Penile cancer Clinicopathologic study of 64 cases

The clinical records of 64 patients with penile cancer admitted to the urologic services at the Presbyterian and Francis Delafield Hospitals from 1947 through 1969 have been reviewed. The pertinent data are analyzed and included in this report. The relationship between cancer of the penis and phimosis, and age and race are discussed. The treatment of choice was partial or total penectomy followed by external radiotherapy. Radical dissection of the inguinal lymph nodes did not seem to improve results while it contributed to increased morbidity. Survival rates were evaluated according to the types and stages of penile cancer, as well as to the methods of treatment. The over-all five-year survival rate was 49 per cent. Autopsy studies in 9 patients who died of penile cancer revealed the inguinal and pelvic lymph nodes were involved in 8 patients.     

Vesicouterine fistula: a review of eight cases

Eight cases of vesicouterine fistula (VUF) (obstetrical etiology in six cases and inflammatory bowel disease in two) have been treated in the past 14 years. All six obstetrical cases were related to cesarean section. Both cases of colovesicouterine fistula presented acutely with watery vaginal discharge or fecaluria. Presenting complaints were vaginal urinary incontinence (five cases), hematuria (three), and vaginal discharge (two). Diagnosis was made with cystoscopy in seven cases and computed tomography in one. VUF usually was between posterior bladder and anterior uterine walls above the internal os. Of the initial treatments, six were surgical (three hysterectomies) with an abdominal (five) or transvaginal (one) approach. Mean follow up was 9 months (range, 2–24). Urinary incontinence resolved in all surgically treated patients. Two patients reporting cyclic hematuria were initially managed medically (medroxyprogesterone injections), with delayed surgical repair elsewhere. Surgical repair is the primary treatment for VUF. Successful pregnancy and cesarean delivery have been reported after VUF repair, without sequelae.     

原发性主动脉消化道瘘九例临床分析

目的　提高主动脉消化道瘘的诊治水平。 方法　对９ 例主动脉消化道瘘病例进行回顾性临床分析,并结合文献对该病的流行病学特征、临床诊治进行探讨。 结果　主动脉消化道瘘发生率占同期收治消化道出血的０－０７２％ （９／１２ ４３１） ,占同期胸腹主动脉瘤的３－４％ （９／２６２） 。９ 例中男５例,女４ 例,平均年龄５６－８ 岁。均有预兆性出血特征,腹部搏动性包块和休克,６ 例出现腹痛,所有特殊检查均未能诊断主动脉消化道瘘。术中或尸解诊断主动脉十二指肠瘘４ 例,主动脉空肠瘘３ 例,主动脉横结肠瘘１ 例,主动脉食管瘘１ 例。９ 例中有５ 例行急诊手术,共有７ 例死亡,２ 例存活。３ 例行主动脉瘤及肠瘘手术,其中原位人工血管置换术２ 例存活。 结论　临床对具有出血、腹痛、腹部搏动性包块三联征,影像学检查发现患有胸腹主动脉瘤者,应高度怀疑主动脉消化道瘘可能。迅速积极的手术是唯一有效抢救病人的治疗方法     

Asymptomatic nephrocutaneous fistula: a report of 2 cases

We report 2 rare cases of a spontaneous nephrocutaneous fistula. The diagnosis was made incidentally during hospitalization for other reasons. The role of calculus in the etiological pathogenesis of nephrocutaneous fistula is emphasized. Although classically surgical treatment is indicated a more conservative approach can be advocated in some asymptomatic cases.     

胆囊结肠瘘(附15例临床报告)

目的：探讨胆囊结肠瘘的诊断要点和治疗方法。方法：对22年来收治的15例胆囊结肠瘘作回顾性分析。男9例，女6例，平均年龄62．5岁，病史平均4．5年。分析其临床及病理资料，并予随访。结果：胆囊结肠瘘在胆石症中的发生率0．17％（15／8652），术前诊断正确率为40％（6／15）。15例均予胆囊切除、结肠瘘口Ⅰ期缝合修补，常规放置引流管，术后平均第5天恢复进食。手术并发症包括73E3、肺部和泌尿系感染各1例（6．7％）。无1例发生吻合口痿。术后平均住院8．5天。每例随访半年以上，无远期并发症。结论：对于病史较长，反复胆囊炎发作，胆道积气，胆囊萎缩，与邻近结肠肝曲粘连，并有症状突发减轻病史自9老年胆石症患者，应高度警惕并发胆囊结肠痿的可能。只要术中仔细探查、妥当缝合、充分引流，术后适当推迟恢复进食时间，采用胆囊切除、结肠痿口Ⅰ期缝合修补法治疗胆囊结肠痿是安全、可靠的。     

