目的：探讨腹腔镜检查对胃癌分期的价值。方法: 2007 年1月至2007 年11 月收治的胃癌患者14 例胃癌患者在全麻下行腹腔镜检查。结果: 腹腔镜T分期与术后病理检查结果符合率为92.9％，术前临床T分期与术后病理检查结果符合率为64.3%。腹腔镜分期显著优于临床分期Plt;0.05。在14例术前临床分期均未发现腹膜转移的病例中，腹腔镜探查发现有腹膜转移（P1-P3）者4例，腹腔镜对腹膜转移的评估显著优于临床分期P lt;0.05。结论: 腹腔镜可作为常规检查手段的一种补充，能对进展期胃癌进行准确的诊断和分期，有助于手术决策制定及估计治疗结果与预后，避免不必要的剖腹探查。
目的:探讨老年结直肠癌并急性肠梗阻的处理原则和方法。方法:回顾性分析10年间收治的78例(70～80岁)结直肠癌并急性肠梗阻的临床资料。78例中Dukes B期20例,C期18例,D期40例。全部患者经手术治疗,包括急诊手术46例,择期性手术32例。采用右半结肠一期切除肠吻合治疗30例,左半结肠一期切除吻合40例。Hartmann 5例, Di×on手术2例,肿瘤近端肠管造瘘1例。结果:术后出现并发症16例(20.5%)21例次,包括切口感染14例次,腹腔感染5例次和吻合口瘘2例次,死亡3例(3.85%),75例(96.2%)痊愈出院。结论:对于急性结直肠癌性梗阻除非有急诊手术指征,应首先采用非手术治1～2 d,尽可能转为择期手术;一期切除吻合治疗结直肠癌并发急性梗阻,是方便可行而安全有效的方法,加强围手术期处理是手术成功的关键。
Objective To evaluate the anatomical and functional results of retinotomy in treatment of complicated retinal detachment. Methods Twenty-three eyes were treated with retinectomy during vitrectomy for complicated retinal detachment with proliferative vitreoretinopathy when complete reattachment of retina was not obtained despite careful mambrane peeling. After released the peripheral vitreoretinal contraction or pulled subretinal membranes, perfluorocarbon liquid injection, laser retinopexy and silicone oil tamponade were performed. Retinotomy size ranged from 30-degree to 360-degree (average 132-degree). Results Retinal attachment were obtained in all of the operated eyes at the end of the operation. Silicone oil was removed from 15 eyes (65．0%) within 3～11 months postoperatively. After a minimum follow-up of 6 months, the retinae were completely attached in 17 eyes ( silicone oil was not removed in 4 eyes ) and visual acuity of 0.02 or better was obtained in 11 eye (48．0%). Recurrent retinal detachment occurred in 2 eyes in which the silicone oil had been removed. The major complications were recurrence of the proliferation in 6 eyes (26．0%) and hypotony in 3 eyes (13．0%). Conclusion Retinotomy is beneficial to reattach the retina for eyes with advanced proliferative vitreoretinopathy in seemin gly inoperable cases. (Chin J Ocul Fundus Dis,2001,17:87-89)
Objective To investigate the causes of failure of the primary vitrectomy,sum up the experience for secondary vitreous surgery and improve the success rate of primary vitrectomy for complicated retinal detachment． Methods The records of a consecutive series of 60 patients(65 eyes)that underwent secondary vitreous surgery between 1997 to 1998 were retrospectively reviewed.The age of patient ranged from 9 to 63 years(mean 36),and the followup period ranged from 3 to 18 months(mean 10.5 months). Results The main causes of failure of the primary vitrectomy were postoperative recurrence of proliferative vitreoretinopathy(PVR),unwell closed retinal breaks,and intra-and postoperative complications.In 46 of 65 eyes the retina was reattached after secondary vitreous surgery(70．1%)．Postoperatively,31 eyes (47.7%) had a visual acuity(VA)improved,16 eyes(24.6%)had a VA unchanged,and 18eyes(27.7%)had a VA reduced．Fifteen eyes(23.1%)had a VA of ge;0.05 and the best VA was 0.4．Thirty-nine eyes were followed-up from 3 to 18 months(mean 10.5)．In 35 of 39 eyes,the retina was reattached(89.7%),26 eyes(40%)had a VA of ge;0.05,and 7 eyes(10.7%)were hypotonic. Conclusions The keys to the success of secondary vitreous surgery are to restore the mobility for retina by eliminating the PVR completely,and avoid intraoperative complicattions by choosing the appropriate closure procedure for retinal breaks and the suitable intraocular tamponades. (Chin J Ocul Fundus Dis,20000,16:24-26)
目的:探讨胆总管结石致急性梗阻性黄疸手术治疗的效果。方法:回顾分析72例手术治疗胆总管结石致急性梗阻性黄疸患者的临床资料。结果:术后死亡3例。随访3~6年,效果优良者62例。3例胆总管T管引流术后3年复发肝胆管结石。结论:对该病的治疗术前应尽量做全面辅助检查,明确结石的部位及大小,胆管的形态及位置。根据病情确定手术时机和方式,对保证患者安全,减少术后并发症,提高治愈率有重要意义。
目的:探讨大肠癌致肠梗阻的诊断和手术方法。方法:回顾分析2002～2008年间65例结直肠癌致肠梗阻病例的外科治疗资料。结果:术后出现并发症9例,切口感染6例,腹腔感染2例,吻合口瘘1例。结论:结直肠癌致肠梗阻应争取Ⅰ期切除吻合。合理选择手术方式,做好术中结肠灌洗和围手术期治疗是手术成功关键。