十二指肠切除术

Objective:To observe the clinical results of LC combined with EST in treating cholecystolithiasis and choledocholithiasis.

目的： 总结腹腔镜胆囊切除术＋十二指肠乳头括约肌切开术治疗胆囊、胆总管结石的体会。

Methods:The clinical data of 6 cases that received LC combined with EST herapy for cholecystolithiasis and choledocholithiasis were analyzed retrospectively.

目的：总结腹腔镜胆囊切除术＋十二指肠乳头括约肌切开术治疗胆囊、胆总管结石的体会。方法：为6例患者行LC＋EST。

Results: Among 80 cases of ACST, 76 cases were successfully implemented LC, gallbladder puncture and decompression choledocholithotomy T-tube drainage were performed in 11 cases, choledocholithotomy T-tube drainage in 15 cases, common bile duct gall bladder fistula Toishi T-tube drainage in 14 cases, gallbladder removal choledocholithotomy T-tube drainage in 36 cases, operative time 15-120 min, bleeding 10-80 ml; 4 cases transitted laparotomy, 1 case of gallbladder and surrounding tissue adhesion serious, ampulla signs disappear, and the hepatoduodenal ligament ill-defined, 2 cases of gallbladder contraction deep within the liver, gallbladder triangle scar adhesions, and 1 case of duct stone impaction and severe adhesions; postoperative hospital stay was 8-11 d, all were well recovered; pathological diagnosis, acute cholecystitis in 41 cases （51.2％）, acute suppurative cholecystitis in 24 cases （30.0％）, acute gangrenous cholecystitis in 15 cases （18.8％）.

结果：重症急性胆囊炎80例，76例成功实施LC，其中，胆囊穿刺减压胆总管切开取石T管引流11例，胆总管切开取石T管引流15例，胆囊造瘘胆总管切开取石T管引流14例，胆囊切除胆总管切开取石T管引流36例，手术时间15～120 min，术中出血10～85 ml；4例中转开腹，其中，1例胆囊与周围组织粘连严重，壶腹部标志消失，与肝十二指肠韧带界限不清，2例胆囊萎缩深陷肝脏内，胆囊三角区瘢痕粘连，1例胆囊管结石嵌顿且严重粘连，术后住院时间8～11 d，术后恢复均良好，治愈出院；80例术后病理诊断，急性单纯性胆囊炎41例（51.2％），急性化脓性胆囊炎24例（30.0％），急性坏疽性胆囊炎15例（18.8％）。

Methods 36 patients with acute perforation of gastroduodenal ulcer were treated by subtotal gastrectomy and homemade stapler were used.

对36例应用国产吻合器行胃大部切除术的胃十二指肠溃疡急性穿孔病例进行临床分析。

Generally several different treatments are used to cure Acute Perforation of Gastroduodenal Ulcer, such as gastrorrhaphy, subtotal gastrectomy, and the non-operational method represented by gastrointestinal and acupuncture.

对胃、十二指肠溃疡病急性穿孔的治疗，历来有不同的主张，如主张施行穿孔修补术、胃大部分切除术、以胃肠减压及针灸为主的非手术疗法等。

How to assess the difficulty and the possibility of pancreatoduodenectomy and to avoid negative laparotomy has been a question that concerns people.

如何在术前评估胰头十二指肠切除的难度和可能性，避免阴性剖腹探查，是当今人们关注的热点。

After preoperative treatment, 12 patients (26%) were considered to have clinically resectable tumors, and nine (19% of the total number of patients) had Whipple pancreatoduodenectomy one month after completion of radiation.

化疗治疗后，12例(26%)病人被认定有临床可切除肿瘤，9例(19%)完全放疗一个月后进行Whipple 胰腺十二指肠切开术。

Results Findings in the operation and pathologic diagnosis: gastric ulcer in 11 cases (50%); duodenal ulcer in 7 cases(33.9 %); Postbulbar duodenal ulcer in 1 case (4.5%); complexity ulcer in 3 cases(13.6%); among them, canceration in 2 cases (9.1%) Procedures: subtotal gastrectomy with Billroth 1 anastomosis in 6 cases(27.3%), subtotal gastrectomy with Billroth II anastomosis in 15 cases.

结果手术所见及病理诊断：胃溃疡11例(50％)；十二指肠球部溃疡7例(33.9％)；十二指肠球后溃疡1例(4.5％)；复合性溃疡3例(13.6％)；其中伴癌变2例(9.1％)。手术方式：胃大部切除Billroth 1式吻合术6例(27.3％)，胃大部切除BillrothⅡ式吻合术15例(68.2％)，全胃切除Roux—en—Y吻合术1例(4.5％)，其中溃疡旷置术3例(13.6％)。

Methods15 patients with burn area of (38±15)% and with upper gastrointestinal hemorrhagic stress ulcer received surgical procedures, including sutured hemostasis, pyloroplasty, selective vagotomy, or subtotal gastrectomy, and so on, between 4 to 12 days after burn.

方法烧伤后上消化道应激性溃疡大出血患者15例，烧伤面积(38±15)%，出血部位12例位于十二指肠，3例位于胃。手术时间在伤后4～12天，手术方式为缝扎止血、幽门成形、选择性迷走神经切断、溃疡外旷置术或胃大部分切除术。

But we don't care about Battlegrounds.

但我们并不在乎沙场中的显露。

Ah! don't mention it, the butcher's shop is a horror.

啊！不用提了。提到肉，真是糟透了。