Mirizzi综合征的手术对策

目的Mirizzi综合征（MS）是胆石症少见的一种并发症,探讨外科治疗MS的策略,尽量减少手术损伤。方法收集我院2003年至2008年手术治疗的36例MS病例,回顾分析术前处理、手术方式选择、术后并发症及预后情况。结果本组患者均经腹腔镜或开腹手术证实,Ⅰ型23例,Ⅱ型11例,Ⅲ型2例。20例术前行鼻胆管引流术。所有手术均行大部分胆囊切除,MSⅠ型行胆囊管直接缝扎;MSⅡ型行残留胆囊壁对缝或通过瘘口胆总管内置＂T＂管引流;MSⅢ型行部分壶腹壁贴附肝胆管缺损处进行修补或肝胆管空肠吻合。本组无一例胆管损伤及严重腹腔感染,均痊愈出院,随访6-36个月,预后良好。结论无论行腹腔镜还是开腹手术治疗Mirizzi综合征,都要以最小的手术创伤获得最佳的治疗效果,减少手术并发症,使患者尽快康复。     

肝管狭窄综合征的腹腔镜手术治疗

目的本文介绍了Mirizzi综合征应用腹腔镜手术治疗的初步经验,探讨了应用腹腔镜治疗Mirizzi综合征的可能性.方法在腹腔镜手术条件下,使用特殊设计的牵引器,将肝脏引向头端,显露胆囊,仔细解剖胆囊至适当部位,切开胆囊取出嵌顿的结石,完成Ⅰ型手术.对于Ⅱ型病人,则经过胆囊管残端及瘘管放入Folley管,进行胆总管造影,探明并处理结石,仔细关闭瘘管并在其远端另行放置T型管作暂时性外引流,放置引流管完成手术.结果本组17例病人在腹腔镜条件下顺利完成手术,效果良好.结果 Mirizzi综合征的Ⅰ型及Ⅱ型病人都可以在腹腔镜条件下完成手术,为扩大腹腔镜手术范围积累了经验.     

368例复杂困难型腹腔镜胆囊切除手术解剖技巧与分析

随着腹腔镜外科技术的不断提高和腹腔镜设备器械的改进,腹腔镜外科技术现已广泛应用于腹部多种手术。采用腹腔镜胆囊切除术（Laparoscopic cholecystectomy,LC）治疗胆囊良性疾病已较为普遍。随着手术的推广、手术适应症的扩大,大多数基层医院也开展了该手术,术中所遇到的复杂问题也不断增加。如急性胆囊炎、慢性胆囊炎急性发作所致胆囊Calot三角水肿、粘连,Mirizzi综合征、慢性萎缩性胆囊炎、胆道系统变异等情况,增加了术中、术后出血和胆道损伤的风险,这一类胆囊在临床上称为“复杂困难型胆囊”。我院肝胆外科2002年3月至2011年3月共开展腹腔镜胆囊切除术2268例,属于复杂困难型胆囊共368例（16．7％）。本文回顾性分析LC处理复杂困难型胆囊的手术解剖技巧,现报告如下。     

肝管狭窄综合征的腹腔镜手术治疗

目的　本文介绍了Mirizzi综合征应用腹腔镜手术治疗的初步经验 ,探讨了应用腹腔镜治疗Mirizzi综合征的可能性 .方法　在腹腔镜手术条件下 ,使用特殊设计的牵引器 ,将肝脏引向头端 ,显露胆囊 ,仔细解剖胆囊至适当部位 ,切开胆囊取出嵌顿的结石 ,完成Ⅰ型手术 .对于Ⅱ型病人 ,则经过胆囊管残端及瘘管放入Folley管 ,进行胆总管造影 ,探明并处理结石 ,仔细关闭瘘管并在其远端另行放置T型管作暂时性外引流 ,放置引流管完成手术 .结果　本组 17例病人在腹腔镜条件下顺利完成手术 ,效果良好 .结果　Mirizzi综合征的Ⅰ型及Ⅱ型病人都可以在腹腔镜条件下完成手术 ,为扩大腹腔镜手术范围积累了经验 .     

