先天性胆管囊肿的外科治疗及疗效分析

目的 探讨先天性胆管囊肿外科治疗手术方式对疗效的影响。方法 在15年间收治先天性胆管囊肿患者120例，在本院首次手术者73例。手术方式分3类5种。I类：单纯囊肿外引流术（7例）；Ⅱ类：囊肿空肠Roux-en-Y吻合术（5例）；Ⅲ类：囊肿切除并肝管空肠Roux-en-Y吻合（32例）或囊肿切除并间置空肠肝管十二指肠吻合术（25例）；不规则手术4例。结果 68例术后随访6个月－5年（中位时间2．年），Ⅰ类手术再手术3例；Ⅱ类手术后因出现反流性胆管炎和胆道结石而再手术2例；Ⅲ类手术类后生活质量达优率为88．7％，无再手术。结论 单纯囊肿外引流只是一种应急措施；囊肿内引流术只有能解决短期的胆汁引流问题，并发症多导致再次手术；囊肿切除并胆道理建术是比较理想的治疗方式。     

胰腺体尾部腺癌的临床分析（附42例报告）

目的 总结胰腺体尾部腺癌的外科治疗经验,探讨胰腺体尾部腺癌的外科疗效。方法 对1987～1998年间收治的42例有病理证实的胰腺体尾部腺癌病人进行回顾性临床分析。结果 42例中,30例行探查手术,12例切除病变的胰腺,手术切除率40%,总切除率28.6%,术后30d死亡率为0 。切除术后9例存活达12.0个月,5例存活24.0个月,其中有4例仍存活,2例存活36.0个月。未能手术切除者平均生存期4.4个月（1.2～10.5个月）。结论 胰腺体尾部腺癌的预后极差,5年生存率很低,但手术切除病变的胰腺可显著延长病人的生存期,特别是对于病变尚属限于胰腺体尾部的患者。     

肝切除术20年回顾:单一中心连续2008例肝切除术的经验

目的 分析与肝切除术相关的手术期和围手术期因素.方法 回顾性研究和分析解放军总医院1986至2005年2008例连续性肝切除手术病例的临床资料.结果 2008例肝切除病例中恶性肿瘤占58.5%,其中原发性肝癌占76.1%,肝门胆管癌占6.7%;良性疾病占41.2%,其中血管瘤占41.7%,肝内胆管结石占29.6%.实施单独尾状叶切除术25例,微波在线预凝肝切除术236例.全部肝切除病例术中出血量＜200 ml者占50.5%,＞400 ml者占28.4%;而微波在线预凝肝切除术中出血量＜200 ml者占60.6%,＞400 ml者占19.9%,两数值均明显区别于全部肝切除病例(P＜0.05).总的术后并发症发生率为14.44%,转移性肝癌为16.40%,肝内胆管结石为16.32%;原发性肝癌的术后并发症发生率为12.54%,其中小肝癌和巨大肝癌分别为11.65%和14.69%,二者差异无统计学意义.总的住院病死率为0.55%,其中肝恶性肿瘤住院病死率为0.60%,肝门胆管癌为2.53%.结论 在重视优化围手术期处理和创新手术技术的前提下,能够使肝切除术保持低并发症发生率和低病死率.     

肝海绵状血管瘤外科治疗20年的经验与反思

Objective To summarize the experience in surgical treatment of hepatic cavernous hemangioma (HCH). Methods The clinical data of 345 patients who received HCH resection in General Hospital of PLA from 1986 to 2005 were retrospectively analyzed. Results The ratio between male and female patients was 1/1.8. Eighteen patients (5.2%) were incidentally found with HCH during or after operation. Most of the HCH were located in the right lobe, with the proportion of 16.2% (56/345). Ninety-one patients (26.5%) had small HCH (diameter<5.0 cm), 173 (50.3%) had large HCH (diameter ranging from 5.0-10.0 cm), and 80 (23.2%) had giant HCH (diameter>10.0 cm). The mean diameter of the HCH was (8.0±5.0) cm. Three hundred and twenty-three (99.7%) patients were with Child pugh A. Right subcostal incision and enucleation were performed on all patients. The incidence of postoperative complications and mortality were 11.3% (39/345) and 0.3% (1/345), respectively. Caudate lobe resection was performed on 9 of 11 patients with the tumor located in caudate lobe. Conclusions Some HCHs may be easy to be misdiagnosed as hepatic solid tumor. HCH resection (inclu-ding hepatic caudate lobectomy) is safe for patients with HCH, and the most severe operative complication is massive bleeding during hepatectomy.     

