目的 分析重症急性胰腺炎(SAP)并发症发生的原因,拟定最佳治疗方案,减少对预后的影响。方法 对1992~2001年收治的35例SAP进行回顾性分析,观察其胰腺病理改变、治疗方式、并发症及其预后间的关系。结果 ①胰周积液者无死亡; ②胰腺组织坏死伴感染时易发生胃肠瘘,创面开放和闭合引流与胃肠瘘的发生无明显关系(Pgt;0.05); ③4例胰周积液者有胰腺假性囊肿形成; ④胰周积液无感染者平均住院时间为19 d,胰腺及胰周组织坏死者住院时间gt;49 d。结论 急性呼吸窘迫综合征、腹腔脓肿、肠瘘及胰瘘是SAP的主要并发症,可影响其预后。
目的 探讨生长抑素-14肽与生长激素联合应用在预防胰十二指肠切除术后并发症发生中的作用。方法 我院1995年3月至2003年3月共收治因胆总管下段癌、十二指肠乳头癌及胰头癌行胰十二指肠切除术患者48例,对其中26例(治疗组)应用生长抑素-14肽6 mg/d(持续微量泵泵入)及生长激素8 U/d(分两次肌注)治疗,余22例为对照组,术后常规应用全肠外营养及抗生素治疗,比较两组的治疗结果。结果 术后发生并发症对照组17例(77.3%),治疗组5例(19.2%),两组比较差异有显著性意义(P<0.05)。治疗组胰液量及胰周引流液中淀粉酶的含量明显低于对照组(P<0.05),两组术前、术后蛋白质指标,治疗组于术后第7天基本恢复到术前水平,而对照组第10天才达到术前水平。结论 联合应用生长抑素及生长激素能有效降低胰十二指肠切除术后并发症的发生率。
目的探讨手辅助腹腔镜腹部肿瘤切除术手术技术。方法应用手辅助腹腔镜技术结合吻合器及超声切割止血刀完成直肠癌切除1例,乙状结肠癌切除2例,胃壁平滑肌瘤切除1例,胆囊、胆总管结石并左侧腹巨大肠系膜囊肿行胆囊切除、胆总管探查、囊肿切除1例。结果5例患者术后恢复良好,失血量最多为100 ml。结论手辅助腹腔镜技术操作安全,损伤小,将是腹腔镜大器官切除的新方向。
Objective To study the clinical anatomical basis of the liver hanging maneuver through research of applied anatomy. Methods Retrohepatic portions of the inferior vena cava of 21 cadaver were observed intracavitarily, and the numbers of short hepatic vein (SHV) opening were counted based on different possible pathway of the liver hanging maneuver and different width of retrohepatic tunnel (10 mm, 6 mm). Results The number of SHV was 0 to 3 (median=1) using standard pathway of the liver hanging maneuver in 6 mm retrohepatic tunnel, and the number of SHV was 0 to 2 (median=0) using EM pathway that was on the right border of retrohepatic portion of the inferior vena cava and 1 cm away from the inferior border of liver. There was a significant difference between the EM pathway and standard pathway, P=0.003.Conclusion The results show that setting up a retrohepatic tunnel through the liver hanging maneuver is feasible and safe.