81例结肠脾曲综合征的诊断与外科治疗

目的：总结结肠脾曲综合征（SSFC）的诊断与外科手术治疗。方法：对1989年1月—2008年12月收治的81例SSFC患者的临床资料进行回顾性分析。结果：本组患者以反复发作性腹痛、腹胀及便秘并顽固性不全结肠梗阻为主要临床表现。X线钡剂灌肠造影显示,结肠脾曲均较肝曲高7cm以上,迂曲成角〈45°,并横结肠冗长。行结肠脾曲松解术2例和结肠脾曲侧侧吻合术3例,近期效果尚好,远期（6个月～2年）效果不良;76例采用较彻底手术,包括近段结肠大部切除14例、结肠次全切除术20例、全结肠切除术42例,术后均痊愈。结论：根据临床特点和钡剂灌肠造影,可以明确诊断SSFC,应积极手术治疗,以近段、次全、全结肠彻底切除效果最佳。     

胰腺实性假乳头状瘤的临床诊治(附25例报告)

目的 探讨胰腺实性假乳头状瘤(solid pseudopapillary tumor of the pancreas,SPTP)的诊断和治疗.方法 回顾性分析2000年1月至2010年12月收治的经手术切除病理确诊的25例SPTP病人的临床资料.结果 本组术前诊断SFTP 2例.行胰腺体尾部切除11例,其中6例联合脾切...     

老年人结肠脾曲综合征的诊断及手术选择

<正>结肠脾曲综合征(SSFC)是由于结肠脾曲固定点先天异常而引起的大便排空障碍或不完全性结肠梗阻,是一种少见的顽固性结肠假性梗阻,临床病例不多,常受到忽视,从而导致长期的误诊[1]。目前发现老年人中该病的发病率呈增高趋势。本院自1999年7月至2006年12月共收治结肠脾曲综合征老年患者17例,现对其进行回顾性分析,探讨诊疗效果,以利于临床开展有效的诊疗工作。     

心脏瓣膜术后心室辅助治疗

目的 总结瓣膜病变术后重症心衰病人置入心室辅助(VADs)装置时,心脏瓣膜或人工瓣膜处理方法及围术期抗凝管理的经验.方法 回顾1994年1月到2008年6月,宾夕法尼亚大学附属医院心脏中心157例置入VADs病人中,10例为瓣膜术后重症心衰者.对于二尖瓣和三尖瓣病变,无论成形或置换,置入VADs时均未处理原瓣膜或人工瓣膜(环).5例主动脉瓣病变病例置入VADs时,2例用生物瓣膜取代了原机械瓣膜,1例未处理原来生物瓣膜,1例未处理原机械瓣膜,1例取出机械瓣膜,用牛心包封闭主动脉根部.结果 所有病人置入VADs术后应用抗凝治疗.10例病人中,停VAD出院和VAD姑息治疗各1例;转心脏移植4例;4例死亡,3例为多器官衰竭,1例为血栓栓塞事件.结论 瓣膜病变术后置入VADs总的生存率是60%,与非瓣膜病心衰病人置入VADs相比,未增加手术风险.

Abstract：

Objective An increasing number of patients requiring ventricular assist devices (VAD) have had previous valvular corrections,including valve repair,and valve replacement with mechanical or bioprosthetic valves.The operative and peri-operative management of these patients has been varied.Methods A retrospective study of VADs between Jan 1994 and June 2008 revealed 10 patients with previous prosthetic valves requiring management during and after VAD placement.Three patients were supported post-cardiotomy after valve surgery.Two patients were supported due to cardiogenic shock postopera-tively.Four patients were supported as a bridge to transplantation.One patient was supported as a destination therapy.Results The mitral valve was left untreated during VAD implantation regardless of valve repair or replacement.For aortic valves,the mechanical aortic valve was replaced with tissue valve in two patients and left untreated in one case.One patient had tricuspid valve repair previously and was left untouched.All patients with prosthetic valves in aortic,mitral and tricuspid position during VAD support received anticoagulation therapy.There were 4 deaths,and 4 went on to transplantation.One patient weaned from VAD and discharge from hospital.One patient received HeartMate Ⅰ as destination therapy.The most common causes of death were multisystem organ failure and sepsis.One patient had a thromboembolic event.Conclusion The survival rate of 60% is encouraging when compared to overall survival rates.The most common cause of death was multisystem organ failure.Patients with prosthetic valves may be safely managed during VAD support.     

