肝移植术后胆漏的防治

胆道并发症是肝移植术后常见的并发症之一，是造成肝移植失败及影响生存率的重要原因，已经成为制约肝移植疗效进一步提高的重要因素。胆道并发症的发生原因复杂，胆道重建一直是肝移植术中最薄弱的环节之一，早在1976年就被Calne称之肝移植的致命性弱点（the heel of Achilles）。关于肝移植胆道重建中的“T”管和内支撑架留置问题一直有较大争议。我们在肝移植工作中总结各环节的经验，并选择了多种引流方式，以探讨不同的引流方式对肝移植术后胆漏等并发症的影响。通过对50例肝移植不同胆道引流方式下胆漏等并发症发生情况的分析，提出了胆道引流方式选择原则。同时提出了我们的肝移植术后胆道并发症防治方案。     

肝移植术后缺血型胆道病变的研究进展

肝移植术后的胆道并发症是肝移植的致命弱点，是阻碍肝移植疗效提高的重要因素。因此，它被肝移植先驱Calne爵士称为“阿咯琉斯之踵”（the heel of Achilles）。随着对肝移植胆道并发症的进一步认识和外科技术的提高，因外科技术原因造成的吻合口、引流管相关并发症发生率呈下降趋势，而非外科技术原因的移植肝缺血型胆道病变（ischemic—type biliary lesion，ITBL）则成了肝移植术后胆道并发症的主要类型。因此，被称为“阿咯琉斯之踵再现”。缺血型胆道病变是指肝移植术后移植肝非吻合技术性的胆管树的破坏，其发生率为29／6～19％。由于其发病原因复杂，临床处理困难，已成为影响肝移植患者长期存活及导致移植物丢失的主要原因之一。为此，肝移植术后缺血型胆道病变的研究已引起了全球移植专家的高度重视。     

活体肝移植术后胆道并发症的防治对策

肝移植术后胆道并发症是肝移植最常见的并发症之一，是目前影响肝移植术后临床效果的主要问题之一，发生率高，成为移植物慢性失功的主要原因，近年来由于器官短缺，活体肝移植在我国有快速增加的趋势，尽管外科技术的发展使成人间活体肝移植有很高的成活率，随之而来的胆道并发症又出现新的特点和严峻的挑战：胆道并发症的高发。     

肝移植术后胆道并发症的防治

肝移植术后的胆道并发症是一个常见的临床问题。尽管器官获取、保仔和外科技术已有了很大进步的今天，肝移植术后的胆道并发症发生率仍高达10％～25％。胆道并发症的发生率也始终影响着部分肝移植物使用的增加，包括减体积肝移植物、劈离式肝移植物和活体肝移植。肝移植术后最常见的胆道并发症是胆道狭窄和胆漏。另外，     

七例八次背驮式原位肝移植

对４例Ｗｉｌｓｏｎ病及３例晚期肝病患者施行了８次背驮式原位肝移植术，其中１例为减体积性背驮式原位肝移植。３例已分别存活２年、９个月、６个月，４例死于术后并发症。认为代谢性疾病是原位肝移植的最佳适应证，其次是肝硬变；术后感染、急性和慢性排斥、肺部并发症及胆道并发症是影响患者存活的重要因素；背驮式原位肝移植对全身血流动力学的影响较小。     

肝移植术后胆道并发症的病因学探讨

肝移植术后胆道并发症发生率一直徘徊在１０％～２５％。胆道并发症主要为胆瘘和胆道狭窄，狭窄又可分为吻合口狭窄和非吻合口狭窄，引起上述并发症的原因较多。本文结合有关国内外文献，探讨肝移植术后胆道并发症的发病原因，以便早期诊断及处理，降低肝移植术后胆道并发...     

