胆囊切除术前上消化道检查的临床意义

目的: 调查术前上消化道检查对预测胆囊切除术后综合征的意义. 方法: 回顾调查了1997年1月~2000年10月在我院行胆囊切除术的患者1245例,其中522例术前行上消化道内镜检查,178例行上消化道钡餐造影检查,232例行上腹部平片检查.其中53例行胆囊造漏术,764例行胆囊切除术,52例行其他手术. 结果: 上消化道内镜检查发现166例合并浅表性胃炎,36例合并肥厚性胃炎,12例合并萎缩性胃炎,5例合并霉菌性胃炎,6例合并胃息肉,4例合并胃癌,25例合并上消化性溃疡,11例合并十二指肠乳头旁憩室,10例合并十二指肠滞留,2例合并轻中度食道静脉曲张,245例上消化道内镜检查无异常.上消化道钡餐造影检查发现8例合并十二指肠滞留,7例合并十二指肠乳头旁憩室,22例合并上消化性溃疡,141例上消化道钡餐造影检查正常.腹部平片检查对术前诊断无临床指导意义.术后59例产生了并发症及后遗症,如:胆道感染、急性胰腺炎、胆道蛔虫感染、胆瘘、胆道损伤以及肠粘连等. 结论: 胆囊术后综合征的发生与外科技术和其他上消化道并存疾病有关.术前上消化道检查对于预测胆囊术后综合征具有重要意义.     

腹腔镜胆囊切除术中胆道造影的临床探讨

目的 :减少腹腔镜胆囊切除术后胆总管残留结石的发生率。方法 :根据病史及术前B超检查结果 ,对可疑胆总管结石行腹腔镜胆囊切除术中胆道造影 ,明确胆道情况。结果 :同期行LC 6 5 0例 ,术中胆道造影 89例 ,成功 78例 ,成功率 87 6 4% ,术中发现胆总管结石 19例 ,占同期LC总数的 2 92 %。结论 :术中胆道造影成功率高 ,显像清晰 ,是一种良好的胆道检查方法 ,为腹腔镜胆囊切除术的成功奠定了基础 ,同时也使患者避免了二次手术的痛苦     

腹腔镜胆囊切除处理非结石性的胆绞痛症状

在某些组报告中非结石性胆囊炎病例约占胆囊切除术的 5 %～ 2 2 %。具有胆绞痛症状而影像学检查阴性者并不少见 ,曾采用多种诊断手术 ,诸如上消化道内镜检查、上消化道放射学检查、CT扫描、胆囊收缩素刺激闪烁显像 (CCK HIDA) ,其评定临床结果的正确性仍不清楚。加拿大Cariboo纪念医院外科于 1 997～ 2 0 0 1年曾行 75 5例腹腔镜胆囊切除术 ,88例为非结石性胆囊炎 ,病人主诉胆源性症状 ,多种影像学检查排除其他病因 ,计女性 73例、男性 1 5例 ,平均年龄 42岁 ( 1 9～ 78岁 ) ,平均随访 2 5个月。 69例慢性症状 ,如餐后右上腹痛反复发作…     

免钛夹两套管腹腔镜胆囊切除术

为进一步减少腹腔镜胆囊切除术的腹壁创伤 ,避免钛夹对上腹部ＣＴ检查的影响 ,防止术后发生由钛夹引起的夹闭胆管 ,及以钛夹为核心的胆总管结石等并发症 ,我科开展了免钛夹两套管腹腔镜胆囊切除术 ,现报告如下。临床资料1997年 11月至 1999年 12月我们用免钛夹两套管法行腹腔镜胆囊切除术 2 5 2例 ,占同期腹腔镜胆囊切除术的38 8% (2 5 2 / 6 5 0 ) ,其中胆囊息肉 5 0例、慢性胆囊炎、胆囊结石 2 0 2例。本组男 6 2例 ,女 190例 ,年龄 2 2～ 79岁 ,平均47 5岁。手术器械 :用Ｓｔｒｙｋｅｒ电视腹腔镜系统 ,前斜 30度腹腔镜、10ｍｍ套管、5ｍ…     

腹腔镜胆囊次全切除术的应用体会

目的 :总结腹腔镜胆囊次全切除术的经验。方法 :1 2例因粘连严重处于炎症急性期 ,不适宜行腹腔镜胆囊切除术 ,采取保留小部分胆囊后壁 ,不要求完整游离胆囊管 ,仅在适当位置行关闭胆囊管。结果 :1 2例均顺利完成手术 ,无并发症发生。结论 :腹腔镜胆囊次全切除术是腹腔镜胆囊切除术的补充     

