目的：探討DSA診斷小腸血管畸形的價值。方法：本文分析21例小腸血管畸形患者的臨床及DSA特征，其中男性14例，女性7例，所有患者均行腸系膜上、下動脈造影。結果：臨床特征：①急性消化道出血為主癥狀；②常規(guī)檢查一般為陰性；③血紅蛋白含量短期內(nèi)降至4～6 g/mL。DSA特征：①動靜脈瘺；②局部腸壁染色增濃；③局部血管異常增多，結構紊亂。其中12例進行了動脈導絲栓塞，2例栓塞后出血，進行外科手術切除。結論：DSA是診斷血管畸形所致小腸出血的最有效的方法，動脈導絲栓塞是安全，有效的治療方法，同時為外科手術切除提供的正確部位。
目的:探討鼻咽纖維血管瘤術前栓塞的應用價值。方法:17例鼻咽纖維血管瘤患者,單純手術摘除10例,術前3天進行數(shù)字減影血管造影(DSA)檢查及血管內(nèi)栓塞術7例。結果:7例術前栓塞組術中出血200～700mL,平均430mL;輸血0～550mL;10例單純手術組出血550～1430mL,平均1200mL,輸血350～1200mL。術前栓塞組出血量和輸血量較單純手術組顯著減少。結論:術前瘤體栓塞治療鼻咽纖維血管瘤是安全有效、理想的術前輔助治療手段。
摘要:目的:探討腹腔鏡膽囊切除術(laparoscopic cholecystectomy, LC)后發(fā)生嚴重并發(fā)癥的原因、治療措施和經(jīng)驗教訓。方法:分析 2007 年 8 月至2009 年 4月期間華西醫(yī)院膽道外科收治的LC術后發(fā)生嚴重并發(fā)癥的7例患者的臨床資料。結果:2例繼發(fā)性膽總管結石合并化膿性膽管炎患者,采用內(nèi)鏡下十二指腸乳頭切開(endoscopic sphincterotomy, EST)取出結石;3例膽道損傷患者,均進行肝門膽管成形和肝總管空腸吻合術;1例絞窄性腸梗阻患者,切除壞死空腸管后,行空腸對端吻合術;以上6例患者均順利出院,隨訪8～20個月,均生活良好。1例患者LC術后發(fā)生肺動脈栓塞,積極搶救后因呼吸衰竭而死亡。結論:術中仔細輕柔的操作以及辯清肝總管、膽總管與膽囊管的三者關系是預防LC術后發(fā)生嚴重并發(fā)癥的關鍵。合理可行的治療措施是提高發(fā)生并發(fā)癥的患者生活質(zhì)量的保障。LC術時,膽道外科醫(yī)生思想上要高度重視,不可盲目追求速度,必要時及時中轉(zhuǎn)開腹。Abstract: Objective: To investigate the causes and therapeutic measures and the experience and lesson of sever complications after laparoscopic cholecystectomy (LC). Methods:Clinical data of 7 patients with severe complications after LC from August 2007 to April 2009 were analyzed retrospectively. The clinical data was got from biliary department of West China Hospital. Results: Two cases of secondary common bile duct stone with acute suppurative cholangitis got cured by endoscopic sphincterotomy. Three cases of severe bile duct injury after LC had stricture of the hilar bile duct, and all of the cases were performed RouxenY hepaticojejunostomy with the diameter of stoma 2.03.0 centimeters. One case of strangulating intestinal obstruction was cured through jejunum endtoend anastomosis after cutting off the necrotic jejunum. All of the above 6 patients recovered well. Following up for 820 months, all lived well. One patient got pulmonary embolism after LC and dead of respiratory failure after active rescue. Conclusion: Carefully making operation and distinguishing the relationship of hepatic bile duct and common bile duct and the duct of gallbladder are the key points to prevent sever complications during LC. Reasonable and feasible treatment is the ensurement of increasing the living quality of the patients with sever complications after LC. And the surgeons of biliary department must have a correct attitude toward LC and should concern think highly during LC and should not pursue speed blindly. In necessary, the operation of LC should be turned into open cholecystectomy.
摘要:目的:探討床旁超聲檢查在肝移植術后下腔靜脈(IVC)并發(fā)癥診斷中的應用價值。方法:對424例肝移植術后患者進行床旁超聲檢查,對下腔靜脈并發(fā)癥,包括狹窄及栓塞的資料進行回顧性分析和總結。結果:床旁超聲檢查發(fā)現(xiàn)下腔靜脈并發(fā)癥患者18例,其中狹窄6例,栓塞12例。結論:床旁超聲檢查在肝移植術后,尤其是對術后早期發(fā)生的下腔靜脈并發(fā)癥的診斷及監(jiān)測具有重要的作用,為臨床診斷和治療提供及時、有價值的影像學依據(jù)。Abstract: Objective: To evaluate the value of bedside ultrasound in diagnosis and monitoring of inferior vena cava (IVC) complications after liver transplantation. Methods: 424 cases with liver transplantation were examined by bedside ultrasound after the operations. The results of IVC complications,including thrombosis and stenosis, were analyzed and summarized. Results: 18 cases with IVC complications were detected by bedside ultrasound, including 6 cases of stenosis and 12 cases of thrombosis. Conclusion: Bedside ultrasound is important for diagnosing and monitoring IVC thrombosis and stenosis after liver transplantation, especially in the earlier period. It could provide valuable imaging for clinical diagnosis and treatment promptly.