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REGIONAL CHEMOTHERAPY BY DRUG DELIVERY SYSTEM INSERTED IN RIGHT GASTROEPIPLOIC VEIN AFTER EXCISION OF HEPATOCARCINOMA AND LIGATION OF THE HEMIHEPATIC ARTERY (REPORT OF 21 CASES)

目的探讨肝癌切除后行区域性化疗治疗肝癌的效果。方法原发性肝癌18例，转移性肝癌3例，均行肿瘤切除，病侧肝动脉结扎，胃网膜右静脉置入药泵，于术中经药泵注入5Fu，拆线后用5Fu（总量6 g）、丝裂霉素（总量8 mg）及阿霉素（总量60 mg）经药泵注入化疗。术后前3年，每年化疗3个疗程，第4～5年，每年化疗1～2个疗程。结果21例中随访3年以上12例，6例失访，3例死亡，本组资料3年生存率为57%。结论肝癌切除后，结扎病侧肝动脉，行门静脉区域性化疗，疗效显著。

腹腔镜胆囊切除术少见并发症(附2例报告)

POSTOPERATIVE RETAINED BILIARY STONES TREATED CHOLEDOCHFIBERSCOPY(REPORT OF 108 CASES)

目的 总结纤维胆道镜对胆道术后残留结石的治疗作用。方法 应用纤维胆道镜治疗胆道术后残留结石108例。结果取石成功率96.9%，结石取净率80.5%。结论 纤维胆道镜对解决胆道术后残留结石有其重要作用，并可降低再手术率。

断流术联合肠腔分流术治疗肝硬变断流术后再出血23例报道

目的探讨断流术联合肠腔分流术（简称“分断联合术”）治疗肝硬变断流术后再出血的临床效果。 方法回顾性分析我院2010年2月至2015年2月期间行贲门周围血管离断术加肠腔分流术治疗肝硬变断流术后再出血的23例患者的临床资料。 结果本组患者术后的门静脉直径较术前明显缩小（P＜0.05）。患者断流后与开腹后门静脉压力比较差异无统计学意义（P＞0.05），分流后较开腹后门静脉压力明显下降，差异有统计学意义（P＜0.05）。随访期间无死亡病例，所有患者肝功能均好转，肝性脑病发生率和再出血率均为4.35%（1/23）。 结论分断联合术治疗肝硬变断流术后再出血既保留了分流和断流术的优点，又能克服二者的缺点，临床效果令人满意。

Pancreatic Carcinoma: Diagnosis and Preoperative Resectability Assessment by Using Gd-DTPA 3D FSPGR Dynamic MR Imaging

ObjectiveTo study the value of Gd-DTPA three dimension fast spoiled gradientecho (3D FSPGR) dynamic MRI in the diagnosis and preoperative respectability assessment of pancreatic carcinoma.MethodsThirty-two cases of pancreatic carcinoma verified by surgery and pathology were included in this study. All of the cases had MRI examinations two weeks before surgery. MRI protocols involved gradient echo T1 weighted（GRE T1W） with fat suppression, fast spin echo respiratory gating T2 weighted (FSE RG T2W) with fat suppression, MR cholangiopancreatography (MRCP) and gadolinium chelate 3D FSPGR T1W dynamic enhancement. Two radiologists reviewed MRI of the 32 cases retrospectively. Preoperative resectability of pancreatic carcinoma was assessed according to the characteristics of tumor lesions, peripancreatic invasion, vascular invasion, lymph node metastases, and liver metastases. The diagnosis and preoperative resectability assessment of pancreatic carcinoma by MRI was compared with surgical findings. ResultsOf 32 cases, 29 cases diagnosed by MRI were confirmed by surgery and pathology (accuracy of MRI, 90.6%). The sensitivity was 84.4%(27/32) and 93.8%(30/32) respectively for GRE T1W with fat-suppression combining FSE RG T2W and for Gd-DTPA 3D FSPGR dynamic MRI in the detection of pancreatic tumors. The accuracy was 87.5%（21/24）, 87.0%（20/23）, 80.0%（12/15）, 88.9%（8/9） and 83.3%（5/6） respectively for Gd-DTPA 3D FSPGR dynamic MRI in assessing local extension, vascular invasion, lymph node metastases, liver metastases and peritoneal carcinomatosis of pancreatic carcinoma. Eight cases of pancreatic carcinoma were considered to be resectable by enhanced MRI, while the tumors in 7 cases of the 8 cases were resected by surgery. Twentythree cases were confirmed nonresectable by surgery in the 24 cases of pancreatic carcinoma considered to be non-resectable by enhanced MRI. The sensitivity, specificity and accuracy were 87.5%，95.8% and 93.8% resectability for the assessment of respectability of pancreatic carcinoma by using Gd-DTPA 3D FSPGR dynamic MRI. There was no significant difference in the assessment of the resectability of pancreatic carcinoma between enhanced MRI and surgery or pathology （κ=0.83）.ConclusionUsing of Gd-DTPA 3D FSPGR dynamic enhanced MRI improves the detections of pancreatic carcinoma and metastasis. It is also accurate in the assessment of the resectability of pancreatic carcinoma.

