肝内胆管结石术后病人的观察及护理

目的总结肝内胆管结石围手术期的护理要点、总结护理经验。方法回顾性分析我院自2005年1月-2010年12月手术治疗肝内外胆管结石150例的临床、护理资料,对其术前全身及营养情况做详细评估,术后密切观察生命体征及病情变化,保证有效循环血量,防治低血压;保持各引流管通畅,加强基础护理及术后并发症的观察及护理。结果该150例复杂肝内胆管结石患者均做了肝叶切除术,无1例手术死亡,其中,伤口感染20例,膈下感染10例,胆漏55例,肺部感染15例,均经非手术治愈。150例共81例获得随访,随访率53.0%,疗效优良率为77.8%,残石率为21.0%,结石复发率为8.7%。结论做好围手术期的护理,尤其是增强术后的护理观察,提高术后护理质量,巩固手术疗效和促进病人康复至关重要。     

EST联合LC治疗胆囊结石合并继发性胆管结石

目的：探讨内镜下0ddi括约肌切开取石术（endoscopic sphincterotomy,EST）联合腹腔镜胆囊切除术（1apanroscopic cholecystectomy,LC）治疗胆囊结石合并继发性胆管结石的疗效。方法：对21例胆囊结石合并继发性胆管结石患者先行EST术,再行LC术。结果：21例均完成EST和LC术,其中1例患者LC术后经胆道造影见胆总管结石残留,再次行EST术。结论：EST联合LC治疗胆囊结石合并继发性胆管结石是一种安全有效的微创治疗模式。     

纤维胆道镜190例的应用体会

目的：探讨纤维胆道镜的临床应用和具体方法．方法：对2000～2004年应用纤维胆道镜190例进行回顾性分析．结果：术中胆总管结石20例，一次性取净率100％；9例肝内外胆管结石，取净率56％；3例胆管肿瘤获得了诊断．术后胆管残留结石156例，经“T”管瘘道取石，一次性取净率64％；多次取石55例；2例胆管下段肿瘤活检获得诊断．结论：纤维胆道镜具有安全、准确、手术成功率高等优点，能解决外科手术后不能解决的残石问题．     

肝门部胆管癌诊断治疗分析

目的 探索肝门部胆管癌的诊断治疗经验。方法 回顾总结了1990年9月至2000年2月，泰州人民医院普外科收治肝门部胆管癌8例手术资料，并复习有关献，就肝门部胆管癌的病因病理学、临床分型、诊断、手术方法、预后进行分析。结果 肝门部胆管癌多为高分化腺癌，生长缓慢，如能行根治性切除远期疗效好。远期疗效明显下降的原因：已伴局部或远处的浸润转移灶，无法做到“根治性切除”；癌细胞可在粘膜下扩展，以致胆管断端残留癌细胞；主观上手术医生因操作技巧问题不邮轻易扩大切除范围而导致手术不彻底的可能。结论 早期诊断、努力提高根治性切除率对提高远期的疗效尤为重要。     

平阳霉素与鱼肝油酸钠治疗肝血管瘤临床观察

目的：探讨平阳霉素碘油乳剂（PLE）与鱼肝油酸钠治疗肝血管瘤的疗效、安全性、患者的耐受程度。方法：每组随机选择各10例肝血管瘤患者，分别用PLE及鱼肝油酸钠栓塞，观察每组患者栓塞后的临床反应及表现，比较其栓塞效果。结果：1．用PLE栓塞组，患者术后一般发热3～7d，最高达38．1℃，术中有肝区憋胀，轻度疼痛，术后肝区疼痛较轻，均未使用止痛针剂。随访5个月，肿瘤平均缩小70％以上。2．用鱼肝油酸钠栓塞组．患者术后一般发热2～3d，最高者达38℃，术中即有肝区憋胀、巨痛，术后肝区疼痛剧烈，每个患者平均使用度冷丁200～300mg。随访5个月，肿瘤缩小72％以上。结论：笔者认为平阳霉素与鱼肝油酸钠对血管的硬化和肝血管瘤的治疗，疗效相当。但平阳霉素栓塞术后，临床反应较轻，痛苦小，患者更容易接受。     

肝门区胆管癌的多层螺旋CT术前评估价值

目的探讨肝门区胆管癌的多层螺旋CT（multislice spiral CT,MSCT）表现及术前评估价值。方法对31例肝门区胆管癌MSCT平扫及增强表现进行分析研究,术前评估肿瘤手术切除的可能性．并与手术病理对照。结果31例肝门区胆管癌均显示肝内胆管不同程度扩张,胆管狭窄、中断．其中可见肝门区肿块24例。MSCT增强扫描以延迟强化为主。术前可切除性评估与手术病理对照．其差异性无统计学意义（P〉0．05）。结论MSCT平扫结合三期增强对显示肝门区胆管癌的直接和间接征象有较大帮助．大大提高了术前评估的准确性。     

