先天性胆管囊肿术式选择与再手术

目的：探讨先天性胆管囊肿术式选择与再手术原因。方法：对1980-1998年手术治疗先天性胆管囊肿91例及再手术23例患者的临床资料作回顾性分析。结果：囊肿切除肝总管空肠吻合术效果最好,再手术率最低;囊肿外引流效果最差,再手术率最高;囊肿内引流术效果亦差,再手术率较高。结论：胆管囊肿一旦明确诊断,应尽早手术,避免急诊手术;囊肿外引流术只能作为急救措施;囊肿内引流应弃用;囊肿切除,肝总管空肠Roux-Y吻合术应用为首选术式。     

肝癌手术指征与术式选择

肝癌手术治疗包括根治性切除、姑息性切除和切除以外的姑息性外科三类。根治性切除是治疗肝癌的最重要、最有效方法之一 ,但由于肝癌发病隐匿 ,确诊可根治性切除者所占比例甚小〔1〕,单纯姑息性切除多无益处 ,切除以外的姑息性外科也只适应于少部分病人 ,故应严格掌握手术指征。术中探查估计术后余肝功能可代偿者应力争根治性切除 ,否则除少数合适者可行姑息性切除外宜采用切除以外的姑息性外科治疗。改进手术技术 ,减少手术对余肝的损害可使手术适应证适度扩大。一、手术探查指征肝癌病人是否手术探查应根据病人整体情况、肿瘤情况和肝功能…     

上睑下垂术式选择及其评价

为探讨和研究矫正上睑下垂的合理术式,以指导手术选择,提高上睑下垂矫正手术成功率。本文从上睑下垂矫正手术的目的着眼,提出了术后在形态和功能上应达到的标准和要求,以及术后效果判定等级,并从原理上对矫正上睑下垂手术方法进行归类、分析和评估。1上睑下垂手术目的及效果判定1.1手术目的和术后效果要求1.1.1上睑下垂矫正手术的根本目的在于:提高下垂的上睑,恢复正常的睑裂高度,暴露出瞳孔,扩大视野,防止弱视,矫正异常形态,改善面容。总之,既要达到功能上的恢复,又要达到美容目的。1.1.2术后理想而完善的矫正效果应具备以下几点:①形态上:…     

胆道再手术指征及术式选择

胆道系统因其解剖变异较多，与胰腺、十二指肠等周围器官关系密切、损伤后呈过度愈合的特殊方式，因此，再手术率高达10．9％，目前仍是腹部外科较难处理的问题。胆道再手术可因胆道手术后的并发症、原有疾病未治愈或复发而再次施行的手术，不包括其他腹部手术后针对胆道疾病所进行的再次手术。胆道再手术可依据时间的早晚、是否分期、医源性或病源性等进行分类。     

十二指肠憩室手术治疗的术式选择与评价

一般认为,无症状的十二指肠憩室无需治疗。如已确诊为十二指肠憩室者,也应首先采用非手术方法治疗,无效才考虑手术治疗。手术适应证:(1)憩室出现危及生命的大出血犤1犦;(2)憩室坏疽或穿孔,出现腹膜炎或腹膜后蜂窝组织炎及脓肿形成者犤2犦;(3)憩室、特别是憩室内乳头容易造成胆管、胰管梗阻,形成结石、胰腺炎,以致引起梗阻性黄疸者;(4)憩室较大并发十二指肠不全或完全梗阻者犤3犦;(5)憩室癌变者;(6)巨大憩室内有异物者;(7)憩室伴明显疼痛或反复出血者;(8)憩室开口较小,钡剂进入6h以上仍不能排空者;(9)经正规非手术治疗,仍存在顽固性的消化道…     

老年人急性胆囊炎的手术适应证与术式的选择

随着老年人人数的增加，老年人急性胆囊炎发病率亦明显增加。老年人急性胆囊炎除具有急性胆囊炎的一般规律，还在病理改变与临床表现有不同的特点，特别是手术适应证与手术术式都具特点，讨论如下。     

当前重症急性胰腺炎手术指征及术式选择

近年来在重症急性胰腺炎 (ｓｅｖｅｒｅａｃｕｔｅｐａｎｃｒｅａｔｉｔｉｓ ,ＳＡＰ)的治疗中早期采用非手术治疗原则已趋于明确 ,但对于胆源性ＳＡＰ、某些非胆源性ＳＡＰ(多为暴发性急性胰腺炎 )及ＳＡＰ保守治疗后期有严重并发症的患者 ,手术可能仍是一个重要的治疗手段 ,现就有关手术治疗中手术指征及其术式选择综述如下。1　手术指征及手术时机选择手术指征随着对ＳＡＰ病程和发病转归的认识而改变。过去认为胰腺坏死必然感染 ,感染产生并发症 ,导致死亡率增高 ,故而有胰腺坏死应该越早手术越好 ,切除越彻底越好。通过多年的临床实践 …     