胰腺实性假乳头状瘤12例诊治体会

目的 探讨胰腺实性假乳头状瘤(solid pseudopapillary tumor of the pancreas,SPTP)的诊治经验.方法 对2003年6月至2010年1月济南军区总医院收治的12例胰腺实性假乳头状瘤病人的临床资料进行回顾性分析.结果 12例中女性10例,中位年龄29岁;术前确诊6例,确诊率50%...     

胰腺实性假乳头状瘤的临床病理特征及外科治疗

目的 探讨胰腺实性假乳头状瘤(solm pseudopapillary tumor of the pancreas,SFTP)的临床病理特征和外科治疗方法.方法 对2003年11月至2010年6月间24例经术后病理学确诊的SPTP病人的临床资料进行回顾性分析.结果 本组中男性7例,女性17例,女性占70.83%,女性中...     

SinoSCORE预测心血管外科手术病死率——广东心血管病研究所经验

目的 评价中国冠状动脉旁路移植手术风险评分系统(SinoSCORE)在预测广东病人心脏手术后院内死亡的临床应用价值.方法 2004年1月到2008年12月,广东心血管病研究所2462例成人心脏病病人接受冠状动脉旁路移植或者瓣膜手术进入注册登记数据库.比较该组病人与SinoSCORE的来源数据库的术前风险因子的区别.通过计算每例病人的SinoSCORE累计积分,分别评价SinoSCORE对该组的病人院内病死率的区分度和校准度.结果 广东病人的性别、吸烟、糖尿病、高脂血症、高血压、脑卒中、慢性肺病、心血管手术史、房颤/房扑、左主干、合并肺高压、合并冠脉手术及合并瓣膜手术较SinoSCORE来源数据库差异有统计学意义,但SinoSCORE仍可以很好地预测广东病人的院内病死率,模型表现出很好的校准度(Hosmer-Lemeshow拟合优度检验,P=0.34)和区分度(ROC曲线下面积,0.84,P＜0.01).结论 SinoSCORE可以用来预测广东病人心脏外科手术后院内死亡.

Abstract：

Objective To validate of the Chinese system for cardiac operative risk evaluation (SinoSCORE) in Cantonese surgery patients. Methods Data from Guangdong Cardiovascular Institute in the period January 2004 through December 2008 were analyzed on 2462 Cantonese heart surgery patients. First, compared risk factors of this series and database of SinoSCORE, and then calculated the additive score of each patients and evaluate the discrimination and calibration of sinoSCORE in Cantonese patients. Results There were some differences between the risk factors of patients from two groups. The gender,smoking, diabetes, hyperlipemia, hypertension, chronic pulmonary diseases, stroke, cardiovascular surgery history, left main disease, atrial fibrillation/atrial flutter, pulmonary arterial hypertension, concomitant coronary surgery and concomitant valve surgery in Cantonese patients were different between two groups. However, The SinoSCORE was able to predict the in-hospital mortality of senior patients with good discrimination ( Hosmer-Lemeshow test, P = 0. 34 ) and calibration ( the area under the receiver operating characteristic curve, 0.84, P ＜ 0.01 ). Conclusion SinoSCORE was able to predict the in-hospital mortality of Cantonese heart surgery patients.     

