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find Author "王幸" 3 results
  • 8例沟槽状胰腺炎外科治疗及文献复习

    目的探讨沟槽状胰腺炎(groove pancreatitis,GP)的临床特点、诊断及外科治疗。方法回顾性收集2020年1月至2021年7月期间四川大学华西医院胰腺外科收治的GP患者的临床病理资料并检索PubMed数据库进行文献复习,总结该病的临床表现、影像特征、外科治疗方案及效果。结果本研究共收集到四川大学华西医院收治的GP患者8例,主要临床症状有腹痛7例、呕吐6例和体质量减轻5例。CT表现主要为胰腺沟槽区低密度占位(8例),可侵犯到胰头(6例),十二指肠管壁不均匀增厚(7例)。8例患者均接受手术治疗,其中2例行保留胰头的十二指肠切除术、6例行胰十二指肠切除术。术后随访3~18个月,7例腹痛患者腹痛症状均得到改善,5例体质量减轻患者术后体质量明显增加。文献复习共收集到39例资料完整的患者,多为男性(87.2%),多有大量饮酒史(82.1%)。临床表现主要有腹痛(94.9%)、呕吐(76.9%)、体质量减轻(92.3%)。CT主要表现为胰十二指肠复合体受累或胰头区肿大(86.5%)及十二指肠壁不均匀增厚(64.9%)。除1例行全胰腺切除术外其余患者均行胰十二指肠切除术,术后20例患者疼痛完全缓解。结论GP临床症状无特异。胰十二指肠切除术是目前最主要的手术选择,对于胰头尚未受侵犯的单纯型GP采用保留胰头的十二指肠切除术可能可行。

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  • Reactive Lymphoid Hyperplasia of Liver: A Case Report and Review of The Literatures

    ObjectiveTo study the clinical manifestation, radiographic characteristics, and treatments of reactive lymphoid hyperplasia(RLH) of liver. MethodsThe clinical data and treatment process of 1 patient with RLH of liver in our hospital was analyzed retrospectively, and the other 49 cases reported in English literature were reviewed. ResultsThere were 33 pieces of case reports found in PubMed database. For all 50 patients, there were 45 female(90%) and 5 male(10%) patients, and the mean age was(57.6±14.0) years(15-85 years). Only 8 patients(16%) were discovered with multiple mass, the rest of them were solitary mass(84%). Of the 50 patients, 6 patients(12%) were discovered because of bellyache, 2 patients(4%) were discovered during operation, 2 patients(4%) were discovered by pathological examination after liver transplantation, 1 patient(2%) was discovered during autopsy, 39 patients were discovered during examination or reexamination. The tumors were located in the right lobe for 25 patients(50%), in the left lobe for 15 patients(30%), in the both lobes for 4 patients(8%), and in the caudal lobe for 1 patient(2%), while 5 cases(10%) were not given in the articles. Eleven patients(22%) had the history of malignancy, 15 patients(30%) were concomitant with autoimmune disease, and 5 patients(10%) were concomitant with virus hepatitis infection. Thirty-six patients(72%) were diagnosed as malignancy preoperatively, and 43 patients(86%) underwent surgical resection. ConclusionsRLH of liver is an extremely rare and benign condition which presents a female predilection and often concomitants with autoimmune disease and history of malignancy. Considering the risk of malignant transformation, surgical resection is recommended and further researches are necessary for better understanding of this disease.

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  • Risk factors for intraoperative massive hemorrhage in patients with pancreatitis-induced sinistral portal hypertension

    ObjectiveTo analyze risk factors of intraoperative massive hemorrhage in patients with pancreatitis-induced sinistral portal hypertension (SPH) and to explore its strategies of treatment.MethodsThe clinical data of patients with pancreatitis-induced SPH admitted to the West China Hospital of Sichuan University from January 2015 to March 2018 were retrospectively analyzed. The intraoperative massive hemorrhage was defined as the blood loss exceeding 30% blood volume. The factors closely associated with the intraoperative massive hemorrhage were analyzed by the forward logistic regression model.ResultsA total of 128 patients with pancreatitis-induced SPH were enrolled in this study, including 104 males and 24 females, with an average age of 47 years old and a median intraoperative bleeding volume of 482 mL. Among them, 93 patients with pancreatitis-induced SPH caused by the pancreatic pseudocyst after acute pancreatitis and 35 caused by the chronic pancreatitis. There were 36 patients with history of upper gastrointestinal bleeding and 46 patients with hypersplenism. Thirty-six patients suffered from the massive hemorrhage. Among them, 30 patients underwent the distal pancreatectomy concomitant with splenectomy, 1 patient underwent the duodenum- preserving resection of pancreatic head, and 5 patients underwent the pseudocyst drainage. The univariate analysis showed that the occurrence of intraoperative massive hemorrhage in the patients with pancreatitis-induced SPH was not associated with the gender, age, body mass index, albumin level, upper gastrointestinal bleeding, hypersplenism, type of pancreatitis, course of pancreatitis, number of attacks of pancreatitis, size of spleen, maximum diameter of lesions in the splenic vein obstruction site, or number of operation (P>0.05), which was associated with the diameter of varicose vein more than 5.0 mm (χ2=19.83, P<0.01), the intraperitoneal varices regions (χ2=13.67, P<0.01), the location of splenic vein obstruction (χ2=5.17, P=0.03), the operation time (t=–3.10, P<0.01), or the splenectomy (χ2=17.46, P<0.01). Further the logistic regression analysis showed that the varicose vein diameter more than 5.0 mm (OR=6.356, P=0.002) and splenectomy (OR=4.297, P=0.005) were the independent risk factors for the intraoperative massive hemorrhage in the patients with pancreatitis-induced SPH.ConclusionsSplenectomy and having a collateral vein more than 5.0 mm in diameter are independent risk factors for intraoperative massive blood loss in surgeries taken on patients with pancreatitis-induced SPH. Attention should be paid to dilation of gastric varices and choice of splenectomy.

    Release date:2019-05-08 05:37 Export PDF Favorites Scan
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