术前B超检查对腹腔镜胆囊切除患者胆囊三角关系的预测

目的 :探讨术前B超检查用于预测腹腔镜胆囊切除术 (LC)患者胆囊三角关系 ,从而估计LC的难易度的价值。方法 :为 6 8例LC患者行术前常规B超检查 ,重点观察胆囊三角 ,并与术中腹腔镜观察相对照。结果 :6 8例中 6 3例的病理结果与术前B超检查诊断相符 ,诊断符合率为 92 6 4% (6 3 6 8)。 6 0例超声扫描胆囊周围与实际观察相符 ,符合率为 88 2 3% (6 0 6 8)。结论 :术前B超对胆囊三角关系的预测具有较高的准确性     

术前肝胆系螺旋CT检查在腹腔镜胆囊切除术中的价值

目的:探讨腹腔镜胆囊切除术前做肝胆系螺旋CT检查的临床价值.方法:对246例拟施行腹腔镜胆囊切除术的患者行术前肝胆系螺旋CT检查,根据检查结果调整手术方案,并指导LC术中操作.结果:246例经术前螺旋CT检查,发现异位胆囊1例,胆肠内瘘1例,Mirizzi's综合征1例,胆囊结石伴胃癌1例,发现肝中静脉分支和胆囊床紧邻5例.根据螺旋CT检查结果及时调整手术方案,全组无手术并发症发生,同时避免了LC可能出现的漏诊.结论:腹腔镜胆囊切除术前做肝胆系螺旋CT检查对预防术中胆道损伤、出血和减少腹腔内其他脏器病变的漏诊有重要价值.     

腹腔镜联合手术的护理

1998年 8月至 2 0 0 0年 12月我院开展了腹腔镜联合手术4 6例 ,治疗效果满意。现将护理体会总结如下。1　临床资料　　本组 4 6例中女 4 4例 ,男 2例 ,18～ 6 2岁 ,平均 4 1岁。本组病例中腹腔镜胆囊切除术 +阑尾切除术 2 7例 ,腹腔镜胆囊切除术 +卵巢囊肿切除术 14例 ,腹腔镜胆囊切除术 +畸胎瘤摘除术 2例 ,腹腔镜胆囊切除术 +阑尾切除术 +肠粘连松解术 1例 ,腹腔镜胆囊切除术 +肝开窗引流术 2例。住院2～ 5ｄ ,平均 2 5ｄ。术后放置腹腔引流管 3例。2　护理体会2 1　心理护理2 1 1　提高自身素质 ,讲究仪表和语言　在临床工作中 ,护士…     

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目的　探讨腹腔镜胆囊切除术中胆囊管增粗的处理方法。方法　自 2 0 0 1年 3月至 2 0 0 3年 5月 ,对3 1例胆囊管增粗病人行腹腔镜胆囊切除术 ,其中胆囊管直径 0 4～ 0 6cm 2 0例 ,直径 >0 6～ 0 8cm 6例 ,直径 >0 8cm 5例。在腹腔镜胆囊切除术中分别采用阶梯施夹法 (2 2例 )、大号钛夹法 (4例 )、圈套器法 (5例 )三种方法处理胆囊管 ,14例置腹腔引流管。结果　 3 0例无并发症治愈出院 ,1例术后第 2天出现胆漏 ,经内镜下逆行胰胆管造影术 (ERCP) 内镜下鼻胆管引流术 (ENBD)及腹腔引流 1个月后治愈出院。结论　在腹腔镜胆囊切除术中 ,应采用适当的方法处理胆囊管增粗     

腹腔镜胆囊切除术并发症的防治(附408例分析)

目的 :分析腹腔镜胆囊切除术并发症的原因 ,探讨有效防治方法。方法 :回顾分析腹腔镜胆囊切除术 4 0 8例的临床资料。结果 :4 0 8例腹腔镜胆囊切除术中 ,胆囊床渗血 4例 ,胆漏 2 4例 ,腹壁戳孔出血 1例 ,胆总管横断 1例 ,中转开腹 6例。结论 :操作规范 ,及时中转开腹术 ,可降低胆管损伤、术中术后出血及胆漏等并发症的发生     

