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目的 探讨急性肠系膜血管闭塞(AMVO)的早期诊断及外科治疗方法。方法 回顾性总结1987年8月至2002年8月收治的24例AMVO，对其临床特征、外科诊断治疗方法及预后进行分析。结果 24例AMVO中肠系膜上动脉栓塞(MAE)9例(37.5％)，肠系膜上静脉血栓形成(MVT)13例(54．2％)，肠系膜上动脉血栓形成(MAT)2例(8．3％)。最常见的临床表现为腹痛(91.7％)。最可靠的诊断方法为肠系膜血管造影(100％)。9例MAE确诊7例。保守治疗3例，急诊手术6例。治愈5例，死亡4例。13例MVT确诊10例。保守治疗7例。介入治疗2例，手术4例。全部治愈。2例MAT均确诊，介入与手术治疗各1例，均治愈。结论 肠坏死发生前早期诊断、积极行介入治疗与剖腹探查为主的外科治疗是提高AMVO疗效的关键。     

体外冲击波碎石治疗儿童尿路结石的疗效观察(附62例报告）

目的：探讨体外冲击波碎石(ESWL)治疗儿童尿路结石的有效性和安全性。方法：采用ESWL治疗儿童尿路结石患者62例，其中肾盂肾盏结石35例，输尿管结石22例，膀胱结石4例，移植肾结石1例。结果：62例随访3个月，结石排净59例(95．2％)，结石残留2例(3．2％)，1例无效(1．6％)，改用手术治疗。结论：ESWL治疗儿童尿路结石安全、有效，是儿童尿路结石的首选治疗方法。     

肾损伤的诊断与治疗 (附106例报告)

肾损伤106例，其中闭合性损伤101例(95.3％)，开放性损伤5例(4.7％)；合并伤22例(20.8％)。IVP检查5例，阳性率60％；B超检查88例，阳性率88.6％；CT检查75例，阳性率100％。非手术治疗81例(76.4％)，均治愈(100％)；手术治疗25例(23.6％)，治愈23例(92％)，死亡2例，术后出现尿瘘2例，再发血尿1例，均经保守治疗痊愈。CT检查准确快速，增强后可了解双肾功能，对判断病情、选择治疗方案有利。治疗主要取决于肾脏伤情，保守治疗是重要的治疗方法。     

生物反馈技术治疗慢性盆底疼痛综合征及慢性前列腺炎

目的：评估生物反馈刺激治疗对慢性盆底疼痛综合征(CPPS)及慢性前列腺炎(CP)的效果。方法：评估30例患者治疗前后，前列腺液(EPS)及精液(SF)和临床症状的变化，包括每日排尿次数、尿急、疼痛和生活质量。使用侵入型的生物反馈刺激治疗仪，治疗周期5～15d，每次20min。结果：30例患者中的14例进行了5次生物反馈治疗，10例进行了10次，6例进行了15次治疗(平均每位患者治疗8．6次)，追踪生物反馈治疗后0～2个月，并比较治疗前和治疗后的结果，显示病情有明显好转。结论：生物反馈刺激治疗对CP或CPPS患者能明显改善疼痛、尿频、尿急和生活质量，对CP患者能减少EPS或SF中的WBC。     

椎管内肿瘤的临床特点及诊治

目的：探讨椎管内肿瘤的临床特点、诊断方法及治疗效果。方法：对1995年3月～2001年10月在本院住院手术治疗的119例椎管内肿瘤的患者进行回顾性分析。结果：本组119例中良性肿瘤116例(97．5％)，恶性肿瘤3例(2．5％)；治愈好转112例(94．1％)，差5例(4．2％)，加重2例(1．7％)。肿瘤全切除103例(86．6％)，部分切除16例(13．4％)。结论：MRI是诊断椎管内肿瘤的重要方法，手术切除是治疗椎管内肿瘤的有效方法。     

时控型遗尿治疗仪临床应用观察

目的探索遗尿症的治疗方法。方法用自行研制的时控型遗尿治疗仪，通过对关元、气海两穴位低频脉冲刺激和定时控制的方法治疗遗尿症25例。结果13例(52％)治愈，10例(40％)显效，2例(8％)无效。结论认为该治疗仪安全可靠、小巧方便、适合家庭使用，是预防和治疗遗尿症的理想仪器。     

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目的 探讨胰腺假性囊肿(PPC)的治疗方法和其基础疾病的关系。方法 收集浙江大学医学院附属第一医院1992～2003年收治的73例PPC的临床资料，根据D’Egidio分型方法分型，前瞻性分析其基础疾病、主胰管解剖和治疗成功率的相关关系。结果 37例D’EgidioⅠ型PPC中16例进行手术引流，8例发生并发症或复发，治疗成功率为50％(8／16)；另11例行经皮穿刺引流，治疗成功率82％(9／11)。24例Ⅱ型PPC中9例行经皮穿刺或手术外引流，5例发生并发症或复发，治疗成功率为44％(4／9)；另12例经手术内引流或切除治疗，治疗成功率为92％(11／12)，12例Ⅲ型PPC，10例经手术内引流或切除治疗，2例复发，治疗成功率为80％(8／10)。结论 对胰腺假性囊肿基础疾病的分型可以指导其治疗。了解胰腺假性囊肿的基础疾病，对Ⅱ型、Ⅲ型PPC行ERCP明确胰管解剖，有利于正确选择治疗方案，降低并发症发生率和复发率。     