鞘内药物输注系统永久植入术治疗顽固性疼痛病人18例

鞘内药物输注系统(IDDS)永久植入术治疗顽固性疼痛病人18例,其中晚期癌痛病人13例,非癌痛病人5例.首先行筛选试验,随后行IDDS永久植入术.癌痛病人采用视觉模拟评分(VAS评分)及QLQ-C30生活质量评分(QLQ-C30)法,非癌痛病人采用VAS评分法,评价疼痛程度,记录副作用及并发症的发生情况,癌痛病人随访至死亡,非癌痛病人均获得随访至今.术后所有病人经短期鞘内给药量调整后,VAS评分降低,癌痛病人QLQ-C30评分升高.部分病人出现恶心呕吐、便秘、尿潴留、皮肤瘙痒、镇静过度等,约1周均明显缓解,无持续残留症状.术中拔除穿刺针时误割断鞘内导管1例;导管与泵的金属接口过度磨擦至导管破裂,出现渗液1例;术后出现低颅压2例,脑脊液渗漏1例,右小腿后外侧持续性神经病理性疼痛1例,无伤口感染、裂开、愈合不良,无导管渗漏、破裂、异位、折叠、被结扎或肉芽肿形成,无泵翻转、位置异常等,设备本身无故障出现.

Abstract：

From November 2003 to May 2010, intrathecal drug delivery system (IDDS) was implanted in 18 patients with chronic intractable pain. Analgesia was provided with morphine. Thirteen patients suffered from late stage cancer and 5 from diseases other than cancer. VAS score was used to measure intensity of pain in all 18patients. QLQ-C30 score was used to evaluate quality of life in cancer patients. The patients were followed up for 3-62 months in 5 non-cancer patients. All 13 cancer patients died at 57 days-10 months after operation. VAS scores were significantly decreased and QLQ-C30 scores increased by intrathecal administration of morphine. Side effects developed in all patients to some extent including nausea, vomiting, constipation, urinary retention, pruritus and over-sedation and vanished in a week. Intrathecal catheter was cut while being pulled out of the needle in 1 patient. Two patients developed low intracranial pressure after operation. Cerebrospinal fluid leakage occurred in 1 patient. One patient developed neuropathic pain in the posterolateral side of right leg.     

VATS在胸膜孤立性纤维瘤诊治中的应用

胸膜孤立性纤维瘤(solitary fibrous tumor of the pleura,SFTP)是一类临床上较少见的间质细胞肿瘤,80%为良性.现总结我们自2000年6月到2008年9月胸腔镜手术切除并经病理证实的21例胸膜孤立性纤维瘤病人的临床资料,报道如下.     

胆管壁坏死的手术处理

目的 探讨胆管壁坏死外科手术处理.方法 回顾性分析了1990年5月至2008年12月收治的94例胆管壁坏死病人的临床资料.结果 无手术病死、无胆瘘、大出血等严重并发症.结论 根据胆管壁坏死的特点采用相应的手术方式.

Abstract：

Objective To explore the surgical treatment of bile duct necrosis.Methods Clinical data of 94 cases of bile duct necrosis treated in this hospital from May1990 to December 2008 were retrospectively analyzed.Results There were no death or severe complications such as biliary fistula and massive hemorrhage in these patients.Conclusion Bile duct necrosis should be treated with a proper surgical approach based on its features.     

结肠脾曲综合征误诊原因及治疗方法探讨

目的　探讨结肠脾曲综合征误诊的原因及治疗方法。方法　对 1993年 5月～ 2 0 0 1年 5月收治的 2 1例结肠脾曲综合征患者的临床资料进行回顾分析。结果　本组病例年龄 5 1～ 88(平均 67.8)岁 ;临床表现为反复腹胀、腹痛 ,便秘等 ;X线钡灌肠造影检查示结肠脾曲过高、迂曲成角 ,甚至扭转 ,常伴横结肠或乙状结肠冗长。经手术松解结肠脾曲、切除冗长结肠 ,处理伴发的其他疾病 ,患者均获痊愈。切除结肠病检示慢性炎症。随访 6个月～ 6年 ,临床症状无复发 ,疗效满意。结论　对结肠脾曲综合征认识不足及未行钡灌肠检查是长期误诊的主要原因。行手术松解结肠脾曲 ,切除伴发的冗长的结肠 ,处理伴发的其他疾病 ,多可获得满意的疗效。     

