肝叶部分切除治疗肝内胆管结石

肝内胆管结石的发生率约占胆道结石的13％～20％,因其在肝内胆管,位置较深,易发生感染形成脓肿及狭窄,而且有相当一部分病人是手术后复发,所以治疗难度较大,对于这一类病人最有效的治疗方法就是行手术治疗。1996～1999年我院对17例肝内胆管结石的病人成功地实施了肝叶部分切除,肝内胆管取石Roux-Y胆肠吻合,胆道重建手术,取得了理想的效果,报道如下。     

肝叶切除术在肝内胆管结石治疗中的应用

目的：探讨肝叶切除治疗肝内胆管结石的效果。方法：对1997年1月-2008年6月收治的55例肝内胆管结石患者采取肝叶切除术治疗,其中肝左外叶切除45例,左半肝切除6例,右后叶切除3例,右前叶切除1例。结果：本组50例获随访,随访时间6个月-10a,其中疗效优34例,良11例,差5例,优良率为90％。术后并发切口感染3例、胆漏2例、肺部感染2例、胸腔积液2例、膈下感染1例、肝衰1例、上消化道出血1例,均经对症处理、抗感染、支持疗法治疗,于术后21～36d治愈。无死亡病例。结论：肝叶切除是治疗肝内胆管结石的的有效措施之一。     

肝左外叶切除治疗肝内胆管结石

目的 总结用肝左外叶切除术治疗肝内胆管结石的经验及疗效.方法 回顾性分析我院近10年来采用肝左外叶切除术治疗原发性肝内胆管结石48例的临床资料、手术方法及术后恢复情况.结果 全组随访6月至8年,其中再发胆管结石2例(占4.17%)胆管炎1例(占2.08%),其余病人无明显胆道症状(占93.7%).结论 肝左外叶切除治疗肝内胆管结石疗效确切.     

全腹腔镜下肝叶切除术治疗肝内胆管结石疗效分析

目的 探讨全腹腔镜下肝叶切除术治疗肝内胆管结石临床疗效及安全性。方法 回顾性分析我院2015年6月~2016年6月收治的肝内胆管结石患者48例,依据其手术方式分为腹腔镜组与对照组,各24例。腹腔镜组给予全腹腔镜下肝叶切除术,对照组给予传统开腹手术切除肝叶,记录两组患者一般资料,比较两组患者手术时间、术中出血量、术后疼痛程度、术后排气时间、腹腔引流量、住院时间以及结石清除率和复发率。结果 腹腔镜组术中出血量、术后排气时间以及住院时间低于对照组（P＜0.05）,腹腔镜组术后疼痛程度评分为（1.80±0.60）分,优于对照组的（3.40±0.50）分,差异具有统计学意义（P＜0.05）。两组患者的手术时间、术后腹腔引流量、结石清除率及随访复发率比较差异无统计学意义（P＞0.05）。结论 全腹腔下肝叶切除术治疗肝内胆管结石具有良好的疗效及安全性,可降低机体损伤,改善疼痛感受,缩短住院周期,提高生存质量。     

肝部分切除治疗左肝内胆管结石97例分析

目的 观察肝部分切除治疗左肝内胆管狭窄及结石的疗效。方法 回顾性分析97例左肝内胆管狭窄及结石病例的手术方法、术后并发症及复发情况。结果 远期随访疗效，随访率80．4％，优良率89．7％，61．9％完全无症状，20．6％偶发胆管炎。结论 左半肝切除术治疗左肝内胆管狭窄及结石的临床疗效较好。     

肝内胆管结石的肝脏病理观察

目的：探讨肝内胆管结石之肝脏病理变化。方法：对７２例肝内胆管结石的肝叶标本进行病理检查，部分尚行粘液及胶原染色。结果：镜一常见的病变是肝间质炎症、胆管上皮及腺体增生和粘液上皮化生（１００％）肝细胞水肿变性及小叶中央性淤胆。胆蛔症。２例伴肝胆管上皮癌，癌旁胆管上皮及腺体异型增生与癌相移行。３３例见局限于门管区的纤维组织增生。结论：肝内胆管结石与胆道炎症、上皮成分增生及粘液化生相关与胆管上皮癌发生有关     

肝内胆管结石治疗模式的探讨

目的探讨多路微创技术治疗肝内胆管结石的疗效. 方法回顾性分析单纯手术(A组)与多路微创技术(B组)两种治疗模式治疗肝内胆管结石的疗效. 结果 B组病人在术后恢复、残余结石方面均优于A组. 结论多路微创技术治疗肝内胆管结石具有手术创伤小,取石率高,残余结石率低的优点,值得推广.     

