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胰腺真性囊腫致梗阻性黃疸1例報告

左胸腔和右髂內動脈克氏針移位一例

目的 報道1 例骨折內固定器械克氏針在人體內的移位。 方法 2004 年3 月，患者曾因右鎖骨骨折行開放鎖骨復位手術，用2 根交叉克氏針內固定，術后3 個月右鎖骨骨折愈合，克氏針未行手術移除。2005 年4月，患者感左胸痛入院，行胸部及盆部X 線、CT 及三維重建，示固定在右鎖骨上的2 根克氏針發生了移位，1 根在左側胸腔，另1 根移位至右骶髂關節前方（右髂內動脈內）。行左側胸腔切開取針和右髂內動脈切開取針術后，結扎右髂內動脈。 結果 術后患者恢復良好，胸痛緩解，右下肢活動感覺無異常。術后7 d 康復出院。 結論 采用克氏針行鎖骨骨折內固定應牢固固定，否則易出現移位，引起嚴重后果。

高位膽石性腸梗阻1例報道

Comparison of Laparoscopic Cholecystectomy between the Highland and Non-highland Area

【摘要】　目的　探討高原地區腹腔鏡膽囊切除術（laparoscopic cholecystectomy，LC）患者的特點，以便更好地進行圍手術期處理。　方法　對2009年2月-2010年5月收治的長期生活在西藏高原地區的患者（高原組）367例和非高原地區患者（非高原地區組）167例的一般資料、術前診斷、合并癥情況進行回顧性分析，兩組患者性別、年齡及病程比較，差異無統計學意義（Pgt;0.05），有可比性。兩組患者診斷均以膽囊結石為主，其次為膽囊息肉，診斷構成比較，差異無統計學意義（Pgt;0.05）；兩組患者合并癥比較，高原組患者高血壓、冠心病、血紅蛋白增多癥及竇性心動過緩的發生率高于非高原地區組（Plt;0.05）；肺部疾病、肝硬化、糖尿病及腦梗死的發生率兩組患者比較差異無統計學意義（Pgt;0.05）。兩組患者均采用常規LC進行治療，對兩組患者術后臨床結果、并發癥等進行統計學分析。　結果　高原組患者手術中轉開腹率（7.1%）高于非高原地區組（2.4%）患者（Plt;0.05）；高原組患者較非高原地區組患者住院時間長、手術時間長、術中出血量多（Plt;0.05）；術后并發癥比較差異無統計學意義（Pgt;0.05）。　結論　高原地區LC患者宜及時中轉開腹，其圍手術期處理得當將有助于減少術后并發癥的發生。【Abstract】　Objective　To explore the characteristics of patients undergoing laparoscopic cholecystectomy in highland area, in order to carry out better perioperative management.　Methods　We collected and analyzed the general information, preoperative diagnosis and complications of 367 patients living in highland area and 167 patients living in inland between February 2009 and May 2010. There was no significant difference between the two groups in sex, age and course of disease (Pgt;0.05). Cholecystolithiasis was the main disease followed by gallbladder polyps, and there was no difference between them in the kind of diseases (Pgt;0.05). The incidence of hypertension, coronary heart disease, hereditary persistence of fetal hemoglobin and sinus bradycardia was higher in patients in highland area than that in patients in non-highland area (Plt;0.05). There was no significant difference in the incidence of lung disease, liver cirrhosis, diabetes mellitus and cerebral infarction between the two groups (Pgt;0.05). Conventional laparoscopic cholecystectomy was conducted in both two groups. Comparative analysis of treatment outcome and postoperative complications was done.　Results　The rate of conversion from laparoscopic surgery to laparotomy in Tibetan patients (7.1%) was higher than that in patients in non-highland area (2.4%) (Plt;0.05). Hospitalization time, operation time and blood loss in Tibetan patients were significantly higher than those in patients in non-highland area (Plt;0.05), but there was no significant difference in postoperative complications between the two groups of patients (Pgt;0.05).　Conclusions　Laparoscopic cholecystectomy for patients in highlardarea should be converted to laparotomy when necessary. Appropriate perioperative management is helpful in reducing the incidence of postoperative complications.

Clinical Analysis of 237 Patients with Indirect Inguinal Hernia Treated by Self-Made Diplopore Suture Needle Under Laparoscopy

目的探討自制雙孔縫合針在腹腔鏡下治療小兒疝囊高位結扎術中的臨床價值。方法對2008年5月至2010年5月期間在成都市第五人民醫院收治的237例腹股溝斜疝兒童應用自制雙孔縫合針在腹腔鏡下行疝囊高位結扎術治療的臨床資料進行回顧性分析。結果237例均在腹腔鏡下完成疝囊高位結扎術。單側手術181例，時間5～7 min,平均5.8 min; 雙側56例，手術時間7～12 min，平均9.1 min。術后均無局部血腫、陰囊水腫、陰囊積氣、切口感染、皮下異物感等并發癥發生。術后隨訪時間為8～24個月（平均18.5個月），21例失訪，未見疝復發及術側睪丸發育異常。結論在腹腔鏡下運用自制雙孔縫合針對小兒疝囊進行高位結扎具有手術時間短、局部創傷小、術后并發癥少、術后疼痛輕、操作簡單等優點，在臨床上具有推廣價值。

APPLICATION OF COMBINATION OF ANTERO-AND RETRO-GRADE TECHNIQUE IN LAPROSECOPIC CHOLECYSTECTOMY

目的 結合腹腔鏡手術的特點，設計出部分順逆結合法腹腔鏡膽囊切除術(LC)，總結該法的應用體會。方法 介紹部分順逆結合法LC的方法。在1 250例LC中有255例采用部分順逆結合法切除膽囊，其中慢性膽囊炎146例，急性、亞急性膽囊炎65例，慢性萎縮性膽囊炎44例。結果 所有患者均獲痊愈。術中發現膽囊三角區細小副肝管4例，膽汁滲漏3例，均予妥善處理，無嚴重并發癥發生。結論 該法吸取了開腹順逆結合法膽囊切除術的優點，又符合腹腔鏡手術的特點，適用于膽囊三角解剖結構不清者的手術。該法對發現解剖變異及避免膽管損傷有一定的作用。

經前胸壁內鏡甲狀腺切除術的初步探索(附3例報告)

Experience of Laparoscopic Ventriculo-Peritoneal Shunt

Objective To summarize the experience of laparoscopic ventriculo-peritoneal shunt for treating patients with hydrocephalus. Methods Twenty-two cases with hydrocephalus were treated with laparoscopic ventriculo-peritoneal shunt.The drainage-tube was put into the right liver-diaphragm interspace in 9 patients and inserted into the pelvic kidney in the others. Postoperative complications, ameliorating conditions of intracranial hypertension and recovery conditions of these patients were observed. Results All the operations were succeeded and the patients got amelioration of intracranial hypertension.No complication correlating with laparoscopic surgery occured. Conclusion Laparoscopic ventriculo-peritoneal shunt have the advantages of less invasive,better intra-abdominal view and more rapid recovery than conventional laparotomy. It’s a safe and feasible method which is worth of wide using.