原因不明的慢性不全性肠梗阻21例手术治疗体会

【摘要】 目的 总结未明原因的慢性不全性肠梗阻患者的手术治疗经验。方法 选取2000年5月至2014年5月间,我院收治的21例原因不明的、未曾接受手术的非器质性病变所致慢性不全性肠梗阻病人的临床资料,所有患者均接受部分结肠切除术或结肠脾曲松解术。患者的临床表现、诊断及手术适应症进行回顾性分析。结果 所有患者均以长期的、有不同程度的腹痛、腹胀、便秘与腹泻反复发作的临床表现就诊,X线钡剂灌肠显示结肠脾曲较高,不同程度成角、狭窄或扭转,左结肠空虚萎缩而右半结肠胀大积粪。手术方法:13例行结肠脾曲松解术、6例行横结肠部分切除术、2例行结肠次全切除术。术后半年内、一年内发生腹痛、腹胀、便秘与腹泻的例数分别为7例和4例。术后2年随访,19例大便通畅、食欲良好、体重增加、腹痛腹胀消失,属恢复良好;2例恢复不良:包括1例行结肠脾曲松解术术后便秘无改善,1例行近段结肠大部切除术后因抑郁症术后腹胀症状无改善。结论 对于长期的、找不到原因的慢性不全性肠梗阻,手术可能是解决问题的重要方法。     

肠系膜下动脉高位结扎后顽固性便秘21例临床分析

目的分析进展期乙状结肠癌或直肠上段癌行根治性切除术后顽固性便秘的致病因素,并总结其治疗经验。方法对江汉大学附属医院胃肠外科2004年1月至2014年12月收治的共21例顽固性便秘病人临床资料进行回顾性分析。结果所有病例既往均为进展期乙状结肠癌或直肠上段癌于外院行根治性手术,原手术均明确记录为肠系膜下动脉高位结扎。术后2~4年(平均3.4年)逐渐出现顽固性便秘,以腹痛、腹胀、大便次数减少及排便困难为主要临床表现。所有病例术前行X线钡剂灌肠造影均显示一共同特征,即结肠脾曲未游离,降结肠未切除,降结肠结肠袋消失,犹如小肠;结肠传输试验均提示为慢传输型,排粪造影均未见出口梗阻。12例再次接受手术,余9例因个人因素放弃手术,仍选择保守治疗(灌肠或口服泻药通便)。所有病人均随访至今,随访时间24~168个月,平均87.8个月,手术组术后效果显著,1年内均恢复正常排便(1~2次/d);而保守治疗组便秘症状无改善。结论乙状结肠癌或直肠上段癌根治术中行肠系膜下动脉高位结扎,而未游离结肠脾曲行包括降结肠、乙状结肠和直肠腹膜返折以上部分肠切除。其后果是部分病人降结肠慢性缺血,结肠形态及生理功能退化,导致顽固性便秘发生(慢传输型便秘)。其有效治疗为再手术行降结肠切除,横结肠-直肠吻合。     

Transverse to Descending Colon Volvulus and Megacolon with Mesenterium Commune: Report of a Case

We report a case of volvulus of the transverse-descending (T-D) colon and megacolon associated with mesenterium commune. A 70-year-old man was referred to our hospital for investigation of severe constipation and abdominal fullness. On physical examination, his abdomen was remarkably distended with generalized tenderness, and weak bowel sounds. Abdominal X-ray showed megacolon at the splenic flexure and a contrast medium enema study showed tapering of the upper rectum. Accordingly, under a diagnosis of T-D colon volvulus, we performed an emergency operation to release the colon volvulus. The intraoperative findings showed a volvulus of the T-D colon with mesenterium commune. The patient recovered uneventfully and his symptoms resolved; however, a postoperative barium enema showed residual megacolon at the splenic flexure.     

