皮下通道型胆囊肝胆管成形术治疗区域性肝胆管结石的中远期疗效观察

目的 观察皮下通道型胆囊肝胆管成形术(STHG)治疗区域性肝胆管结石的中远期疗效。方法 对我院1994年12月—2000年8月期间行STHG手术的31例患术后并发症进行统计分析。结果 STHG术后并发症发生率低，且并发症种类少。结论 STHG保留了胆囊及Oddi括约肌功能，维持了正常的胃肠道生理结构，能有效防止返流性胆管炎及术后的消化功能紊乱，是一种较为理想的治疗区域性肝胆管结石的术式。     

皮下通道型胆囊肝胆管成形术治疗区域性肝胆管结石的中远期疗效观察

目的 观察皮下通道型胆囊肝胆管成形术(STHG)治疗区域性肝胆管结石的中远期疗效。方法 对我院1994年12月-2000年8月期间行STHG手术的31例患者术后并发症进行统计分析。结果 STHG术后并发症发生率低,且并发症种类少。结论 STHG保留了胆囊及Oddi括约肌功能,维持了正常的胃肠道生理结构,能有效防止返流性胆管炎及术后的消化功能紊乱,是一种较为理想的治疗区域性肝胆管结石的术式。     

一种治疗肝胆管结石和狭窄的术式——皮下通道型肝胆管成形术35例临床分析

对于肝胆管结石的治疗目前已取得了很多成功的经验，但最常使用的胆肠吻合术虽经不断改进，仍未能从根本上解决返流性胆管炎、胃肠分泌功能紊乱等并发症。为此，设计了一种新术式：即皮下通道型胆囊肝胆管成形术。在清除结石，解除肝内外胆管狭窄、肝门整形的基础上，利用胆囊壶腹部切开相应大小的切口与之吻合，并适当游离胆囊，使其底部可以被固定到切口皮下。患者必须具备基本正常的胆囊、肝外胆管和Ｏｄｄｉ括约肌。同时要求术中基本取尽肝内结石或切除病灶。已完成此手术共３５例，所有患者手术顺利，术后未发现并发症。其中１例３年后结石复发，１例２年后发生胆道蛔虫，均经皮下胆囊通道用胆道镜轻易取出。该术式既能处理好结石和狭窄问题，又能保存胆囊、胆管、Ｏｄｄｉ括约肌的功能，保持胃肠道的正常生理通路，并能以最简捷的方法处理术后结石复发和胆道内其它问题     

两种肝门整形胆道重建术后胆管炎发生和结石复发的对比

目的　评价皮下通道型胆囊肝胆管成形术 (STGH)与皮下盲袢型肝胆管空肠吻合术(SLCJ)的远期疗效。方法　随访本中心 6年间因肝胆管结石接受这两种手术方式的治愈患者 ,观察他们的胆管炎发生和结石复发的情况。结果　 198例研究对象共有 14 8例获得随访 ,平均随访时间 3年 11个月。两组间部分可能引起胆管炎、胆管结石复发的因素差异均无统计学意义。STHG组与SLCJ组术后胆管炎发生率分别为 5 4 %和 2 1 7% (P <0 0 5 ) ,胆管结石复发率分别为 3.6 %和 17 4% (P <0 0 5 )。结论　STHG组术后远期疗效优于SLCJ组。原因可能是STHG术后保留了Oddi括约肌且在胆囊与肝胆管之间建立了一个宽畅通道 ,防止了胆肠返流的发生 ,发挥了胆囊的浓缩、吸收和排空功能。因此 ,对于胆囊和Oddi括约肌功能基本正常的肝胆管结石患者应该考虑行STHG术。     

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目的：对比皮下通道型胆囊肝胆管成形术（STHG）与皮下盲襻型肝胆管空肠吻合术（SLCJ）后结石复发情况。方法：追踪随访5年间因肝胆结石接受这两种手术方式治愈的病人，观察其胆管炎发生率和胆管结石复发率。结果：共有134例病人获得随访，手术至随访时间平均4年2个月。STHG组与SLCJ组术后胆管炎的发生率分别为6．1％、21．2％，胆管结石复发率分别为4．1％、17．6％。STHG组术后胆管炎的发生率和胆管结石复发率均明显低于SLCJ组，差异有显著性意义。结论：STHG术后疗效优于SLCJ。     

