【摘要】目的 探討暴發(fā)性急性胰腺炎（FAP）的診治方法。方法 回顧性分析1999年3月至2004年5月我院收治的79例重癥急性胰腺炎（SAP）患者的臨床資料。結(jié)果 79例SAP患者中, FAP患者17例，其中3 d內(nèi)手術(shù)的4例均治愈 ，延期手術(shù)4例與非手術(shù)治療的9例均死亡。 結(jié)論 主要根據(jù)SAP患者的臨床表現(xiàn)、動態(tài)B超檢查或APACHE Ⅱ評分短期大幅增高即可診斷FAP。 一旦確診，應(yīng)當(dāng)機(jī)立斷，力爭手術(shù)治療。 血液濾過或使用大劑量激素可能為呼吸、循環(huán)不穩(wěn)定的患者創(chuàng)造手術(shù)時機(jī) 。手術(shù)方式宜盡量簡單有效，開腹手術(shù)和經(jīng)腹腔鏡輔助下的腹腔灌洗術(shù)引流效果較好，局麻下下腹切口減壓引流效果差。手術(shù)前后應(yīng)加強(qiáng)器官功能的監(jiān)護(hù)和支持。
目的 探討一種治療重癥急性胰腺炎（SAP）的新方法。方法 將59例SAP患者根據(jù)是否行選擇性區(qū)域動脈灌注給藥而分成兩組： LAI組為體外藥盒置入?yún)^(qū)域動脈灌注的SAP患者，共30例； 對照組為經(jīng)外周靜脈給藥的SAP患者，共29例。比較兩者的臨床指標(biāo)。結(jié)果 LAI組在緩解腹痛、恢復(fù)腸功能、減少并發(fā)癥、縮短抗生素使用時間、降低全身感染的發(fā)生率等方面均明顯優(yōu)于對照組。使Ⅱ級SAP患者的死亡率從66.67%降至35.71%。結(jié)論 采用體外藥盒置入胰腺區(qū)域動脈持續(xù)灌注，是早期治療SAP的新方法。
目的 探討腹腔鏡在原因不明腹痛診斷和治療中應(yīng)用的可行性。方法 總結(jié)分析44例原因不明的腹痛經(jīng)腹腔鏡診治的臨床資料。結(jié)果 全組44例患者均獲病理學(xué)診斷，其中診斷為腹腔結(jié)核23例，腸粘連17例，小腸平滑肌肉瘤、非霍奇金病、晚期胃癌、腹繭癥各1例。24例（54.6%）明確診斷后予以內(nèi)科治療，17例（38.6%）同時采用腹腔鏡治療，2例（4.5%）中轉(zhuǎn)開腹，1例（2.3%）明確診斷后延期接受開腹手術(shù)治療。所有病例經(jīng)腹腔鏡檢查和治療后，除1例晚期胃癌患者因延期開腹行姑息性手術(shù)后恢復(fù)差而死亡，其余無并發(fā)癥發(fā)生。結(jié)論 腹腔鏡是診斷和治療原因不明腹痛的有效手段，部分病例為后續(xù)治療提供了可靠的依據(jù)，部分病例可同時在腹腔鏡下完成治療手術(shù)。
目的 探討腔鏡結(jié)合術(shù)中彩超取注射式隆乳劑的可行性，總結(jié)手術(shù)經(jīng)驗并探討應(yīng)用價值。方法 2008～2010年期間我院采用腔鏡結(jié)合術(shù)中彩超的方法對16例雙側(cè)乳房接受注射聚丙烯酰胺隆乳者進(jìn)行隆乳劑取出手術(shù),回顧性分析其臨床資料。結(jié)果 經(jīng)1個切口治療的乳房18個，2個的4個，3個的10個； 切口長0.5～1 cm。手術(shù)平均時間128.70 min/例,術(shù)中出血量平均52.67 ml/例。無一例中轉(zhuǎn)開刀手術(shù)，無一例出現(xiàn)術(shù)后出血、感染、引流不暢、隆乳劑殘留等并發(fā)癥,接受取出者均對切口感到滿意。術(shù)后1～3個月復(fù)診，乳房內(nèi)無臨床可觸及的包塊，無一例出現(xiàn)乳頭、乳暈的感覺障礙； 16例行彩超或磁共振復(fù)查均無隆乳劑殘留。結(jié)論 腔鏡結(jié)合術(shù)中彩超取注射式隆乳劑是目前理想的隆乳劑取出方法，它具有美容、微創(chuàng)、安全和可以同期切除部分病變的優(yōu)勢，值得臨床進(jìn)一步探索和應(yīng)用。
【摘要】 目的 探討乳腺癌保乳切除加經(jīng)乳腔鏡清掃腋窩淋巴結(jié)的可行性和手術(shù)難點(diǎn)?！》椒ā?007年2月－2011年2月行乳腺癌保乳切除手術(shù)的27例患者，分成乳腔鏡腋窩清掃組（乳腔鏡組）11例和常規(guī)腋窩清掃組（常規(guī)組）16例，比較兩組患者手術(shù)時間、術(shù)中出血量、術(shù)中清掃淋巴結(jié)數(shù)、術(shù)后引流時間及引流量等?！〗Y(jié)果 手術(shù)時間:乳腔鏡組（186.36±11.20） min，常規(guī)組（158.13±25.29） min，兩組差異有統(tǒng)計學(xué)意義（P=0.002）；術(shù)中出血量:乳腔鏡組（61.82±51.54） mL，常規(guī)組（103.75±42.56） mL，兩組差異有統(tǒng)計學(xué)意義（P=0.030）；兩組術(shù)中清掃淋巴結(jié)個數(shù)、術(shù)后引流時間、引流量比較，差異均無統(tǒng)計學(xué)意義（Pgt;0.05）；隨訪1個月~4年，無一例發(fā)生腫瘤局部復(fù)發(fā)或戳孔轉(zhuǎn)移?！〗Y(jié)論 乳腺保乳切除加經(jīng)乳腔鏡清掃腋窩淋巴結(jié)可以安全應(yīng)用于早期乳癌的保乳治療，操作者需學(xué)習(xí)一定的手術(shù)技巧?！