结肠慢传输型便秘的诊断和外科手术治疗体会

目的：探讨结肠慢传输型便秘的诊断与手术治疗。方法：回顾性分析我院2001至2007年治疗的结肠慢传输型便秘25例患者的治疗资料。其中行保留回盲部的结肠次全切除术8例,行切除回盲部的回肠乙状结肠下端吻合术9例,行全结肠切除术5例,行结肠部分切除术的3例。结果：病理检查结果示结肠肌间神经节细胞减少变性或缺如。盲肠结肠吻合术后患者大便次数2～4次／日,回肠乙状结肠下端吻合术后患者大便次数3～5次／日,全结肠切除术后为5～8次／日,结肠部分切除术后为1—2次／1～2天。结论：结肠次全切除术是治疗结肠慢传输型便秘的有效方法,保留回盲部的结肠次全切除术与切除回盲部回肠乙状结肠下端吻合术疗效无明显差异。     

成人巨结肠的治疗进展

<正>成人巨结肠虽然临床少见，但可严重威胁患者的身心健康和生命安全，其最常见的临床表现是腹胀和便秘。成人巨结肠按照病因可分为成人先天性巨结肠、神经节细胞缺乏症、特发性巨结肠、中毒性巨结肠、医源性巨结肠以及急性假性结肠梗阻综合征等类型。由于早期临床症状不典型以及人们对该病认识的不足，部分患者在确诊时已错失最佳治疗时机。手术是成人巨结肠最有效的治疗措施，本文结合国内外文献对成人巨结肠的外科诊疗现状进行总结，以期为本病的临床诊疗提供参考。1成人先天性巨结肠     

结肠直肠癌伴梗阻Ⅰ期手术治疗的个体化选择

目的对结肠直肠癌伴梗阻患选择最适宜的个体化Ⅰ期手术治疗方案。方法对右半结肠癌伴梗阻采用急诊Ⅰ期根治性切除手术，营养状态较差的患，应用带血管蒂回肠浆肌瓣和纤维蛋白胶保护吻合口：对左半结肠癌伴梗阻选择性应用术中结肠灌洗、结肠浆肌瓣贴敷、放置结肠支架和纤维蛋白胶完成Ⅰ期切除吻合术，不宜Ⅰ期切除，仍坚持分期手术，以策安全；对直肠癌伴梗阻选择性应用直肠支架、圆形吻合器及双吻合器技术和纤维蛋白胶实现Ⅰ期根治性切除。结果6l例中仅1例早期应用双吻合器施行低位前切除手术的直肠癌患，术后发生与技术有关的直肠阴道瘘，后经修补治愈。其他患恢复良好，无吻合口漏及狭窄发生。结论对结肠直肠癌伴梗阻患，选择性应用Ⅰ期手术治疗的6项措施，是提高手术疗效的有效保障。微创疗法和分期手术仍然是保证手术安全性的重要措施。     

小儿先天性巨结肠经肛门手术的护理配合

<正>先天性巨结肠(无神经节细胞症)是小儿先天性胃肠道畸形的多发病[1],是以便秘为特点的病变肠段神经节细胞缺失。先天性巨结肠一旦确诊,应在保证安全的情况下择期手术。先天性巨结肠根治术国内外常用的手术方式、方法很多,自1998年墨西哥De la Torre-Mondragon等[2]报道经肛门Soave直肠拖出术治疗先天性巨结肠获得成功后被广泛应用于临床。我院自2007年5月～2012年8月共行小儿先天性巨结肠经肛门手术19例,取得良好的效果,现将手术护理配合总结报告如下:     

先天性巨结肠根治术后并发症的防治

先天性巨结肠(Hirschsprung's Disease)是以病变肠管神经节细胞缺如为特征的小儿外科常见消化道畸形之一.尽管手术治疗先天性巨结肠的历史已半个多世纪,各种术式也趋成熟,但无论哪一种术式都存在一定的并发症,如何防止和减少并发症的发生仍然是研究和解决先天性巨结肠根治术的重大课题.自1999～2005年,我院手术治疗先天性巨结肠82例,报告如下.     

结肠慢传输型便秘的外科治疗体会(附44例分析)

目的：探讨结肠慢传输型便秘的外科治疗方法。方法：对确诊为结肠慢传输型便秘患者44例进行手术治疗，其中行保留回盲部的结肠次全切除术15例，行切除回盲部的回肠乙状结肠下端吻合术25例，全结肠切除术2例，结肠部分切除术2例。结果：切除标本送病理检查均证实结肠肠间神经节细胞减少变性或缺如。盲肠直肠吻合术后3月患者大便次数多数1～4次／日，平均2．3±1．1次／日，回肠乙状结肠下端吻合术后3月患者大便次数多数1~5次／日，平均2．5±1．2次／日，全结肠切除术后为3~8次／日，结肠部分切除术后为1～2次／1~2日。结论：结肠次全切除术是治疗结肠慢传输型便秘的有效方法，保留回盲瓣的结肠次全切除术与切除回盲部回肠乙状结肠下端吻合术疗效无显著差异。     

新生儿细小结肠症的病因分析及X线诊断(附8例报告)

