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find Author "潘凯" 8 results
  • 特发性结肠急性穿孔5例报告

    我院自1993~2001年共收治特发性结肠急性穿孔5例,男2例,女3例,年龄23~90岁,平均63岁。发病至手术时间为8~72 h,平均25 h。既往有习惯性便秘史3例,直肠脱垂1例,用力大便后突发者2例,有弥漫性腹膜炎4例。穿孔位于直肠与乙状结肠交界处4例,腹膜返折处直肠1例。临床表现主要为腹痛、腹胀、全腹肌紧张等腹膜炎体征,1例部分小肠从肛门脱出,3例并发感染性休克,腹腔穿刺抽出粪汁样液,腹部X线平片见膈下游离气体4例。5例均行剖腹探查手术,2例行穿孔修补、近段结肠造瘘,1例行单纯修补,1例行病变肠段切除 Ⅰ 期肠吻合,另1例行穿孔段结肠切除及近段结肠造瘘。痊愈3例,1例术后因经济原因自动出院,失访,1例术后2天死于感染性休克、呼吸功能衰竭。术中穿孔周围组织病检结果均为“炎症改变”。讨论本病确切病因目前尚未完全明了,可能与慢性便秘关系密切。其发病机理可能与如下因素有关: ①老年人排便反射减弱,结肠内淤积的大量干结粪块压迫肠粘膜,使之产生压迫性缺血,最终造成坏死,穿孔,故该病又称粪性结肠穿孔。 ②穿孔常见部位为乙状结肠与直肠交界处,此为全结肠中最狭窄的部位,血供来源于肠系膜终末血管,分支动脉间吻合少,粘膜血运相对不足,对缺血的耐受性较差。 ③慢性便秘或直肠脱垂,肠内压增高,肠壁肌层变薄,当患者用力排便时,腹内压及肠内压骤然增高而致穿孔。 便秘患者结肠内为干结大便,穿孔后大便外漏量并不大,除非有较大肠管撕裂,且大便在腹腔内扩散速度较慢,也无明显化学性刺激,故本病早期症状、体征并不象上消化道穿孔那样明显,术前不易确诊,多在术中明确诊断。笔者认为当出现下列情况时,应高度怀疑本病: ①年龄在50岁以上,有慢性便秘史; ②腹痛开始于左下腹,数小时后渐累及全腹而出现腹膜炎; ③肛门指诊触及到直肠内干结粪块; ④诊断性腹腔穿刺抽出液体为混浊且含粪臭味; ⑤腹部X线检查有膈下游离气体,同时伴有左侧结肠粪块钙化阴影。

    Release date:2016-08-28 05:11 Export PDF Favorites Scan
  • Analysis of Technical Keypoints of The Second-Phase Diaplasis Treatment after Hartmann Operation

    Objective To discuss the technical keypoints of the second-phase diaplasis treatment after Hartmann operation. Methods Twenty-one cases of the second-phase diaplasis operation of Hartmann operation in this hospital from January 2003 to December 2007 were analysed retrospectively. Results In this group, stapler technique was used in 15 cases, anastomotic ring was used in 3 cases, and one-layer suture was used in 3 cases. The time of these operations was between 118 min and 240 min (mean 164 min). Neither stomal leak nor stomal stenosis occurred, acute ileus occurred in 2 cases, and both recovered after the treatments of gastrointestinal decompression, inhibition of secretion digestive juice and reoperation. Acute retension of urine occurred in 1 case after urine catheter removed. The symptoms disappeared after excises of bladder function. These cases were followed up for 3-36 months (mean 20 months). All the patients recovered to normal function of defecation. Conclusion The technical keypoints of the second-phase diaplasis treatment after Hartmann operation are how to find and liberate the end of the distal colon. It will affect the prognosis and the occurrence of complications after this operation.

    Release date:2016-09-08 11:07 Export PDF Favorites Scan
  • Laparoscopy Assisted Partial Small Bowel Resection(Report of 10 Cases)

    【摘要】目的 探讨腹腔镜辅助下小肠切除术的治疗价值。 方法 回顾性分析我院2001年7月至2004年9月期间实施腹腔镜辅助下小肠切除术10例患者的临床资料。 结果 除1例中转开腹外,余 9例均实施腹腔镜辅助下小肠切除。平均手术时间(70.2±18.3) min (60~120 min),术中平均出血量(30.3±12.6) ml (15~50 ml),平均住院时间(6.5±1.6) d (5~8 d)。所有患者均在术后24 h开始下床活动,48 h内恢复胃肠功能。术后无一例使用止痛剂。全组手术无病灶遗漏,无并发症和手术死亡发生。 结论 腹腔镜辅助下小肠切除术安全、经济并具有良好的治疗效果。

