目的 评价全直肠系膜切除术在直肠癌手术中的价值。方法 回顾性分析148例中下段直肠癌接受全直肠系膜切除术的情况。结果 148例平均失血150 ml（50～600 ml），平均手术时间4.3 h，保肛103例（69.6%），其中Dixon术96例，改良Bacon术7例。术后发生吻合口漏3例（2.9%），全组发生切口感染（包括会阴切口、造瘘口）5例（3.4%）。随访2年以上的病例117例，局部复发8例（6.8%），其中保肛86例中局部复发2例（2.3%），非保肛31例中局部复发6例（19.4%），无尿潴留及性功能丧失，无手术死亡。结论 全直肠系膜切除术使直肠癌患者更容易达到治愈，局部控制及保留括约肌，保留性功能和膀胱功能的标准，且出血少，不增加手术时间及吻合口漏和切口感染。
目的 探讨局麻下经胸前入路行腔镜甲状腺手术的体会。方法 对2009年3月至2010年3月期间四川省南充市中心医院普外科收治的28例在局麻下行腔镜甲状腺手术患者术中及术后情况进行回顾性分析。结果 1例因术中冰冻检查发现为甲状腺癌而转开放性手术未纳入分析。视觉模拟镇痛评分（VAS）: 术中评分结果为0～5分，平均2.2分; 术后评分结果为0～3分，仅2例口服布洛芬缓释胶囊镇痛，其余25例未使用镇痛药物。手术时间为95～215 min，平均117 min; 术中出血量为50～150 ml，平均84 ml。术后引流量为25～70 ml，平均34 ml； 引流管放置时间为2～4 d。住院时间平均4.5 d。术后颈部及胸壁皮下无瘀血、肿胀，无声嘶、呛咳。经随访2~10个月（平均8个月），未见切口处明显瘢痕。结论 局麻下经胸前入路行腔镜甲状腺手术切实可行，并具有良好的美容效果。
Objective To analyze inducing factors and clinical characteristics of deep venous thrombosis (DVT) and to explore clinical value of soluble cell surface differentiation antigen 40 ligand (sCD40L) in early diagnosis of DVT. Methods The patients with the DVT of lower extremity who had not received the anticoagulant and thrombolytic therapy in the Nanchong Central Hospital from January 2012 to January 2017 were collected, these patients were divided into an early-acute stage, mid-acute stage, late-acute stage, and subacute stage according to the clinical course of DVT. The sCD40L expression in the peripheral blood of DVT patients were detected by the enzyme linked immunosorbent assay. Results There were 100 patients with the DVT were included, including 31 cases of early-acute stage, 26 cases of mid-acute stage, 21 cases of late-acute stage, and 22 cases of subacute stage; 66 patients with the peripheral type, 28 patients with the central type, and 6 patients with the mixed type. ① The fracture, malignant tumor, long time in the bed following the thoracic or abdominal operation, joint replacement, and caesarean section were the successively main risk factors of the DVT. ② The early-acute stage of DVT was more common in the fracture patients, the mid- and late-acute stage of DVT often occurred in the joint replacement sufferer, and the subacute stage of DVT was usually found in the malignant tumor patients. ③ The sCD40L expression in the patients with the different stage DVT was signifiantly higher than that in the control group (20 healthy people in the physical examination, P<0.05). Furthermore, there was a significant difference in the different stage DVT patients (F=26.57, P=0.02), that is, the expression of sCD40L was the highest in the early-acute stage of DVT, and then gradually reduced (P<0.05). ④ The sCD40L expression had a significant difference among the central type DVT, mixed type DVT, and peripheral type DVT (F=12.51, P=0.02), which in the peripheral type DVT was significantly higher than that of the central type DVT (P<0.05) and mixed type DVT (P<0.05), but had no difference between the central type DVT and the mixed type DVT (P>0.05). ConclusionsCD40L might act as a blood index of early diagnosis and judgement of extent of DVT, especially be helpful in early-acute stage of DVT.