术中胆管造影在复杂类型腹腔镜胆囊切除术中的临床应用价值

目的:研究术中胆管造影在复杂类型LC中的临床应用价值。方法:在LC中,为复杂类型胆囊炎56例行术中胆道造影。结果:56例中除1例胆囊管结石嵌顿靠近胆总管侧插管失败外,余腹腔镜手术均获成功,成功率为98.2％。结论:在复杂类型胆囊炎患者中开展术中胆管造影摄片,可辩认三管关系,了解胆囊管的长度,明确有无胆囊管或胆总管结石残留,了解胆总管下段有无相对性狭窄,避免损伤右肝管、肝总管、胆总管,提高了LC的安全性,降低了LC中转率及并发症发生率     

腹腔镜胆囊部分切除术治疗急性胆囊炎

目的探讨腹腔镜胆囊部分切除术治疗急性胆囊炎的疗效。方法76例急性胆囊炎患者,均行腹腔镜部分胆囊切除术。结果手术均获成功,平均手术时间为87（45-135）min,无严重并发症。术后随访1.5（1-3）年,无结石残留、复发。结论对急性胆囊炎患者行腹腔镜胆囊部分切除术是安全可行的,适应证的掌握是手术安全的保证。     

腹腔镜胆囊切除手术前后肝外胆管直径变化的临床研究

目的探讨腹腔镜胆囊切除手术前、后肝外胆管直径的变化情况。方法选取我院2006年1月至2007年12月期间入院的慢性结石性胆囊炎患者55例、静止性胆囊结石患者46例及胆囊息肉患者12例共113例行腹腔镜胆囊切除术，分别于术前、术后3个月及术后6个月用B超测量患者肝外胆管直径，收集相关数据进行分析。结果113例患者术前、术后3个月及术后6个月测量的肝外胆管直径分别为（5±2）mm、（8±2）mm及（6±2）mm。其中55例慢性结石性胆囊炎患者术前、术后3个月及术后6个月测量的肝外胆管直径分别为（5±2）mm、（9±2）mm及（6±2）mm；46例静止性胆囊结石患者分别为（5±2）mm、（8±2）mm及（6±2）mm；12例胆囊息肉患者分别为（5±2）mm、（7±2）mm及（5±2）mm。不同疾病患者术后3个月肝外胆管直径均较术前增大，经t检验，差异有统计学意义（P〈0．05）；术后6个月与术前及术后3个月的肝外胆管直径比较经t检验，差异均无统计学意义（P〉O．05）。结论腹腔镜胆囊切除术后肝外胆管直径的变化是一个动态过程，术后3个月肝外胆管直径较术前相比明显增大，术后6个月，肝外胆管直径有明显的回缩，与手术前相比差异不明显。     

胆囊动力学变化对胆囊结石形成的作用

目的 探讨胆囊动力学变化对胆囊结石形成的作用.方法 收集2007年8月至12月武警安徽省总队医院行LC患者的临床资料.根据胆囊结石中胆固醇的含量,将39例胆囊结石患者分为胆色素结石组(13例)、胆固醇结石组(13例)和混合性结石组(13例),分别检测胆囊收缩功能,胆囊壁缩胆囊素受体含量及活性,并将胆囊无结石、炎症的正常者设为对照组(13例).结果 (1)胆囊排空率、胆囊壁缩胆囊索受体含量及活性:胆色素结石组>混合性结石组>胆固醇结石组.(2)胆囊壁缩胆囊素受体含量及活性与胆囊排空率呈正相关(r=0.969,0.938,P<0.01);与结石中胆固醇含量呈负相关(r=-0.949,-0.979,-0.987,P<0.01).结论 胆囊结石中胆固醇含量与胆囊动力、缩胆囊素受体关系密切,可能是胆固醇通过影响缩胆囊素而降低了胆囊动力,促进了胆固醇结石的形成.     