山东省交通医院内镜治疗巨大胆管结石的临床应用研究 肝内外胆管结石不用手术从口中取出来（获省科学技术进步二等奖）

诊疗方法：对胆管结石患者，不用开刀，用内窥镜将结石从口中取出，这项高难技术在山东省交通医院内外镜外科治疗中心得到成功应用。     

胆囊手术医源性胆管损伤的防治体会

为减少胆囊切除手术的并发症,作者总结了本院十年来单纯胆囊切除术致21例胆管损伤的情况(其中12例由外院转入)。通过对损伤发现的时间、损伤部位和类型以及不同类型损伤的不同治疗方式及预后的分析,认为胆囊切除术的关键在于术者对局部解剖的辨认和对肝门处胆管解剖变异的识别能力。     

医源性肝外胆管损伤6例临床防治体会

术中肝外胆管损伤是胆道手术中严重并发症 ,是胆道外科中的一个复杂而困难的问题 ,1997.1～ 2 0 0 2 .12月张家口医学院一附院及我站共收治胆囊手术 5 76例 ,经系统回顾总结 ,其中肝外胆管损伤 6例 ,均在术中发现并进行修补 ,愈后良好 ,现报道如下。1　临床资料1.1　一般情况　本组 6例中女性 5例 ,男性 1例 ;年龄 38～ 6 6岁 ,平均年龄 5 2岁。1.2　肝外胆管损伤部位　 6例均发生在胆囊切除术中 ,5例为 3年资主治医师行胆囊切除术 ,1例为 5年资主治医师行萎缩性胆囊切除术中发生。损伤部位 ,胆总管损伤 4例 ,肝总管损伤 1例 ,左右肝管汇和…     

肝门部胆管癌11例改良脉络化切除的临床研究

目的:探讨对高位胆管癌的治疗方法。方法:对11例高位胆管癌的治疗方法及效果进行诊治分析。结果:术后有2例合并肺部感染,1例出现胆道逆行感染,均经治疗缓解。11例患者全部获得随访,随访时间4年3例、3年3例、2年1例、1年1例、半年1例。随访时间为4年的3例中有1例手术后2年死亡,其余均健在。结论:改良式脉络化切除肝门部胆管癌是一种根治彻底的有效的手术方式。     

卡思卡特城堡

It is worthy of noting that, whilst Crookston Castle witnessed the earlier and happier portion of Mary's variegated life,     

不同的吃喝玩乐

一、吃和喝吃苹果 eat an apple, 吃药 take medicine,吃糖 have some sweets,吃饭 have one's meals,吃馆子 dine out,吃惊 be surprised/     

漏洞百出的教育

Many college freshmen arrive woefully unprepared to do college work, and as disadvantaged populations continue to grow, the share of the American work force that has made it through college is expected to plummet. Many experts blame that educational failure not just on high schools but also on colleges. School & College, a special report by The Chronicle, looks at efforts to fix the system. What reforms would better prepare students for college? What should schools and colleges be doing differently? How should state and federal officials help?     

Western and Eastern culture differences in commercial field

The communication of people partially is the communication of cultures. Culture has a direct effect on international commercial activities in all aspects. Different conceptions about time, space, equality, law and the like, lead people to deal with things in different ways. So to know cultures of the counterpart is to facil-itate our enterprises so as to have a smooth and successful communication in commercial activity.     

只要努力,不要后悔

There are numbers of crossroads on our long and unpredictable life journey where we totally have no idea about which direction to choose. No matter what our decision is, we should not turn back, but face the music and go ahead instead. I am this kind of girl who always does try without regretting, one example is how I dealt with my love.     

浅谈移民问题

Migration occurs behind a variety of reasons and has a great effect on the whole world. People may migrate in order to improve their economic situation, or in order to escape civil strife, persecution, and environmental disasters. The impact of migration is complex, bringing both benefits anddisadvantages. This paper briefly talks about the causes of migration, the allocation of benefits, and the ways in which individual countries and the international community deal with this important subject.     

风的曲线

Rosco and I wait for the fishermen to return.I sit at a wooden bench near the store at Mt.Baker Resort and watch the clouds change shape. Rosco has my belt around his neck and an eight foot tow chain hooked to a tree. Dogs must be on a leash. Ducks and rabbits are loose.     

团图为数的图中的闭团贯数

Given a graph G,a subgraph C is called a clique of G if C is a complete subgraph of G maximal under inclusion and |C|≥2. A clique-transversal set S of G is a set of vertices of G such that S meets all cliques of G. The clique-transversal number, denoted as TC (G), is the minimum cardinality of a clique-transversal set in G. The clique-graph of G, denoted as K (G), is the graph obtained by taking the cliques of G as vertices, and two vertices are adjacent if and only if the corresponding cliques in G have nonempty intersection. Let F be a class of graphs G such that F={G|K(G) is a tree}. In this paper the graphs in F having independent clique-transversal sets are shown and thus TC (G)/|G|≤1/2 for all G ∈ F.     

Sister Carrie, an Adherent of Desires

Sister Carrie is one of the most controversial characters in American literature.Thought as a "fallen woman" firstly,she was defined as a "new woman" by some critics later. However, by digging into the motivaton behind the whole process of Carrie's "success", the relationship between Carrie and her creator (the author), the social conditions of then American, it can be found that Carrie has never been free-standing on her thought and she has never found her real-sdf even after becoming a famous actress. In a society dominated by mass consumerism Carrie is only an adherent of her own desires. She also is a representative of all those country girls flooded into cities, a symbol and a sacrifice of the urbanization of America in a time countryside was overcome by cities.