腹腔镜胆囊切除术4420例治疗体会

目的探讨腹腔镜胆囊切除术（LC）并发症的预防及处理。方法回顾分析2002年2月至2010年10月我院4 420例LC的临床资料,分析手术并发症发生的原因,并发症的预防及治疗措施。结果 4 420例中实施4 332例LC,中转开腹88例,中转率2%;发生术后并发症8例,其中钛夹误夹胆总管2例,迷走胆管漏2例,肝右管损伤1例,胆总管损伤2例,钛夹致胆囊管坏死穿孔1例;全组无手术死亡病例。结论提高手术操作技巧及高度责任感是保障LC手术安全的前提,注重并发症的预防和正确处理是手术成功的关键,适时中转开腹可减少或避免并发症的发生。     

Mirizzi综合征（9例临床分析）

目的 探讨Mirizzi综合征的诊断和治疗。方法 通过9例Mirizzi综合征回顾性分析,进行临床诊断分型及各种手术治疗。结果 Ⅰ型6例,行单纯胆囊切除4例,行部分胆囊切除2例;Ⅱ型2例,2例胆道探查T管引流;Ⅲ型1例行胆肠吻合术;Ⅳ本组末出现此型。8例Ⅰ期手术治愈。1例出现并发症:其中Ⅰ、Ⅲ型末出现并发症;Ⅱ型1例出现胆漏。结论 Mirizzi综合征是一种缺乏典型表现,是以胆囊颈或胆囊管结石嵌顿引起肝总管狭窄或梗阻,并发胆管炎,阻塞性黄疸和肝功能损害为特征的综合征。不易术前诊断,极易造成胆道损伤而引起严重并发症。     

腹腔镜胆囊切除致胆管损伤16例临床分析

目的探讨胆管损伤的防治方法。方法回顾性分析腹腔镜胆囊切除术发生胆管损伤的原因和治疗。结果4例胆管损伤术中发现并立即修复，其中3例手术治愈，8例实施胆肠Roux-en-Y吻合术治愈，2例胆肠吻合后狭窄再次手术治愈，1例死亡（死于胆汁性肝硬化）。结论合理选择手术时机，良好的麻醉和细致的手术操作可以有效预防医源性胆管损伤的发生，根据伤情合理选择手术方式是治疗医源性胆管损伤的关键。     

胆囊后三角解剖入路在急性胆囊炎腹腔镜下胆囊切除术的应用

目的　讨论胆囊后三角解剖入路在急性胆囊炎腹腔镜下胆囊切除术（laparoscopic cholecys- tectomy,LC）的应用。 方法　回顾性分析笔者2004年8月~2010年10月收治的217例急性胆囊炎患者全麻下行三孔法LC的临床资料。 结果　93.1%（202例）成功完成LC,4.6%（10例）中转开腹,5例术后合并胆总管结石,行ERCP取石后治愈。无胆管损伤、胆漏、出血等手术并发症。术后根据手术操作情况决定是否放置引流。术后住院2~12d,平均4.5d。193例术后随访半年无手术并发症。 结论　在急性胆囊炎的病例中采用后三角入路三孔法LC安全可行、手术成功率较高、容易掌握,可减少手术并发症,尤其适用于胆囊三角严重粘连患者,值得提倡与推广。     

Mirizzi综合征的诊断和治疗

Mirizzi综合征是胆囊结石引起的一种少见并发症,术前临床症状无特殊,诊断较困难,或术中损伤了胆管才发现,目前不少学者和医院仍视为腹腔镜胆囊切除术的禁忌证;是对腹腔镜外科医师的一种考验[1]。随物理诊断技术的进步,对本综合征的认识进一步加深,治疗方法也越来越多。本文就Mirizzi综合征作一简要综述。     

