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经皮经肝胆道镜碎石取石术治疗胆肠吻合术后肝胆管结石病

目的探讨经皮经肝胆道镜碎石取石术（PTCSL）必要时联合球囊扩张治疗胆肠吻合术后肝胆管结石病的可行性及安全性。方法重庆医科大学附属第二医院 2015 年 12 月至 2020 年 12 月期间共有 54 例胆肠吻合术后肝胆管结石病患者接受 PTCSL 必要时联合球囊扩张治疗（符合纳入标准）。回顾性收集患者的一般资料、手术情况、术后情况以及术后随访资料。结果54 例患者中有 52 例（96.3%）行 PTCSL 治疗成功，2 例因为胆肠吻合口完全闭塞而失败。术中出血量的中位数为 55 mL（15～520 mL）；取净结石 48 例（88.9%），结石残留 6 例（11.1%）。术后并发症发生率为 27.8%（15/54），无围手术期死亡患者。取净结石的 48 例患者获随访，中位随访时间 33 个月（2～60 个月），有 10 例结石复发，复发率为 20.8%（10/48）。结论PTCSL 必要时联合球囊扩张治疗胆肠吻合术后肝胆管结石病具有良好的安全性和可行性，但是术后需要注意预防结石复发。

Comparison of The Application of Double Stapling Technique and Single Stapling Technique in The Low or Ultralow Anterior Rectal Resection and Colon-Anal Canal Anastomosis for Patients with Rectal Cancer

Objective　To compare the effects of double stapling technique （DST） and single stapling technique （SST） in the low or ultralow anterior rectal resection and colon-anal canal anastomosis for patients with rectal cancer. Methods　The clinical data of 351 patients with rectal caner， who were treated with low or ultralow anterior resection and colon-anal canal anastomosis in West China Hospital from Jan. 2009 to Dec. 2010， were collected and analyzed retrospectively. Operative and postoperative indexes of patients treated with DST （n=302） and SST （n=49） were compared. Results　Compared with DST group， the distance from the dentate line to the edge of tumor， the length of the distal surgical margin 〔（1.83±0.59） cm vs. （2.07±0.56） cm〕， and hospitalization cost 〔（24 350.48±7 812.73） yuan vs.（29 455.32±7 869.33） yuan〕 of SST group were shorter or lower （P＜0.05）， but operative time was longer 〔（112.86±39.29） min vs. （100.10±36.75） min， P＜0.05〕. There were no significant differences on blood loss， duration of firstambulation， duration of first passing flatus， duration of first bowel movement， duration of pulling out nasogastric tube， duration of pulling out urinary catheter， duration of pulling out drain， postoperative hospital stay， total length of hospital stay， and the incidence of complication between the 2 groups （P＞0.05）. All patients were in functional recovery of anal control after operation. All patients were followed-up for 6-24 months （average 16 months）. During the followed-up， only 1 case suffered local tumor recurrence （SST group）， 3 cases suffered distant metastases （all in DST group）， and 15 cases （4.27％） died， of which 13 cases （4.30％） in DST group and 2 cases （4.08％） in SST group. Conclusions　As in the low or ultralow anterior rectal resection and colon-anal canal anastomosis for patients with rectal cancer， SST results in shorter distal surgical margin than DST， so SST is suitable for the patients with shorter distance from the dentate line to the edge of tumor. What’s more， it saves the hospitalization cost effectively.

肝胆管盆式肝肠吻合术治疗肝内胆管结石并狭窄21例体会

Litmus Paper and Fibrin Sealant Help Prevent Potential Pancreatoenterostomy Leakage (Report of 47 Cases)

目的总结降低胰十二指肠切除术后胰空肠吻合口漏发病率的经验体会。 方法切除胰头后，将胰腺残端游离2.5～3.0 cm，利用红色石蕊试纸遇碱性胰液变蓝的特性，帮助寻找胰腺断面被横断的小导管，丝线贯穿缝扎。将空肠袢断端2.0～2.5 cm浆肌层剥除后施行套叠式胰空肠端端吻合，距浆肌层游离缘1.0～1.5 cm 处空肠上下壁各缝1针固定，最后用纤维蛋白胶封闭吻合口。结果47例患者中无一例发生胰空肠吻合口漏。结论该法操作较简便，适用于胰腺残端各种情况的处理。

Application of right ventricular bypass procedures treatment in complex xongenital heart sisease

Follow the advance of surgical treatment in complex congenital heart disease, the application of right ventricular(RV)-bypass procedures in RV-hypoplasia/dysfunction was gradually recognized; the pathological pattern of RV-hypoplasia/dysfunction, the histological change of RV-bypass operation and the option on different operative procedure, emphasis on the indication of bidirectional superior cavopulmonary anastomosis(BCPA),the form and method of procedure,and peri-operative management were reviewed in this paper,the optimal age for BCPA, the optimal timing for conversion to Fontan procedure, on pump or off pump, section of the pulmonary trunk, and its difference from hemi-Fontan and 1 1/2 ventricular operation were discussed.