続bstract】 Objective To investigate the feasibility and surgical difficulty of breast-conserving resection and endoscopy-assisted axillary lymph node dissection for breast cancer patients. Methods Twenty-seven patients treated by breast-conserving surgery from February 2007 to February 2011 in our hospital were divided into endoscopy-assisted axillary lymph node dissection group (the EALND group, n=11) and conventional axillary lymph node dissection group (the CALND group, n=16). Then, we compared the operation time, intra-operative bleeding volume, number of lymph nodes dissected, postoperative drainage time and amount between the two groups. Results The operation time was significantly longer in the EALND group than that in the CALND group [(186.36±11.20) vs. (158.13±25.29) minutes, P=0.002]. The intra-operative bleeding volume of the EALND group was significantly less than that of the CALND group [(61.82±51.54) vs. (103.75±42.56) mL, P=0.030]. There were no significant differences between the two groups in the number of lymph nodes dissected, postoperative drainage time and amount. Follow-up was done for one month to four years, during which no local recurrence or trocar displacing occurred. Conclusion The breast-conserving resection and endoscopy-assisted axillary lymph node dissection can be safely used in early breast cancer patients, and surgical skills should be mastered in the study.
【摘要】 目的 探討腔鏡技術(shù)通過不同切口方式取出聚丙烯酰胺水凝膠（polyacrylamide hydrogel，PAHG）注射隆乳劑手術(shù)的臨床效果，以取得最大隆乳劑清除率?！》椒ā?008年1月－2011年3月雙側(cè)乳房PAHG注射隆乳術(shù)后并發(fā)癥患者35例，將腔鏡技術(shù)分別應(yīng)用于經(jīng)乳房外側(cè)切口和經(jīng)乳暈切口PAHG注射隆乳劑取出手術(shù)。經(jīng)乳房外側(cè)切口治療21例，于乳房外側(cè)緣隱匿部位分別選做長約0.5～1.0 cm的切口1～3個，穿刺吸刮PAHG后在腔鏡結(jié)合彩色多普勒超聲徹底清除PAHG；經(jīng)乳暈切口14例，沿乳暈下緣做2～3 cm弧形切口，吸刮PAHG后，以長頭拉鉤挑起囊腔，在內(nèi)鏡輔助下通過刮除或吸刮交替清除殘留PAHG，彩色多普勒超聲掃查確認(rèn)未見PAHG回聲團(tuán)塊?？偨Y(jié)比較兩種切口中應(yīng)用腔鏡技術(shù)的臨床經(jīng)驗?！〗Y(jié)果 所有患者均順利完成手術(shù)，達(dá)到最大限度取出隆乳劑的目的。無中轉(zhuǎn)改變手術(shù)方式，無術(shù)后出血、感染、引流不暢、隆乳劑殘留等并發(fā)癥；患者均對切口感到滿意。經(jīng)乳暈切口組中6例取出隆乳劑后同期置入硅膠囊假體，該組有1例出現(xiàn)乳頭乳暈的感覺敏感度降低。 結(jié)論 腔鏡輔助下經(jīng)乳腺外側(cè)切口和經(jīng)乳暈切口都能夠安全、有效并最大限度地取出PAHG注射隆乳劑，具有美容、微創(chuàng)和可以同期切除病變組織的優(yōu)勢，經(jīng)乳暈切口手術(shù)方便同期硅膠囊假體的置入。腔鏡技術(shù)值得在PAHG注射隆乳劑取出術(shù)中進(jìn)一步推廣應(yīng)用。【Abstract】 Objective To explore the clinical outcome of endoscopic techniques in the removal of injected breast-augmentation polyacrylamide hydrogel (PAHG) through different incision methods in order to achieve a maximal PAHG removal rate. Methods From January 2008 to March 2011, 35 patients with postoperative complications after bilateral breasts PAHG injection were diagnosed and treated in our hospital. Endoscopic techniques were applied to remove PAHG through the lateral incision of breast or the mammary areolar incision. Twenty-one patients were treated with lateral incision in which 1-3 incisions with a length of 