肝内胆管结石治疗模式的探讨

目的 探讨多路微创技术治疗肝内胆管结石的疗效。方法 回顾性分析单纯手术（A组）与多路微创技术（B组）两种治疗模式治疗肝内胆管结石的疗效。结果 B组病人在术后恢复，残余结石方面均优于A组。结论 多路微创技术治疗肝内胆管结石具有手术创伤小，取石率高，残余结石率低的优点。值得推广。     

腹腔镜辅助下左肝外叶切除治疗左肝胆管结石

目的总结腹腔镜辅助下左肝外叶切除治疗胆管结石的临床经验。方法自2002年6月至2005年10月期间,本院左肝内胆管结石患者21例。患者在腹腔镜辅助下行左肝外叶部分切除及胆道镜探查取石术,部分加做胆囊切除术。结果全部21例行腹腔镜辅助下左肝外叶切除术,17例联合行腹腔镜胆囊切除术。手术时间为90~190min,平均(140±36)min。手术中出血量为100~250ml,平均(160±52)ml。术后恢复顺利,术后平均住院(6.2±1.2)d。结论腹腔镜辅助下行左肝外叶部分切除治疗左肝胆管结石是安全可行的。该术式容易掌握,风险小,为治疗左肝胆管结石提供了一个新方法。     

肝内胆管结石的外科治疗

肝内胆管结石是我国常见病,但其病变复杂,临床治疗具有一定难度。目前肝内胆管结石的治疗原则为“解除梗阻、清除病灶、取净结石、通畅引流”,治疗肝内胆管结石最有效的方法是外科手术。现代医学的发展使肝内胆管结石的外科治疗手段多样化,微创外科治疗理念深入人心。本文主要就近年肝内胆管结石的外科治疗研究进行综述。     

肝胆管结石外科治疗的术式选择与疗效观察

目的探讨肝胆管结石外科治疗的术式选择与疗效。方法选取我院2010年3月至2013年3月肝胆管结石120例病例资料,其中行肝内胆管探查取石术43例;肝部分切除术37例;肝胆管成形术加胆肠吻合术31例;纤维胆道镜取石术9例。回顾性分析不同手术方式的临床疗效。结果术后1~10年的随访,统计分析后发现不同手术之间的术后残石率、术后优良率、术后并发症发生率分别为:肝内胆管探查取石术(42.23%、78.69%、9.23%),肝部分切除术(8.05%、95.93%、18.09%),肝门部胆管成形加胆肠吻合术(13.33%、87.33%、21.32%),纤维胆道镜取石术(31.98%、78.04%、15.69%)。术后总残石率24.17%、总优良率85.83%、术后并发症发生率15.83%。结论根据患者的病史选择合理的手术方式,能降低患者残石率和术后并发症发生率,并提高术后优良率。     

Cholesterol hepatolithiasis with peribiliary cysts

A 78-year-old man was admitted to our clinic because of fatigue. Imaging modalities showed beaded stricture and dilation of the intrahepatic left segmental bile duct. Anomalous pancreatico-biliary ductal union and polycystic kidney disease were absent. Resection of the hepatic left lobe was performed. Grossly, cholesterol stones were impacted in the dilated intrahepatic large bile ducts, and multiple tiny cysts measuring 2-8 mm were noted in the peribiliary areas (peribiliary cysts). Histologically, the cholesterol hepatoliths consisted of cholesterol empty spaces and fibrinous materials, and, in places, foreign body giant cells were seen around the cholesterol crystals. The peribiliary cysts were lined by a layer of cuboidal epithelia. They were intimately intermingled with intrahepatic peribiliary glands, and a close association between the two components was recognized in some places. A mild degree of ascending cholangitis was noted. Bile duct anomalies including von-Meyenburg complexes and simple cysts were not recognized. Peribiliary cysts have been reported in various liver diseases, including portal hypertension, portal thrombosis, cirrhosis, hepatocellular carcinoma, and adult polycystic kidney disease. However, to the best of our knowledge, there have been no reports on peribiliary cysts developing in hepatolithiasis. The present case indicates that peribiliary cysts occur in cholesterol hepatolithiasis, and suggests that they are derived from cystic dilations of intrahepatic peribiliary glands.     

