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find Keyword "探查" 46 results
  • Laparoscopic Common Bile Duct Exploration:A Report of 1221 Cases

    目的:总结运用腹腔镜胆总管探查术的治疗经验。方法:回顾性分析1992年3月~2006年12月运用腹腔镜胆总管探查术对1221例患者进行治疗的经验。结果:即时缝合671例中634例和T管引流550例中501例治疗获得成功。中转开腹9例,胆漏46例,术后残余结石内镜未取净11例,死亡5例。结论:只要选择合适的病例,腹腔镜胆总管探查术对于有较高内镜和腹腔镜技术者是可行、有效和安全的。

    Release date:2016-09-08 10:14 Export PDF Favorites Scan
  • 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。

    Release date:2016-09-08 10:49 Export PDF Favorites Scan
  • Contrast of Ultrasonography in Diagnosis for Hepatorrhexis with Operative Exploration (Report of 120 Cases)

    Objective To discuss the diagnosis value of ultrasonography in hepatorrhexis. Methods The contrast of ultrasonography for 120 cases of hepatorrhexis with operative exploration was made. Results All of the 120 patients were examined with ultrasonography, fragmentation of liver parenchyma in 55 cases, dehiscence of liver parenchyma in 38 cases, liver subcapsular hematoma in 12 cases, and spontaneous rupture of liver cancer in 7 cases. All of the 120 patients were confirmed hepatorrhexis with laparotomy. The positive diagnostic rate of ultrasonography in the hepatorrhexis was 93.3%. Conclusion Ultrasonography is valuable for diagnosing hepatorrhexis and it is one of the important diagnostic approaches.

    Release date:2016-08-28 04:43 Export PDF Favorites Scan
  • 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。

    Release date:2016-08-28 04:49 Export PDF Favorites Scan
  • 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.

    Release date:2016-08-28 05:30 Export PDF Favorites Scan
  • 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。

    Release date:2016-08-31 05:47 Export PDF Favorites Scan
  • Primary Suture versus T-tube Drainage after Laparoscopic Common Bile Duct Stone Exploration: A Systematic Review

    Objective To assess the benefits and harms of routine primary suture (LBEPS) versus T-tube drainage (LCHTD) following laparoscopic common bile duct stone exploration. Methods The randomized controlled trials (RCTs) or quasi-RCTs were electronically searched from the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2010), PubMed (1978 to 2010), EMbase (1966 to 2010), CBMdisc (1978 to 2010), and CNKI (1979 to 2010); and the relevant published and unpublished data and their references were also searched by hand. The data were extracted and the quality was evaluated by two reviewers independently, and the RevMan 5.0 software was used for data analysis. Results Four studies including 3 RCTs and 1 quasi-RCT involving 274 patients were included. The meta-analysis showed that compared with LCHTD, LBEPS was better in shortening operation time (WMD= –17.11, 95%CI –25.86 to –8.36), abdominal drainage time (WMD= –0.74, 95%CI –1.39 to –0.10) and post-operative hospitalization time (WMD= –3.30, 95%CI –3.67 to –2.92), in lowering hospital expenses (WMD= –2 998.75, 95%CI –4 396.24 to –1 601.26) and in reducing the complications due to T-tube such as tube detaching, bile leakage after tube drawing, and choleperitonitis (RR=0.56, 95%CI 0.29 to 1.09). Conclusion LBEPS is superior to LCHTD in total effectiveness for common bile duct stone with the precondition of strictly abiding by operation indication. Due to the low quality of the included studies which decreases the reliability of this conclusion, more reasonably-designed and strictly-performed multi-centered RCTs with large scale and longer follow up time are required to further assess and verify the efficacy and safety of this treatment.

    Release date:2016-09-07 11:01 Export PDF Favorites Scan
  • Comparison on Two Minimally Invasive Procedures for Gallstones Combined with Common Bile Duct Stones: A Systematic Review

