目的 探讨B超引导下穿刺置管引流技术在重症急性胰腺炎治疗中的应用价值。方法 36例重症急性胰腺炎患者均行腹腔穿刺置管引流，其中经皮肝胆管（胆囊）穿刺置管引流（PTCD）23例，腹膜后积液（脓肿）穿刺置管冲洗引流16例，配合常规内科治疗，取得满意效果。结果 所有患者穿刺置管过程顺利，均未出现与穿刺相关的并发症如气胸、血胸、腹腔内出血、穿刺部位感染等。所有患者在禁食、胃肠减压、抗生素、生长抑素、制酸、维持水电解质酸碱平衡及肠内外营养支持治疗的基础上辅以超声引导下穿刺置管引流，仅1例暴发性胰腺炎患者发生脓腔内大出血导致多器官衰竭而死亡，其余35例均治愈，无中转开腹手术，患者腹痛、腹胀、腹部压痛等主要症状和体征缓解时间为（4.4±1.3）d（1～7d），尿淀粉酶恢复正常时间为（3.1±1.5）d（2～8d）,住院时间为（23.4±7.3）d（16～55d）。结论 B超引导下穿刺置管引流术操作简单、创伤轻微，在重症急性胰腺炎治疗中有重要价值。
ObjectiveTo compare the effects of medical glue and stapling in the prevention of postoperative seroma for patients undergoing laparoscopic direct hernia repair. MethodsNinty-four patients were randomly by computer generated randomization number divided into two groups: medical glue group (medical glue was used to fix pseudo-direct hernia sac) and stapling group (staple was used to fix pseudo-direct hernia sac).The time of follow-up was two years.The operative time, length of hospital stay, the pain level on first day and 7th day after operation, postoperative complications (seroma, wound infection, wound bleeding), hospital costs, and hernia recurrence rate within 2 years were observed. ResultsThe medical glue group compared with the stapling group, the operative time was shorter〔(35±5.1) min vs.(41±7.5) min〕, hospitalization time was shorter〔(4±0.51) d vs.(5±0.83) d〕, lower postoperative pain score〔the first day: (5±0.52) scores vs.(6±0.33)scores; the 7th day: (3±0.67) scores vs.(4±0.53) scores〕, and lower cost in hospital〔(5 731±560.50) yuan vs.(8 715±534.33) yuan〕, there were significant difference (P < 0.05).The incidence of seroma and other complications after operation and postoperative 1-year and 2-year hernia recurrence rate showed no significant differences (P > 0.05). ConclusionsThe medical glue has good prevention effects on postoperative seroma for patients undergoing laparoscopic direct hernia surgery, with shorter operative time and lower cost.This method is suitable for all levels of hospitals
Objective To explore whether the intraoperative cholangiography （IOC） should be applied in laparoscopic cholecystectomy routinely or selectively. Methods Data of routine IOC group （1 520 patients）and selective IOC group （457 patients）in laparoscopic cholecystectomy were collected and analyzed， including cholangiography time， success rate， common bile duct stones rate， open cholecystectomy rate， and hospital stay after operation. All IOC cases were performed by home-made cholangiography appliance or infusion needle. Results There were no significant differences between routine IOC group and selective IOC group on cholangiography time， success rate， open cholecystectomy rate， and hospital stay after operation （P＞0.05）. However， compared with routine IOC group， the common bile duct stones rate， anatomic variation rate， and iatrogenic damage rate were significantly higher in selective IOC group （28.25% vs. 13.43%， 10.71% vs. 7.43%， 2.05% vs. 1.02%， P＜0.05）. Conclusions For avoiding iatrogenic bile duct damage and residual stones， routine IOC should be applied in early-stage of laparoscopic cholecystectomy， and IOC should be applied selectively when the surgeon have LC technique at their finger ends.