目的 探讨胰十二指肠切除术后胰瘘引起腹腔大出血行外科治疗的可行性。方法 在343例行胰十二指肠切除术的患者中，2例术后发生严重的胰瘘伴有腹腔大出血，均再次手术行胰肠分离式桥式内引流术。结果 经术后支持治疗、持续腹腔冲洗、抑制胰酶分泌，治疗成功，顺利出院。术后随访18个月，没有胰管梗阻和脱落的迹象。患者没有发生糖尿病。结论 胰十二指肠切除术后胰瘘导致的腹腔大出血治疗非常困难，通过外科再手术行胰肠分离式桥式内引流术，取得成功，避免了复杂的全胰切除，挽救了胰腺功能，提高了患者的成功救治机会，改善了患者术后的生活质量。
目的 探讨胰十二指肠切除术中引流管的放置与术后管理的方法。方法回顾性分析88例胰十二指肠切除术后管理经验。结果 术后腹腔并发症的发生率为10.2%(9/88)，胃排空障碍发生率为3.4(3/88)%，其中保留幽门胰十二指肠切除术后胃排空障碍发生率为5.5%(3/55)。结论 胰十二指肠切除术后腹腔引流是预防术后并发症的重要方法，术中合理放置引流管，术后加强腹腔引流的管理，能减少术后并发症的发生。
目的 探讨肝脏局灶性结节性增生（FNH）的临床诊断与治疗，以提高对FNH的认识。方法 回顾性分析我院普通外科2004年7月至2011年7月期间收治的21例经术后病理证实为FNH的临床资料。结果 本组21例FNH患者中男6例，女15例，平均年龄31.1岁。单发19例，多发2例。9例为体检发现，无不适症状；12例有右上腹隐痛不适症状，均无肝炎、肝硬变病史；1例女性患者有长期口服雌激素病史。化验检查：谷丙转氨酶轻度升高1例，其余肝功能检查、肿瘤标志物及HBsAg均为阴性。术前影像学检查诊断符合率：彩超检查为42.9% （6/14），CT检查为50.0% （6/12），MRI检查为38.5% （5/13）。术后均恢复良好，随访至今无复发。结论 FNH术前确诊率仍较低，主要依赖术后病理学检查。对于术前诊断不明确、病灶巨大或有临床症状者仍应采取手术切除治疗。
Objective To explore and summarize the curative effect and experience of emergency devascularization for treatment of upper gastrointestinal bleeding due to portal hypertension. Melthods The clinical data of 42 patients with upper gastrointestinal bleeding due to portal hypertension， undergoing emergency devascularization from March 2006 to July 2011 in Shengjing Hospital of China Medical University were retrospectively analyzed. Results Of the 42 cases， 29 patients underwent emergency splenectomy plus esophagogastric devascularization， 8 patients underwent emergency spleen artery ligation plus esophagogastric devascularization， and 5 patients only underwent emergency esophagogastric devascularization. The hemostasis rate at 3 hours after emergent disconnection operation was 100%. One patient died of liver failure on 8 days after operation. Three patients supervened with hemorrhage in abdominal cavity on 2 days after operation， and succeeded in hemostasis by conservative treatment. Other patients were successfullydischarged from hospital after postoperative rehabilitation for 2-4 weeks. All cases were followed up regular in 1 year after operation， 5 patients were lost to follow-up. Among the 36 cases followed up， rehaemorrhagia occurred in 1 patientin 8 months after operation， cured by endoscopic variceal ligation subsequently. A primary liver cancer occurred in 1 patient during physical examination in 7 months after operation， followed by partial hepatectomy. Other patients could complete daily life and work. Conclusions The patients suffering from upper gastrointestinal bleeding due to portal hypertension are likely to benefit from appropriate operations. Decisive emergency devascularization can stop the bleeding rapidly and effectively， and save the lives of those patients.
ObjectiveTo summarize experiences of surgical treatment of complex giant cavernous hemangioma of the liver. MethodThe clinical data of 55 patients with complex hepatic cavernous hemangioma with tumor diameter more than 10 cm and in close proximity to hepatic hilar region or vena cava inferior underwent surgical treatment from January 2009 to December 2014 were analyzed retrospectively. ResultsAmong these 55 patients with complex giant cavernous hemangioma,13 cases (23.6%) were male,42 cases (76.4%) were female.The median age was 49.2 years (range from 23 to 68 years).Hepatic hemangioma with multiple lesions was most common (71.0%,39/55).The tumor happened mostly in the right hepatic lobe (47.3%,26/55).The median size of complex giant cavernous hemangioma was 16.2 cm (10.2-50.0 cm).The liver functions of all the patients were normal (Child-Pugh A).Different methods of hepatic inflow occlusion and surgical procedures were performed according to the tumor location and size.Of the patients,17 cases were underwent Pringle maneuver,12 cases were underwent modified Pringle maneuver and 1 case was underwent hemihepatic vascular occlusion;28 cases were treated by extracapsular enucleation,27 cases by liver resection.The average operative time was 202 min (85-420 min).The average intraoperative blood loss was 855.5 mL (50-3 000 mL).Twenty-six cases (47.3%) had no blood transfusion,and 10 cases (18.2%) had autologous blood transfusion.The associated complications occurred in 7 patients after surgery,and no surgical death occurred.The median postoperative hospital stay was 14.8 d. ConclusionsThe essential points in operation for the complex giant cavernous hemangioma are the control and management of the operative massive bleeding,and the preservation of the normal hepatic parenchyma as much as possible.The surgical treatment is safe and feasible under the proper hepatic inflow occlusion and resection methods.The prevention and management of bile leakage is also important.