立体超选择性动脉灌注化疗在乳腺癌降期保乳术中的价值

目的评价术前立体超选择性动脉灌注化疗在ⅡB～ⅢA期乳腺癌保留乳房手术中的价值。方法36例乳腺癌患者，其中ⅡB期10例、ⅢA期26，术前采用立体超选择性动脉灌注丝裂霉素、表阿霉素和5氟尿嘧啶，化疗后再进行手术。结果36例患者灌注化疗后病灶缓解32例，好转3例，无明显变化1例；缓解率达88．9％（32／36），该32例患者肿瘤直径均缩小到2cm以下，获得保乳手术机会。结论术前立体超选择性动脉灌注化疗可使局部晚期乳腺癌降期获得保乳机会。     

原发性胆囊癌69例的外科治疗

目的 总结原发性胆囊癌的治疗经验,探讨提高原发性胆囊癌生存率的方法。方法 回顾性分析了我院１９８６－１９９９年收治的６９例胆囊癌病例资料。本组诊断依赖于临床表现和影像学检查,Ⅰ期４％,Ⅱ期７％,Ⅲ期１５％,Ⅳ期１７％,Ⅴ期５７％。６８％的病例行手术治疗。结果 本组术前诊断率８４％,Ｂ超和ＣＴ是提高诊断率的重要手段。手术切除率４９％,长期存活者仍以Ⅰ、Ⅱ期病例为主,单纯胆囊切除术即可获得良好的存活率,３年为１００％,Ⅲ期病例术后２年存活率为５０％。结论 手术是治疗Ⅰ、Ⅱ、Ⅲ期病例的首选方法。手术能使Ⅳ、Ⅴ期患者的短期存活率稍有延长,早期诊断和手术切除是提高手术疗效的关键。对于有高危因素的无症状胆囊结石和隆起样病变患者,应行预防性胆囊切除。     

胆总管周围淋巴结结核误诊3例报告

例1.女性,31岁.右上腹持续性疼痛,阵发性加剧3月,于1986年5月入院.X 线脚片未见异常.腹部平片未见钙化灶,静脉胆道造影无异常.B 超显示胆总管囊性扩张.术前诊断:胆总管囊肿.手术     

原发性胆囊癌36例临床分析

目的 探讨胆囊癌诊治的有效途径。方法 对我院1986－2001年收治36例胆囊癌患者的临床资料进行回顾性分析。结果 术前诊断率74．3％，64％的胆囊癌合并胆囊结石。B超，CT是诊断胆囊癌的主要手段。误诊率17％。手术的切除率55．％。1年生存率36％，5年生存率10％。结论 Ⅰ，Ⅱ，Ⅲ期胆囊癌首选根治性手术，Ⅳ，Ⅴ期采取综合治疗。早期诊断且行根治性手术是提高胆囊癌患者生存时间的有效方法。对高危胆囊结石的患者宜积极行胆囊切除术。误诊的原因是对胆囊癌认识不足。     

输尿管结石的影像学分析(附124例报告)

目的探讨B超、腹平片(KUB) 静脉肾盂造影(IVU)、CT对输尿管结石的诊断价值。方法回顾性分析了本院124例输尿管结石患者的B超、KUB IVU的诊断资料。结果B超诊断率为78.2%,KUB IVU诊断率为90.3%,KUB IVU综合B超诊断率达96.8%。结论B超、KUB IVU综合对输尿管结石有很高的诊断价值。CT是B超及KUB IVU的补充检查方法。     

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目的 研究提高成人小肠扭转早期诊断率的方法。方法 回顾分析过去１０年经手术证实的成人小肠扭转８３例。结果 首要病因是 腹腔粘连,占５！％,发病年龄６０岁以上者占５７％,９５％的病例有绞窄性肠阻的临床表现;腹部平片诊断率低（１４．５％）。结论提高早期诊断率首先要注重临床症状与体征;不能盲目依赖腹部平片,应特别重视术后粘连引起小肠扭转的诊断。     