    Objective To evaluate the clinical effectiveness of ERCP/S+LC and LC+LCBDE in cholecystolithiasis and choledocholithiasis. Methods A fully recursive literature search was conducted in MEDLINE, EMbase, Cochrane Central Register of Controlled Trials in any language. By using a defined search strategy, both the randomized controlled trials (RCTs) and controlled clinical trials on comparing ERCP/ S+LC with LC+LCBDE in cholecystolithiasis and choledocholithiasis were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trials was evaluated. Meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.0.2 software. Results Fourteen controlled clinical trials (1 544 patients) were included. The results of meta-analyses showed that: a) There were no significant difference in the stone clearance rate between the two groups (RR=0.96, 95%CI 0.92 to 1.01, P=0.14); b) There were no significant difference in the residual stone rate between the two groups (OR=1.05, 95%CI 0.65 to 1.72, P=0.83); c) There were no significant difference in the complications morbidity between the two groups (OR=1.12, 95%CI 0.85 to 1.55, P=0.48); d) There were no significant difference in the mortality during follow-up visit between the two groups (RD= 0.00, 95%CI –0.03 to 0.03, P=0.84); e) The length of hospital stay in the LC+LCBDE group was shorter than that of the ERCP/S+LC group with significant difference (WMD= 1.78, 95%CI 0.94 to 2.62, Plt;0.000 1); and f) The LC+LCBDE group was superior to the ERCP/S+LC group in the aspects of procedure time and total hospital charges. Conclusion Although there aren’t differences in the effectiveness and safety between the ERCP/S+LC group and the LC+LCBDE group, the latter is superior to the former in procedure time, length of hospital stay and total hospital charges. For the influencing factors of lower quality and astable statistical outcomes of the included studies, this conclusion has to be verified with more strictly designed large scale RCTs.

    Release date:2016-09-07 11:00 Export PDF Favorites Scan
  • Clinical Study of Laparoscopic Common Bile Duct Exploration with Primary Suture

    【摘要】 目的 探讨腹腔镜胆总管探查一期缝合的可行性和适应证及临床价值。 方法 回顾性分析2007年7月—2010年10月72例胆管结石患者的临床资料,采用三孔法腹腔镜胆总管探查术,术中胆道镜配合胆道手术器械取石,一期缝合胆总管进行治疗。 结果 72例手术均获成功,无中转开腹,4例出现术后胆漏,经腹腔引流3~5 d治愈,无严重并发症。术后住院4~7 d(平均4.4 d)。72例均获随访,随访时间1~24个月(平均10个月)。术后1个月B型超声,未发现胆道狭窄及残余结石。 结论 腹腔镜胆总管探查术后一期缝合胆总管,安全、有效、微创效果显著,是临床微创治疗胆囊结石合并胆管结石的一种理想术式,值得临床推广应用。其关键是术中取尽结石和把握适应证,同时需要术者熟练掌握胆道镜技术及腹腔镜下胆总管切开缝合、打结等技术。【Abstract】 Objective To discuss the feasibility, indications and clinical value of laparoscopic common bile duct exploration with primary suture. Methods We analyzed the clinical data of 72 patients with biliary duct stone treated from July 2007 to October 2010. Three-port laparoscopic common bile duct exploration with primary suture was adopted; choledochoscopy and open bile duct operation instruments were used to take out the stones during the operation; and the common bile duct was treated with primary suture after operation. Results All operations were carried out successfully without any case of conversion to open operation. Bile leakage occurred in four cases and was cured with abdominal drainage tube for three to five days without any severe complications. Postoperative hospitalization time ranged from four to seven days, averaging at 4.4 days. All patients were followed up for one to 24 months (averaging at 10 months). B-mode ultrasonography examination one month after operation showed no biliary tract stricture or residual stone. Conclusions Laparoscopic common bile duct exploration with primary suture is safe, reliable, minimally invasive, more effective, and can be regarded as an ideal operative method for the treatment of cholecystolithiasis combined with biliary duct stone in clinical practices. It is worth popularizing. The key elements for a successful operation lie in completely taking out the stones and having a sound knowledge of indications. Furthermore, surgeons should master the skills in choledochoscopy techniques, laparoscopic incision, suture and ligation.

    Release date:2016-09-08 09:26 Export PDF Favorites Scan
  • Laparoscopy Combined with Choledochoscopy in Treatment of 53 Patients with Calculi in Common Bile Duct

    目的:总结应用腹腔镜联合胆道镜治疗胆总管结石的体会。方法:回顾分析2003年1月至2009年5月成都市第五人民医院联合应用腹腔镜胆道镜治疗胆总管结石的临床资料。结果:经胆囊颈管取石成功21例,切开胆总管取石27例,其中胆总管I期缝合17例,T管引流31例,3例术后发生胆总管残余结石,经T管窦道胆道镜取石治愈,5例中转开腹。结论:选择合适病例,腹腔镜联合胆道镜治疗胆总管结石患者创伤小,效果好,且安全可靠。

    Release date:2016-09-08 10:04 Export PDF Favorites Scan
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