【摘要】目的 探讨低位直肠癌保肛手术的术式选择及其治疗效果。方法 回顾性分析我院1997年7月至2002年7月期间行低位直肠癌保肛手术治疗的90例患者的临床资料。结果 行低位直肠癌保肛手术者占同期的66.2%(90/136)。90例中距肛缘5 cm以内者14例，5~8 cm者76例； 行Dixon术84例，经肛门局部切除术4例，Parks术2例。术后发生吻合口漏8例，其中Dixon术7例，Parks术 1例； 肛门狭窄2例，其中Dixon术1例，Parks术 1例； 无手术死亡。90例患者术后均获随访,64例随访23~59个月，中位随访时间为39个月，其中Dixon术59例，Parks术2例，局部切除术3例。局部复发6例，其中Dixon术5例，局部切除术1例。 结论 Dixon术是低位直肠癌保肛手术的主要术式； 在严格掌握适应证的情况下，可考虑施行低位直肠癌的局部切除术。
ObjectiveTo investigate the application of three methods about digestive tract reconstruction in radical resection for proximal gastric cancer.MethodsWe retrospectively reviewed the cases of 130 proximal gastric cancer patients who underwent double tract reconstruction (TD, 35 cases), total gastrectomy (TG, 50 cases) and esophagogastrostomy (EG, 45 cases) from Jan. 2016 to Oct. 2018 in Gastrointestinal Surgery Department in our Hospital.ResultsThere were no significant differences in basic data of patients, preoperative nutritional status, hemoglobin content, postoperative recovery time of gastrointestinal function, hospitalization time and early postoperative complications among the three groups (P>0.05). But the operative time, intraoperative bleeding volume, postoperative status of total protein, albumin, hemoglobin, late complications, reflux symptoms, gastro-intestinal quality of life index (GIQLI) between the three groups had statistically significant differences (P<0.05). The operative time of EG was (161.80±30.77) min, which was the shortest. The intraoperative bleeding volume of TG was (107.20±10.70) mL, which was the most. At 6 months after TG, the total protein, albumin and hemoglobin were (62.15±6.72) g/L, (36.14±6.57) g/L and (112.68±16.97) g/L, respectively, which were the lowest level among the three groups. There late complications of the EG were the most serious, in which the Visick score was 46 and the GIQLI index was 103.56±22.01. The above differences were statistically significant (P<0.05).ConclusionsDT performs better in anti-reflux, maintenance of postoperative nutrition, and anti-anemia, but the occurrence of remnant gastric cancer is a potential risk. TG has a lot of bleeding, as well as the performance of postoperative nutrition and anti-anemia is not good, but it can avoid the occurrence of remnant gastric cancer. The operative time of EG is short, but reflux symptoms are more likely to occur after surgery, and the quality of life is bad.
目的比较腹腔镜阑尾切除术(LA)与开腹阑尾切除术(OA)治疗急性阑尾炎的疗效和手术安全性。方法回顾性分析2010年7~12月期间的50例LA患者的临床资料，与同期55例施行OA的患者进行比较。结果LA组与OA组在手术时间及术中出血量方面差异均无统计学意义(Pgt;0.05); LA组术后肠功能恢复时间、下床活动时间及住院时间均明显短于OA组(Plt;0.05)，LA组镇痛药使用率及术后并发症发生率明显少于OA组(Plt;0.05); 但住院费用LA 组高于OA组(Plt;0.05)。结论LA在治疗阑尾炎方面有明显优势，值得推广。
目的 探讨腹腔镜全结肠切除术在家族性腺瘤性息肉病（FAP）中的应用价值。方法 回顾性分析我院2008年1月至2009年10月期间收治的行腹腔镜全结肠切除术的4例FAP患者的临床资料，对手术安全性和术后恢复情况进行分析。结果 4例患者均顺利行腹腔镜全结肠切除术，无中转开腹，无手术并发症及死亡。腹部切口长6.0 cm，手术时间300～380 min（平均330 min），术中出血量90～250 ml（平均160 ml）。术后2～3 d肛门开始排气，术后住院时间7～11 d（平均9 d）出院。出院后大便稀薄，8～12次/d，给予易蒙停治疗后缓解。随访2～22个月（平均14个月），无近期并发症发生。结论 腹腔镜全结肠切除术治疗FAP安全、有效，近期效果良好。