首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 62 毫秒
1.
腹腔镜治疗肝内外胆管结石   总被引:7,自引:9,他引:7  
目的 :探讨腹腔镜治疗肝内外胆管结石的方法。方法 :单纯的胆总管结石 ,结石直径≤ 5mm。采用经胆囊管途径胆道镜取石。单纯胆总管结石 ,结石直径 >5mm或经胆囊管途径取石失败 ,采用腹腔镜胆总管切开探查取石 ,胆总管一期缝合术。胆总管结石合并肝内胆管结石 ,胆道无狭窄 ,采用腹腔镜胆总管切开探查取石、T型管引流术。单纯胆总管结石伴梗阻性黄疸 ,术前ERCP置鼻胆管引流 ,腹腔镜胆总管切开取石 ,结石取尽后 ,胆总管一期缝合。鼻胆管继续留置引流减压 ,3~ 5d黄疸消退 ,拔除鼻胆管。胆总管下端大结石嵌顿 ,腹腔镜下取石困难 ,辅以腹壁小切口 ,将结石取出。结果 :本组 52例 ,经胆囊管途径取石 4例 ,腹腔镜胆总管探查取石、胆总管一期缝合 7例 ,腹腔镜胆总管探查取石、T型管引流 2 8例 ,其中术后胆道残余结石 2 1例 ,1次胆道镜取尽结石 1 0例 ,2次胆道镜取尽结石 7例 ,3次胆道镜取尽结石 3例 ,4次胆道镜取尽结石 1例。需要碎石后取石 1 9例。腹腔镜胆总管切开探查取石 ,鼻胆管引流 7例 ,腹腔镜胆总管切开辅助小切口取石 6例 ,手术全部取得成功。结论 :根据肝胆管结石的部位 ,选择不同的腹腔镜手术方式 ,手术是安全可行的 ,但术中取石仍是腹腔镜手术的难点所在 ,需要进一步探索加以改进  相似文献   

2.
预置鼻胆管胆总管一期缝合术治疗胆道结石的临床研究   总被引:6,自引:0,他引:6  
目的:通过对预置鼻胆管胆总管一期缝合术的设计和研究,探讨胆总管探查术后胆总管切口的处理方法。方法:选择胆道结石患者3例,术前行内镜鼻胆管引流,术中行胆道镜检查和胆总管一期缝合。结果:本组均成功完成手术,术后无胆漏发生,鼻胆管造影未见结石残留。结论:预置鼻胆管胆总管一期缝合术治疗胆道结石可以达到经典胆总管探查手术的效果,同时具有T管引流有效防止术后胆漏发生的优点和胆总管一期缝合术便捷、痛苦少、对患者生理机能干扰小的特点。  相似文献   

3.
目的:探讨腹腔镜联合十二指肠镜治疗胆囊结石合并胆总管结石的临床疗效.方法:回顾分析2009年1月-2010年12月腹腔镜胆囊切除术(LC)联合十二指肠镜治疗35例胆囊结石合并胆总管结石患者的临床资料.所有患者均采取经十二指肠镜逆行胰胆管造影(ERCP),内镜下十二指肠乳头括约肌切开术(EST),取出胆总管结石,放置胆道塑料支架引流(ERBD).ERCP后3d内行LC,术后4d出院.出院后1~2周内再次行十二指肠镜取出胆道支架并行ERCP了解胆管有无残余结石.结果:35例患者均1次取净胆总管结石,1例EST术中出血,34例成功行LC,1例中转开腹行胆囊切除术.术后并发急性胰腺炎2例,所有患者均无胆漏、十二指肠穿孔、黄疸等并发症.结论:腹腔镜联合十二指肠镜治疗胆囊结石合并胆总管结石具有疗效确切、创伤小、恢复快等优点.  相似文献   

4.
目的:探讨肝移植术后胆道并发症的内镜诊疗价值。方法:2001年4月~2004年7月对12例肝移植术后胆道并发症患者,应用电子十二指肠镜进行胆道造影,乳头切开、取石、放置鼻胆管或塑料内支架引流等诊疗方法。结果:原位肝移植术后出现胆道并发症12例,共行ERCP15次:胆管吻合口狭窄、胆总管结石伴急性梗阻性化脓性胆管炎3例,急诊内镜取石、鼻胆管引流,再次内镜胆总管塑料内支架引流。胆管吻合口狭窄伴胆管泥沙样结石2例,内镜乳头切开、取石、引流。胆管吻合口狭窄5例,其中塑料内支架引流2例,未置引流1例,鼻胆管放置失败1例,胆管吻合口严重狭窄导丝无法通过1例。胆漏2例,因胆总管吻合口严重狭窄,导丝未能通过。结论:肝移植术后胆道并发症经内镜诊疗具有微创、安全、有效,有一定的诊疗价值。  相似文献   

5.
目的:探讨胆总管切开探查胆管一期缝合的方法和效果。方法:回顾性分析我院2003/2007年胆总管切开探查胆管一期缝合80例,取尽结石或蛔虫,经胆道造影或胆道镜检查证实胆管无异常后一期缝合。结果:58例胆总管结石,22例胆道蛔虫,全部一期缝合,术后8例漏胆,保守治疗,全组术后9~12d治愈出院。结论:肝外胆管结石、蛔虫已取尽,术中胆道造影或胆道镜检查证实肝内外胆管无异常,胆总管切开探查后胆管一期缝合是安全可行的。  相似文献   

