坏死性胰腺炎再手术的探讨

坏死性胰腺炎再手术的探讨封光华夏金声徐铨我院自１９８４年１月～１９９６年２月，经手术治疗的急性出血坏死性胰腺炎５２例，再次手术１５例（占２８８％），其中多次手术５例，共行再次手术２１次。死亡６例，死亡率占再手术病例的４０％。为提高本病治疗水平，降低...     

急性坏死性胰腺炎的治疗

急性坏死性胰腺炎的治疗陈国强１金庆丰２尽管急性坏死性胰腺炎的诊断与治疗已取得较大进展，但病死率仍高，治疗方法的选择尚有争论。我们自１９８１年７月～１９９６年６月治疗急性坏死性胰腺炎２３２例，效果较满意，现报告如下。临床资料１病例：本组２３２例，男９４...     

急性坏死性胰腺炎的术式选择

急性坏死性胰腺炎的术式选择林联翔１赵尔康１黄志清２高敏３急性坏死性胰腺炎（ＡＮＰ）为高危急腹症，亦称急性出血性坏死性胰腺炎、重症胰腺炎，是一种发病急，进展快，病情重，病死率高的急腹症，需要外科治疗。我们三院自１９８８年以来手术治疗ＡＮＰ５７例，治愈４...     

急性出血坏死性胰腺炎术后并发症的防治(附156例分析)

急性出血坏死性胰腺炎术后并发症的防治（附１５６例分析）镇江医学院附属医院普外科（２１２００１）谢啸东姚昌宏（指导）丹阳市人民医院外科张庆林徐卫星１）急性出血坏死性胰腺炎（ＡＨＮＰ）是一种症状凶险疾病，手术治疗后并发症甚多，平均病程常需２～３个月以上。...     

坏死性胰腺炎诱发周围脏器损害的分析

目的 探讨坏死性胰腺炎诱发周围器官损害的手术治疗方式。方法 对１９８３￣１９９７年４６例坏死性胰腺炎中９例诱发周围器官损害的原因进行分析，并分别探讨了对胃壁穿孔、十二指肠穿孔、小肠穿孔、结肠穿孔及胆囊、胆总管和胆囊动脉受累的手术治疗方法。结果 ９例中６例死亡，３例存活。结论 坏死性胰腺炎诱发周围脏器损害的病死率高，在发生全身器官衰竭之前果断、及时、有效地采取不同的手术治疗方式可以提高生存率，有的需     

中西医结合治疗急性出血坏死性胰腺炎的体会

中西医结合治疗急性出血坏死性胰腺炎的体会河南省人民医院外科（郑州４５０００３）张莉，马玉春我院自１９８６年１月至１９９４年ｌｌ月收治急性出血坏死性胰腺炎１６例，均经手术证实。应用中西药物治疗，取得较好的效果，总结如下：１临床资料本组男性６例，女性１０...     

开放引流治疗急性出血坏死性胰腺炎

开放引流治疗急性出血坏死性胰腺炎上海东方医院外科（２００１２０）殷国寿１９８８年１月至１９９４年５月，我院外科共收治急性出血坏死性胰腺炎４１例，全部病例均经手术及病理确诊，在治疗过程中，我们逐步总结经验，改进手术方式，从小的引流切口到大的引流切口，使...     

老年急性出血坏死性胰腺炎的手术治疗

老年急性出血坏死性胰腺炎的手术治疗郑克让胡稳心杜立学王伟民＊１９８５年１月至１９９５年１２月我科共手术治疗急性出血坏死性胰腺炎（以下简称ＡＨＮＰ）５１例，其中６０岁以上的老年患者２４例，占４７．１％。现对２４例老年ＡＨＮＰ的外科治疗分析如下：临床资料...     

