Search

直腸息肉術后發生腹膜后積氣及感染 1 例報道

Ultrasound Guided Combined with Laparoscopic Microwave Ablation in Treatment for Special Site Liver Cancer

Objective　To explore the clinical value and experience of ultrasound guided combined with laparoscopic microwave ablation in treatment for special site liver cancer．Methods　The clinical data of 9 patients with liver cancer treated by ultrasound guided combined with laparoscopic microwave ablation in our hospital from February 2008 to October 2010 were analyzed retrospectively．Results　There were 6 cases of primary liver cancer， 3 cases of metastatic hepatic carcinoma. Eight cases of multiple tumors， 1 case of single tumor．There were one or more lesions invading liver capsular，a total of 13 lesions in all the patients． Among them，6 lesions located in diaphragm， 3 closed to bowel， 2 neared stomach，1 located in gallbladder bed and 1 in hilar．No serious complications and no death happened during operation．The following-up time was （9.2±4.7） months （4 to 18 months）， there were 2 lesions of part residual， including 1 case of microwave ablation again，1 case of percutaneous ethanol ablation， and 11 lesions of complete ablation （84.6%，11/13） 1 month after operation by CT examination．Four cases recurred 3 months after operation by CT examination， including 2 cases of microwave ablation again，1 case of percutaneous ethanol ablation，1 patient with pulmonary metastasis and giving up treatment，1 patient with poor liver function and died of liver failure 6 months after operation；1 patient with multiple lesions died of brain metastases 10 months after operation； the rest were still alive．Conclusions　Ultrasound guided combined with laparoscopic microwave ablation is a safe and effective method in the treatment for special site liver cancer，the curative effect is good and worth of spread．

Ultrasound-Guided Percutaneous Transhepatic Gallbladder Drainage Combined Laparoscopic Cholecystectomy in Treatment of Severe acute Cholecystitis(Report of 117 Cases)

目的探討超聲引導下經皮經肝膽囊穿刺引流術（PTGD）聯合二期腹腔鏡膽囊切除術（LC）治療急性膽囊炎的安全性和可行性。 方法回顧性分析我院2008年7月至2013年7月期間對急性膽囊炎先行PTGD后二期LC的117例患者的臨床資料。 結果本組117患者PTGD術后均成功實施二期LC，PTGD術順利，無并發癥發生，PTGD管平均留置時間27.4 d（21～31 d）。LC采用單孔法33例，三孔法84例，全部病例均治愈。手術平均時間為48.5 min（32～92 min），腹腔引流管拔除平均時間為2.3 d（2～4 d）。無中轉開腹者，無膽管損傷、出血、膽汁漏等并發癥發生。病理結果為急性膽囊炎。本組隨訪患者無術后并發癥。 結論超聲引導下PTGD聯合二期LC治療急性膽囊炎安全、有效。

?

目的 探討自制雙套管持續沖洗負壓引流治療胰腺術后胰瘺的效果。 方法 回顧性分析2008 年 8 月至2014 年3 月期間于筆者所在醫院接受自制雙套管持續沖洗負壓引流治療的12 例胰瘺患者的臨床資料，總 結效果。 結果 12 例患者均接受雙套管持續沖洗負壓引流治療，治療期間引流管若有堵塞，可拔出體外清理。所 有患者均于拔管后治愈。更換雙套管早期（1 ～ 3 d）患者發熱等感染癥狀明顯緩解，引流10 ～ 22 d 后引流量逐漸 減少。出院后所有患者均獲訪6 個月，患者恢復良好，胰瘺部位包裹吸收，無并發癥發生。 結論 自制雙套管持續 沖洗負壓引流治療胰腺術后胰瘺的效果滿意，安全可行。

Experience about Transumbilical Single-Port Laparoscopic Appendectomy by Using Traditional Instrument

目的　總結經臍單切口腹腔鏡闌尾切除術的技術要點。方法　回顧性分析2012年1月至12月期間中國醫科大學附屬第四醫院收治并行經臍單切口腹腔鏡闌尾切除術的55例闌尾炎患者的臨床資料。結果　54例患者手術均獲成功，1例患者因腹膜后闌尾而中轉為3孔法。手術時間為（40.6±12.3） min （35～90min），住院時間為（4.5±1.3） d （3～6d），住院費用為（1.2±0.3）萬元（0.8～1.5萬元），術后均無并發癥發生。術后49例患者獲訪，隨訪時間為1～6個月，平均4.8個月。術后患者均恢復良好，臍部瘢痕不明顯，美容效果較滿意。結論　采用通用器械行經臍單切口腹腔鏡闌尾切除術安全、可行，美容效果較佳。

Influence of Pancreatoduodenectomy on CD4+CD25+ T Cells in Patients with Pancreatic Head Carcinoma and Its Clinical Significance

ObjectiveTo investigate the proportion of peripheral blood CD4+CD25+ regulatory T cells (Tregs) in patients with pancreatic head carcinoma, the dynamic changes of these cells before and after pancreatoduodenectomy were also analyzed. MethodsThe proportions of peripheral blood CD4+CD25+ Tregs in patients with pancreatic head carcinoma and normal individuals were examined by using flow cytometric analysis. The CD4+/CD8+ ratio was also studied before and after operation. ResultsThe patients with pancreatic head carcinoma showed higher ratio of CD4+CD25+ and CD4+CD25high Tregs compared with normal control before operation (Plt;0.05). However, the percentage of these T cells reduced significantly after pancreatoduodenectomy, which was most obviously on the 3rd day after operation (Plt;0.01, Plt;0.05). After operation, CA199 level began to decrease, which was obvious on the fourteen day after operation. This tendency of CD4+CD25high Tregs changes was similar to that of CA199. The patients showed an decreased ratios of CD4+/CD8+ compared with normal controls, which further declined after operation, and reached the lowest point on the seventh day after operation (Plt;0.05). ConclusionsPancreatoduodenectomy may be helpful for the recovery of antitumor immunity. The perioperative period of patients with pancreatic head carcinoma may be a beneficial windowphase for immune intervention and Tregs may be served as target cells.