十二指肠后壁穿透性溃疡致高位胆管梗阻1例报告

十二指肠后壁穿透性溃疡致高位胆管梗阻１例报告郑朝纪，张振寰，张文哲，张树友北京协和医院（１００７３０）患着男性，６５岁，因皮肤黄染２０天伴右上腹阵发性绞痛１０天，于１９９３年５月１１日入院。患者于１９９３年４月２０日出现巩膜及全身皮肤黄染，呈进行性加...     

OVERVIEW FOR THE DIAGNOSIS AND TREATMENT OF GALLBLADDER CARCINOMA

Objective. To improve the recognition of diagnosis and treatment of gallbladder cancer. Methods. Retrospective analysis of 52 cases of gallbladder carcinoma in our hospital from 1988 to 1998. Results. Preoperative diagnostic rate was 90.3%, of which 12 cases (23%) were early stage of carcinoma. The total operation resection rate was 55.8%, for which only 17.8% were advance stage of carcinoma. Conclution. The early diagnosis is the key factor of increasing treatment successful rate. The following are the symptoms that raise our special attention to carcinoma of gallbladder: ( 1 ) Age over 50 have recurrent eholecysfitis and with past history of gallstone; (2) Congenital malformation of bile duct; (3) Local thickening and irregularity of gallbladder,gall; (4) Polypoid lesion larger than lem inside gallbladder; (5) Atrophic gallbladder; (6) Intraluminal stone of gallbladder does not move when change in body position; (7) Regional lymph node enlargement.     

胆管导管内乳头状肿瘤的临床病理特征与治疗策略

目的:探讨胆管导管内乳头状肿瘤（IPNB）的临床病理特征与治疗策略。方法:采用回顾性描述性研究方法。收集2000年8月至2020年4月中国医学科学院北京协和医院收治的40例IPNB病人的临床病理资料;男19例,女21例;年龄为（60±14）岁。病人术前均行影像学检查和血液检验,判断肿瘤位置和范围,评估其可切除性。根据病...     

109例成人型胆管囊肿的诊治经验

Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment.     

109例成人型胆管囊肿的诊治经验

Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment.     

互联网在外科临床教学中的意义简

 分析在互联网时代,互联网给外科教学带来的影响,通过分析其在外科教学过程中的应用,以便充分合理地利用互联网资源,更好地提高外科教学效果。     

90例原发性腹膜后肿瘤治疗分析

原发性腹膜后肿瘤起病隐匿，发现时肿瘤已生长巨大．完整切除率较低，术后复发率高，所以如何提高手术切除率、改善预后仍是临床急需解决的问题。我院基本外科于1996年1月-2004年12月共收治原发性腹膜后肿瘤病人113例，其中有完整病历资料记载者90例，本文对该组病人结合临床资料进行分析、探讨。     

腹腔镜手术治疗胆囊癌的安全性和效果分析

目的探讨腹腔镜手术在胆囊癌患者中应用的安全性和治疗效果。方法回顾性分析2012年1月至2022年9月北京协和医院收治的197例胆囊癌患者的临床和病理学资料。男性86例, 女性111例, 年龄(64.4±9.8)岁(范围:35～89岁)。根据手术方式不同将患者分为腹腔镜组(53例)和开腹组(144例)。应用倾向性评分匹配法对两组患者的基本信息进行匹配, 并对匹配后患者的临床资料和预后进行比较。定量资料按照是否符合正态分布分别用t检验和Mann-WhitneyU检验进行组间比较;分类资料用χ2检验或Fisher确切概率法进行组间比较。应用Kaplan-Meier曲线对两组患者的生存率进行分析, 并采用Log-rank检验进行组间比较。结果腹腔镜组和开腹组各有48例患者匹配成功。两组患者在一般情况、是否合并胆囊结石、是否接受肝脏部分切除、肿瘤分期等方面保持平衡(P值均>0.05)。匹配后腹腔镜组患者手术时间更短(t=-3.987, P<0.01), 术中出血量更少(Z=-4.862, P<0.01), 总住院时间(Z=-5.009, P<0.01)和术后住院时间(Z=...     

胆管囊肿再次手术的安全性及疗效分析

目的探讨胆管囊肿再次手术的安全性及疗效。方法回顾性分析2013年1月至2018年12月北京协和医院收治的116例胆管囊肿患者的临床资料,采用倾向值匹配法,对再次手术和首次手术病例的一般情况和并发症进行比较。结果共纳入80例患者,32例获得匹配,均为女性,平均年龄(43.7±15.7)岁。腹痛是最常见的症状,发生于29例患者(90.6%)。吻合口狭窄、肝内胆管结石、囊肿残余均是常见的再次手术原因,分别为8、6、6例。随访时间7⁷3个月,平均(36.7±22.5)个月。胆道感染是最常见的并发症,术后近期发生胆道感染6例,远期胆道感染10例。再次手术和首次手术病例在一般情况、近期及远期并发症等方面的差异均无统计学意义(P> 0.05)。结论胆管囊肿再次手术病例并不少见,吻合口狭窄是最常见的再次手术原因,再次手术和首次手术的安全性和疗效相近。     

胆囊周围炎及粘连引起十二指肠不全梗阻一例

患者女,44岁。因间断性中上腹痛6个月,反复呕吐不能进食一个月于1986年4月21日入院。患者于1982年体检时B 超发现胆囊内有数个强光团,确诊为胆囊结石。但当时并无自觉症状。自1985年9月起多次出现右上腹剧烈绞痛,但不伴发热、寒战和黄疸。曾按胆结石服中药及熊去氧胆酸治厅,疼痛有所减轻。自1986年3月下旬起,中上腹痛较前加重,无规律性,伴胃脘部不适、胀满、有振水音,每于食后加重,大约6～7小时后即出现恶心呕吐,初为食物,继为胃液。虽有饥饿感但不能多进食,每天食量约一市两左