胆汁分泌及其对胆管结石形成的影响

介绍胆管胆汁分泌的调节机制,某些激素对胆汁分泌作用的最新进展。胆汁分泌异常极易导致许多肝脏疾病的发生和发展。重点介绍胆汁淤滞对形成肝内胆管结石的影响。     

胆汁分泌及其对胆管结石形成的影响

介绍胆管胆汁分泌的调节机制，某些激素对胆汁分泌作用的最新进展。胆汁分泌异常极易导致许多肝脏疾病的发生和发展。重点介绍胆汁淤滞对形成肝内胆管结石的影响。     

Pathologic features of hepatolithiasis in Japan

A national survey of pathologic features of hepatolithiasis was conducted in Japan. The significance of hepatobiliary lesions in the pathogenesis of hepatolithiasis was evaluated in 31 autopsy livers and 242 surgically resected livers. Eighty-two percent shared several morphologic and clinical features, eg, the presence of multiple calcium bilirubinate or brown pigment stones within the intrahepatic duct and a characteristic hepatobiliary morphology. These cases were distributed throughout Japan without distinct geographic differences. The stones were found in the left and/or right hepatic duct and/or their tributaries. The ducts that contained stones had uneven dilatation of their lumena with focal stenosis. The walls of the involved ducts were thickened mainly by fibrosis. The hepatic parenchyma associated with stones within intrahepatic bile ducts showed mild to severe atrophy and fibrosis. Histologically, the ducts that contained stones showed fibrosis, proliferation of mucous and serous glands, and inflammatory cell infiltration in their walls and the periductal tissue. A large amount of mucus secreted from the affected ducts was seen within the biliary sludge and calcium bilirubinate stones were found in the involved ductal lumena. These findings suggest that the large amount of mucus and the formation of unevenly dilated ductal lumena may be important in the formation of intrahepatic calculi because these factors may favor nucleation and promote local bile stasis, thereby accentuating the ductal changes and stone formation (a vicious cycle).     

儿童烧伤治疗及瘢痕防治策略的探讨

本文结合儿童生理特点,从儿童烧伤休克复苏补液的液体选择、晶体配方、输注方式;创面修复中敷料的选择、新型敷料的应用;深度烧伤创面手术时机和处理方法以及覆盖物的选择,多方位对儿童烧伤治疗进行阐述。同时,对烧伤瘢痕的预防措施,如压力疗法、激光治疗、支具应用;瘢痕的手术和非手术治疗的新进展;儿童瘢痕整形手术方法的选择;烧伤治疗全程康复措施和经验等作了分享和探讨,旨在为临床一线工作的医护人员提供参考依据。     

Morphological examination of intrahepatic bile ducts in hepatolithiasis

Summary Numerous glandular elements are characteristically found within and around the intrahepatic bile duct walls in hepatolithiasis. These glandular elements were studied by reconstruction of serial sections and mucus histochemistry. The glands were of two types: glands within the thickened ductal wall (intramural) and those outside the wall (extramural). The former were mucous glands arranged in tubular pattern and the latter seromucous glands arranged in tubuloalveolar pattern. Mucous acini of both glands were rich in neutral, carboxylated and sulfated mucus glycoproteins. Serial section observations showed that the intramural glands communicated with bile duct lumina directly, and the extramural glands with ductal lumina via their own conduits. The intramural glands were usually continuous with the epithelia lining bile ducts, suggesting that they were derived from an invagination and subsequently proliferating epithelium lining bile ducts. The extramural glands may have arisen from a proliferation of the pre-existing peribiliary glands. Hypersecreted mucus from the intramural and extramural glands might be causally related to the development and growth of calculi in the intrahepatic biliary tree.     

浅谈突发性成批烧伤患者的救治策略

突发成批烧伤的特点是指在没有准备的情况下,同一时间、同一致伤原因引起的多人烧伤,具有突发性、救治难度较大的特点。成批烧伤的原因大多由于火灾、爆炸或密闭空间内爆炸引起,因此除体表烧伤外,常伴有吸入性损伤、爆震伤、其他外伤及化学物质中毒等,更加重了烧伤伤情的复杂程度。因此,分析突发性成批烧伤患者的救治过程,