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 summarize the research progress of secondary fracture of adjacent vertebral body after percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). Methods Recent literature concerning PVP and PKP was extensively reviewed and summarized. Results The main reasons of secondary fracture of adjacent vertebral body after PVP and PKP are the natural process of osteoporosis, the initial fracture type, the bone cement, the surgical approach, the bone mineral density, and other factors. Conclusion Secondary fracture of adjacent vertebral body after PVP and PKP is a challenge for the clinician, a variety of factors need to be suficiently considered and be confirmed by a lot of basic and clinical epidemiological studies.
【Abstract】 Objective To explore the effect of recurrent anterior shoulder dislocation on the secondary intra-articular injuries through analyzing the correlation between the number of dislocation, disease duration, and the secondary intra-articular injuries. Methods The clinical data were analyzed retrospectively from 59 patients with recurrent anterior shoulder dislocation who underwent arthroscopic Bankart reconstruction using suture anchor between January 2005 and June 2009. There were 48 males and 11 females, and the average age was 27.6 years (range, 15-42 years). The causes of first dislocation included contact sports (21 cases), non-contact sports (13 cases), daily activities (11 cases), and trauma (14 cases). The average number of preoperative dislocations was 10.6 times (range, 3-32 times). The time between first dislocation and surgery was 11 months to 12 years (median, 5.9 years). The results of apprehension test and relocation test were positive in all patients. The University of California Los Angeles (UCLA) score was 22.3 ± 2.4, and Constant-Murley score was 73.1 ± 5.8 preoperatively. According to the arthroscopic findings, the effect of recurrent anterior shoulder dislocation on the secondary intra-articular injuries was analyzed. Results All incisions healed by first intention, and no early complication occurred. All 59 patients were followed up 37.3 months on average (range, 16-58 months). At last follow-up, UCLA score was 34.6 ± 1.7 and Constant-Murley score was 86.7 ± 6.1, showing significant differences when compared with preoperative scores (P lt; 0.05). The number of preoperative dislocations was positively correlated with the severity of secondary articular cartilage injury (rs=0.345, P=0.007) and the severity of Hill-Sachs injury (rs=0.708, P=0.000). The time between first dislocation and surgery had a positive correlation with the severity of secondary articular cartilage injury (rs=0.498, P=0.000), but it had no correlation with the severity of Hill-Sachs injury (rs=0.021, P=0.874). Conclusion For patients with recurrent anterior shoulder dislocation, early Bankart reconstruction is benefit to functional recovery of shoulder and can avoid or delay the occurrence or development of secondary intra-articular injuries.
ObjectiveTo investigate the effectiveness of the mortise-tenon orbicularis oris muscle flap for philtrum column deformity secondary to the unilateral cleft lip repair. MethodsBetween January 2009 and August 2011, 43 patients with philtrum column deformity secondary to unilateral cleft lip repair were treated. There were 23 males and 20 females with an average age of 23.6 years (range, 18-31 years). The left philtrum column was involved in 26 cases, and the right side in 17 cases. Cleft lip was repaired with Millard I in 15 cases and with Millard II in 28 cases. The time between cleft lip repair and philtrum column deformity correction was 15-30 years (mean, 21.7 years). The bilateral double orbicularis oris muscle flap was obtained, and then was divided horizontally into two layers. The overlapping suture of the bilateral lower muscle flap was perfomed, and the upper layer muscle was designed into the mortise-tenon orbicularis oris muscle flap and was sutured with contralateral skin. ResultsAll incisions healed by first intention. Forty cases were followed up 13.4 months on average (range, 6-34 months). The patients achieved satisfactory effects in bilateral symmetry philtrum column and normal concave shape. At 6 months after operation, significant improvement was observed in 38 cases and no obvious improvement in 2 cases. ConclusionThe mortise-tenon orbicularis oris muscle flap is a simple operation and can obtain good results in the appearance and function of the upper lip in the correction of philtrum column deformities secondary to the unilateral cleft lip repair.