OPERATIVE BIOPSY OF THE PANCREAS USING THE TRUCUT NEEDLE

The results of 14 operative biopsies of the pancreas using the Trucut technique are presented. There was no significant complication attributable to the biopsy, and in all cases an adequate tissue specimen was obtained, facilitating either frozen or paraffin section histological diagnosis. One false negative result was obtained which was due to sampling error. This technique is recommended as a good alternative when operative pancreatic biopsy is required. It is technically simple, has an acceptably low sampling error, provides a good tissue specimen for histological examination, and has few complications.     

OMENTOPLASTY IN ABDOMINOPERINEAL RESECTION OF THE RECTUM

Book reviews in this article: An omental pedicle graft, based on the right gastro-epiploic artery to facilitate perineal healing, was used in 20 cases of abdominoperineal resection of the rectum. There was one postoperative death. Primary healing of the perineum occurred in all cases. The technique is described and recommended.     

CEPHALORIDINE PROPHYLAXIS IN RESECTION OF THE LARGE INTESTINE

A controlled prospective clinical trial of cephaloridine chemoprophylaxis in resection of the large intestine was undertaken between 1974 and 1978. Data were available on 159 of 177 unselected patients. All were operated on by one surgeon. Three groups were studied: intraabdominal resection and anastomosis (102 patients); pullthrough resection and anastomosis (30 patients): and resection, with colostomy or ileostomy, without anastomosis (27 patients). In the total patient series cephaloridine reduced wound infection from 38.3% to 15.4% (P< 0.003). There was no significant decrease in intraabdominal infection. In the group of patients undergoing intraabdominal resection and anastomosis the wound infection rate was reduced from 40.0% to 14.9% (P< 0.01). Cephaloridine reduced wound infection from 50.0% to 21.4% (P = 0.05) in those patients in whom drainage tubes were inserted. A decrease in the incidence of faecal fistula from 10.9% to 4.3% was not significant. Wound infections were not reduced significantly after pullthrough excisions or resections without anastomosis. The results support the routine prophylactic use of cephalosporins in patients undergoing intraabdominal resection of the large intestine with anastomosis.     

消化性溃疡外科治疗的手术方式

胃十二指肠溃疡是消化道常见疾病,随着各种新药和治疗方法的不断出现,临床上绝大多数消化性溃疡属内科治疗范畴,但仍有一些特殊类型的、难治性的溃疡及其并发症仍需外科治疗。现简要介绍其常见的手术方式及其适应证。1　外科手术治疗消化性溃疡的理论基础外科治疗溃疡的主要目的是消除或减少引起胃酸分泌的因素,去除溃疡病灶。手术方式有胃大部切除术和迷走神经切断术以及由此衍变的各种术式。其中胃大部切除术切除了大部分胃的主细胞和壁细胞,减少胃酸和胃蛋白酶的分泌场所,消除胃酸分泌的体液因素,且术后返流的碱性十二指肠液也可中和胃酸…     

保留肛门括约肌手术治疗低位直肠癌

对应用保留肛门括约肌手术治疗低位直肠癌64例作回顾性分析。5年生存率81.25％，局部复发率8．62％。讨论了手术方法的依据，手术适应证和术后并发症的防治。结果表明，对适当选择的低位直肠癌病例．保留肛门括约肌手木的生存率和病人生括质量都是令人满意的。     

切断胰腺显露门静脉法提高胰头癌手术切除率

目的探讨胰头癌手术中,与传统手术方法比较,切断胰腺显露受累门静脉法对提高切除率的作用。以及胰头癌姑息性切除的临床意义。方法回顾10年间手术治疗的94例累及门静脉的胰头癌。1997年1月-2002年3月45例为传统手术方法组;2002年3月-2007年5月49例为手术改进组,对有血管浸润者,采取切断胰腺显露受累门静脉的方法切除肿瘤,配合局部放疗、化疗。并进行随访。结果传统手术方法组总的切除率35．56％;直接切断胰腺法组65．31％,P=0．0075。两组围手术期并发症及死亡率无显著差别。前者术后6个月生存率97．78％,1年71．11％,3年24．44％;后者分别为97．96％,75．51％,46．94％。术后3年生存率比较,差异有显著性,P=0．040。结论切断胰腺显露受累门静脉法简单、安全,对于有门静脉浸润的胰头癌,可以显著提高手术切除率,延长患者远期生存时间。     

PRIMARY LYMPHOMA OF THE PANCREAS

Lymphoma of the pancreas is uncommon. Secondary invasion from contiguous, retroperitoneal lymph node disease is the predominant mode of involvement. Lymphoma originating in and remaining localized to the pancreas is very rare. A case of primary lymphoma confined to the pancreas, in a 35 year old man, is described. Only two other similar cases could be found in the English literature.