两种微创术式治疗肝外胆管结石的临床对比分析

目的 探讨腹腔镜胆囊切除、胆总管切开探查术（LC--CBDE）与内镜下括约肌切开术联合腹腔镜胆囊切除术（EST-LC）两种微创术式治疗肝外胆管结石的临床疗效。方法 1999年6月至2006年2月采用两种微创术式治疗肝外胆管结石63例，LC—CBDE组41例、EST-LC组22例。比较两组病人的手术时间、术中出血量、术后肠道功能恢复时间、术后疼痛视觉模拟评分（VAS）、术后住院天数、并发症发生率、结石清除率等指标。结果 LC—CBDE组与EST—LC组两组间手术时间、术中出血量、术后肠道功能恢复时间、术后疼痛视觉模拟评分（VAS）、并发症发生率、结石清除率等指标的差异无显著性（P〉0．05）；LC—CBDE组住院天数较EST—LC组短，差异具非常显著性（P〈0．01）。结论 LC—CBDE与EST—LC两种微创术式治疗肝外胆管结石均具有创伤小、疼痛轻、出血少、胃肠功能恢复快、并发症少、疗效确切等优点，值得推广，但选择哪一术式需具体分析病情并根据术者腹腔镜手术技巧、内镜操作熟练程度而定。     

Level of functioning of siblings and parents of probands of varying degrees of retardation

A further analysis of already published data supports the position that retardates of low ability level less frequently have retarded siblings, retarded parents, and parents low in occupational level than do retardates higher in ability level. The analysis supports the position that there are two types of retarded individuals, persons retarded as a result of gene or chromosomal anomalies, brain injury, etc., who more frequently occur in the lower-level retardate group, and persons whose retardation represents polygenic segregation, who more frequently occur in the higher-level group.     

局部注射辛伐他汀对骨质疏松大鼠股骨髁骨小梁的改建效应

背景：局部注射具有成骨作用的辛伐他汀,可显著增加骨质疏松大鼠股骨颈及股骨髁部的骨密度及力学强度,分析局部注射辛伐他汀对股骨髁骨小梁的影响。 目的：进一步研究骨质疏松大鼠股骨内局部注射辛伐他汀对股骨髁骨小梁的影响。为将辛伐他汀应用于临床骨质疏松局部治疗提供实验基础。 方法：18只雌性SD大鼠双侧卵巢切除后3个月,制备大鼠骨质疏松模型。实验大鼠随机数字表法均分为3组,分别在实验大鼠的右侧股骨髓腔内单次注射辛伐他汀溶液5 mg、10 mg,对照组单纯注射空白载体。分别在注射后1个月处死大鼠并取材。Micro-CT扫描并定量分析骨组织形态变化。 结果与结论：给药后1个月,Micro-CT扫描结果显示,辛伐他汀治疗组的骨微结构参数如骨皮质厚度、骨小梁密度及连接率明显优于对照组。说明疏松骨骼单次注射小剂量辛伐他汀可显著促进股骨髁部骨小梁改建,改善骨骼微结构,可为强化局部、防治骨质疏松骨折的新选择进一步提供实验基础。     

石斛属民族药用植物的分类及生药学研究

中药石斛早在《神农本草经》中就被列为上品,其应用历史悠久,具有养阴生津、补肾益气、润喉护嗓、活血明目、抗癌防老等功效。本文对国内外石斛属民族药用植物的分类及生药学研究进行了综述。     

膝关节骨性关节炎的关节镜治疗体会

目的我科自2001～2005年4月对59例67膝的骨性关节炎（0A），进行关节镜检查及镜下清理术。方法镜检：膝关节骨性关节炎伴不同程度滑膜炎，滑膜皱壁粘连纤维片，关节软骨不同程度破坏。镜下清除增生滑膜，松解粘连，去除剥脱软骨、修复关节面。结果随访2月～4年，平均1.5年，术后综合评估2月～1年，优良率94％；1～2年，优良率79.2％；2年以上优良率54.8％。结论关节镜对膝关节骨性关节炎诊断能提供了比较全面的资料，并对骨性关节炎早期有良好疗效，具有创伤小、恢复快、并发症少和重复治疗等优点。     