肝海绵状血管瘤外科治疗20年的经验与反思

Objective To summarize the experience in surgical treatment of hepatic cavernous hemangioma (HCH). Methods The clinical data of 345 patients who received HCH resection in General Hospital of PLA from 1986 to 2005 were retrospectively analyzed. Results The ratio between male and female patients was 1/1.8. Eighteen patients (5.2%) were incidentally found with HCH during or after operation. Most of the HCH were located in the right lobe, with the proportion of 16.2% (56/345). Ninety-one patients (26.5%) had small HCH (diameter<5.0 cm), 173 (50.3%) had large HCH (diameter ranging from 5.0-10.0 cm), and 80 (23.2%) had giant HCH (diameter>10.0 cm). The mean diameter of the HCH was (8.0±5.0) cm. Three hundred and twenty-three (99.7%) patients were with Child pugh A. Right subcostal incision and enucleation were performed on all patients. The incidence of postoperative complications and mortality were 11.3% (39/345) and 0.3% (1/345), respectively. Caudate lobe resection was performed on 9 of 11 patients with the tumor located in caudate lobe. Conclusions Some HCHs may be easy to be misdiagnosed as hepatic solid tumor. HCH resection (inclu-ding hepatic caudate lobectomy) is safe for patients with HCH, and the most severe operative complication is massive bleeding during hepatectomy.     

原发性肝癌的超声与临床病理诊断的对比

目的 对比观察肝癌的超声与临床病理特征。探讨超声检查在肝癌诊断与病程判断中的应用效果。方法 自1988年至1996年经手术治疗原发性肝癌304例。经B超检查65例，彩色超声多普勒检查239例．其中趣声引导下行穿刺活检18例。结果 经超声检查拟诊为肝癌者263例，诊断符音率为86．5%=42例诊断不符合者包括误诊9例．仅提示可疑病灶30例．未发现病灶3例。可疑病灶经穿刺活检诊断率为94．4％(17／18)。无论原发癌灶大小，超声对卫星灶、脉管癌栓、淋巴结转移三者总的检出率仅分别为48．1％(51／106)、40．5%(32／79)、36.8％(14／38)。结论 对没有典型超声图像特征而AFP为阴性的病灶．可选择穿刺活检以防误诊或漏诊。超声对肝癌病程发展的判断与手术后临床存有诊断差距，临床医生应结合CT、MRI或DSA检查推断实际病程。     

胰腺囊性病变的诊断与治疗(附40例报告)

目的探讨胰腺囊性病变诊断与治疗的有效方法。方法总结我科１９９２～１９９７年收治的经手术和病理证实的４０例胰腺囊性病变的诊治经验。结果患者主要临床表现为上腹部胀痛、腹部包块,Ｂ超、ＣＴ扫描见胰腺囊性肿块。但定性诊断仅靠临床表现、影像学检查较困难,特别难以鉴别假性囊肿与囊性肿瘤。结论胰腺囊性病变的确诊需病理诊断,正确的诊断决定治疗方式的选择。     

胰腺体尾部癌88例临床分析

目的探讨胰腺体尾部癌的诊断与治疗.方法回顾性分析我院1983年7月至2004年7月收治的88例经病理证实的胰腺体尾部癌病人的临床资料.结果 88例中,男57例,女31例,上腹部胀痛不适和腰背部疼痛是主要临床症状,B超确诊率为78.4%（69/88）,CT确诊率为84.5%（60/71）.MRI确诊率为87.5%（28/32）.57例病人行手术治疗,其中行胰体尾癌根治性切除20例,行胃空肠吻合4例;^125I粒子置入术1例;剖腹探查活检32例,手术总切除率为22.7%.31例行B超下穿刺活检,未行手术.行胰体尾根治性切除者的1,3,5年生存率分别为70%（14/20）,30%（6/20）,15%（3/20）.结论胰腺体尾部癌病人预后差,改善预后的关键在于早期诊断,提高根治切除率.     

加氧低温灌流下31磷-磁共振频谱与肝酶测定在判断大鼠供肝活力中的意义

目的　探讨判断经受热缺血的肝脏活力的方法。方法　将 18只SD大鼠随机分成 3组 :A组肝脏热缺血时间 (WI)为 0min ;B组WI为 30min ;C组WI为 6 0min。各组肝脏冷保存后 2～2 .5h ,采用31磷 磁共振频谱 (31P MRS)测定各组加氧低温灌流 30min时的离体肝脏频谱 ,同时测定保存液和灌流液中肝酶的变化。结果　β 三磷酸核酸 (β NTP)与亚甲基二磷酸 (MDP)的比值 ,B组与A组比较 ,P >0 .0 5 ;C组与A、B组比较 ,P <0 .0 1。肝酶测定结果 :随着热缺血时间的延长 ,保存液中的肝酶逐渐升高 ,每组之间比较 ,差异均有显著性 (P <0 .0 5 ) ;灌流液中的肝酶 ,A组与B组比较 ,差异无显著性 (P >0 .0 5 ) ,C组与A、B两组比较 ,差异均有极显著性 (P <0 .0 1)。结论　测定加氧低温灌流下大鼠离体肝脏的ATP再生能力能较好判断其活力 ,该方法在临床热缺血供肝活力的判断上具有一定参考价值 ;同时测定保存液和灌流液中的肝酶含量 ,能配合31P MRS判断肝脏的活力。     

大肠多原发癌18例总结

本院收集了我院自1972年至1985年间485例大肠癌中18例大肠多原发癌(发病率3.75％),其中同时多原发癌8例(44.4％),异时多原发癌10例(55.5％)。首发癌部位无一定规律,后发生的原发癌多见于降结肠及乙状结肠。本组资料表明大肠息肉易发生多原发