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DIAGNOSIS AND TREATMENT OF CLOSED TRAUMA OF DUODENUM　(REPORT OF 33 CASES)

目的 探討閉合性十二指腸損傷的診斷與術式選擇及其效果。 方法對1980～1999年間收治的33例閉合性十二指腸損傷患者臨床資料進行回顧性總結分析。結果 合并傷27例，其中胰腺損傷占24.2%(8/33)，術前診斷率為18.2%(6/33)，術中漏診率為15.2%(5/33)。術式選擇：單純十二指腸損傷以修補為主，十二指腸裂口較大或缺損者，可采用空腸漿膜覆蓋術及十二指腸空腸Y型吻合術等其它術式，合并有胰腺損傷者宜行Graham簡化術。同時應行充分的十二指腸減壓和腹腔引流。術后并發癥發生率為39.4%(13/33)，治愈率為84.8%(28/33)，死亡率為15.2%(5/33)。 結論 十二指腸損傷應重視早期診斷，在剖腹探查中應識別其損傷特征，并掌握切開探查方法，防止漏診；術式選擇寧簡勿繁，不同患者適時、適當地采用最佳的診斷和治療方法是十二指腸損傷手術成功的關鍵。

外傷性脾破裂138例報告

OPERATION OF RETAINING SPLEEN FOR SPLEEN TRAUMA (REPORT OF 77 CASES)

目的 探討外傷性脾破裂手術適應證和方法。方法 對77例外傷性脾破裂進行保脾手術治療，按姜洪池脾損傷四級分類法： Ⅰ級8例，Ⅱ級41例，Ⅲ級18例，Ⅳ級10例。附加脾動脈結扎術6例。結果 死亡4例； 2例并粘連性腸梗阻。獲隨訪45例，隨訪時間3個月至3年，僅4例兒童有反復上呼吸道感染，無1例發生脾切除后兇險感染(OPSI)。結論 根據脾損傷的部位和程度，可采用兩種以上的聯合保脾術式，對控制傷脾出血及保留脾臟功能有重要價值。

The Application of Plug Mesh TensionFree Hernioplasty of Abdominal External Hernia (Report of 58 Cases)

目的探討疝環充填式無張力疝修補術在腹外疝修補術中的價值。方法回顧性總結1999年5月至2002年10月我院應用疝環充填式無張力疝修補術治療腹外疝患者58例，共62例次。其中合并高血壓、心肺功能不全、前列腺肥大、糖尿病者占39.7%（23/58）。　結果切口均為一期愈合。術后3～7 d出院。隨訪１～29個月，平均18個月，隨訪率為89.7%（52/58）,無一例復發。結論疝環充填式無張力疝修補術具有創傷小、符合解剖生理、痛苦少、恢復快及復發率低等優點。

Clinical Application of Meglumine Diatrizoate in Diagnosing and Treating Adhesiveness Small Bowel Obstruction

Objective To analyze the effect of meglumine diatrizoate on diagnosing and treating adhesiveness small intestinal obstruction. Methods The clinic data of 484 cases of adhesiveness small intestinal obstruction were analyzed retrospectively. Those patients were treated with radiography with 76% of meglumine diatrizoate by orally or injected. Results After taking meglumine diatrizoate, 362 patients were cured, and the other 122 cases were diagnosed clearly and treated with surgery. Conclusions Meglumine diatrizoate can be used to diagnose adhesiveness small intestinal obstruction and confirm where the obstruction is. It can be the routine treatment for adhesiveness small intestinal obstruction and can be used repeatedly. It also can provide evidence to surgical treatment and guide to make the surgical project.

膽道鏡氣囊導管治療膽管裂傷大出血3例體會

Clinical Application on Meglumine Diatrizoate in Treatment of Adhesive Ileus

目的　觀察泛影葡胺在粘連性腸梗阻中的診斷及治療效果和手術時機的選擇。方法　對137例粘連性腸梗阻患者經胃管注入76%泛影葡胺60~100 ml行胃腸道造影，通過腹部X線攝片動態觀察造影劑在胃腸道中的位置及通過情況，以確定梗阻部位以及梗阻是否完全，從而確定手術時機。結果　137例中103例造影劑在6~24 h后到達結腸而給予保守治療，平均癥狀緩解時間為14.8 h，1~6 d (平均3.3 d)后癥狀消失。另34例見造影劑不能到達結腸且癥狀體征加重而行手術治療,痊愈。結論　泛影葡胺胃腸道造影在對粘連性腸梗阻明確梗阻部位及手術時機的選擇方面有很好的指導作用，可作為臨床醫師診斷與治療粘連性腸梗阻的一種手段。

Effects of Gefitinib on Expression of Epidermal Growth Factor Receptor in Bile Duct Epithelial Cells and Its Significance

Objective To observe the effect of gefitinib on expression of epidermal growth factor receptor (EGFR) in bile duct epithelial cells, and the feasibility of inhibiting hyperplasia of bile duct epithelial cells with gefitinib. Methods Sixty-one patients with hepatolithiasis having to be in hospital for surgery from the First People’s Hospital of Shuangliu county were selected, with 25-65 years old, average 46.92 years. The patients were randomly divided into therapy group and control group. There were 30 cases in therapy group, in which fine duct was placed on lesion bile duct during operation, and through whom gefitinib solution was perfused after operation. There were 31 cases in control group with only T tube drainage after operation. The bile duct sample was obtained respectively during the operation and 6 weeks and 12 weeks after operation. The histology and expression change of EGFR were observed by HE staining, immunohistochemistry and RT-PCR method respectively. Results There were no significant differences in pathohistology changes of bile duct and the EGFR protein and mRNA expression between therapy group and control group during operation. The hyperplasia of epithelium mucosae and submucosal gland in the therapy group were obviously decreased as compared with those in control group, the EGFR mRNA and protein expression in therapy group were weaker than those of control group （Plt;0.05） 6 weeks and 12 weeks after gefitinib treatment. Conclusion EGFR is overexpressed in the chronic proliferative cholangitis, and continuously local application of gefitinib after operation can specifically interrupt the activation and expression of EFGR and then effectively inhibit the hyperplasia of bile duct epithelial cells.