127例胆囊癌20年临床对比分析

目的 分析我院近20年胆囊癌病例,为提高胆囊癌的诊治水平提供一些经验。方法 回顾1983年1月-2001年11月间有病理报告证实的胆囊癌127例,前10年58例,后8年69例,对比前后10年间的诊断与治疗方法,以及患者的预后。结果 前10年的术前诊断率为29.3％,术后病理诊断率18.9％。后8年分别为60.9％、4.3％,与前10年相比P<0.01。全组NevinⅠ、Ⅱ期的患者共13例,行单纯胆囊切除术,随访3年均生存。Ⅲ期以上患者前10年的54例,行标准胆囊癌根治术,术后未做其他治疗。其术后1、3年生存率分别为的64.8％、24.1％。后8年60例,根治手术率达38.3％（P<0.05）,术后1、3年生存率分别为71.7％（P>0.05）及43.3％（P<0.05）。本组无腹腔感染、胆漏、肝肾功能衰竭等严重术后并发症,无手术死亡。结论 胆囊癌起病隐匿,与有多年的慢性胆囊炎、胆囊结石病史有关;B超及CT检查可提高胆囊癌术前诊断率。术中对胆囊局部增厚、变硬或隆起性病变做冰冻检查,是防止漏诊的必要手段。胆囊癌根治术是提高患者1、3年生存率的有效方法。     

慢性胰腺炎伴胰管结石的诊断与外科治疗

目的：探讨慢性胰腺炎伴胰管结石的诊断特点与手术方法的选择。方法：回顾分析外科治疗的慢性胰腺炎伴胰管结石的16例临床资料。结果：16例中常见的临床症状是腹痛(占100％)、食欲不振及恶心呕吐(占62．5％)、脂肪泻(占12．5％)、消瘦(占18．8％)及腹部肿块(占6．3％)。胰管扩张及胰腺结石的B超诊断率分别为81．3％及75．0％；胰管结石的腹部平片诊断率为81．3％；胰管结石的CT和MRI诊断率均为61．5％，包括胰头部局限性肿大为23．1％和胆总管扩张15．4％。手术方式包括胰管切开减压胰管空肠内引流术10例(Partington手术9例及Puestow手术1例)，胰十二指肠切除术3例(Child方法)，胰体尾部切除术3例(联合胆总管切开、T管引流术2例)。结论：严格选择适应证和合理的手术方式，对改善慢性胰腺炎伴胰管结石患者的生活质量和控制疾病发展具有重要作用。     

原发性胆囊癌31例临床分析

目的 探讨原发性胆囊癌的早期诊断及外科治疗方法 .方法 回顾性分析31例经病理证实的原发性胆囊癌患者的l临床资料.结果 全组术前诊断率61.3%;31例胆囊癌患者中单纯胆囊切除术14例,胆囊癌根治术5例,姑息性胆囊切除术7例,剖腹探查术5例.Nevin分期Ⅰ期0例,Ⅱ期8,Ⅲ期5,Ⅳ期5,Ⅴ期13.结论 目前发现的胆囊癌多为中晚期,B超及CT是早期发现胆囊癌的首选方法 .根据临床分期实施积极正确的手术可改善胆囊癌的预后.根治性手术是治愈胆囊癌最有效的手段.     

闭合性腹部损伤行B超诊断的临床意义探讨

目的：研究探讨B超检查对闭合性腹部损伤中的诊断临床意义。方法回顾性分析2013年1月至2013年12月本院收治的闭合性腹部损伤患者128例,入院就诊后行B超检查,并行手术治疗,根据手术结果对照分析B超检查闭合性腹部损伤准确率。结果经过B超检查和手术结果对比观察所示,128例闭合性腹部损伤患者中经手术证明腹部实质性脏器损伤患者93例（占72.66％）,B超诊断准确率为91.40％,经手术证明腹部非实质性脏器损伤患者35例（占27.34%）,B超诊断准确率为74.29％,B超检查腹部闭合性实质器官损伤准确率优于非实质性器官准确率。结论 B超检查诊断闭合性腹部损伤有较高的准确率,可为临床进一步准确治疗提供重要的依据,因此是闭合性腹部损伤诊断的首选方法,适合临床广泛应用。     

胆石性肠梗阻的诊断与治疗

胆石性肠梗阻是一种较为少见的机械性肠梗阻,多因胆囊巨大结石通过胆肠内瘘排入肠道引起阻塞性肠梗阻.治疗的关键是梗阻原因的诊断,治疗方法主要为手术治疗.2013年4月苏州大学附属第二医院收治了1例老年胆石性肠梗阻患者.术前经X线片和CT检查胆囊壁增厚与十二指肠粘连窦道形成,左髂区机械性肠梗阻（胆源性结石直径约4 cm）,内科治疗3d后行急诊剖腹探查＋取石术治疗肠梗阻,术中见胆囊无结石,与家属沟通后未切除胆囊,术后随访观察.随访至2013年12月患者恢复较好,复查B超胆囊肠道内瘘口未显示,胆囊炎症消退.     

