经会阴微创腹会阴联合切除术的临床实践

腹会阴联合切除术(APE)仍然是治疗低位直肠癌的标准手术方式。经肛提肌外APE可降低直肠癌环周切缘阳性率和肿瘤穿孔率,但术后并发症发生率较高。随着微创外科技术的不断发展,有研究者提出经会阴微创腹会阴联合切除术(Tpm-APE)。与传统APE比较,Tpm-APE具有潜在技术优势,然而目前缺乏大样本、多中心临床研究证据支持。笔者分享参与一项国际多中心临床研究的设计与结果,探讨目前Tpm-APE治疗低位直肠癌的临床实践。     

经会阴联合术式治疗成人完全性直肠脱垂15例

笔者自2009年1月—2012年12月,采用经会阴直肠黏膜缝合短缩术、直肠周围间隙注射术、肛门紧缩术三种方法联合治疗成人完全性直肠脱垂15例,疗效满意,现报告如下。 1资料与方法 1.1临床资料全部15例均为我科2009年1月—2012年12月收治的住院患者,其中男6例,女9例;年龄最小36岁,最大82岁,平均60.2岁。病程最短1年,最长30年,平均10.6年。参照2002年中华中医药学会肛肠分会制定的直肠脱垂诊断标准[1]（二型三度分类法）,其中Ⅱ度脱垂11例,脱垂长度3～6 cm,肛管位置正常;Ⅲ度脱垂4例,脱垂长度6～12 cm,伴肛管外翻。所有患者均伴有不同程度的肛门松弛。1.2治疗方法患者取截石位或侧卧位,在局麻或骶麻下实施以下联合术式。     

直肠癌腹会阴联合切除臀大肌束拉闭法重建原位肛门术

直肠癌腹会阴联合切除臀大肌束拉闭法重建原位肛门术丁克姜春英管仲安冯继亮山东中医药大学附属医院（济南２５００１１）我科对４例低位直肠癌患者行腹会阴联合切除臀大肌束拉闭法重建原位肛门术，术后重建肛门功能良好，提高了患者生存质量，现报道如下。１手术方法１．...     

腹腔镜低位直肠癌经腹会阴联合切除并侧方淋巴结清扫术

手术采用5孔法,按日本学组提出的3间隙原则进行,TME手术完成第一间隙完整切除后,保护下腹神经丛及下腹神经,清扫其与髂总动脉、髂内动脉之间的第二间隙淋巴结,以及髂内外动脉间闭孔内的第三间隙淋巴脂肪组织。可视肿瘤部位、肿瘤浸润深度以及侧方淋巴结肿大情况,选择性行单侧或双侧的侧方淋巴结清扫。     

腹会阴联合切除术体位操作

腹会阴联合切除术是肛肠科一种常用手术方式。我院１９９６年至１９９８年共采用腹会阴联合切除术式５８例。其中直肠癌患者５４例,直肠、会阴部损伤３例,先天性肛门闭锁１例。最小年龄１岁,最大７８岁,中位年龄４０岁。其中男３２例,女２６例。术中我们先后采取先平卧位术中再改头低脚高截石位和直接取头低脚高截石位两种体位。术中经过顺利,均无不良反应。现就腹会阴联合切除术时体位的摆置操作体会报告如下。作腹会阴联合切除时直接取头低脚高膀胱截石位,不用中途改变体位,这样既可节省手术时间,又可减少术中污染机会,同时使得…     

经腹会阴联合行全阴道切除患者的术后护理

目的探讨经腹会阴联合行全阴道切除患者的术后护理方法。方法对7例经腹会阴联合行全阴道切除术患者给予阴道创面渗液及出血的观察与处理、感染监测、体位及功能锻炼、下肢静脉血栓的预防、心理支持等。结果 7例中2例在术后第3、5天发生阴道创面出血,1例出血量30mL,经压迫止血加重置碘仿纱条填塞后出血停止;另1例出血量为500mL,经压迫止血加重置碘仿纱条填塞,24h后再次发生阴道创面出血,出血量500mL,予以压迫止血加重置碘仿纱条填塞,静脉应用止血药物,出血控制。所有患者未出现其他并发症,术后14~40d康复出院。结论加强对该类患者的术后护理:阴道创面渗液及出血的观察与处理、感染监测、体位及功能锻炼、下肢静脉血栓的预防等,是促进患者康复的重要因素。     

