食管胃吻合技术的改进及临床应用

目的 为探讨食管癌、贲门癌行根治术后,胃重建食管时食管胃吻合技术,以预防吻合口瘘、狭窄及出血的发生.方法 采用机械吻合、手工缝合加同、胃底高位悬吊及胸膜覆盖相结合.结果 采用此法吻合的38例患者无吻合口瘘发生.结论 此吻合法适用于食管胃吻合术,安全可靠,能有效地预防吻合口瘘的发生,有推广价值.     

经腹近端胃大部分切除食管胃隧道式吻合术的体会

目的 探讨经腹近端胃大部分切除食管胃隧道式吻合术的临床应用价值.方法 回顾分析89例经腹近端胃大部分切除食管胃隧道式吻合术的临床资料.结果 对89例病人术后观察无吻合口瘘,术后返流性食管炎发生率低,吻合口狭窄的机会少.结论 经腹食管胃隧道式吻合术可减少吻合口瘘,防止胃食管返流及吻合口狭窄,易操作,恢复快.     

经腹经食管裂孔老年性贲门癌根治术临床分析

目的探讨老年性贲门癌经腹经食管裂孔手术方式的安全性。方法回顾性分析2000年至2007年间336例65岁以上贲门癌患者经腹经食管裂孔行根治性切除,利用吻合器将残胃或空肠与食管行端侧吻合的临床资料。结果本组未发生死亡,无吻合口漏,返流性食管炎157例,吻合口狭窄15例,应激性溃疡10例,呃逆50例,胃瘫17例,术后住院时间11～25天。结论老年贲门癌患者经过术前适当调整接受经腹经食管裂孔手术方式是安全的,且并发症少,恢复快。     

经腹经食管裂孔老年性贲门癌根治术临床分析

目的探讨老年性贲门癌经腹经食管裂孔手术方式的安全性。方法回顾性分析2000年至2007年间336例65岁以上贲门癌患者经腹经食管裂孔行根治性切除,利用吻合器将残胃或空肠与食管行端侧吻合的临床资料。结果本组未发生死亡,无吻合口漏,返流性食管炎157例,吻合口狭窄15例,应激性溃疡10例,呃逆50例,胃瘫17例,术后住院时间11～25天。结论老年贲门癌患者经过术前适当调整接受经腹经食管裂孔手术方式是安全的,且并发症少,恢复快。     

从贲门癌食管浸润长度探讨手术径路的合理选择

目的 探讨贲门癌手术径路的合理选择.方法 对施行根治性手术的120例贲门癌患者,测量其食管浸润长度,分析手术径路选择的合理性.结果 83例患者食管浸润长度≤2cm,其中Ⅰ型(癌灶中心位于胃食管接合部的接合线以上)25例,经腹入路1例,经胸腹入路2例,经胸入路22例;Ⅱ型(癌灶中心位于接合线及以下)58例,经腹入路50例,经胸腹入路8例.37例患者食管浸润长度＞2 cm,其中Ⅰ型9例均经胸腹入路;Ⅱ型28例,经腹入路3例,经胸腹入路25例.所有患者上切缘均无癌残留.结论 当贲门癌食管浸润长度≤2 cm时,Ⅰ型选择经胸及经胸腹入路,Ⅱ型以经腹入路手术为主;当食管浸润长度＞2 cm时,Ⅰ型和Ⅱ型以经胸腹入路手术为主.依据贲门癌食管浸润长度,合理选择手术径路,可避免切缘癌残留,达到根治目的.     

胃大部切除术后吻合口癌、贲门癌及食管癌的外科治疗

目的 探讨胃大部切除术后吻合口癌、贲门癌及食管癌的外科治疗.方法 回顾性分析21例胃大部切除术后吻合口癌、贲门癌及食管癌患者的临床资料.其中贲门癌术后吻合口癌4例;胃溃疡胃大部切除术后贲门癌2例;胃溃疡胃大部切除术后食管上段癌3例;胃溃疡胃大部切除术后食管中段癌6例;胃溃疡胃大部切除术后食管下段癌6例.行残胃全切+食管部分切除,空肠食管吻合术6例;食管胃部分切除,弓下食管胃吻合3例;食管次全切除结肠代食管12例.结果 术后切口感染1例,吻合口瘘1例,1例死于肺部感染,随访20例患者中,4例术后第3年死于心脑血管意外,存活的16例患者饮食基本正常.结论 胃大部切除术后吻合口癌、贲门癌及食管癌患者若全身情况许可,无远处转移均应争取手术治疗,消化道重建器官的选择应根据患者首次手术切除情况及术者熟练程度而定.     