胃肠道间质瘤的影像学表现及其病理分析

目的分析胃肠道间质瘤的影像学特点,探讨消化道造影及CT扫描对该肿瘤的诊断价值。方法回顾性分析经临床手术病理证实的57例胃肠道间质瘤的影像学资料,并参照其病理进行良恶性分析。结果 57例胃肠道间质瘤良性9例,占15.8%,恶性48例,占84.2%;贲门胃43例,占75.4%:小肠12例,占21.1%;肠系膜2例,占3.6%。直径3.0cm5例,占8.77%;直径3.0～5.0cm23例,占40.35%;直径5.0cm29例,占50.88%。术前转移2例,占3.5%。结论 (1)消化道造影与CT扫描影像学表现有助于胃肠道间质瘤的诊断;(2)肿瘤发生的部位、大小、生长方式、强化程度、邻近组织有无受浸及转移、风险等级是胃肠道间质瘤良恶性判断的重要标准;(3)影像学表现及病理为胃肠道间质瘤的临床治疗及预后提供重要参考价值。     

Fiberoptic endoscopy: Precise definition of upper gastrointestinal disease

When properly employed, endoscopic examination of the upper gastrointestinal tract with the flexible maneuverable-tip fiberoptic instruments is the most accurate method of diagnosing any upper gastrointestinal tract disease. Two hundred consecutive endoscopic procedures in the upper gastrointestinal tract were performed without significant morbidity or mortality; the results were reviewed to ascertain the overall diagnostic value of this modality. Although the overall numbers in each subgroup are still small, the experience indicates that: (1) thorough endoscopic examination of the upper gastrointestinal tract can be carried out expeditiously in most patients without morbidity; (2) upper gastrointestinal tract disease can be precisely defined in the majority of patients; and (3) endoscopic examination frequently alters the initial clinical diagnosis. The precise cause of upper gastrointestinal tract hemorrhage can be diagnosed in at least three of four cases. Some unnecessary operations can be avoided and proper therapy for specific sources of bleeding can be initiated promptly.     

Diagnostic failures in endoscopy for acute upper gastrointestinal haemorrhage

BACKGROUND: Oesophagogastroduodenoscopy (OGD) is the diagnostic tool of choice in acute upper gastrointestinal haemorrhage. However, the factors causing diagnostic failure are not well documented or discussed. METHODS: OGDs performed by a single surgeon for acute upper gastrointestinal haemorrhage were reviewed retrospectively for 'missed' diagnosis. RESULTS: There were nine cases (1.4 per cent) of 'missed' diagnosis in 638 OGDs performed over a 3-year period. Incomplete examination caused by a fundal pool precluded three examinations in which two Dieulafoy's lesions and one chronic gastric ulcer were later found. Other difficult examination sites were the cardia/high lesser curve (three cases), the stomal line of a gastrojejunostomy anastomosis (two) and at the junction of the first and second part of the duodenum (one). Four of the overlooked diagnoses were Dieulafoy's lesions. CONCLUSION: OGD was able to diagnose the cause of bleeding in 98.6 per cent of patients with acute upper gastrointestinal haemorrhage. The factors that caused diagnostic failure were a difficult examination site and failure to recognize lesions (Dieulafoy's).     

泛影葡胺造影在诊断上消化道穿孔中的应用

目的：探讨泛影葡胺造影对上消化道穿孔者的诊断价值。方法：对临床上怀疑上消化道穿孔的112例患者,术前使用泛影葡胺造影,并对该组的临床资料进行回顾性分析。患者在透视下动态观察有无造影剂经胃、十二指肠漏出并摄片分析,有造影剂漏出为阳性,无则为阴性。结果：112例患者行泛影葡胺造影,阳性者72 例：胃穿孔31 例,其中胃溃疡穿孔27例,胃癌穿孔4例;十二指肠球部穿孔 41例。阴性者40例,其中39例经CT、急诊胃镜检查及剖腹探查确诊为其他疾病,但有1例阴性者行剖腹探查诊断为胃后壁穿孔。该法的诊断符合率99.1 %,敏感性98.6%,特异性100%,全组假阴性1例,无假阳性。结论：泛影葡胺在诊断上消化道穿孔中安全、有效、方便、价廉,有其重要应用价值。     

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目的 评价隧道式责门周围血管离断术治疗门静脉高压症尤其是上消化道出血的近、远期疗效.方法 回顾性分析西安交通大学医学院第二_附属医院普通外科1995年9月至2005年12月收治的307例门静脉高压症病人的临床资料.所有病人均行隧道式责门周围血管离断术,随访观察该术式的近、远期疗效.结果 术后止血率为97.69%,围手术期病死率为4.23%,主要死因有上消化道出血、腹腔内出血、肝衰、肝肾综合征.共有63例(20.63%)病人出现近期并发症.随访病例248例,平均随访时间(50±6)个月.术后5年再出血发生率为3.41%,10年再出血发生率为11.93%.结论 该术式治疗门静脉高压症尤其是上消化道出血近、远期疗效可靠,严重并发症少.     

