门静脉高压症合并胃十二指肠溃疡的外科治疗

作者自１９８４年４月至１９９３年２月手术治疗门静脉高压症２７３例，发现合并胃十二指肠溃疡或溃疡出血的共９例，占３．２９％（９／２７３）。贲门周围血管离断术加溃疡切除的幽门成形术５例，脾切除加胃大部切除术１例，胃大部切除术３例。急症手术２例，死亡１例；择期手术７例，无手术死亡。经３～８年随访无溃疡复发和再出血。本文对病因、诊断、手术方式选择进行了分析。     

胃大部切除术后远期并发症的防治

鉴于目前胃大部切除术已在广大基层医院开展,重视胃大部切除术并发症的预防及治疗就显得十分重要。 1 复发性溃疡 胃大部切除术后复发性溃疡多发生在胃肠吻合口或其附近,多发生在十二指肠溃疡术后,BillrothⅡ式多于BiUroth Ⅰ式手术。总的发病率约2％～5％。溃疡复发原因是手术后胃酸未能有效地降低,常见的     

胃十二指肠溃疡急性穿孔1226例临床分析

目的探讨急性胃十二指肠溃疡穿孔的诊断和治疗方法。方法对1980年至2002年期间，我院外科收治的1226例急性胃十二指肠穿孔病人的临床资料进行了回顾性的分析。结果122例保守治疗成功。1104例行手术治疗，其中行单纯穿孔修补术393例，围手术死亡率6．9％。行胃大部切除术和溃疡病局部切除术711例，围手术死亡率0．72％。结论胃大部切除术是胃十二指肠溃疡急性穿孔的主要治疗方法。在保守治疗过程中，应该掌握外科的手术适应证，以便提高治愈率，降低手术死亡率。     

急诊胃大部切除术治疗胃十二指肠溃疡穿孔

目的 探讨适用于基层医院的胃十二指肠溃疡急性穿孔的手术治疗方法。方法 对l99l～2001年收治的胃十二指肠溃疡急性穿孔行急诊胃大部切除术的84例患者临床资料及随访结果进行回顾性分析。结果 84例急诊胃大部切除术的病人术后恢复顺利，痊愈出院，无死亡病例。通过l～5年的随访，患者一般在术后3～4个月生活，体质恢复到正常水平，能胜任日常工作。l例(1．2％)在2年后出现吻合口溃疡。结论 胃大部切除术去除了溃疡病灶和泌酸环境，达到了根治的目的，且手术安全性高。因此，在基层医院，在患者条件许可时，对胃十二指肠溃疡穿孔应尽可能行胃大部切除术治疗。     

胃切除术后复发性溃疡65例临床分析

１９６４～１９９２年间，我院手术治疗胃切除术后复发溃疡６５例。原发溃疡为十二指肠溃疡者占９４．６％。本组中有严重并发症３６例（５５．４％），其中大出血１５例（２５．９％），急性穿孔１２例（１８．５％），梗阻７例（１０．８％），胃空肠结肠瘘２例（３．１％）。复发溃疡的发病原因：胃切除不足２８例（４３．１％），胃窦残留９例（１３．９％），输入袢过长２例（３．１％），胃素瘤５例（７．７％），间置空肠１例     

胃大部切除术后黄疸三例教训分析

胃大部切除术后黄疸三例教训分析马克华我院近２０年来共行胃大部切除术４１６例，其中术后出现黄疸３例，约占０．７２％。现报告如下。例１：男，４９岁。因十二指肠球部溃疡行胃大部切除术（毕Ⅱ式）。术中见溃疡与周围粘连较严重。分离粘连，切除溃疡，术后第２天出现...     

空肠消化性溃疡外科治疗的近期和远期疗效

空肠消化性溃疡是胃大部切除术后的一个严重的晚期併发症。其发生率与上次手术方式有关,在单纯胃空肠吻合术为25～30％。Zenker等发现由于十二指溃疡及胃溃疡而行毕Ⅱ式胃大部切除术者各有6.2％及1.7％的复发率,而行毕Ⅰ式胃大部切除术者则各为12.6％及3.2％。Wells等观察到,对先前已作了胃大部切除术的病人,如果仅行单纯迷走神经切断术而不再次行胃的切除,有24％溃疡复发。     

