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1　病历简介病人男性 ,72岁。因胆囊结石在外院行胆囊切除术。术后 2 0余天起出现进食后上腹饱胀、呕吐。每日呕吐 1～2次 ,多为胆汁样物 ,每次量约 10 0 0ｍｌ,一般不含食物。早餐多可正常摄入 ,但中、晚餐仅可少量进食。以后病人自己发现腹部包块 ,于腹胀时明显 ,呕吐后缩小。 7个月来体重减轻达 15ｋｇ以上。曾在省内多家医院以粘连性肠梗阻接受保守治疗。体检 :消瘦貌 ,体重 48ｋｇ。腹部平软 ,右肋缘下有一7ｃｍ长的手术疤痕 ,可见肠型。左中上腹部可及 8ｃｍ× 6ｃｍ边界不清的质韧肿物 ,略有活动度。肠鸣音活跃。直肠指诊无异常发现…     

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乳腺导管内乳头状瘤是指发生在导管上皮的良性肿瘤,因其常合并上皮非典型增生,有继发浸润性癌危险[1]。营口市中心医院普外科2007年3月至2014年12月收治乳腺导管内乳头状瘤共100例,报告如下。1资料与方法1.1一般资料我院2007年3月至2014年6月期间收治因乳腺导管内乳头状瘤接受乳腺区段切除术病例100例。所有病人均经病理及术后免疫组化确定为乳腺导管内乳     

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??Diagnosis and treatment of complicated intrahepatic bile duct stone??An efficacy analysis of 60 cases LI Chun-yang, NI Qi-hong, WANG Jian. Department of Hepatic and Biliary-Pancreatic Surgery, Renji Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
Corresponding author: WANG Jian, E-mail: dr_wangjian@126.com
Abstract Objective To investigate the reasonable approach of diagnosis and treatment to complicated intrahepatic bile duct stone Methods The radiological diagnosis??surgical approach??complication and clinical efficacy of 60 cases of complicated intrahepatic bile duct stone performed surgical treatment from January 2011 to October 2015 in Renji Hospital of Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. Results According to the classification of hepatolithiasis??44 cases were type I (regional type)??16 cases were type II (diffused type)??and 28 cases were type E (additional type??combined with extrahepatic bile duct stone). A total of 59 cases were Child A grade and 1 case was Child B grade. The sensitivity of diagnosis of single-CT??single-MRI+MRCP??and CT combined with MRI were 86.7%??93.9% and 97.2% respectively. All the 60 cases underwent anatomical liver resection??and 12 cases with high-position bile duct stricture underwent cholangioenterostomy. The complication rate was 25% with no liver failure or perioperative death. The residual stone rate in patients using intraoperative ultrasound combined with choledochoscope was 0 (0/25)??which was significantly lower than that in patients using choledochoscope only (20%??7/35). A total of 55 cases had follow-up from three months to five years. The follow-up rate was 91.6%; high life quality rate was 96.2%; residual stone rate was 11.7%??and recurrence rate was 9.61%. Conclusion Using ultrasound combined with upper abdominal CT and MRI+MRCP can increase the detection rate of intrahepatic bile duct stone. Using choledochoscope combined with intraoperative ultrasound can decrease the residual stone rate. Anatomical liver resection can decrease the residual stone rate and recurrence rate.     

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目的　探讨胰腺囊性肿瘤的诊断和治疗。方法　对 1978年以来 19例胰腺囊性肿瘤的临床资料进行回顾性分析。结果　肿瘤位于胰头部 4例 ,胰体尾部 15例。行不同术式的肿瘤切除 13例 ,外引流 1例 ,内引流 2例 ,剖腹探查、肿瘤活检 3例。无手术死亡。随访囊腺瘤 3例 ,分别随访 6个月、16年和 2 1年仍生存 ;囊腺癌 9例 ,生存时间 <6个月 3例 ,6个月至 2年 4例 ,3年 4个月 1例 ,最长 1例 8年仍生存。结论　B超和CT是诊断胰腺囊性肿瘤的有效方法 ,二者结合使用可提高诊断率。该病切除率高 ,预后较好。应首选手术治疗。     

