目的 探讨老年人结肠脾曲综合征的诊治方法。方法 对1993年9月至2003年9月收治的22例老年人结肠脾曲综合征患者的临床资料进行回顾性分析。结果 临床表现为便秘伴腹痛、腹胀、消瘦、头痛、头晕、心悸、腹膜炎等； X线钡剂灌肠造影检查示结肠脾曲过高、迂曲成角，甚至扭转，可伴有横结肠冗长。行横结肠与降结肠侧侧吻合术，切除冗长结肠，随访2～8年，疗效满意。结论 对老年结肠脾曲综合征患者，钡剂灌肠检查应是常规检查，一旦确诊，应手术治疗。
目的 评价CT及MRI在中晚期胆囊癌周围脏器侵袭和转移中的诊断价值。方法 回顾性分析我院2003年3月至2010年6月期间收治的经手术病理证实的中晚期胆囊癌患者45例，所有患者术前均同时行CT和MRI检查。结果 ①在诊断胆囊癌方面，CT诊断符合率为93.33% （42/45），MRI诊断符合率为88.89% （40/45），二者比较差异无统计学意义（χ2=0.287 2，P＞0.05）。②在诊断胆囊癌转移的敏感度方面，肝脏直接浸润和转移诊断方面CT为72.00% （18/25），MRI为92.00% （23/25）；胆管受侵诊断方面CT为83.33% （5/6），MRI为100% （6/6）；胰腺转移诊断方面CT为100% （3/3），MRI为100% （3/3）；淋巴结转移诊断方面CT为70.00% （7/10），MRI为90.00% （9/10）；腹膜、网膜转移诊断方面CT为33.33% （1/3），MRI为33.33% （1/3）。诊断胆囊癌转移的总诊断符合率CT为72.34%（34/47），MRI为89.36% （42/47），MRI明显高于CT （χ2=4.083 3，P＜0.05）。结论 MRI在诊断胆囊癌方面与CT相当，但在诊断肿瘤侵犯邻近器官及转移方面MRI略优于CT。
Objective To investigate the possibility of laparoscopic cholecystectomy （LC） on porcelain gallbladder. Methods Twenty-four cases of porcelain gallbladder， who were operated in China Medical University， including 13 LC cases， from 2006 to 2008 were retrospectively reviewed. Results Of 24 porcelain gallbladder cases (0.48%) in 4964 cholecystectomy patients， calcification of gallbladder in 87.50%(21/24) patients was diagnosed by ultrasonography. Of 13 patients who were cured by LC, one suffered from postoperative leak bile, no metastasis were found by following up 12 or 14 months in two gallbladder carcinoma cases. Conclusion There’s specificity of ultrasonographic image in porcelain gallbladder, in which LC is safe to be performed and routine frozen pathology during operation is necessary.
Objective To investigate the effects of hand assistant laporoscopic splenectomy plus pericardial devascularization on systemic stress responses. Methods Forty patients with cirrhotic portal hypertension were selected， 20 cases of which were underwent hand assistant laparoscopic splenectomy plus pericardial devascularization (LAP group)， and the other 20 were underwent open splenectomy plus pericardial devascularization (OP group). The levels of blood glucose （BG）, insulin (Ins), triiodothyronine （T3）, tetraiodothyronine （T4）, corticosteroid （CS） and other related clinical data were measured before operation and on day 1-3 after operation, which were compared between two groups. Results There was no statistical significance between two groups on those levels before operation. On day 1 after operation， BG and CS level in both two groups were higher than those before operation (P＜0.05), but they were recovered on day 2 after operation in LAP group (Pgt;0.05), and on day 3 after operation in OP group (Pgt;0.05). BG and CS level in OP group were markedly higher than those in LAP group on day 2 after operation (P＜0.05). On day 1 after operation， Ins, T3 and T4 level of two groups were lower than those before operation (P＜0.05), but they were recovered on day 2 after operation in LAP group (Pgt;0.05) and on day 3 after operation in OP group (Pgt;0.05). Ins, T3 and T4 level in OP group were lower than those in LAP group on day 2 after operation (P＜0.05). There was no significant difference in operation time between two groups (Pgt;0.05). But laparoscopic surgery had more advantages than conventional open surgery such as reducing bleeding quantity in operation, shortening recovery time of bowel and urinary bladder function and the length of stay. Conclusion Compared with laparotomy, the laparoscope not only imposes less impact on physical stress system, but also makes recovery after operation more quickly.
