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肝总管绒毛状腺瘤1例报道

Treatment of 23 Cases of Blunt Abdominal Injury in the Deyang People’s Hospital after the Wenchuan Earthquake

Objective　To analyze the outcome of patients with Blunt Abdominal Injury (BAI) in the Deyang People’s Hospital after the Wenchuan Earthquake, in order to provide evidence for future improvement in emergency response after earthquakes and in the treatment of BAI patients. Methods　Data on the BAI patients within 1 week after the earthquake were collected from the Information Department of the Hospital. Microsoft EXCEL was used for data input. Results　A total of 23 BAI inpatients were treated, of whom 15 were from Mianzhu City and sent to hospital within 12 hours of the earthquake. This was 1.9% of the total inpatients. The BAI inpatients suffered severe and complex injuries, and 5 of them died (mortality rate: 22%). Linenectomy was conducted for patients with spleen injuries and two inpatients developed incision infection due to lack of antibiotics during the perioperative period. Conclusions　 It is important to establish an emergency response mechanism for medical rescue for patients with the viscera injury, including BAI, after an earthquake. This would help to guarantee rational allocation of the rescue workers, triage of the wounded, optimization of operation, as well as a reduction in mortality from BAI.

Clinical Features and Common Etiologies of Recurrent Acute Pancreatitis

Objective　To analyze the clinical features， common etiologies， prevention measurements of recurrent acute pancreatitis （AP）. Methods　The clinical characteristics and imaging examination data of 43 patients with recurrent AP were analyzed retrospectively， which was compared with the results of 258 patients with primary AP. The recurrence etiologies were analyzed. Results　There were no significant differences on the fever， jaundice， abdominal pain relief time， pancreatic local complications， and ratio of severe AP between two groups （P＞0.05）. Comparion of etiologies between recurrent AP and primary AP， cholecystitis and diet factor （alcoholic） had priority in patients with primary AP （P=0.038， P=0.006， respectively）， but the hyperlipidemic， duodenal nipple disease， and small stone in the common bile duct were the major etiologies in patients with recurrent AP （P=0.007， P=0.008， respectively）. No relapse was found within the follow up for 3 months to 2 years （the average time was 14.2 months）. Conclusion　Find out the exact etiology and performe correct therapy are the key to the treatment and prevention of recurrent AP.

4种解剖标志帮助识别胆囊管避免胆管损伤（附316例报道）

目的 总结 4 种解剖标志在腹腔镜胆囊切除术中对胆囊管的辨识作用。 方法 收集 2016 年 3 月至 2017 年 9 月期间四川省德阳市人民医院行腹腔镜胆囊切除术（传统的 3 孔法或 4 孔法）的患者共 316 例，术中用4 种解剖标志中的至少 2 种进行相互印证辨识清楚胆囊管后再切断胆囊管。 结果 316 例患者中，有 3 例患者因术中意外原因中转开腹；有 1 例患者因长期慢性炎症造成胆囊管挛缩、增厚水肿的胆囊颈紧贴胆总管，应用 4 种解剖标志成功辨识出此种变异，术中顺利切除胆囊；其他患者顺利辨识出胆囊管并成功切除胆囊，无一例患者发生胆管损伤。 结论 笔者总结的这 4 种解剖标志的寻找与相互印证可以很好地帮助识别胆囊管，从而避免在腹腔镜胆囊切除术中的胆管损伤。

Application of Ultrapro Mesh in Laparoscopic Repair for Inguinal Hernias

目的　探讨Ultrapro轻量型网片在腹腔镜腹股沟疝修补术中的优点和应用价值。方法　回顾性总结分析我院2008年8月至2010年10月期间，腹腔镜腹股沟疝修补术中应用Ultrapro轻量型网片的28例患者的临床资料。结果　28例患者共行疝修补术36例次，其中实施经腹腹膜前腹腔镜疝修补术（TAPP） 9例次，腹腔镜全腹膜外疝修补术（TEP）27例次；1例TEP中转行TAPP。平均手术时间为（103.4±39.8） min，术中平均出血量为（7.7±4.9） ml，术后平均住院时间（4.8±1.4） d。术后修补区暂时性神经异常1例，阴囊积液2例，尿潴留1例。28例均随访（15±1.6）个月（1～25个月），期间未观察到网片感染、疝复发、慢性疼痛、异物感或睾丸萎缩等并发症。结论 　Ultrapro轻量型网片在腹腔镜腹股沟疝修补术中应用方便、视野清晰、柔软、硬度适中、放置定位容易，术后患者并发症少、恢复快，具有较好的临床应用价值。

