血液病脾切除术的并发症

目的总结血液病患者脾切除术的手术指征、并发症和治疗效果。方法回顾性分析１９８６年～１９９５年间７５例血液病患者的脾切除术资料,其中良性血液病６５例,恶性血液病１０例。结果良性血液病的术中失血量、术后并发症与脾脏大小有关,常见术后并发症依次为肺部感染、膈下感染及术后出血,术后并发症发生率为２０％。手术后血液学参数改善的程度依次为遗传性球形红细胞增多症、原发性血小板减少性紫癜、自身免疫性溶血性贫血、原发性血小板减少性紫癜合并自身免疫性溶血性贫血。恶性血液病行脾切除术后,术后并发症发生率为５０％,且不能延长生存期。围手术期长期使用抗菌素未能降低手术感染率。结论脾切除术对良性血液病行之有效,对恶性血液病患者则需慎重。脾切除术的围手术期不需长期使用抗生素     

脾切除治疗68例良性血液病的效果观察

目的探讨脾切除对内科治疗无效的几种良性血液病的治疗效果。方法对68例良性血液病脾切除术病人的临床资料进行回顾性分析。结果无围手术期死亡病例,术中均无大出血,根据血液学参数结果,脾切除对遗传性球形红细胞增多症、原发性血小板减少性紫癜、β型地中海贫血、α型地中篎堆⒆陨砻庖咝匀苎云堆腥非械闹瘟菩Ч?有效率分别为100%、91.3%、90.0%、72.7%及66.7%。结论脾切除术对上述良性血液病行之有效。     

脾切除对几种血液病的治疗作用(附56例分析)

目的 总结对血液病病人行脾切除的治疗效果、适应证和手术并发症。方法 回顾性分析１９８１～１９９８年间５６例血液病病人脾切除术的资料,根据治疗效果,总结出适应证及并发症的预防。结果 根据血液学参数结果,脾切除对原发性血小板减少性紫癜、遗传性球形红细胞增多症、自身免疫性溶血性贫血、原发性血小板减少性紫癜合并自身免疫性溶血性贫血（Ｅｖａｎｓ病）有确切的治疗效果,有效率分别为８７．５％,８０％,７７．８％     

脾脏相关血液系统疾病的外科治疗

目的 探讨脾切除术(包括腹腔镜脾切除术)治疗某些血液病的手术指征、治疗效果及并发症的防治.方法 对27例因血液系统疾病行脾切除的病历资料进行回顾性分析.结果 遗传性球形红细胞增多症(HS,4例):有效率100%;特发性血小板减少性紫癜(ITP,17例):显效率 76.47%(13/17)非霍奇金淋巴瘤(NHL,6例):切除脾脏有益于其综合治疗.术后并发症的发生率为7.41%(2/27).结论 脾切除治疗HS疗效肯定,是HS首选的治疗方法.脾切除治疗大多数ITP有效,应选择好适应证.ITP病人对皮质激素治疗的反应并不一定影响脾切除的疗效.对于恶性淋巴瘤,脾切除可作为其综合治疗措施中的主要手段.选择好手术适应证,做好围手术期处理,有益于减少并发症的发生.     

腹腔镜脾切除术治疗遗传性球形红细胞增多症(附18例报道)

目的探讨腹腔镜脾切除术治疗遗传性球形红细胞增多症的可行性、手术技巧及效果评价。方法收集我科2006年1月至2008年1月收治的行腹腔镜脾切除术治疗的遗传性球形红细胞增多症患者18例的临床资料进行回顾性分析。结果所有患者均顺利完成腹腔镜脾切除术。术中出血50～600ml,平均200ml。手术时间50～150min,平均136min（包括胆囊切除时间）。术后住院时间5～10d,平均7.8d,所有患者住院期间无暴发感染、胰漏等并发症发生。术后随访4～12个月,平均6.7个月,术前症状完全消失。结论腹腔镜脾切除术是治疗遗传性球形红细胞增多症的一种安全有效的方法。     

腹腔镜治疗脾脏疾病

腹腔镜技术在脾脏外科的应用已有13年的历史。由于新型手术器械和设备的不断涌现,脾脏基础研究的不断开展,以及脾切除手术技巧的提高,腹腔镜脾脏外科已发生了质的飞跃,是继腹腔镜胆囊切除全面推广后又一种成熟的腹腔镜技术。笔者根据自己的经验和有关文献就腹腔镜治疗脾脏疾病的几个问题进行探讨如下。一、腹腔镜脾切除术(laparoscopic splenecto-my,LS)的适应证和禁忌证LS的适应证选择应遵循从易到难的原则:①需行脾切除治疗的血液病病人。如遗传性球形红细胞增多症、原发性血小板减少性紫癜(ITP)、遗传性椭圆形红细胞增多症、霍奇金病…     