气钡双重造影在结肠癌诊断中的应用价值

为探讨气钡双重造影在结肠癌诊断中的应用价值,回顾经气钡双重造影检查诊断为结肠癌的40例患者X线征象资料,并与手术及病理检查结果进行对比分析。结果显示,术后病理检查诊断,结肠癌39例,肠结核1例,气钡双重造影X线摄片诊断准确率为97．5％（39／40）;39例经病理检查证实为结肠癌的患者气钡双重造影X线摄片显示,肿瘤位于升结肠6例,肝曲8例,横结肠4例,脾曲2例,乙状结肠19例,与手术所见完全一致,准确率为100％。结肠癌气钡双重造影主要X线表现为软组织肿块、充盈缺损、腔内龛影、肠壁增厚、肠管狭窄、边缘僵硬、肠黏膜破坏中断。结果表明,气钡双重造影诊断结肠癌准确率高,而且操作简单、易于掌握,在基层医院具有较高的应用价值。     

腹腔镜辅助Soave手术治疗小儿结肠脾曲综合征的临床体会

目的:探讨腹腔镜辅助Soave手术治疗小儿结肠脾曲综合征的治疗效果与安全性。方法:回顾分析2005²012年为52例结肠脾曲综合征患者行腹腔镜辅助Soave手术的临床资料。患儿均以反复便秘为主要临床表现,钡剂灌肠检查脾曲较肝曲升高>1.52012年为52例结肠脾曲综合征患者行腹腔镜辅助Soave手术的临床资料。患儿均以反复便秘为主要临床表现,钡剂灌肠检查脾曲较肝曲升高>1.5².0椎体,脾曲夹角<45度,横结肠扩张,降结肠冗长。结果:52例手术均获成功,手术时间802.0椎体,脾曲夹角<45度,横结肠扩张,降结肠冗长。结果:52例手术均获成功,手术时间80⁹5 min,平均(88±5.32)min;术中出血量295 min,平均(88±5.32)min;术中出血量2⁵ ml,平均(3±0.78)ml;切除肠管225 ml,平均(3±0.78)ml;切除肠管22⁴2 cm,平均(36±2.26)cm;术后24 h肠鸣音恢复,肛门排气或排便,术后恢复饮食时间142 cm,平均(36±2.26)cm;术后24 h肠鸣音恢复,肛门排气或排便,术后恢复饮食时间1² d。术后体温≤37.5℃。腹部切口甲级愈合率100%。术后肛周轻度污粪2例,无一例发生切口感染、结肠回缩、夹层感染、切口疝等并发症。术后随访82 d。术后体温≤37.5℃。腹部切口甲级愈合率100%。术后肛周轻度污粪2例,无一例发生切口感染、结肠回缩、夹层感染、切口疝等并发症。术后随访8⁸5个月,平均(62±5.42)个月,效果满意;随小儿年龄的增长,大便次数逐渐减少,远期大便285个月,平均(62±5.42)个月,效果满意;随小儿年龄的增长,大便次数逐渐减少,远期大便2⁴次/d。结论:腹腔镜辅助Soave手术具有操作简单、创伤轻、出血少、并发症少、安全、切口美观等优点,是治疗小儿结肠脾曲综合征的理想术式。     

Intestinal occlusion caused by malignant neoplasia of the colon: surgical strategy

