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51.
肝门胆管癌近年有增多趋势,本文报告我院1975年~1985年间肝门胆管癌60例,占全部肝外胆管癌82例之73.1%,占同期全部胆道手术3626例之1.65%。临床表现主要有三型:1)阻塞性黄疸29例,其中25例曾误诊为肝炎;2)急性胆管炎12例;3)长期胆道疾病14例,其他5例。本组行B超检查19例,ERCP10例,PTC39例。最后诊断根据PTC和/或ERCP,剖腹术及病理检查结果。 56例施行了手术治疗,仅6例施行肿瘤连同半肝切除,姑息性肝胆管内引流15例,外引流23例,其他方法12例。平均存活时间:6例切除组24.5月,48例姑息手术组8.7月,未手术的4例为5月。文中强调早期诊断,凡40岁以上出现阻塞性黄疸或“传染性肝炎”均须警惕胆管癌,进行B超,CT,ERCP或PTC检查,文中强调PTC是诊断本病重要手段,可选择进行右左肝管PTC。本病应争取手术切除,不能切除者行肝胆管内引流或外引流,二者疗效无明显差别。 相似文献
52.
H. Anderl G. Wechselberger M. Ninkovic A. Schwabegger P. Scougall 《European journal of plastic surgery》1996,19(6):327-329
Thoracic duct fistula is a rare but potentially serious complication of head and neck surgery. Such fistulae may be difficult to treat, and several techniques, both operative and non-operative, have been advocated. A case of successful surgical treatment of a chronic thoracic duct fistula is presented. The fistula occurred in a 51-year-old female following treatment of a solitary supraclavicular breast metastasis by local excision and radiotherapy. The divided duct was ligated and the area was covered with the clavicular head of the sternocleidomastoid muscle. 相似文献
53.
54.
Summary Obturator hernias comprise a rare group of abdominal hernias. They are often diagnosed when the small bowel has become obstructed
and the patients are operated on without the causes of the obstruction being known. Although many techniques for closure of
the defect are available, there is no agreement at the present time as to which is the procedure of choice. 相似文献
55.
经内镜胆管引流术在肝门部恶性胆管梗阻中的应用及其评价 总被引:9,自引:2,他引:7
肝门部恶性肿瘤手术切除率极低,临床处理十分棘手。作者采用内镜胆管引流术治疗此类肿瘤288例次(肝门部胆管癌184例、胆囊癌23例、肝细胞癌侵犯肝门部胆管47例、其他转移性肿瘤34例),其中行内镜鼻胆管引流162例次、塑料内置管引流80例次、放置可膨式金属胆道支架46例、4例患者接受同期双内置管引流。引流总有效率为67.0%,其中效果满意者43.1%;40例患者术后1个月内发生胆管炎,发生率为13.8%,3例死亡;长期随访病例的平均存活期5.3个月。我们观察到治疗的效果与Bismuth分型有密切关系,如果全肝40%以上的胆系得到引流,黄疸有望消退;左、右两侧胆管同时引流可扩大引流范围,提高疗效;应合理选择三种内镜胆管引流方法并适时灵活转换才能获得满意的疗效。结论:对于肝门部肿瘤,内镜胆管引流术是一种安全有效的治疗手段,可作为首选的姑息性治疗。 相似文献
56.
From July 1989, to June 1996, 160 patients with congenital bile duct dilatation (CBD) were treated at our institution. The
incidence of CBD at our institution has increased annually. In approximately 90% of patients with CBD there was associated
anomalous arrangement of the pancreaticobiliary ductal system, and we concluded that this was one of the main causes of CBD.
Pediatric endoscopic retrograde cholangiopancreatography was first introduced to China in 1989, and has been successfully
performed in 90.2% of 92 patients at our institution. We found that age at diagnosis was closely related to the subtype, complications,
and mortality of CBD. The subtype also correlated with the presenting symptoms. One hundred and forty-seven of the 160 patients
underwent surgery. Of these 147 patients, 136 (92.5%) were cured with normal liver function and 9 (6.1%) improved with liver
impairment. Two patients died, one of postoperative pneumonia and one of liver failure. We conclude that early radical surgery
and careful postoperative follow-up are essential in the prevention of CBD complications such as cholangitis, pancreatitis,
biliary stones, and development of carcinoma.
This article is based on a special lecture delivered before the 19th meeting of the Japanese Society of Pancreatico-biliary
Maljunction, on September 14, 1996, in Tokyo 相似文献
57.