腹腔镜脾切除术治疗血液系统疾病51例报告

目的：探讨腹腔镜脾切除术治疗血液系统疾病的可行性及效果。方法：应用腹腔镜脾切除术治疗经内科治疗无效或治疗后复发的原发性血小板减少性紫癜（idiopathic thrombocytopenic purpura,ITP）患者42例,遗传性球形红细胞增多症（hereditary spherocytosis,HS）患者9例。结果：本组51例无手术死亡及严重并发症发生,脾切除术后血液检测指标均明显改善,术后第7天ITP患者的血小板计数均值由23×109/L升为618×109/L;HS患者的网织红细胞均值由18%降至2.1%,血红蛋白均值由6.1g/L升至9.8g/L。结论：腹腔镜脾切除对部分血液系统疾病的治疗具有微创、安全、有效、美容效果好、术后患者康复快等优点,值得推广应用。     

经腹腔镜脾切除治疗血液病

我院于 1993年 10月至 2 0 0 1年 2月应用腹腔镜脾切除术治疗原发性血小板减少性紫癜 (ITP)及遗传性球形红细胞增多症 (HS)患者 2 0例 ,并与传统手术方法进行比较 ,报告如下。临床资料1.一般资料 :腹腔镜脾切除组中 ,原发性血小板减少性紫癜患者 16例 ,遗传性球形红细胞增多症 4例。男 7例 ,女13例 ,年龄 16～ 6 5岁 ,平均 33岁。脾脏大小 8cm× 5cm×4cm～ 2 2cm× 13cm× 6cm ,平均 12cm× 8cm× 5cm。术中发现副脾 4例 (2 0 % )。 1988年 7月至 1993年 8月间应用传统手术方法脾切除治疗血液病患者 2 2例 ,其中原发性血小板减少性紫癜患…     

腹腔镜脾切除术

1991年，Delaitre首先报道了一腹腔镜脾切除术(LS)的病例．此后很多医生果用这一技术治疗原发性血小板减少性紫囊(ITP)，遗传性球形红细胞增多症等血液病。虽LS的手术时间较开敷脾切除术(OS)长，但就术后住院时间、胃肠道功能完全恢复时闻、术后麻醉药用量及美观等方面而言，LS均优于OS，是一种安全可行的脾脏切除的新方法。     

血液病行选择性脾切除术后早期病程:骨髓增生症患者併发症率最高

血液病患者多数为治疗目的行脾切除,但有时手术也为诊断目的。脾切除术对自家免疫性疾病的效果已经明确,而对其他血液病如恶性淋巴增生或骨髓增生、脾切除术的效果就难以肯定,因为这些患者一般情况常很恶劣、易患感染、容易出血。脾切除术后可能取得的临床效益必须与术后并发症及死亡率的危险性仔细权衡。因此本文分析术后早期佛发症的发生率及类型,并找出可能影响并发症与死亡率的病人特征的关系。     

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??Splenectomy for hematological disease:an analysis of 64 casesLIU Ji??SUN Bei??JIANG Hong??chi??et al.Department of Hepatopancreato Biliary Surgery??the First Affiliated Hospital of Harbin Medical University??Harbin 150001,China Corresponding author??SUN??Bei?? E??mail??sunbei70@tom.com AbstractObjectiveTo investigate the therapeutic efficacy,indications and postoperative complications of splenectomy in patients with hematological diseases.MethodsThe clinical data of 64 patients suffering from hematological diseases admitted between January 1996 and January 2008 at the First Affiliated Hospital of Harbin Medical University were analyzed retrospectively.The therapeutic efficacy,the postoperative complications and some preventive measures were discussed.ResultsSplenectomy could exert significant therapeutic effects on the diseases of idiopathic thrombocytopenic purpura (ITP),hereditary spherocytosis (HS),autoimmune hemolytic anemia (AHA) and polycythemia vera (PV).The effective rates were 84%,100%,60% and 50% respectively.But the treatment effects on the others diseases such as non??Hodgkin′s lymphoma (NHL),myelofibrosis,chronic myelogenous leukemia were below the mark.ConclusionSplenectomy is effective on the benign hematological diseases whenever non??surgical management is invalid.However,the malignant hematological diseases treated by splenectomy need to be choosed carefully.     

胰腺损伤后期并发症诊断和治疗

胰腺损伤发生率有逐年增高趋势,其并发症发生率和病死率高,然而其高病死率与并发症的发生发展密切相关,正确认识和处理胰腺损伤的后期并发症是提高其治愈率的关键。创伤性胰腺炎、胰瘘、胰腺假性囊肿、感染、肠瘘等是胰腺损伤后的常见并发症。     

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胰腺损伤发生率有逐年增高趋势,其并发症发生率和病死率高,然而其高病死率与并发症的发生发展密切相关,正确认识和处理胰腺损伤的后期并发症是提高其治愈率的关键。创伤性胰腺炎、胰瘘、胰腺假性囊肿、感染、肠瘘等是胰腺损伤后的常见并发症。     

