目的 探讨腹腔镜术后Trocar部位疝的发生、分型和诊治方法。方法 1例77岁的女性患者，因“右附件囊性畸胎瘤”行腹腔镜右附件切除术，术后2 d出现右下腹Trocar部位疝并发肠梗阻，结合文献对其发生率、分型、发病因素、临床表现、诊治原则及预防进行分析。结果 手术证实部分小肠嵌顿于Trocar切口内，行小肠松解和切口缝合术，术后3 d痊愈出院。结论 Trocar部位疝并不少见，因素复杂，根据发生的时间和形态可将其分为早发型、迟发型和特殊型3型； 多需要手术治疗，缝合Trocar切口筋膜是有效的预防方法。
Objective To determine the effectiveness of percutaneous catheter drainage (PCD) and to compare PCD with percutaneous needle aspiration (PNA) in the management of bacterial liver abscess. Methods The medical records of 206 patients with bacterial liver abscess admitted to this hospital between January 1989 and December 2009 were analyzed retrospectively. The outcomes of 96 patients receiving percutaneous treatment including PCD (PCD group, n=56) and PNA (PNA group, n=40) were compared, including the length of hospital stay, rates of procedure-related complications, treatment success, and death. Results There was no statistical difference in patients’ demographics or abscess characteristics between two groups (Pgt;0.05). The morbidity, mortality, and length of hospital stay in the PCD group and the PNA group were 1.79% vs 2.50%， 1.79% vs 2.50%， and (19.2±13.1) d vs (20.2±12.9) d, respectively, and the P values were 1.000, 1.000, and 0.887, respectively. There was statistically significant difference in successful rate between two groups （96.43% vs 75.00%， P=0.002）, but all simple abscesses with diameter of 5 cm or less were successfully managed in both PNA group and PCD group （13/13 vs 16/17， P=1.000）. Conclusions PCD is more effective than PNA in the management of bacterial liver abscess. PNA can be used as a valid alternative for simple abscesses with 5 cm in diameter or smaller.
Objective To analyze the application of bipolar radiofrequency-assisted device or monopolar radiofre-quency-assisted ablation in treatment for liver cancer by operation. Methods From June 2008 to May 2012， 56 patients with liver cancer underwent operation with bipolar radiofrequency-assisted device （Habib group， n=22） or monopolar radiofrequency-assisted ablation （mRFA group， n=34） were selected retrospectively. The operation time， postoperative morbidity， hospital stay， hospital costs， intraoperative bleeding， and therapeutic effects were compared in two groups. Results The percentage of patients with liver cirrhosis was 85.7% （48/56）， with multiple tumors was 12.5% （7/56）， underwent laparoscopic operation was 16.1% （9/56）. Patients with the tumor diameter greater than 5 cm in the Habib group were more than that in the mRFA group （P=0.000）， the laparoscopic surgery proportion had no significant difference in two groups （P=0.074）. ① The intraoperative bleeding in the Habib group was more than that in the mRFA group （P=0.000）. Two patients were adopted a hepatic portal blocking and 3 patients with intraoperative blood transfusion in the Habib group. ② The operation time in the Habib group was longer than that in the mRFA group （P=0.021）， but there was no difference of the operation time in two groups patients with tumor diameter greater than 5 cm （P=0.191）. ③ The postoperative morbidity had no obvious difference in two groups 〔18.2% （4/22） versus 11.8% （4/34）， P=0.780〕. ④ Thehospital stay and the hospital costs in the Habib group were significantly more than those in the mRFA group （P=0.001， P=0.004）.⑤The tumor residuals were found in two patients with tumor diameter greater than 5 cm. Conclusions Treatment for liver cancer by operation with bipolar radiofrequency-assisted device or monopolar radiofrequency-assisted ablation is safe and effective. The monopolar radiofrequency-assisted ablation has advantages of less intraoperative bleeding， more minimal invasion proportion， less hospital stay and hospital costs for liver cancer patients with small tumor （diameter＜3 cm）， multifocal tumors and minimal invasion conditions as compared with bipolar radiofrequency-assisted device. Operation with bipolar radiofrequency-assisted device in patients with larger tumors （diameter≥5 cm） resection might be a better choice.
目的探讨脾梗塞的诊断和治疗方法。方法回顾性分析2005年1月至2010年4月期间7例脾梗塞患者的临床资料。结果7例患者中有明确病因者5例，无明确病因者2例。 7例患者均行增强CT检查明确诊断。 除1例患者胰体尾囊腺癌侵犯脾动脉行胰体尾部、远端胃及全脾切除术外，其余6例均经保守治疗好转。结论增强CT检查对诊断脾梗塞有重要价值，大多数脾梗塞可经保守治疗痊愈。
Objective To analyze the treatment and effect of bacterial liver abscess over the past two decades in one single center. Methods The total 198 patients with bacterial liver abscess during the last twenty years were studied retrospectively. They were divided into three groups according time: 1989-1995 group, 1996-2002 group and 2003-2008 group. Gender and age of patient, location, number and size of abscesses, treatment, hospital days, morbidity of complications and mortality among the groups were compared. Results There were 54, 69, 75 cases in 1989-1995, 1996-2002 and 2003-2008 group respectively. No significant differences were found in gender and age of patient, location, number and size of abscess among three groups （Pgt;0.05）. In 1989-1995 group, 35 cases (64.8%) were treated with laparotomy, 8 cases (14.8%) with laparoscope, and 11 cases (20.4%) with percutaneous treatment (needle aspiration or catheter drainage). In 1996-2002 group, 15 cases (21.8%) were treated with laparotomy, 21 cases (30.4%) with laparoscope, 31 cases (44.9%) with percutaneous treatment (needle aspiration or catheter drainage), and 2 cases (2.9%) were treated with antibiotherapy. In 2003-2008 group, 5 cases (6.7%) were treated with laparotomy, 13 cases (17.3%) with laparoscope, 54 cases (72.0%) with percutaneous treatment (needle aspiration or catheter drainage), and 3 cases (4.0%) were treated with antibiotherapy. The constituent ratio of treatment was significantly different among three groups (P＜0.05). The hospital days was (18.5±12.2) d, (16.4±12.8) d and (20.1±14.6) d, the morbidity of complications was 9.3% (5/54), 4.3%(3/69) and 4.0%(3/75), the mortality was 3.7%(2/54), 1.4%(1/69) and 1.3% (1/75) respectively, but there were no significant differences of three indexes among three groups. Conclusion With the development of surgical techniques, effective antibiotic therapy and percutaneous treatment (needle aspiration or catheter drainage) have been the main therapeutic methods, and laparoscopy and laparotomy are necessary supplement.