腹腔镜在有腹部手术史肠梗阻诊治中的应用价值

①目的 探讨腹腔镜技术在有腹部手术史的肠梗阻病人诊治过程中的应用价值。②方法 回顾总结32例有腹部手术史肠梗阻腹腔镜诊治术的临床资料。③结果 腹腔镜对肠梗阻的诊断符合率达97．3％，但腹腔镜肠粘连松解术的完成率仅有46．9％，主要是受手术设备、器械和术者经验的限制。④结论 经腹腔镜探查后开腹肠粘连松解术可最大程度地减少手术创伤，明显降低术后粘连的再发生率，有效地提高病人术后的生活质量。腹腔镜对有腹部手术史肠梗阻的诊治价值较大。     

肝内胆管结石并发肝内胆管癌的研究进展

肝内胆管结石合并肝内胆管癌,由于难于早期发现,根治性切除机会较少,预后不佳.本文结合国内外文献,就肝内胆管结石合并肝内胆管癌基础及临床研究进展作一综述.     

腹腔镜肾囊肿去顶减压术1例

腹腔镜肾囊肿去顶减压术１例张斌１张炳远１董胜国２病人，女，５５岁。因间断性腹痛５年入院。查体：中年女性，发育正常，营养良好，腹部平坦，全腹未触及肿块，双侧肾脏触诊未见明显异常，双肾区无叩痛。Ｂ超检查诊断为：左肾下极囊肿，大小约５．１ｃｍ×４．４ｃｍ．...     

经腹膜外与经腹腔切除原发性腹膜后肿瘤的对比研究

目的　总结经腹膜外和经腹腔切除原发性腹膜后肿瘤的优缺点 ,探讨最佳手术途径。方法回顾性分析原发性腹膜后肿瘤切除术 4 6例 ,其中经腹腔途径 (transabdominalapproach ,TAA)手术 2 6例 ,为TAA组 ,经腹膜外途径 (extraperitonealapproach ,EPA)手术 2 0例 ,为EPA组。 结果术后并发症发生率EPA组 (2 / 2 0 )比TAA组 (11/ 2 6 )低 (P <0 0 5 ) ,EPA组输血量 4 0 0 (QR∶70 0 )ml少于TAA组 80 0 (QR∶180 0 )ml(u =2 136 85 ,P <0 0 5 ) ,手术时间EPA组 (2 0 5± 6 0 )min短于TAA组(2 5 9± 110 )min(t=2 12 74 ,P <0 0 5 ) ,术后住院天数EPA组 (13± 4 )d少于TAA组 (18± 8)d(t =2 95 33,P <0 0 1) ,差异均有显著意义。结论EPA是原发性腹膜后肿瘤简便安全的手术途径。     

三种二孔法腹腔镜胆囊切除术的临床应用

我们于2005年5月至2007年12月对48例患者实行不同方法的二孔法腹腔镜胆囊切除术,效果满意,现报告如下.     

Transwell侵袭实验测定M受体对胆管癌细胞侵袭的影响

Objective To explore the experiment condition and method for the application of in vitro in vasive Transwell chamber and to observe muscarinicreceptor stimulant and muscarinicreceptor antagonist's influence to cholangiocarcinoma's invasiveness.Methods Two hundred microliter cell suspension of various concentrations(0.5×105/mL,1.0×105/mL,1.5×105/mL and 2.0×105/mL)was added into the upper chamber of the Transwell chamber,and the cells were allowed to penetrate the matrigel for 12,18,24and 48 hours respectively.The numbers was gotten as the invasive cells on the under surface of the membrane.After optimal cell concentration and time were gotten,pilocarpine of various concentrations(0 mmol/L,0.1 mmol/L,0.3 mmol/L and 0.5 mmoL/L)was added into the upper chamber of the Transwell chamber,then the cells on the matrigel were stained and counted.So did the cells when atropine of various concentrations(0.01 mmol/L,0.01 mmol/L,0.05 mmoVL and 0.1 mmol/L)were added into the upper chamher of the Transwell chamber in according to pilocarpine of various concentrations(0 mmol/L,0.3 mmol/L,0.3 mmol/L and 0.3mmol/L).Results With the increase of the time and cell concentrations，the cells couts that penetrated the matrigel increased，while the increase tended to he stable when the culture time exceeded 36 hous and the cell concentration Was over 1.0×105/mL.By adding pilocarpine,there were significant differences between the control and experimental groups(P＜0.05)，but there were no significant differences in experimental groups with various concentrations.There were no significant differences in blank group and experimental groups with atropine added(P＞0.05).When added pilocarpine and atropine,there were significant differences between blank and experimental groups(P＜0.05)，but there were no significant differences in experimental groups with various concentrations.Conclusions Thirty-six hours as invasive time,and one cell concentration 1.0 × 105/mL were optimal to test invasion abilities of cholangiocarcingma cells to different medicines or reagents.There is the possibility that museariniereceptor exists in cholangiocarcinoma cells，and may play an important role in cholangiocarcinoma's invasiveness and metastasis.     

肝门部胆管癌合并重度黄疸者行肝叶切除后并发症的诊治

肝门部胆管癌由于其独特的解剖位置和生物学行为,在根治性手术中50%～100%需要联合肝叶切除[1].对合并重度黄疸的病人(血清总胆红素>171 μmol/L)行联合肝叶切除,其术后并发症诊治情况目前国内未见单独报道.     

腹腔镜技术对不明原因腹水的诊断价值

①目的 探讨诊断性腹腔镜技术对不明原因腹水的诊断价值。②方法 对56例经多种影像学检查难以明确病因的腹水病人行诊断性腹腔镜检查。③结果 腹腔镜检查病人无手术并发症，52例病人得到明确诊断，诊断明确率达92．8％。④结论 诊断性腹腔镜技术可作为不明原因腹水病人安全准确的诊断方法。     

邻近主肝静脉根部肝肿瘤的手术治疗

①目的 探讨邻近主肝静脉根部肝肿瘤切除的可能性。②方法 分析我院近3年经手术切除的累及主肝静脉根部肝肿瘤病人35例的临床资料。其中原发性肝癌22例，并发肝硬化12例；肝血管瘤11例；肝细胞局限性增生1例；肺癌肝转移1例。③结果 行左半肝切除 Ⅷ段切除术10例，左半肝切除术2例，Ⅷ段切除或部分切除术5例，肝Ⅶ段和Ⅷ段切除术10例，肝中叶切除术8例。9例肝中静脉主干结扎或切除，1例直接吻合，1例肝右静脉干因出血而切除，1例肝右静脉结扎。全肝血流阻断8例。术后出现中等量腹水2例和胸腔积液2例，胆汁漏1例，1例在术后3月死于肝功能衰竭。④结论 主肝静脉受累的肝脏肿瘤切除虽具有较大风险，但只要方法适宜手术仍然是安全和可行的。