A controlled clinical trial of whole gut lavage as a method of bowel preparation for colonic operations.

In a prospective randomized clinical trial, whole gut lavage was evaluated against conventional mechanical cleansing for colonic operations. The lavage took less time to perform, was better tolerated by patients, and resulted in more satisfactory preparation as judged by frequency of collapsed intestines. There was no difference in the outcome in the two series as measured by wound infection rate and length of hospitalization. It is concluded that whole gut lavage is as good as conventional mechanical cleansing but surpasses the latter in logistic advantages.     

Mechanical bowel preparation for colonic resection and anastomosis

In a series of 72 consecutive elective and emergency colectomies with primary anastomosis, all pre- and perioperative mechanical preparation of the bowel was omitted and the patient covered only by a single peroperative intravenous dose of cefuroxime and metronidazole. No anastomotic dehiscence was clinically apparent and wound infection was noted in only 8.3 per cent of patients.     

Preoperative evaluation and general preparation for chest-wall operations

Chest-wall reconstruction is a major procedure with a risk of life-threatening complications. Accurate preoperative assessment is therefore critical, as it allows detection and treatment of correctable problems and permits the surgeon to individualize postoperative management. Risk factors may be cardiovascular, pulmonary, or nutritional. The guiding principle of planning for the reconstruction is that there must be absolutely no tension at the site of the full-thickness defect in the chest wall.     

Palliative operations for lung cancer

The goal of the palliative resection can be threefold: relief of symptoms without expected survival benefit, obviation of an urgent situation and maintenance or restoration of a good quality survival. Clear distinction should be made between this type of operation and incomplete resection: in spite of a curative intent, the latter type of operation is characterized either by residual disease or positive most distal lymph node station. Classification of palliative operations for lung cancer based on the underlying pathology seems to be most suitable for clinical use: 1) tumours without extrapulmonary extension; 2) tumours with direct involvement of adjacent organs; 3) metastatic involvement of intrathoracic or distant organs; 4) lung tumours associated with nonmalignant pathology (lung suppuration, pleural empyema). Although palliative operations for lung cancer can be considered in carefully selected patients, they should always be avoided if other, less aggressive non-surgical procedures offer the same quality of palliation.     

结肠癌腹腔内淋巴化疗的临床研究

目的　观察结肠癌患者术前麻醉诱导期联合应用善宁、卡铂对结肠淋巴结铂浓度的影响 ,以及预防性腹腔内淋巴化疗对术后腹膜后淋巴结转移的影响。　方法　 182例结肠癌患者随机分为预防性腹腔内淋巴化疗组 (90例 )和对照组 (92例 ) ,均行根治性切除术。淋巴化疗组患者 ,在术前麻醉诱导期开始联合应用善宁 (0 1mg ,2次 )、卡铂 (2 0 0mg) ;对照组仅用卡铂 (2 0 0mg)腹腔内化疗 ,比较 2组患者术中结肠边缘淋巴结、中间淋巴结以及中央淋巴结铂浓度。 2组患者术后继续腹腔内淋巴化疗或腹腔内化疗 ,以腹部CT检查比较其对术后腹膜后淋巴结转移的影响。　结果　腹腔内淋巴化疗组患者用药 2、3h后 ,边缘淋巴结、中间淋巴结以及中央淋巴结铂浓度明显高于对照组 ;术后腹膜后淋巴结转移率明显低于对照组 ,差异均有极显著性意义 (P <0 0 1)。 2组门静脉血液铂浓度、转移淋巴结与未转移淋巴结之间铂浓度差异均无显著性意义 (P >0 0 5 )。　结论　联合应用善宁、卡铂可明显提高结肠淋巴结铂浓度 ,减少术后淋巴转移 ,是一种有效的腹腔内淋巴化疗方式。     

