尿干化学法检测阴性不可偏废沉渣镜检

通过对 5 0 0例经尿 11项试纸检查阴性的标本 ,沉渣镜检发现尚有 6 7例阳性 ,阳性率为 13.4 %。提示尿沉渣镜检 ,不失为泌尿系统疾病检查的必要手段不应忽视及偏废     

肝动脉栓塞治疗肝癌肝动脉-门静脉瘘所致的大量腹腔积液

目的:探讨肝动脉栓塞治疗肝癌肝动脉-门静脉瘘(APF)所致大量腹腔积液的临床应用价值。方法:并发高流量APF和大量腹腔积液的肝癌患者9例,以明胶海绵颗粒栓塞载瘘动脉,消除或减少APF,用碘化油尽量栓塞肝癌病灶。结果:APF消失7例,少量残留2例;门静脉血流方向全部由逆肝转为向肝;肝癌病灶内碘化油沉积良好6例;术后2周内腹腔积液完全消失5例,少量残余4例;2周后肝功复查,5例肝功能原有明显损害者全部明显改善;全部病例原有腹胀、腹痛、厌食、乏力症状不同程度缓解。结论:对肝癌并高流量APF所致腹腔积液,动脉栓塞治疗简单、安全、有效。     

Urinary bladder carcinoma producing granulocyte colony stimulating factor (G-CSF): A case report with immunohistochemistry

A rare case of urinary bladder carcinoma with granulocyte colony stimulating factor (G-CSF) production was reported. In an 83-year-old female, marked neutrophilia in the peripheral blood decreased from 132,500/mm³ to 3,300/mm³ after tumour resection. The tumour was a transitional cell carcinoma. The serum G-CSF level reduced from 238 pg/ml pre-operatively to normal (60 pg/ml) after the operation. Immunohistochemical investigation of the resected tumour with monoclonal antibody specific for G-CSF revealed positive staining in the carcinoma cells, confirming G-CSF secretion.     

颈淋巴结清扫手术后乳糜漏的处理

目的 :探讨颈淋巴结清扫手术后乳糜漏的处理方法。方法 :回顾分析颈淋巴结清扫手术 12 85例术后发生乳糜漏 2 1例的临床资料。结果 :乳糜漏的发生率为 1.6 % ,18例经保守治疗治愈 ,3例经再次手术治愈。结论 :对颈淋巴结清扫术后的乳糜漏应及早诊断 ,术中应加强预防并及时处理     

尿路复合性恶性肿瘤（附21例报告）

报告２１例尿路复合性恶性肿瘤，位于肾盂２例，膀胱１９例。主要临床表现为血尿，绝大多数病人伴有尿路刺激症状。低分化的移行细胞癌（ＴＣＣ）与继发性复合肿瘤有密切关系。２１例中１例为ＴＣＣ复合肉瘤，１１例为ＴＣＣ复合鳞癌，７例为ＴＣＣ复合腺癌，２例为腺癌复合鳞癌。本组２例肾盂肿瘤分别行肾输尿管全长加膀胱袖口状切除术和肾部分切除术，术后存活６个月和１年；膀胱肿瘤１４例行膀胱部分切除术，已生存３年４例，１年２例，未满１年２例，３例１～２年内死亡，失访３例；２例根治性膀胱全切术已生存５年和３年以上；３例行ＴＵＲＢｔ，已生存３年１例，１５年１例，未满１年１例。对尿路复合性恶性肿瘤的组织学、临床和病理特征进行了讨论。     

小血管套叠粘接吻合法在血液透析者中建立动静脉内瘘的应用

慢性肾病患者常需要建立动静脉内瘘进行透析，常规间断缝合法吻合动静脉难度大、耗时长。为了缩短吻合时间，提高远期通畅率，进行了套叠粘接吻合法建立动静脉内瘘的实验研究，并将这一方法应用于透析患者建立动静脉内瘘的血管吻合。将动脉端套入静脉端，只需吻合两针，用医用胶封闭吻合口。经８个月观察，通畅率达１００％，血流量均超过３００ｍｌ／ｍｉｎ。达到了透析需要。     