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目的 探讨胃大部切除术后吻合口溃疡发生的主要原因和手术治疗经验。方法 回顾性分析1996年3月至2001年5年间经手术治疗的9例吻合口溃疡病人的临床资料。结果 8例病人经原吻合口切除和胃空肠Roux-en－Y吻合术，1例行B－I式吻合，术后随访1－5年无溃疡再复发。结论 胃大部切除术后发生吻合口溃疡的主要原因与第一次手术切除胃的范围不够有关。对出现并发症的吻合口溃疡的病例应首先采取外科手术治疗；原吻合口切除和胃空肠Roux-en－Y吻合是治疗吻合口溃疡的效手段。     

胃大部切除术后残胃癌51例临床诊疗分析

目的研究胃大部切除术后发生残胃癌（gastric stump cancer，GSC）的相关因素及治疗结果。方法回顾性分析462例接受胃大部切除术患者的临床资料，共发生GSC51例，残胃癌发病距胃大部切除术平均时间为15年。34例行手术治疗，其中24例行根治手术，10例行姑息性切除；未能切除的17例中，行姑息性胃空肠吻合6例，空肠造瘘4例，活检术2例，未手术5例。结果围手术期无死亡病例，根治性切除和姑息性切除的中位生存期分别为32．7个月和13．2个月。未行手术切除的17例GSC患者，于发病后3～11个月内死亡。51例GSC患者中，原溃疡位于胃部者占23．1％（40／173），十二指肠球部占3．8％（11／289），两者有显著差异（P〈0．05）；采用BillrothⅡ式和BillrothⅠ式胃大部切除术患者的术后GSC发生率分别为12．8％（41／321）和7．1％（10／145），两者比较有显著差异（P〈0．05）。结论外科手术在GSC的治疗中具有积极的意义。GSC多发生于BillrothⅡ式胃大部切除术后且原发溃疡位于胃部的患者，术后10年以上者发生癌变的危险性较大。     

胃大部切除术后典型并发症分析

<正> 胃大部切除术是外科治疗胃十二指溃疡穿孔出血主要方法之一,1980年～1999年我院共作胃大部切除术100例,术后出现并发症者7例。现将该7例典型病例,结合文献分析讨论。 1 典型病例 例1,女、30岁,十二指肠溃疡穿孔修补术后症状不缓解,行溃疡旷置式胃大部切除术。术后72h左季肋部突然剧痛,继之出现     

Sagittal plane analysis of the open and closed methods in children with displaced supracondylar fractures of the humerus (a radiological study)

OBJECTIVES: The aim of this study was to compare the radiological outcome of open and close reduction and osteosynthesis methods in the treatment of type II and III supracondylar humerus fractures in childhood with respect to the immediate post-operative reduction quality in sagittal plane. METHOD: One hundred and forty four-pediatric patients with type IIb and III supracondylar humerus fractures treated at two centers between 1995 and 2005 were evaluated radiologically within a retrospective study. Seventy-six patients (54 boys, 22 girls, mean age 7.6, range 2-12) were treated by closed reduction and cross percutaneous pinning while 68 (49 boys, 19 girls, mean age 7.3, range 2-13) were treated by open reduction. The reduction quality of the open and closed groups was compared on immediate post-operative lateral radiographs by measuring of lateral humerocapitellar angle, anterior humeral line and anterior coronoid line criteria. The reduction quality was classified excellent, good, fair and poor according to the achievement of three, two, one or none of the criteria, respectively. Reductions classified as excellent and good were introduced as acceptable results. RESULTS: At least one criterion was achieved in all the patients of both the groups. The mean humerocapitellar angle was 30.1 degrees in closed reduction group while the mean of it was 29.8 degrees in open reduced group. Radiograph of 48 (63.1%) patients with closed reduction were found to display the anterior humeral line intersecting the middle one-third of capitellum while this criteria was 45 (66%) in open reduction group. The anterior coronoid line was disturbed in three patients in each of both the groups. The reduction quality was evaluated to be excellent in 32 patients, good in 31, fair in 13 at the closed reduction group while these evaluations were 31, 20 and 17 in open reduction group, respectively. Successful reduction was achieved in 74.9% of the patients in closed reduction group and 75% of the patients in open reduction group. CONCLUSION: It is concluded that there was no significant difference between closed and open reductions of pediatric displaced supracondylar fractures with regard to the radiological criteria of reduction quality in sagittal plane.     