A 10% mannitol solution effective for colonic preparation for X-ray

Hydroelectrolytic changes, the time of action and complications induced by oral administration of 10 per cent mannitol solution in the colonic preparation for X-ray examination were examined. Twentysix patients were examined using two different solution volumes: one liter in 15 patientsand two liters in 11 patients. No significant biochemical changes were noted. X-ray study of the colon revealed an insufficient evaluation in 3.8 per cent, sufficient in 7.6 per cent, and good in 88.6 per cent of cases. In 6 per cent nausea and vomiting occurred, in 11.7 per cent abdominal distention, and in 7.6 per cent hypotension. This approach was well tolerated, particularly when one liter of the solution was used. Footnote: These data were presented at the 7th World Congress of CICD in Japan, September 6–9, 1982.     

A 10% mannitol solution effective for colonic preparation for X-ray

Hydroelectrolytic changes, the time of action and complications induced by oral administration of 10 per cent mannitol solution in the colonic preparation for X-ray examination were examined. Twenty-six patients were examined using two different solution volumes: one liter in 15 patients and two liters in 11 patients. No significant biochemical changes were noted. X-ray study of the colon revealed an insufficient evacuation in 3.8 per cent, sufficient in 7.6 per cent, and good in 88.6 per cent of cases. In 6 per cent nausea and vomiting occurred, in 11.7 per cent abdominal distention, and in 7.6 per cent hypotension. This approach was well tolerated, particularly when one liter of the solution was used.     

直肠癌手术方法的进展

手术是结直肠癌治疗的难点,也是争论最大、进展最快的领域之一.围绕追求手术的根治性并延长生存期,同时尽量保留肛门功能、提高患者的生活质量的目标,近年来直肠癌手术无论是在理念、具体方法、辅助手段等方面都有了很大的发展.因篇幅所限,本文仅综述近年来直肠癌手术方法的进展.     

Palliative operations for incurable gastric cancer

The experiences of 206 patients who underwent palliative operations for advanced gastric carcinoma have been reviewed to evaluate the effect of treatment. Gastroenterostomy for obstruction alleviates vomiting for most patients, but significant palliation followed operation in only 1/3 of cases. The procedure was accomplished with an acceptable mortality rate, and the average period of postoperative hospitalization was 13 days. The results of palliative partial gastrectomy for patients having obstructive symptoms preoperatively were only slightly better than those following gastroenterostomy. Approximately 1/3 of the patients lived in relative comfort for more than a year. The poor progress of 6 patients who received total gastrectomy supports the opinion that total gastrectomy is not a satisfactory palliative operation. Palliative esophagogastrectomy for patients with dysphagia gave results similar to, or possibly better than, palliative resections for distal lesions. Although the results following the use of prostheses for inoperable malignant stricturing of the esophagogastric junction were disappointing, the procedure had significant advantages when compared with the marked limitations and disadvantages of jejunostomy and the transient relief afforded by transesophageal dilatation. Review of the records of patients who had had a feeding jejunostomy confirmed the general opinion that this procedure seldom is indicated in the management of advanced gastric carcinoma.

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Résumé L'efficacité des opérations palliatives pour cancer gastrique avancé a été revue dans une série de 206 cas. La gastroentérostomie pour obstruction supprime les vomissements dans la majorité des cas, mais ne donne une palliation valable que dans 1/3 des cas; la mortalité est acceptable et la durée d'hospitalisation est, en moyenne, de 13 jours après l'opération. Chez les malades ayant des symptomes d'obstruction, les résultats de la gastrectomie palliative sont à peine meilleurs que ceux de la gastroentérostomie: ±1/3 des patients ont une survie confortable pendant plus d'un an. Les résultats décevants de 6 gastrectomies totales confirment l'inutilité de cette opération à titre palliatif. En cas de dysphagie, l'oesogastrectomie palliative donne des résultats comparables à ceux des résections pour lésions distales, peut-être même meilleurs. Les résultats des prothèses internes pour les lésions inopérables sténosant la jonction oesogastrique ont été décevants; la méthode est cependant supérieure à la jéjunostomie, dont le bénéfice est minime et les inconvénients majeurs, et à la dilatation oesophagienne dont les résultats sont fugaces. L'analyse des dossiers de malades avec jéjunostomie d'alimentation confirme l'opinion générale: cette opération est rarement indiquée dans le cancer gastrique avancé.