皮下通道型肝囊肝胆管成形术治疗肝胆管结石和狭窄

为了解决传统的胆肠吻合术治疗肝胆和这结石所存在的各种不足，如返流性胆管炎、胃肠分泌功能紊乱等，作者设计了一种术式：即皮下通道型肝囊肝胆一管成形术。在清除结石、打开肝门胆管狭窄环，并作好整形以后，将胆囊壶腹部切开相 应大小的切口与之吻合，并适当游离胆囊，使其底部可以被固定到切口皮下。     

治疗肝内胆管结石一定要切除胆囊吗

目的 探讨胆囊在肝内胆管结石手术治疗中的应用价值，并论证保留胆囊的可行性。方法 收集1994～2002年所有肝胆管结石病人的临床资料，总结既往胆囊切除的情况和原因；研究存在胆囊的肝胆管结石病人的胆囊功能状况。介绍一种应用完整胆囊解除肝门胆管狭窄的新术式——皮下通道型胆囊肝胆管成形术(STHG)，并总结其临床疗效。结果 8年间肝胆管结石病人共计247例，81例已切除胆囊，占32．8％，胆囊存在的肝胆管结石病人166例，其中胆囊形态功能正常者125例，占75．3％。其中有102例实施了STHG，不但保留了胆囊，而且使它发挥下列重要作用：①纠正肝门狭窄，改善肝内胆管的引流；②提高肝内胆管中胆汁酸浓度，从而防止该处色素结石复发；③保留了肝外胆管及Oddi括约肌的功能，防止肠胆反流；④为日后处理肝内结石复发提供一条便利通道。结论 肝胆管结石病人大多数胆囊功能正常。STHG应用正常完整的胆囊作为肝门胆管狭窄的修补材料，其术后近远期疗效好，值得推广应用。     

肝胆管结石的微创手术治疗进展

肝胆管结石(hepatolithiasis)是指位于左、右肝管分叉以上的胆管结石。肝胆管结石常合并反复发作的胆管炎,导致肝胆管狭窄、肝实质萎缩,继发性胆汁性肝硬化甚至胆管癌。肝胆管结石病变复杂,术后并发症多、结石残余率及复发率均较高,其治疗一直是肝胆外科的难题。手术微创化是当今国际外科学发展的一大趋势,肝胆管结石的微创手术治疗方法及疗效也有了很大的进步。本文将近年来肝胆管结石的微创手术治疗进展作简要综述。     

手术治疗肝胆管结石合并狭窄的体会

目的 总结手术治疗肝胆管结石合并狭窄的经验。方法 对126例肝胆管结石合并胆管狭窄患者进行手术并随访,其中行T管引流33例,肝肠盆式Roux-Y吻合47例。胆肠Roux-Y吻合28例,胆囊人工乳头问置肝总管十二指肠吻合18例,同时附加肝左外叶切除75例,右肝部分切除27例。结果 术后发现残余结石23例(残石率18.％),胆瘘及肝脓肿各1例,上消化道出血3例,无死亡病例。随访102例,其中3年以上者87例,效果优良者占86.2％;结石复发2例,不同程度的胆管炎12例。结论 术前影像检查和合并症的处理是手术成功的保证,术式选择要视梗阻部位,胆管狭窄和扩张的程度而定,以肝叶或段切除和保留Oddi括约肌功能者疗效佳。     

肝叶切除治疗肝胆管狭窄及结石

肝胆管结石及高位胆管狭窄的治疗仍为当前胆道外科难题。本文总结我院320例肝叶切除术(右肝切除34例,左肝切除286例)的经验,全组手术死亡率1.8%,术后发生感染并发症39例次。270例获1～13年随访,远期疗效优良者84.6%。文中讨论了肝胆管狭窄及结石的常用治疗方法,主张局限于一侧或一叶的肝胆管狭窄及结石,尤以左侧肝胆管狭窄及结石伴肝实质损害者,施行左肝切除术远比左肝管Ⅰ～Ⅲ级分支广泛切开及内引流术易行,切除病灶彻底,术后疗效佳。文中亦讨论了手术适应证及手术的要点。     

