�Ź�����ά�������ž�����ѹ֢�е�Ӧ�ü�ֵ

目的　评价磁共振技术对门静脉系统全方位三维成像在门静脉高压症中的应用价值。方法　 2 0 0 2年 9月至 2 0 0 3年 10月通过规范扫描时相、增加采集块厚及减影后处理等成像优化技术 ,对 5 1例肝硬化病人作磁共振血管三维成像 (three dimensionalMRangiography ,3DMRA) ,以整体地、全角度地三维显示门静脉系统及其侧支循环 ,结合临床手术进行对比、分析。结果　 5 1例病人中有 4 6例门静脉主干清晰成像 ,其余 5例为门静脉海绵样变或癌栓。食管下段及胃底静脉、前腹壁静脉、左性腺静脉、直肠上静脉曲张及自发性胃肾 /脾肾分流的比例分别为 73 3% ,2 8 9% ,2 0 % ,2 0 % ,8%。减影技术能提高侧支曲张静脉的成像评分 (P <0 0 5 )。接受手术者共 39例 ,结合其MRA影像制定方案 ,均取得预期手术效果。结论　 3DMRA全方位显示门静脉系统及侧支循环 ,具有准确全面、直观无创等优点 ,对门静脉高压症的手术决策有重要指导作用。     

ȫ�������ٻ����������ٰ�����������е�Ӧ�ü�ֵ

乳腺癌是妇女常见的恶性肿瘤之一。近年来，我国女性乳腺癌发病率持续明显上升，目前已跃居我国女性恶性肿瘤第二位。乳腺X线检查目前被公认为乳腺癌的首选检查方式，特别对早期乳腺癌的诊断更具优势。近年来，随着影像设备不断更新，全数字化乳腺X线摄影机的出现，使乳腺癌病变X线征象显示清晰度有了明显的提高，从而为诊断、治疗提供依据成为可能。随着全数字乳腺机在乳腺疾病普查中的应用，临床诊治中早期乳腺癌所占比例明显增大。     

ǻ�ڳ������ľ���ѹ���ۺ���ǻ�������е�Ӧ�ü�ֵ

??Importance of intravascular ultrasound in endovenous management of iliac vein compression syndrome LI Wei-miao, FU Wei-guo. Department of Vascular Surgery??Affiliated Zhongshan Hospital of Fudan University??Shanghai200032??China
Corresponding author??FU Wei-guo??E-mail??fu.weiguo@
zs-hospital.sh.cn
Abstract Recent advent of vein stent-angioplasty and its surprising high safety and long-term patency in the treatment of iliac vein compression syndrome has apparently improve the symtoms and patients' quality of life. Sometimes accurate information of the lesion sometimes cannot be derived from routine venography for its restrictions. However??intravascular ultrasound ??IVUS??is able to complement it. Using IVUS during procedure to assess the stenotic lesions and guide the optimal stent placement can dramatically increase the operative outcome. Thus, IVUS is the mainstay of iliac vein stenting.     

Ӱ�����ڸ���������ǻ�������е�Ӧ�ü�ֵ

??Value of imaging in the endovascular repair for abdominal aortic aneurysm LIU Chang-jian. Department of Vascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
Abstract The development of endovascular techniques depends on the concomitant development of imaging techniques. The ideal imaging method for endovascular aortic repair (EVAR) should provide data for diagnosis, for assessment of the vessel diameters, for characterization of the wall of the aorta and iliac arteries and the aneurysm neck, and for guidance on stent graft deployment, so as to assess the plan of treatment and accurate parameters of stent graft. Angiography alone cannot provide all information necessary for EVAR. Advanced methods, which include rotational angiography , CTA, MRA and intravascular ultrasound, have been playing an important role in endovascular treatment of vascular disease. The combined use of new imaging techniques will further improve the treatment of vascular disease in the future.     

��ܾ������ٵ�������ͷ״�������е�Ӧ�ü�ֵ

??Application value of fiberoptic ductoscopy in the diagnosis and treatment of intraductal papilloma JIANG Hong-chuan, LI Meng-xin. Department of Breast Surgery, Beijing Chao-yang Hospital Affiliated to Capital Medical University, Beijing 100020,China
Corresponding author: JIANG Hong-chuan, E-mail??jhc2000@
sohu.com
Abstract The application of fiberoptic ductoscopy (FD) make it possible that intraductal papilloma can be directly observed and diagnosed, which changes the surgical indication of the patients with nipple discharge. Localization of the lesions in the duct achieved by FD can minimize the surgical area and avoid the blind microdochectomy. What’s more, interventional FD exempt some patients with solitary intraductal papilloma from open surgery by extracting the lesion from the duct.     

