瘘

Methods Using Seldinger technique method,guide Magic-BD micro-catheter with Balt detachedable rubber ball to the fistulas level,when verified the ball inside the fistula of carotid-cavernous sinus but outside the carotid artery,filled the ball fully enough with iodine material until the abnormal noise disappear and release the ball remained the internal carotid artery patent.

采用Seldinger法插入导管鞘后，用带Balt可脱球囊的magic-BD导管透视下经导引管送达瘘口水平，当球囊突然"低头"或改变方向时，表示球囊已通过瘘口，进入海绵窦。以等渗造影剂交换气体后充盈球囊至杂音消失，造影证实瘘闭塞完全，并保持颈动脉通畅。

All the patients had no facial nerves injuries, no limitation in mouth opening and no mastication difficulty. Conclusion The buccinator musculomucosal island flaps pedicled superior-anteriorly and posteriorly are trustworthy and safe for palatal fistula repair. It can be transferred conveniently to repair fistula of any position.

应用蒂在前上和蒂在后的岛状颊肌粘膜瓣修复腭瘘是一种比较安全可靠的方法，其成活率高，可以灵活转移修复各个部位的腭瘘，在修复软硬腭交界部位腭瘘的同时可延长软腭、矫正腭咽闭合不全。

Methods The clinical data of 42 cases were analysised by retrospective study.15 cases were put double pigtail stents via cystoscope and 3 cases via percutaneous nephrostomy,22 cases were performed one step's percutaneous nephrostomy and 2 cases pyelostomy. Results The patients were followed - up for 3 - 26 months .

回顾性分析42例恶性肿瘤并发输尿管梗阻的临床资料。15例患者成功逆行放置双猪尾导管，22例首选一步法经皮肾穿刺造瘘术，3例实施肾造瘘加顺行双猪尾导管置入术，2例行开发性肾盂造瘘术。

Results 4 cases were treated by thoracic close drainage as long term treatment; 6 cases were cured with exclusive thoracic close drainage; 123 cases of bronchopleural fistula were treated with decortication or thoracoplasty after their symptoms of ardent fever, cough and expectoration vanished due to drainage ; 23 cases of hronchopleural fistula were treated with thoracic close drainage, cleaning up focus of infectionrestoring fistulae-splanchnic wall decortication and repeated chest drainage ,4 cases were cured and the extent of operation and thoracic deformity in 19 cases were diminished.

结果 4例不能耐受进一步手术者采用闭式引流术作为永久性的治疗；6例单纯引流治愈；123例因支气管胸膜瘘等经引流后高热、咳嗽、咳痰等症状消失，择期行胸膜纤维板剥脱术或胸廓成形术；23例合并支气管胸膜瘘拟行胸廓成形术的患者，经引流、病灶清除-瘘修补-脏层纤维板剥脱术、再引流，4例治愈，19例减小了手术范围及胸廓畸形的程度。

objectiveto investigate the diagnosis and treatment of traumatic duodenal rupture.methodthe clinical data of 13 patients with traumatic duodenal rupture hospitalized from may 1991 to december 2008 were retrospectively analyzed,and the material cause was automobile accident mainly.resultsin these 13 patients,after hospitalization,6 cases were diagnosed in 3 hours,4 cases were diagnosed in 24～72 hours,and 3 cases were diagnosed after 72 hours.three cases with duodenal cleft repair,2 cases with duodenal ostomy,2 cases with duodenum and jejunum roux-en-y anastomosis,1 case with duodenal diverticular surgery,1 case with meliorative duodenal diverticular surgery,1 case with duodenal broken ends closure and anastomosis of stomach with jejunum,1 case with duodenal distal closure and anastomosis of duodenal local with jejunum,and 2 cases with resections of pancreas duodenum.after the operation,6 cases (46.2%) appeared some complications of wound infection,duodenal fistula,digestive tract hemorrhage,pancreatic fistula,abdomen infection and so on.two cases (15.4%) died from multiple system organ failure and septic shock.conclusionthe early diagnosis and correct operation style selection are the keys for duodenal rupture.