     

蓖麻油和聚乙二醇4000在结直肠癌术前肠道准备中的联合应用

目的:为探索联合应用蓖麻油与聚乙二醇4000在术前肠道准备中的肠道清洁效果.方法:选取结直肠癌病例96例,随机分为3组,A组予以蓖麻油、B组予以聚乙二醇4000,C组予以蓖麻油十聚乙二醇4000进行术前肠道准备,分别观察患者末次排便是否为清水样便、开腹后小肠是否瘪塌以及切开结肠时肠腔是否清洁.结果:显示联合应用蓖麻油与聚乙二醇4000组末次排便呈清水样便的发生率为93.9%,术中小肠瘪塌的发生率为100%,切开结肠的肠腔清洁发生率为100%.结论:结果表明,联合应用蓖麻油与聚乙二醇4000有着良好的肠道的清洁效果.临床上适合应用于术前肠道准备.     

Patient preparation in pediatric surgery

This article has outlined the developmental concerns which make pediatric preparation for surgery a necessity. The goals, methodology, and essential elements of programming have been presented, along with a review of the supporting literature. Some of the major concerns expressed by children have been illustrated. In summary, the following are the essential points to keep in mind when planning pediatric patient care: Honesty. There is no substitute for the trust developed between an honest physician and the patient. Awareness of developmental concerns. The timing, wording, and presentation of preparation materials must be based on an accurate assessment of the child's cognitive and emotional readiness. Involvement of the patient and parent in decision making, treatments, and procedures whenever possible. Patients and families who feel in control are much more trusting and receptive to the physician's plan. Follow-up. Make certain the patient and family are aware of your continued concern for their well-being. In addition, ask what they feel helped them and their child the most, and what could have been done to be more helpful. This helps continued refinement of a program designed to meet client needs.     

Radical combined colonic resection for cancer recurrence

Experience of reoperative radical combined colonic resection for colonic cancer in 9 patients was presented. There were no complications, nor mortality. The preoperative radiation therapy and chemotherapy conduction had permitted to create an optimal conditions for the surgical intervention performance, which promoted the patients life span increase and improved its quality significantly.     

达芬奇机器人系统辅助右半结肠切除术

目的 探讨达芬奇机器人系统辅助右半结肠切除术的安全性与可行性.方法 总结2010年5-11月完成的5例达芬奇辅助右半结肠切除术的方法 及术后恢复情况.结果 5例患者行右半结肠切除,其中1例同时行胆囊切除.手术均顺利完成,无中转开腹.手术时间140～200 min,术中失血量30～80 ml.术后无并发症发生.结论 达芬奇机器人系统应用于右半结肠癌手术是安全可行的.

Abstract：

Objective To investigate the safety and feasibility of robot-assisted laparoscopic right hemicolectomy for colonic cancer. Methods These 5 patients with ascending colonic cancer received robot-assisted laparoscopic right hemicolectomy. Results All operations were performed successfully. There was no postoperative complications. Da Vinci surgical system was found to be associated with fewer hemorrhage, rapid postoperative intestinal recovery, and therefore a shorter hospital stay. Conclusions Robot-assisted laparoscopic right hemicolectomy can be applied safely and with feasibility for colonic cancer.     

Extended and combined operations for lung cancer

On the basis of classificating components of the TNM system 1720 patients with "later" stages of the development of lung cancer were selected from 3000 patients with this disease operated upon in the clinic for many years. Specific features of performing extended and extended combined operative interventions, treatment at the postoperative period are described and substantiated. After their discharge from the hospital correspondingly 26% and 21.5% of the patients who had the IIIA stage of the disease are alive for more than 5 years, that convinces in expediency of their surgical treatment.