Gallstone ileus masquerading as an obstructed femoral hernia

Gallstone ileus affects primarily elderly women. In many instances, no history of previous biliary disease is discernible. Although it has been known since the 17th century, gallstone ileus continues to present in such an intriguing way that, more often than not, the diagnosis is made intraoperatively. A 68‐year‐old woman, presented with abdominal pain and vomiting. She had a slightly distended and mildly tender abdomen, and the bowel sounds were normal. There was an irreducible, slightly tender right femoral hernia. Plain X‐rays of the abdomen were normal and an ultrasound showed a contracted fibrotic gall bladder with small stones. Laparoscopy failed to detect an obstructing gallstone, which was discovered in a second laparotomy. Cholecystectomy and fistula closure were carried out in the same sitting. A retrospective review of a preoperative Gastrografin study showed clear radiological evidence of the condition. Gallstone ileus tends to be forgotten as a cause of bowel obstruction or abdominal pain in elderly women. With this in mind, careful interpretation of a Gastrografin study might provide the diagnosis preoperatively. In relatively fit patients, cholecystectomy and fistula closure could be safely added to the emergency enterolithotomy.     

胆石性肠梗阻的诊治(附11例临床分析)

目的探讨胆石性肠梗阻的临床特点和治疗方法. 方法我院1985年～2000年共收治胆石性肠梗阻11例,术前仅3例确诊.均经手术治疗,其中10例行肠管切开取石,1例因肠坏死切除坏死肠段.失访2例,余9例患者一期术后6～9月行胆囊切除和(或)内瘘修补术. 结果Ⅰ期手术后并发呼吸道感染2例,切口感染1例,随访结果显示Ⅱ期手术后9例患者均获治愈. 结论胆石性肠梗阻术前确诊率低,但及时的B超及X线检查有助于其早期诊断,分期手术治疗胆石性肠梗阻效果显著.     

El íleo biliar como causa de abdomen agudo. Importancia del diagnóstico precoz para el tratamiento quirúrgico

Gallstone ileus is an uncommon type of mechanical intestinal obstruction caused by an intraluminal gallstone, and preoperative diagnosis is difficult in the Emergency department. This study is a retrospective analysis of the clinical presentation of 5 patients with gallstone ileus treated between 2000-2010. Clinical features, diagnostic testing, and surgical treatment were analyzed. Five patients were included: 2 cases showed bowel obstruction; 2 patients presented a recurrent gallstone ileus with prior surgical intervention; and one patient presented acute peritonitis due to perforation of an ileal diverticula. In all cases CT confirmed the preoperative diagnosis. In our experience, gallstone ileus may present with clinical features other than intestinal obstruction. In suspicious cases CT may be useful to decrease diagnostic delay, which is associated with more complications.     

Gallstone ileus as a complication of acute cholecystitis. Laparoscopic diagnosis and treatment

Gallstone ileus accounts for 1-4% of all cases of intestinal obstruction, with its incidence rising with age of patients. There is often a long delay between onset of symptoms (usually abdominal pain, vomiting, and bowel distension) and proper treatment, with a simple enterolithotomy as the one of choice. We report a case of an atypical gallstone ileus presented as a complication of acute cholecystitis, treated with a laparoscopic guided enterolithotomy. A 67-year-old woman on the 5th p.o. day after a laparoscopic procedure for an empyematous cholecystitis (no sign of fistula or duodenal perforation and a "negative" intraoperative cholangiography) presented continuous vomiting as the only symptoms of a subileus (radiographic diagnostic images negative for intestinal obstruction or intraluminal gallstone or duodenal fistula). A laparoscopic diagnostic approach revealed a gallstone in the distal jejunum. Through a 5 cm midline incision the intestine, including the gallstone, was brought out extracorporally and the stone was removed by a simple enterolithotomy. The postoperative course was uneventful and the patient had no complaint at a 1-year follow-up. We consider the laparoscopic approach, in patients with "abdominal emergencies," feasible and safe in experienced hands. It provides diagnostic accuracy as well as therapeutic capabilities, as in the case of gallstone ileus we have reported.     

Gallstone ileus

Twenty patients with gallstone ileus were treated over a 20-year period. The demographics were typical: mean age 76, female to male ratio of 5:1, and 60 per cent incidence of concomitant medical ailments. An 85 per cent preoperative diagnostic rate was unusually high. An analysis of the study halves demonstrated a stable preoperative diagnostic rate, decrease in preoperative delay (7.5 vs. 4.7 days), and a rise in mortality rate (0 vs. 11%) without an unfavorable effect from a 26 per cent incidence of single-stage procedures (0% mortality). Gallstone ileus still carries a mortality rate of five to ten times that of all other nonmalignant mechanical small bowel obstructions. Anticipated improvements related to augmented preoperative diagnostic yields shortened preoperative delays, and selective surgical management have not been substantiated. Improved mortality rates may await refinements in resuscitation, monitoring, and surgical skills.     