Anatomical study of distribution of valves of the cutaneous veins of adult''s limbs

Since the cutaneous veins of the four limbs have been used as autogenous grafts in the treatment of cardiovascular disorders, knowledge of distribution of the valves is increasingly required depending upon the use. In the gross anatomical study of distribution of valves of the trunci venae, there has been argument about locational relationships between the venous roots and the valves in the vicinity of the roots and the inter-valvular distance. However, there have been only few reports discussing detailed information about valves of the cutaneous veins of the four limbs. The authors observed patterns of distribution of the cutaneous venous valves of the four limbs of cadavers prepared for practice in anatomy. The following parts were excised from each cadaver: the cephalic, basilic, and the great saphenous veins, which originate from the acral venous network and flow into the proximal deep veins, and the venous roots communicating with these veins. An incision was made on each excised vein in the direction of the long axis under observation with a stereoscopic microscope, and the inter-valvular distance and the distance between the valve and the orifice of venous root in the vicinity of the valve were measured. The inter-valvular distance varied with type of the truncus venae, and it varied according to area even in the same truncus venae.     

Pathways of the realization of immunomodulating effects of neurotransmitters

Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 115, N ^o 4, pp. 401–404, April, 1993     

Characterization of sterols of three digenetic trematodes of buffalo

Sterols of three digenetic trematodes were isolated and characterized by infrared and 1H nuclear magnetic resonance spectroscopies, and gas-liquid chromatography and gas chromatography-mass spectrometry. Sterols identified were cholesterol, cholestanol, 24-methylcholesterol, 24-methylcholestanol, 24-ethyl-22-dehydrocholesterol, 24-ethyl-22-dehydrocholestanol, 24-ethylcholesterol and 24-ethylcholestanol.     

Mechanisms of generation of slow components of bioelectric activity in diagnostics of functional state of the gastrointestinal tract

New electrophysiologic devices were used for the diagnostics of the state of excitable structures in the gastrointestinal tract and correction of their motor functions. Bioelectrical and biomechanical activities form the basis of functioning of internal organs. The mechanisms of generation of slow bioelectrical activity that are important for clinical and physiological studies are described. One of these mechanisms is a capacitance parametric transducer converting the energy of contractions into specific electric signals reflecting muscle functions. Another mechanism results from slow oscillations of resting potentials of interrelated excitable cells in large neuromuscular structures of internal organs. The elaborated procedure is efficient for preventing early postoperative paresis of the gastrointestinal tract. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 128, No. 10, pp. 448–452, October, 1999     

胃小弯侧血管弓的MDCT解剖

目的：研究正常胃小弯侧血管弓及其属支血管的多排螺旋CT表现。方法：回顾性分析51例正常成人的上腹部CT资料,观察胃小弯侧血管弓及其属支血管的显示情况、血管弓形态及其与胃壁的关系。结果：51例均显示胃小弯侧血管弓,血管弓贲门部属支、胃体部属支和幽门部属支分别显示46例、15例和10例;血管弓与胃壁紧邻41例。结论：MDCT检查可良好显示正常胃小弯侧血管弓及其属支血管。     

Assessment of the efficacy of treatment of hemangiomas

Assessment of the aftereffects of cryoexposure and ultrahigh-frequency cryoexposure on hemangioma tissue of various types, cavernous and squamous, showed a higher cryogenic effect in hemangiomatous tissue preexposed to ultrahigh-frequency waves. A quantitative criterion is proposed for assessing the efficacy of the studied methods of exposure. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 119, N ^o 6, pp. 669–672, June, 1995