肝吸虫及粘液团块致胆道阻塞20例临床分析

报道２０例华支睾肝吸虫粘液团块致胆道阻塞病例，全部术前误诊。认为重视肝吸虫流行病学特点，注意本病病史长，黄疸波动的临床表现以及肝吸虫的特殊影像学表现，可以提高术前诊断率。本病的治疗原则是：解除胆道梗阻，保持胆汁引流通畅，药物驱虫。如果术前能明确诊断，非手术治疗是首选。     

人工合成可吸收性夹在腔镜手术中的应用

对25例胸、腹腔镜手术的病人使用人工合成可吸收性夹来钳闭胆囊管、阑尾残端及胸、腹腔内脏器管的较大血管。结果表明:病人使用本夹无并发症发生。认为:人工合成可吸收性夹克服了金属钛夹的诸多不足,具有操作简便、安全可靠的优点,适合大多数腔镜手术的使用。     

腹腔镜脾切除术治疗免疫性血小板减少性紫癜——单个教学医院经验

Background  High anatomic location, fragility, and generous blood supply of the spleen makes laparoscopic splenectomy (LS) difficult to master, and few patients need splenectomy for benign disorders. The aim of this research was to assess operative outcomes and hematological results of a large series of patients treated with LS for chronic immune thrombocytopenic purpura (ITP) and to determine which clinical variables predict favorable hematological outcome.

Methods  LS was successfully performed for 154 patients with chronic ITP from September 1999 to April 2009 at the First Affiliated Hospital of Sun Yat-sen University. Operative outcomes were assessed retrospectively. Long-term follow-up data were obtained from outpatient medical records and phone interviews. Clinical and laboratory variables (including gender, age, disease duration before surgery, previous response to steroids, preoperative platelet count, and postoperative peak platelet count) were evaluated by univariate analysis to identify potential predictors of hematological outcome. Multivariate Logistic regression model was used to determine independent predictors of hematological outcome.

Results  One patient died from subphrenic abscess and postoperative sepsis. The overall major morbidity rate was 8.4%. None of the patients required a second surgery for complications. Of the 127 patients available for a mean follow-up of 43.6 months (range 9–114 months), the overall initial response (i.e., at two months after LS) and long-term response to LS were achieved in 89.0% and 80.3%, respectively. Five patients (3.9%) developed pneumonia 3–35 months after LS. Univariate analysis showed a significant difference in mean age between responders (29.1 years) and nonresponders (38.8 years; P <0.05). Patients who responded to steroid therapy had better hematological outcome than those who did not respond (P <0.05). Compared to nonresponders, responders to LS had a significantly higher postoperative peak platelet count (404×10⁹/L versus 213×10⁹/L, P <0.001). Multivariate Logistic regression analysis identified postoperative peak platelet count as the only independent predictor of favorable response to LS ( P <0.001).

Conclusions  LS is a safe and effective treatment for chronic ITP. Postoperative peak platelet count may serve as a major predictor of long-term response.

     

华支睾吸虫致肝胆管梗阻的诊治

华支睾吸虫病是一种流行性寄生虫疾病,人们通过进食感染了吸虫病的生鱼虾类食物而生病。今年《南方日报》报道广东人群平均感     

二氧化碳气腹对红细胞变形能力影响的临床观察

采用核孔滤膜法对二氧化碳气腹腹腔镜手术(1 组) 手术前、麻醉后气腹前、气腹后30min、手术后24h 及开腹手术(2 组)手术前、手术中、手术后24h 红细胞变形能力(RCD) 进行测定,结果发现1 组气腹后及手术后RCD 较手术前及气腹前减弱,统计学分析有显著差异( P<0 .05),1 组与2 组手术后RCD 比较有显著差异(P< 0.05)     

内镜超声检查在腹腔镜胆囊切除术前的价值

目的评估内镜超声检查(EUS)对于胆囊结石患者在行腹腔镜胆囊切除术(LC)术前排除胆总管下段良性疾病的价值。方法回顾性分析我院从2004年1月至2008年1月患有胆囊结石并行LC的住院病历资料共1000例,选取常规B超(BUS)提示胆总管直径≥0.7cm病例共202例,分为EUS组和BUS组,计算EUS组的诊断率、敏感度、特异度,BUS组的胆总管下段良性病变的漏诊率。结果 EUS的对胆总管良性疾病的敏感度和特异度分别为98.2%、92.5%,阳性预测价值阴性预测价值分别为94.7%、92.5.4%,术前正确诊断率为95.8%;BUS组对胆总管结石的术前漏诊率为55.7%(21/46),对所有胆总管下段良性疾病的漏诊率为65.2%(30/46);所有EUS组患者未发生严重并发症。结论胆囊结石患者当术前B超提示胆总管直径≥7mm时,胆总管结石或者下段良性病变的比例为65.2%,其中大部分为胆总管结石,EUS对胆总管下段良性疾病诊断的敏感度、特异度、阳性预测价值、阴性预测价值和正确诊断率均高于90%,因此EUS可以作为胆总管良性扩张的诊断筛查方法。     

腹腔镜脾切除术治疗不同类型的免疫性血小板减少性紫癜

【目的】探讨腹腔镜脾切除术（LS）治疗皮质激素治疗无效型（SR）和激素依赖治疗型（SD）的免疫性血小板减少性紫癜（ITP）的结果。【方法】回顾性分析1999年9月至2008年2月期间129例成功完成LS的ITP患者的临床资料,并分为SR组（82例）与SD组（47例）,比较两组的治疗结果。统计方法中率的比较采用χ2检验,均数比较采用Studentt检验。【结果】129例患者并发症发生率为9.3%,1例SR型患者因术后腹腔感染、败血症而死亡。血液学疗效：79.1%患者完全显效（CR）,10.1%部分显效（PR）,10.8%无效（NR）。SR组与SD组患者术前1d血小板计数分别为（90&#177;66）&#215;10^9/L和（124&#177;69）&#215;10^9/L（P〈0.05）,手术时间分别为（120&#177;46）min和（121&#177;45）min（P〉0.05）,术中出血量分别为（83&#177;145）mL和（95&#177;288）mL（P〉0.05）,术后48h总引流量分别为（106&#177;148）mL和（65&#177;67）mL（P〈0.05）,并发症发生率分别为9.7%和8.5%（P〉0.05）,术后7d血小板计数分别为（340&#177;215）&#215;10^9/L和（426&#177;264）&#215;10^9/L（P〈0.05）。血液学疗效：SR组CR70.7%,PR12.2%,NR17.1%,而SD组CR93.6%,PR6.4%,两组间差异有统计学意义（P〈0.05）。【结论】LS治疗ITP具有良好的疗效。在术前准备妥当的情况下,SR型患者手术安全性与SD型相近,但其总体血液学疗效明显差于后者。     

肝吸虫及粘液团块致胆道阻塞20例临床分析

报道２０例华支睾肝吸虫粘液团块致胆道阻塞病例，全部术前误诊。认为重视肝吸虫流行病学特点，注意本病病史长，黄疸波动的临床表现以及肝吸虫的特殊影像学表现，可以提高术前诊断率。本病的治疗原则是：解除胆道梗阻，保持胆汁引流通畅，药物驱虫。如果术前能明确诊断，非手术治疗是首选。