Objective To explore the clinical value and experience of ultrasound guided combined with laparoscopic microwave ablation in treatment for special site liver cancer．Methods The clinical data of 9 patients with liver cancer treated by ultrasound guided combined with laparoscopic microwave ablation in our hospital from February 2008 to October 2010 were analyzed retrospectively．Results There were 6 cases of primary liver cancer， 3 cases of metastatic hepatic carcinoma. Eight cases of multiple tumors， 1 case of single tumor．There were one or more lesions invading liver capsular，a total of 13 lesions in all the patients． Among them，6 lesions located in diaphragm， 3 closed to bowel， 2 neared stomach，1 located in gallbladder bed and 1 in hilar．No serious complications and no death happened during operation．The following-up time was （9.2±4.7） months （4 to 18 months）， there were 2 lesions of part residual， including 1 case of microwave ablation again，1 case of percutaneous ethanol ablation， and 11 lesions of complete ablation （84.6%，11/13） 1 month after operation by CT examination．Four cases recurred 3 months after operation by CT examination， including 2 cases of microwave ablation again，1 case of percutaneous ethanol ablation，1 patient with pulmonary metastasis and giving up treatment，1 patient with poor liver function and died of liver failure 6 months after operation；1 patient with multiple lesions died of brain metastases 10 months after operation； the rest were still alive．Conclusions Ultrasound guided combined with laparoscopic microwave ablation is a safe and effective method in the treatment for special site liver cancer，the curative effect is good and worth of spread．
目的比较单孔腹腔镜与传统腹腔镜胆囊切除术的临床效果。 方法选取2012年9月至2013年5月期间于我院就诊的胆囊良性疾病患者，分别接受单孔腹腔镜胆囊切除术（单孔腹腔镜组，45例）和传统腹腔镜胆囊切除术（传统腹腔镜组，48例），分别观察并对比2组患者的手术时间、术中出血量、术后（6 h和24 h）疼痛评分、止疼药物的应用率、术后住院时间及患者对切口的满意度。 结果2组患者术前的一般特征差异无统计学意义（P＞0.05）。单孔腹腔镜组的手术时间明显长于传统腹腔镜组〔（59.11±14.15）min比（40.21±11.11）min，P=0.00〕，术后6 h疼痛评分及止痛药物应用率均明显低于传统腹腔镜组〔6 h疼痛评分：（3.33±1.41）分比（4.60±1.30）分，P=0.00；止痛药物应用率：6.67%（3/45）比31.25%（15/48），P=0.04〕，术后患者对切口的满意度评分明显高于传统腹腔镜组〔（4.76±6.00）分比（2.60±0.76）分，P=0.02〕。单孔腹腔镜组和传统腹腔镜组的术中出血量、术后24 h疼痛评分及术后住院时间比较差异均无统计学意义〔术中出血量：（14.67±4.80）mL比（13.85±3.85）mL，P=0.36；24 h疼痛评分：（1.60±0.65）分比（1.80±0.70）分，P=0.14；术后住院时间：（3.11±0.77）d比（3.06±0.67）d，P=0.75〕。2组均无并发症发生。 结论单孔腹腔镜较传统腹腔镜胆囊切除术可减轻术后疼痛，美容效果好，且并不增加手术风险。
目的探讨超声引导下经皮经肝胆囊穿刺引流术（PTGD）联合二期腹腔镜胆囊切除术（LC）治疗急性胆囊炎的安全性和可行性。 方法回顾性分析我院2008年7月至2013年7月期间对急性胆囊炎先行PTGD后二期LC的117例患者的临床资料。 结果本组117患者PTGD术后均成功实施二期LC，PTGD术顺利，无并发症发生，PTGD管平均留置时间27.4 d（21～31 d）。LC采用单孔法33例，三孔法84例，全部病例均治愈。手术平均时间为48.5 min（32～92 min），腹腔引流管拔除平均时间为2.3 d（2～4 d）。无中转开腹者，无胆管损伤、出血、胆汁漏等并发症发生。病理结果为急性胆囊炎。本组随访患者无术后并发症。 结论超声引导下PTGD联合二期LC治疗急性胆囊炎安全、有效。
目的 探讨孤立性纤维性肿瘤的诊断及外科治疗方法。方法 回顾我院10年来经手术切除并行病理检查确诊为孤立性纤维性肿瘤的病例资料，就其诊断和外科治疗方法进行总结与分析。结果 共16例次患者，肿瘤分别位于胸腔、腹股沟、后腹膜、外阴、颈部、下肢等部位，无明显特异的临床症状。所有病例均行手术完全切除肿瘤，术后经病理学检查和免疫组化染色检查确诊。对患者定期随访，其中2例分别于术后5年和7年肿瘤复发，2例分别随访3年和5年后失访，2例患者分别于随访的第9个月和16个月因全身多发转移死亡，其余患者仍在随访中。结论 孤立性纤维性肿瘤大多数病例表现为局部缓慢生长的无痛性肿块，无明显的临床症状，术前诊断较困难，目前仅能依靠术后免疫组化检查确诊，手术切除是最佳的治疗方法。
Objective To investigate the reasons and preventions of bleeding after percutaneous microwave ablation for liver cancer. Methods The data of 156 patients with liver cancer between September 2006 and December 2009 treated with percutaneous microwave ablation (226 times) were recorded. The reasons and preventions of bleeding after percutaneous microwave ablation were analyzed. Results Eleven patients (11 times) suffered from bleeding. The rate of bleeding is 4.87% (11/226), including 2 cases of biliary bleeding, 9 cases of intraperitoneal hemorrhage. All patients who suffered from bleeding firstly received medical therapy to control bleeding, 5 cases were successful; in the other 6 cases who failed in medical therapy, 1 case was stopped bleeding with opening procedures, 4 cases received transcatheter embolization to stop bleeding with gelatin sponge, 1 case died due to excessive blood loss. According to Chi-square test result, the bleeding was significantly related with liver cirrhosis, lower platelet count, obvious prolongation of prothrombin time, subcapsular tumor, Child-Pugh B/C grade, and re-ablation （P=0.044, 0.041, 0.028, 0.001, 0.016, 0.016）. The multiple variables logistic regression analysis showed that liver cirrhosis, platelet count, prothrombin time, location of tumor, and Child-Pugh grade were the influential factors of bleeding after microwave ablation （OR=5.273, P=0.036; OR=8.534, P=0.043; OR=4.893, P=0.045; OR=7.747, P=0.010; OR=6.882, P=0.015）. Conclusions There were some factors were significantly related with the bleeding after percutaneous microwave ablation: liver cirrhosis, abnormal blood clotting function （lower platelet count and prolongation of prothrombin time）, tumor located on the surface of liver, and Child-Pugh C grade. When failed to stop bleeding with medical therapy, transcatheter embolization is an effective method to control bleeding.