急性出血性坏死性胰腺炎围手术期的麻醉处理

急性出血性坏死性胰腺炎围手术期的麻醉处理陈德征，景卫山急性出血性坏死性胰腺炎，多伴有休克、酸中毒和水、电解质平衡紊乱。围术期又需多次施麻醉和手术清理坏死组织，病程长达月余。本院１９９０年１２月～１９９２年４月共处理３例，均为青壮年男性，术前体检心肺无...     

急性出血坏死性胰腺炎患者手术治疗意义的探讨

作者总结４年来治疗急性出血坏死性胰腺炎（ＡＨＮＰ）７０例的经验。胆源性３９例，非胆源性３９例。早期简化手术治疗１４例，非手术治疗５６例，其中中转手术１１例，手术距发病时间９～９０天，中转手术原因：坏死组织感染５例，无菌性坏死性包块引起胆道及胃肠道梗阻２例，大量胰性腹水１例，巨大假性囊肿１例，假性囊肿破裂出血２例。１１例中行坏死组织清除及外引流７例（其中３例采用多个小切口），囊肿内引流１例，囊肿外引流２例，单纯腹腔置管引流腹水１例；术后腹腔感染９例，消化道瘘１例，胰瘘６例。全组死亡３例，死亡率为４．３％。早期手术指征为诊断不明及伴有严重胆管炎；中转手术指征为：（１）坏死组织继发不可控性感染；（２）无菌性坏死性包块出现并发症；（３）胰腺假性囊肿及其并发症；（４）大量腹水经保守治疗不能控制；（５）胆源性坏死性胰腺炎治愈后应择期行胆道手术；（６）坏死性胰腺炎原因不明。     

胰腺十二指肠联合损伤的诊断和治疗

目的 探讨胰腺十二指肠联合损伤的诊断和治疗方法,以提高临床疗效.方法 回顾性分析11例胰腺十二指肠联合损伤的临床资料.胰头十二指肠联合损伤7例,胰体十二指肠联合损伤4例;全组施行胰十二指肠切除术2例,胰头、十二指肠修补术5例(包括胰头修补+十二指肠修补术1例,胰头修补+带蒂空肠瓣十二指肠修复术2例,胰头、十二指肠修补+十二指肠憩室化手术2例);胰体尾部修补+十二指肠修补术1例,带脾脏胰体尾部切除+十二指肠修补术1例,胰体尾切除+十二指肠切除+空肠十二指肠端端吻合术2例.结果 术后3例发生胰漏(27.3%),经持续低负吸引治愈.全组9例痊愈(81.8%),2例死亡(18.2%).结论 早期诊断、及时手术以及正确的手术方式是治疗成功的关键.     

Peripheral stimulation for treatment of trigeminal postherpetic neuralgia and trigeminal posttraumatic neuropathic pain: a pilot study

OBJECTIVE: Trigeminal neuropathic pain (TNP) after facial trauma or herpes zoster infection is often refractory to treatment. Peripheral nerve stimulation has been used to treat occipital neuralgia; however, efficacy in controlling facial TNP or postherpetic neuralgia is unknown. A retrospective case series of patients who underwent subcutaneous placement of stimulating electrodes for treatment of V(1) or V(2) TNP secondary to herpetic infection or facial trauma is presented. METHODS: Ten patients received implanted subcutaneous pulse generators and quadripolar electrodes for peripheral stimulation of the trigeminal nerve supraorbital or infraorbital branches. Long-term treatment results were determined by retrospective review of medical records (1998-2003) and by independent observers interviewing patients using a standard questionnaire. Surgical complication rate, preoperative symptom duration, degree of pain relief, preoperative and postoperative work status, postoperative changes in medication usage, and overall degree of therapy satisfaction were assessed. Mean follow-up was 26.6 +/- 4.7 months. RESULTS: Peripheral nerve stimulation provided at least 50% pain relief in 70% of patients with TNP or postherpetic neuralgia. Medication use declined in 70% of patients, and 80% indicated that they were mostly or completely satisfied with treatment overall. There were no treatment failures (<50% pain relief and a lack of decrease in medication use) in the posttraumatic group, and two failures (50%) occurred in the postherpetic group. The complication rate requiring reoperation was 30%. CONCLUSION: Peripheral nerve stimulation of the supraorbital or infraorbital branches of the trigeminal nerve is an effective method for relief of TNP after facial trauma or herpetic infection. A prospective trial using this novel approach to treat these disorders is thus warranted.     