腹会阴联合直肠癌切除术后会阴伤口感染的危险因素分析

腹会阴联合直肠癌切除术(abdominoperineal resection,APR),是治疗低位直肠癌、肛管癌和一些重症炎症性肠病的常用手术方法,会阴伤口感染是术后常见的并发症之一.回顾性分析我院1994-2005年腹会阴联合切除术155例患者的临床资料,并对术后会阴伤口感染发生的相关危险因素进行探讨.     

会阴裂伤修补术24例分析

造成会阴裂伤的主要原因多为孕妇在分娩时会阴发生裂伤未得到及时的修补，或是修补未取得成功。按照会阴的损伤程度可以分为3度，而Ⅲ度裂伤由于对肛门括约肌的功能与结构造成了破坏，患者临床症状表现为不同程度的大便失禁等。     

改良的会阴操作法在经腹会阴联合直肠癌根治术中的应用

Objective To compare the safety and effectiveness of two methods of perineal dissection in 60 consecutive patients of rectal carcinoma undergoing combined abdominoperineal resection.Methods In this retrospective study from 2007 to 2009, 30 cases underwent Miles' operation using modified method of perineal dissection( MM group) and 30 cases undergoing Miles' operation using classic method of perineal dissection ( CM group). Operative time, accidental tumor ( or rectal) perforation during the procedure, iatrogenic injury to the urethra ( or vagina) and postoperative perineal complications were compared between the two groups. Results The mean perineal operative time was (45±15) min in MM group and ( 70 ± 20) min in CM group respectively ( t = 5. 48, P ＜ 0. 05 ). There were no significant differences in the rate of tumor ( or rectal) perforation and that of urethral (vaginal) injury. There were significant difference in the rate of postoperative perineal complications (χ2=4.01, P＜0.05).Conclusions Modified method of perineal dissection is effective and safe, and this method offers a new approach for the perineal dissection during Miles' operation.     

改良的会阴操作法在经腹会阴联合直肠癌根治术中的应用

Objective To compare the safety and effectiveness of two methods of perineal dissection in 60 consecutive patients of rectal carcinoma undergoing combined abdominoperineal resection.Methods In this retrospective study from 2007 to 2009, 30 cases underwent Miles' operation using modified method of perineal dissection( MM group) and 30 cases undergoing Miles' operation using classic method of perineal dissection ( CM group). Operative time, accidental tumor ( or rectal) perforation during the procedure, iatrogenic injury to the urethra ( or vagina) and postoperative perineal complications were compared between the two groups. Results The mean perineal operative time was (45±15) min in MM group and ( 70 ± 20) min in CM group respectively ( t = 5. 48, P ＜ 0. 05 ). There were no significant differences in the rate of tumor ( or rectal) perforation and that of urethral (vaginal) injury. There were significant difference in the rate of postoperative perineal complications (χ2=4.01, P＜0.05).Conclusions Modified method of perineal dissection is effective and safe, and this method offers a new approach for the perineal dissection during Miles' operation.     