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目的 提高对胆石性肠梗阻的认识，及时明确诊断和手术治疗。方法 回顾性分析１３例胆石性肠梗阻的临床及影像学资料。结果 １３例均经手术治愈，仅３例术前确诊为胆石性肠梗阻。结论 滚动性梗阻是胆石性肠梗阻的特征，及时的Ｂ超和Ｘ线检查有助于早期明确诊断，手术解除结石梗阻是唯一的治疗手段。     

Gallstone ileus in the absence of the gallbladder: case report and review of the literature

Although small-bowel obstruction due to gallstone ileus is uncommon, it assumes increasing importance with advancing age. The obstructing gallstone enters the bowel through an internal fistula between gallbladder and duodenum. The authors describe the case of a patient who had undergone cholecystectomy and in whom gallstone ileus occurred secondary to a stone that entered the bowel through a choledochoduodenal fistula. Treatment was traditional with removal of the obstructing stone, but the fistula was left undisturbed. The authors believe that further biliary tract symptoms are unlikely. The patient was well 8 weeks after operation and roentgenograms indicated that the internal biliary fistula was patent.     

Bowel obstruction and perforation due to a large gallstone. A case report

IntroductionGallstone bowel obstruction is a rare form of mechanical ileus usually presenting in elderly patients, and is associated with chronic or acute cholecystitis episodes.Case presentationWe present the case of an 80 year old female with abdominal pain, inability to defecate and recurrent episodes of diarrhea for the past 8 months. CT examination uncovered a cholecystoduodenal fistula along with gas in the gall bladder and the presence of a ≥2 cm gallstone inside the small bowel lumen causing obstruction. Patient was admitted to the operating room, where a 3.2 cm gallstone was located in the terminal ileus. A rupture was found in the antimesenteric part of a discolored small bowel segment, approximately 60 cm from the ileocaecal valve, through which the gallstone was recovered. The bowel regained its peristalsis, and the rupture was debrided and sutured. Patient was discharged uneventfully on the 6th postoperative day.DiscussionGallstone ileus is caused due to the impaction of a gallstone inside the bowel lumen. It usually passes through a fistula connecting the gallstone with the gastrointestinal tract. It can present with nonspecific or acute abdominal symptoms. CT usually confirms the diagnosis, while there are a number of treatment options; conservative, minimal invasive and surgical. Our patient was successfully relieved of the obstruction through recovery of the gallstone using open surgery, with no repair of the fistula.ConclussionAlthough rare, gallstones must be suspected as a possible cause of bowel obstruction, especially in elderly patients reporting biliary symptoms.     

胆石性肠梗阻五例报告并文献复习

目的 探讨胆石性肠梗阻的临床特点及诊治方法.方法 回顾性分析5例胆石性肠梗阻患者的临床资料,并复习2000-2009年国内相关文献,对胆石性肠梗阻的发病情况、临床表现、影像学检查、诊断及治疗情况进行总结.结果 本组5例患者中4例为60岁以上女性,其中3例有胆石病史,胆石经胆囊十二指肠瘘排入肠道 另2例有胆肠内引流术史,胆石经内引流口排入肠道.4例行肠切开取石并肠道胆道彻底手术,另1例行单纯肠切开取石 5例患者均手术治愈,术后无复发病例.国内文献复习共获取胆石性肠梗阻有效病例441例,占所有肠梗阻的1.15%,其中女性患者占67.12%,老年患者占73.56%.87.92%的胆石是经胆肠内瘘口排入肠道 64.17%的梗阻位于回肠.术前有71.89%的患者误诊为其他类型肠梗阻.225例行肠切开取石并肠道胆道彻底性手术,其术后复发率及胆囊癌变率低于216例行单纯肠切开取石患者（均P＜0.05） 而术后胆肠瘘、切口感染、肺部感染、治愈率及死亡率两种术式间差异则无统计学意义（均P＞0.05）.结论 胆石性肠梗阻发病率低,以老年女性多见 胆石多经胆肠内瘘口进入肠道,梗阻部位以回肠多见.单纯肠切开取石术后有一定的复发及胆囊癌变风险,故若患者全身情况允许,应首选肠切开取石并胆道肠道彻底性手术.