Search

Larparoscopy Combined with Choledochoscopy for Common BileDuct Exploration in Treatment Bile Duct Calculus

桡骨远端骨折合并腕部尺神经损伤六例分析

目的 总结桡骨远端骨折合并尺神经损伤的临床特点、治疗方法及预后。 方法 分析2002 年8 月－ 2008 年8 月收治的6 例合并尺神经损伤的桡骨远端骨折患者临床资料。男4 例，女2 例；年龄21 ～ 55 岁，平均39岁。新鲜骨折4 例，其中开放骨折1 例；陈旧性骨折2 例。骨折类型按国际内固定研究学会（AO/ASIF）分型：A3 型2 例，B2、B3、C2、C3 型各1 例。6 例均有尺神经卡压和损伤表现。受伤至治疗时间3 h ～ 3.5 个月。分别给予切开复位钢板螺钉内固定、切开复位克氏针内固定加外固定架固定、闭合复位外固定架固定治疗。 结果 术后6 例均获随访，随访时间12 ～ 24 个月，平均18 个月。按中华医学会手外科学会上肢部分功能评定试用标准评定，获优5 例，可1 例。术后X 线片显示骨折对位良好，术后4 ～ 5 个月桡骨远端骨折均骨性愈合。随访期间无内固定物松动及骨折移位等并发症发生。除1 例陈旧性骨折手内在肌萎缩、运动功能恢复不明显外，余5 例尺神经感觉、运动功能均恢复较理想，爪形手畸形消失。 结论 合并尺神经损伤的桡骨远端骨折，开放手术时应行尺神经探查减压术，如未行探查手术应密切观察其病情变化。

Unilateral Exploration in Primary Hyperparathyroidism (Report of 26 Cases）

目的探讨原发性甲状旁腺机能亢进（PHPT）小切口单侧探查的适应证和探查经验。方法对我科1992年1月至2001年12月所作的26例小切口单侧探查病例的临床病理资料进行回顾性分析。结果小切口单侧探查26例，成功25例。结论对诊断明确且准确定位者先采取定位侧小切口； 冰冻切片证实为甲状旁腺肿瘤，且病理学特点与其临床表现、实验室检查和定位诊断相符者可仅行单侧探查。

Clinical Experience of Laparoscopic Common Bile Duct Exploration with Choledochoscopy for Cholecystolithiasis and Choledocholithasis in 67 Cases

目的　探讨腹腔镜胆总管探查联合胆道镜治疗胆囊结石合并胆总管结石的手术方法及其临床应用价值。方法　回顾性分析2008年3月至2012年6月期间笔者所在医院收治并行腹腔镜胆总管探查联合胆道镜治疗的67例胆囊结石合并胆总管结石患者的临床资料。结果　67例胆囊结石合并胆总管结石患者中，6例经胆囊管探查取石并行胆囊管一期结扎，15例行胆总管探查取石并行胆总管一期缝合，46例行胆总管探查取石后经T管引流。所有患者的手术均获成功，无中转开腹，无术后大出血及手术死亡。手术时间为（120±30）min（90～150min），术中失血量为（30±10）mL（20～40mL），平均住院时间为8.3d（7～14d）。术后3例患者发生轻度漏胆，经引流后痊愈；4例发生切口感染，经引流并给予抗生素治疗后治愈；1例发生术后早期炎性肠梗阻，经胃肠减压、灌肠、给予生长抑素加地塞米松等保守治疗后痊愈。术后所有患者均获访，随访时间为1个月～3年，平均随访时间为2.1年。随访期间，均无胆道感染和胆管狭窄发生，无结石复发。结论　腹腔镜胆总管探查联合胆道镜治疗胆囊结石合并胆总管结石安全有效。

The implication of anastomotic port exploration and dredging in coronary artery bypass grafting

ObjectiveTo evaluate the changes of the flow parameters before and after the anastomotic port exploration and dredging during coronary artery bypass grafting by using the transit time flow measurement (TTFM).MethodsA total of 167 patients who underwent continuous coronary artery bypass grafting and anastomotic port exploration and dredging surgery in Beijing Anzhen Hospital from 2018 to 2019 were enrolled in this study. There were 136 male and 31 female patients aged 41-82 (58.35±17.26) years. If the probe entered and exited the anastomotic port smoothly, it was recorded as a non-resistance group; if the resistance existed but the probe could pass and exit, it was recorded as a resistance group; if the probe could not pass the anastomotic port for obvious resistance, it was recorded as the stenosis group. In the stenosis group, the grafts were re-anastomosed and the flow parameters were re-measured by TTFM.ResultsA total of 202 anastomotic ports were carried out by exploration and dredging. Among them, 87 anastomosis (43.1%) were in the non-resistance group, and there was no significant change in the blood flow volume (BFV) and pulsatility index (PI) before and after exploration and dredging (6.16±3.41 mL/min vs. 6.18±3.44 mL/min, P=0.90; 7.06±2.84 vs. 6.96±2.49, P=0.50). Sixty-four anastomosis (31.7%) were in the resistance group, the BFV was higher after exploration and dredging than that before exploration and dredging (17.11±7.52 mL/min vs. 4.96±3.32 mL/min, P<0.01), while the PI was significantly smaller (3.78±2.20 vs. 8.58±2.97, P<0.01). Fifty-one anastomosis (25.2%) were in the stenosis group, and there was no significant change in the BFV and PI before and after exploration and dredging (3.44±1.95 mL/min vs. 3.48±2.11 mL/min, P=0.84; 10.74±4.12 vs. 10.54±4.11, P=0.36). After re-anastomosis, the BFV was higher (16.48±7.67 mL/min, P<0.01) and the PI deceased (3.43±1.39, P<0.01) than that before exploration and dredging.ConclusionThe application of anastomotic exploration and dredging can reduce the occurrence of re-anastomosis, and promptly find and solve the stenosis of the distal coronary artery, improve the poor perfusion of distal coronary, and thus improves the prognosis of patients.