0.5-1.0 cm were selected at hidden lateral sites of breasts, and PAHG was removed by vacuum sucking followed by endoscopic technique with Doppler color ultrasound to achieve a complete removal. Fourteen patients were treated with mammary areolar incision where an arc-shaped 2-3 cm incision was made under the lower margin of mammary areola. After vacuum sucking of PAHG, long head hook was used to lift the cyst and endoscopic technique was used along or alternate with sucking to remove the remaining PAHG. Doppler color ultrasound scanned to confirm the absence of PAHG mass. The clinical experiences of these two endoscopic techniques were compared and summarized. Results All patients successfully underwent the surgery and achieved a goal of maximal removal of PAHG. None of the patients had to switch surgery approach, and no such complications as post-surgery bleeding, infection, obstructed drainage or PAHG remaining occurred. Patients were all satisfied with the appearance of incisions. Six patients were given silicone prosthesis implantation after removing PANG through the areola incision, among whom one patient showed a decreasing sensitivity in mammary nipple and areola. Conclusions Both endoscopic techniques through the lateral incision of breast and the mammary areolar incision are safe, and can achieve maximal removal of PAHG. They both have the advantages of beautifying, minimal invasiveness and simultaneous removal of pathologic tissues. The mammary areolar incision facilitates implantation of silicone prosthesis simultaneously. The endoscopic techniques are worthy to be further applied into removal of PAHG
目的 總結(jié)CT引導(dǎo)經(jīng)皮置管引流（PCD）對急性胰腺假性囊腫（PPC）的有關(guān)問題。方法 通過檢索近年來國內(nèi)、外有關(guān)文獻(xiàn)，分析總結(jié)其適應(yīng)證、使用時機(jī)、技術(shù)操作、并發(fā)癥、療效等方面的研究進(jìn)展。 結(jié)果 該術(shù)式可及早用于急性PPC，預(yù)防和減少后者因傳統(tǒng)的等待觀察而可能出現(xiàn)的并發(fā)癥。手術(shù)操作方法簡單、并發(fā)癥少、療效好，已取代某些開腹手術(shù)。加用生長抑素更可縮短療程。部分患者術(shù)后處理可在門診進(jìn)行，更節(jié)省費(fèi)用。結(jié)論 本術(shù)式系簡單而安全有效的微創(chuàng)技術(shù)，且費(fèi)用較低。認(rèn)真掌握適應(yīng)證，進(jìn)一步改進(jìn)設(shè)備和操作技術(shù)，療效將進(jìn)一步提高，值得推廣使用。
目的 觀察內(nèi)鏡治療急性膽源性胰腺炎（ABP）的療效及其并發(fā)癥。方法 30例ABP患者在抗炎、抑酶等綜合治療基礎(chǔ)上，經(jīng)內(nèi)鏡（1～3 d 內(nèi)）逆行胰膽管造影（ERCP）及經(jīng)內(nèi)鏡十二指腸乳頭括約肌切開（EST）或鼻膽管引流（ENBD）等治療。結(jié)果 內(nèi)鏡治療后22 例（73.3%）輕癥急性膽源性胰腺炎（MABP）患者3～5 d 體溫恢復(fù)正常； 8例（26.7%） 重癥急性膽源性胰腺炎（SABP）患者3～8 d 腹部體征好轉(zhuǎn)，血常規(guī)、淀粉酶及血生化1~2周內(nèi)基本恢復(fù)，平均住院18.7 d，3例死亡（10.0%）。內(nèi)鏡治療過程中5例出現(xiàn)十二指腸乳頭括約肌切口少量出血，經(jīng)簡單治療止血，未再出現(xiàn)其他并發(fā)癥。與同期開腹手術(shù)治療相比較，癥狀體征緩解、血常規(guī)、淀粉酶、血生化恢復(fù)正常及住院的時間更短，死亡率無明顯差異。結(jié)論 ABP早期ERCP 及內(nèi)鏡治療安全有效。