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目的 比较内镜下治疗与传统治疗急性胆源性胰腺炎(ABP)的效果和安全性.方法 68例随机分为内镜组和传统组各34例(重症患者分别有9、8例),所有患者入院后即给予内科综合治疗,内镜组患者入院24 h内行十二指肠乳头括约肌切开术,传统组患者待病情稳定后择期手术.结果 内镜组:34例ABP的血常规、淀粉酶和血生化于1、2周内基本恢复;25例轻症者经内镜治疗后2～5d体温恢复正常;9例重症者3～8d腹部体征好转.传统组:34例中有6例行急症手术.内镜组的重症患者并发症发生率为11.1%(1/9);而传统组为50%(4/8),其数值是高于内镜组,但差异无统计学意义(P＞0.05).内镜组住院时间为(16.5±4.0)d,低于传统组的(54.0±37.0)d,差异有统计学意义(P＜0.05).结论 内镜下行微创治疗ABP的住院时间短且安全性好. 相似文献
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Two broodmares were diagnosed with rupture of the urinary bladder. One mare revealed abnormalities post partum and the other associated with ante partum uterine torsion. The clinical symptoms included mild abdominal pain, anorexia, decreased urinary volume and increased peritoneal fluid. In one mare, based on the creatinine level of the peritoneal fluid and serum biochemical abnormalities, uroperitoneum was diagnosed. In the other mare, the bladder rupture was found during the celiotomy for surgical repair of uterine torsion that was diagnosed upon rectal examination. Surgery was performed without a urethral sphincterotomy. The vaginal floor was incised in a standing position and the bladder was diverted into the vagina in order to suture the tears located in the ventrocaudal aspect of the bladder. Both mares survived after treatment for uraemia. Bladder rupture, although uncommon, may affect peripartum mares. Approach to the ruptured bladder without urethral sphincterotomy in a standing position should be considered as a choice for surgical repair. 相似文献
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An 11-year-old mare presented 36 hours after foaling with a ruptured bladder. Uroperitoneum was diagnosed on ultrasound and from the creatinine concentration of the peritoneal fluid. Bladder endoscopy demonstrated tissue necrosis and a rent in the dorsocranial aspect of the bladder. Following stabilisation, including abdominal drainage and lavage, the mare was taken to standing surgery. Under continuous sedation and epidural anaesthesia, and after surgical preparation, a Balfour retractor was placed in the vagina. Using sterile lubricant and moderate force, it was possible to insert a hand into the bladder. The tear was easily palpable on the dorsal portion of the bladder. Two fingers were inserted through the tear and used to provide traction to evert the bladder completely into the vagina where it could grasped with the surgeons other hand to prevent further trauma. A second surgeon could then visualise the entire tear and repaired this using a single layer of size zero PDS suture in a single continuous pattern. As soon as the bladder was repaired, it was replaced via the urethra. The mare did well after surgery and was discharged after 48 hours, apparently normal.This report is the first describing repair of the bladder without an abdominal incision or incision into the urethral sphincter. This greatly reduces the chance of possible complications such as urine pooling after surgery with the previously described standing technique or bladder trauma due to traction with abdominal surgery. 相似文献
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