肝移植病人术后巨细胞病毒感染的预防和治疗

目的 分析肝移植术后病人巨细胞病毒(CMV)感染的诊断、预防和治疗。方法 采用回顾性分析的方法，分析我科2000年8月至2002年1月期间进行的同种异体原位肝移植病例。结果 共进行同种异体原位肝移植36例。术后8例发生巨细胞病毒感染，其中2例出现腹泻，发热2例，1例为黄疸，4例无明显症状。在CMV感染的病人中，检测到CMV—IgM( )或(和)CMV-DNA( )，其中CMV—IgM( )5例，CMV-DNA( )6例。病人经更昔洛韦治疗后血清CMV-DNA变为阴性。全部治愈。结论 对病人CMV—IgM和CMV—DNA(FQ-PCR方法)联合检测应用能够对CMV感染病人作出诊断并且指导治疗。更昔洛韦能够有效的治疗CMV感染。     

重症急性胰腺炎52例诊治探讨

目的 探讨重症急性胰腺炎(severe acute percreatitis，SAP)的手术治疗时机。方法 对52例SAP手术治疗和非手术治疗患者回顾性分析，其中38例手术，14例非手术。早期手术26例，延期手术12例。结果 本组总病死率为23．1％(12／52)，其中早期手术组死亡5例(19．2％)，延期手术组死亡5例(41．7％)。非手术组死亡2例(14．3％)。结论 SAP应按个体化治疗原则，把握手术治疗时机，能有效降低病死率。     

防治重症急性胰腺炎感染的临床研究

目的 探讨防止重症急性胰腺炎(SAP)后期感染的治疗方法，提高SAP后期治疗水平。方法 总结分析1995—1999年和2000--2001年4月两个阶段共收治的134例SAP病人的治疗效果。第1阶段用常规保守治疗；第2阶段采取尽早进食，肠内营养及口服肠道益生菌等措施治疗。结果 第1阶段收治SAP后期102例，感染发生45例(44．1％)，复发5例(4．90％)，住院时间平均56d，死亡11例(9．8％)。第2阶段收治32例，感染7例(21．8％)，住院时间平均38d，复发2例(6．25％)，死亡2例(6．25％)。结论 适度提前进食、肠内营养及口服肠道益生菌等治疗措施有助于降低SAP后期感染率，改善预后。     

先天性胆管囊肿瘤变与首次手术术式的关系探讨

目的 探讨先天性胆管囊肿瘤变与原手术术式的关系。方法 对近30年来收治的21例先天性胆管囊肿癌变患者的资料进行回顾性分析。结果 本组先天性胆管囊肿总癌变率14．8％；原手术为囊肿内引流术者的癌变率显著高于囊肿切除术（P＜0．001）；囊肿内引流术后患者癌变年龄显著小于囊肿切除术（P＜0．01）和未手术者（P＜0．01）；囊肿内引流术后发生癌变的年限显著短于囊肿切除术（P＜0．01）；囊肿内引流术后癌变者的发病年龄比未手术者早15．4年。结论 囊肿内引流术能加速和促进癌变发生，应废用；囊肿切除术应列为首选术式；囊肿应尽可能切净，不能切净者应剥除内膜或破坏其粘膜。     

Treatment of hilar carcinoma by bile drainage combined with internal radiotherapy using 192iridium wire

Eighteen patients with a cholangiocarcinoma involving the hilum of the liver, and one patient with a carcinoma of the gall bladder causing obstruction of the common hepatic duct, have been treated with bile drainage using a U-tube (8 patients) or a percutaneous transhepatic catheter (11 patients) followed by internal radiotherapy with 192iridium wire. The median survival is 11 months, and 9 patients (47 per cent) have survived for 12 months or longer. The addition of internal radiotherapy may be beneficial to patients with hilar cholangiocarcinoma causing biliary obstruction in whom bile drainage can be established.     

肝门部胆管癌103例外科治疗远期疗效的评析

作者回顾总结了１９８６年１月～１９９６年１月十年间行手术治疗的１０３例肝门部胆管癌的临床特征、手术方式和远期生存率等。１０３例肝门胆管癌行手术切除者６６例,非切除者行胆管内外引流者３７例,总手术切除率为６４．１％。手术死亡率２．９％。手术切除组中行根治性切除者３６例,姑息性切除者３０例。根治性切除者１、３、５年的生存率分别为：９６．７％、２３．３％和１３．３％,最长生存者至今已达８年。而姑息性切除者３年生存率仅为３．８％,无５年生存者。作者提出新的肝门部胆管癌的临床分型法。发现肝门部胆管癌的组织类型及分化程度,与肿瘤浸润及转移特征密切相关,分化程度越差其预后亦越差。     

SYNCHRONOUS CARCINOMA OF THE GALL-BLADDER IN PATIENTS WITH BILE DUCT CARCINOMA

One hundred and twenty-four patients with bile duct carcinoma treated during 16 years were analysed retrospectively for multiple biliary tract carcinoma. Sixty-two cases had undergone a cholecystectomy either as part of a pancreaticoduodenectomy or a bile duct resection or as part of an internal drainage procedure. Three (5%) were found to have an incidental separate carcinoma of the gall-bladder. The discontinuity between the two sites of cancer was histologically confirmed. Clinical concern was that approximately 5% of patients with bile duct carcinoma had a synchronous carcinoma of the gall-bladder. Thus, careful examination of the entire biliary tract including the gall-bladder is necessary at the time of curative surgery for bile duct carcinoma.     