����ҽѧ�����ڻ������ֲ��ǰ�����е�Ӧ�ü�ֵ

活体肝移植的发展缓解了供肝不足和受体增加的矛盾,是目前治疗终末期肝病的最佳疗法。为保证肝移植手术的顺利进行及供、受体的安全性,术前供体肝脏体积评估以及了解肝内管道是否存在变异尤为重要。随着数字医学技术的不断发展,术前采用三维重建软件对供体肝脏进行个体化三维重建,测算肝脏体积、评估肝内管道以及进行虚拟手术,能够促进临床医生对肝脏空间结构的了解和对手术方案的评估,进一步保证了手术的安全性和可靠性,对于活体肝移植的术前评估有非常重要的临床意义。     

����ҽѧ�����ھ޿��͸ΰ���Ϻ������е�Ӧ�ü�ֵ

巨块型肝癌在我国肝癌病人中所占比例较高,其手术治疗难度大、并发症多、预后差。准确的术前评估对改善其疗效尤为重要。三维手术模拟软件的应用可清晰地立体重建肝脏内的解剖,对感兴趣区域的距离、体积等进行精确计算,同时可以模拟不同手术方案,根据病人具体情况对手术范围、方式进行调整,对改善复杂、疑难和巨块型肝癌手术的疗效有一定价值。     

����Ӫ�����ϵ�֭��������֢���������������е�Ӧ�ü�ֵ

目的： 观察体外胆汁回输对重症急性胰腺炎术后氮平衡和部分营养指标的改变，以探讨其临床应用价值。方法：选择24例重症急性胰腺炎的病人随机分为观察组12例及对照组12例，其中观察组均在术后第3天经空肠造瘘口饲养加体外胆汁回输，对照组给予持续性TPN。观察氮平衡、血淀粉酶、血常规及细胞分类、血肌酐及尿素氮、体重进行统计学处理并计算住院日、病死率，了解其效果。结果：体外胆汁回输组在重症急性胰腺炎术后氮平衡恢复、改善营养状况、防治肠道细菌易位加重感染、减少住院日及住院费用方面较对照组好。结论：肠内营养联合体外胆汁回输在重症急性胰腺炎中具有重要的临床应用价值。     

����ҽѧ�����ڸ�ǻ�͸�Ĥ��޴�������Ϻ������е�Ӧ�ü�ֵ

腹腔和腹膜后巨大肿瘤是一种较少见的肿瘤。目前,手术是惟一有效治疗措施。数字医学技术及其相关研究将CT、MR等二维平面图像转化成立体三维图形,可以直观、形象的观察腹腔肿瘤与其他脏器、血管和组织的空间解剖关系。     

MRI�ڱ������������е�Ӧ�ü�ֵ

近年来乳腺磁共振成像(MRI)检查技术取得了巨大的发展,表面线圈技术和成像序列的改进,使图像的时间分辨率和空间分辨率得到很大提高;通过静脉注射顺磁性造影剂Gd-DTPA后进行多时相双乳快速增强扫描,即目前乳腺MRI检查所常规应用的动态对比增强MRI成像(dynamic contrast enhanced MRI,DCEMRI),不仅可以使肿瘤强化,更好的观察肿瘤的形态和边界,并且可以获得肿瘤组织的强化随时间的变化特征,有助于对肿瘤的血供进行分析和特征的提取,鉴别肿瘤的性质.     

����ʮ��ָ����ͷ�г�������ͷ���׿������е�Ӧ�ü�ֵ

??Applied value of duodenum-preserving pancreatic head resection (DPPHR) in treating tumor of pancreatic head Department of General Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China Abstract There is a close relationship anatomically between pancreatic head and duodenum. It was known previously that it was inevitable to resect pancreatic head together with duodenum. Beger firstly reported duodenum-preserving pancreatic head resection (DPPHR) for the patient with chronic pancreatitis in 1972. Imaizimi reported modified Beger’s operation, duodenum-preserving total pancreatic head resection (DPTPHR) for the patient with low-degree malignant tumor of pancreatic head without lymph nodes clearance in 1990. DPPHR resect only focus of pancreatic head, do not destroy continuous instruction of digest tract, and improve postoperative life quality. Recently, DPPHR has been extensively used in surgical clinics.     