移植肝冷保存/再灌注胆管损伤的机制

肝移植术后胆道的生理及病理变化一直是众所关注的课题。胆道并发症是影响肝移植受者术后生活质量、导致移植物丧失甚至病人死亡的重要因素，总体发生率为5．8％-40.0％，而对于某些特殊类型的肝移植，如活体右半肝移植的胆道并发症发生率可高达15％-64％，儿童肝移植胆道并发症的发生率也明显为高。近年来，随着移植技术的进步和新型免疫抑制剂的使用，受者及移植物的短期存活率有了显著提高，但长期生存率依然没有明显的改善，而胆道并发症被认为是导致这一结果的最主要原因之一。     

肝移植与介入治疗

肝移植是治疗终末期肝病惟一有效的手段。我国肝移植例数逐年增加，随着手术技术的不断成熟和新型免疫抑制剂的出现，并发症的诊治亦取得了一定的经验。肝动脉血栓和胆道并发症是最常见的。介入治疗具有创伤小的优势，常能达到与手术同等的疗效。本文重点介绍肝移植术后血管和胆道并发症介入治疗的最新进展，同时还将介绍经颈静脉肝内门体分流术（transjugular intraheptic portosystemic shunt，TIPS）对肝移植手术的影响。     

高压氧预防和治疗肝移植术后动脉并发症

目的 探讨高压氧预防和治疗肝移植术后动脉并发症的作用。方法 对5例肝移植术后发生动脉并发症的受者在保持原外科术后治疗的基础上给予高压氧（202．65 kPa）治疗，每天1～2次，每次治疗1 h，10次为1个疗程。结果 经治疗，5例受者的全身状况均得到明显改善。肝功能检查示胆红素等指标明显恢复正常；B型超声波检查未发现新发液化坏死灶，原液化坏死灶缩小，甚至消失。结论 高压氧可预防和治疗肝移植术后动脉并发症，保护缺血的肝脏细胞，为患者再次肝移植提供了时间和机会。     

肝移植术后并发症——肝移植术后常见并发症的处理

近十年来我国临床肝移植飞速发展，在移植例数和疗效上取得了长足进步。目前，全国肝脏移植年例数已经超过3000例，形成了数个移植年例数超过100例的大的移植中心。随着手术技术的成熟和麻醉技术的完善，术后近期死亡率已降至5％以下，近期移植效果已经接近世界先进水平；但是，术后各种并发症的出现仍然是影响肝移植近期疗效及长期生存率的重要因素。因此，重视肝移植术后并发症的处理，是提高我国肝移植长期疗效的重要环节。     

Perioperative complications associated with operative treatment of acetabular fractures.

BACKGROUND: Perioperative complications in a large number of consecutive patients with displaced acetabular fractures treated operatively were evaluated in an effort to elucidate potentially preventable complications. METHODS: Perioperative complications were identified and evaluated in 131 consecutive patients with displaced acetabular fractures treated operatively using the Kocher-Langenbeck surgical exposure. The perioperative complications were identified using a registry. RESULTS: There were a total of 76 complications related to the acetabular fracture and patient polytrauma. Eighteen complications resulted from technical errors and the patient's postoperative course. Obese patients frequently had unusual perioperative complications. CONCLUSION: Perioperative complications occur commonly in patients with displaced acetabular fractures treated operatively using a Kocher-Langenbeck surgical exposure. Some of these complications may be avoidable, and are related to polytrauma. Most technical complications should be avoidable. Unusual complications were identified, especially in obese patients.     