Malignant tumors of the large bowel become often clinically evident as an obstruction in 8-29% cases, specially the neoplasms at the splenic flexure (50%) or descending colon (25%). Different factors (urgency, age, colonic distension and lack of adequate bowel preparation) influence therapeutic choice, specially about the bowel resection and one stage anastomosis. Twenty-six patient with neoplastic stenosis of the large bowel (8 of ascending colon and proximal transverse, 5 of splenic flexure or descending colon, 12 of the sigma, 1 of the rectum) have been surgically treated. 4 patient have been subjected to right emicolectomy and ileo-transverse anastomosis; 2 to Hartman's operation; 1 to anterior resection of the rectum; 3 to left hemicolectomy and 2 to resection of the sigma with colic on table irrigation and one-stage anastomosis; 13 to colostomy; 1 to palliative ileo-colic bypass. Two patients (7.5%) died in post-operative period. In patients subjected to one-stage procedures for left colic stenosis, the Authors haven't observed major complications, but one patient developed an anastomic leakage (4%), conservative treated. In stenosis localized to ascending colon or hepatic flexure standard surgical operation is right emicolectomy. In patients affected by cancer of descending colon, the Hartmann's operation is considered the more rational procedure, even if 50% of the patients aren't reoperated on for reconstruction. The one-stage anastomosis is indicated only in selected cases, specially subjected to TPN before surgery or balancing of the metabolic parameters and to antibiotic prophylaxis. The subtotal or total colectomy is indicated when signs of colic perforation are found or when the colon is massively dilatated or there are signs of colonic necrosis or in case of other lesions of the large bowel preoperatively known.     

成人先天性巨结肠的诊断与外科治疗

目的探讨成人先天性巨结肠的诊断与外科治疗。方法回顾性分析1992年6月至2004年6月问收治的15例成人先天性巨结肠患者的临床资料。结果15例患者年龄17．54岁。人院前有9．5个月至50．0年(平均21．4年)的长期便秘、腹胀史；6例患者有急性腹痛史；均无脱水或营养不良表现。钡剂灌肠可见肠管狭窄段和扩张段。予以Soave手术2例，次全结肠切除加结肛吻合术13例；术后所有患者排便功能优良。结论自幼长期慢性便秘史和钡灌肠检查是诊断的主要依据；结肠次全切除加结肛吻合术是安全有效的手术方式。     

Obstructing carcinoma of the left colon managed by subtotal colectomy

Obstructing carcinomas of the left colon are traditionally managed with a staged resection, as immediate colonic anastomosis is associated with a high risk of anastomotic dehiscence. We have prospectively performed total or subtotal colectomy in 18 consecutive patients presenting with obstruction at or distal to the splenic flexure. The operative mortality was 11%, which compared favourably with the results of other methods of surgical management. The procedure is safe and no cases of anastomotic dehiscence occurred. Subtotal colectomy achieves in a single procedure relief of the obstruction, tumour resection and restoration of gut continuity whilst allowing resection of synchronous lesions and eliminating the risk of metachronous tumour. Frequent liquid stool was not a significant sequel of a subtotal colectomy in this series.     

腹腔镜手术治疗成人结肠冗长症疗效分析

目的:探讨腹腔镜全结肠切除术治疗成人结肠冗长症的临床效果。方法:回顾分析2011年4月至2013年4月为7例结肠冗长症患者行腹腔镜手术治疗的临床资料。5例伴有顽固性便秘,2例伴便秘与腹泻交替症状,且经X线钡剂灌肠确诊为全结肠冗长症。结果:7例均顺利完成结肠切除术,最后以回肠末端同直肠上端直接吻合。术后未发生严重并发症。术后住院6~9 d,平均(7.8±1.5)d。随访9~24个月,平均(15.0±4.5)个月,疗效均满意,生活质量明显改善,未出现长期腹泻及肠梗阻、便秘复发等远期并发症。结论:X线钡剂造影检查结合长期的顽固性便秘病史是现阶段结肠冗长症诊断的理想方式。应用腹腔镜全结肠切除术治疗成人结肠冗长症疗效确切,具有患者创伤小、康复快、安全有效等优点,但应严格掌握手术适应证。