【摘要】 目的 總結腹腔鏡對小兒美克爾憩室的臨床診斷和應用價值。 方法 2005年4月-2009年12月，將41例行美克爾憩室切除術患兒隨機分為兩孔法腹腔鏡手術組和傳統手術組，就手術治療、術后并發癥、術后效果等臨床資料進行對比分析。 結果 腹腔鏡手術組患兒手術時間、術中出血量、下床活動時間、住院時間等均優于傳統手術組；術后并發癥發生例數均明顯少于傳統手術組。 結論 腹腔鏡對患兒美克爾憩室的診斷和治療具有明顯優越性，可作為小兒美克爾憩室治療的首選方式。【Abstract】 Objective To investigate the diagnostic and applicative value of laparoscopy for Meckel’s diverticulum in children. Methods The clinical data of 41 children with Meckel’s diverticulum who underwent resection between April 2005 to December 2009 were retrospectively analyzed. The patients were divided into tow-port laparoscopy-assisted resection group (group A,19 patients) and traditional resection group (group B, 22 patients). The intra-operative accidental injury, postoperative complications, postoperative general condition and prognosis were evaluated via randomized contrast analysis. Results The time of operation, amount of bleeding, recover intestinal peristalsis,out-of-bed activities time and the average days in hospital in group A were less than those in group B. The postoperative complications occurred in one and eight patients in group A and B respectively. Conclusion Laparoscopy had obvious superiority for the children’s Meckel’ s diverticulum in diagnosis and treatment,which should be the best choice.
目的:探討MRI不同檢查方法對十二指腸乳頭旁憩室(periampullary diverticulum,PAD)的診斷價值。方法:應用MRI多序列檢查方法診斷PAD23例,并進行分析。結果:T1WI顯示為囊狀低信號影,與十二指腸相通者1例,其余22例表現為不均勻略低及高低混雜信號,均未明確診斷;橫斷位壓脂T2WI顯示含氣液平面囊性病灶15例;冠狀位FIESTA序列表現為混雜高信號或高信號影15例;呼吸觸發3D MRCP表現為高或混雜高信號影16例;冠狀位屏氣3DCE LAVA動態增強掃描均清晰顯示。其中合并膽系結石13例,膽系炎癥及感染13例,胰腺炎3例,膽胰管擴張3例,十二指腸炎癥3例。結論:MRI能多序列、多方位、直觀、無創的清晰顯示PAD的部位、大小、范圍及與鄰近結構的關系,同時顯示膽胰疾病形態學改變。故MRI多序列檢查非常必要,是PAD診斷及鑒別診斷的重要方法。
目的:探討盲部憩室炎的診斷和手術方式的選擇。方法:回顧性分析18例盲部憩室炎的臨床資料,包塊臨床表現、腹部體征、輔助檢查、手術方式及隨訪結果。結果:18例均有右下腹疼痛及右下腹壓痛。術前診斷困難,僅通過鋇灌腸結腸造影和結腸鏡確診各1例,誤診為急性闌尾炎12例、闌尾周圍膿腫1例、回盲部腫瘤3例。憩室單發3例,多發性15例,其中2個憩室9例,3個憩室6例。單純憩室切除9例,回盲部切除2例;右半結腸切除7例。全組患者均獲治愈,無嚴重并發癥發生。結論:盲腸憩室炎的臨床特征與急性闌尾炎相似,極易誤診為急性闌尾炎等。術中應注意探查,避免遺漏病變。根據憩室具體情況決定手術方式。
【摘要】目的探討十二指腸憩室的診斷與治療。方法對南方醫院1982～2002年20年期間收治的110例十二指腸憩室患者的臨床資料作回顧性分析。結果憩室分布于十二指腸球部10例，降部77例，水平部15例，升部8例； 憩室合并炎癥28例，合并出血14例，合并急、慢性膽胰疾病35例，無合并癥33例。手術治療47例，其中行十二指腸憩室切除術10例，憩室內翻縫合術5例，胃大部切除術13例，胃大部切除+膽腸RouxenY吻合術10例，Oddi氏括約肌成形術2例，胃大部切除+膽囊切除術5例，胰十二指腸切除術2例。術后發生十二指腸瘺1例，手術治療47例全部治愈，無一例死亡。結論十二指腸憩室以降部多發，無癥狀者可行保守治療，若合并炎癥、出血、膽胰疾病，則需根據憩室部位合理選擇手術方式。
ObjectiveTo discuss the reason and treatment strategy of gallbladder muddy stones after cholecysto-lithotomy. MethodsThe clinical data of 62 patients with gallbladder muddy stones after cholecystolithotomy who were treated in our hospital from December 2008 to December 2014 was analyzed retrospectively. ResultsThere were 43 patients without any symptom and 19 patients with acute cholecystitis in 62 patients. Four patients were diagnosed with septation gallbladder, 6 patients with long and tortuous cystic duct, 3 patients with calculus of cystic duct, 4 patients with common bile duct stones, 39 patients with periampullary diverticula, 18 patients with pancreaticobiliary maljunction, 6 patients with duodenal papilla stenosis, 29 patients with duodenal papillitis, and 3 patients with duodenal papilla adenocarcinoma. Two patients were treated with laparoscopic cholecystectomy (LC), 1 patient with endoscopic sphincterotomy (EST) /endoscopic balloon dilation (EPBD) and LC, 1 patient with percutaneous transhepafic gallbladder drainage (PTGD) and open cholec-ystectomy, 14 patients with PTGD and EST/EPBD, 1 patient with PTGD and hepatocholangioplasty with the use of gallbladder (HG), 34 patients with EST/EPBD, 3 patients with EST/EPBD and endoscopic biliay metal stent drainage (EBMSD), 5 patients with HG, and 1 patient with EST/EPBD and HG. The gallbladder muddy stones disappeared after operations in 55 patients with gallbladder reserved, and gallbladder ejection fraction increased from (42±12) % to (59±16) %. Of the 62 patients, 53 patients were followed up for 6 months to 6 years (the median time was 3.6-year). During the follow-up period, 3 patients were diagnosed with gallbladder stones, 2 patients with common bile duct stones, and 2 patients with intrahepatic and extrahepatic bile duct stones. ConclusionBile efferent tract obstruction is the important reason for the formation of gallbladder stones. HG, EST, and balloon expansion are the efficient methods to resolve the bile efferent tract obstruction.