肝门胆管狭窄的病因分析与影像学诊断的临床评价

目的:总结分析肝门胆管狭窄的病因并探讨各影像学诊断方法在肝门胆管狭窄疾病中的诊断符合率.方法:回顾分析我院及山西医科大学第二医院于1982-200482例资料完整的肝门胆管狭窄患者的主要病因以及超声(US)、磁共振胰胆管造影(MRCP)、逆行胰胆管造影(ERCP)、经皮肝穿胆道造影(PTC)等影像诊断结果,分析各项影像技术在肝门胆管狭窄诊断中的适应症和诊断符合率.结果:恶性病变占肝门胆管狭窄病的87.80%,其中大部分由肝门胆管癌引起,占总例数的76.83%,其次胆囊癌占7.32%,结肠癌肝门转移1.22%,肝细胞癌并发癌栓2.44%等.良性病变占12.2%,主要为损伤性胆管、胆管囊肿、硬化性胆管炎以及胆管结石等.US,ERCP,PTC,MRCP对肝门胆管狭窄的诊断准确率分别为84.15%,92.86%,100%,100%.结论:恶性病变是肝门部胆管狭窄病的主要原因,良性病变相对比例较小.在肝门胆管狭窄的诊断中,影像学诊断技术扮演着关键辅助作用的角色,能协助临床迅速获得准确结论.     

Biomarkers for the Prediction and Diagnosis of Fibrostenosing Crohn’s Disease: A Systematic Review

1. Download : Download high-res image (161KB)
2. Download : Download full-size image

     

Evaluation of Intraductal Ultrasonography,Endoscopic Brush Cytology and K-ras,P53 Gene Mutation in the Early Diagnosis of Malignant Bile Duct Stricture

Background:In qualitative diagnosis of bile duct stenosis,single diagnostic measure is difficult to make a correct diagnosis,to combine several diagnostic techniques may be helpful to make an accurate ...     

Redo pullthrough for Hirschsprung disease: A single surgical group's experience

Introduction

This study presents our surgical experience for redo-pullthrough (RedoPT) for Hirschsprung disease (HD). It reviews the patient's clinical outcomes and assesses stooling patterns after RedoPT.

Methods

A retrospective review of our institution's RedoPTs as well as one author's overseas cases was performed. Stooling scores were tabulated using an established survey tool and compared to primary PT matched patients.

Results

Between 1974 and 2012, 46 individuals (52% males) underwent RedoPT, representing 3 percent of all HD pullthroughs. Median age at primary PT and RedoPT was 1 year (range 1 week–18 years) and 3.5 years (range 8 weeks–41 years), respectively. Indications for RedoPT were predominately for aganglionosis/transition zone pathology (71%); followed by stricture or an obstructing Duhamel pouch (19%), tight cuff (8%) and a twisted PT (4%). None were performed for an isolated clinical diagnosis of repeated bouts of enterocolitis. RedoPT surgical approach depended upon the initial pullthrough technique and any previous complications. Stooling scores were significantly (P < 0.05) worse in the RedoPT patients compared to the historically-matched group of children undergoing a primary PT for HD (5.5 ± 1.2 vs. 12.2 ± 1.4, primary PT versus RedoPT, respectively). When breaking down this total score into individual parameters, stooling pattern scores (1.0 ± 0.2 vs. 4.1 ± 0.4, P = 0.001) and enterocolitis scores (2.0 ± 0.4 vs. 4.2 ± 0.4, P = 0.001) were statistically worse in the RedoPT group. Patients in both groups had similar overall continence rates.

Conclusion

Appropriately selected children undergoing a RedoPT can achieve good results, with comparable continence rates to those undergoing a primary PT.     

睾丸鞘膜移植治疗前尿道长段狭窄的远期疗效分析

目的 探讨睾丸鞘膜替代尿道治疗前尿道长段狭窄的方法.方法 40例前尿道长段狭窄患者采用带蒂的睾丸鞘膜代尿道一期尿道成形术治疗,术后随访时分别行逆行尿道造影和尿流率检查.结果 本组40例手术一次性成功,术后3周拔除尿管,平均随访24个月,术后测定平均最大尿流率明显高于术前.结论 带蒂睾丸鞘膜可作为良好的尿道替代物,手术创伤小,取材方便,组织修复快,对长段前尿道狭窄是一种行之有效的方法.     

Oddi括约肌狭窄的诊断与治疗

本文通过对３７５例胆囊、胆总管结石患者术后有残留症状者，经Ｂ超、ＥＲＣＰ、Ｔ管造影诊断为Ｏｄｄｉ括约肌狭窄者１６７例，均经十二指肠镜乳头括约肌切开（ＥＳＴ）治愈。同时讨论了Ｏｄｄｉ括约肌狭窄的原因、临床表现及诊断治疗中注意事项。     

中南地区正常成人上呼吸道的MRI测量及其临床价值

目的:测量中南地区正常成人上呼吸道MR扫描后各层面径线长度、咽壁厚度及横截面积等指标,为临床诊断该区域病变提供客观指标。方法:对182例健康成人行MR上呼吸道扫描,并测量软腭后区、悬雍垂区、舌后区和会厌后区气道各径线长度、咽壁厚度和横截面积等指标,以单侧95%可信区间确定各测量指标的参考值。结果:在气道各个扫描平面中,绝大多数冠状径大于矢状径,男子组和女子组间比较,除软腭后区外,大多数测量指标差异显著,并指定了男、女各测量指标的正常值范围。结论:成人上呼吸道MRI测量及正常值的确定,为临床判断该区有否占位性病变及阻塞性睡眠呼吸暂停综合征(OSAS)患者气道解剖性狭窄部位的确定提供了客观指标。