以麻痹性肠梗阻为主要临床表现的急腹症29例诊治分析

目的 总结以麻痹性肠梗阻为主要临床表现的急腹症的诊治经验。方法 回顾性分析哈尔滨医科大学第一临床医学院2005年1月至2008年5月收治的29例以麻痹性肠梗阻为主要临床表现的急腹症病人的临床资料。结果 29例包括：阑尾炎坏疽穿孔12例,胆囊穿孔3例,肝脓肿破溃2例,胃十二指肠穿孔5例,肠伤寒穿孔2例,蛔虫性小肠穿孔1例,结肠肿瘤致穿孔2例,急性血运障碍性肠梗阻2例。治愈27例（93.1%）,死亡2例(6.9%)。结论 以麻痹性肠梗阻为主要临床表现的急腹症术前病因诊断困难,除外反射性、代谢性、药物性等因素应尽早剖腹探查。     

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??High risk factors and managements of pancreatic fistula after acute pancreatitis SUN Bei??LI Le. Department of Hepatobiliary and Pancreatic Surgery??the First Affiliated Hospital??Harbin Medical University??Harbin 150001??China
Corresponding author: SUN Bei??E-mail: sunbei70@tom.com
Abstract Pancreatic fistula is the most common complication after acute pancreatitis and the clinical manifestations are highly variable. Pancreatic fistula is best managed by a multidisciplinary team comprised of endoscopists??interventional radiologists and surgeons in the field of acute pancreatitis therapy. Minimally invasive oriented and damage control surgery modeled therapeutic concepts leads clinicians to solve the followed complications by conservative treatments and endoscopic treatments. Surgical interventions should be processed only when all the procedures above failed.     

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??The surgical experience for the tumor of neck of pancreas??A report of 102 cases ZHANG He??SUN Bei??CHEN Hua??et al. Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University??Harbin 150001??China
Corresponding author??SUN Bei??E-mail??sunbei70@tom.com
Abstract Objective To summarize the experience of the surgical treatment of the tumor of neck of pancreas. Methods The clinical data of patients with tumor of neck of pancreas who undergone the surgical treatment between January 1, 2008 and December 1, 2013 in the First Affiliated Hospital of Harbin Medical University were analyzed retrospectively. Results All the cases included 24 cases of enucleation of the tumor??22 cases of central pancreatectomy??33 cases of distal pancreatectomy??22 cases of pancreaticoduodenectomy??1 case of duodenum-preserving pancreatic head and neck resection. Pancreatic fistula occurred in 35 cases??34.3%??. Two cases were treated with a stent in pancreatic duct and the others were cured with non-invasive methods. Biliary fistula occurred in 1 case 12 days after operation and was cured without invasive process. Two cases with postoperative hemorrhage were treated with operations and discharged from hospital with healing. No perioperative death occurred. Conclusion There are so many kinds of surgical techniques for the tumor of neck of pancreas. We should choose a radical, safe surgery and try to preserve the function of pancreas.     

急性胰腺炎并发胰瘘高危因素及治疗

胰瘘是急性胰腺炎最常见的并发症,病人常表现出不同的临床症状。对于胰瘘的治疗,建议通过多学科协作,由内镜科、介入科和外科医师组成治疗团队,以微创治疗策略为导向,以损伤控制外科理念为原则,通过非手术治疗、内镜及介入治疗等尽最大可能解决并发胰瘘带来的后续问题,但当以上方法无效时,外科手术则成为解决问题的最终途经。     

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重症急性胰腺炎(severe acute pancreatitis,SAP)病因复杂、并发症多、病死率高,临床治疗措施纷繁各异。不同时期人们对其认识存在时代局限性。纵观SAP诊治发展史,其治疗观念的转变和疗效的提高呈现曲折式发展的态势。当今,科学技术和医学蓬勃发展,尤其进入新世纪后,基础医学、相关学科、边缘学科融入与交叉,使得SAP疗效显著提高。现代SAP治疗的新亮点主要体现为多学科与微创化。     

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胰十二指肠切除术是腹部外科最具挑战性的手术之一。其手术时间长,操作复杂,切除范围广,对切除后消化道重建提出较高要求。经过外科医生不懈的努力,已经衍生出多种重建方式。合理的选择重建方式是胰十二指肠切除术成功与否的关键。选择合适的、术者熟练掌握的重建方式对于胰十二指肠切除术后并发症的防治具有重要意义。     

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??Clinical stages and surgical strategies of gallbladder carcinoma SUN Bei, ZHANG Guang-quan. Department of Biliary and Pancreatic Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001?? China
Corresponding author: SUN Bei, E-mail: sunbei70@tom.com
Abstract Gallbladder carcinoma represents common and malignant type among the biliary tract carcinoma associated with poor prognosis. Surgical resection is considered as the only efficient therapeutic method and specific operation is based on gallbladder carcinoma clinical stages. TNM staging system for gallbladder carcinoma, developed by the American Joint Committee on Cancer and the International Union Against Cancer, is the most widely used and is a guideline for the appropriate therapy and prognosis of gallbladder carcinoma.