合并主胰管断裂的胰腺外伤诊断与治疗分析

目的 对胰腺外伤合并主胰管损伤的诊治进行探讨.方法 回顾性分析44例严重胰腺外伤同时合并主胰管断裂患者的临床资料及诊治经过.结果 B超联合CT检查对外伤性严重的胰腺损伤确诊率为100%,但是否合并主胰管损伤则需要手术中探查结果来实现.本组患者行远端胰腺空肠Roux-Y吻合术27例,改良十二指肠憩室化和十二指肠空肠Roux-Y吻合术3例,胰十二指肠切除2例.41例患者经救治均痊愈出院.并发症发生率为29.5%,病死率为6.8%.结论 胰腺损伤临床表现隐蔽,CT可提高术前确诊率.而降低严重胰腺外伤患者的病死率关键在于提高术前诊断率、及时和选择合理的手术方式以及加强手术并发症的预防与治疗措施.     

Treatment of small-bowel fistulae in the open abdomen with topical negative-pressure therapy

Background

An open abdomen (OA) can result from surgical management of trauma, severe peritonitis, abdominal compartment syndrome, and other abdominal emergencies. Enteroatmospheric fistulae (EAF) occur in 25% of patients with an OA and are associated with high mortality.

Methods

We report our experience with topical negative pressure (TNP) therapy in the management of EAF in an OA using the VAC (vacuum asisted closure) device (KCI Medical, San Antonio, TX). Nine patients with 17 EAF in an OA were treated with topical TNP therapy from January 2006 to January 2009. Surgery with enterectomy and abdominal closure was planned 6 to 10 weeks later.

Results

Three EAF closed spontaneously. The median time from the onset of fistulization to elective surgical management was 51 days. No additional fistulae occurred during VAC therapy. One patient with a short bowel died as a result of persistent leakage after surgery.

Conclusions

Although previously considered a contraindication to TNP therapy, EAF can be managed successfully with TNP therapy. Surgical closure of EAFs is possible after several weeks.     

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目的 探讨胰腺损伤的诊断与治疗经验.方法 分析自2002年4月至2007年2月间中国医科大学.附属第一医院普通外科收治的15例胰腺损伤的临床资料情况.按美国创伤外科学会(AAST)以及术中探查所见胰腺损伤分级:Ⅰ级2例,Ⅱ7例,Ⅲ级3例.Ⅳ级2例和V级1例.5例行非手术治疗.10例病人经过手术治疗:胰头血肿清创止血、腹腔多管引流1例;胰头颈部破裂缝合修补、胰周引流术4例;胰头侧断端胰管结扎闲镇缝合、胰体尾部切除术3例;胰头侧断端胰管结扎闭锁缝合、体部断端胰空肠Roux-en-Y吻合术2例.结果 12例治愈.其中1例发生创伤性胰腺炎,2例发生胰漏,经引流、胰酶抑制剂、抗炎等治疗治愈.2例好转,腹痛症状较前减轻,血淀粉酶降至正常范围.1例因多发创伤死亡.结论 早期诊断、准确掌握手术时机、必要时果断开腹仔细探查是治疗胰腺损伤的关键.依据胰腺损伤类型选择合理的术式与充分引流,可以有效提高治愈率并减少术后并发症.     

