目的探讨胆囊切除术后再次手术的原因及其防治措施。方法对近6年我院收治的胆囊切除术后仍有症状，经B超、ERCP、MRCP、腹部X线平片及十二指肠低张造影等检查发现需再次手术的81例患者的临床资料进行回顾性分析，并结合文献，对其常见原因及其预防治疗措施进行了讨论。结果81例患者根据不同病因予以了相应的手术，如残株胆囊切除术、胆总管切开取石术、十二指肠憩室手术等。再次手术均取得良好效果，无手术死亡。结论对胆囊切除术后仍有症状者应作全面检查，部分患者可找出原因进行相应治疗，能取得良好效果； 而且绝大部分的再次手术，通过术前评估及术中各种技巧的应用是可以防范的。
Objective To study the diagnosis and treatment of portal hypertension in secondary biliary cirrhosis(PHSBC). MethodsTwenty-five cases of PHSBC within recent 16 years in our hospital were analyzed. Their clinical, pathological and follow-up data were reviewed retrospectively. They were divided into 4 groups according to their primary diseases:13 patients with hepatolithiasis, 6 with postoperative stricture of biliary duct, 4 with malignancy of biliary duct and 2 with others.Results All patients were diagnosed clinically, and 4 were further pathologically confirmed. Eight cases were treated conservatively, while the remaining 17 underwent operations according to their primary diseases, and one combined with splenectomy and esophagogastric devascularization. The rate of discharge with improvement by surgical and non-surgical treatment was 64.7% and 37.5%, and hospital mortality was 17.6% and 12.5% respectively. Conclusion The diagnosis of PHSBC mainly depends on its characteristic clinical manifestations. The early surgical resolution of bile duct obstruction is the key to good prognosis. If complicated with rupture and hemorrhage of oesophagofundal varices, the surgical procedure should be considered carefully.
Ｄｕｒｉｎｇ ｔｈｅ ｐａｓｔ ５４ ｍｏｎｔｈｓ ａ ｔｏｔａｌ ｏｆ ２４ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｓｅｃｏｎｄａｒｙ ｈｅｐａｔｉｃ ｃａｒｃｉｎｏｍａ ｈａｖｅ ｂｅｅｎ ｔｒｅａｔｅｄ ｂｙ ｒｅｓｅｃｔｉｏｎ ｏｆ ｈｅｐａｔｉｃ ｍｅｔａｓｔａｓｉｓ ａｎｄ ｐｏｓｔｏｐｅｒａｔｉｏｎ ｐｅｒｃｕｔａｎｅｏｕｓ ｉｎｔｒａｈｅｐａｔｏｐｏｒｔａｌ ｃｈｅｍｏｔｈｅｒａｐｙ（ＰＨＰＣ） ｕｎｄｅｒ ｕｌｔｒａｓｏｕｎｄ ｇｕｉｄａｎｃｅ Ａ ｆｏｌｌｏｗｕｐ ｆｒｏｍ ｆｉｖｅ ｍｏｎｔｈｓ ｔｏ ｆｏｕｒ ｙｅａｒｓ ｓｈｏｗｓ ｔｈａｔ ２１ ｐａｔｉｅｎｔｓ ｈａｖｅ ｓｕｒｖｉｖｄｅ ｆｏｒ ５ ｔｏ ４８ ｍｏｎｔｈｓ ｅｘｃｅｐｔ ３ ｅｘｔｒｅｍｅｌｙ ａｄｖａｎｃｅｄ ｃａｓｅｓ． Ｔｈｅ ａｕｔｈｏｒｓ ｓｕｇｇｅｓｔ ｔｈａｔ ａ ｃｏｍｂｉｎｅｄ ｔｈｅｒａｐｅｕｔｉｃ ｍｅｔｈｏｄ ｆｏｒ ｔｒｅａｔｉｎｇ ｓｅｃｏｎｄａｒｙ ｈｅｐａｔｉｃ ｃａｒｃｉｎｏｍａ ｉｓ ｍｏｒｅ ｅｆｆｅｃｔｉｖｅ ｔｈａｎ ｅｉｔｈｅｒ ｓｉｍｐｌｅ ｈｅｐａｔｅｃｔｏｍｙ ｏｒ ｃｈｅｍｏｔｈｅｒａｐｙ．
Twenty-three patients (28 extremities) suffering secondary ulcer after high ligation and stripping of great saphenous vein were chosen to receive muscle flap formation of potiteal vein. Of which, 21 patients (25 extremities) ulcer scabbed within one week and healed in 2 weeks after operation. The other s were cured in 5 weeks. All patients were followed up 6-12 months with no recurrence and satisfactory results.
