内镜鼻胆管引流术在腹腔镜和开腹胆总管探查术中的应用

目的　评价内镜鼻胆管引流术 (Endoscopicnasobiliarydrainage ,ENBD)配合腹腔镜和常规开腹手术治疗胆总管结石的疗效。　方法　回顾分析 1997年 1月～ 2 0 0 1年 7月应用ENBD配合完成腹腔镜胆总管探查、I期缝合术 4 4例及开腹胆总管探查、I期缝合术 34例。　结果　 78例均手术成功 ,术后无胆漏、胆道出血、胆管炎等并发症。术中结石取净率 10 0 % (78 78)。术后住院时间 :腹腔镜组为 (6 2±1 3)d ,开腹组为 (7 4± 2 1)d。随访 5 7例 ,时间 (1～ 4 5 )年 ,平均 2 6年 ,腹部彩色B超检查无胆管狭窄及结石复发。　结论　ENBD配合腹腔镜和开腹胆总管探查取石、胆总管I期缝合术安全、可靠。     

THE DIAGNOSIS AND TREATMENT OF PSOAS ABSCESS: A 12 YEAR REVIEW

Over a 12 year period, 25 psoas abscesses occurring in 17 patients were managed at Royal Perth Hospital (900 bed hospital). Symptoms were present, on average, for 5 weeks prior to diagnosis, which was typically confirmed by computerized tomography. Fifty-nine per cent of cases were primary and percutaneous drainage effected a cure in 80% of all cases. Percutaneous drainage resulted in a non-significant trend towards shorter inpatient stay.     

The Oxford Optical Pointer: a direction-sensing device with proportional electrical output

For some disabled people pointing provides a more convenient means of communication and control than the use of switches. The quadriplegic who retains good control of head movement can be provided with a number of input alternatives, but no existing system meets all the requirements of a general-purpose electronic pointing device. Consequently the Oxford Optical Pointer has been developed. The principle by which it converts relative direction into analogue electrical signals is described and its application as a head-mounted device for controlling an electric wheelchair is presented.     

Magnum system for routine coronary angioplasty: A randomized study

The Magnum system, initially designed for coronary angioplasty (PTCA) of chronic total occlusion, consists of a balloon catheter and a solid steel 0.021 inch (0.53 mm) steerable and removable wire with a soft and moldable distal portion, tipped with a 1 mm olive. To evaluate its performance in routine PTCA, 200 unselected consecutive patients were randomized to two equal groups, i.e., group Magnum (100 patients, 115 vessels) and group Standard (100 patients, 118 vessels) including 18 and 21 patients with chronic total occlusions, respectively. Randomization was performed by the sealed envelope system in the catheterization laboratory and crossover of system was imposed if it was not possible to place a balloon correctly within 20 min of fluoroscopy time. There were no significant differences between groups concerning clinical and angiographic baseline characteristics, size of initial balloons (3.0±0.3 mm in both groups), fluoroscopy time to cross the lesion with the wire (Magnum: 4±5, Standard: 5±6 min), total fluoroscopy time (Magnum: 11 ± 9, Standard: 12±12 min), and need for crossover (Magnum: 10%, Standard: 16%). Success rates per lesion were comparable with 90% in group Magnum and 84% in group Standard, as were the complications with one inhospital death in group Standard, occurring three weeks after PTCA and stent implantation. There was no emergency operation. Six patients per group had myocardial infarction of whom two in group Magnum and one in group Standard developed a Q-wave. The following variables were significantly in favor of the Magnum system compared with the Standard system: success rate in nontotal lesions (97% versus 90%) crossover success in total occlusions (0 vs. 33%), fluoroscopy time to cross the lesion with the balloon once the wire was in place (1 ± 2 vs. 2 ± 4 min), and use of a single versus 1.2±0.5 wires per lesion. The only advantage of the Standard systems was the more common use of 7 French guiding catheters (Magnum: 40%, Standard: 53%, p = 0.09). The Magnum system compares favorably with standard systems for routine PTCA. The robust design of the Magnum wire does not impair ease of placement and safety but saves material and facilitates balloon advancement across the lesion.     

