目的 探讨金属银夹标记胆道通道，利用胆道镜技术治疗胆肠吻合术后肝胆管结石复发的可行性、安全性和有效性。方法 回顾性分析大连市友谊医院47例胆管结石行胆肠Roux-en-Y吻合术患者的资料，在空肠盲袢或输出袢处使用银夹作标志，术后通过胆道镜行胆管残留结石或复发结石或狭窄的治疗。结果 11例术后胆管残留结石和5例残留结石合并胆管狭窄者经T管窦道行胆道镜探查、取石及肝胆管狭窄的治疗而治愈。2例结石复发的患者根据空肠的金属银夹标记物，在数字减影血管造影（DSA）下进行穿刺置管建立胆道镜通道，通过胆道镜成功取出了结石，避免了再手术。结论 发挥胆道镜技术治疗肝胆管结石的优势，经以银夹标志的胆道通道，可望成为治疗胆肠吻合术后复发结石手段的有益补充。
【Abstract】 Objective To make the young patients with osteoarthritis and genu varum of knee delay total knee arthroplasty,to observe the cl inical effect of mosaicplasty of femoral medial condyle, patellar-plasty and high tibial osteotomy inthe treatment of osteoarthritis of knee with varum. Methods From June 2004 to February 2006, 8 patients with osteoarthritisof knee with varum(10 knees) were treated with combined operation such as mosaicplasty of femoral medial condyle, patellarplastyand high tibial osteotomy. There were 2 males with 3 knees, and 6 females with 7 knees,with an average age of 50 years(42-56 years). The left knees and right knees were involved in 3 cases respectively and bilateral knees in 2 cases. All patients hadknee ache after walk or long-time standing. The X-ray showed hyperosteogeny at peri-patella and circum ferential femur-tibialjoint，especially in the medial. The gap between patella and femur narrowed or disappeared，especially in the medial femurtibialjoint. The femoral tibial angel (FTA) was 185-200°(mean 190°). The HSS score of knee was 55-75(mean 60). The history ofknee ache was 1-12 years(mean 5 years). Results All patients were followed up for 7-24 months (mean 15 months). All theincisions healed by first intention, no early compl ication occurred. The cl inical bone heal ing time was 8-11 weeks(mean 9 weeks).Rectification of FTA was 15-30°(mean 20°). Normal weight-loading al ignment was recovered. The valgus angle of knee was 10°.The range of motion of knee was 100-120° after operation, increasing by 5-20° (mean 10°) when compared with preoperation.The X-ray of postoperation showed that genu varum was corrected obviously and that no displacement, loosening and breakageoccurred. The mean score of HSS was 80 (75-88), increasing by 20 when compared with preoperation. Conclusion Mosaicplastyof femoral medial condyle can make articular cartilage repair in certain degrees, patellar-plasty can rel ieve ache of fore region of knee effectively, and high tibial osteotomy can recover normal weight-loading al ignment. The curative effect is good withthe combined methods.
目的探讨保留幽门的胰十二指肠切除术(PPPD)的手术适应证、捆绑式胰肠吻合术的特点及胃排空障碍的治疗。方法12例均行PPPD，消化道重建按Child法，胰肠吻合均采用捆绑式胰肠吻合。结果除1例术后第21天并发切口裂开、肺栓塞死亡外，其余11例均顺利出院，平均住院时间24 d，随访1年，1例术后8个月死亡，余均健在。结论PPPD是治疗胰头癌及壶腹周围癌的一种具有广阔应用前景的术式，捆绑式胰肠吻合有望作为胰肠吻合的标准术式。