���ֻ�΢�������ڸε��ܽ�ʯ�����е�Ӧ�ü�ֵ

??Value of digital minimally invasive technology in diagnosis and treatment of the hepatolithiasis FANG Chi-hua??XIANG Nan. The First Department of Hepatobiliary Surgery??Zhujiang Hospital??Southern Medical University??Guangzhou 510282??China
Corresponding author??FANG Chi-hua??E-mail??fangch_dr@126.com
Abstract Hepatolithiasis is an intractable disease characterized by high residual and recurrent incidence after hepatectomy. Insufficient comprehensive preoperative evaluation??inappropriate treatment selection and inopportune operation timing were tightly responsible for the negative outcomes. Based on digital minimally invasive technology??which mainly consist of three-dimensional reconstruction??surgery simulation??and 3D printing technique??systematic preoperative assessment and optimized scheme could by obtained though systematic preoperative risk evaluation and optimized scheme on 3D classification and individualized segmentation. Consequently??the operation could be conducted accurately. Thus??the incidence of recurrence and possibility of stone residual??as well as postoperative complications and the duration could be minimized extremely. In conclusion??digital minimally invasive technology is conducive to achieve the therapeutic goal of hepatolithiasis-complete clearance of stones??elimination of strictures??removal of lesions and adequate drainage of the affected segments of the biliary tree and is helpful to improve the diagnosis and treatment in hepatolithiasis.     

��ǰϸ�봩��ϸ��DNA�����������ٰ�����е�Ӧ�ü�ֵ

目的 通过术前检测细胞DNA倍体情况，探讨DNA指数（DI）在胰腺癌诊断中的应用价值。方法 选取疑诊胰腺癌病人30例行术前B超引导经皮穿刺，涂片行HE和改良eulgen法染色，用ICM进行DNA含量测定。结果 在最终确诊的27例胰腺癌中，异倍体25例，其中HE诊断的敏感性是66.67%，DI值诊断的敏感性为92.6%，其差异具有统计学意义（P＜0.05），良现变3例均不属异倍体。在HE漏诊的9个病例中，8例根据DI值可作出正确判断，3例良性的DI值无假阳性结果。结论 细针穿刺细胞DNA含量检测在术前胰腺癌的确诊中有着较重要的应用价值。     

Mammotone΢�����ϵͳ���鷿��������е�Ӧ�ü�ֵ

目的 用微小介入的方法针取乳房组织进行活检，医师不开刀手术就能取得足量乳房组织进行确定诊断。方法 Mammotone微创活检系统在乳房肿块活检诊断系统进行取材，将探讨单次置入乳房的病灶中利用该系统的真空抽吸辅助装置和特殊的旋转设计，将病灶吸附于管腔内，再用传送装置将管状刀送入管腔内，将病灶取出，结果 88例病人，102处病灶中，恶性31处，良性71处，其中纤维腺瘤28处，乳腺增生或增生性腺瘤43处，34处小于2cm病灶被完全取除，其余68处病灶均经手术切除并复送病理，与活检符合率为97.1%。结论 经皮微创穿刺乳房肿块活检是目前定性诊断乳腺病变的理想方法。在临床实际工作中应根据具体条件和需要与传统方法选择应用。     

EST��ENBD�ڼ��ﵨ�������е�Ӧ��

随着微创和内镜技术的发展 ,内镜下Oddi括约肌切开术 (EST )和内镜下经鼻胆管引流术 (ENBD)因其能简单快速地解决问题而且创伤小 ,痛苦少的优势被越来越多地应用到急性胆道疾病的诊治中 ,并取得了很好的临床效果。现将我院自 1996～ 2 0 0 2年急诊行EST及ENBD治疗胆道疾病的情况介绍如下。1　临床资料共计 70例 ,其中男性 3 1例 ,女性 3 9例。平均年龄56 8岁。所有病例均有腹痛、寒战、发热、黄疸等急性胆管炎表现。其中胆总管结石 40例 ,胆总管结石合并肝内胆管结石2 0例 ,胆道蛔虫 5例 ,胆管末端良性狭窄 5例。以上病例均经彩超、C…     

���������ڵ������Ѫ�е�Ӧ�ü�Ӧע����й�����

胆道大出血在临床上并不少见。随着经皮肝穿刺操作的普及 ,胆道大出血的发生率亦随之增加。其病死率高 ,内科保守治疗和传统的外科治疗多难以奏效。近来 ,由于介入放射技术的发展 ,选择性和 (或 )超选择性动脉造影和栓塞成为胆道大出血最有价值的定位诊断和治疗方法。国内外关于介入治疗胆道大出血的报道也不断增多。现综合国内外文献 ,就胆道大出血病因、介入造影和栓塞技术对诊断及治疗价值的评估以及介入治疗应注意的有关问题等进行探讨。胆道大出血传统的治疗方法包括内科保守治疗和手术治疗。保守治疗对少量胆道出血可能暂时有效。由于…     

