Hepatic hydrothorax: diagnosis and management. Case report and review of the literature

Current practice standards indicate the need for tube thoracostomy in the management of clinically significant recurrent pleural effusions. The following case presentation and review of the literature illustrate a contraindication to chest tube insertion with pleural effusions associated with portal hypertension (hepatic hydrothorax) and suggest alternative therapies.     

超声诊断先天性胆总管囊肿的价值

目的探讨超声检查对先天性胆总管囊肿的诊断价值。方法对30例胆总管囊肿患者的超声检查结果进行回顾性分析并与手术及病理结果对照。结果超声诊断胆总管囊肿符合率为93.3%（28/30）,胆总管球形、椭圆形或梭形无回声区,囊肿与近端肝管相通是诊断本病的重要依据。结论胆总管囊肿的声像图表现较有特征性,超声可作为临床诊断的首选影像学方法 。     

Perforated choledochal cyst in a Jehovah's Witness patient

Perforation is a rare presentation of a choledochal cyst. The case reported is a 9-month-old female baby with a perforated choledochal cyst. Being a Jehovah's Witness, blood tranfusion was refused. Apart from highlighting this social dilemma, the suitability of a cystojejunostomy as a temporary measure in the above scenario is evaluated and discussed.     

Cervical pregnancy. Case report and literature review

Cervical pregnancy is an uncommon life threatening form of ectopic pregnancy that is associated with the unexpected occurrence of uncontrollable haemorrhage from the cervix. To avoid hysterectomy and to maintain fertility, several conservative methods of termination have been used. We present herein, one such case which relates to a young woman who had successful conservative management of a cervical pregnancy using vasopressin infiltration of the cervix, a McDonald cerclage and cervical curettage followed by balloon tamponade. Subsequently, she became pregnant again with a normal intra-uterine pregnancy and had a successful vaginal delivery.     

先天性胆管囊肿43例诊治体会

目的 探讨先天性胆管囊肿的诊断及治疗经验。方法 对该院18年来43例先天性胆管囊肿的诊断、治疗及疗效进行回顾性分析。结果 先天性胆管囊肿具有典型的腹痛、黄疽及腹部包块三联征者少，仅12％，合并肝胆胰疾病者多，高迭74％。临床Ⅰ型较多见，B超、CT和MRCP均有重要的诊断价值。首选术式为囊肿切除，肝管空肠Roux-en-y吻合术，术后并发症少，效果良好。结论 先天性胆管囊肿一经确诊，应尽早手术治疗，首选术式为囊肿切除，肝管空肠Roux-en-y吻合术。     

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.     

胆管囊肿的诊治分析(附41例报告)

目的：探讨胆管囊肿的诊断及治疗方法。方法：回顾性分析41例先天性胆管囊肿的临床资料。结果：临床表现为腹痛32例（78．0％）,黄疸18例（43．9％）,腹部包块14例（34．1％）,发热,寒颤6例（14．6％）,出现胆管囊肿三联征6例（14．6％）,30例行B超检查,26例见胆管扩张;18例行CT检查,15例发现胆管扩张;10例行MR检查,9例有胆管扩扩长。37例患者施行手术治疗,27例行胆管空肠吻合（23例行Roux-en-Y吻合）,3例行单纯胆管十二指肠吻合,3例行外引流术,2例行肝叶（段）部分切除,2例行单纯囊肿切除,胆管重建。结论：伴腹痛,肿块,黄疽,胆管囊肿,三联征者不多见。I型在临床上多见,B超,CT和MR有重要诊断价值。能代替有创检查如PTC或ERCP。目前最佳手术方法为囊肿切除,胆管空肠吻合术。     

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.     

纵隔型甲状旁腺囊肿1例报道及文献复习

甲状旁腺囊肿非常少见,位于胸骨后纵隔内的纵隔型甲状旁腺囊肿更是少见。我们报道1例纵隔型甲状旁腺囊肿的诊断和治疗,并结合文献资料一起分析。     

Giant gas-filled cyst of sigmoid colon. Report of a case and review of the literature

The largest recorded gas-filled cyst of the sigmoid colon, in a man of 67, is presented. The literature of the other recorded cases is reviewed. The gas in the cyst was analysed and a suggestion put forward that bacteria play some part in the aetiology of the gas in the cyst.     

Management of choledochal cyst with portal hypertension

Portal hypertension (PHT) is a rare complication associated with choledochal cysts. Management issues of PHT patients are inadequately addressed, as its incidence is low and underlying causes variable. We report three cases of choledochal cyst with PHT. All patients had type IVa choledochal cysts, and the causes of PHT were secondary biliary cirrhosis (SBC) (two cases) and alcoholic liver disease (one case). Clinical presentation included jaundice, gastrointestinal bleeding and ascites. One patient with SBC successfully underwent excision with Rouxen-Y hepaticojejunostomy, while the patient with cholangitis was managed with endoscopic retrograde cholangiopancreatography stenting. The last patient with alcoholic liver disease was managed conservatively for seven years and died of liver failure. Management of choledochal cysts depends on the severity of liver disease in cases of cirrhosis of unrelated cause, while those with SBC should be considered for surgical management. Endoscopic stenting may be considered as a temporary measure in high-risk cases.