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        west china medical publishers
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        find Author "李正平" 3 results
        • Intraoperative Choledochoscopy in 28 Patients with Suspicious Duodenal Injuries

          目的 探討膽道鏡在探查十二指腸損傷中的臨床價值。方法 回顧性分析我院2001年3月至2011年2月期間收治的28例十二指腸損傷患者應用膽道鏡探查的臨床資料。結果 開腹后直視十二指腸球部損傷7例,膽道鏡探查發現其中3例合并水平部損傷,2例合并降部與水平部交界處損傷。直視下未見十二指腸損傷患者中膽道鏡探查發現十二指腸損傷21例,其中降部5例,水平部6例,降部與水平部交界處3例,升部2例,十二指腸多處傷5例。按Lucas分級,Ⅰ級4例,Ⅱ級12例,Ⅲ級7例,Ⅳ級5例。Ⅰ級損傷患者中3例在膽道鏡下未見血腫繼續增大,局部損傷未行處理;1例血腫壓迫十二指腸導致腸腔狹窄,在膽道鏡引導下避開腸系膜血管,切開腸系膜行血腫清除及止血術。Ⅱ級損傷患者中6例在膽道鏡引導下避開腸系膜血管切開腸系膜行全層縫合。其他病例分別采用十二指腸破口空腸Roux-en-Y吻合術(Ⅱ級3例,Ⅲ級1例)、十二指腸空腸端端吻合術(Ⅱ級1例,Ⅲ級3例)、十二指腸空腸Roux-en-Y吻合術(Ⅱ級2例,Ⅲ級2例,Ⅳ級1例)、Graham簡化術(Ⅲ級1例,Ⅳ級4例),術后通過空腸切口處放置十二指腸內引流。術后發生并發癥12例,其中腸瘺2例,胰瘺2例,腸梗阻3例,腹腔膿腫2例,胰腺膿腫3例。死亡3例,治愈25例。結論 在十二指腸損傷患者中應用膽道鏡探查,可以確切診斷十二指腸受損情況,防止漏診,也可以在膽道鏡引導下行相應部位的處理。

          Release date:2016-09-08 10:23 Export PDF Favorites Scan
        • Modified Soave Procedure with Stapler for Treatment of Hirschsprung Disease

          ObjectiveTo explore the clinical value of modified Soave procedure with stapler for the treatment of Hirschsprung disease. MethodsThe clinical data of 26 patients with Hirschsprung disease adimitted in No.477 hospital from January 2002 to December 2010 were analyzed retrospectively. All the patients underwent modified Soave operation with rectal mucosa and proximal intestine stapled end-to-end. ResultsAll operations were successful without anastomotic leakage, aponeurosis of investment infection, and colonitis. Increased stool frequency presented in two cases, which were cured with astringents on day 15 and 30 after operation, respectively. Mild fecal contamination was in one case. All cases were followed up between 3 months to 60 months, with an average 32 months, without incontinence and constiptation. ConclusionModified Soave procedure with stapler is safe and effective for the treatment of Hirschsprung disease in elder children and adult.

          Release date:2016-09-08 10:45 Export PDF Favorites Scan
        • 腹腔鏡聯合膽道鏡在小腸出血手術中的應用

          目的探討腹腔鏡聯合膽道鏡在小腸出血手術中的應用 方法回顧性分析筆者所在醫院2003年1月至2015年12月期間收治的21例小腸出血患者經腹腔鏡聯合膽道鏡探查的臨床資料。 結果本組21例小腸出血患者均順利完成腹腔鏡探查,5例直接發現病灶,聯合應用膽道鏡檢查發現病灶16例。病變部位位于空腸15例,其中腫瘤9例,憩室2例,血管病變4例;回腸5例,其中腫瘤3例, 憩室1例, 血管病變1例;多部位病變1例,為憩室。病理報告顯示平滑肌瘤6例,腺瘤3例,平滑肌肉瘤1例, 惡性間質瘤2例,Meckel憩室炎伴出血4例,血管畸形3例,黏膜下血管瘤2例。惡性腫瘤3例均位于空腸。術后患者復查大便隱血均陰性。恢復良好,隨訪未再發消化道出血。 結論腹腔鏡聯合膽道鏡檢查對常規檢查無法明確病因的小腸出血有較好的診斷價值,該技術方法操作簡便、創傷小、病變診斷準確性高,在基層醫院有較好的臨床應用價值。

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