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目的 探讨胃肠道恶性肿瘤根治性手术后肠梗阻的原因。方法 对1996年10月至2003年6月间北京肿瘤医院手术治疗64例胃肠道恶性肿瘤手术后发生肠梗阻的病例进行回顾性分析，并探讨发生肠梗阻的时间及性质与梗阻原因的关系。结果 64例肠梗阻中，肿瘤复发占60．9％(39／64)，良性原因占39．1％(25／64)。72％(18／25)的良性原因所致肠梗阻发生在术后6个月以内。肿瘤复发所致的肠梗阻全部出现在术后6个月以上。肿瘤局部复发是胃癌和直肠癌术后肠梗阻的主要原因，小肠坠入盆腔粘连成团也是直肠癌术后肠梗阻的重要原因。结论 根据初次手术时间结合肿瘤原发部位可大致判断肠梗阻的性质和原因。     

Pyelocolic fistula: a case study

In this study, the case has been reported of a left renocolic fistula that was detected in a patient with hepatitis C and cirrhotic complications who was hospitalized for urogenital tuberculosis. It was decided to perform left nephrectomy and digestive suture, but surgery was delayed due to hemostatic abnormalities and massive cytolysis, and the patient died before surgical treatment, three days after the discovery of the fistula. The findings in the literature have been reviewed, and the common occurrence of this type of fistula has been underlined. They are the most frequently encountered type with of entero-urinary fistula, and account for 60% of documented cases. Their etiological and clinical characteristics of have been described in detail. In general, treatment consists of performing a nephrectomy and digestive suture.     

Chronic relapsing pancreatitis: a review of 64 cases.

A collected series of 64 cases of chronic relapsing pancreatitis is reported. Analysis of this material reveals several points of interest. There is a difference in the aetiological spectrum in Britain when compared with reports from France and the United States. In particular, nearly half the British cases were idiopathic. The clinical presentation and the age and sex ratios also varied with aetiology. Endoscopic retrograde cannulation of the pancreatic duct was of little value in confirming a diagnosis of pancreatitis in the problem case. This investigation did, however, demonstrate that a widespread dilatation of the pancreatic duct was a minority finding. In those patients with alcoholic pancreatitis follow-up studies have shown that, if the addiction can be broken, there is a 75 per cent chance that pain will diminish or disappear with the passage of time. The main indication for surgical intervention was severe pain and this study has shown that if strict criteria are observed, a worthwhile relief of symptoms can be achieved. In particular, subtotal pancreatectomy produced good results in up to 85 per cent of cases, although with an appreciable short term postoperative morbidity.     

亲属活体肾移植64例临床分析

观察亲属供肾肾移植的临床效果.方法 对64例亲属供肾肾移植的临床资料进行总结分析.结果所有供者无手术并发症,术后5~12 d内出院,术后1周血清肌酐(Scr)(91±25)μmol/L,术后2周供者肾功能恢复到术前水平.受者术后1周平均Scr 142 μmol/L.术后发生急性排斥反应的8例,给予甲泼尼龙及抗胸腺细胞球蛋白(ATG)冲击治疗后逆转.移植肾功能正常者55 例,移植肾失功行规律血液透析3例,死于肺部感染2例,死于结核性脑膜炎1例,死于心力衰竭1例,死于移植后肝衰竭1例,因经济原因不规则服药发生慢性排斥反应死亡1例.结论 亲属活体供肾对供者来说短期内肾功能及日常生活无明显影响,短期内是安全、有效、可行的,并且在一定程度上缓解了肾源紧缺问题.     

Congenital cheek fistula: a report of three cases.

Three cases of the rare condition of congenital cheek fistulae are presented. These differ from preauricular fistulae in terms of their location and the direction in which the fistula is lying. Each cheek fistula seemed to be situated along the line of the junction between the mandibular and maxillary processes of the first branchial arch.     

医源性胆管损伤64例临床分析

目的 分析总结医源性胆管损伤诊治经验。方法 回顾性分析2005年1月至2009年12月中国医科大学附属盛京医院收治的64例医源性胆管损伤病人的临床资料。结果 64例中发生于开腹胆道手术41例,腹腔镜胆囊切除术16例,其他手术7例。4例损伤较轻,术后出现胆汁瘘,行鼻胆管引流术;5例首次术中发现行损伤处T管引流术;55例行胆管空肠Roux-en-Y吻合术。1例死亡,2例吻合口狭窄再次手术,1例术后支架管脱落后吻合口狭窄再次手术,63例痊愈。结论 术中发现胆管较小损伤（<3mm）慎用单纯缝合修补,应积极实施T管引流。术中发现胆管横断,术后数天发现胆管损伤或重建术失败者,胆肠Roux-en-Y吻合术为首选术式;胆肠吻合应慎用环型吻合器。     