Clinical analysis of thoracic exploration of chest trauma

目的 探讨胸外伤开胸探查的手术指征及救治策略。 方法 回顾性分析我院自 2006 年 1 月至 2014 年 12 月经开胸探查救治 51 例胸外伤患者的临床资料，其中男 43 例、女 8 例，年龄 24（17～75）岁。 结果 全组损伤严重度评分（ISS）平均 19.4 分。闭合性损伤 16 例，开放性损伤 35 例，治愈 45 例（88.24%），死亡 6 例（11.76%）。死亡原因为心脏破裂、失血性休克、感染性休克、多器官功能障碍综合征（MODS）、弥散性血管内凝血（DIC）。 结论 及时就医、快速诊断、准确把握手术指征、多科室联合诊治是救治胸外伤的关键。

腹腔镜胆总管探查术后一期缝合与T管引流的临床研究

目的探讨腹腔镜胆总管探查术后一期缝合与T管引流的手术疗效。 方法回顾性分析2012年1月至2013年12月期间太仓市第一人民医院肝胆外科行腹腔镜胆总管探查术50例患者的临床资料，其中18例行胆总管一期缝合，32例行胆总管T管引流，分析2组患者的临床疗效。 结果50例患者无中转开腹，均治愈出院。缝合组及引流组平均胆总管直径分别为（10.6±1.5）mm及（11.3±1.5）mm，胆总管结石数分别为（3.0±2.0）枚及（3.2±2.2）枚，平均结石直径分别为（5.5±1.6）mm及（5.8±2.1）mm，其差异均无统计学意义（P＞0.05）。缝合组和引流组手术时间分别为（107.9±20.3）min和（101.6±36.4）min，分别于手术后（3.8±1.0）d和（3.3±1.0）d拔除腹腔引流管，总住院时间分别为（11.6±3.1）d和（12.0±2.2）d，术后恢复时间分别为（8.9±0.9）d和（7.4±1.1）d，其差异也无统计学意义（P＞0.05）。缝合组和引流组患者住院总费用分别为（14 525.1±2 274.6）元和（16 568.3±2 701.5）元，缝合组住院总费用低于引流组（P＜0.05）。引流组术后有结石残留1例，发生胆汁漏1例；缝合组无并发症发生。 结论与T管引流相比，腹腔镜胆管探查术后一期缝合不增加手术时间、总住院时间、术后恢复时间及术后引流时间，而能减少住院总费用，在合适的病例中，腹腔镜下胆总管探查术后一期缝合安全有效。

Clinical Experience of Laparoscopic Common Bile Duct Exploration

目的 探讨腹腔镜胆总管切开取石术的优势，总结手术操作经验及常见并发症的预防与处理。方法回顾性分析我院1999年6月至2010年4月期间收治的108 例胆管结石患者行腹腔镜胆总管探查取石术的手术方法、操作要点及并发症的处理。结果 腹腔镜手术成功 105例, 中转开腹3例; 手术时间（120±20） min,出血量（25±5） ml,住院时间（9±1） d; 术后发生胆道出血3例,漏胆7 例,残余结石6 例; 全组无死亡病例。结论 腹腔镜胆总管切开取石术具有创伤小、痛苦轻、恢复快、对腹腔脏器干扰小、住院时间短等优点，值得临床推广。

MANAGEMENT OF COMMON BILE DUCT CALCULI WITH LAPAROSCOPIC CHOLEDOCHOTOMY， COMMON BILE DUCT EXPLORATION AND PLACEMENT OF T TUBE

Objective To study the effect of laparoscopic common bile duct exploration via choledochotomy and T tube drainage. Metheods Laparoscopic exploration of common bile duct with choledochoscopy via choledochotomy was performed in 105 patients, T tube was placed in all patients with laparoscopic suturing technique.Results Except negative exploration in 2 cases, duct clearance was achieved in 99 per cent (102/103) of patients. Conclusion Laparoscopic exploratoin of common bile duct via choledochotomy and T tube drainage is one of the safe and effective management options for common bile duct calculi.

Clinical Study for Patients with Cholecystolithiasis and Extrahepatic Bile Duct Stones by Laparoscopic Treatment

目的比较腹腔镜胆囊切除联合胆总管探查术（LC＋LCBDE）与内镜下Oddi括约肌切开取石联合腹腔镜胆囊切除术（EST＋LC）治疗胆囊结石合并肝外胆管结石的临床疗效。 方法回顾性分析45例行LC＋LCBDE及60例行EST＋LC患者的临床资料，观察2组在单次结石清除率、中转手术率、手术并发症、住院时间等指标方面的效果。 结果2组患者的基线资料相近，无手术死亡病例；2组术后并发症发生情况的差异无统计学意义（P＞0.05）；LC＋LCBDE组单次治疗成功率高于EST＋LC组，而住院时间及中转手术率则短于或低于EST＋LC组（P＜0.05）。 结论LC＋LCBDE是治疗胆囊结石合并肝外胆管结石患者安全有效的方法。