Comprehensive review of post–organ transplant hematologic cancers

A higher risk for a variety of cancers is among the major complications of posttransplantation immunosuppression. In this part of a continuing series on cancers posttransplantation, this review focuses on the hematologic cancers after solid organ transplantation. Posttransplantation lymphoproliferative disorders (PTLDs), which comprise the great majority of hematologic cancers, represent a spectrum of conditions that include, but are not limited to, the Hodgkin and non‐Hodgkin lymphomas. The oncogenic Epstein‐Barr virus is a key pathogenic driver in many PTLD cases, through known and unknown mechanisms. The other hematologic cancers include leukemias and plasma cell neoplasms (multiple myeloma and plasmacytoma). Clinical features vary across malignancies and location. Preventive screening strategies have been attempted mainly for PTLDs. Treatments include the chemotherapy regimens for the specific cancers, but also include reduction of immunosuppression, rituximab, and other therapies.     

胆囊炎患者胆汁中内皮素浓度的意义

目的探讨胆囊炎患者胆汁中内皮素浓度及其意义。方法采用放射免疫分析法测定了４０４例单纯型、４８例化脓型和２７例坏疽型结石性胆囊炎患者胆汁中内皮素浓度。结果三型胆囊炎患者胆汁内皮素浓度分别为２７４±８３ｐｇ／ｍｌ,４２３±１１１ｐｇ／ｍｌ和６７５±１３８ｐｇ／ｍｌ,与对照组测值１９４±４７ｐｇ／ｍｌ比较,具有显著性差异（Ｐ＜０．０５～０．０１）。结论胆汁中内皮素参与了胆囊炎的病理过程,其作用机制尚需深入研究。     

Decreasing incidence of cancer after liver transplantation—A Nordic population‐based study over 3 decades

Cancer remains one of the most serious long‐term complications after liver transplantation (LT). Data for all adult LT patients between 1982 and 2013 were extracted from the Nordic Liver Transplant Registry. Through linkage with respective national cancer‐registry data, we calculated standardized incidence ratios (SIRs) based on country, sex, calendar time, and age‐specific incidence rates. Altogether 461 cancers were observed in 424 individuals of the 4246 LT patients during a mean 6.6‐year follow‐up. The overall SIR was 2.22 (95% confidence interval [CI], 2.02‐2.43). SIRs were especially increased for colorectal cancer in recipients with primary sclerosing cholangitis (4.04) and for lung cancer in recipients with alcoholic liver disease (4.96). A decrease in the SIR for cancers occurring within 10 years post‐LT was observed from the 1980s: 4.53 (95%CI, 2.47‐7.60), the 1990s: 3.17 (95%CI, 2.70‐3.71), to the 2000s: 1.76 (95%CI, 1.51‐2.05). This was observed across age‐ and indication‐groups. The sequential decrease for the SIR of non‐Hodgkin lymphoma was 25.0‐12.9‐7.53, and for nonmelanoma skin cancer 80.0‐29.7‐10.4. Cancer risk after LT was found to be decreasing over time, especially for those cancers that are strongly associated with immunosuppression. Whether immunosuppression minimization contributed to this decrease merits further study.     

胃切除术后应用改良Braun术式重建胃肠道预防返流性胃炎

目的探讨预防胃十二指肠溃疡术后碱性返流性胃炎的发生和逆转原残胃粘膜的炎性病变的新手术治疗方法。方法采用胃部分切除术后改良Ｂｒａｕｎ术式对胃十二指肠球部溃疡病急性穿孔并弥漫性腹膜炎２３例病人进行治疗。术后１～２年随访２２例，其中１９例行胃镜复查及残胃液甘胆酸（ＣＧ）测定、幽门螺杆菌（ＨＰ）检查。９例钡餐透视观察残胃排空情况。结果所有病人术后恢复好，Ｖｉｓｉｃｋ分级优良率为９５７％；残胃炎消除率为７３７％；ＨＰ感染率由术前的５８％降至２１％；胃镜及钡餐检查无１例出现胆汁返流，仅１例残胃排空延迟钡餐检查为输出袢粘连。结论改良Ｂｒａｕｎ术式的应用可有效地减少残胃炎发生，对预防残胃炎及残胃癌发生有积极意义     

Risk of lip cancer after solid organ transplantation in the United States

Solid organ transplant recipients have an increased risk of lip cancer, but the reasons are uncertain. Using data from the Transplant Cancer Match Study, we describe the epidemiology of lip cancer among 261 500 transplant recipients in the United States. Two hundred thirty‐one lip cancers were identified, corresponding to elevated risks for both invasive and in situ lip cancers (standardized incidence ratios of 15.3 and 26.2, respectively). Invasive lip cancer incidence was associated with male sex (adjusted incidence rate ratio [aIRR] 2.01, 95% CI 1.44‐2.82), transplanted organ (0.33, 0.20‐0.57, for liver transplants and 3.07, 1.96‐4.81, for lung transplants, compared with kidney transplants), and racial/ethnic groups other than non‐Hispanic whites (0.09, 0.04‐0.2). In addition, incidence increased with age and during the first 3 years following transplant, and was higher in recipients prescribed cyclosporine/azathioprine maintenance therapy (aIRR 1.79, 95% CI 1.09‐2.93, compared with use of tacrolimus/mycophenolate mofetil) and following a diagnosis of cutaneous squamous cell carcinoma (4.21, 2.69‐0.94). The elevation in lip cancer incidence is consistent with an effect of immunosuppression. Notably, the very strong associations with white race and history of prior skin cancer point to an important role for ultraviolet radiation exposure, and cyclosporine and azathioprine may contribute as photosensitizing or DNA damaging agents.     