A Rare Case of Biliobiliary Fistula

Abstract: Biliobiliary fistula is a rare clinical entity. The case of a 72 year old female, who presented with epigastric pain and jaundice, is detailed herein. Endoscopic retrograde cholangiopancreatography (ERCP) revealed two stones, one each in the common bile duct and the gallbladder. Continuous endoscopic nasobiliary drainage (ENBD) was performed to relieve obstructive jaundice. Further study with contrast medium administered via the ENBD tube revealed a fistula between the neck of the gallbladder and the common bile duct. The cystic duct was intact. A stone was considered to have migrated into the common bile duct through the fistula. A diagnosis of biliobiliary fistula, Corlette type I was made. However, in this particular case, a biliobiliary fistula was noted at a site below the junction of the cystic duct and common bile duct. Removal of the gallbladder stones was followed by cholecystectomy. The common bile duct was then repaired by utilizing a T-tube. No evidence of malignancy was recognized in the resected gallbladder specimen. In the one year to date since surgery, the patient has been asymptomatic and without signs of biliary disease.     

BILIARY HYPERPRESSURE IN RAT EXTRAHEPATIC CHOLESTASIS ALTERS HORSERADISH PEROXIDASE BILIARY EXCRETION

1. The authors investigated the effect of two extrahepatic cholestasis models (one by bile duct ligation and the other by choledocho-jugular fistula) on the hepatic clearance of horseradish peroxidase in male Sprague-Dawley rats divided into four groups. 2. In groups A (n = 5 rats) and B (n = 5), bile duct ligation was performed, while a choledocho-jugular fistula was created in groups C (n = 5) and D (n= 7). A 10 mg intravenous bolus of horseradish peroxidase was injected after 24 h (groups A and C), 48 h (groups B and D) or 1 h (Group E; five sham-operated rats). Serum and bile samples were then serially collected for 2 h. 3. In all groups, serum horseradish peroxidase levels increased soon after injection and then rapidly decreased, the curves being similar. Biliary excretion increased for 30 min and then slowly decreased. The highest horseradish peroxidase biliary concentrations and outputs were found in Group B followed by Group A; both groups had significantly higher levels than Group E. No difference was found between horseradish peroxidase biliary excretion of groups C and D and that of sham-operated rats. 4. When each group was considered separately, sampling times correlated with the corresponding ratios of bile/ plasma HRP. Significant differences were found between the relative slopes of groups A, B and E, but not between those of groups C, D and E. 5. In conclusion, bile duct obstruction greatly affects the plasma-bile transfer of fluid phase markers, such as horseradish peroxidase, while single retention, caused by choledocho-jugular fistula, has no influence. The increased biliary hyperpressure related to the duration of cholestasis may account for the degree of horseradish peroxidase transfer which, in turn, probably depends on an enhanced paracellular passage.     

Ileocutaneous fistula formation following laparoscopic polypropylene mesh hernia repair

A rare case of enterocutaneous fistula caused by chronic erosion of polypropylene mesh after laparoscopic repair of a recurrent inguinal hernia is described. Successful treatment was achieved by fistulectomy, total resection of the implanted mesh, and small-bowel segmental resection. The patient recovered well postoperatively, and at follow-up 18 months later, the herniorrhaphy has remained intact. This complication needs to be added to the differential diagnosis in patients who present inflammation, abscess formation, or cutaneous fistula following laparoscopic hernia repair. Received: 7 October 1996/Accepted: 14 October 1996     

A new operational approach for the piriform sinus fistula

It has been well documented that piriform sinus fistulae often cause suppurative thyroditis; however, when a piriform sinus fistula does not present this symptom, making a correct diagnosis is very difficult. We have experienced 11 cases of a piriform sinus fistula. The conventional operational approach was performed in the initial eight patients, among which there were four recurrences in two patients. Therefore, a new operational approach was introduced for the three most recent cases and one recurrent case. First, the existence of the internal orifice of the fistula is confirmed with a laryngoscope, after which a transverse incision on the neck is made and the abscess dissected. The side wall of the piriform sinus is then opened with the help of a laryngoscope and the bottom part of the mucosa of the sinus transected with the internal orifice of the fistula, after which the fistula is removed en bloc with the bottom part of the sinus and abscess cavity. Using this operation, we experienced no complications and there has been no recurrence so far.This paper was presented at the 23rd Annual Meeting of Pacific Association of Pediatric Surgeons, June 1990 in Kona, Hawaii.