A stratified intraoperative surgical strategy is mandatory during laparoscopic common bile duct exploration for common bile duct stones 总被引:3,自引:0,他引:3
J. F. Gigot B. Navez J. Etienne E. Cambier P. Jadoul P. Guiot P. J. Kestens 《Surgical endoscopy》1997,11(7):722-728
Background: Open exploration and endoscopic sphincterotomy (ES) remain the preferred treatment of common bile duct stones (CBDS). The
recent spread of laparoscopy has worsened the dilemna of choosing between surgical and endoscopic treatment of CBDS. The aim
of this study was to critically evaluate the results of our preliminary experience with laparoscopic common bile duct exploration
(CBDE) for CBDS.
Methods: Ninety-two consecutive patients were prospectively submitted to laparoscopic CBDE. Surgical strategy included an initial
transcystic approach or laparoscopic choledochotomy. Failure of stone clearance was managed by conversion to open CBDE or
by postoperative ES. Electrohydraulic lithotripsy and papillary balloon dilatation were selectively used. Stone clearance
was assessed by choledochoscopy and control cholangiography.
Results: The overall laparoscopic stone clearance in this series was 84% (transcystic route 63% and choledochotomy 93%). Conversion
to laparotomy was mandatory in 12% of the patients because of incomplete stone clearance and in 5% because of intraoperative
complications. Postoperative ES was required in 4% of the patients, giving an overall surgical success rate of 96%. When indicated
(small and limited number of stones located below the cysticocholedochal junction, with a dilated and patent cystic duct)
the transcystic route had the lower success rate, the higher complication rate, and the shorter operative time and postoperative
hospital stay. When indicated (accessible and dilated common bile duct over 7 mm), laparoscopic choledochotomy had the higher
success rate, the lower complication rate, the longer operative time, and the longer postoperative hospital stay, which is
related to associated external biliary drainage. The hospital mortality included two high-risk patients (2%) and the complications
rate was 15%.
Conclusions: Laparoscopic CBDE is safe in selected patients. A stratified intraoperative surgical strategy is mandatory in deciding between
a transcystic route and choledochotomy with specific indications for each approach. When feasible, laparoscopic choledochotomy
is more efficient and safe than the transcystic route, but it is associated with a longer postoperative hospital stay, which
is due to external biliary drainage.
Received: 7 May 1996/Accepted: 19 November 1996 相似文献
58.
肝硬化病人施行胆道手术35例分析 总被引:2,自引:0,他引:2
本文对我院近10年来收治的肝硬化病人施行胆道手术35例进行分析,术前漏诊肝硬化12例,占3O%以上,死亡5例,有3例死于胆囊床大出血与术前漏诊有关。作者就术前漏诊原因、术前准备和手术处理体会进行讨论。 相似文献
59.
Background: For patients with incurable malignant gastric outlet obstruction and cholestasis, laparoscopic gastrojejunostomy combined
with endoscopic biliary stent placement seems to offer a minimally invasive palliation.
Methods: We retrospectively analyzed the data of 16 patients submitted to laparoscopic gastrojejunostomy. Laparoscopic gastroenterostomy
was performed as an antecolic, side-to-side gastrojejunostomy with enteroenterostomy. In 12 patients cholestasis was relieved
preoperatively by stent placement via endoscopy (n= 6, 37.5%), percutaneous access (n= 5, 31%) or bilioenteric anastomosis (n= 1, 6.25%). One patient needed a percutaneous Yamakawa prosthesis postoperatively.
Results: Mean operative time was 126 min. There were no intraoperative complications. In one patient conversion to open surgery became
necessary because of extensive adhesions. The only postoperative complication was bleeding from a trocar site requiring reintervention;
there was no mortality. Median postoperative hospital stay was 7 days. Delayed gastric emptying was observed in 3 (18.7%)
patients. Median survival was 87 days after the operation. All patients died from their primary disease but could maintain
oral intake during the remaining survival time.
Conclusions: We conclude that laparoscopic gastrojejunostomy and endoscopic or percutaneous biliary stenting provide a good functional
result while impairing the quality of life only to a minimal extent.
Received: 7 May 1996/Accepted: 12 December 1996 相似文献
60.
162例气管插管患者的气道管理 总被引:16,自引:2,他引:14
笔者通过报道162例气管插管患者的气道管理,阐述痰痂形成的原因:(1)气道干燥,湿化不够。(2)吸痰管插入深度不够,吸痰不彻底。管理措施:(1)用金霉素眼膏润滑吸痰管,使之易于插入,保证吸痰管插入深度超过插管远端3-5cm。(2)预防气道干燥,注重湿化效果,重视吸痰环节。认为气囊不需定时放气,只需不定时调整气囊压力。 相似文献