肾脏黏液样小管状和梭形细胞癌(附2例报道及文献复习)

目的 探讨肾脏黏液样小管状和梭形细胞癌(Mucinous tubular and spindle cell carcinoma,MTSCC)的临床及病理学特点.方法 对本院收治的2例肾脏黏液样小管状和梭形细胞癌患者临床及病理特点进行观察和讨论并结合相关文献复习.结果 2例患者术后诊断:肾脏黏液样小管状和梭形细胞癌.临床及病理特征符合相关文献对该型肾癌的报道,术后长期严密随访无复发.结论 MTSCC是罕见的肾癌分型,症状隐匿,具有独特的病理学特征,早期手术是最佳治疗方法,预后良好,罕见预后较差报道.     

梗阻性黄疸患者血浆可溶性P-选择素与内毒素、D-二聚体的关系及其意义

目的　研究梗阻性黄疸 (梗黄 )患者血浆可溶性P -选择素 (sP selectin ,sP s)与内毒素 (ET )及D -二聚体 (D d)的关系及其意义。方法　应用ELISA和鲎试剂比色法测定梗黄组、急性胆囊炎组和健康人组血浆sP s ,D d和ET含量。结果　健康人组血浆sP s含量为 (93 .43± 17.65 )ng/ml ,ET (0 .0 0 3 0± 0 .0 0 0 4)EU /ml ,D d(0 .3 9± 0 .2 1)mg/L ;急性胆囊炎组血浆sP s含量为 (2 3 3 .3 2± 82 .12 )ng/ml ,ET (0 .40 12± 0 .15 0 6)EU /ml ,D d(0 .76± 0 .2 7)mg/L ;梗黄组血浆sP s含量为 (3 5 1.90± 93 .83 )ng/ml ,ET(0 .3 814± 0 .14 3 0 )EU /ml ,D d(2 .14± 0 .3 7)mg/L。急性胆囊炎组和梗黄组sP s ,D d及ET均高于健康人组 (P <0 .0 1) ;梗黄组ET与急性胆囊组差异无显著性 ,但梗黄组sP s和D d较急性胆囊炎组高 (P <0 .0 1) ,梗黄组的以上二物质含量呈正相关性 (P <0 .0 1) ;急性胆囊炎组sP s与ET呈正相关性 (P <0 .0 1)。协方差分析表明 ,在相同ET含量时 ,梗黄组sP s高于急性胆囊炎组 (P <0 .0 1) ,且与D d有相关性 ,二者有相同变化趋势。结论　胆道梗阻是ET致血管内皮细胞损伤和血小板活化的敏感性因素 ,梗黄患者血液高凝状态与继发性纤溶反应处于动态平衡 ,提示动态监测血浆sP s和D d变化 ,     

甲状腺髓样癌

目的探讨甲状腺髓样癌的诊断要点及临床治疗原则。方法对我院１９７６～１９９６年收治的８８例甲状腺髓样癌的临床资料进行回顾性分析。结果患者均以颈部肿块就诊,可伴发腹泻。病理证实淋巴结转移率７３２４％。散发型甲状腺髓样癌８６例,家族型甲状腺髓样癌２例。误诊率２３８６％（２１／８８）。治疗方法均以手术切除原发灶或合并颈淋巴结清除为主。术后随访局部广泛切除术的５,１０,１５年存活率分别为４５４５％,２５００％,１００％;合并行颈部淋巴清扫术的５,１０,１５年存活率分别为７２４１％,６３１６％,６６６７％。结论甲状腺髓样癌术前确诊困难,但有下列情况应考虑本病：不论甲状腺是否触及肿块,但有淋巴结肿大并伴有顽固性非炎性腹泻者;有家族史者;血清降钙素明显高于或低于正常者。作者主张不论是否触及肿大淋巴结,对甲状腺髓样癌均应行原发灶根治性切除加同侧颈部淋巴清扫术。