目的：探讨外伤性十二指肠破裂的诊断和治疗方法。方法：回顾分析外伤性十二指肠破裂患者13例临床资料。结果：入院后3 h内确诊6例，24～72 h内确诊4例，72 h后确诊3例。3例行十二指肠裂口修补，2例行十二指肠造瘘，2例行十二指肠空肠roux-en-y吻合，1例行十二指肠憩室化手术，1例行改良十二指肠憩室化手术，1例行十二指肠两断端关闭、胃空肠吻合，1例行十二指肠远端关闭、近端与空肠端侧吻合，2例行胰十二指肠切除术。术后6例(46.2%)出现切口感染、十二指肠瘘、消化道出血、胰瘘或腹腔感染等并发症，2例(15.4%)患者死亡，分别死于多器官系统衰竭和感染中毒性休克。结论：早期诊断与正确的术式选择是成功救治外伤性十二指肠破裂的关键。

Pancreatic leak was verified in 8 out of 13 cases with pancreatic enucleation, 6 out of 10 cases with distal pancreatectomy with or without splenectomy and I out of 6 cases with central pancreatectomy.

摘除术13例中8例发生胰瘘，胰体尾脾切除术8例中6例发生胰痰，保留脾的胰体尾切除术2例均未发生胰瘘，中段胰腺切除术6例中有1例发生胰瘘。

Portal braches of 4-5 orders were found in all 19 cases of Child Grade I, with esophageal varices and paragastric varices and no fistula of hepatic artety-portal vein or portal vein embolus; Portal braches of 3-4 orders were displayed in all 16 cases of Child Grade II, besides esophageal varices and paragastric varices, cirsomphalos, retroperitoneal varices, paraesophageal varices, dilated azygos vein were also noted, some patients had fistula and portal vein embolus; in Child Grade III, portal branches of 3~4 orders were displayed with more collateral circulations, dilated left renal vein and paragallbladder varices were appeared, with fistula and portal vein embolus or not.

Child I级19例，肝内门静脉显影4~5级，侧枝循环以食管及胃周静脉曲张为主，没有肝动脉－门静脉瘘或门静脉血栓形成；Child Ⅱ级16例，肝内门静脉显影3~4级，侧枝循环除食管及胃周静脉外，脐周静脉、腹膜后静脉、食管周围静脉、奇静脉也有所开放，部分有肝动脉－门静脉瘘或门静脉血栓形成；Child Ⅲ级6例，肝内门静脉显影3~4级，侧枝循环开放较Ⅱ级增多，可出现左肾静脉扩张或胆囊周围静脉曲张，伴或不伴有肝动脉－门静脉瘘或门静脉血栓形成。16排螺旋CT门静脉造影对上述病例分级为一级17例，二级18例，三级6例，与Child分级结果高度相关。

The disposable ringed cystiform closed anal tube was used to 58 cases of analconserving operation,34 cases of sigmoid fistulation and 68 cases of blind enema and drug effusion and compared with cases of the use of single-cavity cylindrical anal tube in respect of anastomotic leakage,infection of fistula and drug effusion.

将一次性环囊肛管用于58例保肛式手术、34例乙状结肠造瘘手术及68例肛管排气及药物灌肠病人，并与应用单腔圆柱式肛管病人从吻合口瘘、吻合口狭窄、造瘘口感染、药液外溢、肛管脱出发生率方面进行比较。

RESULTS: The morbidity of this kind fistula was 1.83%(4/219) in our hospital. All the 5 patients suffered fistula 1-13 days after esophagogastrostomy; bronchopleural fistula occurred in 2 patients.

结果：本组三切口食管癌手术的颈部吻合口内瘘的发生率为1.83%(4/219)。5例患者内瘘发生时间为术后第1~13天，其中2例合并支气管胸膜瘘。

According to the principles of classification of urethral damages, the urinary fistulae after kidney transplantation was classified in terms of the cause, location and extent of them. Moreover, why it was difficult to cure urinary fistulae was discussed, and the key points in the diagnosis were illuminated.

文章根据尿道损伤疾病分类的原理，将肾移植后尿瘘分别按照尿瘘病因、尿瘘部位、病变程度等进行分类；讨论了肾移植后尿瘘经久不愈的原因以及诊断时应注意的几个问题。

The split between the two groups can hardly be papered over.

这两个团体间的分歧难以掩饰。

This approach not only encourages a greater number of responses, but minimizes the likelihood of stale groupthink.

这种做法不仅鼓励了更多的反应，而且减少跟风的可能性。