目的总结截肋引流术在脓胸治疗中的应用价值 方法回顾性分析2008年1月至2013年1月于九原区医院胸外科及大连医科大学附属第二医院胸外科21例脓胸患者的临床资料，其中男15例、女6例，年龄33～65（42.5± 4.5）岁。脓胸位于左侧胸腔9例，右侧胸腔12例。患者均采用截肋引流术进行治疗。 结果21例截肋引流术均获得成功，无围术期死亡病例。术后应用抗菌素7～10 d。术后3～7 d拔除上胸腔引流管。术后10～21 d当胸腔引流液少于20 ml时，将脓腔内引流管引流改为开放引流，23～40 d完全拔出脓腔引流管。术后胸部X线片示18例患者肺膨胀良好，无残腔；3例患者有少量包裹性积液。21例患者均顺利出院。随访6个月至5年，患者症状消失，胸部X线片示肺膨胀良好，无残腔，无复发。 结论截肋引流术是一项安全有效的治疗技术，对于急慢性脓胸均有一定的临床应用价值。
目的 总结超声引导下经皮经肝穿刺胆管引流术(PTCD)的优、缺点,为临床治疗重症急性胆管炎（SAC）提供参考。方法 回顾性分析我院1994年8月至2008年7月期间对156例老年SAC患者行在超声引导下的PTCD治疗的临床资料。结果 156例行PTCD均获成功,1次穿刺成功140例，其成功率达89.7%（140/156）; 16例首次穿刺失败后再次穿刺均成功。无一例发生腹腔出血、胆汁性腹膜炎等并发症。本组引流效果较好,中毒危象缓解，黄疸减退，肝功能改善。结论 PTCD较外科手术创伤小、操作简单、快速,具有微创的特点,对老年、有严重合并症及复杂疾病不能耐受手术及麻醉的SAC患者，其作为紧急抢救措施切实可行,并为后期施行根治性手术争取了时间。
目的 探讨急性胰腺炎继发感染的治疗方法。方法 分析总结我院1998～1999年收治的20例胰腺感染患者，采用经后上腰腹膜后引流及灌洗方法治疗的资料。结果 术后并发症： 残余脓肿2例，消化道出血1例，肠瘘4例，胰瘘6例，经治疗后患者全部治愈。结论 该治疗方法残余感染及死亡率低。
目的:应用微创液化引流术治疗高血压壳核出血的疗效。方法:对120例高血压壳核出血患者,在CT引导下,依据血肿大小、形态及患者病情,选择适宜的穿刺点、方向,行CT平面导向下微创液化引流术,清除血肿。结果:120例患者出院94例,死亡26例,病死率为21.6%。对存活65例患者随访6个月至2年,以日常生活能力(ADL)评估患者神经功能,ADL128例(43％),ADL220例(30.7%)、ADL310例(15.3％)、ADL45例(7.6％)、ADL52例(3.0%)。结论:应用微创液化引流治疗壳核出血,能最大限度地清除血肿,避免或减轻并发症,具有较大优越性。
Sixteen cases unresectable carcinoma of the head of the pancreas complicated with jaundice were treated by one stage cholecysto-jejunal and gastro-jejunal loop double anastomosis, the same result of jaundice drainage and prevention of bile reflux were obtained when compared with simple cholecysto-jejunal loop anastomosis, on the other hand, the obstructive symptoms resulting from postoperative cancerous comppression of duodenum and pylorus were avoided as well. The operation is simple with less physiologic disturbance and the patient can lead better postoperative live.
【Abstract】ObjectiveTo study the effect of bile reinfusion on immunologic function of erythrocyte in patients with obstructive jaundice after external drainage of biliary tract.MethodsPatients with obstructive jaundice who had received biliary tract external drainage were randomly divided into bile reinfusion group (n=24) and simple external drainage group (n=27). Patients without jaundice,who received cholecystectomy in the same period with the above ones,were selected randomly as control group(n=25). In external drainage groups patients’ bile was collected daily, and was filtered through gauze, and then, pumped back into the patients’ duodenum or jejunum after being heated to 38 ℃-40 ℃. The bile reinfusion could be started after the intestinal function recovered postoperatively. The changes of C3bRRT, ICRT, RFER and RFIR were observed before and after operation. The data were analysed through SPSS8.0.ResultsPreoperative C3bRRT and RFER levels in patients with obstructive jaundice were lower than those without jaundice significantly, and Preoperative ICRT and RFIR levels in patients with obstructive jaundice were higher than those without jaundice significantly. C3bRRT levels in bile reifusion group was higher obviously than those in simple drainage group (P＜0.05) on the 14th postoperative day. ConclusionImmunologic function of erythrocyte in patients with obstructive jaundice is inhibited, and bile reinfusion after biliary tract external drainage can be helpful to the recovery of immunologic function of erythrocyte.
