腹腔镜下肝胆胰脾手术40例的临床应用

目的 :探讨腹腔镜下肝、胆道、胰、脾外科手术的可行性及适应证。方法 :从 1 998年 6月～ 2 0 0 2年 6月共行腹腔镜肝、胆道、胰、脾手术 40例 ,其中肝脏手术 2 1例 ,胆道手术 1 4例 ,胰腺手术 1例 ,脾脏手术 4例。结果 :40例手术中 ,37例在完全腹腔镜下手术 ,3例为腹腔镜辅助手术 ,全组手术均成功进行 ,无严重并发症发生。平均手术时间 1 2 5min ,平均术中失血 85ml,术后平均住院天数 7.3d。结论 :腹腔镜外科手术应用于肝、胆道、胰、脾是安全可行的 。

Anatomical Variants of Celiac Trunk in Relation to Its Branching: A Preliminary Sub-Saharan Study

Background: Surgical treatment of upper mesocolic organs is improved by preoperative diagnosis of anatomical variants of celiac trunk. According to the literature, these anatomical variants are little known in sub-Saharan Africa. Purpose: To evaluate the prevalence of anatomical variants of celiac trunk in relation to its branching. Materials and methods: This was a cross-sectional study of descriptive type. It retrospectively evaluated 160 abdominal contrast enhanced CT-scan, from patients attending Yalgado OUEDRAOGO teaching hospital, from 1 January 2015 to 30 September 2016. Patients with a history of heavy abdominal surgery were excluded. Images obtained by 64-row CT-scan were analyzed for anatomical variants of the celiac trunk. Results: One hundred and twenty-eight patients (80%) had a classic anatomical configuration of celiac trunk, while thirty-two (20%) had at least one anatomical variant. Two anatomical variants were found in fifteen patients (9.4%) while five other patients (3.1%) had more than two variants. The most frequent anatomical variant was the hepato-splenic bifurcation, found in fourteen patients (8, 8%). It was followed by common celiac and mesenteric trunk, and then collateral arteries, in particular left hepatic artery and right lower diaphragmatic artery, each with three patients (1.9%). Conclusion: Anatomical variants related to celiac trunk branching, are as frequent in our study as in the literature. However, the two most common anatomical variants were hepato-splenic bifurcation and common celiac and mesenteric trunk.

Peritonitis in myelofibrosis:a cautionary tale

BACKGROUND: Primary myelofibrosis (PMF) is a myeloproliferative disorder characterized by bone marrow fibrosis. Extra-medullary hematopoiesis sometimes occurs even in the peritoneal cavity, apart from organs such as the liver, spleen, and lymph nodes. This may sometimes be complicated by spontaneous infection and complications. We report a rather unusual case of PMF, who presented as an emergency with spontaneous peritonitis to general surgery department and had a fulminant clinical course. METHOD: A clinical case note review was done and a literature search was undertaken. RESULTS: A rather unusual case of PMF, who presented as an emergency with spontaneous peritonitis to general surgery department. The patient underwent a laparotomy and had a fulminant clinical course. CONCLUSIONS: Peritonitis in myelofibrosis may have a number of causes. Clinicians need to be aware of them and provide conservative management prior to surgical treatment. (Hepatobiliary Pancreat Dis Int 2010; 9: 651-653)

肝脾动脉栓塞术治疗肝癌伴门脉高压及脾亢

目的:探讨肝脾动脉栓塞术治疗肝癌伴门脉高压及脾亢的价值。材料与方法:160例患者白细胞、血小板平均值分别为2.7x10^9/L、55.6×10~9/L,121例(75.6%)食道胃底静脉曲张,全部患者在肝动脉化疗栓塞术的同时行部分脾栓塞术(PSE),其中52例行2次以上 PSE。结果:86.3%(138/160)患者术后白细胞及血小板恢复正常,2个月复查白细胞、血小板平均值分别为6.5×10~9/L、166.8×10~9/L,6个月复查为4.7×10~9/L、114.2×10~9/L,较术前明显增高,门脉高压症状减轻,肝功能改善,78.8%(126/160)病人肿瘤得到控制,75.0%(120/160)病人 AFP下降,1、2、3年生存率分别为68.1%、38.2%、20.6%。结论:肝脾动脉栓塞术治疗肝癌伴门脉高压、脾亢是一种安全有效的方法。