坏疽穿孔型阑尾炎术后放置引流管与否的临床观察

目的探讨坏疽穿孔型阑尾炎术后是否应放置腹腔内引流管问题。方法2000年至2007年收治坏疽穿孔型阑尾炎50例,放置腹腔内引流管者20例,未放置腹腔内引流管者30例,对术后是否出现出血和切口感染现象进行观察分析。结果放置引流管组患者在术后无1例出现溶血现象,术后切口感染率为35%;未放置引流管组亦无1例腹腔内出血的症状或体征和切口感染。结论只要手术操作精确,熟练、阑尾系膜结扎可靠,残端处理满意,不必放置引流管观察有无出血和切口感染现象的发生。

外伤性十二指肠破裂临床治疗分析

十二指肠位置较深，周围解剖关系复杂，具有独特的生理特性，十二指肠损伤时，常合并周围其他脏器损伤．导致术前诊断困难．术中探查也易漏诊，术中处理困难，加上供应血管为终末动脉．损伤后血供不足，愈合差，术后并发症多而重，病死率高，诊断和处理及时与否对预后影响较大，据统计，伤后24h以内手术者：死亡率5％-10％．超过24h者．死亡率40％-50％：现将我院普外科2006～2007年共收治的10例外伤性十二指肠破裂治疗情况．报告如下：

ESOPHAGUS-STOMACH-ABDOMINAL WALL DRAINAGE FOR DELAYED INTRATHORACIC ESOHPAGEAL PERFORATION

Objective To design a technique of esophagus-stomach-abdominal wall drainage for the de-layed intrathoracic esophageal perforation and to improve the therapeutic results. Methods Four patients were treated by this simplified technique. There were 1 case of lower intrathoracic esophageal perforation to the left thorax , 1 high and 2 middle perforation to the right. This technique used two plastic tubes (chest tube) in a diameter about 1 .2cm . One tube served as an intercostal drainage tube to drain purulent effusion , the other was inserted abdominally through stomach to the esophagus about 10cm above the esophageal perforation. Results The four patients were treated successfully by the esophagus-stomach-abdominal wall drainage. There was no mortality or severe morbidity or complication. Hospitalizations were shortened. Conclusion This technique is simple, safe and effective. It may provide a more promising alternative method of treatment for delayed esophageal perforation, especially in the critically ill patients. The procedure can also be extended to deal with esophagus-stomach anastomotic leak.

腹腔镜在胆管损伤后胆管狭窄治疗中应用价值及争议

医源性胆管损伤是胆管外科医师永远都无法避免的议题。医源性胆管损伤后病人会出现胆漏、胆管狭窄、胆汁性肝硬化等并发症,甚至导致灾难性的后果,给医师带来严重精神负担。目前医源性胆管损伤后期胆管狭窄处理仍是以胆肠内引流为主要的治疗方法。随着腹腔镜技术在肝胆外科的广泛发展,腹腔镜下胆肠内引流术为医源性胆管损伤后期的治疗带来新的理念及方法。