Continued assessment of the combined Collis-Nissen operation

The combined Collis-Nissen operation has been performed in 353 patients. Forty-five percent had reflux esophagitis without stricture; 20%, peptic stricture; 72%, a sliding hiatal hernia; 17%, a paraesophageal hernia; 21%, previous antireflux operation; 15%, esophageal spasm; 8%, scleroderma; and 32%, marked obesity. There were 4 postoperative deaths (mortality rate, 1.1%). Complications occurred in 28 patients (8%) and included wound infection (2.2%), esophageal or gastroplasty tube leak (1.7%), bleeding (1.1%), splenic injury, gastric atony, and crural repair dehiscence (each less than 1%). Follow-up includes personal interview, esophageal manometry, and standard acid reflux testing. The average length of follow-up for 261 patients (74%) followed at least 12 months is 43.8 months. Fifty-eight percent have been followed at least 36 months; 41%, 48 months; and 29%, 60 months or longer. Subjectively, in these 261 patients, reflux has been eliminated in 75%, is mild in 11%, is moderate in 9%, and is severe in 5%. Eight percent have postthoracotomy pain; 3%, early satiety ("bloats"); and 1%, postvagotomy diarrhea. Seventeen percent require either periodic or regular esophageal dilations for dysphagia. Objectively, intraesophageal pH studies show good reflux control in 91% and poor reflux control in 9%. Twenty-six patients (10%) have required reoperation for recurrent reflux or dysphagia. These results substantiate satisfactory reflux control using the Collis-Nissen operation in patients at risk for recurrence after standard repairs, but also emphasize that, like other antireflux procedures, the Collis-Nissen operation is not without some degree of postoperative adverse symptoms.     

腹腔镜联合手术的临床应用

目的：探讨腹腔镜联合手术的优越性和临床应用价值。方法：回顾分析2002年12月至2009年12月81例腹腔镜联合手术的临床资料,其中腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）＋腹腔镜阑尾切除术（laparoscopic appendec-tomy,LA）32例,LC＋腹腔镜胆总管探查术20例,LC＋肝囊肿开窗引流术6例,LC＋肠粘连松解术6例,LC＋卵巢囊肿或畸胎瘤切除术11例,LC＋筋膜内子宫切除术3例,LA＋卵巢囊肿切除术2例,完全腹膜外腹腔镜疝修补术＋精索静脉曲张高位结扎术1例。结果：81例腹腔镜联合手术均获成功,无中转开腹及手术并发症发生。结论：腹腔镜联合手术安全、有效,值得临床推广应用。     

Successful combined operation for Takayasu's arteritis.

We report a case of Takayasu's arteritis complicated with aortic regurgitation and severe stenosis of the left coronary ostium and the innominate artery. Simultaneous surgical treatment of aortic valve replacement, coronary ostium endarterectomy, and aortosubclavian artery bypass using saphenous vein were performed. We discuss the choice of simultaneous operation and the option of surgical treatment for coronary ostium lesion due to Takayasu's arteritis.     

联合血管切除的胰腺癌手术再探讨

<正>早期胰腺癌就可以发生胰外播散,由于胰腺癌生物学特性及其解剖位置的特殊性,决定了其浸润至局部淋巴结、肠系膜血管(superior mesentericvein,SMV)、门静脉     

One-stage combined operation of congenital dislocation of the hips in older children

From 1977 to 1983, 17 patients with 20 long-standing congenitally dislocated hips were treated with a one-stage combined operation and then followed for more than 3 years by our institution. The growth of the proximal femur after femoral osteotomy was studied. The average neck-shaft angle was 111 degrees immediately after operation, and 128 degrees at follow-up. The outcome was largely independent of either age at operation or bilateral involvement. Our findings revealed 30% good and 50% excellent results in our patients.     

重睑术联合Y-V成形内眦赘皮矫正术

目的 探讨重睑术同期行Y-V成形法内眦赘皮矫正术的临床应用效果.方法 自2007年5月至2011年11月,对229例单睑伴内眦赘皮求美者行重睑术及Y-V成形内眦赘皮矫正术,将新建内眦的内眦韧带、眼轮匝肌固定于鼻侧腱膜上,使新建内眦具有正常的解剖结构和美观的外部形态.结果 所有求美者泪阜大部分显露,双内眦间距缩短.术后随访3个月至1年,内眦赘皮得到完全矫正,美观自然,无复发,切口瘢痕不明显,效果满意.结论 Y-V成形内眦赘皮矫正术在重睑术同期进行具有设计简单、创伤小、术后效果好、切口瘢痕不明显等优点,值得临床推广.