Stools containing altered blood-plasma urea: creatinine ratio as a simple test for the source of bleeding

The plasma urea:creatinine ratio (U:C ratio) is known to be elevated in cases of upper gastrointestinal bleeding. Almost all patients with haematemesis have upper gastrointestinal (or generalized) bleeding so that in this study we characterized the diagnostic power of the U:C ratio in patients with stools containing altered blood without haematemesis in the hope that this simple laboratory test (used in conjunction, perhaps, with clinical data) might reduce the number of patients subjected to an unrewarding gastroscopy or colonoscopy. Of 76 cases seen in a provincial and a metropolitan hospital, 42 and 34 patients had upper and lower gastrointestinal bleeding, respectively. Fifty-four per cent of those with upper gastrointestinal bleeding and none of those with lower gastrointestinal bleeding had U:C ratios above 110 on admission. However, a discriminating level of 90 is considered to be more suitable, judged by the quadratic uncertainty score. At this level the odds for upper gastrointestinal bleeding were 15:1.     

Dieulafoy病19例临床分析

目的:探讨Dieulafoy病发病情况、诊断及治疗方法。方法:回顾性分析19例Dieulafoy病的临床表现、诊断、治疗方法及疗效。结果:全部病例均表现突发上消化道大出血。初次胃镜检查确诊12例（63.2%），第2次检查确诊4例（21.1%），术中探查确诊3例（15.8%）；14例经一次内镜下止血成功，1例经二次内镜下止血成功，4例行外科手术止血（包括1例内镜下止血后72h再出血者）。结论:急诊胃镜是诊断Dieulafoy病首选方法；治疗首选内镜下止血，内镜下止血不成功者，应立刻手术治疗。     

腹腔镜联合ECT诊治小儿消化道出血的临床价值

目的：探讨腹腔镜联合ECT诊断与治疗小儿消化道出血的临床价值。方法：34例患儿术前均行ECT检查,其中阳性32例,2例显示阴性且保守治疗（止血、输血等）效果欠佳,术前行胃镜、肠镜检查,排除上消化道出血及结肠病变,34例患儿均行腹腔镜探查。结果：经腹腔镜探查,28例为美克尔憩室,4例为肠重复畸形,1例为B细胞型淋巴瘤浸润回肠,1例探查阴性。ECT检查阳性32例,其中1例为消化道肿瘤,1例经腹腔镜探查结果阴性,经保守治疗未再出现便血;2例ECT检查阴性,行腹腔镜探查发现美克尔憩室。腹腔镜探查阳性的患者均同时行手术治疗,术后均恢复顺利,未见出血。结论：腹腔镜联合ECT诊治小儿消化道出血是安全、可行的,可提高小儿消化道出血的诊断率,值得广泛应用于临床。     

The examination of the digestive tract in patients with iron-deficiency anemia

According to literature the gastroenterologic consultations for iron-deficiency anemia are quite frequent. The aim was the evaluation of the part played by gastrointestinal examinations for the diagnosis of iron-deficiency anemia. There were 115 patients admitted in the Medical Clinic between 1998-1999, with iron-deficiency anemia in the absence of macroscopic bleeding who carried out upper or lower endoscopy. A digestive lesion which account for iron deficiency anemia was identified in 35% of the cases. In the upper digestive tract there were 60%, in decreasing order of frequency: peptic ulcer, gastric cancer, erosive gastritis, angiodysplasia. In the lower digestive tract were 35% of the cases (colorectal cancer, polyps, angiodysplasia and hemorrhoids). In 5% of the cases there were found synchronization of the digestive tract lesions. So the digestive tract examination is worth doing because it establishes the diagnosis in 35% of the cases with few symptoms. The digestive tract lesions are more frequent in the upper tract, but they are more severe in the lower digestive tract. The possibility of the synchronization of lesions proves the necessity of carrying out the complete examination of the whole digestive tract.     

腹腔镜胆囊切除术后假性动脉瘤的诊治

目的:探讨腹腔镜胆囊切除术(LC)后假性动脉瘤的诊治方法。方法:对4例LC术后假性动脉瘤患者的临床资料进行分析,对其诊治要点及预防措施进行探讨。结果:4例患者主要临床表现包括右上腹痛、上消化道出血、黄疸等,彩色多普勒超声检查提示诊断,选择性血管造影明确诊断并同时行栓塞治疗成功,均治愈。结论:彩色多普勒超声和选择性血管造影是本病的主要诊断方法。介入栓塞治疗应作为假性动脉瘤治疗的首选方法。假性动脉瘤的形成与手术操作有关,应重在预防。