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Influence of Neoadjuvant Chemotherapy to Rectal Cancer Early Postoperative Complications in Multi-DisciplinaryTeam: A Case2 Control Study

【 Abstract 】 Objective To discuss incidence of the complications in the rectal cancer patients ’ early postoperative being treated with neoadjuvant chemotherapy combined with surgical intervention. Methods The rectal cancer patients under surgical therapy being diagnosed definitely, with neoadjuvant chemotherapy under multi-disciplinary team (MDT) or without and firstly being discovered from April to October of 2007 were studied. The complication conditions of these patients 1 month after operation were studied and observed, and the differences between MDT group and non-MDT group were compared. Results According to the condition, 189 rectal cancer patients were internalized. Among all the patients, the distance of tumor to the dentate line were lt;3 cm 38 cases, 3 ～ 7 cm 86 cases, ≥ 7 cm 65 cases; pathological stage were Ⅰ stage 5 cases ， Ⅱstage 122 cases， Ⅲstage 50 cases， Ⅳstage 12 cases. There were 181 cases laparotomy, 8 cases laparoscopic operation; 33 cases stoma operation, 156 cases non-stoma operation. The total incidence of postoperative complication was 27.0% （51/189）. Of all, incision bleeding was 1 case, abdominal (deep) bleeding were 4 cases, anastomosis bleeding were 5 cases, pulmonary infection was 1 case, wound infection were 7 cases, urinary tract infection were 3 cases, abdominal (deep) infection was 1 case, unknown fever were 19 cases, superficial layer wound dehiscence was 1 case, wound co-liquation were 15 cases, anastomosis leakage were 3 cases, rectovaginal fistula were 2 cases; intestinal obstruction were 7 cases, urinary retention were 7 cases, stress ulcer were 2 cases. Follow-up in 2-10 months after operation, there was no death case. The baseline between MDT group and non-MDT group was equal. The ratio of postoperative blood transfusion of MDT group was obviously less than that of non-MDT group （P＜0.05）. Moreover, the operation time of MDT group was obviously shorter than that of non-MDT group, and the difference was statistically significant （P＜0.05）. But the ratio of laparotomy and laparoscopic operation, of stoma operation and non-stoma operation, as well as the types of radical excision operation of rectal cancer didn’t show any statistical difference between two groups (Pgt;0.05). The postoperative venting time, defecation time, intake time didn’t show any statistical difference between two groups too. But the postoperative out-of-bed activity time and the postoperative in-hospital days of MDT group was obviously shorter than that of non-MDT group, and the difference was statistically significant （P＜0.05）. In MDT group the postoperative total complication rate was less than non-MDT group, and the difference was statistically significant （P＜0.05）. Among all the complications, the MDT group had a lower rate of wound infection, wound co-liquation and urinary retention （P＜0.05）. Using multifactorial logistic regression analysis, the risk factor which influenced the postoperative complication rate in MDT group were: postoperative intake time and postoperative hospitalization time. But the risk factor in non-MDT group was only according to postoperative hospitalization time. Conclusion The patients who were treated by MDT, definite operative method combining neoadjuvant chemotherapy or not didn’t increase the postoperative complication rate and risk. So it could be believed that such a composite treatment was feasible and safe in early postoperative stage. But it needs further studies to evaluate the medium- and long-term clinical effect.

终末期冠心病原位心脏移植一例

目的 总结终末期冠心病患者施行心脏移植的临床经验，探讨术后血管病变的预防策略。 方法 在体外循环下采用双腔法原位心脏移植。术后采用环孢菌素A、骁悉和泼尼松等药物抗排斥反应，并监测其血药浓度。结果 患者术后8h清醒，56h脱离呼吸机。围手术期过程平稳，术后1个月心功能分级（NYHA）恢复至Ⅱ级，10个月后恢复至Ⅰ级。 结论 心脏移植可作为冠心病患者的终极治疗措施，术后对患者进行系统的药物治疗十分重要。

Endoscopic Submucosal Dissection for Early Colorectal Cancer

男性乳房发育症诊治分析

目的　探讨男性乳房发育症的诊治方法。 方法　对2000年1月－2012年8月收治的35例男性乳房发育症患者的诊断治疗方法进行回顾性分析。 结果　8例行手术切除，效果满意；10例服用药物三苯氧胺加平消片治疗3个月，腺体组织消退； 8例停用一些药物或改变饮食后半年消失； 1例3岁误服避孕药而诱发的患儿，停药后2个月消退；其余8例找不到原因且无症状患者，目前仍在随访观察中。 结论　男性乳房发育症有多种原因引起，生理性的无需治疗，病理性的需积极治疗原发病，如为药物引起可酌情考虑停用有关药物，然后予对症治疗，必要时手术切除。

DIAGNOSIS AND TREATMENT OF ACUTE MEDIAL COLLATERAL LIGAMENT RUPTURES OF THE KNEE

Objective To study the diagnosis and treatment of the acute medial collateral ligament ruptures of the knee.Methods From August 1998 to August 2003, 87 cases of acute medial collateral ligament ruptures were examined with physical method and MR imaging. Out of them, 35 cases of Ⅰdegree and Ⅱ degree ruptures were treated with non-surgery and 52 cases of Ⅲ degree ruptures were treated surgically. The torn medial collateral ligaments were mended, 21 of which were strengthened with the anterior partial gracilis muscle tendon after the arthroscopy. Results In 35 cases of Ⅰ and Ⅱ degree ruptures, 32 were followed up 13 months on average. According to Lysholm scoring system, the clinical results were classified as excellent or good in 93.7% of the cases. In 52 cases of Ⅲ degree ruptures, 50 were followed up 16 months on average. The excellent or good result was 90%.Conclusion For Ⅰ and Ⅱ degree ruptures, MR imagimg is an important way to definitely- diagnose medial collateral ligament ruptures. Abduction stress test of knee extension shows that the medial direct instability is a main way to definitely diagnose Ⅲ degree ruptures. The results of conservative treatment of Ⅰ degree and Ⅱ degree ruptures are excellent. Surgical therapy are fitfor the cases of Ⅲ degree ruptures. 

