目的探讨肝癌手术切除后的序贯综合治疗,以达到有效防治肿瘤复发的目的。方法从我科收治的肝癌患者中挑选3例手术治疗后进行序贯综合治疗并取得良好效果病例，对其临床资料进行分析，从中获取有关肝癌术后治疗的经验。结果3例肝癌患者在我科手术后接受了积极的预防复发措施，虽最终均出现复发，但对待复发的肿瘤均采取积极的应对措施，获得了长期生存。结论对于肝癌手术切除后的患者进行积极的序贯性综合治疗有较好的临床意义，鼓励对术后复发病例进行积极序贯综合治疗。
目的 探讨超声刀在肝包虫全囊切除术中的应用。方法 回顾性分析11例接受超声刀肝包虫手术患者的治疗及效果。结果 9例患者行全囊切除，其中1例因包虫与胆管相通，在进行全囊切除后，缝扎胆管，同时行T管引流； 1例因包虫与膈肌粘连无法分离，给予外囊大部切除术； 1例因包虫与膈肌粘连无法分离，给予外囊大部切除术； 1例10岁患者为肝顶部包虫，手术行内囊切除及外囊大部切除后，出现残腔感染，经穿刺引流后，证实为漏胆，经引流后痊愈出院。9例全囊切除患者术中均未输血，术后未出现并发症。结论 在肝包虫全囊切除术中应用超声刀是安全、有效的。
①在自发性气胸的治疗方面:目前尚无足够高质量的临床证据确定任何干预或非干预措施对自发性气胸的治疗更有效.现有2个小样本的随机对照试验(RCT)显示,胸腔闭式引流比穿刺抽气治疗气体消散更快,但穿刺抽气治疗更能减少患者痛苦和住院时间;1个小样本的随机对照试验显示,采用标准的胸腔闭式引流管或细管,两者的置管时间无差异,但对大量积气的患者,标准管的气体吸收率高于细管;另1个小样本的随机对照试验显示,在使用瓣膜单向阀或水封引流瓶方面,两者对患者的气胸吸收率无影响,但使用瓣膜单向阀更能减少患者痛苦和住院时间;在胸腔闭式引流管连接负压吸引方面,1个小样本的随机对照试验显示,是否连接负压吸引对疗效无影响.②在自发性气胸复发的预防方面:2个随机对照试验和1个非随机对照试验显示,化学性胸腔粘连术比非化学性胸腔粘连术更能减少自发性气胸的复发率,但胸腔粘连术同时也引起患者疼痛和住院时间的延长;无足够临床证据证明需在首次或自发性气胸复发时采用胸腔粘连术;无足够临床证据进行外科和化学性胸腔粘连术疗效的比较,仅有1个小样本的随机对照试验提示进行电视胸腔镜手术比直接开胸术的住院时间短,但在降低复发率方面,两者无显著性统计学差异,但由于样本量的问题,尚不排除两者问有临床意义差异.
Objective To review the research progress of bone graft resorption after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation, and provide a guide for further research on bone graft resorption. Methods The relevant literature in recent years was extensively reviewed. The pathogenesis, classification, risk factors, clinical function impact, and management of bone graft resorption after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation were summarized. Results Bone graft resorption is the common complication after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation. Stress shielding and poor blood supply may contribute to the occurrence of bone graft resorption. The absence of significant preoperative glenoid bone loss, open procedure, earlier graft healing may to be the risk factors for bone graft resorption. Various assessment methods and classification systems are used to evaluate the region and severity of bone graft resorption. Partial resorption may be considered as a natural glenoid remodeling process after the surgery, but severe and complete resorption is proved to be one of the reasons for failed procedures and there is no effective measure to prevent it, except for accepting revision surgery. Conclusion The pathogenesis, risk factors, clinical function impact of bone graft resorption after Latarjet procedure for the treatment of recurrent anterior shoulder dislocation has not been fully elucidated and there is a lack of effective management strategies, so further clinical and basic researches are needed.
Objective To summarize the experiences and methods on reoperation of recurrent incisional hernia after mesh repair with prosthetic patch. Methods Sixteen patients who got reoperation from January 2007 to December 2010 because of recurrent incisional hernia after mesh repair were analyzed retrospectively. Results All patients received prosthetic patch repair for reoperation. Thirteen patients received new mesh repair accompanied with old mesh removal, repair conducted by suturing new mesh with old mesh together in two patients, and repair performed by new mesh overlapping the old mesh in one patient. All patients recovered with primary wound healing. Fluid upon the mesh occurred in 3 patients and cured by percutaneous puncture and pressure dressing. Postoperative hospital stay was 7 to 16 days and the average 9 days. The drainage was removed 2 to 7 days after operation and the average was 4 days. All the 16 patients were followed up. And during a follow-up range of 5 to 36 months and the average 20 months, there was slight foreign body sensation in one patient, no chronic pain in wound area occurred. And no abdominal wall hernia recurrence occurred. Conclusions Reoperation of recurrent incisional hernia after mesh repair need to consider the recurrent position, material of the previous mesh, and the previous surgical methods, and should select appropriate prosthetic patch and surgical procedure, then could gain satisfied results.
ObjectiveTo summarize the experience of diagnosis and treatment of a case of adult hepatic fibrohistiocytoma with recurrent rupture and hemorrhage.MethodsRetrospective analysis on this case of recurrent adult fibrohistiocytoma with rupture and hemorrhage admitted to Shengjing Hospital Affiliated to China Medical University in May 2018 was conducted, discussion on MDT was conducted before surgery, and the causes of recurrent rupture and hemorrhage, as well as the experience of diagnosis and treatment were summarized and analyzed.ResultsThis patient was generally in good condition. After MDT discussions among the imaging department, oncology department, interventional department, and hepatobiliary surgeons, it was considered that surgical treatment was the best treatment scheme. After full communication with the patient and his family, the patient had chosen open tumor resection and the operation was smooth. The operation time was 278 min, intraoperative bleeding was about 100 mL, and no blood transfusion was performed. No bleeding, abdominal infection, gastroparesis, and other complications occurred after the operation, and the patient was discharged successfully on the 13th day after the operation. The patient had been interviewed for 8 months and the tumor recurred again 1 month ago. Currently, oral apatinib had been targeted for treatment for more than 1 month, and the follow-up treatment continued.ConclusionsRecurrent adult fibrous histiocytoma with rupture and hemorrhage is rare in clinical practice, and the treatment is mainly based on surgical resection. Postoperative comprehensive treatment combined with radiotherapy, chemotherapy, molecular targeting, and immunotherapy is the main treatment. Its short-term efficacy is satisfactory, but long-term efficacy still needs to befurther observed.
腹股沟疝是普外科领域里最常见的疾病之一。根据北美和欧洲国家的有关流行病学资料统计，腹股沟疝的发病率约为1‰～5‰。尽管目前国内尚无全面、系统的流行病学资料，但2001年上海地区腹股沟疝患病情况的初步流行病学调查结果显示，腹股沟疝的发病率大约在3.6‰，60岁以上老年人的发病率则高达11.8‰［1］。按此估算，我国的腹股沟疝发病人数将超过几百万人，而目前较为保守地估算，我国每年的腹股沟疝和切口疝手术会在5～10万例。