目的 探讨闭孔疝的诊断和治疗方法。方法 回顾性分析了我院2001年10月至2009年8月期间收治并经手术证实的8例闭孔疝患者的临床资料。结果 8例均为女性，其中7例是老年、体弱的多产妇，1例是已婚年轻女性。平均年龄74.6岁（46～85岁），平均体重为39.1 kg（34～43 kg），平均生育5胎（1～10胎）。8例患者中5例术前经CT检查确诊而行手术治疗，3例由外院转入者在行急诊剖腹探查术中确诊。7例行坏死小肠切除吻合术，1例行嵌頓小肠复位术。 术后4例出现并发症：1例肺炎、1例切口感染、1例低蛋白水肿、1例为酸中毒和低血钾（死亡）。7例痊愈出院，1例死亡。结论 闭孔疝缺乏特异性表现，对年老体弱的经产妇出现腹痛、呕吐和股部疼痛应想到闭孔疝的可能；CT检查能提高闭孔疝的诊断率。准确的诊断和及时的手术干预是改善闭孔疝患者预后的关键。
Objective To explore the situation and prevention of pancreaticoduodenectomy perioperative complications. Methods The clinical data of 111 cases of pancreaticoduodenectomy were retrospectively analyzed， and the possible factor of complications was analyzed. Results There were postoperative complications in 48 patients （43.2%）， which one kind complication occurred in 25 cases， two kinds in 15 cases， and three kinds or more in 8 cases. Four cases （3.6%） died after operation. Conclusions Pancreaticoduodenectomy is a higher risk surgery in abdominal operation. Strengthen perioperative prevention and treatment are important measures to reduce morbidity and mortality after pancreaticoduodenectomy.
Objective To explore the clinical value of the improved style of pancreatodeodenectomy. Methods Retrospective analysis the data of 111 cases of pancreatodeodenectomy. Forty-one cases of 111 cases were performed the modified Whipple pancreatic jejunal anastomosis， which reconstruction residual pancreatic duct jejunum into the intestinal mucosa sets of accurate end to side anastomosis type （modified group）. Another 70 cases were performed the conventional Whipple pancreatic jejunal anastomosis， which classic lines set into the pancreas jejunum anastomosis （conventional group）. The incidence rate of pancreatic fistula after operation were compared in two groups. Results The postoperative recovery in modified group was smooth， and there was no case of pancreatic fistula. Thirteen cases （18.57%） had pancreatic fistula in conventional group. The difference of incidence rate of pancreatic fistula between two groups was statistically significant （P＜0.05）. The difference in other complications such as gastrointestinal bleeding， delayed gastric emptying， biliary fistula， abdominal infection， lung infection， and wound infection were no statistically significant （P＞0.05）， and the difference of survival rate was also no statistically significant （P＞0.05） in two groups. Conclusions Pancreatic duct jejunum end to side into the mucous membrane of the mucosal anastomosis sets of pancreatodeodenectomy can significantly prevent pancreatic fistula， it is worth to promote the use in clinical work.
ObjectiveTo explore the clinical efficacy and security of early enteral nutrition (EN) on patients with gastric cancer after radical operation. MethodsSeventy cases who treated in Affiliated Hospital of Inner Mongolia Medical University from Dec. 2008 to Apr. 2013 were randomly divided into EN group (n=35) and parenteral nutrition (PN) group (n=35), analysis and comparison of nutrition indicators and recovery indicators between 2 groups were performed. ResultsThere were no significant differences on levels of count of white blood cell (WBC), serum albumin (ALB), prealbumin (PA), and transferring (TRF) before operation between the 2 groups (P > 0.05). On 3 and 7 days after operation, the levels of ALB, PA, and TRF were all higher in EN group (P < 0.05) besides level of count of WBC. In addition, hospital stay and hospitalization cost were both lower in EN group (P < 0.05), but there was no significant difference on postoperative exhaust time and complication incidence (P > 0.05). ConclusionsEN is a safe, effective, and economical method of nutritional supplements, and it is a preferred method of nutritional support for patients with advanced gastric cancer after operation at prophase, which is worthy to apply widely in clinical.
目的 总结活体部分小肠移植在治疗短肠综合征合并肠瘘中的临床经验。方法 1例短肠综合征合并肠瘘患者接受其子的150 cm 回肠，供肠动、静脉分别与受体的腹主动脉和下腔静脉行端侧吻合，受体残余空肠与供体回肠近端行端端吻合，受体结肠与供肠远端行端侧吻合，供肠远端造瘘作为观察窗，术后给予免疫抑制等治疗。 结果 患者小肠移植术后恢复顺利，肠道功能恢复，血管吻合口通畅，正常生活110 d后因心脏意外死亡。结论 短肠综合征合并肠瘘患者实施活体部分小肠移植是可行的，植入肠管的血管植入技术对小肠移植成功非常重要。