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find Author "赖钊" 2 results
  • Retrospective Analysis on Spleen-preserving Treatment Methods for Patients with Splenic Injury

    ObjectiveTo summarize the treatment effects and success rate of spleen-preserving treatments for patients with splenic injury, and to explore the ideal spleen-preserving treatment for different types of splenic injury. MethodWe retrospectively analyzed the clinical data of 136 patients with splenic injury who underwent spleen-preserving treatment in the Department of Hepatobiliary Surgery between July 1998 and December 2010. And the treatment effects of different combined treatment methods were compared and studied. ResultsTwenty-seven patients were treated without surgery; 23 underwent vascular suture combined with fibrin glue treatment; 26 accepted splenic artery ligation, partial suture and fibrin glue treatment; 20 underwent ultrasonic scalpel partial splenectomy and wound spray fibrin glue treatment; 17 accepted splenic artery ligation and RF hemostatic cutter row spleen resection; and 23 accepted laparoscopic ultrasonic scalpel with partial splenectomy and wound spray fibrin glue treatment. Spleen-preserving succeeded in 131 cases (95.58%) and failed in 5 cases (4.42%) without any deaths. ConclusionsIn the treatment of splenic injury, the success rate of different methods of spleen-preserving is close. The success rate of combined use of several spleen-preserving methods together is higher. Under the principle of "Save lives first, and preserve spleen second", we should carry out individualized treatment plan for the patients based on patients' general condition, the extent and grade of splenic rupture, and medical equipment and technical conditions. For those medical units with good treatment conditions, combined spleen-preserving treatment can be performed.

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  • 胆囊结石合并胆总管结石术式选择的临床研究

    目的 探讨治疗胆囊结石合并胆总管结石的手术方式选择。 方法 回顾性分析笔者所在医院 2013 年 12 月至 2015 年 12 月期间择期行腹腔镜胆囊切除+胆总管探查术(LC+LCBDE 组,87例)和经内镜乳头括约肌切开+腹腔镜胆囊切除术(EST+LC 组,69例)治疗的 156 例患者的临床资料。 结果 2 组病例均获得了良好的治疗效果。LC+LCBDE 组手术成功率为 100%(87/87),EST+LC 组为 91.30%(63/69)。LC+LCBDE 组的手术成功率、手术时间、住院时间及住院费用方面均明显优于 EST+LC 组(P<0.05)。LC+LCBDE 组术后发生 1 例胆汁漏,EST+LC 组共发生 6 例并发症,其中 2 例胰腺炎、1 例黑便、1 例急性化脓性胆管炎及2 例结石残留,LC+LCBDE 组的总并发症发生率明显低于 EST+LC 组(P<0.05)。尤其是对于胆总管直径≥1.0 cm、结石数目>3 枚及结石直径>1.5 cm 时, LC+LCBDE 组的手术成功率和并发症发生率较 EST+LC 术式的优势更加明显。术后随访至少 1 年 (12~35 个月),LC+LCBDE 组有 1 例发生胆道感染而无结石复发,EST+LC 组共有 13 例发生胆道感染、8 例结石复发,术后胆道感染发病率和结石复发率 LC+LCBDE 组均明显低于 EST+LC 组(P<0.001)。 结论 从本研究有限的病例数据来看,治疗胆囊结石合并胆总管结石可优先考虑 LC+LCBDE,尤其是对于胆总管直径≥1.0 cm、结石数>3 枚及结石直径>1.5 cm 时;但对于 0.6 cm<胆总管直径<1.0 cm 时选择 LC+LCBDE 宜慎重,需权衡利弊;而对于胆总管直径<0.6 cm 时可优先选择行 EST+LC。

    Release date:2017-10-17 01:39 Export PDF Favorites Scan
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