食管贲门癌术后吻合口瘘预防的有关问题

食管贲门癌术后吻合口瘘是常见严重的并发症,死亡率33.2%,占手术死亡的首位。国内25组材料吻合口瘘发生率为4.3%。影响吻合口瘘的因素很多,诸如患者营养状况,吻合口局部血运,吻合张力,吻合技术,吻合方式,癌肿残留,感染等有关。现就有关问题提出并加以讨论。临床资料自1972年以来行食管贲门癌切除,食管胃吻合820例,其中男性607例(70.02%),女性213例(25.98%)。切除后行食管胃颈部吻合329例(40.12%),弓上吻合105例(12.8%)。弓下吻合386例(47.07)。发生吻合口瘘27例(3.29%),死亡12例(44.44%),为总人数的1.71%。     

食管胃前壁“围巾式”吻合术的临床应用

目的探讨食管胃吻合术并发症的防治方法。方法食管下段、贲门癌患者行食管胃前壁“围巾式”吻合,重建胃底术式。结果本组26例,随访均未发生吻合口瘘,吻合口狭窄2例,经内镜扩张2次后缓解;有2例出现反酸、烧心症状,服用奥美拉唑和莫沙比利后缓解;无1例出现胸骨后灼痛症状。结论采用食管胃前壁“围巾式”吻合对减少术后吻合口并发症有效。     

食管贲门癌切除术后吻合口瘘的治疗体会

目的总结36例食管贲门癌切除术后食管胃吻口瘘的治疗体会,分析吻合口瘘的相关因素.方法回顾36例食管贲门癌切除术后吻口瘘的临床资料,5例2次手术治疗,31例保守治疗.结果35例治愈,1例死亡.结论发生吻合口瘘的因素较多,但最重要的仍是手术操作的熟练、手术方式和技巧.对早期吻合口瘘,如无明显的手术禁忌证,则二次手术可以提高治愈率.对中晚期瘘患者,尤其是胸腔严重感染者,则应以保守治疗为主.     

体外预测泌尿系结石理化性质的研究进展

目的 探讨贲门癌手术径路的合理选择。方法 对施行根治性手术的120例贲门癌患者，测量其食管浸润长度，分析手术径路选择的合理性。结果 83例患者食管浸润长度≤2cm，其中Ⅰ型（癌灶中心位于胃食管接合部的接合线以上）25例，经腹入路1例，经胸腹入路2例，经胸入路22例；Ⅱ型（癌灶中心位于接合线及以下）58例，经腹入路50例，经胸腹入路8例。37例患者食管浸润长度〉2cm，其中Ⅰ型9例均经胸腹入路；Ⅱ型28例，经腹入路3例，经胸腹入路25例。所有患者上切缘均无癌残留。结论 当贲门癌食管浸润长度≤2cm时，Ⅰ型选择经胸及经胸腹入路，Ⅱ型以经腹入路手术为主；当食管浸润长度〉2cm时，Ⅰ型和Ⅱ型以经胸腹入路手术为主。依据贲门癌食管浸润长度，合理选择手术径路，可避免切缘癌残留，达到根治目的。     

Oral satiety in the obese and nonobese.

Elapsed mealtime, number of mouthfuls per meal, and the time each mouthful was chewed were observed in thirty subjects, fourteen of whom were obese and sixteen, nonobese. Obese subjects consumed their meals and chewed mouthful in significantly less time than did nonobese subjects. There was no significant difference between the two groups in the number of mouthfuls per meal. In obese subjects, oral satiety as assessed in this study, appeared to play a less-than-meaningful role in the attainment of postprandial satiety. The clinical implications of these observations are discussed.     