Ureteral complications and aortoiliac reconstruction

A 33-year experience with 58 ureteral complications in 50 of 3580 patients undergoing aortoiliac reconstruction was analyzed. Ureteral obstruction was treated before or in conjunction with aneurysm repair in six patients with aneurysmal disease. The remaining 44 patients had 46 ureteral complications after aortic reconstruction; complications included hydronephrosis (42), ureteral leak (3), and ureteral necrosis (1). A high incidence of associated graft complications was noted. Graft thrombosis developed in one of the six patients undergoing prior or simultaneous ureteral procedures, and graft infection developed in another. Thirty-six graft complications developed in 24 (55%) of the 44 patients with postoperative ureteral complications. The complications included 19 anastomotic aneurysms, eight graft limb thromboses, six graft infections, and three aortoenteric fistulas. Twenty-nine of the 44 patients with postoperative ureteral complications underwent ureteral or graft operations or both. These included five patients having ureteral operations alone, seven with a ureteral procedure and subsequent graft operation, eight requiring simultaneous ureteral and graft procedures, and nine undergoing a graft operation with ureteral observation. Six of these 29 patients (21%) died after operation, all from graft complications including aortoenteric fistulas (three), ruptured anastomotic aneurysms (two), and graft infection (one). Graft complications affected 55% of 44 patients with postoperative ureteral complications, compared to 12% of 3536 patients without ureteral complications (p less than 0.0001). Patients with postoperative ureteral complications were 4.4 times as likely to have graft complications compared to those without ureteral complications (p less than 0.0001). These data suggest that such urologic complications may be markers for recognition of or harbingers for graft complications.     

原位肝移植术后并发症的影像学评价

目的：对评价原位肝移植(orthotopic liver transplantation，OLT)术后并发症的影像学检查方法进行评价。方法：对OLT术后并发症的影像学检查结果进行分析，并对各类并发症的相关影像学表现加以总结。结果：B超可用作OLT术后并发症的早期筛查；彩色多谱勒超声能早期发现血管性并发症；螺旋CT和MRI对术后血管性和(或)胆管性并发症、肝实质本身异常以及肝外转移性并发症有很高的诊断价值；对排斥反应．目前影像学检查还无特征性表现。结论：影像学检查(特别是超声、螺旋CT和MRD在OLT术后各类并发症的诊断中具有重要的作用。     

Intravenous catheter complications in the hand and forearm

BACKGROUND: We studied the complications of peripheral intravenous (i.v.) catheters in the hand and forearm in a teaching hospital over a 3-year period. METHODS: The records of 67 patients who developed i.v. catheter-related complications were reviewed. RESULTS: The most common sites for developing complications in order of frequency were the forearm, hand, wrist, and antecubital fossa. There were 56 minor and 11 major complications. More than 50% of minor complications occurred in the hand and wrist, and more than 50% of major complications occurred in the hand. In 68% of minor complications, the patients were aged 50 years or older and 68% were women. Minor complications comprised 26 intravenous infiltrations, 23 cases of thrombophlebitis, and 7 cases of cellulitis. Ninety percent of major complication patients were aged 50 or older and 82% were women. Major complications included septic thrombophlebitis in three; hematomas resulting in skin necrosis in two; and infiltration related complications in six, resulting in skin necrosis in two, compressive nerve lesions in two, digital stiffness in one, and compartment syndrome in one. Ten patients with major complications were over the age of 50 years and nine were women. Two patients receiving anticoagulation developed large dorsal subcutaneous space hematomas. Chemotherapeutic agents contributed to two minor complications and one major complication. CONCLUSION: The hand is a common site for minor and major i.v. catheter complications. Women and older patients are more susceptible to these complications. Peripheral i.v. line complications are not uncommon and can result in morbidity and increased health care costs from prolonged hospitalization, extended use of i.v. antibiotic therapy, and surgical intervention.     

硅橡胶隆鼻美容术并发症诱发因素分析及其处理措施

目的：探讨硅橡胶隆鼻美容术并发症诱发因素及处理措施，有效的治疗及预防硅橡胶隆鼻术的并发症。方法：收集2010年12月至20012年3月间收治的50例行硅橡胶隆鼻术后出现并发症的患者，对术后出现的外形不美、假体偏移或漂浮等并发症进行总结分析，并总结并发症的处理措施。结果：对患者出现并发症诱因分析后所有患者均得了治愈，患者满意度为100％。结论：分析硅橡胶术后并发症的诱因并进行合理的治疗是解决并发症关键，同时对于隆鼻术进行积极的预防措施并发症是可以避免的。     