保脾手术的适应证与术式选择

近半个世纪以来,尤其是近２０年来,通过对脾脏生理功能及脾脏与多种疾病关系的逐渐深入研究,外科学界对脾脏的功能及其与疾病的关系已有了较完整和准确的理解,并由此奠定了现代脾脏外科学的基础。本文仅介绍现阶段外伤脾保留性手术的适应证与术式选择。１　保脾手术的适应证和术式选择　　现代脾脏外科在处理外伤脾脏时重视保留脾脏及其功能,但需根据具体病情和客观条件严格遵循基本原则及妥善选择手术方式。１－１　保脾手术的基本原则１－１－１　抢救生命第一,保留脾脏第二。脾外伤时手术治疗的首要目的是立即止血,挽救生命。因此…     

保留脾脏手术的术式选择体会

保留脾脏手术的术式选择体会哈尔滨医科大学附属第一医院（１５０００）姜洪池，张景芳，许军，宋春芳，吴业权大庆石油管理局总医院（１６３００１）田均，耿成斌随着脾脏功能研究的深入及外科技术的发展，对脾破裂及某些脾脏疾病，临床多采取保脾手术，尤其是在儿童更是...     

Complications of buttocks augmentation: diagnosis, management, and prevention

Over the past several years, there has been a tremendous growth and interest in buttocks augmentation in the United States. Surgical techniques have evolved over time to correct anatomical deficiencies and fulfill patient requests, including silicone implant placement (subcutaneous, intramuscular, submuscular, and subfascial) and autologous micro fat grafting. Unfortunately, these techniques have presented great challenges with regard to the incidence, diagnosis, management, and prevention of various postsurgical complications. Extensive collaboration and transparency in discussing complications has resulted in refinement of both surgical technique and medical management,resulting in improved outcomes for patients undergoing buttocks augmentation.     

额部提升术术式选择

作为年龄衰老的一个进程标志,眉和眼部会有特征性的变化,皱纹及深的横线纹会在额部出现,眉的位置会下降,上睑出现多余皮肤而下睑出现袋状形态。30多岁的时候,随着时间推移,更明显的改变是会出现致疲劳和生气的外观,衰老的上下睑还会影响视力和出现流泪的症状,对于这样的患者,     

我别笑我丰臀了

于君是我出访韩国时认识的一个女孩，当时她是中韩整形交流会的韩方接待。在我眼里，她是一个不折不扣的美女：身材高挑，曲线分明，凹凸有致，清纯气质中隐含一丝妖娆的性感。[编者按]     

轻松打造俏丽美臀臀部整形术探讨

从古至今，人们从未放弃对完美的追求，无论是在运动场上亦或手术台上。美胸风潮早已不再新鲜，当又一波低腰劲风吹过，满火街紧绷绷的低腰裤，可爱性感的短裙，无不鼓起人们对于美臀的向往和渴望。如果你羡慕珍妮佛·洛佩兹的性感美臀，却又实在缺乏先天条件，NO PROBLEM，整形外科医生可以帮你实现美臀梦想。     

Gunshot wounds to the buttocks

Twenty patients sustaining gunshot wounds (GSW) to the buttocks (including one shotgun wound) were treated at two affiliated institutions during the last 5 years. Male patients predominated nine to one. Fifteen patients with extraperitoneal injuries had a benign course. One underwent negative exploratory laparotomy based upon positive physical findings. The remaining five patients had clinical abdominal findings consistent with severe intra-abdominal injuries (four organs per patient). Although the morbidity was high, there was no mortality in this series. Careful analysis of a bullet's trajectory will allow detection of a possible intraabdominal component of this type of injury, mandating early surgical management.     

Management of burns of the perineum and buttocks

Twenty patients are reported who suffered acute thermal bums of the perineum and buttocks and were treated at the Shriners Burns Institute, Cincinnati Unit. Seventeen of the 20 patients had burns which resulted from ignition of clothing. The most common source of ignition was refuse fires. Ages ranged from 11 months to 12 years; 17 of the patients were males and 3 were females.Topical agents used to treat the perineal burns consisted of mafenide (Sulfamylon), gentamicin and silver sulphadiazine. All perineal burns were treated by the open technique. The whirlpool was used two times a day for cleansing and débriding the superficial eschar. Initial wound care, in addition to hydrotherapy, consisted of cleaning the perineum twice a day with a mixture of saline, peroxide and ‘Dreft’, after which the topical agent was applied. Once the eschar was removed, the wounds were prepared for grafting by the use of porcine xenografts or cadaver allografts. Meshed skin grafts were used for final coverage.Pseudomonas aeruginosa was the most common organism recovered; Escherichia coli was a close second. Follow-up on these patients revealed that late complications of the buttocks and perineum were minimal. A colostomy was performed in 1 of the 20 patients. This experience indicated that colostomy is not necessary for the handling of perineal burns and that involvement of the perineum in acute burns can be handled by relatively simple means.     

Beautiful buttocks: characteristics and surgical techniques

The authors describe four characteristics that determine attractive buttocks in addition to the balanced anatomical dimensions of the maximal point of gluteal projection. Based on this information, defects of the gluteal region can be classified into five types.The most appropriate size and shape of gluteal implants and the proper surgical technique for gluteal augmentation can be chosen by first identifying the buttock type ofa patient. The proposed method of buttock classification helps achieve a gluteal contour that closely matches the standard of beauty.