The Treatment of Severe Acute Pancreatitis by Using Somatostatin and Parenteral Nutrition

目的探讨生长抑素和肠外营养对重症急性胰腺炎的治疗作用。方法采用生长抑素和肠外营养支持对15例重症急性胰腺炎患者进行治疗（实验组），并与同期22例未采用上述治疗措施者（对照组）进行比较分析。生长抑素用思他宁，并按6 mg/d持续静脉滴注； 肠外营养支持视临床情况按常规给予。结果实验组并发症发生率、手术率和死亡率均显著低于对照组（P＜0.01）。结论生长抑素和肠外营养支持对重症急性胰腺炎具有较佳的治疗效果。

Important Role of Preperitoneal Space in Laparoscopic Transabdominal Preperitoneal and Totally Extraperitoneal Hernia Repair

Objective　To explore the important role of preperitoneal space in laparoscopic transabdominal preperitoneal （TAPP） and totally extraperitoneal （TEP） hernia repair. Methods　The clinical data of 66 patients （78 sides） performed laparoscopic TAPP and TEP hernia repair from January 2008 to April 2011 in this hospital were analyzed retrospectively. Results　TAPP hernia repair were performed in 16 cases （20 sides），TEP hernia repair were performed in 50 cases （58 sides）. Three cases of TEP hernia repair transferred to TAPP hernia repair. The unilateral operation time was （86.92±36.38） min，intraoperative bleeding was （6.08±3.43） ml. Postoperative complication rate was 16.7% （11/66），including 3 cases of postoperative serum swelling，3 cases of temporary paraesthesia of nerve feeling in the repair area，2 cases of scrotum emphysema，2 cases of urinary retention，and 1 case of intestinal obstruction. There were 2 cases of recurrence. The hospital stay was （4.52±0.99） d. The return to activities and working time was （10.32±1.86） d after discharge. Sixty-six cases were followed up for （18.56±1.96） months （range 1-38 months），the patch infection，chronic pain，and testicular atrophy complications were not been observed. Conclusions　Acquainting and mastering laparoscopic preperitoneal space and its important structure are the key to avoid intraoperative and postoperative complications of laparoscopic inguinal hernia repair.

颅耳沟小切口微创手术治疗先天性隐耳畸形

目的 总结颅耳沟小切口微创手术治疗先天性隐耳畸形的疗效。 方法 2011 年 1 月—2015 年 5 月收治先天性隐耳畸形 8 例，其中男 6 例，女 2 例；年龄 5～13 岁，平均 10 岁。单侧 3 例，双侧 5 例。13 只隐耳均可用外力牵拉复位至正常大小形态及颅耳沟。于颅耳沟内设计长约 3 cm 弧形切口，并充分松解耳廓软骨与颅侧面、耳廓上部软骨间及软骨和皮肤之间的纤维粘连，游离颅侧面皮肤向颅耳沟推进修复创面缺损，术后纱布卷固定支撑耳廓 3 周。 结果 术后 8 例患者 13 只隐耳畸形均矫正满意；术后 3 周拆除支撑纱布卷后耳廓无回缩，形态正常。8 例患儿均获随访，随访时间 1～3 年，平均 1 年 6 个月。耳廓外形无明显回缩。1 例术后 1 周耳后皮肤部分坏死，为纱布卷偏大致皮肤长期受压缺血所致，去除纱布卷后换药愈合。 结论 颅耳沟小切口微创手术是治疗先天性隐耳畸形有效而简便的手术方法。