高脂血症性急性胰腺炎15例治疗体会

2001年1月～2006年6月，我们共收治急性胰腺炎（AP）患者160例，其中高脂血症性急性胰腺炎15例。现回顾性分析其临床资料，以提高其诊治水平。     

术后胃瘫综合征28例诊治分析

术后胃瘫综合征（Postsurgicalgastroparesis syndrome，PGS）是一种腹部手术后非机械性梗阻、以胃排空障碍为主要征象的胃动力紊乱综合征。PGS病程长，易发生营养不良和水电解质平衡紊乱，影响术后的快速康复。常见于术后3～10d，主要表现为上腹部胀满、吸气、反酸、呕吐大量胃内容物或宿食等，直接影响术后疗效。近年来，术后胃瘫的发生率逐渐上升。正确的诊断和治疗胃瘫，对避免盲目再手术，     

外科手术后营养不良并发Wernicke脑病 (附3例报告)

Ｗｅｒｎｉｃｋｅ脑病是维生素Ｂ1缺乏所致的急性或亚急性中枢神经系统代谢性疾病。经典的病例多见于慢性酒精中毒 ,营养不良 (如妊娠剧吐 )等。而在外科手术后营养不良并发该病者国内报告不多 ,现将本院 1995～ 1998年诊治 3例报告如下。1　病历摘要1.1　例 1,男性 ,4 9岁 ,工人 ,因上腹痛 2个月诊为“结肠癌”。入院后行“右半结肠切除加十二指肠憩室切除术” ,术后 2 0天不能进食 ,呕吐 ,上消化道造影考虑十二指肠水平部梗阻 ,行“空肠十二指肠Ｒｏｕｘ ｙ吻合术 ,粘连松解术” ,术后 4天排便、排气 ,但仍有呕吐深绿色胃液 ,患者术后半个…     

胰腺癌化疗进展

胰腺癌是较常见的消化系统恶性肿瘤之一 ,在西方国家的发病率为 12 .5 /10万 ,患者病死率超过 97% [1] 。近 2 0年来 ,胰腺癌在治疗上进展甚微 ,关键问题大部分患者确诊时已属晚期 ,失去手术切除的机会[2 ,3] 。胰腺癌根治性手术切除率仅在 18%左右[4 ] 。胰腺癌患者的自然病程ＵＩＣＣⅢ(ＴＸＮ1Ｍ0 )为 4.8个月 ,ＵＩＣＣⅣ为 2个月[5] 。在寻求早期诊断努力外 ,还要重视胰腺癌的综合治疗 ,尤其是化疗。化疗对能否手术切除的胰腺癌患者都能显著提高其生存期和生活质量[6,7] 。目前 ,胰腺癌的化疗方案尚无统一标准 ,但化疗中研究最多 ,应用…     

腹腔镜联合胆道镜治疗胆道结石29例分析

目的 探讨腹腔镜联合胆道镜在治疗胆道结石中的临床应用价值。方法 两镜联合治疗胆总管结石患者29例。采用腹腔镜联合胆道镜行胆囊切除、胆总管探查取石术，胆总管放置T管引流27例，胆总管一期缝合2例。结果 均以微创外科方法完成手术，术中未置胃肠减压管。平均手术时间86min。术后疼痛轻微，1～2d胃肠功能恢复。T管放置时间为2个月，均经T型管造影证实无残余结石后拔出T型管。住院天数6～9d（带T管出院），平均7d。无明显并发症发生，7例残留结石术后3个月后在门诊经纤维胆道镜取石后拔除T型管。结论 腹腔镜结合胆道镜胆囊切除、胆总管探查取石术与开腹的传统胆囊切除、胆总管探查取石术比较，其手术适应证、术前准备、术后处理相似；但腹腔镜技术具有损伤小、痛苦轻、恢复快、住院时间短、术后并发症少等优点，具有广泛的临床应用前景。     

姑息手术加区域灌注化疗治疗晚期胰头癌

胰腺癌是一种高度恶性的消化道肿瘤,主要为导管细胞癌.其中胰头癌占70%～80%,发病率呈逐年上升趋势.胰头癌手术切除率低,仅15%左右.因此姑息手术加化疗等综合治疗成为当今治疗胰头癌的主要手段.     

