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腹腔镜与内镜治疗肝外胆管结石（附87例报道）

目的探讨腹腔镜与内镜两种不同方法在肝外胆管结石治疗中的临床应用价值。 方法回顾性分析2008年7月至2014年8月期间收治的87例单纯肝外胆管结石患者的临床资料。 结果2组在术后肠功能恢复时间及取石成功率比较差异无统计学意义（P＞0.05）。内镜组的手术时间、住院时间及术中出血均明显少于腹腔镜组（P＜0.05）。随访2个月～6年（平均3.5年），腹腔镜和内镜组各有4例胆道感染和2例胰腺炎。另外，腹腔镜组2例结石复发；内镜组有1例结石复发，1例胆管出血，1例胆管狭窄。2组并发症发生率比较，差异无统计学意义（P＞0.05）。 结论肝外胆管结石较大、较多时适合应用腹腔镜治疗，胆管未扩张的较小结石或有上腹手术史的结石则应用内镜治疗较合理。内镜在肝外胆管结石治疗中较腹腔镜显示出更大微创优势。

腹腔镜治疗肠粘连所致的慢性下腹痛21例报道

Effect of Partial Splenic Embolization on Splenectomy plus Devascularization of Esopha-geal and Gastric Vein

ObjectiveTo explore the effect of partial splenic embolization on splenectomy plus devascularization of esophageal and gastric vein. MethodsTwenty three cirrhosis patients with portal hypertension combined the hypersplenism (partial splenic embolization group), who received partial splenic embolization in our hospital from June 2010 to June 2015, as well as 30 cirrhosis patients with portal hypertension combined the hypersplenism without undergoing partial splenic embolization in the same period (non-partial splenic embolization group), were collected retrospectively. All patients underwent splenectomy plus devascularization of esophageal and gastric vein. Comparison of operation time, intraoperative blood loss, intraoperative blood transfusion volume, postoperative total flow of abdominal drainage tube, postoperative gastrointestinal function recovery time, hospital stay, and the incidence of complication was performed. ResultsThe operation time[(3.56±0.70) h vs. (1.78±0.28) h], intraoperative blood loss (900 mL vs. 250 mL), intraoperative blood transfusion volume (800 mL vs. 200 mL), postoperative total flow of abdominal drainage tube (450 mL vs. 150 mL), postoperative gastrointestinal function recovery time[(43.38±18.68) h vs. (27.60±12.39) h], hospital stay (12 d vs. 7 d), and incidence of incision infection[34.8% (8/23) vs. 10.0% (3/30)] of partial splenic embolization group were all higher or longer than those corresponding indexes of non-partial splenic embolization group (P < 0.05). All patients of 2 groups were followed up by telephone visit for 6-58 months, and the median was 28-month. There was no recurrence of gastrointestinal hemorrhage during the follow-up period. ConclusionsSplenectomy is more difficult, and maybe has more intraoperative blood loss and complications for cirrhosis patients with portal hypertension combined the hypersplenism, who received partial splenic embolization ever. For these patents, the recovery time is longer. We should make choice of partial splenic embolization or splenectomy directly according to the patients' situation, to implement individualized treatment, so we can make the biggest benefit for patients.