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约 10 %的胆囊结石病人并存胆总管结石[1 ] 。外科医师在行胆囊切除手术时 ,漏诊术前未发现的无症状的胆总管结石[2 ] 并不鲜见。这类病人往往需要以后再次开腹手术或接受经十二指肠镜乳头肌切开或乳头肌球囊扩张 (ＥＳＴ、ＥＢＤ) [3] 手术 ,造成治疗上的烦琐和其它一系列问题。本文回顾性分析胆囊切除术中发现的术前漏诊的胆总管结石11例。报告如下。1　临床资料1996年 4月至 2 0 0 2年 1月共行 5 63例胆囊切除手术 ,术中发现术前漏诊的胆总管结石 11例。男 4例 ,女 7例。年龄 3 5 6～ 78 5岁。术前主要通过病史和Ｂ超诊断为胆囊结石 ,无…     

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目的 总结无功能性胰岛细胞瘤的诊治经验.方法 应用中国医学科学院医学信息研究所"中国生物学医学文献数据库"光盘,检索无功能性胰岛细胞瘤1999年11月至2007年12月的文献报道.结果 获得有效文献29篇,共报道无功能性胰岛细胞瘤489例.结合中国医科大学附属第一医院普通外科2002-2007年间手术治疗的无功能胰岛细胞瘤15例,总结其临床表现、诊断、治疗方法及结果.结论 无功能胰岛细胞瘤症状缺乏特异性,超声和CT可作为首选的检查方法.外科手术是治疗该病、延长病人生存时间的有效手段.     

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肝细胞腺瘤 (ｈｅｐａｔｏｃｅｌｌｕｌａｒａｄｅｎｏｍａ ,ＨＣＡ)是一种极少见的肝细胞良性肿瘤 ,由于发病隐匿 ,具有易破裂出血和恶变的特点 ,而且与其它良恶性肝肿瘤的鉴别十分困难 ,所以ＨＣＡ越来越受到临床医生们的重视。尽管如此 ,人们对ＨＣＡ的认识仍然不够 ,外科医生和病理学家尚缺乏经验 ,在ＨＣＡ的诊断及正确治疗上存在着很大的争论。　　本文通过总结我科在诊治ＨＣＡ方面的经验教训 ,结合近期文献报道 ,分析、探讨ＨＣＡ的临床病理特点和合理的诊治方案。1　临床资料1 1　一般资料　　我科 196 1～ 2 0 0 0年诊治并经病理…     

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目的 总结家族性息肉病的临床诊断与治疗经验。方法 对1985—2003年21例家族性息肉病病人的诊断与治疗进行回顾性分析。结果 21例均行纤维结肠镜检查，诊断全结肠及直肠息肉14例(67％)、直肠及乙状结肠息肉7例(33％)。21例均行手术治疗。结论 家族性息肉病有明显的家族史，临床以血便为主要表现，同时可伴有腹痛、腹泻。纤维结肠镜临床检查可确定诊断。手术是治疗家族性息肉病的首要方法。可根据病人的具体情况选择术式。     

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目的探讨腹部闭合性损伤延迟性肠坏死的诊断与治疗。方法回顾性分析2000年1月至2008年1月第二军医大学附属长海医院普外科治疗415例腹部闭合性损伤的临床资料,其中11例(2.65%)发生延迟性肠坏死,均于明确诊断后行手术治疗。结果 8例行一期肠段切除吻合术,3例因腹腔污染严重无法行一期确定性手术,先施行肠造口术,6个月后再行二期肠吻合术。11例全部治愈,其中2例发生肠瘘,经积极治疗后痊愈。结论腹部闭合性损伤致延迟性肠坏死临床症状不典型,易导致漏诊或延迟处理,病死率高,临床医生应严密动态观察,CT的正确诊断率较高,早期剖腹探查有利于提高治疗效果。     