腹腔镜下不同手术入路根治术治疗右半结肠癌疗效研究

目的探讨腹腔镜下不同手术入路根治术治疗右半结肠癌的疗效。方法选取2012年1月—2015年12月于我院接受腹腔镜手术治疗的右半结肠癌患者90例,统计患者的一般资料并按照中间入路和尾侧中间联合入路方式分为Ⅰ、Ⅱ两组,记录并分析两组手术时间、术中出血量、清扫淋巴结数量等术中情况以及恢复排气排便时间、引流时间、住院时间等术后情况;用Sysmex全血细胞分析仪分别对两组患者手术前后白细胞进行计数。结果两组患者的一般资料均无显著性差异(P>0.05);相比Ⅰ组(中间入路),Ⅱ组(尾侧中间联合入路)所需手术时间显著减少,清扫淋巴结总数以及阳性淋巴结个数显著增多(P<0.05);Ⅱ组引流时间长,引流量大,患者中位生存期长,术后3年存活率高,与Ⅰ组相比差异具有统计学意义(P<0.05);同组内比较,手术后患者血清中白细胞数水平显著升高(P<0.05)。两组间比较,手术前两组血清中白细胞数差异不显著(P>0.05);手术后两组白细胞数亦无显著性差异(P>0.05)。结论腹腔镜手术中采用尾侧中间联合入路方式治疗右半结肠癌,具有较好的远期疗效。     

Oral contraceptives and cancer of the reproductive organs

This article, prepared by the medical consultant to the International Planned Parenthood Federation, reviews recent evidence regarding oral contraceptives (OCs) and cancers of the reproductive organs. Several case-control and prospective studies not only have shown that OCs do not increase the risk of cancer of the endometrium or ovary, but also that OC use exerts a protective effect against the development of these cancers. The current evidence suggests that there is no overall increase in the risk of breast cancer among OC users, but the possibility that particular groups of women (i.e., those with a history of benign breast disease or a family history of breast cancer, those who used OCs before their 1st full-term pregnancy, and women who used OCs before the age of 25 years) may be at higher risk cannot be excluded. There have been reports that breast cancer tumors have more favorable outcomes in OC users than in nonusers. Finally, the evidence that the risk of cervical cancer may be slightly increased by prolonged OC use is stronger, but not yet definitely confirmed. Most of the studies that have found an increased risk of cervical dysplasia or carcinoma of the cervix among OC users have not controlled properly for selection, diagnostic, or confounding bias. It is noted that many of the OC users included in epidemiologic studies were taking OCs marketed in the early 1960s that contained higher doses of estrogen and progestagen than preparations on the market today. Given the lack of conclusive evidence regarding the risk of cervical dysplasia and malignancy in OC users, cervical smears should be obtained on a regular basis. Despite these cautionary measures, it is concluded that OCs remain one of the most reliable methods of contraception available.     

贲门癌45例手术治疗体会

目的:总结贲门癌45例手术无吻合口瘘的治疗经验,以避免或减少吻合口瘘的发生.方法:对我院自2003年10月～2004年9月手术治疗的45例贲门癌无吻合口瘘进行回顾性分析.结果:贲门癌45例手术无吻合口瘘的发生.结论:手术中保留吻合口两端的血运、加强对吻合口的保护和减少吻合口的张力等措施和术后加强围手术期的饮食管理,可避免或减少吻合口瘘的发生.     

MSCT肝癌微血管侵犯征象对肝癌术后复发的相关性分析

目的 探讨MSCT肝癌微血管侵犯征象对肝癌术后复发的相关性。方法 对我院行根治性切除的孤立性肝癌患者进行为期2年的随访，以是否复发作为随访终点；并对其术前MSCT资料进行回顾性分析，将MSCT肝癌微血管侵犯征象与随访结果进行对照分析。结果 MSCT肝癌微血管侵犯征象与病理肝癌微血管侵犯、肝癌术后复发均存在显著相关性（均P<0.05）。MSCT肝癌微血管侵犯征象预测肝癌术后复发的敏感度、特异度以及准确度分别为71.88%（23/32）、81.48%（22/27）以及76.27%（45/59）。结论 MSCT肝癌微血管侵犯征象与肝癌术后复发具有一定的相关性。     

