胆管癌围手术期死亡因素分析

目的探讨影响胆管癌围手术期死亡的危险因素。方法对62例胆管癌手术患者的临床资料进行回顾性研究。用Logistic回归法分析影响围手术期死亡的危险因素。对每一指标行单因素分析，筛选出P〈0．1的自变量方可进入多因素分析。结果单因素分析显示影响围手术期死亡的可能因素有7个，即年龄、术前总胆红素、γ-GT、白（清）蛋白、肝功能分级、肿瘤分期、术前合并症；多因素分析显示显著影响围手术期死亡的危险因素有3个，按影响大小依次为年龄、肿瘤分期和γ-GT。结论高龄、高1-GT水平和肿瘤分期晚增加胆管癌围手术期死亡的风险。     

腹腔镜胆囊切除术难易度的相关因素分析

目的 :分析腹腔镜胆囊切除术 (LC)难易度的相关因素。方法 :设定LC难易度相当于LC手术时间 ,通过分析年龄、性别、体重、病程、症状、下腹部手术史、超声下胆囊大小、胆囊透声度、胆囊壁厚度、胆囊病变性状以及术中所见粘连等 ,得出LC手术时间 (难易度 )与上述指标的相关性和相关方程。结果 :与LC手术时间 (难易度 )相关的主要因素为临床症状、胆囊透声度、胆囊壁厚度、胆囊病变性状等。结论 :前瞻性判断LC的难易度 ,有利于减少并发症的发生     

Biliary extracorporeal shockwave lithotripsy

Biliary extracorporeal lithotripsy has been considered one of the alternatives to surgery for the treatment of gallstones in the bile ducts and in the gallbladder. Although this technique can fragment almost all gallstones, the clinical effectiveness of this new treatment modality must be measured by successful elimination of all fragments. Some physical principles, stone targeting, patient protocol, complications, and clinical results are presented.     

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目的 注意肝胆管结石合并胆管变异，提高肝内胆管结石的诊断治疗水平。方法 总结2001-2002年来手术治疗的5例肝胆管结石合并无肝右管或肝左管病例的诊断治疗过程和治疗方法。结果 5例病人都是手术中被发现肝胆管结石合并胆管变异，其中4例为无肝右管，1例为无肝左管，均行不同部位的肝切除和胆管空肠吻合，术后无残石，治疗效果良好。结论 对肝胆管结石需警惕合并胆管异常，治疗应争取切除结石并胆管异常的肝叶。     

Primary Common Bile Duct Carcinoid Demonstration by Computerised Tomography,Ultrasonography and Angiography

A 64 year old woman presenting with bleeding esophageal varices had a well circumscribed 5 cm diameter carcinoid tumor originating in the common bile duct, demonstrated by angiography, computerised tomography (CT) and ultrasonography, and this was surgically excised. This is the third case of common bile duct carcinoid tumor reported in the literature^1,2 and the first to be demonstrated by angiography, CT and ultrasonography.     

医源性胆道损伤手术修复方式的探讨

目的　探讨医源性胆道损伤手术修复的方式。方法　回顾性分析 1990 年 3 月至 2002年9月收治的145例医源性胆道损伤的临床资料。结果　145 例分别选择胆管端 端吻合,利用自身组织和医用生物胶作胆道修复、肝胆管盆式 Roux en Y内引流等术式,130 例患者平均随访 3 6 年(3个月~11年),效果优良率达94 6%。结论　在优良的胆道外科技术保证下,灵活选择适合于患者胆道损伤情况的手术方式,才能取得良好的疗效。     

复杂性上尿路结石的微创综合治疗

目的 总结经皮肾微造瘘输尿管镜碎石术（MPCNL）综合其它技术治疗复杂性上尿路结石的临床经验。方法 回顾性分析2002年6月至2004年11月采用MPCNL结合经皮肾造瘘术、ESWL、URL和开放手术等方法治疗复杂性上尿路结石73例患者资料。分析其病史特点、综合治疗方法、并发症和结石取净率等临床资料。73例患者，男43例，女30例，平均45岁。均为肾铸形结石或多发结石。结果 Ⅰ期治疗结石排净率71．2％（52／73），Ⅱ期治疗排净率61．9％（13／21），结石总排净率89．1％（65／73）。并发症：发热12例（16．4％），术中大出血8例（10．9％），术后继发大出血3例（4．0％），尿外渗7例（9．6％），肾盂，输尿管穿孔3例（4．0％）。平均住院天数17．6d。MPCNL结合ESWL15例（20．5％），开放手术结合MPCNL5例（6．8％），术前结合肾造瘘术治疗28例（38．4％），术中结合URL治疗26例（35．6％）。结论 复杂性上尿路结石的综合治疗需制定个体化方案，MPCNL结合其它微创技术治疗复杂性上尿路结石有利于减少损伤，降低并发症，提高碎石取石效果。     