6.
陈迅  唐才喜  赵志坚 《医学临床研究》2010,27(10):1966-1967
[目的]总结胆内瘘的诊治经验.[方法]对31例胆内瘘的病例进行回顾性分析.[结果]术前均行B超检查,其中30例提示胆囊炎、胆囊结石;5例提示胆管扩张、胆管结石;6例提示胆囊积气; 2例显示胆道积气.术前2例行腹部X线平片检查提示小肠梗阻,1例见结石影;8例行磁共振胆胰管造影检查,其中2例显示胆囊、胆管气体;2例黄疸病人分别提示肝尾叶或胰头占位,术中探查未见占位,仅发现肝门胆管或胆总管内有结石.术前仅5例考虑到胆内瘘的诊断,其余均在术中发现.30例行胆囊切除或部分切除,1例胆总管胃瘘行瘘管切除,瘘口修补, 3例胆囊胆总管、肝总管瘘在取尽结石后,经瘘口置T管引流.术后随访1~5年,无死亡病例,5例术后出现胆漏,经引流治愈,其余均恢复良好.[结论]X线、钡餐、B超、CT和磁共振胆胰管造影等检查对诊断胆内瘘有帮助.治疗时应修补瘘口,瘘口过大可利用部分胆囊壁来修补.  相似文献   

7.
鼻胆管引流术(ENBD)是在十二指肠镜直视下胆管置管并经鼻腔引流到体外的减压技术,是一种操作简便、安全有效的胆道引流方式,不仅能充分引流胆汁,而且能冲洗胆管,反复进行胆管造影,对减轻胆道压力,消除黄疸,控制并发症和改善病人全身情况有重要作用,梗阻性黄疸、急性化脓性胆管炎等胆道、胰腺疾病十分有效的治疗方法。1资料与方法1.1一般资料我科于2004年开展经内镜鼻胆管引流术,共治疗30例,其中男20例,女10例;年龄在30岁~72岁;胆总管结石15例,胆源性胰腺炎3例,梗阻性黄疸5例,ERCP术后留置鼻胆管7例。1.2置管方法病人取俯卧或屈膝左侧卧…  相似文献   

8.
内镜逆行胰胆管造影(ERCP)下鼻胆管引流术临床主要用于治疗急性化脓性梗阻性胆管炎、减轻梗阻性黄疸、胆道结石嵌顿、胆瘘的预防、预防治疗性ERCP术后胰腺炎[1],其操作简便、安全,成功率达100%.但术后鼻胆管引流不畅、梗阻、感染常见,国内发生率达60%以上.  相似文献   

9.
目的探讨内镜逆行性胰胆管造影术(ERCP)在腹腔镜胆囊切除术后胆漏及隐匿性胆总管结石诊断和治疗中的应用价值。方法患者为85岁女性,因"上腹疼痛1月余,复发加重2d"入院。患者1个月前在某院(简称外院)诊断为胆囊结石伴胆囊炎,并行了腹腔镜胆囊切除术。术后患者一直有上腹隐痛症状,2d前腹痛加重伴呕吐。外院治疗后腹痛无明显好转,转入重庆医科大学附属第二医院。入院后完善磁共振胰胆管成像(MRCP)等相关检查,初步诊断:(1)急性胰腺炎;(2)胆囊切除术后胆囊积液:感染?出血?胆漏?故拟行ERCP进一步检查、治疗。结果 ERCP术中造影提示造影剂外溢,考虑胆漏。术中胆道造影未见明显充盈缺损,但取石球囊刮出直径0.4cm的黄色质软结石1枚,术中安置鼻胆管1根。术后诊断:(1)急性胆源性胰腺炎;(2)胆总管结石;(3)胆囊切除术后胆漏。术后患者腹痛症状明显减轻,1周后复查MRCP见胆囊窝积液明显减少,术后8d拔除鼻胆管,术后9d出院。结论 ERCP在诊断及治疗腹腔镜胆囊切除术后发生的胆漏具有明显的优势,并能诊断及治疗隐匿性胆总管结石。  相似文献   

10.
目的 探讨腹腔镜胆囊管微切开分别进行术中联合内镜留置鼻胆管引流与十二指肠乳头导管扩张后胆总管一期缝合的疗效。方法 选取我院收治的胆总管结石合并胆囊结石患者83例,均行腹腔镜下微切开胆囊管进行胆道镜取石,其中43例同期术中十二指肠镜留置鼻胆管引流后胆总管一期缝合(鼻胆管组),40例同期术中胆道扩张导管扩张十二指肠乳头后胆总管一期缝合(导管扩张组)。比较两组患者术中出血、手术时间;丙氨酸转氨酶、血淀粉酶、总胆红素、术后第一日腹腔引流量;腹腔引流管拔管时间,住院时间;术后急性胰腺炎、残留结石及胆漏。结果 所有患者均顺利完成手术,两组手术时间、术中出血量差异有统计学意义(P<0.05);引流管拔管时间、术后第一日腹腔引流量、术后丙氨酸转氨酶、胆红素、血淀粉酶、住院时间等指标比较差异均无统计学意义(P>0.05);鼻胆管组术后3例急性胰腺炎,2例胆漏,1例残留结石;导管扩张组术后1例急性胰腺炎,2例胆漏,无残留结石,两组并发症比较差异无统计学意义(P>0.05)。结论 腹腔镜微切开胆囊管胆道镜取石行胆总管一期缝合,采用鼻胆管引流或导管扩张均能达到解除胆道梗阻、通畅引流、减少胆总...  相似文献   

11.
This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.  相似文献   

12.
Ranganath C  Heller AS  Wilding EL 《NeuroImage》2007,35(4):1663-1673
Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.  相似文献   

13.
目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高<20%视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P<0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P<0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P<0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.  相似文献   

14.
The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.  相似文献   

15.
16.
17.
Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.  相似文献   

18.
Delineating the Concept of Hope   总被引:2,自引:0,他引:2  
  相似文献   

19.
20.
Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号