下消化道出血的易忽略原因——结肠血管发育异常三例报告

对于下消化道出血的病因和定位诊断,采用传统的胃肠钡剂造影、结肠镜检,以至手术探查,仍有22%病人未能明确。随着选择性肠系膜动脉造影的开展,以及嗣后的纤维结肠镜检查,证明结肠血管发育异常(Vascular dysplasias of colon)并不罕见,可占下     

MESOCAVAL SHUNT IN TREATMENT OF REBLEEDING AFTER SPLENECTOMY FOR PORTAL HYPERTENSION

We performed end-to-side mesocaval shunt for 20 portal hypertensive patients with rebleed- ing after splenectomy. The bleeding was imme- diately controlled in 7 treated by emergency mesocaval shunt. There was no o.perative death, and none of the patients developed encephalo- pathy. Follow-up from 4 months t0 7 years re- vealed that 3 deaths were due to acute massive hemorrhage, hepatic failure and carcinoma of the stomach respectively. Two patients with re- bleeding treated by partial esophagogastrectomy are living and well. The conditions of the other 15 patients are fairly good too. Our experience shows that mesocaval shunt is effective in the treatment of rebleeding in portal hypertensive patients after splenectomy. But to further study the hemodynamic changes and long-term re- suIts, more TPatients and longer period of fol- low-up are required.     

损伤性胆管狭窄治愈1例

<正> 损伤性胆管狭窄是胆道手术后严重的并发症。本例在外院行胆囊切除胆总管探查术后引起肝总管狭窄而转来,我院治疗痊愈。患者李××,男性,54岁,1986年10月3日入院。患者于1986年5月在某院因胆管炎,作胆囊切除胆总管探查术。术后第九天“T”管胆汁引流量明显减少,继而皮肤巩膜出现黄染。经抗菌素治疗后黄疸消退,胆汁引流量增加。作经“T”管胆管造影,显示左右肝管分     

肠系膜上-下腔静脉端侧分流术治疗门脉高压症术后再出血的评价

本文报导肠-腔静脉端侧分流术治疗脾切除术后再出血40例。急性大出血行分流术16例中14例有效地控制了出血,住院期间死亡3例,其中2例因出血未能控制,一例死于肝肾功能衰竭,无一例发生脑病。随访37例,访期3个月至9年。再出血6例,2例死亡,2例行食管下段胃上部切除术,2例经保守疗法痊愈。5例作选择性肠系膜上动脉造影,显示吻合口通畅,向肝血流存在。随访期间死亡5例,除上述2例大出血外,余3例分别为肝功能衰竭、返流性胃炎和胃癌。本文着重讨论手术指征,方法和分流后血液动力学的变化。     

间接门脉造影术在门脉高压外科中的应用

本文报告间接门脉造影46例(50次),除4例显影不满意外,其余均清晰显影。本组早期有3例出现动脉穿刺处局部血肿,无其他并发症。本文介绍了间接门脉造影的指征、操作方法与X线表现。作者认为本法方便易行,创伤小而重复性强,对了解门脉系统血管情况,估计门脉血液动力学变化和观察分流术效果很有价值。