输血增加创伤后感染的危险性

业已证明,输血可导致器官移植和肿瘤病人的免疫抑制。创伤病人的感染与输血的关系则仍有争议。本文旨在评估输血对创伤后感染的固有影响。作者对8所医院1987～1989年两年间住院48小时以上的5366例病人进行研究,年龄在13岁以上。大面积烧伤和远端肢体骨折病人除外。记录损伤原因、计算简略损伤评分(AIS)、损伤严重性评分(ISS)和修正创伤评分(包括呼吸频率、Glasgow昏迷评分及收缩血压)所需要的资料。入院时收缩血压低于90mmHg者定为休克。记录住院第一个24小时和整个住院期间的输血总量。医院内感染的确定以(美国)疾病控制中心的标准为根据。下列感染定为轻型感染:静脉炎和血栓性静脉炎、急性上呼吸道感染、尿道炎和尿路     

结肠直肠癌的局部复发

一、概况结直肠癌经切除术后在肿瘤床或其周围重新生长称为结直肠癌局部复发。局部复发如发生在结肠周围脂肪、肠系膜或淋巴结,则称为腔外复发。如发生在吻合口的缝合或钉合线上,则称为腔内复发。复发癌可单独发生在吻合口,也可与腔外复发并存,且以后者更常见。局部复发可引起严重病     

整段肝外胆管的小肠节段置换

80～97%的良性胆道狭窄为医源性损伤所致。各种重建手术的远期效果常不满意。自体组织和异种物质成形术由于具有保留生理性的乳头通道、防止食物反流等优点而常被用于重建技术,且这种重建手术保证了食物和胆汁的充分混合。作者对小肠节段置换整段肝外胆管进行了实验研究。材料和方法:实验动物为小猪12只,实验周期420无。静脉全麻后,先作胆囊切除术,高位胆总管插入T管。然后制备带血管的一小肠段作移植物。在T管开口的远端切除3～6cm的一段胆总管。小肠段在对系膜边劈开,并转移至十二指肠上的肝十二指肠韧带,其远端向Vater氏壶腹。胆总管空肠远、近端吻     

胃肠外科重症APACHEⅡ评分的临床意义（附244例分析）

采用前瞻性研究对１９９２年１２月至１９９５年９月期间胃肠外科入院需要进入ＳＩＣＵ监护和治疗的２４４例病人进行了急性生理学和慢性健康状况评分（ＡＰＡＣＨＥⅡ）。ＡＰＡＣＨＥⅡ评分统一在入ＳＩＣＵ第一个２４小时进行，所有病例随访至出院或死亡，记录每例转归，并与ＡＰＡＣＨＥⅡ总分作相关性分析。结果显示，全组２４４例ＡＰＡＣＨＥⅡ总平均分值为１１．２分，最低为５分，最高为３７分。存活病例共２１６例，平均分值为９．７分。死亡共２８例，病死率为１１．５％，死亡２８例的ＡＰＡＣＨＥⅡ评分平均为２２．６分（Ｐ＜０．００１）。全组ＡＰＡＣＨＥⅡ１０分以下共１５２例，１例死亡（０．７％）；１０～２０分６９例，死亡１０例（１４．５％）；２０～３０分２０例，死亡１４例（７０．０％）；３０分以上３例，全部死亡。病死率高低与ＡＰＡＣＨＥⅡ分值有密切的关系。本组风险病死率与实际病死率作回归分析，其ｒ＝０．９０５，Ｐ＜０．００１。从ＲＯＣ曲线可发现，其风险预测的准确性较高。急诊手术病人的ＡＰＡＣＨＥⅡ平均分值高于选择性病人，其手术死亡率也明显高于选择性手术病人。     

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最近几十年 ,世界逐渐进入了一个知识爆炸的信息年代。医学新知识每年以 6 7%速率递增 ,医学领域中的各种新理论、新知识、新技术、新方法、新药物层出不穷 ,日新月异。医学文献资料辅天盖地、浩如烟海。普通外科也毫不例外。外科医师想掌握了解本学科的最新进展和成果 ,必须坚持每天阅读大量的文献 ,在今天这个信息传递高度发达的年代 ,方法和技术上是没有困难的。但是 ,人的精力是有限的 ,时间也是紧缺的 ,医疗、教学和科研任务又非常繁重 ,因此 ,外科医生面对大量的信息 ,要求对自己专业知识的更新做到面面俱到是不现实的。另外 ,在实际…     

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.     

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.     

全直肠系膜切除支撑捆扎法低位或超低位结肠-直肠(肛管)吻合术

目的介绍在全直肠系膜切除基础上用支撑捆扎法完成低位直肠癌低位或超低位结肠-直肠(肛管)吻合手术术式。方法对346例低位直肠癌在全直肠系膜切除和根治性清扫基础上,用支撑捆扎法进行保留肛门括约肌手术,对直肠断端距齿状线≥1cm者用改良Welch手术完成结肠-直肠吻合术;直肠断端距齿状线≤1cm者行保留肛门内括约肌的结肠-肛管吻合术。结果本组346例手术中无死亡病例,术后近期出现吻合口漏4例(1·2%),局部引流2周治愈2例、横结肠造口转流2例,无吻合口出血。吻合口距离齿状线距离:2~3cm者114例,1~2cm者145例,0~1cm者87例。术后吻合口狭窄10例,狭窄率2·9%。Lifetable法计算5年生存率和局部复发率分别为78·6%及6·3%。手术后3个月排便功能的优良率为82·6%。结论支撑捆扎法用于低位直肠癌保肛手术可以完成耻骨直肠肌上缘到肌间沟平面的吻合,吻合口漏和吻合口狭窄发生率较低。     

怎样判断腹腔有无出血

怎样判断腹腔有无出血中山医科大学附属第一医院（广州，５１００８０）詹文华腹腔出血的常见原因有：①腹部闭合伤或开放伤所致的实质脏器（脾、肝和肾）和血管破裂；②腹内脏器病变自发性破裂（如肝癌、输卵管妊娠）；③腹部手术后早期出血。判断典型的腹腔出血困难不大...