目的 探讨老年人结肠脾曲综合征的诊治方法。方法 对1993年9月至2003年9月收治的22例老年人结肠脾曲综合征患者的临床资料进行回顾性分析。结果 临床表现为便秘伴腹痛、腹胀、消瘦、头痛、头晕、心悸、腹膜炎等； X线钡剂灌肠造影检查示结肠脾曲过高、迂曲成角，甚至扭转，可伴有横结肠冗长。行横结肠与降结肠侧侧吻合术，切除冗长结肠，随访2～8年，疗效满意。结论 对老年结肠脾曲综合征患者，钡剂灌肠检查应是常规检查，一旦确诊，应手术治疗。
Objective To discuss the clinicopathologic risk factors related to local recurrence of rectal cancer after radical surgery. Methods The complete clinicopathologic data of 368 patients with rectal cancer from January 2004 to April 2011 in this hospital were retrospectively analyzed by univariate and multivariate analysis methods. Results There were 73 cases suffered from local recurrence and accounted for 19.84% （73/368） of rectal cancer during the same period. Univariate analysis results showed that gender， tumor from anal margin， tumor circumference， TNM staging， histology type， vessel infiltration， tumor perforation， stomal leak， and chemoradiotherapy were associated with postoperative recurrence （P＜0.05）. Multivariate analysis results showed that tumor from anal margin， tumor circumference， TNM staging， histology type， vessel infiltration， tumor perforation， and chemoradiotherapy were prognostic factor for local recurrence of rectal cancer （P＜0.05）. Conclusions There are many factors related to postoperative local recurrence， but the most dangerous factor is vessel infiltration.
目的 探讨老年患者特发性结肠穿孔的临床特点。方法回顾性分析我科2000年5月至2010年5月期间收治的28例特发性结肠穿孔老年患者的临床资料。 结果28例患者中男16例，女12例; 年龄60～87岁，中位年龄69.2岁。所有患者表现为急性腹痛或腹膜炎； 术前5例确诊，23例误诊； 均行急诊剖腹探查手术，穿孔位于乙状结肠与直肠交界处有18例，位于降结肠4例，乙状结肠中段5例，直肠上段1例。 8例行穿孔部位结肠外置，再择期行二次手术； 16例行乙状结肠下段及直肠上段切除、结肠造瘘术； 4例行病变部位一期切除吻合、回盲部导管减压引流术。术后病理报告: 结肠壁局灶性炎性反应坏死，穿孔边缘清楚，肌层断裂整齐，黏膜剥脱，其中10例伴黏膜溃疡。 住院时间为2～4周，平均2.6周。 20例患者痊愈出院，死亡8例，其中4例死于中毒性休克，2例因吻合口漏并发腹腔脓肿死于严重感染和多器官功能衰竭，2例死于并发肺部感染、呼吸衰竭。 结论诊断性腹腔穿刺及CT检查对老年患者的特发性结肠穿孔诊断极为重要，一旦确诊或疑诊应尽早手术治疗。
【摘要】 目的 探讨急性假性结肠梗阻的临床诊断与治疗。方法 回顾性分析24例急性假性结肠梗阻患者的临床资料。结果 24例患者均有机械性肠梗阻的临床表现。12例经保守治疗治愈； 6例经结肠镜结合中西医药物治疗治愈； 6例行手术治疗，其中4例因误诊为器质性结肠梗阻而手术，2例死亡。结论 要提高对急性假性结肠梗阻的认识，多数急性假性结肠梗阻可通过非手术方法治愈，在采取积极保守治疗的同时，通过临床仔细分析可与器质性结肠梗阻相鉴别，要严密观察患者腹部体征，防止肠穿孔等并发症的发生。
Objective To investigate the pathological features， diagnosis， treatment， and prognosis of multiple primary colorectal cancer （MPCC）. Methods Clinical data of 41 patients with MPCC treated in The Fourth Affiliated Hospital and The First Affiliated Hospital of China Medical University from Aug. 1993 to Mar. 2009 were retrospectively analyzed. Results Forty one patients with MPCC， including 29 patients with synchronous colorectal cancer （SCC） and 12 patients with metachronous colorectal cancer （MCC）， accounted for 1.8% （41/2 340） of colorectal cancer during the same period of time， and with adenomatous polyps in 19 cases and polyps canceration in 10 cases. Among 29 patients with SCC， 15 cases （51.7%） were diagnosed by preoperative fiberoptic colonoscopy， 9 cases （31.0%） were diagnosed by preoperative fiberoptic colonoscopy， abdomen CT， and barium enema， 5 cases （17.2%） were diagnosed by intraoperative exploration and intraoperative fiberoptic colonoscopy， respectively. All of the 12 patients with MCC were diagnosed by preoperative fiberoptic colonoscopy and abdomen CT. For 29 patients with SCC， tumor locations were from proximal appendix to distal rectum， but 12 patients with MCC were adverse. Sixty-five （77.4%） tumors were tubular or papillary adenocarcinoma， and 56 （66.7%） tumors were well and moderately differentiated adenocarcinoma. The TNM stage of most tumors （72） was stageⅡ or Ⅲ phase， account for 85.7%. Radical surgeries were performed in 37 patients and palliative surgeries in 4 patients， and there were no complications after operation. During the follow-up for 3-5 years （mear 3.6 years）， the overall survival rate of 3- and 5-year were 48.8% （20/41） and 34.1% （14/41）， respectively. In detail， 3-year survival rate of SCC group and MCC group were 48.3% （14/29） and 50.0% （6/12）， respectively；5-year survival rate were 31.0% （9/29） and 41.7% （5/12）， respectively. Conclusions Cause of MPCC has not been clear， but it has possible relationship with adenomatous polyps. Preoperative fiberoptic colonoscopy， abdomen CT， and barium enema are very important for patients with SCC， and intraoperative fiberoptic colonoscopy is also necessary. Patients with MCC should enhance postoperative follow-up with fiberoptic colonoscopy. Further more， radical resection should be performed as early as possible.