    Release date:2016-08-28 04:28 Export PDF Favorites Scan
  • Treatment for Perforation of Retrobulbar Duodenal Ulcer

    目的 探讨十二指肠球后溃疡穿孔临床上正确的围手术期处理办法。方法回顾性分析我院1998年5月至2004年11月6例十二指肠球后溃疡穿孔的临床症状、穿孔部位、手术方式、治疗结果和随访情况。结果6例患者均为溃疡穿孔,分别行急诊手术,术后1例死亡,1例转院,4例完全治愈。结论术中根据患者条件选择合理的手术方式,重视术后引流,早期肠内营养是改善患者预后的关键。

    Release date:2016-09-08 11:53 Export PDF Favorites Scan
  • 碘伏清洗Ⅲ类切口防止感染的应用探讨

    Release date:2016-09-08 11:54 Export PDF Favorites Scan
  • Impacts of Conversion to Open in Laparoscopic Rectal Cancer Radical Resection on Postoperative Recovery

    Objective To investigate the impact of conversion to open in laparoscopic rectal cancer radical resection (LRR) on postoperative recovery. Methods The data from Feb. 2003 to Feb. 2007 of 176 cases who were given LRR and 32 cases receiving conversion in LRR (CRR) were analyzed retrospectively, and were compared about operation time, hospitalization time, hospitalization expenses, intraoperative blood loss, recovery time of bowel movement and postoperative complications with 59 cases of open rectal cancer radical resection (ORR). Results There were no differences among LRR, CRR and ORR about operation time, hospitalization time, intraoperative blood loss and recovery time of bowel movement (Pgt;0.05). The hospitalization expenses of LRR and CRR were higher than that of ORR (P=0.001, P=0.001), there was no difference between CRR and LRR (P=0.843). But the postoperative complications rate of ORR was higher than those of LRR and CRR (P=0.023,P=0.004). Conclusion Compared with ORR, LRR has relatively conversion rate, and then increases the hospitalization expenses.

    Release date:2016-09-08 10:57 Export PDF Favorites Scan
  • Cool-tip Radiofrequency Ablation Therapy Instrument Based on Impedance Control Algorithm

    A new cool-tip radiofrequency (RF) ablation therapeutic instrument based on impedance control algorithm is introduced in this paper. The equipment is composed of hardware system and software system. The RF power output and real time data acquisition are completed by the hardware system, while the software is used mainly to finish the control of the ablation range, the core of which is impedance control algorithm, and it also used to complete the display of the real time data in the course of the experiment. The impedance algorithm has solved the problem of impedance increased rapidly during the RF ablation, which has also expanded the scope of ablation. The pig liver experiments showed that the impedance control algorithm had strong adaptability. It also obtained a result of ablation range up to 3.5~4.5 cm single needle. It has the high clinical practical value of one-time inactivation of 3~5 cm tumor.

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  • Multivariate Statistical Analysis: Significant Factors Causing Free Malignant Cells in Rectum During Radical Resection of Rectal Cancer

    Objective To analyze the risk factors inducing tumor cells exfoliating during radical resection of rectal cancer. Methods Sixty patients who were diagnosed as rectal cancer from May 2006 to November 2007 and given radical operations were assigned prospectively in this study. Before cutting the rectal stump below the tumor, saline was instilled into rectum to irrigate the stump. Collected irrigating fluids were sent to pathology laboratory, and the exfoliated malignant cells were tested by HE (haematoxylin and eosin) dyeing and common smear technique. The results of examines were collected and statistical analysis, including a Logistic regression model, was performed. Results Exfoliated malignant cells were found in 27 samples. By univariate analysis, the statistically significant factors defining a high risk of exfoliating were age, tumor size, TNM stage, operation time and operation method (Plt;0.05). Only TNM stage, operation time and operation method were confirmed by Logistic regression analysis to independently result in a statistically significant increased risk of exfoliating. Conclusion Irrigating the rectal stump before cutting down the tumor is essential to avoid local recurrence. The effects of TNM stage, tumor size and operation time are important. Although the laparoscopic surgery is more predominant than conventional surgery for non-neoplasma technology, irrigating is an important process.

    Release date:2016-09-08 10:57 Export PDF Favorites Scan
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