食管癌切除胃食管颈部吻合与胸腔内吻合的对比分析

目的 比较食管癌切除胃食管颈部吻合与胸腔内吻合的手术疗效。方法 中下段食管癌患者165例，根据手术方式不同，将其分为两组，胃食管颈部吻合组：73例，经左颈、右胸、上腹正中三切口手术40例，经左胸、左颈二切口手术33例。胸腔内吻合组：92例，经左胸或右胸径路行主动脉弓上吻合47例，弓下吻合45例。比较两组术后并发症的发生率和生存率。结果 术后食管胃颈部吻合组残端癌、手术死亡率和吻合口瘘死亡率均低于胸腔内吻合组（Plt;0.05）；两组患者间5年生存率差别无统计学意义（Plt;0.05）；但淋巴结转移阴性和阳性患者5年生存率两组间比较差别均有统计学意义（Plt;0.05）。结论 食管癌切除胃食管颈部吻合术治疗中下段食管癌符合肿瘤根治原则，肿瘤切除彻底，残端癌的发生率和死亡率低。

THE LONG-TERM OPERATIVE RESULTS OF CONGENITAL CHOLEDOCHAL CYST

目的 探讨先天性胆总管囊肿(congenital choledochal cyst,CCC)术式选择与疗效的关系。方法 对1989年至1998年间38例CCC手术治疗病例进行回顾性研究。结果 38例中行胆肠Roux-Y吻合术20例，肝总管十二指肠高位大口吻合术18例。术后随机获随访31例。13例胆肠Roux-Y吻合术后随访3～7年，发现5例并发十二指肠溃疡，3例并发胆道逆行感染。18例肝总管十二指肠高位大口吻合术后随访2～5年，发现1例并发胆道逆行感染，无1例并发十二指肠溃疡。结论 由于肝总管十二指肠高位大口吻合术后远期并发十二指肠溃疡发生率较低，其与胆肠Roux-Y吻合术相比，是提高CCC患儿术后远期生活质量较理想的术式。

急诊内镜下止血夹治疗消化道机械吻合术后早期吻合口出血的疗效

目的 探讨急诊内镜下使用止血夹治疗消化道机械吻合术后早期吻合口出血的疗效。 方法 回顾性分析 2005 年 1 月至 2016 年 12 月期间在笔者所在医院胃肠外科接受内镜下止血的 12 例消化道机械吻合术后早期吻合口出血患者的临床资料。 结果 本组 12 例患者中，10 例患者一次止血成功；2 例出现再次出血，其中 1 例再次内镜下止血成功，1 例胃空肠吻合术后患者止血失败、行手术治疗。所有患者术后均未出现吻合口漏等严重并发症。术后 11 例内镜止血成功患者获访 6～28 个月，中位随访时间 18 个月，随访期间未见再次出血。 结论 急诊内镜下止血夹治疗消化道机械吻合术后早期吻合口出血的操作简单、安全及有效，可作为首选方法在临床上推广应用。

Application of Pancreaticogastrostomy for Pancreatoduodenectomy (Report of 24 Cases)

目的　研究胰腺-胃吻合术在胰十二指肠切除术消化道重建中的合理性。方法　对2002年3月至2004年10月期间实施胰十二指肠切除和胰腺-胃吻合术重建消化道的24例壶腹周围癌患者的临床资料进行回顾性分析。结果　所有患者均顺利完成胰腺-胃吻合手术，胰瘘的发生率为8.3%（2/24），通过保守治疗均痊愈。结论　胰腺-胃吻合术是胰十二指肠切除术后一种安全的消化道重建方法。

PRIMARY SCLEROTIC CHOLANGITIS(REPORT OF 24 CASES)

Objective To explore the diagnostic and treating scheme of primary sclerotic cholangitis. Methods 24 cases of primary sclerotic cholangitis identified by radiological and pathological examinations from 1972 to 1998 were analysed retrospectively. According to Thompson, 1 case was classified as type Ⅰ, 5 cases were type Ⅱ, 10 cases were type Ⅲ and 8 cases were type Ⅳ. The operation were as follows,resection of gallbladder plus T tube drainage in 8 cases, plus Roux-en-Y anastomosis of bile duct and jejunum in 12 cases, plus U tube stent and drainage in 4 cases. Results The total mortality rate was 25% (6/24) in 2～18 years follow-up after operation. Conclusion Early diagnosis and operation may resolve the drainage of bile into the jejunum. When serious lesions and worse liver functions exist, liver transplantation should be considered.