胸大肌肌皮瓣修复口腔癌根治术后组织缺损

目的探讨带蒂胸大肌肌皮瓣修复口腔癌根治术后大面积组织缺损的临床效果。方法对11例中晚期口腔癌,其中舌癌6例、口底癌2例、颊癌2例、下牙龈癌1例,进行联合根治术,同期采用胸大肌肌皮瓣修复术后口腔颌面部组织缺损。结果11例中8例肌皮瓣全部成活,外形及功能恢复良好。另3例肌皮瓣部分坏死,换药后痊愈。随访1～9年无局部复发,2例舌癌患者术后2年死于肺转移。结论带蒂胸大肌肌皮瓣血供丰富组织量大,同期修复中晚期口腔癌根治术后大面积组织缺损安全可靠,疗效满意。     

Carcinoma of the lung in Iceland: 1931-1974

During the period 1931-1974, 464 cases of primary lung cancer were diagnosed in Iceland. Only 34 cases were recorded from 1931-1954, but during the next two decades 156 cases and 274 cases were reported, a total of 430 cases which are analyzed in this paper. There is a preponderance of small cell anaplastic carcinoma 33.4% in this series. Epidermoid or squamous cell carcinoma was found in only 24.7% of cases and large cell anaplastic carcinoma in 15.4%. During the period 1955-1974, 143 major surgical procedures were performed for lung cancer in this country, 68 exploratory thoracotomies and 75 resections. Of the resections 58.7% were pneumonectomies. There were 3 surgical deaths in the resected series, for a mortality of 4%. Pneumonectomy carried a mortality of 6.8%, but lobectomies or segmental resections carried no mortality. In the resected series the absolute 5-year survival rate is 29.3%. Patients with epidermoid lesions have the most favorable prognosis. There is a definite correlation between tobacco consumption or cigarette smoking in Iceland and the rising incidence of lung carcinoma.     

Carcinoma of the lung in Iceland: 1931–1974

During the period 1931–1974, 464 cases of primary lung cancer were diagnosed in Iceland. Only 34 cases were recorded from 1931–1954, but during the next two decades 156 cases and 274 cases were reported, a total of 430 cases which are analyzed in this paper. There is a preponderance of small cell anaplastic carcinoma 33.4% in this series. Epidermoid or squamous cell carcinoma was found in only 24.7% of cases and large cell anaplastic carcinoma in 15.4%. During the period 1955–1974, 143 major surgical procedures were performed for lung cancer in this country, 68 exploratory thoracotomies and 75 resections. Of the resections 58.7% were pneumonectomies. There were 3 surgical deaths in the resected series, for a mortality of 4%. Pneumonectomy carried a mortality of 6.8%, but lobectomies or segmental resections carried no mortality. In the resected series the absolute 5-year survival rate is 29.3%. Patients with epidermoid lesions have the most favorable prognosis. There is a definite correlation between tobacco consumption or cigarette smoking in Iceland and the rising incidence of lung carcinoma.     

Invasive epidermal carcinoma of the cervix in a woman with an IUD: A case report

A case is described of a 36 year old woman who was admitted to the Gynecological Service because of irregular uterine bleeding of 3 months duration. Speculum examination showed a large erosion of the cervix, and biopsy revealed a carcinoma of the cervix.There is no doubt that no casual relationship exists between the intrauterine contraceptive device that had been inserted into her uterus one year prior to discovery of the carcinoma and the cervical cancer, yet attention is drawn to the importance of regular routine check-ups of women who have an IUD, especially when irregular uterine bleeding occurs.     

口腔种植牙患者的围手术期护理

目的：探讨口腔种植牙患者的围手术期护理的意义。方法：医护人员对牙种植患者术前、术中、术后三个阶段实施术前准备、健康教育、心理护理。结果：短期随访未发现种植体松动失败病倒，无医疗纠纷发生。结论：良好的口腔种植牙患者的围手术期治疗和护理可提高种植成功率，减少医疗纠纷。