be documented in Japan. The etiology of this rare complication of blunt trauma is described in this report.     

间接暴力致肝门部放射状损伤

目的　探讨腹部闭合性损伤致肝门部放射状肝破裂的形成机制、临床特点及治疗特点。方法　回顾性总结了 1990年 8月～ 2 0 0 2年 9月间 8例闭合性腹部外伤致肝门部放射状肝破裂及合并伤的临床表现、治疗方法和结果。结果　 8例病人全部经手术治疗痊愈 ,对胆囊撕脱伤及胆管裂伤患者随访 2～ 3年 ,无不良反应。结论　肝门部放射状肝破裂由间接暴力所致 ,可伴有胆囊撕脱伤 ,肝门胆管、血管及第三肝门裂伤。主要表现为失血性休克 ,修补肝破裂的同时 ,注意合并伤的处理。     

Delayed jejunal perforation following blunt abdominal trauma

Jejunal perforation is a known complication of abdominal trauma. We report two cases of jejunal perforation presenting nearly 2 months following blunt injury to the abdomen and discuss possible mechanisms for delayed small bowel perforation.     

十二指肠损伤27例临床诊治体会

目的 探讨十二指肠损伤的诊治策略。 方法 对1997 年9 月至2008 年月5 月山东大学第二附属医院普外科收治的27 例十二指肠损伤病例的临床资料进行回顾性分析。 结果 术前确诊10 例(37.04 %) ,术中确诊15例(55.56%),漏诊2 例(7.41 %) ;治愈24 例(88.89 %) ,死亡3 例(11.11 %) ;发生并发症10 例(37.04 %) ,十二指肠瘘是主要的并发症。结论 简单而合理的手术方式是治疗十二指肠损伤的重要措施。     

Paediatric case of a large gastric rupture after a blunt abdominal trauma: Report of a case in a District General Hospital

INTRODUCTIONIsolated gastric rupture after blunt abdominal trauma is rare. In current literature gastric rupture from blunt abdominal trauma ranges between 0.02% and 1.7%. This document reports the first non-motor-vehicle case of an isolated gastric rapture after blunt abdominal injury, which repaired after early diagnosis and aggressive surgical treatment.PRESENTATION OF CASEA 14-year-old boy attended our emergency surgical department after sustained a blunt abdominal trauma following a fall from his bicycle. He presented with pain and left para-umbilical abdominal ecchymoses. Examination revealed subcutaneous emphysema and a palpable abdominal wall dimple.DISCUSSIONRadiological examination with CT scan determined the need for exploratory laparotomy. Operation revealed, extensive rupture of the left lateral border of the rectus abdominus muscle, free intra-peritoneal position of the nasogastric tube with gross spillage of gastric contents and pneumo-peritoneum observed with 7-8cm full thickness rupture of anterior stomach wall, from the lesser towards the greater curvature. Primary, two-layer closure was performed. On the 5th post-operative day he developed gastrorrhagia. He was discharged on the 15th postoperative day.CONCLUSIONWe present this case report focusing on the paediatric patient to illustrate isolated gastric injury in terms of mechanism of injury, clinical presentation, and immediate surgical management.     

Laparoscopy in blunt abdominal trauma

Summary BACKGROUND: The decision in favor of surgery or nonoperative conservative treatment in abdominal trauma requires a precise diagnosis that is not always possible with imaging techniques. As there is particular danger that an injury to the diaphragm or intestines be overlooked, the indications for exploratory laparotomy should be generous. Owing to this circumstance, however, up to 41% of exploratory laparotomies turn out to be nontherapeutic and could be, or could have been, avoided with laparoscopy. METHODS: A diagnostic laparoscopy with therapeutic option in blunt abdominal trauma should only be attempted in stable patients. Usually three trocars are used and the exploration of the abdomen is systematic, beginning with the right upper quadrant and continuing clockwise. Small lacerations of the intestines and mesentery can be detected and sutured endoscopically, as well as injuries to the diaphragm. Injuries to parenchymal organs are not a primary indication for laparoscopy, but they can be sealed with tissue adhesive and collagen tamponade to prevent further bleeding. RESULTS: Routine use of laparoscopy can achieve a sensitivity of 90–100% in abdominal trauma. This can reduce the number of unnecessary laparotomies and the related morbidity. CONCLUSIONS: Laparoscopy can be performed safely and effectively in stable patients with abdominal trauma. The most important advantages are reduction of morbidity, shortening of hospitalization and cost-effectiveness. In the future, new developments in laparoscopy equipment and the introduction of computer technology and robotic devices can be expected to have a decisive influence on the treatment of trauma patients.     

Mini-laparoscopy in blunt abdominal trauma

Summary Blunt abdominal trauma in multiorgan injured or comatose patients always presents a problem. The aim is to assess, in the shortest period of time, which organ injury requires priority and whether intra-abdominal bleeding or perforation exists. Abdominal lavage proved to be too sensitive. Not every positive case needs exploration. Approximately 15%–20% of the cases explored because of positive lavage did not show a significant bleeding site that would require surgical treatment. The authors developed a mini-laparoscope that can be used at the bedside, in the emergency room, or in the intensive care unit. The procedure can be performed with intravenous sedation and local anesthesia. In 150 cases, no hemoperitoneum was found in 53% of these cases. Except for 1 (see text for details), none of these patients needed further exploration. In 21%, severe hemoperitoneum was discovered; these patients were transferred to the operating room, and this was confirmed by surgery. In 26%, a small amount of blood was found in the gutters. These patients were observed in the intensive care unit and an unnecessary exploration was avoided. Laparoscopy gives a wider range of decision making by observing the abdominal cavity. It can be completed in 10–20 min at the bedside. No serious complications were encountered. This procedure should be taught and practiced in trauma centers. Partially based on a presentation to the International Congress on Surgical Endoscopy, Ultrasound, and Interventional Techniques, Berlin 1988