一期多通道微创经皮肾穿刺取石术治疗鹿角状结石

目的 探讨微创经皮肾穿刺取石术（minimally invasive-percutaneous nephrolithotomy，MPCNL）一期多通道治疗肾鹿角状结石的可行性与临床疗效。方法 2002年2月至2006年4月，采用MPCNL治疗鹿角状结石患者56例。其中全鹿角状结石21例，部分鹿角状结石35例。结石大小3．5cm×2．1cm～8．5cm×4．2cm，平均5．1cm×2．8cm。结果 一期手术平均手术时间112min，一期结石取净36例（64．3％）。18例接受二期MPCNL，12例结石清除，二期MPCNL后结石总清除率85．7％（48／56）。8例患者残留结石大小2～12mm，其中3例术后1个月接受体外冲击波碎石术。术后53例随访1～6个月，原残留结石8例中结石清除4例。结论 一期多通道MPCNL治疗鹿角状结石，创伤小、并发症少、恢复快、结石清除率高，可以选择性地作为鹿角状结石患者的治疗方案。     

胆管探查术后的胆管狭窄

目的提出并探讨胆管探查术后胆管狭窄的临床特点、诊治及病因、预防。方法回顾收治的8例胆管探查术后的胆管狭窄病例，分析其临床表现、T管造影、临床病理分型、术中所见及治疗结果。结果8例分别于原T管拔出后数天至数年出现梗阻性黄疸；T管造影示原胆管内径平均为5．9mm；病理分型：7例为Bismuth Ⅱ型，1例为Ⅲ型。术中7例可发现狭窄部位线结。Roux—Y胆肠吻合术处理后平均随访超过2年，均未再出现黄疸或发热。结论胆管探查术后胆管狭窄似乎是手术后胆管狭窄的一个特殊类型，有其显著特点，重建术后通常疗效满意。应用导尿管经十二指肠乳头H日借支樘外引流可以十分有效地预防胆管探杳术后胆管狭窄的发牛。     

Efficacy of laparoscopic cholecystectomy in acalculous gallbladder disease: long-term follow-up.

OBJECTIVE: Our aim was to determine the efficacy of laparoscopic cholecystectomy in symptomatic patients with ultrasound negative and abnormal gallbladder ejection fractions; Patients with gallbladder ejection fractions less than 35% on hepatobiliary scan were offered laparoscopic cholecystectomy. METHODS: Between January 1995 and January 2001, 1564 patients underwent laparoscopic cholecystectomy at our institution: 256 were confirmed to have acalculous gallbladder disease by pathology report and reconfirmation of abnormal hepatobiliary scan data. A 30-day postoperative follow-up was obtained by retrospective medical record review. For this study, we contacted all 256 patients by mail questionnaire and followed up on nonresponders with telephone interviews; we also reviewed hospital records to verify preoperative symptom patterns. The survey was completed by 154 patients (60%): 48 (31%) by mail and 106 (69%) by telephone interviews. The study included 115 (75%) female and 39 (25%) male patients, and the average age was 42 years (range, 13 to 95). All hepatobiliary laboratory parameters were normal pre- and postoperatively. The survey was completed in December 2001, 1 to 5 years postoperatively (mean 3 years). RESULTS: Preoperatively, 142 patients (92%) had right upper quadrant pain, 114 (74%) had nausea, 88 (57%) had vomiting, 120 (73%) had heartburn, and 118 (77%) had food intolerance. In a 30-day postoperative period, these numbers had reduced to 48 (37%), 14 (90%), 8 (5%), 22 (14%), and 34 (22%), respectively. had laparoscopic cholecystectomy, and 95% stated that they would recommend laparoscopic cholecystectomy to other patients. CONCLUSION: This study shows that patients with acalculous gallbladder disease benefit from laparoscopic cholecystectomy.