����������θ������Ѫ�е�Ӧ�ü�����֢

选择性血管造影诊断及栓塞治疗胃肠道出血 ,方法简便安全 ,效果迅速可靠 ,为临床首选治疗方法之一。近年 ,随着导管技术的进步及新型导管材料的开发和应用 ,人们再次认识到介入治疗在胃肠道出血中的应用价值。介入治疗有自身的特点 ,包括治疗技术的选择 ,靶血管的选择 ,栓塞剂及其用量的选择 ,以及并发症的防治等对治疗效果均有一定影响。本文结合近年文献 ,就胃肠道出血介入治疗的临床应用及其并发症的防治等 ,综述如下。1　胃肠道出血介入治疗的适应证及方法胃肠道出血可分为上消化道出血和下消化道出血 ,出血原因可分为炎症性、肿瘤性、…     

��ǻ���������˼����ڸ���������������е�Ӧ�ü�����

??Application and evaluation of laparoscopy and robot in the treatment of malignant liver tumor PENG Cheng-hong, ZHAO Shu-lin, JIN Jia-bin. Department of General Surgery, Ruijin Hospital Affiliated to School of Medicine of Shanghai Jiao Tong University??Shanghai 200025??China
Corresponding author: PENG Cheng-hong, E-mail: chhpeng@188.com
Abstract Minimally invasive surgery has become the fist choice for surgical diseases, which lead to more and more application of laparoscopy and robot surgery in liver cancers. In lots of liver surgery centers, the minimally invasive surgeries are taken as the first choice. Although there are some success approaches??laparoscopy is not widely spread in liver resection surgeries such as segment ??/??/?? resection. Robotic surgery may be more practical in operations related to those regions because of its unique technical advantages. For the oncological outcomes of liver cancers??laparoscopy and laparotomy are almost equivalent. Laparotomy??laparoscopic surgery and robot assisted surgery will coexist for a long time. The three operative methods have their own advantages and indications. Individualized choice of surgical method is especially important for patients.     

��֧֧�ܼ����ڹ�����֧Ѫ���ؽ��е�Ӧ�ü�����

??Application and evaluation of branched stent-graft technique in reconstruction of aortic arch branches LU Qing-sheng. Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University,Shanghai 200433,China
Abstract Branched stent-graft technique is more suitable for endovascular treatment of aortic aneurysms or dissection involving the aortic arch??with more in line with normal anatomical structure and lots of researches have been done all over the world. In China??there are head attached branched stent-graft and bifurcated spliced branched stent-graft. But clinical trials of them failed due to design defects and release methods problem. Japanese Inoue integrated branched stent-graft either failed. Other overseas including Cook's "inner chimney" branched stent-graft??Bolton Medical's large window inner chimney branched stent-graft??Gore's inner periscope branched stent-graft??Medtronic's protruding window connecting branched stent-graft are undergoing clinical trials??but none has been approved by the public. Castor branched stent-graft is the first branched stent-graft approved by the state in the world. It can be used as a commercial branched stent-graft. It was jointly developed by Department of Vascular Surgery, Shanghai Changhai Hospital and Shanghai MicroPort Company. The integrated design of the stent and the safety and precision design of the delivery and release system make it obtain good clinical application results. However??Castor branched stent-graft is a single branched stent-graft??its application still has some limitations??to completely solve the aortic arch lesions still need further research. The combination of various technologies may be the direction of endovascular repair of aortic arch lesions in the next 5 years.     

��ǻ���������������������е�Ӧ�ü�����

胰腺囊性肿瘤生物学行为多样。手术是治疗胰腺囊腺瘤惟一有效方法。目前,腹腔镜治疗胰腺囊性肿瘤术式包括胰腺囊肿剜除术、腹腔镜下保留脾或不保留脾的胰体尾切除术、腹腔镜胰腺节段切除、胰腺假性囊肿引流术及腹腔镜下胰十二指肠切除术或全胰切除术。腹腔镜治疗胰腺囊性肿瘤具有创伤小、并发症少、术后恢复快等优点,是未来胰腺囊性肿瘤治疗的主要方式。