损伤性高位良性胆管狭窄的外科治疗策略

Iatrogenic bile duct injuries (BDIs) and subsequent benign biliary stricture is a medical catastrophe which is associated with significant perioperative morbidity and mortality,reduced long-term surviv...     

医源性胆道损伤52例报告

目的:总结医源性胆道损伤的经验教训。方法:对过去33年间5 2例医源性胆道损伤进行回顾性分析。结果:肝外胆道手术所致4 8例,胃大部切除术及肝脏手术所致各2例。损伤部位在肝总管与胆总管交界处34例,肝总管6例,胆总管6例,左右肝管汇合部4例,左、右肝管各1例。胆管完全性损伤30例,部分性损伤2 2例。结论:要警惕医源性胆道损伤的发生,及早诊断并修复胆道的连续性是提高疗效的关键     

医源性膈疝MSCT多平面重组表现

目的 分析食管癌术后继发医源性膈疝(IDH)的MSCT多平面重组(MPR)表现,探讨其诊断价值.方法 回顾性分析2010年1月至2014年3月间食管癌术后继发IDH 16例.将其CT号随机混编入其他50例食管癌术后无食管裂孔(EH)扩大患者队列,由2名不知研究目的从事腹部影像诊断的高年资医师分别就横断位和MPR图像进行判断.对不同医师、不同方法判断结果及影像表现差异采用x2检验.结果 16例IDH中3例局限性于EH,横断位2例呈假“肠套叠”征,1例呈肠扭转表现;MPR直观显示肠管挤入EH顶压胸腔胃呈“壁贴壁征”.13例超出EH范围,横断位表现为胸腔内肠管于各方向汇聚于EH处胸腔胃,其中,前外、后外及前后外侧分别为9例、5例和2例,前外侧明显多于前后外侧(x2 =6.79,P＜0.05),2例并肠系膜扭转;MPR直观显示胸腔内管肠及其系膜血管通过EH与腹腔相应结构连通.由2名医师横断位提示IGH诊断分别为3例和4例,MPR全部提示IDH诊断,均显著高于横断位(x2=21.89,19.20,P值均＜0.05).结论 食管癌术后继发IDH横断位表现隐匿,仔细观察并及时辅以MPR,对诊断具有重要意义.     

医源性胆管损伤的治疗现状

Iatrogenic bile duct injury (IBDI) is a severe complication in general surgery, especially during laparos-eopic cholecystectomy. Many factors may cause IBDi, in which the conscientiousness, skill and experience of the surgeons play a more important role than the abnormal anatomy and patholo-gical changes of the patient. The Bismuth's classification, which originated from the era of open surgery, does not cover the whole spectrum of bile duct injuries. Strasberg's classification made a supplement by including other types of extrahepatie bile duct injuries. The variation of opportunities leads to different thera-peutic strategies. When the injuries are diagnosed intraopera-tively, a conversion to open surgery is the option of choice, and the prosthesis should be performed by a more experienced surgeon. If the bile duct injury is diagnosed in the early stage after operation, therapeutic principles are as follows: biliary peritonitis often required an emergency reoperation, while extra-peritoneal drainage is taken for patients with simple biliary leak. The most serious postoperative complication after IBDI is steno-sis, sometimes followed by fistula. Sufficient preoperative prepa-ration is essential, which includes controlling the biliary tract infection, improving the liver and renal function and nutritional state of the patient.     

医源性胆管损伤的治疗进展

胆管损伤一直是普外科倍受关注的问题.随着人们对胆管损伤后果严重性认识的提高,并采取了许多积极有效的预防措施,使胆管损伤的发病率有所下降,并随着医学技术的发展和大量的临床实践总结使已经造成胆管损伤的患者在治疗方法和临床疗效上都有了很大改善.同时又面临许多新的困难.本文概述了医源性胆管损伤的治疗现状.     

腹腔镜胆囊切除术相关医源性胆管损伤多中心临床研究

目的 对我国目前腹腔镜胆囊切除术相关医源性胆管损伤病例的诊治现状进行回顾性分析、总结。方法 依托医渡云大数据平台,回顾性分析2002年3月至2018年3月我国13个省、直辖市地区的16家三甲医院中收治因胆囊良性疾病行腹腔镜胆囊切除术造成医源性胆管损伤的105例病人临床资料进行分析。结果 105例胆管损伤病人占16家医院同期收治腹腔镜胆囊切除病人的0.104%,其中男44例,女61例,年龄50.0（25~76）岁。其中损伤与修复手术在相同医院完成者34例（32.4%）,在外院发生胆管损伤后转入者71例（67.6%）。胆管损伤后最常见的临床表现依次为腹痛、发热和黄疸。所有病人中治愈率为88.5%,其中20%须行多次手术治愈,死亡1例,病死率0.95%。损伤后早期（48 h内）手术效果优于48 h以后修复者。发生损伤后首次修复失败再转入的病人治疗效果最差,均再手术。结论 腹腔镜胆囊切除术相关胆管损伤须根据损伤原因、部位与程度等综合因素行个体化胆道修复治疗,一旦发生,及时诊断并由经验丰富的专科医师进行首次确定性修复手术是改善预后的关键。     

医源性胆管损伤分型及其意义

腹腔镜手术的快速发展为病人减轻了痛苦,同时也增加了医源性胆管损伤的发生率。胆管损伤是普外科较为严重的术后并发症之一,一旦发生,其不良后果直接影响到病人的生活质量。明确胆管损伤的类型和原因,并做到精准分型,是预防以及正确处理胆管损伤、改善病人预后的关键所在。     

Rectal puncture complicating caudal blockade in a child with severe rectal distension

We describe a case of unrecognized rectal puncture following unsuccessful caudal blockade in a patient later found to have marked rectal distension on MRI. This may have contributed to the rectal injury.     

First,Do No Harm: Adverse Effects and the Need for Practice Standards in Neurofeedback

Adverse and iatrogenic effects associated with psychotherapy have been substantiated in research for more than 40 years. Controlled research also exists in the field of neurofeedback (electroencephalographic biofeedback) that documents that negative effects can occur from inappropriate training. This article presents accumulating evidence, taken directly from acknowledgments by neurofeedback practitioners of the existence of both transient side effects and of more serious adverse reactions that have occurred. Unlicensed and unqualified practitioners pose a risk to the public and to the integrity and future of the profession. It is vitally important that both professionals and professional societies emphasize standards of practice and that the public be protected from individuals seeking to use neurofeedback to work with medical, psychiatric, and psychological conditions for which they are not qualified and licensed to work. Some in the field propose pursuing biofeedback or psychophysiology licensure as a means to establish standards of practice and address ethical concerns. This is a reasonable option to consider, although it may take many years to implement in various states. In the meantime it is vitally important that individuals offering neurofeedback services for clinical diagnostic conditions be licensed to lawfully provide services for such conditions.