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Caroli病是一种先天性的肝内胆管囊性扩张症。外科治疗的目的包括清除病灶,防止胆管癌变;通畅胆汁引流,缓解症状。肝切除是目前最常用的外科治疗方式,对局限性的Caroli病可达到根治的效果,病人术后胆管炎等症状可长期缓解。而对于少部分弥漫型病人,也可选择性清除肝内主要的扩张病灶,并进行密切的随访,如病人进一步进展,肝移植常成为治疗的选择。对于多数弥漫型病人,肝移植是最终的治疗选择,可获得满意的长期效果。     

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目的 探讨胰腺实性假乳头状瘤（SPT）的诊断、治疗和预后。方法 回顾性分析中国协和医科大学肿瘤医院腹部外科1999年1月至2006年11月收治的29例实性假乳头状瘤的临床表现、影像学特征、病理结果、治疗和预后。结果 28例获得手术切除，术式包括Whipple术、胰体尾联合脾切除术、胰腺区段切除和肿瘤局部切除。术后出现胰漏4例，消化道出血1例，经治疗后恢复出院，1例味能切除者行化疗和介入治疗。术后随访2个月至7年，除未能切除的1例术后14个月死亡外，其他均未出现复发和转移。结论 SPT多见于年轻女性，临床表现无特异性。CT是最准确的影像检查方法，结合临床特点可以在术前作出准确诊断。SPT的恶性程度较低。以手术切除为主，完整切除后预后良好。     

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??Diagnosis and treatment of lower extremity vascular injury WANG Li-xin, GUO Da-qiao??FU Wei-guo??et al. Institute of Vascular Surgery??Zhongshan Hospital??Fudan University, Shanghai 200032??China Corresponding author: GUO Da-qiao??E-mail??guodaqiao@zshospital.net Abstract Objective To evaluate the clinical features, diagnosis and treatment of lower extremity vascular injury. Methods The clinical data of 43 cases of vascular injury admitted between June 2002 and May 2007 at Zhongshan Hospital of Fudan University were retrospectively analyzed. Of them, 30 cases were suffered from lower extremity vascular injury. Twenty-two cases received open surgery. Six cases underwent endovascular therapy. Two cases were given medical therapy for no surgical indication. Results Open surgery group: In the peri-operative session, 2 cases were complicated with osteofascial compartment syndrome and reperfusion injury, which resulted in one death; 2 cases with popliteal arteries injury received amputation for re-thrombosis of the treated vessel. Except one death and two amputation cases, all other 19 cases were followed up for 2??36 months. One case was suffered from moderate anastomotic stoma stenosis after 36 months with the ABI declined to 0.75. No complication was identified in the other cases. Endovascular repair group: In the peri-operative session, the symptoms due to the vascular injury were totally relieved without severe complication occurred. The patients were followed up for 6??24 months. The stents implanted were patent and no complication was found. Medical treatment group: The ischemic symptoms were alleviated after the medical therapy. Two cases were followed up for 1 and 12 months respectively and the intermittent claudication distance were both increased. Conclusion Despite of technical improvements in diagnosis and management of vascular injury, the morbidity and mortality still could not be avoided. Endovascular therapy is a new method in the management of vascular injury, offering a promising alternative to operative repair and the short to mid term follow up outcome was satisfied.     

