胰十二指肠切除术近期合并症及技术改进

目的:探讨如何提高壶腹周围肿瘤的切除率以及降低胰十二指肠切除术后的主要并发症-胰漏的发生.方法:1995年3月～2000年12月本院行胰十二指肠术126例,除经典的手术步骤,作者对手术方法进行了改进,完整切除胰腺钩突,在门静脉与胰头粘连时应仔细分离,受到浸润时可合并门静脉侧壁或部分切除,胰肠端侧吻合时,将胰腺残端确切地套入空肠,并在吻合口两角危险区及前壁覆盖一束大网膜.结果:胰十二肠切除技术的改进,提高了切除率和生存率,而且并发症并未增加,本组患者1、3年生存率分别为71.4%、48.6%;胰肠端端吻合胰漏的发生率为4.8%,端侧吻合加吻合口周围附以带蒂大网膜无胰漏发生.结论:随着外科学的进步,胰十二指肠切除及合并门静脉部分切除已是安全有效的手术方式,胰肠端侧吻合加吻合口周围覆盖大网膜能有效地避免胰漏的发生.     

Successful Embolization of Coronary Arteriovenous Fistula Using an Interlocking Detachable Coil

Although the efficacy and feasibility of coil embolization of coronary arteriovenous fistulas have been reported, the procedure may be complicated by migration of the coil into peripheral vessels or pulmonary arteries. We report two cases of successful coil embolization of such lesions using an interlocking detachable coil. This system can provide safer and more effective coil embolization in patients with coronary arteriovenous fistula.     

The use of magnetic resonance imaging in the assessment of malignant vaginal fistulas

The objective of this study was to determine whether magnetic resonance imaging (MRI) could reliably demonstrate fistulas and any associated mass and to see whether these findings were beneficial in the management of the fistula. Twelve consecutive patients presenting with suspected vaginal fistulas were examined prospectively with MRI, using a combination of sequences, for the presence, extent and configuration of fistulas and any associated mass. Comparison was made with CT when available. All patients underwent examination under anesthesia (EUA) and the findings compared. Of the 12 women presenting, seven had vesico-vaginal fistulas (VVF) and seven had recto-vaginal fistulas (RVF). Four women had both types of fistulas. The underlying pathology was cervical cancer (seven cases), colonic cancer (three cases), breast cancer (one case) and ovarian cancer (one case). Vaginal fistulas were unequivocally seen on MRI in eight of 10 cases with fistulas. In the two cases with a difference between the MRI and EUA findings, the MRI was interpreted as showing more than was found at EUA. In the seven women with VVF, MRI detected five of the cases. In the seven women with RVF, MRI detected all seven cases. Magnetic resonance imaging was correct in determining the presence of recurrent disease in the pelvis when an associated mass was seen (seven cases). Computer-assisted tomography was compared in 10 cases and in six cases, the results were comparable and in four cases, more information was obtained from the MRI. Magnetic resonance imaging appears to be accurate in detecting and defining complex gynecologic fistulas and should be considered the investigation of choice to aid the planning of restorative, salvage or palliative surgery.     

Tracheoesophageal fistula: New option in management

Tracheoesophageal fistula is a life threatening condition. Patients not managed surgically ultimately die of their disease. Surgical management is the treatment of choice. We present a case of a patient that developed a tracheoesophageal fistula after tracheostomy. Surgical repair was done which failed due to infection. The patient was managed with the help of an esophageal stent and Trichloroacetic Acid cautery. This approach can be used in selected patients, depending upon the size and site of TEE Larger fistulae and those situated lower down e.g. supra carinal cannot be managed by this technique.     

Iatrogenic bladder stone and associated vesicovaginal fistula after hysterectomy

A patient had irritative lower urinary tract symptoms for 2 years after hysterectomy. During cystoscopy, a bladder stone was seen and removed, but watery vaginal discharge emerged. The subsequent transvaginal ultrasound revealed a fistulous tract between the bladder and the vagina. The methylene blue test further confirmed the diagnosis of vesicovaginal fistula. We performed a delayed Latzko procedure to successfully repair the fistula.     

扩张置管治疗癌性复杂性食管狭窄和瘘的近远期疗效观察

目的应用带膜金属支架治疗癌性难治性食管狭窄和瘘,并对近、远期疗效进行观察。方法在电子内镜下应用扩张器和支架置入器,对临床确诊的难治性食管狭窄和(或)瘘的48例患者进行支架置入术。根据病情的不同情况选择不同的治疗方式。结果48例患者共放置支架64个,置管后狭窄处直径由(4.02±1.35)mm增至(15.05±4.02)mm(P<0.01),吞咽困难由3.28±0.42级改善为0.94±0.73级(P<0.01),食管瘘患者瘘口全部闭合。随访1个月及1年有效率分别为100%、74.2%,1年失访共3例,复发共8例经重复治疗缓解。结论内镜直视扩张置管治疗难治性食管狭窄和瘘,操作直观简便,定位准确,成功率较高,近远期效果较好。     

Rendu–Osler–Weber syndrome presenting with pulmonary arteriovenous fistula

A pulmonary arteriovenous fistula is an abnormal connection between pulmonary arteries and veins. Patients with Rendu–Osler–Weber syndrome may present with this vascular malformation, which is a typical finding of the disease. Approximately 5–15% of Rendu–Osler–Weber syndrome patients have pulmonary arteriovenous malformations (AVM) and there is usually a family history of AVM in these patients. The malformations are usually located in the lower lobes. In this paper, I describe a 49‐year‐old male patient with dyspnoea, cough, haemoptysis and epistaxis. Physical examination showed nasal telangiectasias, cyanosis of the lips and nails, and a systolic bruit over the left lung. Chest X‐ray revealed a 5‐cm mass in the left lower lobe and after magnetic resonance examination, together with 3‐D magnetic resonance angiography, it was demonstrated to be a pulmonary arteriovenous fistula. The history of a niece with a similiar history of suspected pulmonary arteriovenous fistula led me to consider the possibility of Rendu–Osler–Weber syndrome presenting with a pulmonary arteriovenous fistula.     

隧道式拖线加内口切挂术治疗后位马蹄型肛瘘46例

采用隧道式拖线加内口切挂术治疗后位马蹄型肛瘘 4 6例 ,4 4例为一次性治愈 ,2例经一次扩创后治愈 ,平均疗程 (2 6± 3)天。