第三脑室底造瘘治疗脑积水的手术并发症

目的 探讨第三脑室底造瘘治疗脑积水产生手术并发症的原因及预防措施。方法 对13例（15例次）行第三脑室底造瘘术治疗脑积水出现并发症的情况进行回顾性分析。结果 本组患者出现脑室内感染2例、膜膜下积液1例、造瘘口再堵塞1例、术中出血后的血凝块堵塞第三脑室形成脑疝1例。并发症的主要原因为手术设备的不良和先期经验的不足。结论 采用良好的手术设备,提高对各种并发症发生原因的不足,可减少手术并发症的发生。     

Complications after total knee arthroplasty: a comprehensive report

In most reports of complications following TKA, the method of assessment and report of complications is not defined specifically. It is thus unclear whether certain complications did not occur or were simply not assessed at all. A detailed list of possible complications following TKA was developed, and the occurence of complications in 567 primary TKAs was followed up meticulously according to this list for one year postoperatively. The proportion of knees with complications was 23.6%. A revision operation was performed in 5.6%. The most frequent complication was delayed wound healing. Only a worldwide accepted standard list of well-defined complications will allow comparison of future studies on complications in TKA. For purposes of quality control, the amount of detail recorded must be weighed carefully against its practical value.     

Surgical complications of microendoscopic procedures for lumbar spinal stenosis.

Microendoscopic discectomy (MED) is one of the minimally invasive endoscopic procedures for treating lumbar disc herniation. We have applied MED techniques to posterior decompression procedures for treating lumbar spinal stenosis (LSS). In the present study, we examined the surgical complications in 114 consecutive patients surgically treated with MED procedures for LSS. Intraoperative complications occurred in 9 patients. Six patients (5.3%) experienced a dural tear, and three (2.6%) had a fracture of an inferior facet. Early postoperative complications occurred in 13 patients. Twelve patients (10.5%) experienced transient neurological complications. The clinical outcomes at the mean 28-month follow-up were not affected by these surgical complications. Other major complications such as nerve injury and surgical site infection were not observed. Most of the complications occurred in the initial series of patients, and the incidence of complications decreased with an increase in the surgeon's experience and the application of several preventive measures against the complications. The surgeon should undergo training when MED techniques are applied in surgical treatment in order to recognize the specific complications associated with such procedures and apply preventive measures against these complications.     

Intraoperative complications of laparoscopic adrenalectomy

A laparoscopic or retroperitoneoscopic access to the adrenal gland is the standard of care for adrenalectomy in most cases. Although in laparoscopic adrenalectomy the approach is minimally invasive, the procedure is challenging. This is reflected in the scope of possible complications. The surgeon must consider complications related to the anatomical topography of the adrenal gland, which typically encompasses the complications known from open surgery and complications related to the minimal invasive access. In this topic paper we will address the most frequently encountered complications of adrenalectomy: vascular injuries, injuries of the bowel, pleural tears, and injuries to the liver, spleen and pancreas. Fortunately, these complications occur rarely. However, many of these complications can have devastating consequences. Therefore, it’s the surgeon’s obligation to be aware of the possible complications he might encounter during laparoscopic adrenalectomy. This awareness is essential for their prevention and it helps the laparoscopic surgeon to identify complications intraoperatively.     

Infectious and noninfectious complications in major head and neck surgery

The Hemovac drainage system was required postoperatively for 156 patients who had undergone major head and neck surgical treatment. This study distinguishes infectious complications from noninfectious complications by the aerobic and anaerobic cultures that were taken from the Hemovac line drainage and any subsequent complications. The 33% complication rate included only those of the head and neck and excluded general medical complications. Of the 52 patients having complications, 19 had infectious, 24 had noninfectious, and nine had both infectious and noninfectious complications.