胆管支气管瘘29例临床分析

目的 总结胆管支气管瘘(bronchobiliary fistula,BBF)的病因、病理及诊治经验.方法 回顾性分析1976-2009年收治的29例BBF患者的临床资料.结果 29例患者均有腹痛、寒战发热、黄疸、肝肿大;胸闷、咳嗽并咯血及咯胆汁痰,量为100～200 ml/d;右下肺闻及湿性啰音或呼吸音减弱或消失.29例患者先后选择胸部X线片或腹部X线片、A型超声、BUS、CT或PTC、MRCP、ERCP等诊断措施.29例患者均采用手术治疗,术式分别为胆总管切开取石、T型管引流术及膈下或肝脓肿引流、瘘管切除或膈肌瘘口修补术19例(其中2例同时行肝右后叶不规则切除术);胆囊切除、胆总管切开取蛔虫及取结石、T型管引流、膈下脓肿引流及膈肌瘘口修补术3例;胆囊切除、胆总管切开取蛔虫及取结石,胆管空肠Roux-en-Y型吻合术1例;肝外伤性膈下脓肿引流术,胆总管切开、T型管引流术3例;单纯行膈下脓肿引流及胆总管切开及T型管引流术2例;Oddi括约肌狭窄行肝脓肿切开引流及膈肌瘘口修补术并行胆管空肠Roux-en-Y型吻合术1例.手术治愈26例;死亡3例.结论BBF来自肝胆管梗阻和感染导致胆源性肝脓肿及肺脓肿,手术解除梗阻、去除病灶、通畅引流是治愈BBF的关键措施.     

手术后胰瘘的处理:附20例分析

目的　探讨手术后胰瘘的处理方法。方法　回顾性总结 2 0例胰瘘的治疗方法 ,其中 15例行非手术治疗 ,5例行手术治疗。结果　非手术治疗和手术治疗者全部治愈 ,效果满意。结论　大部分胰瘘可通过非手术治疗而愈。但当出现胰瘘管和主胰管相通或 5个月非手术治疗未愈的情况时 ,应改行手术治疗 ,胰瘘管空肠吻合是简单安全有较的方法     

胆管支气管瘘29例临床分析

目的 总结胆管支气管瘘(bronchobiliary fistula,BBF)的病因、病理及诊治经验.方法 回顾性分析1976-2009年收治的29例BBF患者的临床资料.结果 29例患者均有腹痛、寒战发热、黄疸、肝肿大;胸闷、咳嗽并咯血及咯胆汁痰,量为100～200 ml/d;右下肺闻及湿性啰音或呼吸音减弱或消失.29例患者先后选择胸部X线片或腹部X线片、A型超声、BUS、CT或PTC、MRCP、ERCP等诊断措施.29例患者均采用手术治疗,术式分别为胆总管切开取石、T型管引流术及膈下或肝脓肿引流、瘘管切除或膈肌瘘口修补术19例(其中2例同时行肝右后叶不规则切除术);胆囊切除、胆总管切开取蛔虫及取结石、T型管引流、膈下脓肿引流及膈肌瘘口修补术3例;胆囊切除、胆总管切开取蛔虫及取结石,胆管空肠Roux-en-Y型吻合术1例;肝外伤性膈下脓肿引流术,胆总管切开、T型管引流术3例;单纯行膈下脓肿引流及胆总管切开及T型管引流术2例;Oddi括约肌狭窄行肝脓肿切开引流及膈肌瘘口修补术并行胆管空肠Roux-en-Y型吻合术1例.手术治愈26例;死亡3例.结论BBF来自肝胆管梗阻和感染导致胆源性肝脓肿及肺脓肿,手术解除梗阻、去除病灶、通畅引流是治愈BBF的关键措施.