THE MULTI-ORGANS OPERATIONS AT THE SAME TIME AND BY THE SAME PORES (REPORT OF 51 CASES)

目的 探讨腹腔镜胆囊切除术(LC)同时同孔完成多脏器手术可能性及手术方法。方法 总结1993年3月至1999年4月完成LC 2 170例，其中LC同时同孔完成多脏器手术51例。结果 该51例手术全部成功，无1例术中中转开腹，除1例患者LC同时同孔行绝育手术后怀孕，其余无术中及术后并发症发生。结论 LC同时同孔完成多脏器手术实现了跨区域、多脏器同期手术，虽创伤范围增多，操作有一定的难度，仍具有微创外科的特点。一次完成多种手术，不明显增加患者的痛苦及费用，避免了患者在一种疾病治愈后再次住院手术治疗另一种疾病。

开腹术中射频消融治疗肝右叶外伤18例临床分析

目的 探讨术中射频消融止血法在肝右叶外伤中的应用。 方法 回顾性分析术中射频消融治疗 18例肝右叶外伤患者的临床资料。 结果 所有患者均痊愈出院，无死亡病例。术后出现膈下脓肿 1 例，肝周积液 2 例，低流量胆瘘 1 例，经术后外科引流、抗感染治疗后治愈。 结论 处理较为困难的肝右叶肝外伤，术中射频消融止血法是一种有效的可供选择的手术方式。

Analysis on Diagnosis and Treatment of 38 Adult Patients with Congenital Choledochal Cyst

目的　探讨成人先天性胆总管囊肿的诊治方法和手术技巧。方法　对2001年5月至2011年5月期间我院手术治疗的成人先天性胆总管囊肿38例的临床资料进行回顾性分析。结果　全部病例均行B超和磁共振（MRCP）检查确诊，均行手术治疗。其中7例行急诊囊肿外引流术。行择期手术者中24例行囊肿切除、胆肠吻合术，其中3例合并肝叶切除术； 行内引流术4例； 仅行胆囊切除术3例。囊肿剥除采用点状钳夹、电凝及推剥囊肿黏膜外纤维血管束的办法，不出血，无副损伤。无手术死亡病例，术后恢复顺利。38例患者中术后获随访28例（73.68％），失访10例； 随访时间 3～120个月，平均74个月。24例行囊肿切除者症状消失20例，偶感上腹痛、抗炎治疗后症状可缓解1例，3例失访；11例行内或外引流术者术后近期均有不同程度的胆管炎症状，其中6例于术后2～10 年再手术，另5例失放，6例再手术者中2例术中发现癌变，分别于再手术后2个月和10个月死亡，余4例临床症状消失；3例仅行胆囊切除术者，2例失访，1例仍有反复发作的畏寒、发热及右上腹痛。结论　B超和MRCP检查有助于明确诊断； 囊肿全切除、肝管空肠Roux-en-Y 吻合术应作为胆总管囊肿的首选术式，囊肿外引流术仅在合并严重感染、全身情况差的患者采用； 手术技巧的改进可为手术提供安全保障。