Treatment of patients with recurrent gliomas with cyclophosphamide and vincristine

Seventeen patients with recurrent gliomas were treated with the combination of cyclophosphamide and vincristine. All but one had previously received and failed chemotherapy. Cyclophosphamide was administered at doses ranging from 250 to 1000 mg/sq m by intravenous infusion on Days 1 and 2, and vincristine was given at a dose of 1.0 mg/sq m (2 mg maximal dose) intravenously on Day 1; cycles were repeated every 4 weeks. Clinical and radiographic improvement was observed in eight of 16 evaluable patients, and four other patients had stabilization of previously progressive disease. Four patients are alive and off treatment without evidence of recurrence for a median period of 37 months; these included an adult with a cerebral anaplastic astrocytoma now more than 51 months after therapy. Toxicity included moderately severe myelosuppression that required hospitalization in seven patients. These results indicate that the combination of cyclophosphamide and vincristine has activity in the treatment of recurrent gliomas, and warrant the use of these drugs in larger controlled studies, particularly if they can be used in conjunction with hematopoietic growth factors.     

Interaction of verapamil with gallamine and pancuronium and reversal of combined neuromuscular blockade with neostigmine and edrophonium

In this in vitro study, the effects and interactions of verapamil with gallamine and pancuronium and reversal by edrophonium and neostigmine of combined neuromuscular blockade, produced by the muscle relaxants and verapamil, were studied in an avian skeletal muscle. The results show that verapamil reduced the amplitude of indirectly-elicited twitch tension and potentiated the neuromuscular blockade produce by the two muscle relaxants. Edrophonium and neostigmine reversed the neuromuscular blockade produce by the muscle relaxants alone, and in combination with verapamil. Edrophonium was more potent than neostigmine in reversing the combined neuromuscular blockade produced by the muscle relaxants with and without verapamil.     

胆囊切除术胆总管探查阴性48例的分析

胆囊切除同时行胆总管探查是胆道外科最常见的术式之一,但有一部分病例胆总管探查阴性。我院在1996年1月至2001年6月间,收治的急、慢性胆囊炎、胆道感染病人中共有161例施行胆囊切除加胆总管切开探查、T管引流术,其中有48例为探查阴性,术后2周T管造影无残余结石。现分析如下。临床资料本组男16例,女32例。年龄25～78岁,平均52.5岁。急诊手术41例,择期手术7例。病史:有上腹绞痛病史者48例。术前体检发现有肉眼黄疸者16例,有寒战高热者32例。既往史中有胰腺炎病史者5例,有黄疸史者10例,有寒战高热者6例。实验室检查:血、尿淀粉酶升高者16例,…     

Induction and maintenance of anesthesia with propofol and with thiopental-isoflurane. Comparative study]

Thirty one patients of both sexes, ASA I-II, aged 18-65 years have undergone a randomized trial in order to compare two anesthetic techniques. Patients in group I (n = 15) received a 2.5 mg/kg induction dose of propofol followed by a continuous infusion of the same drug at 3.6-9 mg/kg/h. Patients in group II (n = 16) were induced with 4 mg/kg thiopentone and maintained with 0.5-1.5% isoflurane. Both groups were evaluated for time and quality of induction, collateral effects, quality and hemodynamic stability during maintenance and time and quality of recovery. Induction time for patients in group I (49.6 +/- 15 seg) was significantly longer than for group II patients (23 +/- 3 seg) (p less than 0.01). Respiratory depression (apnea period longer than 20 seconds) was also commoner and longer in group I (p less than 0.01) although no problems were observed with manual ventilation. One patient in group I required an extra dose for induction. Both groups had similar hemodynamic changes along the procedure. Awakening time for patients in group I (24.2 +/- 7.3 min) was significantly longer than for patients in group II (14.3 +/- 4.4 min) (p less than 0.001). Although surgery times were longer in group I, a possible cumulative effect of propofol for infusions over 90 min cannot be discarded.