川芎嗪注射液对梗阻性黄疸大鼠血及肝组织中内皮素含量的影响

目的探讨川芎嗪注射液（Ligusticum wallichii piperazine injections，LWPI）对梗阻性黄疽（OJ）大鼠血及肝组织中内皮素（endothelin，ET）水平的影响及其对肝脏的保护作用。方法采用胆总管结扎法（bile duct ligation，BDL）建立OJ模型，注射生理盐水及州芎嗪注射液．观测血清谷丙转氨酶（ALT）及总胆红素（T—Bil）的变化，并与肝组织病理改变进行对照分析。结果①大鼠OJ形成14d后，血浆及肝组织中ET含量与对照组及假手术组相比明显升高，ALT、T—Bil亦明显增高，其变化与病理改变一致。②应用川芎嗪注射液干预后血及肝组织中ET与OJ模型组相比明显下降，ALT、T—Bil亦明显下降。病理结果显示肝组织损伤减轻。结论川芎嗪注射液可降低OJ大鼠血及肝组织中重要的致伤因子ET的含量，减轻肝损伤，发挥其减黄、保肝的作用。     

急性肠系膜上静脉血栓的诊疗体会

急性肠系膜上静脉血栓（superior mesentericvenous thrombosis,SMVT）形成是一种少见的急腹症。最早由Eilot在1895年首先报道,1935年由Warren和Eberthert总结并确立了临床上相对独立的完整的疾病[1]。SMVT是一种肠系膜静脉阻塞性疾病,发病率较低,因其症状不典型、     

脱细胞真皮基质和聚丙烯补片修补大鼠腹壁疝的实验研究

Objective To study the value of porcine acellular dermal matrix(ADM) made by complex maceration and Marlex mesh as ventral hernia-repairing material. Methods ADM was made from the full thick skin of the back of swines by complex maceration. The male SD rats were randomly divided into three groups including ventral hernia group(n =7), ADM group(the ventral hernia repaired by ADM, n =28) and Marlex mesh group (the ventral hernia repaired by Marlex mesh group, n = 10). The occurrence of ventral hernia was observed on postoperative 1 week. Six rats were respectively selected from the Marlex group and ADM group and tension resistance at 5weeks after surgery was observed. Results The occurrence of ventral hernia in ADM group and Marlex mesh group was significantly lower than that of ventral hernia group(0.04%, 0.0%, 100.0%, P ＜ 0. 01 ) in postoperative 1week, but there was no difference between ADM group and Marlex mesh group ( P ＞ 0.05 ). Marlex had a significantly higher breaking strength than ADM[(417 ±44)N vs( 111 ±27)N,P ＜0.01]. But 5 weeks after surgery, the tension resistance of ADM-fascial interface was higher than that of the Marlex-fascial [( 103 ± 27 ) N vs(71 ± 19 ) N,P ＜ 0. 05]. Conclusion As a material of repairing ventral hernia, ADM prepared by the complex maceration may be superior to Marlex mesh.     

脱细胞真皮基质和聚丙烯补片修补大鼠腹壁疝的实验研究

Objective To study the value of porcine acellular dermal matrix(ADM) made by complex maceration and Marlex mesh as ventral hernia-repairing material. Methods ADM was made from the full thick skin of the back of swines by complex maceration. The male SD rats were randomly divided into three groups including ventral hernia group(n =7), ADM group(the ventral hernia repaired by ADM, n =28) and Marlex mesh group (the ventral hernia repaired by Marlex mesh group, n = 10). The occurrence of ventral hernia was observed on postoperative 1 week. Six rats were respectively selected from the Marlex group and ADM group and tension resistance at 5weeks after surgery was observed. Results The occurrence of ventral hernia in ADM group and Marlex mesh group was significantly lower than that of ventral hernia group(0.04%, 0.0%, 100.0%, P ＜ 0. 01 ) in postoperative 1week, but there was no difference between ADM group and Marlex mesh group ( P ＞ 0.05 ). Marlex had a significantly higher breaking strength than ADM[(417 ±44)N vs( 111 ±27)N,P ＜0.01]. But 5 weeks after surgery, the tension resistance of ADM-fascial interface was higher than that of the Marlex-fascial [( 103 ± 27 ) N vs(71 ± 19 ) N,P ＜ 0. 05]. Conclusion As a material of repairing ventral hernia, ADM prepared by the complex maceration may be superior to Marlex mesh.