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??Emergency diagnosis and treatment for blunt abdominal injury: An analysis of 128 cases YOU Jian-quan, GU Bin, YU Qing, et al. Department of Emergency Medicine, Taizhou People’s Hospital, Taizhou 225300, China
Corresponding author ??YOU Jian-quan, E-mail: youjianquan@163.com
Abstract Objective To improve the early diagnosis and salvage achievement ratio of blunt abdominal injury. Methods One hundred and twenty-eight cases of blunt abdominal injury treated from 2009 to 2011 in Taizhou People’s Hospital were reviewed retrospectively. Results Of the 128 cases of blunt abdominal injury, 113 cases received surgical treatment, 15 cases received conservative treatment. After treatment, 117 cases were cured and 11 patients died. Conclusion Most abdominal injuries were multi-site and/or multi-organ associated injuries. Diagnostic peritoneal puncture and ultrasonography were simple and reliable diagnostic methods. As soon as possible to final diagnosis, maintenance blood volume and reasonable normalization remedy were the keys to improve the early diagnosis and salvage achievement ratio of blunt abdominal injury.     

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胰腺癌预后恶劣,主要原因是其具有早期即发生淋巴结转移和沿神经束膜扩散至胰外的生物学特征.     

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目的 探讨急性肠系膜血管闭塞(AMVO)的早期诊断及外科治疗方法。方法 回顾性总结1987年8月至2002年8月收治的24例AMVO，对其临床特征、外科诊断治疗方法及预后进行分析。结果 24例AMVO中肠系膜上动脉栓塞(MAE)9例(37.5％)，肠系膜上静脉血栓形成(MVT)13例(54．2％)，肠系膜上动脉血栓形成(MAT)2例(8．3％)。最常见的临床表现为腹痛(91.7％)。最可靠的诊断方法为肠系膜血管造影(100％)。9例MAE确诊7例。保守治疗3例，急诊手术6例。治愈5例，死亡4例。13例MVT确诊10例。保守治疗7例。介入治疗2例，手术4例。全部治愈。2例MAT均确诊，介入与手术治疗各1例，均治愈。结论 肠坏死发生前早期诊断、积极行介入治疗与剖腹探查为主的外科治疗是提高AMVO疗效的关键。     

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??Management of hyperparathyroidism in patients with differentiated thyroid carcinoma??An analysis of 384 patients HU Ya, LIAO Quan, NIU Zhe-yu, et al. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences & Peking Union Medical College, Beijing 100730, China
Corresponding author: ZHAO Yu-pei, E-mail: zhao8028@263.net
Abstract Objective To investigate the strategy of diagnosis and surgery for hyperparathyroidism in patients with differentiated thyroid carcinomas. Methods The clinical data of 384 patients with hyperparathyroidism who had underwent parathyroidectomy between January 2009 and December 2012 in Peking Union Medical College Hospital were analyzed retrospectively for coexistent differentiated thyroid carcinomas. Results All the patients were confirmed by pathology. A total of 367 patients were with primary hyperparathyroidism. The final pathological diagnoses of the parathyroid lesions included adenoma (n=286), adenocacinoma (n=14) and hyperplasia (n=84). A total of 12 patients with primary hyperparathyroidism and 1 patient with secondary hyperparathyroidism were complicated with differentiated thyroid carcinoma, which included papillary carcinoma in 12 patients and follicular carcinoma in 1 patient. Whether complicated with differentiated thyroid carcinoma and hyperparathyroidism patients’ age, gender, parathyroid pathological type was not related. Conclusion Hyperparathyroidism complicated with differentiated thyroid carcinoma is a rare condition. Routine preoperative thyroid ultrasonography and parathyroid hormone measurement may help to improve the surgical effectiveness and avoid unnecessary reoperations.     

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目的通过建立肝癌组织标本库,保护并合理利用肝癌组织标本资源,为分子生物学及临床研究提供组织标本。方法查阅相关文献总结标本库建立规范化流程资料,提供理论依据。同时结合西安交通大学附属第一医院肝胆外科门诊病人量、手术例数及实验室条件拟定该院标本库建立流程。结果建立了肝癌标本库组织及血液标本收集的规范化流程及对应的信息管理系统,已完成了标本库建立的前期工作,开始初步规范化收集肝癌标本并完善相关临床病例资料。结论建立资料完整的规范化肝癌标本库对保护肝癌组织资源及今后肝癌研究都十分重要。