目的 探讨嵌顿性食管旁疝的诊断和外科治疗。方法 对我院手术治疗的4例嵌顿性食管旁疝患者的临床资料进行分析。结果 2例急诊剖腹探查确诊，2例经胸部X线平片和CT检查确诊； 4例均行经腹Hill胃背侧固定术，术后均无并发症，无疝复发。结论 胸部X线平片及CT检查是诊断本病的主要手段； 一旦获得诊断或高度怀疑，应及早手术治疗； 经腹Hill胃背侧固定术式简单、可靠、复发率低，适合基层医院医生掌握。
Objective To compare the curative effect of procedure for prolapse and hemorrhoids (PPH) with MilliganMorgan hemorrhoidectomy (MMH) for acute incarcerated hemorrhoids. Methods A retrospective study of 103 patients with acute incarcerated hemorrhoids treated by surgery was performed. The patients were divided into PPH group (n=58) and MMH group (n=45) according to the different operation program who underwent. Operative time, pain score of VAS, time required for anodyne, postoperative complications, hospital stay, and hospital charges were compared. Results The symptoms were both relieved in two groups patients. Although the hospital charges of patients in MMH group were fewer, the patients in PPH group had advantages of shorter operative time, less postoperative pain, lower requirement for anodyne, fewer complications (edema of anal edge), and shorter hospital stay (Plt;0.01). Conclusion PPH is as safe and effective as MMH, and furthermore its short-term therapeutic effect is better than MMH.
Objective To investigate the value of laparoscopy in resetting and repairing of inguinal incarcerated hernia. Methods Clinical data of 11 patients with acute inguinal incarcerated hernia treated with laparoscopy from March 2007 to February 2008 were reviewed, including 3 cases of direct inguinal hernia and 8 cases of oblique inguinal hernia. Results There were 7 patients with incarcerated hernia who were reset automatically after general anaesthesia, and 4 patients who were reset with laparoscopy. All the hernias were repaired with the transabdominal preperitoneal (TAPP) method after observed or improved the blood cycle of the incarcerated intestinal tract under laparoscopy. Average follow-up time was 6.6 months (2-12 months) after operation. Good recover and no recurrence were showed in all patients. Conclusion Laparoscopy is a safe technology in resetting and repairing of inguinal incarcerated hernia
目的评价应用疝环充填式无张力疝修补术治疗腹股沟嵌顿疝并发小肠坏死的手术效果。方法对于我院2001年5月至2009年5月期间收治的21例腹股沟嵌顿疝并发小肠坏死患者应用疝环充填式无张力疝修补术给予一期修补，先行坏死肠管切除，后置入网塞。结果无手术死亡病例，1例患者发生切口感染，经换药后治愈。平均住院时间65 d。全部患者随访6个月至8年，平均51个月，未见复发。结论 疝环充填式无张力疝修补具有创伤小、安全及患者恢复快的优点，对于腹股沟嵌顿疝并发小肠坏死可以行一期修补，临床效果满意。
目的 探讨腹股沟难复疝和嵌顿疝手术并发症的防治。方法 回顾性分析笔者所在医院2005年1月至2012年1月期间收治的69例腹股沟疝行手术治疗患者的临床资料。难复疝37例，嵌顿疝32例（其中Richter疝3例、Littre疝1例、Maydl疝3例 、Amyand疝1例）。结果 69例患者均行手术治疗，其中行单纯疝囊高位结扎术3例，Shouldice法修补术10例，Lichtenstein术7例，无张力充填式疝修补术43例，Modified Kugel补片修补术6例。术后1例死亡。术后早期并发症13例，包括肠管损伤3例、腹股沟神经损伤4例、血清肿4例、切口感染2例； 晚期并发症9例，包括慢性疼痛2例、缺血性睾丸炎1例及疝复发6例。结论 术前对于复杂性嵌顿疝和滑动疝经验不足，术后对于并发症的预防性处理不足是导致术中、术后并发症的主要原因。正确认识复杂性嵌顿疝和滑动疝，以及正确选择网片可减少难复疝和嵌顿疝手术并发症的发生。
目的探讨嵌顿性胆囊结石行腹腔镜胆囊切除术(LC)的经验。方法回顾性分析我院1998年1月至2004年12月期间用LC治疗嵌顿性胆囊结石365例的临床资料。结果358例成功施行LC,7例中转开腹,2例术后发生胆瘘,无胃肠道、胆管损伤等并发症,无死亡病例,全部患者均痊愈出院。结论随着腹腔镜技术日臻完善，嵌顿性胆囊结石选择LC，一次性切除病灶，术后恢复快，并发症少。
【摘要】目的探讨不同病理状态下结石嵌顿性胆囊炎腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床应用价值。方法回顾性分析2001年1月〖CD3/5〗2009年10月期间172例结石嵌顿性胆囊炎患者行腹腔镜手术的临床资料。结果腹腔镜手术成功164例,成功率为9535％,中转开腹8例,中转率为465％。术中出血1例,术后并发胆漏1例,胆管残余结石1例,切口感染1例,并发症发生率为233％(4/172),无胆管损伤,无死亡。结论LC治疗结石嵌顿性胆囊炎安全、可行,但必须严格掌握手术适应证、时机和技巧。适时中转手术是提高手术成功率、降低并发症的关键。
ObjectiveTo explore the feasibility and characteristics of three-port laparoscopic cholecystectomy (LC) in the treatment of cholecystitis with gallbladder calculi incarceration. MethodsThe clinical data of 160 patients with gallbladder calculi incarceration treated by three-port LC between July 2010 and December 2014 were analyzed retrospectively. Among the patients, there were 104 cases of calculi incarcerated in the gallbladder neck area, 20 cases in the cystic gall duct, and 36 cases in the gallbladder ampullar region. Elective operations were carried out for 120 patients and 40 underwent emergency operation. ResultsThree-port LC was successfully completed in 154 patients (96.25%), and the other 6 patients were converted to open surgery among whom 2 underwent elective operation (1.67%) and 4 underwent emergency operation (10.00%). Two converted patients in the elective operation group had Mirizzi syndrome and gallbladder carcinoma respectively; all the 4 converted patients in the emergency operation group had a disease course of about one week with compacted triangle structure and gallbladder edema thickening of 1.0 cm, causing difficult separation under laparoscope. Seventy patients had varying degrees of enlargement and edema of gallbladder, 60 had varying degrees of gallbladder atrophy, and 30 had almost normal gallbladder. There were 80 cases of dark green thick bile, 10 of purulent bile, 40 of white bile, and 30 of empty gallbladder and no bile. No complications were found during the follow-up of 6 to 36 months, except that one patient was found to have secondary common bile duct stones three months after discharge, and the patient was cured by endoscopic retrograde cholangiopancreatography. Conclusions Elective or emergency three-port LC is safe and feasible for gallbladder calculi incarceration as long as the operator had skilled technique and made the right decision on opportunity of conversion.
【摘要】 目的 总结腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）治疗结石嵌顿性急性胆囊炎的疗效。 方法 2001年8月-2009年11月，采用LC治疗187例结石嵌顿性急性胆囊炎。 结果 179例顺利完成 L C手术；8例术中改为开腹手术。其中3例术后发生胆瘘，均经乳胶管引流胆汁，7～14 d后拔管；其余患者均痊愈出院。 结论 LC治疗结石嵌顿性急性胆囊炎安全可行，但应遵循个体化原则，熟练镜下操作技巧及正确处理方法是获得满意疗效关键。