目的:探讨新生儿细小结肠症的常见病因及X线诊断要点。方法:回顾总结8例经手术及病理证实为先天性细小结肠症患儿的临床资料,分析其病因及影像特征。结果:本组病例临床均表现为腹胀合并呕吐,均可见肠梗阻征象,其中高位梗阻2例、低位梗阻6例。全部病例结肠造影均表现细小,结肠直径<1cm。手术证实小肠闭锁6例,胎粪性肠梗阻1例,全结肠无神经节细胞症1例。结论:先天性细小结肠症可以原发于结肠,也可以继发于其他疾病,X线检查是诊断该病的首选方法之一。     

舒适护理在先天性巨结肠灌肠中的应用

<正>先天性巨结肠是新生儿期消化道畸形,由于先天性神经节细胞缺少而致肠段狭窄,继发巨结肠,又称肠管无神经节细胞症,由于肠管持续痉挛,造成狭窄从而失去正常的蠕动功能,使肠黏膜增厚、水肿、肠壁扩张,造成巨结肠段,因反复便秘、腹胀、呕吐从而影响患儿正常生长。临床上采用手术治疗,术前回流灌肠,可取得良好效果并可缓解症状及维持排     

多发性节段型肠无神经节细胞症的临床分析

目的 探讨多发性节段型肠无神经节细胞症的病因、诊断和治疗。方法 回顾性分析1987至2005年间我院收治的3例患儿,年龄5d、29d、18个月,均为男性。病理检查HE染色。行全结肠切除回肠脱出巨结肠根治术。结果 3例患儿均于术前诊断先天性巨结肠,术中探查回肠末段和升结肠起始段狭窄,病理切片证实狭窄段肠壁内无神经节细胞。结论 长段型先天性巨结肠患儿应探查全结肠及回肠,以免漏诊;先天性巨结肠的发病原因不仅是胚胎早期由神经嵴的神经母细胞向肠管移行过程中胚胎发育停顿引起,也可能是神经节细胞发育成熟过程中不同节段的神经节细胞发育障碍引起。     

结肠直肠Z表吻合术治疗先天性巨结肠132例

１９７３年以来，应用自制的器械行改良的结肠直肠Ｚ形吻合术治疗小儿先天性巨结肠１３２例，取得满意效果。这一改良Ｄｕｈａｍｅｌ要试完全去除了直肠与结肠间隔，彻底消除了闸门及盲袋，手术操作简便，术后不管扩肛。１３２例无手术死亡，最长随诊２２年，全部患者排便正常，无上失禁及及污粪。肛门外形正常。体会：（１）严格掌握切除肠管范围，防止无神经节细胞或变性神经节细胞存留是防止术后复发的关键；（２）充分游离拖出肠     

Diabetes mellitus. I: Routine plain abdominal radiography.

The plain abdominal radiographs of 43 consecutive diabetic patients were studied. Disordered bowel motility which was unrelated to the severity of the diabetes mellitus occurred in 76.7% while artheriosclerosis occurred in 65%. Only 7% (3 patients) had pancreatic calcification; of these, one was a complication of urinary schistosomiasis (Schistosoma haematobium). All the patients with pancreatic calcification were above 45 years of age and had had diabetes mellitus for more than 7 years. This study shows that pancreatic calcification is uncommon among Nigerian diabetics, so plain abdominal radiography should be limited to patients who are above 45 years and who have had the illness for more than 7 years.     

Pancreatic polypeptide and exocrine pancreatic function in the elderly.

The relationship between exocrine pancreatic function and plasma pancreatic polypeptide levels was studied in 14 normal elderly subjects and in ten elderly patients with exocrine pancreatic insufficiency determined by the para-amino-benzoic acid test. There was a decrease in the total pancreatic polypeptide response after a standard mixed meal in the group with pancreatic insufficiency (t = 2.753, p = 0.01). An increase above basal of less than 100% in plasma pancreatic polypeptide levels 30 min after a standard mixed meal is strongly associated with exocrine pancreatic insufficiency (Fisher's exact test, p = 0.005).     

胰腺损伤的诊断和治疗（附16例报告）

目的：探讨胰腺损伤的诊断与治疗方法。方法回顾性分析安徽医科大学第二附属医院急诊科收治的16例胰腺损伤的临床资料。结果2例行保守治疗,4例行胰周清创外引流术,2例行胰头颈部破裂缝合修补和胰周多管引流术,5例行远端胰腺切除和脾切除术,2例行近端胰腺裂口缝合,远端胰腺空肠Roux-en-Y吻合,1例行急诊Whipple术。12例治愈,其中2例术后引流液的淀粉酶升高,考虑胰漏,经引流等保守治疗痊愈,胰腺假性囊肿形成1例,术后2月行内引流术治愈,1例因多器官功能衰竭死亡。结论胰腺损伤早期诊断困难,应结合临床及动态复查B超、CT检查,积极采取早期手术治疗,根据胰腺损伤类型选择适当术式,提高治愈率减少并发症。     

Endoscopy with endoscopic cholangiopancreatography. The combination as a primary diagnostic procedure.

