目的 探討B超引導下穿刺置管引流技術在重癥急性胰腺炎治療中的應用價值。方法 36例重癥急性胰腺炎患者均行腹腔穿刺置管引流，其中經皮肝膽管（膽囊）穿刺置管引流（PTCD）23例，腹膜后積液（膿腫）穿刺置管沖洗引流16例，配合常規內科治療，取得滿意效果。結果 所有患者穿刺置管過程順利，均未出現與穿刺相關的并發癥如氣胸、血胸、腹腔內出血、穿刺部位感染等。所有患者在禁食、胃腸減壓、抗生素、生長抑素、制酸、維持水電解質酸堿平衡及腸內外營養支持治療的基礎上輔以超聲引導下穿刺置管引流，僅1例暴發性胰腺炎患者發生膿腔內大出血導致多器官衰竭而死亡，其余35例均治愈，無中轉開腹手術，患者腹痛、腹脹、腹部壓痛等主要癥狀和體征緩解時間為（4.4±1.3）d（1～7d），尿淀粉酶恢復正常時間為（3.1±1.5）d（2～8d）,住院時間為（23.4±7.3）d（16～55d）。結論 B超引導下穿刺置管引流術操作簡單、創傷輕微，在重癥急性胰腺炎治療中有重要價值。
ObjectiveTo compare the effects of medical glue and stapling in the prevention of postoperative seroma for patients undergoing laparoscopic direct hernia repair. MethodsNinty-four patients were randomly by computer generated randomization number divided into two groups: medical glue group (medical glue was used to fix pseudo-direct hernia sac) and stapling group (staple was used to fix pseudo-direct hernia sac).The time of follow-up was two years.The operative time, length of hospital stay, the pain level on first day and 7th day after operation, postoperative complications (seroma, wound infection, wound bleeding), hospital costs, and hernia recurrence rate within 2 years were observed. ResultsThe medical glue group compared with the stapling group, the operative time was shorter〔(35±5.1) min vs.(41±7.5) min〕, hospitalization time was shorter〔(4±0.51) d vs.(5±0.83) d〕, lower postoperative pain score〔the first day: (5±0.52) scores vs.(6±0.33)scores; the 7th day: (3±0.67) scores vs.(4±0.53) scores〕, and lower cost in hospital〔(5 731±560.50) yuan vs.(8 715±534.33) yuan〕, there were significant difference (P < 0.05).The incidence of seroma and other complications after operation and postoperative 1-year and 2-year hernia recurrence rate showed no significant differences (P > 0.05). ConclusionsThe medical glue has good prevention effects on postoperative seroma for patients undergoing laparoscopic direct hernia surgery, with shorter operative time and lower cost.This method is suitable for all levels of hospitals
Objective To explore whether the intraoperative cholangiography （IOC） should be applied in laparoscopic cholecystectomy routinely or selectively. Methods Data of routine IOC group （1 520 patients）and selective IOC group （457 patients）in laparoscopic cholecystectomy were collected and analyzed， including cholangiography time， success rate， common bile duct stones rate， open cholecystectomy rate， and hospital stay after operation. All IOC cases were performed by home-made cholangiography appliance or infusion needle. Results There were no significant differences between routine IOC group and selective IOC group on cholangiography time， success rate， open cholecystectomy rate， and hospital stay after operation （P＞0.05）. However， compared with routine IOC group， the common bile duct stones rate， anatomic variation rate， and iatrogenic damage rate were significantly higher in selective IOC group （28.25% vs. 13.43%， 10.71% vs. 7.43%， 2.05% vs. 1.02%， P＜0.05）. Conclusions For avoiding iatrogenic bile duct damage and residual stones， routine IOC should be applied in early-stage of laparoscopic cholecystectomy， and IOC should be applied selectively when the surgeon have LC technique at their finger ends.