【摘要】目的探讨脾脓肿的易感因素、诊断与治疗。方法对1990年6月至2002年8月收治的11例脾脓肿患者资料进行回顾性分析。结果11例患者中8例行手术或穿刺治疗，3例保守治疗。10例患者治愈或好转出院，1例保守治疗无效死于败血症。结论加强对脾脓肿的认识是提高本病早期诊断的关键，脾切除是治疗脾脓肿的首选方式。
胆总管在穿过十二指肠壁时与胰管汇合，汇合后略膨大，称Vater壶腹（简称壶腹）。壶腹及其外周环绕的括约肌向十二指肠肠腔突出，使十二指肠粘膜隆起形成十二指肠乳头。在壶腹周围（包括壶腹），上述组织结构所发生的肿瘤统称为壶腹周围肿瘤，并以恶性居多。壶腹周围的恶性肿瘤包括来自壶腹、胆总管下端、十二指肠乳头和胰头的癌肿，临床上把前三者连同胰头癌统称为壶腹周围癌。目前，外科手术仍是治疗壶腹部肿瘤的主要手段，提高壶腹部肿瘤的外科治疗技术水平是患者获得治愈的唯一途径。壶腹部肿瘤因其组织来源不同其生物学行为亦表现出很大差异，应根据壶腹部肿瘤的不同组织来源、生物学行为及其发展阶段作出合理的外科治疗。
Objective To investigate the treatment and prognosis of moderate ischemic mitral regurgitation (IMR) in coronary artery disease(CAD). Methods From January 1998 to May 2006, 28 patients of CAD with moderate IMR underwent coronary artery bypass grafting (CABG) and mitral valve plasty(MVP, 24) or mitral valve replacement (MVR,4). The Reed method were used in 9 cases, the annuloplasty ring were used in 15 cases. Mechanical valve were implanted in 1 case and biological valve in 3 cases. Results There was no operative or hospital death. Twentysix patients were followed up to a mean period of 41 months. There were two late death(one was MVP, the other was MVR). In MVP cases, nineteen patients were in New York Heart Association (NYHA) functional class Ⅰ and Ⅱ, 3 in class Ⅲ, which was better than that of preoperative one. Ultrasonic cardiography (UCG) examination showed no mitral regurgitation in 5 cases, mild in 7, light in 6, moderate in 3, severe in 1. Left atrial volume (LAV) and left ventricular enddiastolic volume (LVEDV) were 54.1±12.7ml and 60.9±14.8 ml, decreased more significantly than that preoperatively (Plt;0.05). In MVR cases, 2 cases were survival and followed. One patient was in NYHA functional class Ⅰ, 1 in class Ⅱ, which was better than that of preoperative one. Conclusion Moderate IMR with CAD should be treated carefully. MVP with annuloplasty ring have better early results. For patients with bad heart function and abnormal left ventricular wall motion, the late results need more studies.
Objective To explore the indications for liver transplantation among patients with hepatolithiasis. Methods Data from 1431 consecutive patients with hepatolithiasis who underwent surgical treatment from January 2000 to December 2006 were retrospectively collected for analysis. Surgical procedures included T-tube insertion combined with intraoperative cholangioscopic removal of intrahepatic stones, hepatectomy, cholangiojejunostomy, and liver transplantation. Results Nine hundred and sixty-one patients who had a stone located in the left or right intrahepatic duct underwent hepatectomy or T-tube insertion combined with intraoperative cholangioscopic removal of intrahepatic stones. The rate of residual stones was 7.5% (72/961). Four hundred and seventy patients who had a stone located in the bilateral intrahepatic ducts underwent surgical procedures other than liver transplantation; the rate of residual stones was 21.7% (102/470). Only 15 patients with hepatolithiasis underwent liver transplantation; they all survived. According to the degree of biliary cirrhosis, recipients were divided into 2 groups: a group with biliary decompensated cirrhosis (n=7), or group with biliary compensated cirrhosis or noncirrhosis group (n=8). There were significant differences in operative times, transfusion volumes and blood losses between 2 groups (P＜0.05). In the first group, 6 of 7 patients experienced surgical complications, and in the second, 8 recipients recovered smoothly with no complications. Health status, disability and psychological wellness of all recipients (n=15) were significantly improved in 1 year after transplantation as compared with pretransplantation (P＜0.05). Conclusion Liver transplantation is a possible method to address hepatolithiasis and secondary decompensated biliary cirrhosis or difficult to remove, diffusely distributed intrahepatic duct stones unavailable by hepatectomy, cholangiojejunostomy, and choledochoscopy.
Objective To investigate the diagnosis and treatment of congenital choledochal cysts(CCC) in children. MethodsThe manifestation, auxiliary examination, mode of operation and effect of 42 patients with CCC in children from Jan., 1980 to June, 1999 were analyzed retrospectively.Results The patients with the triad of jaundice, an abdominal mass, and pain was 38.1% among the 42 patients. B-ultrasonic diagnosis was made with a correct diagnostic rate of 95.2%. The effective rate of internal drainage was significantly lower than that of resection of the cyst(χ2=19.36, P＜0.001) while the reoperation rate and incidence of carcinoma of internal drainage were higher than those of resection of the cyst(χ2=11.59, P＜0.001 and χ2=4.97, P＜0.05). Conclusion B-ultrasonic diagnosis is recommended as the first examination method. Internal drainage should be abandoned. Resection of the cyst with Roux-Y hepaticojejunostomy is recommended as the treatment of choice on extrahepatic cholangiectasis. Liver transplantation is a reasonable choice to treat the diffuse intrahepatic cholangiectasis.
Objective To investigate diagnosis and surgical management of femoral head osteonecrosis in sickle cell disease(SCD). Methods The related literature available today was reviewed, and the clinical advance in the diagnosis of femoral head osteonecrosis complicating SCD and its surgical management was evaluated. Results Although the advance in the diagnosisand the surgical treatment for the femoral head osteonecrosis in SCD had been achieved, challenging clinical problems still remained because of many complications after the surgical treatment. Whether the surgical management was reasonablein a particular stage of the disease and for a specific patient still required investigation. Conclusion Whether the salvage of the patient’ship joint should be performed or the artificial joint replacement should be performed still needs a cautious consideration before either of the surgical managements is given.
迄今,外科手术仍为胃癌的首选治疗手段,随着对既往外科治疗经验教训的不断分析与总结,同时,对肿瘤基础研究的深入以及其他综合治疗方法的进步,胃癌外科治疗已从原来单纯依赖解剖学为手术基础而逐渐发展为以肿瘤生物学行为为基本依据的新理念,使得胃癌的外科手术更趋合理,更符合“个体化”的要求。现谨就目前胃癌外科治疗中常遇见的有关问题进行探讨。