术后复发性溃疡56例分析

术后复发性溃疡是指在胃、十二指肠溃疡手术后,发生在吻合口或其附近的溃疡,或无吻合口的手术在胃、十二指肠或空肠发生的新溃疡,称为复发性溃疡。过去称吻合口溃疡或边缘性溃疡,因有些溃疡手术没有吻合口,故称复发性溃疡为宜。我院自1964～1984年共手术治疗术后复发性溃疡56例,分析讨论如下。临床资料性别和年龄:56例中男50例,女6例。年龄19～69岁,平均44.1岁。原发溃疡的部位:本组有记录的49例中。胃溃疡2例,冒及十二指肠复合溃疡1例,幽门溃疡1例,其余45例均为十二指肠溃疡。原手术种类:单纯胃空肠吻合13例(8例为溃疡     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

胃粘液腺癌的临床病理特点及预后

目的：探讨胃粘液腺癌（mucinous gastric carcinoma,MUC)与胃非粘液腺癌（non-MUC)的临床病理差异。方法：1994－2001年收治的438例胃癌中粘液癌36例。比较MUC与non-MUC的临床病理及预后。结果：MUC比non-MUC更易发生浆膜浸润（T3＋T3：MUC94．4％，non-MUC78．9％），浸润性更强（Borrmanm Ⅲ型＋Ⅳ型：MUC88．9％，non-MUC 56．2％）和更易发生淋巴结转移（淋巴结阳性率：MUC94．4％，non-MUC81．1％）。MUC晚期患者比例（Ⅲ Ⅳ：MUC88.9%,non-MUC73.9%)和腹膜播散率高（MUC27．8％，non-MUC 12．4％）。MUC比non-MUC的根治切除率低（MUC 69．4％，non-MUC81．1％）。MUC组的1年，2年生存率分别为50．5％，33．1％，中位生存期为12．2个月；non-MUC组的1年，2组生存率分别为74．9％，64．7％，5年生存率为31％，中位生存期为28．9个月，二者差异有显著性意义（P＜0．01）。结论：MUC的预后差，与确诊时中晚期比例和浆膜浸润率，淋巴结转移率，腹膜播散率高以及根治切除率低有关。     

我国胃癌外科临床研究的现状及方向

胃癌外科治疗的历史如果以Billroth 1881年在维也纳为一位胃癌患者成功施行世界上第1例(BⅠ)胃切除为起点的话,距今已近124年了。本世纪初,胃癌是全球头号杀手的癌肿(the leading cancer killer),其发病率近几十年虽有所下降,但仍然居肺癌之后排第二位。据WHO估计,1999年全球胃癌新发病例为80万。由于人口老化,全球总发病率在下降的情况下,其新发病例数的绝对值还在增加。我国胃癌发病率仍然居所有癌肿的第一位,死于胃癌人数约占全球该病死亡总人数的1/4。我国胃癌的外科治疗经过同道们多年的共同努力,在基础和临床研究方面,作了大量的工…     

快速康复外科在结直肠癌择期手术中的应用效果

Objective To investigate the clinical application of fast track surgery in patients undergoing elective colorectal carcinoma surgery. Methods Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: fast-track group (35 cases) and conventional care group (35 cases). Results Sixty-two patients finished the study, 32 cases in fast-track group and 30 cases in conventional care group. The median and average time to the first passage of flatus (2±1 vs. 4±2, P<0.01), the first passage of stool (3.8±1.6 vs. 6.4±2.5, P=0.0007), resumption of normal diet [(4±2) vs. (8.2±2.2), P<0.01] and the length of postoperative stay (6±1 days vs. 11.7±3.8 days, P<0.01) were much shorter in the fast-track group than in the conventional care group. The preoperative incidence of thirst (2/32 vs. 23/30, P<0.01), hunger (5/32 vs. 20/30, P<0.01) and postoperative infectious complications (2/32 vs. 8/30, P=0.04) were much lower in the fast-track group than in the conventional care group. Conclusion Fast track surgery in patients undergoing elective colorectal resection was safe and effective.     

老年大肠癌659例的临床及病理特点分析

目的 探讨老年大肠癌的临床及病理特点。方法 回顾性分析1994年2月至2006年5月间手术并经病理确诊的65岁及65岁以上（老年组）大肠癌659例的临床资料，对发病情况、肿瘤部位、病理分期、组织分型等方面进行分析，并与同期收治的1115例65岁以下（非老年组）大肠癌的资料进行比较。结果 老年组年龄为65～99岁，平均71．6岁，男：女为1．51：1，具有癌瘤或息肉家族史的患者占3．5％（23／659），非老年组为7．5％（84／1115），两组比较差异有统计学意义（P=0．000）。老年组伴发肠梗阻或同时肝转移的比例分别是14％和9％，老年组中45％的患者肿瘤发生于直肠，其次是乙状结肠（24％），组织学上老年大肠癌以恶性程度较低的腺癌最为常见，而恶性程度高的低分化癌、黏液腺癌和印戒细胞癌所占的比例明显低于非老年组。老年大肠癌临床Dukes分期相对较早，58％的患者为DukesA、B期，明显高于非老年组。结论 老年大肠癌遗传性较低，其发病部位仍以直肠最为常见，同时也表现向近段大肠迁移的趋势，组织分型好、分化程度高、临床分期较早。     

结直肠癌伴同时性肝转移的治疗

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.     

结肠癌联合胰十二指肠切除术

目的探讨结肠癌患者实施联合胰十二指肠切除术(PD)的必要性和方法。方法总结1994年1月至2002年12月间1750例结直肠癌患者中5例横结肠癌患者(0.3%)行联合PD术的临床资料。结果结肠癌联合PD术的5例患者(其中1例加肠系膜上静脉部分切除吻合)均无手术死亡。1例术后并发胰瘘和切口感染,但均康复出院。3例术后半年因肿瘤复发死亡,2例随访至今45个月和72个月仍无瘤生存。结论结肠癌侵犯胰十二指肠较少见。结肠癌联合胰十二指肠切除手术是安全的,能为部分患者提供长期生存的机会。     

胰腺癌肝转移致发作性低血糖1例报告

患者 男,35岁。1989年9月2日入院。入院前四个月来饥饿时头晕、乏力、出汗,继之不省人事,共发作6—7次。发作时当地医院检查血糖为2.1～2.4mmol/L,经静脉注射葡萄糖后苏醒。发作以来未发生精神异常,无腹痛。食欲及大小便如常,体重略有增加。体查 全身营养状况良好,体重60kg。腹部检查未发现异常。血象、大小便常规及血生化检查无特殊。SGPT 257 单位r-GT 180μ/L,凝血酶原时间15秒(正常对照13.4秒),AFP<20μg/L。饥饿试验于禁食14小时后出现低血糖症状,抽血查血糖1.0mmol/L,静注50％葡萄糖80ml后症状消失。纤维胃镜及X线钡灌肠检查无异常。B超显示肝右叶可见多个大小不等的园形低回声     

急性胃粘膜病变

急性胃粘膜病变(Acute gastric mucosal Lesions)又称应激性溃疡(Stress ulceration)或出血性胃炎(Haem-orrhagic gastritis)、急性糜烂性胃炎(Acute erosive gastri-tis),是指机体在严重创伤、大面积烧伤、严重感染和休克等严重应激状态下,胃粘膜的完整性受到损害,胃近端发生急性多发性浅表性胃粘膜糜烂和溃疡。但严格地说,应激性溃疡并非就是急性胃粘膜病变。