Change in the value of palliative interventions in cancer of the head of the pancreas

An analysis of 412 patients with carcinoma of the head of the pancreas treated only with palliative procedures revealed remarkable differences in the results following internal anastomosis procedures and external T-tube drainage. The anastomosis group showed in comparing the years 1963-1982 with the years 1983-1987 a decline in the frequency of such procedures from 89% to 54% and a decline of the mortality from 12% to 4% while the survival time (220 days) showed no change. According to the low mortality rate we prefer internal anastomosis procedures to PTCD. However, as the results of T-tube drainage are still poor (mortality rate 36%; survival time 190 days) an attempt of PTCD seems indicated if the untreatable situation is recognized preoperative, as PTCD achieves similar results as T-tube drainage.     

Changing patterns in the management of pancreatic pseudocysts.

The records of patients treated from 1938 through June, 1974, for pancreatic cysts have been reviewed. There was 205 cysts including 168 pseudocysts, 21 neoplastic, 13 retention, and 3 congenital pseudocysts. An analysis of two eras has been made: cysts treated prior to 1962 (56 patients) and cysts treated after 1962 (98 patients). In the earlier era 66.4% of patients were treated by external drainage and 34% by excision or internal drainage. By marked contrast in the more recent era only 27% were treated by external drainage and 73% by excision or internal drainage. The recurrence rate fell from 27% in the earlier era to 6% in the modern era. Improved morbidity was evidenced by a reduction from 32.2% to 15.3% in additional procedures required. Individualization in the treatment of pseudocyts with adherence to establish criteria for procedure selection with increased reliance on excision or internal drainage, as well as early diagnosis and timely intervention have improved the results of surgical therapy in this disease.     

内引流术加动脉区域灌注化疗治疗晚期胰腺癌应用

目的 探讨晚期胰腺癌的姑息治疗方法。方法 对26例晚期不能切除的胰腺癌行胆总管－－十二指肠T形管内引流术治疗，结扎胰十二指肠上动脉近心端，远心端插入化疗泵，术中、术后行动脉灌注化疗。结果 26例患者术在术后退黄；减轻患者症状，提高生存质量，延长生存时间等方面有显著疗效，其中1例生存18个月。结论 内引流术加动脉区域灌注化疗是治疗晚期不能切除胰腺癌的一个较好方法。     

Surgical treatment of pancreatic pseudocysts. A review of 42 cases

21 years' experience of operated pancreatic pseudocysts is reviewed. The number of patients was 42, with mean age of 50 +/- 5 years. Thirteen patients (31%) were alcoholic. In 6/42 cases (14%) pancreatic carcinoma was considered the reason for pseudocyst formation. In 30 patients an internal and in 11 an external drainage was created. Operative mortality occurred in 3 patients (7%). External drainage was effected in patients with complicated pseudocyst. The complication rate in this group was 6/11 (55%) and in the internal drainage group 7/30 (23%). Internal drainage is a safe and effective procedure in patients with a mature pseudocyst wall. External drainage should be used in patients critically ill or with an immature pseudocyst wall.     

晚期肝外胆管癌34例临床治疗分析

报告３４例晚期肝外胆管癌临床治疗结果。其中施行胆管空肠吻合术２例，经皮肝穿刺胆道外引流（ＰＴＣＤ）９例，经ＰＴＣＤ放置内置管８例，剖腹探查９例，单纯肝动脉灌注化疗３例，未治３例。出院后随访发现，放置内置管组生存时间明显高于其它各组。作者认为对不能手术切除的晚期胆管癌，在条件适合时采用经ＰＴＣＤ内置管效果较好，该法损伤小，又无ＰＴＣＤ的许多不良后果。     

经皮肝穿胆道引流术治疗梗阻性黄疸

目的 评价经皮肝穿胆道引流术治疗梗阻性黄疸的临床价值。方法 １２例梗阻性黄疸,其中９例恶性梗阻（胆管癌４例,肝门淋巴结转移压迫胆管５例０采用ＰＴＣＤ姑息性引流,３例高危良性梗阻采用ＰＴＣＤ进行术前胆道减压。结果 ４例患者行内外引流术,８例行外引流术。经１－３周引流,８例血清总胆红素降至近正常,３例下降不满意,１你无效。３例高危良性梗阻者于引流减压后安全地进行了手术,７例恶性梗阻者于ＰＴＣＤ后１周１