Objective To discuss the value of biliary stent in treatment of malignant biliary obstruction with different pathways of bile duct stent insertion. Methods Fourty-two cases of malignant biliary obstruction whose biliary stent insertions were through operation (n=18), PTCD (n=17) and ERCP (n=7) respectively were reviewed retrospectively. Results The bile duct stents were successfully inserted in all patients through the malignant obstruction and achieved internal biliary drainage. Compared with the level of the bilirubin before operation, it decreased about 100 μmol/L one week after the stent insertion in all patients. Compared with the levels of glutamic oxalacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase and glutamyltranspeptidase before operation, they decreased 1 week after the stent insertion （Plt;0.05). The median survival time was 22 weeks. The average survival time was (32.89±33.87) weeks. Two patients died in hospital after PTCD, and the mortality was 4.76%. Complications included 8 cases of cholangitis, 3 cases of bile duct hemorrhage and 2 cases of hepatic failure. Conclusion The bile duct stent insertions through operation, PTCD and ERCP are all effective in relieving the bile duct construction with malignant biliary obstruction. Each method should be chosed according to the systemic and local condition for every patient so as to improve the safety and efficiency, and to decrease the occurrence of complications.
Objective To explore the influencing factors of pancreatic fistula after pancreaticoduodenectomy (PD), and to compare the incidence of pancreatic fistula after pancreaticoduodenectomy with internal drainage of main pancreatic duct and external drainage according to the pancreatic fistula risk score (FRS) system, to provide the basis for the best drainage scheme in clinic. Methods The clinical data of 76 patients with PD who treated in the Affiliated Hospital of Xuzhou Medical University from January 2016 to December 2017 were analyzed retrospectively, to explore the risk factors of pancreatic fistula. Single factor analysis was based on group chi-square test or Fisher exact probability method, and multivariate analysis was based on unconditioned logistic regression model. According to the results of FRS, the difference of pancreatic fistula in different risk groups was explored. The statistical method was chi-square test. Results The incidence of pancreatic fistula after PD was 31. 5% in 76 patients.Univariate analysis showed that the diameter of the main pancreatic duct and the texture of the pancreas were the related factors affecting the occurrence of pancreatic fistula after PD (P<0.05), and the soft pancreas was the independent risk factor for the occurrence of pancreatic fistula after PD (OR=3.886, P=0.011). There was no significant difference in the incidence of postoperative pancreatic fistula between the internal drainage group and the external drainage group (P>0.05). There was no pancreatic fistula occurred in the patients with negligible risk. The incidence of postoperative pancreatic fistula in patients with high risk of external drainage group was only 12.5%, comparing with patients in internal drainage group (63.6%), the difference was statistically significant (P=0.026). There was no significant difference in the incidence of postoperative pancreatic fistula between patients in the external drainage group with moderate risk and low risk compared with the corresponding patients in the internal drainage group (P>0.05). Conclusions Pancreatic texture was an independent risk factor for pancreatic fistula after PD. External drainage maybe more effective than internal drainage in preventing pancreatic fistula after PD in patients with high risk of FRS.
Objective To compare efficacy of laparoscopic and open duodenal circular drainage operation for superior mesenteric artery compressing syndrome (SMACS). Methods From December 2012 to December 2015, the clinical data of 23 cases of laparoscopic duodenal circular drainage operation (laparoscope group) and 28 cases of open duodenal circular drainage operation (open group) were analyzed. The operation time, intraoperative bleeding, postoperative ambulation time, postoperative analgesics usage, postoperative the first exhaust time, postoperative the first feeding time, postoperative hospitalization time and postoperative incidence of complications were compared. The patients were followed up to confirm the effect after the operation. Results There were no differences of the age, sex, and body weight index between the laparoscope group and the open group (P>0.05). The operation time had no significant difference between these two groups (P>0.05). Compared with the open group, the intraoperative bleeding was less (P<0.05), the postoperative ambulation time, postoperative the first exhaust time, postoperative the first feeding time, postoperative hospitalization time were shorter (P<0.05), the rates of postoperative analgesics usage, incision infection, pulmonary infection, and intestinal obstruction were lower (P<0.05) in the laparoscope group. The rates of anastomotic leakage and anastomotic bleeding, and total postoperative complications rate had no significant differences between these two groups (P>0.05). All the patients were followed up for 8–36 months. The clinical symptoms disappeared and the body weight increased to normal level in the two groups. Conclusions Preliminary results of in this study show that laparoscopic duodenal circular drainage operation in treatment of SMACS has some advantages such as less trauma, faster recovery, fewer complications and shorter hospitalization time. Laparoscopy will be an ideal choice for treatment of SMACS.