前列腺导管腺癌临床病理和诊治特点分析

Objective To discuss the pathological and clinical features, diagnosis and treatment of prostatic duct adenocareinoma. Methods The clinical data of nine cases of prostatic duct adeno-carcinoma were retrospectively analyzed, with the average age of 76 (59-106) years. Six cases were presented with dysuresia and/or nocturia, and two of them had the painless gross hematuria. Two pa-tients presented painless gross hematuria as the first symptom. One case was detected the elevated ser-um PSA in a routine healthy examination. Radical prostatectomy (RP) was performed in 1 case;RP and bilateral orchidectomy and external beam radiotherapy (EBRT) were performed in 1 case;5 cases underwent transurethral resection of the prostate (TURP) combined with photoselective vaporization of the prostate (PVP) by green laser and bilateral orchidectomy;1 case underwent TURP combined with PVP;1 case underwent bilateral orchidectomy combined with EBRT. Eight cases took flutamide for 3-45 months. All patients were followed-up according to the scheduled time. Results The op-erations were successfully performed in all 9 patients. The papillary or cauliflower-like tumors infiltra-ted colli culus seminalis and prostate duct nearby. The glands were coated with tall pseudostratified columnar cells. The nuclei were large, dark stained with more frequent mitoses. The positive rates of immunolabelling antibody PSA, AR, PAP were found to be 89%(8/9), 100%(5/5), 100%(5/5) re-spectively. The distribution of Gleason score was 6-7(3 cases), and≥8(6 cases), and a coexisting acinar carcinoma component was identified in 5 cases of the group. Nine cases had a mean follow up for 20(3-48) months. Five cases have developed biochemical recurrence, of whom 3 died of bone metas-tasis and multiple organ failure, and 1 developed lung and bone metastasis. Three cases remained alive without recurrence. The remaining 1 case survives during the follow-up survey for 6 months until now, without examinations due to the old age. Conclusions Duct adenocarcinoma of the prostate presents the low incidence and lacks of typical symptoms in the early stage. Diagnosis was confirmed mainly on the basis of pathology. The tumors tend to have a more advanced stage and a very short term survival rate. The treatment options and management are similar to that of high-grade adenocar-cinoma of the prostate;meanwhile, close follow-up survey should be performed.     

腹腔镜治疗老年萎缩性胆囊炎44例临床分析

目的:探讨老年萎缩性胆囊炎患者的腹腔镜治疗方法,并预防胆管损伤并发症的发生。方法:回顾分析腹腔镜治疗老年萎缩性胆囊炎44例患者的临床资料。结果:41例顺利完成手术,3例中转开腹,12例放置腹腔引流管,术后肝下积液1例,无其他并发症发生及死亡病例。结论:老年人萎缩性胆囊炎的腹腔镜治疗属于复杂手术,与术中操作技巧,把握好中转手术的时机,充分围手术期准备,熟练术中操作技巧,把握中转开腹的时机,合理使用器械等是预防和减少并发症的关键。     

免气腹腹腔镜胆囊切除术的临床应用价值

目的探讨免气腹腹腔镜胆囊切除术的临床应用价值。方法回顾性分析2006年3月至2008年3月间38例免气腹腹腔镜胆囊切除术患者的临床资料。结果38例患者均顺利完成手术．手术成功率100％,无血管损伤、脏器穿孔、胆道损伤、胆漏或者中转开腹等并发症发生。8例患者术后出现右肩背酸痛,对症治疗好转。结论免气腹腹腔镜胆囊切除术扩大了腹腔镜胆囊手术的范围,避免了气腹对人体的影响,尤其是针对心肺功能不全的老年患者,有不可取代的作用,是值得推广的。建立手术空间牵拉膈肌可能是造成腹腔镜术后肩背疼痛的重要原因。     

胆囊疾病合并肝硬化的腹腔镜胆囊切除术

目的探讨腹腔镜胆囊切除术（Lc）在胆囊疾病合并肝硬化中的可行性与疗效。方法回顾分析32例胆囊疾病合并肝硬化实施LC的临床资料。结果32例中顺利施行LC30例,2例因出血而中转开腹。术后出现腹水3例,胆漏1例,经引流、保肝等治疗后痊愈。无腹腔感染及肝功能衰竭等严重并发症。结论胆囊疾病合并肝硬化肝功能ChildA、B级的LC手术是可行的。加强围手术期处理是保证手术成功的关键。     

电视腹腔镜胆囊切除术临床并发症的预防总结

目的 分析腹腔镜胆囊切除术中胆囊三角的解剖并探讨如何预防电视腹腔镜胆囊切除术（LC）中胆管损伤。方法 回顾分析行腹腔镜胆囊切除术患者950例。结果 完成LC手术945例（98.95%），中转开腹10例（1.05%），术后胆漏2例，腹腔内出血1例。结论 良好的胆道外科意识、科学的解剖方法和精细的手术操作是避免LC术中胆管损伤的关键。     

原发性胆囊癌端粒酶检测的临床意义

目的 探讨端粒酶在原发性胆囊癌中的活性及临床意义。方法 采用端粒重复序列扩增法（TRAP）检测了胆囊癌细胞系,46例原发性胆囊癌组织,22例癌旁组织,19例胆囊良性病变。结果 胆囊癌细胞系呈端粒酶阳性,癌组织的端粒酶阳性率为84．8％,显著高于癌旁组织和胆囊良性病变（P＞0．05）。端粒酶活性与胆囊癌病理类型和分化程度无相关性（P＞0．05）。与浸润深度和淋巴结转移有显著相关性（P＜0．05）。结论 端粒酶激活与原发性胆囊癌的发生、发展有密切关系,并有可能成为原发性胆囊癌的临床肿瘤标记物。