Objective To evaluate application value of choledochoscope and nasal bile duct drainage in the treatment of complicated liver echinococcosis combined biliary fistula.Methods The anthors retrospectively summarized and analyzed the clinical data of 144 patients with complicated liver echinococcosis combined biliary fistula.Treatment group (n 68) underwent liver hydatid internal capsule remove + intraoperative choledochoscopy and nose biliary drainage,control group (n-76) underwent the traditional internal capsule remove.The average length of hospital stay,residual cavity drainage catheter time,residual cavity bile leakage and residual cavity infection index of two groups were measured.Results The rate of T tube utilization,residual cavity infection,the incidence of biliary fistula in treatment group were significantly lower than the control group (P＜0.05).The length of hospital stay,the rate of discharge with drainage tube and the average length with tube were significantly less than control group (P＜0.05).Conclusion Intraoperative choledochoscopy and nasal bile duct drainage treatment of complicated liver hydatid,can reduce liver hydatid content residual and biliary fistula,reliable to deal with biliary fistula,part of a primary suture common bile duct,biliary fistula and residual cavity infection rate is low,patients recover quickly,shorter time of hospital stays,is worth popularizing.

Purpose To explore the value of 64-slice spiral CT digital subtraction angiography in diagnosis of cerebral arteriovenous malformations (AVM).Materials and Methods 26 patients with AVM were performed with plain CT scan, enhanced arterial phase and venous phase CT scan on a 64-slice spiral CT scanner. The subtracted arterial phase data was obtained through subtracting the plain CT images from arterial phase images, then the subtracted venous phase data was obtained through subtracting arterial phase images from venous phase images, and subtracted mixed arterial-venous phase data through subtracting plain CT images from venous phase images. Then volume rendering (VR) and maximum intensity projection (MIP) were used to reconstruct the cerebral vessel images. Results The inference of cranial bones was completely removed in all subtracted cerebral vessel images, thus clearly demonstrating malformed vascular nest, feeding arteries and draining veins. And 7 malformed temporal vascular nests, 5 parietal vascular nests, 5 frontal vascular nests, 6 occipital vascular nests and 3 cerebellar vascular nests were revealed;39 feeding arteries were detected altogether. Single feeding artery was found in 15 cases, and multiple feeding arteries in 9 cases. Meanwhile 33 draining veins were observed, and single draining vein was found in 10 cases, multiple veins in 16 cases.Conclusion 64-slice subtraction angiography can remove the inference of cranial bones and clearly demonstrate the feeding arteries, malformed vascular nests, draining veins, potentially providing a reliable evidence for therapeutic planning and postoperative follow-up.

Objective:To evaluate component separation technique (CST)for the managetment of abdominal wall defect after resection of abdominal wall tumor.Methods:Clinical data of 12 patients treated by CST form Jan 2016 to Jan 2019 at our two Hospitals were retrospectively analyzed. The abdominal wall defect after tumor radical resection were reconstructed with synthetic mesh.Results:The most common pathological type was dermatofibrosarcoma protuberans (4 cases), followed by desmoid fibroma (2 cases) and abdominal metastasis of colon cancer (2 cases). The maximum diameter of tumor was (5.3±1.5) cm by CT preoperatively.The largest transverse diameter of abdominal wall defect after tumor resection was (9.4±1.4) cm.7 patients were treated with CST. 10 patients used synthetic mesh. Incision-related complications occurred in 3 patients, abdominal hypertension and atelectasis in 1 case and acute myocardial infarction in 1 case. All patients were helped and discharged.One patient died of liver metastasis of colon cancer 17 months after operation, and the other 11 patients had no recurrence of tumor or incisional hernia.Conclusion:Using CST in patients with abdominal wall tumor can effectively close the defect, reconstruct the function of abdominal wall and prevent the occurrence of incisional hernia.