The combination of upper gastrointestinal endoscopy and endoscopic retrograde cholangiopancreatography was evaluated as a primary diagnostic procedure in 91 consecutive patients suspected of pancreatic or biliary tract disease. In 77 (85%) of the patients, the origin, nature, or extent of disease was established by endoscopy (13 patients), pancreatography (25 patients), or cholangiography (39 patients). This combined technique compares favorably with other means of diagnosing pancreatic or biliary tract disease.     

Chronic pancreatitis: diagnosis and treatment.

Three-dimensional magnetic resonance cholangiopancreatography is currently the most exciting new imaging technique for chronic pancreatitis. Endoscopy-assisted duodenal intubation during the secretin-cholecystokinin test reduces intubation time in difficult cases. The NBT-para-amino benzoic acid test has been refined to enhance its discriminant power. The cholesteryl-[C13]octanoate breath test and the faecal elastase test are newer highly sensitive and specific tubeless tests. Pain in chronic pancreatitis continues to be a vexing therapeutic issue. Enzyme treatment continues despite criticism. Neurotensin is the new suspected mediator of the feedback mechanism, which is downregulated by enzyme therapy. Steroid ganglion block is an exciting therapeutic tool for pain relief. Endoscopic pancreatic sphincterotomy, Dormia basketing and pancreatic stenting in conjunction with extracorporeal shock wave lithotripsy should be performed early in chronic pancreatitis to prevent parenchymal atrophy with ensuing exocrine and endocrine pancreatic dysfunction. The modified Puestow''s procedure preserves endocrine and exocrine pancreatic functions besides relieving pain. Closed loop insulin infusion allows superior management of pancreatic diabetes following near total pancreatectomy. The standardised incidence rate of pancreatic cancer is 16.5 in patients with alcoholic chronic pancreatitis and 100 for tropical chronic pancreatitis. Aggressive treatment protocols combining neo-adjuvant chemoradiation and intra-operative radiation with surgery are being used to improve the prognosis in this dismal complication of chronic pancreatitis.     

高强度聚焦超声治疗晚期胰腺癌25例

目的观察高强度聚焦超声治疗晚期胰腺癌的近期疗效及安全性。方法应用高强度聚焦超声肿瘤治疗机治疗晚期胰腺癌25例。结果临床受益率76.00%（19/25）,无效率24.00%（6/25）。癌性疼痛缓解率80%（16/20）。所有病例均未出现胰液外漏、腹腔内出血、胃肠道损伤等相关并发症。结论高强度聚焦超声治疗晚期胰腺癌能取得一定的疗效,治疗安全性高。     

Computerized tomography, diagnostic ultrasound, and radionuclide scanning. Comparison of efficacy in diagnosis of pancreatic carcinoma

Forty-six patients, including 33 with proved pancreatic carcinoma, were studied with computerized tomography (CT), ultrasound (US), and radionuclide (RN) scanning. The results of each scanning procedure were compared with the surgical and clinical findings. The detection rate was 82% for CT, and 92% with US. A mass is the most important finding in the diagnosis of pancreatic carcinoma. Measurements of the pancreas with CT and US were similar, with visualization of all parts of the pancreas routinely better with CT scans. Radionuclide scans were abnormal in 96% of the patients with pancreatic carcinoma as well as in 75% of patients without pancreatic disease. A rational approach to examination of a patient with suspected pancreatic carcinoma should begin with US scan with available, because the detection rate with this method is equal to that with CT and its cost per procedure and for equipment is substantially less.     

Chronic pancreatitis and pancreatic carcinoma.

The differential diagnosis between pancreatic cancer and chronic pancreatitis is very important as the management and prognosis of these two diseases is different. In most patients with pancreatic disease, the diagnosis can be established but there is a subgroup of patients in whom it is difficult to differentiate between these conditions because the clinical presentation is often similar and currently available diagnostic tests may be unable to distinguish between an inflammatory or neoplastic pancreatic mass. This paper reviews the aetiology, pathology and clinical features of these diseases and discusses the limitations of conventional diagnostic methods and how newer techniques may be of value in the differential diagnosis.     

胰腺癌患者体内维生素E水平的改变

目的 探讨维生素E（VieE）在胰腺癌患者体内改变及其作用机制。方法 对不同胰腺病患者血清中VitE的浓度进行了比较分析。结果 在胰腺病患者中，急性胰腺炎、慢性胰腺炎、胰腺癌患者血清中VitE的含量均显著低于正常对照组（P＜0．05），胰腺癌组血清VitE显著低于急性胰腺炎、慢性胰腺炎组（P＜0．001）。结论 胰腺癌患者本内VitE量显著减少，提示胰腺癌变可能与体内氧化／抗氧化系统失衡有关。     

闭合性胰腺损伤诊治探讨——附12例

目的探讨闭合性胰腺损伤的诊治方法。方法回顾性分析1983-2005年发生的12例闭合性胰腺损伤的病例。结果3例保守，9例手术，治愈10例，死亡2例。结论早期诊断时，CT对胰实质损伤诊断价值最大，ERCP在理论上最理想，最准确的是早期探查。手术方式要根据胰腺损伤的部位，严重程度灵活选择。