目的探讨诊治闭合性肝外伤的有效方法。方法回顾分析了1990～2000年收治的168例闭合性肝外伤的临床资料。结果均行腹腔穿刺，阳性率为94.6%（159/168），B超检查92例，阳性率为95.7%（88/92），CT检查33例，阳性率为93.9%（31/33），术前确诊率为98.2%。168例中，行非手术治疗37例（22.0%），手术治疗131例（78.0%）。治愈161例（95.8%），其中非手术治疗37例均痊愈； 手术治疗131例中痊愈124例，死亡7例（4.2%）。结论外伤史、体征、腹腔穿刺、B超和CT检查是诊断肝外伤的重要依据，及时手术治疗是降低严重肝外伤病死率的关键。
【摘要】 目的 探讨早期微创腹腔置管灌洗在重症急性胰腺炎（severe acute pancreatitis，SAP）治疗中，对减轻炎性反应的作用。 方法 选择2007年1月-2009年6月收治的SAP患者56例，随机分为早期微创腹腔置管灌洗组（灌洗组，n=28）和常规治疗组（对照组，n=28）；两组同时给予生长抑素，抑酸，抗感染，保持水、电解质及酸碱平衡等综合治疗，灌洗组在常规治疗基础上早期予以微创腹腔置管灌洗。检测两组治疗前及治疗后2、5、7 d C反应蛋白（C-reactrve protein，CRP）、血清肿瘤坏死因子α（tumor necrosis factor α，TNF-α）、 白细胞介素6（interleukin，IL-6）、IL-8水平。 结果 两组治疗前CRP、TNF-α、IL-6、IL-8水平差异无统计学意义（Pgt;0.05），治疗后2、5、7 d比较差异有统计学意义（Plt;0.05）。 结论 早期微创腹腔置管灌洗操作简便易行、创伤小、疗效佳，对减轻SAP所致的全身炎性反应具有较好效果，是治疗SAP有效方法之一。【Abstract】 Objective To explore the effect of the early minimally invasive peritoneal lavage in severe acute pancreatitis (SAP) from Januany 2007 to June 2009. Methods A total of 56 cases of SAP were randomly divided into early minimally invasive peritoneal lavage group (lavage group, n=28) and conventional treatment group (control group, n=28). The patients were given comprehensive treatment, including somatostatin, acid suppression, anti-infection, and maintaining water, electrolyte, and acid alkali balance.In lavage group, the patients were treated with early minimally invasive peritoneal lavage in addition.The levels of C reactive protein(CRP), serum tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), and interleukin 8(IL-8)were detected before and 2, 5, 7 days after tretment. Results There was no significant difference in CRP, TNF-α, IL-6, or IL-8 before treament between the two groups (Pgt;0.05). There were significant differences in CRP, TNF-α, IL-6, and IL-8 after treatment between the two groups (Plt;0.05). Conclusion Early minimally invasive peritoneal lavage is a simple, minially invasive, and effective techinique in treating SAP.
Objective To evaluate the role of curved-cutter-stapler in anus-preserving for low rectal cancer. Methods The clinical data of 32 patients with low rectal cancer from June 2007 to December 2008 who received low anterior resection and ultra low anterior resection by using curved-cutter-stapler were reviewed retrospectively. Results No operation death case, complete cutting and safe closure in all cases, one case was complicated with anastomotic leakage, and one case of rectovaginal fistula. Thirty patients were followed up 4 to 22 months after the operation, with an average time of 12.6 months, no hemorrhea of pelvic cavity and anastomotic stoma or anastomotic stenosis cases. Conclusion Curved-cutter-stapler has the advantages of complete cutting, safe closure and low complications, and easy being used in anus-preserving operation for low rectal cancer, which can increase the rate of anus-preserving.