Topical negative pressure wound therapy: a review of its role and guidelines for its use in the management of acute wounds

Over the past two decades, topical negative pressure (TNP) wound therapy has gained wide acceptance as a genuine strategy in the treatment algorithm for a wide variety of acute and chronic wounds. Although extensive experimental and clinical evidence exists to support its use and despite the recent emergence of randomised control trials, its role and indications have yet to be fully determined. This article provides a qualitative overview of the published literature appertaining to the use of TNP therapy in the management of acute wounds by an international panel of experts using standard methods of appraisal. Particular focus is applied to the use of TNP for the open abdomen, sternal wounds, lower limb trauma, burns and tissue coverage with grafts and dermal substitutes. We provide evidence-based recommendations for indications and techniques in TNP wound therapy and, where studies are insufficient, consensus on best practice.     

Pancreatic trauma

Injuries to the pancreas are relatively rare, occurring in around 10% of case involving serious trauma to the abdominal cavity, with 65% of such injuries resulting trauma occurs only exceptionally, involving only 5% of all injuries. The mortality of this entity is influenced by many factors, especially the age of the injured person, the seriousness of the injury, the duration of the shock, the potentially associated trauma, early diagnosis and correct selection of suitable treatment. The authors present here 4 case reports describing injuries to the pancreas and documenting the diagnostic and therapeutic approaches in cases of this very serious trauma.     

Late complications of pancreatic trauma

Pancreatic trauma is rare and experience concerning its management is consequently limited. Lessons learnt in the investigation and treatment of a group of 11 patients (median age 28.0 years, range 14-44 years), who presented with the sequelae of trauma, are described. These patients were referred to a centre with an interest in pancreatic disease at a median time of 6.0 months (range 1.5-34 months) after blunt (n = 9) or penetrating (n = 2) injury to the pancreas. Ten of the 11 patients had undergone either single (n = 4) or multiple (n = 6) previous operations. Ten of the 11 patients had either strictures or disruptions of the main pancreatic duct demonstrated by endoscopic retrograde cholangiopancreatography (ERCP) and ultrasonography (n = 8) or by exploration of the pancreas (n = 2). Satisfactory results were achieved by non-operative treatment in one patient and by distal pancreatectomy in eight. One further patient, who underwent distal pancreatectomy, later required completion resection because of unsuspected ductal injury in the head of the gland. The final patient continued with symptoms of pancreatitis after pancreaticoduodenectomy. It is concluded that the non-resolving sequelae of pancreatic trauma are associated with injury to the main pancreatic duct and that specialist investigation should be performed before surgical intervention is contemplated.     

胰腺外伤51例临床分析

目的:探讨如何对胰腺外伤进行准确的诊断和有效的治疗.方法:回顾分析过去10年间所收治的胰腺外伤51例的临床诊断及治疗经过.结果:术前45例行胰腺CT检查,均有阳性发现;45例行B型超声检查,18例有阳性发现,阳性率40%,两者阳性率差异明显(P＜0.01).血淀粉酶明显升高者9例.非手术治疗3例,均治愈;手术治疗48例,术后24 h死亡6例,均为有严重合并伤的病例.结论:从影像学的诊断上来看,CT明显优于B超,胰腺CT可以作为胰腺外伤的确诊依据,胰腺外伤的治疗应以手术为主.     

Pancreatic trauma: diagnostic and therapeutic emergency. Apropos of 35 cases

35 consecutive pancreatic trauma were operated (21 blunt trauma and 14 penetrating injuries). 30 patients were operated in emergency and diagnosis was suspected before laparotomy in only one case. 12 patients had a superficial lesion, 21 had a wirsung disruption (14 in the left pancreas, 7 in the right pancreas), 2 had a diffuse pancreatitis. For the 30 patients operated in emergency, 20 had a conservative treatment, 10 had a resection. 5 patients died (14.2%), from exsanguination (2 cases), missed diagnosis or inadequate treatment (2 cases), sepsis after adequate management (1 case). Our experience suggests that an aggressive diagnosis management in emergency, with pre or pre-operative wirsungography, could determined with precision the type of the lesion and permit an adequate management, to decrease mortality.