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find Author "蒋波" 3 results
  • 胰头次全切除术治疗难切性胰头良性病变

    胰头慢性肿块型胰腺炎及胰头部铸型结石常引起患者难以忍受的上腹部及腰背部疼痛,常需行胰头十二指肠切除术[1,2]才能缓解疼痛症状,但此类患者常因胰头周围反复炎症粘连,无法沟通胰颈与肠系膜上静脉及门静脉之间的解剖间隙,但考虑到胰头为良性病变,在辨清肠系膜上静脉、门静脉右缘基础上,行胰头次全切除、解除主胰管梗阻而达到缓解症状的目的。笔者于2006年3月至2007年10月期间为3例难切的胰头部良性病变(1例胰头肿块型胰腺炎和2例胰头结石)患者施行了胰头次全切除术。  手术方法: 先作Kocher切口,游离胰头十二指肠与下腔静脉之间间隙,显露肠系膜上静脉、门静脉主干,肝十二指肠韧带呈胼胝样粘连,解剖出肝固有动脉后,向下于肝总动脉分叉处显露胃十二指肠动脉,结扎并切断之; 按Whipple术常规游离并切除15 cm近端空肠,切除60%胃,紧靠肠系膜上静脉、门静脉右缘切断胰腺,清除主胰管内结石,疏通扩张的主胰管; 然后进行消化道重建,先行胰空肠端端吻合,主胰管内置4 mm硅胶导管,并用3-0肠线固定,导管从距胰空肠吻合口5 cm空肠壁穿出,距胰空肠吻合口10 cm行胆总管空肠端侧吻合,吻合口内置16号T管,直臂从肝总管前壁穿出,最后距胰空肠吻合口45 cm于结肠前行胃空肠吻合术。结果: 无死亡病例,未出现如胰瘘、出血等严重并发症,术后腹痛缓解,体重增加。  讨论 胰头部肿块型胰腺炎和铸型结石只有切除胰头、通畅主胰管才能缓解患者的腹痛症状,重新恢复胰腺内、外分泌功能。行胰头十二指肠切除术的关键是能沟通胰头与下腔静脉,胰颈与肠系膜上静脉、门静脉之间的间隙。胰头与下腔静脉之间的间隙一般容易沟通,但是此类患者由于胰腺反复炎症,胰颈与肠系膜上静脉、门静脉之间的间隙形成致密粘连,若强行沟通,常造成上述两血管穿通、撕裂,造成难以控制的术中大出血,按照常规胰十二指肠切除术,此两关不能通过,只能放弃此手术,但是术后患者顽固性腹痛症状仍得不到缓解[3]。笔者考虑此类患者均为良性病变,决定行胰头次全切除,完成此手术前提是能很好地显露肠系膜上静脉和门静脉右侧缘全程,直视下紧靠该两血管右缘,在不损伤这两血管基础上切断胰腺,去除整体标本后,尽量取尽胰管内结石,疏通扩张的胰管,再按Child法行消化道重建。值得注意的是胰头次全切除术的前提是胰头为良性病变,如为恶性肿瘤,此方法是错误的,它违反了外科治疗的原则,无法达到肿瘤根治性切除的目的。

    Release date:2016-09-08 10:57 Export PDF Favorites Scan
  • Effect of form-deprivation myopia on optic nerve head and retinal morphology in guinea pigs

    ObjectiveTo evaluate the effect of form deprivation myopia on optic nerve head and retinal morphology in guinea pigs using optical coherence tomography (OCT). MethodsTwenty guinea pigs aged from 4 to 5 weeks were chosen and randomly divided into the experimental group and control group, with 10 guinea pigs in each group. Form deprivation myopia was established for the right eyes of guinea pigs in experimental group for 4 weeks. The guinea pigs of control group were not intervened. Before and 4 weeks after form deprivation, refraction was measured by retinoscopy after cycloplegia; the axial length was measured by A-scan ultrasound; retinal nerve fiber layer (RNFL) thickness, optic nerve head and retinal morphology of guinea pigs were analyzed using OCT. ResultsBefore form deprivation, there were no statistically significant differences in spherical equivalent, axial length, RNFL thickness, disc edge area, optic disc area, average cup disc ratio, vertical cup disc ratio, cup volume, retinal thickness, or retinal volume between the experimental group and control group of guinea pig (P > 0.05). After 4 weeks of form deprivation, RNFL thickness of (64.9±17.7) μm in guinea pigs in experimental group was thinner compared to (97.9±25.1) μm in control group (t=-2.845, P=0.015). Retinal thickness of (142.7±3.4) μm in guinea pigs in experimental group was thicker compared to (138.4±3.5) μm in control group (t=2.338, P=0.038). There were no significant differences in disc edge area, optic disc area, average cup disc ratio, vertical cup disc ratio, cup volume or retinal volume between groups (P > 0.05). There were statistically significant differences in spherical equivalent, axial length, RNFL thickness, vertical cup to disc ratio cup volume, and retinal thickness between after and before form deprivation in the right eye of guinea pigs in the experimental groups (t=46.001, -50.119, 5.385, 3.447, -2.814, -8.911; P < 0.05), while there were no statistically significant differences in disc edge area, optic disc area, average cup disc ratio, or retinal volume (P > 0.05). ConclusionForm deprivation myopia has an effect on RNFL and retinal thickness.

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  • Association of Colonic Adenomatous Polyps and Helicobacter Pylori Infection: A Case-control Study

    ObjectiveTo investigate the relation between colonic adenomatous polyps and Helicobacter pylori infection. MethodsA case-control study was conducted to collect clinical data of patients with colonic adenomatous polyps in People's Hospital of Zhongjiang County from February 2014 to September 2015. Patients with healthy colon of the corresponding period of the hospital were collected as a control group. The difference of positive rate of Hp infection was compared between the colonic adenomatous polyps group and the control group. According to the age, gender, living condition, location, type of pedicle, pathological type and number, the colonic adenomatous polyps group was divided into subgroups and the differences of positive rate of Hp infection were compared among the subgroups. ResultsA total of 219 patients involving 119 cases and 100 controls were included. The positive rate of Hp infection in the colonic adenomatous polyps group was significantly higher than that in the control group (69.7% vs. 52.0%) with a significant difference (χ2=7.239, P=0.007). Among 119 patients with colonic adenomatous polyps, no statistical differences were found in the positive rate of Hp infection among subgroups of different age, gender, living condition, location, type of pedicle, pathological type and number (all P values>0.05). ConclusionHp infection may increase the risk of developing colonic adenomatous polyps.

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