Abstract： Tricuspid insufficiency founded in the setting of left-sided heart disease is usually secondary tricuspid insufficiency caused by tricuspid valve annular dilation. Some patients had rheumatic tricuspid valve diseases. Tricuspid valve repair rather than valve replacement is recommend for functional tricuspid regurgitation. Linear annuloplasty and ring annuloplasty are two main tricuspid valve repair methods. However, the indications for treatment of secondary tricuspid regurgitation remain controversial. The optimal surgical repair technique to eliminate secondary tricuspid regurgitation remains challenging. In this article, we review the assessment of tricuspid valve lesions, criteria for correction, and surgical management of secondary tricuspid insufficiency.methods. However, the indications for treatment of secondary tricus
Objective To investigate the expression pattern of hypoxia-inducible factor 1α (HIF-1α) in experimental secondary spinal cord injury (SSCI) in rats and its potential effects on SSCI. Methods A total of 66 SD rats (female or male) with weight (250 ± 20) g were randomly divided into 3 groups: normal control group (group A, n=6), pseudo injury group (group B, n=6), and spinal cord injury (SCI) group (group C, n=54). In group A, no treatment was given as normal control. In groupB, only laminectomy was appl ied. In group C, laminectomy was appl ied and static compression model of SCI was built at T10 level. The expression of HIF-1α was measured with HE and immunohistochemical staining in groups A, B (1 hour after pseudo injury), and C (1, 3, 6, 12 hours and 1, 2, 3, 7, 14 days after SCI). Results All rats survived to the end of the experiment. HE staining showed that the spinal tissue of groups A and B were dense and the nucleus were round and big with l ight staining and clear nucleolus. The injured neuron at 1-12 hours after SCI of group C presented pyknosis and deep eosin staining. The swelling axon with bubbles and the disintegrated and disorganized medullary sheath in white matter appeared at 1-3 days after SCI. The hyperplasia of gl ial cells were obvious and gray matter cells were broken and apoptosis with cavities in injured spinal segment was observed at 7 and 14 days after SCI. Immunohistochemical staining showed that HIF-1α was poorly expressed in group A and increased a l ittle in group B. The positive expression in group C increased at 3 hours after SCI, which was found in spinal cord anterior horn neurons and a small amount of gangl ion cells. It reached peak at 1 day, maintained at a high level during 1-3 days and then decl ined. At 14 days, it appeared only in a small amount of gangl ion cells of white matter. There was no significant difference in the number of HIF-1α positive cells between groups A and B (t=1.325, P=0.137). The number of HIF-1α positive cells at each time point in group C was more than those in groups A and B (P lt; 0.05), and there were significant differences between all time points in group C (P lt; 0.05). Conclusion The expression of HIF-1α increases after SCI, it is related to the ischemia hypoxia after SSCI, and the expression pattern was correlated with the injury time.
OBJECTIVE To study the early protective effects of basic fibroblast growth factor(bFGF) on the experimental acute spinal cord injury. METHODS Thirty-four SD rats were randomly divided into three groups, and were subjected to contusion of thoracolumbar spinal cord. A thin plastic tube was placed in subarachnoid space below the injury level for perfusion. The bFGF-treated rats were received 20 microliters bFGF(containing bFGF 100 U) at once, 30 min, 1, 2, 3, 4, 6, 12, 24 and 48 hours after injury, and an equal volume of normal saline was given to the control group at the same time. The injured spinal cord was detected by morphological observation and biochemical index after injury. RESULTS The degree of ionic disorder in bFGF-treated rats was significantly ameliorated and the contents of H2O were also markedly decreased. The morphological finding showed that the damages of gray and white matter in bFGF-treated rats were slighter than those of saline-treated rats. CONCLUSION bFGF has some protective effects on the secondary lesion of early spinal cord injury in rats.