绝经后子宫颈巨大宫内膜囊肿一例

Experience of Diagnosis and Treatment for Spontaneous Perforation of Sigmoid Colon in The Aged

目的　探讨老年人自发性乙状结肠穿孔的病因、诊断及治疗方法。方法　对四川大学华西医院胃肠外科中心2009～2011年期间收治的9例自发性乙状结肠穿孔老年患者的临床资料进行回顾性分析。结果　9例患者中7例有长期便秘史，术前均诊断为“全腹膜炎、腹腔脏器穿孔”而行急诊手术。术中见穿孔位于直乙交界处6例，乙状结肠中上段3例，均在系膜对侧缘。3例行病变处肠段切除加远端封闭、近端造瘘术（Hartmann术），4例行乙状结肠部分切除吻合、横结肠双腔造瘘术，1例行穿孔修补术，1例行穿孔修补加横结肠造瘘术。8例患者治愈出院，1例患者因经济原因放弃治疗。结论　老年人自发性乙状结肠穿孔临床上较少见，其发病与解剖学因素、病理学因素密切相关，便秘等是其重要诱因。及时手术、选择适宜的手术方式以及彻底清除腹腔污染是治疗成功与否的关键。

围手术期多学科协作诊治流程在继发性甲状旁腺功能亢进症中的临床应用

目的总结多学科协作诊治（multidisciplinary team，MDT）模式运用于继发性甲状旁腺功能亢进症（secondary hyperparathyroidism，SHPT）的效果。方法回顾性收集 2017 年 3 月至 2019 年 5 月期间在成都市第三人民医院按照 MDT 流程完成手术的 45 例 SHPT 患者的临床资料。结果本组 45 例患者的手术均顺利，无术中死亡和围手术期死亡患者。手术时间 56～220 min、（125±40）min；术中出血量 2～30 mL、（12±7）mL；住院时间 7～12 d、（9.07±0.86）d；术前准备时间 2～5 d、（3.26±0.72）d；术后拔管时间 2～5 d、（3.20±0.69）d。与术前的 iPTH 水平相比，术后 1 h、术后 1 周和术后 1 个月的 iPTH 水平均降低（P<0.05）。患者术后的血钙和血磷水平均较术前降低（P<0.01），但手术前后的血钾水平比较差异无统计学意义（P=0.55）。术后 32 例患者的骨及关节疼痛症状均不同程度缓解，其中 3 例无法行走患者可以下地自行行走；9 例瘙痒患者的症状也有明显缓解；4 例不宁腿患者中有 3 例明显缓解；40 例乏力患者中有 15 例自述术后 1 周后乏力症状缓解，19 例自诉术后 1～2 个月一定程度缓解。术后 2 例出现重度低钙血症，1 例出现出血，1 例出现声音轻度嘶哑，6 例出现肺部感染，1 例出现脂肪液化，2 例出现 SHPT 复发。术后有 3 例患者于半年后失访；有 19 例患者于当地医院完成随访，随访时间为8 个月～2.5 年，中位数为 14.5 个月，未出现复发；其余患者于成都市第三人民医院随访 6 个月～2.5 年，中位数为 13.5个月，也未出现复发。结论MDT 的诊疗流程是保障围手术期安全的前提，该流程可以让内外科医生各司其职，紧密配合，更好地监测患者内环境，以减少术后并发症，降低手术风险，缩短术前准备时间，提高治疗效果，最大限度地保障患者安全。

中国癫痫诊断治疗现状

随着认识的深入和研究的进展，近年来国际癫痫学科领域先后对癫痫的定义、分类及诊断治疗进行了重要更新，国内癫痫学科团队不仅在诊疗实践中紧跟国际步伐，力争使我国癫痫医疗可及性及质量位居世界前列，还在抗癫痫药物的规范使用、添加治疗、微创手术及共病防治等多方面为世界癫痫诊疗的进步做出了众多贡献。目前，我国癫痫诊疗面临的最大问题是癫痫医疗资源的发展不平衡，治疗缺口仍大，进一步推行和完善中国癫痫医疗质量指标体系建设，或将成为解决我国癫痫诊治全面规范化及同质化的重要策略。

49例结核性毁损肺的外科治疗

目的 总结结核性毁损肺手术治疗的经验。 方法 回顾分析我院近12年来手术治疗49例结核性毁损肺的临床资料，其中行右肺上叶切除术11例，右全肺切除术9例，左肺上叶切除术3例，左全肺切除术25例，左上余肺切除术1例。全组未作胸廓成形术。术中出血量200～4 000ml，输血31例，输血量300～3 600ml。手术时间1.8～8.0h。 结果 无手术死亡，18例痰抗酸杆菌涂片阳性患者全部转阴。随访2个月～11年10个月。术后并发支气管胸膜瘘3例，血胸4例，胸腔积液3例，乳糜胸1例，均采用相应的治疗而治。 结论 手术治疗结核性毁损肺，应做好防范手术风险和预防术后并发症的充分准备。