Abstract：

Objective To summarize the etiology,pathological mechanism, and the experience of diagnosis and treatment of bronchobiliary fistula (BBF). Methods Clinical data of 29 BBF patients admitted and operated on from 1976 to 2009 were analyzed retrospectively. Results Clinical menifestation included abdominal pain, chill and high fever,jaundice, hepatomegaly, chest distress, cough, hemoptysis,bilious cough, moist rale in the lower right lung or decreased or disapeared breath sound. Abdominal radiograph, chest X-ray, BUS, CT, PTC, MRCP and ERCP are helpful for localizing diagnosis. All the 29patients were surgically treated. 19 patients were treated by choledochotomy to extract common bile duct stones, T-tube drainage, liver abscess drainage, fistula excision and diaphragmatic repair. Three patients were treated by cholecystectomy, choledocholithotomy, and T-tube drainage. One patient underwent cholecystectomy, choledocholithotomy, and Roux-en-Y hepatojejunostomy. Three patients received liver abscess drainage, choledochotomy, T-tube drainage. 2 patients did subphrenic abscess drainage,choledochotomy, T-tube drainage. One patient complicating Oddi sphincter stenosis received liver abscess drainage, diaphragmatic repair, and Roux-en-Y hepatojejunostomy. 26 patients were cured. 3 patients died.Conclusions The etiology of BBF is obstruction related bilious tract infection leading to liver abcess and lung abscess. In the process of surgical treatment, relief of bilious tract obstruction, clearance of focal lesion and effective drainage of biliary tract are the mainstay of management.     

胆管支气管瘘29例临床分析

目的 总结胆管支气管瘘(bronchobiliary fistula,BBF)的病因、病理及诊治经验.方法 回顾性分析1976-2009年收治的29例BBF患者的临床资料.结果 29例患者均有腹痛、寒战发热、黄疸、肝肿大;胸闷、咳嗽并咯血及咯胆汁痰,量为100～200 ml/d;右下肺闻及湿性啰音或呼吸音减弱或消失.29例患者先后选择胸部X线片或腹部X线片、A型超声、BUS、CT或PTC、MRCP、ERCP等诊断措施.29例患者均采用手术治疗,术式分别为胆总管切开取石、T型管引流术及膈下或肝脓肿引流、瘘管切除或膈肌瘘口修补术19例(其中2例同时行肝右后叶不规则切除术);胆囊切除、胆总管切开取蛔虫及取结石、T型管引流、膈下脓肿引流及膈肌瘘口修补术3例;胆囊切除、胆总管切开取蛔虫及取结石,胆管空肠Roux-en-Y型吻合术1例;肝外伤性膈下脓肿引流术,胆总管切开、T型管引流术3例;单纯行膈下脓肿引流及胆总管切开及T型管引流术2例;Oddi括约肌狭窄行肝脓肿切开引流及膈肌瘘口修补术并行胆管空肠Roux-en-Y型吻合术1例.手术治愈26例;死亡3例.结论BBF来自肝胆管梗阻和感染导致胆源性肝脓肿及肺脓肿,手术解除梗阻、去除病灶、通畅引流是治愈BBF的关键措施.     

胆囊结肠瘘的临床分析：附14例报告

目的:探讨胆囊结肠瘘的临床特点。方法:回顾性分析中南大学湘雅医院15年来收治的8 235例胆囊结石患者中确诊的14例胆囊结肠瘘患者的临床、病理、随访等资料。结果:胆囊结肠瘘在胆石症患者中的发生率为0.17%(14/8 235);14例患者中,术前确诊2例(14.28%),其余为术中确诊;残余胆囊与横结肠间形成内瘘1例,胆囊体部与横结肠间形成内瘘2例,因胆囊萎缩后胆囊瘘口位置不明1例,其余10例胆囊与横结肠瘘口均位于胆囊底部。14例患者均行胆囊切除术,结肠瘘口行I期修补缝合术12例,行部分结肠切除、吻合术2例;术后切口和膈下感染各1例(7.14%)。结论:对于高度怀疑胆囊结肠瘘患者,运用ERCP等多种检查有助于提高其术前确诊率。     

Vesico-vaginal fistula: report of 1050 cases

The authors reports their experience of a large series of 1050 cases of vesico-vaginal fistulas recorded during 30 years and analyse their epidemiological, anatomo-clinical, and therapeutic aspects. Patients could be classified as a function of site of fistula into 3 types, according to the Benchekroun's classification: type I ureto-vaginal fistula (30%); type II cervico-vaginal fistula (22%); type III vesico-vaginal fistula (48%). Etiology was mainly obstetrical (93%). An associated lesion was detected in 10.4% of cases (uterine, ureteral and rectal). Treatment was only performed after a minimal period of three months with the following results in obstetrical vesico-vaginal fistulas. Type I fistula, using a low approach and requiring urethral refection in 100 cases, showed good results in only 60% of cases. Type II fistulae, usually treated through a low approach (80%), were treated with 80% good results. Type III fistula, were nearly always corrected (98%) after two procedures. The overall results are good in 80% of cases. The failures concerned in majority the complex vesico-vaginal fistulas type I, are treated by urinary diversion (51 Coffey, 5 Bricker) and since 1975, 73 continent ileocecal or ileal bladders using Benchekrouns' technique.