Subhepatic collections complicating laparoscopic cholecystectomy: Percutaneous management

Ten patients with subhepatic fluid collections complicating laparoscopic Cholecystectomy were successfully treated by interventional radiological procedures. The series included five abscesses, three hematomas, one biloma, and one serous collection. Abdominal pain or fever developed from 3 to 21 days after the laparoscopic intervention. All patients were asymptomatic 72 h after percutaneous drainage and there were no complications related to the procedure. Subhepatic fluid accumulations are common findings after laparoscopic cholecystectomies and have been considered an unreliable indicator of infection or other postoperative complications. However, the significance of these collections should not be underestimated in symptomatic patients. In such cases we propose diagnostic aspiration and drainage, when necessary, to safely and promptly establish the precise diagnosis and treatment. More serious complications can be avoided by early percutaneous intervention.     

内镜治疗老年总胆管结石30例体会

目的：探讨内窥镜治疗老年总胆管结石的安全性和有效性。方法：对我院普外科收治的30例70岁以上的老年总胆管结石患者进行回顾性分析，所有患者均经B超或螺旋CT明确诊断并接受内镜治疗，治疗方法包括逆行胰胆管造影（endoscopic retrograde cholangiopancreatography,ERCP)，鼻胆管引流（endoscopic nasobiliary drainage,ENBD)，乳头括肌切开（endoscopic shincterotomy,est)和取石术，碎石术，测定患者内镜治疗前后的生化指标变化。结果：30例老年总胆管结石患者行ERCP检查，成功率100％，28例行EST，总胆管结石直径＜1.0cm者成功率100％，结石直径1.0-1.5cm者成功率86％，结石直径≥1.5cm者需进行机械碎石取石，成功率75％；另有2例患者植入塑料支架作长期引流。1例患者发生与内镜有关的并发症，死亡例，30例患者治疗后各项生化指标较治疗前均有明显改善（P＜0．001）。结论：内镜治疗老年总胆管结石成功率增高，避免了手术创新，安全性好，缩短住院时间，是当前治疗老年总胆管结石的首选方法。     

Increased numbers of higher left intraocular pressures in 428 patients referred to the glaucoma clinic

Seventy-four per cent of 428 patients referred to the glaucoma clinic at Concord Hospital exhibited intraocular pressure (IOP) asymmetry. There was a preponderance of left eyes, in that two-thirds of the patients with asymmetrical pressures had the higher IOP in the left eye. As the degree of asymmetry increased, this trend became more pronounced. In addition, the statistically significant difference between right and left mean IOP among the glaucoma patients was not found among normal controls, even when the order of testing the eyes was reversed.     

LAPAROSCOPIC TREATMENT FOR PERFORATED APPENDICITIS WITH PELVIC ABSCESS

We performed laparoscopic appendectomy and drainage to treat panperitonitis due to perforated appendicitis that occurred in a 28‐year‐old woman. We believe this is an appropriate procedure to treat perforated appendicitis because it is safe and minimally invasive, and faster recovery can be expected than after conventional open appendectomy.     

胃镜下探条或自制气囊扩张治疗贲门失弛缓症疗效的对比研究

目的对比分析胃镜下应用探条或自制气囊扩张治疗贲门失弛缓症的疗效。方法1998年1月～2007年12月，胃镜下治疗贲门失弛缓症45例，其中应用自制气囊扩张22例（自制气囊组），应用探条扩张23例（探条组），比较2组疗效。结果探条组23例扩张1～9次，平均3．6次；自制气囊组22例扩张1～6次，平均2．3次。2组术中及术后均无并发症发生。首次治疗费用探条组（1542．57±281．30）元，自制气囊组（861．91±176．48）元（t=9．671，P=0．000）。扩张后3个月的疗效2组差异无显著性[探条组显效14例（61％）、有效8例（35％）、无效1例（4％），自制气囊组显效15例（68％）、有效5例（23％）、无效2例（9％），Z=-0．351，P=0．726]。扩张后6个月的疗效2组差异有显著性[探条组显效5例（22％）、有效3例（13％）、无效15例（65％），自制气囊组显效10例（45％）、有效7例（32％）、无效5例（23％），Z=2．564，P=0．010]。结论胃镜下应用探条和自制气囊扩张治疗贲门失弛缓症安全、简便，患者恢复快，尤其自制气囊扩张器设备简单，就地取材，疗效肯定，在基层医院具有良好的推广价值。