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find Author "沈雄山" 5 results
  • Diagnosis and Treatment of Early Postoperative Inflammatory Small Bowel Obstruction

    目的 探讨术后早期炎性肠梗阻的病因、临床特点及诊断与治疗。方法 对我院40例腹部手术后早期炎性肠梗阻患者的诊断和治疗情况进行回顾性分析。结果 全部患者症状缓解的时间为3~7 d(平均5 d)、住院时间为7~20 d(平均13 d)。随访时间为6~12个月(平均9个月),随访中有2例再次出现肠梗阻, 经保守治疗治愈。结论 术后早期炎性肠梗阻好发于腹腔污染重或创伤大的腹部手术,多发生于术后1~3周,肠梗阻症状和体征典型,很少发生肠绞窄坏死,保守治疗效果好。

    Release date:2016-09-08 10:50 Export PDF Favorites Scan
  • 经皮经肝胆囊穿刺置管引流术治疗老年急性胆囊炎的疗效分析

    目的 观察经皮经肝胆囊穿刺置管引流术(PTGD)治疗老年(年龄>60 岁)急性胆囊炎的疗效。 方法 回顾性分析笔者所在医院 2014 年 12 月至 2016 年 12 月期间行 PTGD 治疗的 36 例老年急性胆囊炎患者的临床资料。 结果 全部患者均一次性穿刺置管成功。33 例患者在 PTGD 治疗后 72 h 内腹痛明显缓解,体温逐渐恢复正常,白细胞计数、碱性磷酸酶及总胆红素水平也均恢复至正常水平。术后有 2 例患者因引流管脱落而再次行 PTGD 治疗;1 例患者术后发生出血,经积极对症处理后缓解。36 例患者住院时间为(7.3±1.6)d,置管时间为(15.2±3.4)d。33 例合并结石患者中 4 例患者因身体差、合并疾病重而自行放弃后期的手术治疗,顺利拔管后出院并定期随诊;其余 29 例患者均择期行手术治疗。3 例无结石患者中 2 例经引流管胆道造影证实胆囊管闭锁,以无水乙醇反复冲洗毁损胆囊黏膜达到化学性切除,术后随访 1 年,未再发生胆囊炎症状,腹部超声检查证实胆囊腔完全闭锁;另 1 例患者顺利拔管后出院并定期随诊。 结论 本组病例的初步结果提示,对老年急性胆囊炎患者,采用 PTGD 是一种安全、简便、有效的治疗方法,能迅速缓解临床症状,为择期手术赢取时间。

    Release date:2017-12-15 06:04 Export PDF Favorites Scan
  • Surgical Treatment of Hilar Cholangiocarcinoma

    目的 探讨肝门部胆管癌2种手术方法的疗效。方法 回顾性分析我院1998~2006年期间收治的37例肝门部胆管癌患者的临床资料。结果 37例患者中13例行根治性手术切除, 其1年与3年的生存率分别为100%(13/13)和76.92%(10/13),中位生存期为22.43个月; 另24例行姑息性手术(均为肝内胆管内引流术),其1年与3年生存率分别为54.55%(12/22)和9.09%(2/22),中位生存期为15.42个月。结论 根治性手术是治疗肝门部胆管癌的主要手段; 姑息性手术,如合理的肝内胆管内引流能改善患者的生存质量。

    Release date:2016-09-08 10:56 Export PDF Favorites Scan
  • Cinical Analysis of 63 Cases of Laparoscopic Splenectomy

    目的探讨腹腔镜脾切除术的安全性及疗效。 方法回顾分析2008年5月至2012年10月期间笔者所在医院完成的63例腹腔镜脾切除术患者的资料。其中特发性血小板减少性紫癜8例,自身免疫性溶血性贫血1例,脾囊实性占位性病变6例,肝硬变伴门静脉高压、脾功能亢进48例。 结果63例患者均顺利完成腹腔镜脾切除术,无中转开腹,手术时间80~250 min,平均136.5 min;术中出血100~2 100 mL,平均220 mL;住院时间6~14 d,平均7.4 d。术后无手术死亡。 结论腹腔镜脾切除术安全、有效、可行,手术成功的关键是防止术中大出血。

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  • Application of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type Ⅰ substernal goiter

    Objective To assess clinical value of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type Ⅰ substernal goiter. Methods The clinical data of 75 patients with type Ⅰ substernal goiter in the Department of General Surgery of the Central Hospital of Xiaogan from April 2013 to April 2017 were retrospectively analyzed. These patients received the surgical resection by the meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach. Results There were 12 Hashimoto thyroiditis, 10 thyroid adenoma, 41 nodular goiter, and 12 thyroid carcinoma in the 75 patients with type Ⅰ substernal goiter. Five cases underwent the unilateral total thyroidectomy. Fifty-eight cases underwent the bilateral total thyroidectomy. The bilateral total thyroidectomy plus central lymph node dissection were performed in the 9 patients with thyroid carcinoma, the bilateral total thyroidectomy plus central lymph node dissection plus affected ipsilateral neck lymph node dissection were performed in the 3 patients with thyroid carcinoma. The average operative time was 100 min, the average intraoperative blood loss was 50 mL, the average postoperative hospital stay was 5 d. The rate of parathyroid injury was 2.7% (2/75), the rate of hypocalcemia caused by parathyroid injury was 2.7% (2/75). There were 3 cases (4.0%) of unilateral recurrent laryngeal nerve injury, 1 case (1.3%) of the outer branch of the upper laryngeal nerve injury. There were 2 cases of tracheal partial softening in the 75 patients. None of postoperative bleeding and seroma happened. No death and the tumor recurrence and metastasis of patients happened during follow-up period. Conclusions Preliminary results in this study show that operation of meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach in treatment of type Ⅰ substernal goiter is safe and feasible, it could effectively reduce postoperative complications of thyroidectomy, and protect parathyroid and it’s function, recurrent laryngeal nerve, and superior laryngeal nerve.

    Release date:2018-02-05 01:53 Export PDF Favorites Scan
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