目的:分析经后腹腔镜肾上腺囊肿去顶减压术的疗效,安全性和临床价值。方法:我院2004年12月至2007年12月6例经后腹腔镜肾上腺囊肿去顶减压临床资料进行回顾分析。结果:经后腹腔镜5例肾上腺囊肿患者顺利切除去顶,其中左侧肾上腺囊肿3例,右侧肾上腺囊肿3例。1例转开放,为双侧肾上腺囊肿。平均手术时间(45.73±1.32)min,平均术中出血量(7.35±0.45)mL。平均住院天数(7.67±0.24)天,平均术后住院天数(5.0±0.11)天。结论:经后腹腔镜肾上腺囊肿去顶减压是一种安全,有效且可行的治疗方式,必要时应及时转开放。
目的 探讨成人先天性胆总管囊肿的诊治方法和手术技巧。方法 对2001年5月至2011年5月期间我院手术治疗的成人先天性胆总管囊肿38例的临床资料进行回顾性分析。结果 全部病例均行B超和磁共振（MRCP）检查确诊，均行手术治疗。其中7例行急诊囊肿外引流术。行择期手术者中24例行囊肿切除、胆肠吻合术，其中3例合并肝叶切除术； 行内引流术4例； 仅行胆囊切除术3例。囊肿剥除采用点状钳夹、电凝及推剥囊肿黏膜外纤维血管束的办法，不出血，无副损伤。无手术死亡病例，术后恢复顺利。38例患者中术后获随访28例（73.68％），失访10例； 随访时间 3～120个月，平均74个月。24例行囊肿切除者症状消失20例，偶感上腹痛、抗炎治疗后症状可缓解1例，3例失访；11例行内或外引流术者术后近期均有不同程度的胆管炎症状，其中6例于术后2～10 年再手术，另5例失放，6例再手术者中2例术中发现癌变，分别于再手术后2个月和10个月死亡，余4例临床症状消失；3例仅行胆囊切除术者，2例失访，1例仍有反复发作的畏寒、发热及右上腹痛。结论 B超和MRCP检查有助于明确诊断； 囊肿全切除、肝管空肠Roux-en-Y 吻合术应作为胆总管囊肿的首选术式，囊肿外引流术仅在合并严重感染、全身情况差的患者采用； 手术技巧的改进可为手术提供安全保障。
Objective To study the effect of microtraumatic treatment of postoperative recurrent bone cysts in juvenile patients. Methods FromDecember 1984 to December 2003, 36 cases of postoperative recurrent bone cysts after focal curettage and bone graft included 19 males and 17 females, aging 9-21 years-with an average of 15 years. The size of bone cyst ranged from 2.5 cm×6.0 cm to 3.5 cm×13.0 cm with an average of 3.0 cm×8.0 cm. The locations were proximal humerus in 18 cases, humeral shaft in 10 and femoral trochanteric region in 8. The focal curette and bonegraft were given once in 23 cases, twice in 10 cases and 3 times in 3 cases. The interval between recurrence and microtraumatic treatment was 5-13 months (6.5 months on average). The posteroanterior and lateral X-ray films were takento determine the location, range and feature of the focus. Under local anesthesia, 2 canulated needles were used; one was used to aspirate the contents of the cyst, the other was used to inject hydrocortisone acetate. The dose was determined according to the range of the focus. The treatment was repeated every 3.54 months until the focus healed. Results All patients were followed up from 3 to 18 years with an average of 5 years. The microtraumatic treatment was repeated 3-11 times with an average of 6 times. Twenty-six cases healed completely, 6 cases healed significantly, and 4 cases healed partially. No local or general complications occurred during the treatment. Conclusion This microtraumatic method for the treatment of postoperative recurrent bone cyst in juvenile patients has following advantages : less pain, easy manipulation, no hospitalization, low cost and definite effect.
目的探讨成人Ⅰ型胆总管囊肿的诊断和治疗。方法回顾性分析1997年1月至2004年7月期间收治的8例成人Ⅰ型胆总管囊肿的临床资料。结果5例行胆总管囊肿全切除、RouxenY肝管空肠吻合术； 2例行囊肿部分切除、RouxenY囊肿空肠吻合术； 1例行囊肿部分切除、 RouxenY肝管空肠吻合术，术中常规行胆道镜检查，无一例手术死亡。8例患者术后平均随访2．8年(1~7年)，未发现胆道恶性肿瘤。1例行囊肿部分切除的患者，在术后出现3次右上腹绞痛，1次急性胆管炎表现，均经支持、对症、抗感染等治疗后好转。 结论 成人Ⅰ型胆总管囊肿的诊断主要依靠B超、逆行胰胆管造影(ERCP)或磁共振胆胰管造影（MRCP）检查，囊肿全切除、RouxenY肝管空肠吻合是安全、有效的手术方式，其疗效比较满意； 囊肿部分切除、RouxenY囊肿空肠吻合术虽疗效不及完整囊肿切除令人满意，但对于在技术上难以作到囊肿完全切除者，部分囊肿切除是明智的选择，建议术中常规胆道镜检查。
OBJECTIVE To introduce a new method of bone defect repairing after bone cyst curettage. METHODS Eight cases with bone cyst were treated with this new method. The pieces of autogenous periosteum were implanted into the hematoma within the enveloped bone defect created after the bone cyst curettage. Among these patients, there were 5 males and 3 females, aged from 14 to 36 years old. All the lesions located in the upper of femur except one being located in humerus. The results were evaluated through the postoperative radiological findings with the preoperative ones and analysis of clinical functions. RESULTS All the patients were followed up for 2 to 11 years. X-ray films showed that osteogenesis developed well and that the enveloped bone defects had been repaired. No recurrence was found and the function of the affected limbs were maintained. CONCLUSION Autogenous periosteum grafting is effective in the treatment of solitary bone cyst.