回盲部憩室炎的外科诊治探讨

目的探讨回盲部憩室炎的诊断和手术方式的选择。方法 27例回盲部憩室炎患者,其中末段回肠憩室炎10例,盲肠憩室炎10例,升结肠憩室炎7例。根据憩室部位、大小及周围肠管是否受累选择手术方式,包括憩室单纯切除术、回肠部分切除+端端吻合术、回盲部切除+回肠升结肠端侧吻合术。结果全组患者均获治愈,无围手术期死亡,无吻合口漏等严重并发症发生。结论回盲部憩室炎与急性阑尾炎临床表现极为相似,常需术中探查方能确诊。术中应注意探查,避免遗漏病变,根据憩室的具体情况选择合适的术式。     

结肠憩室的外科治疗

目的探讨外科治疗结肠憩室的方式及疗效。方法回顾性分析手术治疗的14例结肠憩室患者的临床资料。憩室位于盲肠5例,升结肠3例,降结肠2例,乙状结肠4例,均行手术治疗,包括行憩室切除结肠吻合术5例,回盲部切除+回肠升结肠端端吻合术3例,右半结肠切除术2例,乙状结肠憩室切除、造口+直肠残端闭合4例(Hartmann术,6周后行二期吻合)。结果手术均获成功,无手术并发症,效果满意。结论结肠憩室出现穿孔、出血、脓肿及腹腔感染等并发症时宜行手术治疗,应根据憩室部位、大小、并发症及腹腔感染程度选择不同手术方式。     

介绍一种回结肠端端套入式吻合术的方法

我们于1975～1980年对回盲部切除或右半结肠切除的20个病例,其中盲肠、升结肠及结肠肝曲癌共10例,回盲部淋巴肉瘤3例,回盲部结核3例,均采用右半结肠切除回肠横结肠端端套入式吻合术;肠套叠致回盲部坏死2例,右腹股沟斜疝嵌顿致回肠末段、回盲部及阑尾坏死1例,回盲部扭转致肠坏死1例,术中均行坏死部肠管切除回肠升结肠端端套入式吻合     

创伤性腹股沟疝囊内回盲部破裂的手术方法选择(附3例报道)

目的总结创伤性腹股沟疝囊内回盲部肠管破裂的治疗经验以供临床参考。方法回顾性分析笔者所在医院于2000年1月至2016年12月期间收治的3例创伤性腹股沟疝囊内回盲部肠管破裂患者的临床资料。结果 3例患者均为男性,其中1例右腹股沟滑动性疝患者行回盲部切除、回肠升结肠端侧吻合术;1例右腹股沟斜疝患者行回肠末端破裂清创吻合术,附加盲肠回肠皮管造瘘以保留回盲瓣;1例右腹股沟斜疝患者行改良的经盲肠回肠皮管造瘘术。2例避免了切除回盲部的过度医疗之嫌。术后3例患者均一期治愈,无吻合口漏、修补口瘘、腹腔脓肿形成、切口感染等并发症发生。术后3例患者均获随访,随访时间2~3年,随访期间无一例疝复发。结论对创伤性腹股沟疝囊内回盲部肠管破裂患者,需根据损伤部位及损伤程度施行不同的手术。     

回盲部切除术

外科手术治疗的基本原则是要彻底切除病变组织和尽可能多保留正常组织。我们认为回盲部疾病的手术治疗也应遵循以上原则。由于升结肠没有可活动的肠系膜,肠管比较固定,血运较差,回盲部切除回肠升结肠吻合术受到一定的限制。因此,许多报道主张回肓部疾病的手术应采用右半结肠切除的术式。我院1966～1984年间收治79例回盲部疾病患者.其中行右半结肠切除术57例,行回盲部切除术22例。现结合本     

小儿肠套叠的外科手术治疗

分析2008年6月—2013年6月我科手术治疗的35例肠套叠患儿的病例资料,探讨生理解剖因素与疾病的关系。25例患儿行肠套叠复位+固定术;3例行坏死肠段切除、结肠回肠端侧吻合术+固定术。7例未见套叠。测量盲肠及升结肠长度,目测回盲部粗细及夹角,观察肠系膜淋巴结大小。手术无死亡。术后1例并发腹壁疝,1例切口感染,随访38±1.5个月,无复发病例。患儿盲肠及升结肠平均游离长度9.50+1.57cm;8例合并回盲瓣肥厚,2例合并Mecke憩室,21例合并肠系膜淋巴结炎。小儿肠套叠可能与过度游离的盲肠及升结肠长度、回盲部淋巴结肿大等生理解剖因素有关。     

腹腔镜阑尾切除术中盲肠憩室炎的处理

目的探讨腹腔镜阑尾切除术中盲肠憩室炎的处理方式。方法我院2010年3月~2015年4月934例腹腔镜阑尾切除术中发现盲肠憩室炎16例,根据憩室大小及周围炎症程度行腹腔镜憩室切除术和开腹右半结肠切除术、回盲部切除、盲肠部分切除术及憩室切除术。结果腹腔镜憩室切除术3例;中转开腹手术13例:右半结肠切除术1例,回盲部切除3例,盲肠部分切除术6例,憩室切除术3例。手术时间25~90 min,平均45.3 min。术中出血量5~160 ml,平均31.6 ml;术后肠功能恢复时间1~5 d,平均3 d;术后住院时间3~8 d,平均7 d。16例术后随访10~48个月,平均36.3月,无腹痛、腹胀等发生。结论盲肠憩室炎的临床特征与急性阑尾炎相似,极易误诊,腹腔镜手术中要仔细探查,避免漏诊,根据术中具体情况决定手术方式。     

升结肠部分切除治疗回盲部良性疾病

升结肠部分切除治疗回盲部良性疾病孟庆晨，于卫光，党永康，钱海波我院１９８３～１９９４年１２月采用升结肠部分切除，回肠一升结肠吻合术治疗回盲部良性病变患者３２例，男２１例，女１１例，年龄５个月～６７岁。回结肠套叠肠坏死１２例，肠梗阻回肠末端坏死７例，阑...     

美克耳氏憩室炎与阑尾炎并存一例

患儿女性,9岁。以急性阑尾炎之诊断,在硬膜外麻醉下行阑尾切除术。手术进入腹腔见有混浊的炎性渗液,距回盲部30cm处回肠对系缘膜肠壁有指状1.5×1.5cm憩室,尖端肿胀发黑。距回盲部45cm处回肠亦有3.5×4cm的憩室,也明显充血。两憩室均与邻近肠管粘连。探查见阑尾肿胀、充血。同时做阑尾切除、两处憩室肠管楔形切除术。术后病理诊断:急性美克耳氏憩室炎,急性蜂窝织炎性阑尾炎。     

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近回盲瓣回肠末段端端吻合术系指切除病变末段回肠及其系膜 ,结扎、切断回结肠动脉回肠支 ,近端小肠与靠近回盲瓣末段回肠行端端吻合术。此术式由于受传统解剖观念影响 ,即因局部供血不足吻合后会缺血坏死 ,认为距回盲瓣 5cm以内的吻合易发生吻合口漏 ,故临床上不主张此处行端端吻合术。笔者曾收治 5例 ,均行此术并取得了成功。介绍如下。1　临床资料本组 5例病人 ,男 3例 ,女 2例。年龄 3 5～ 75岁 ,中位年龄 55 2岁。根据临床表现不同 ,共分 2组。肠梗阻组 :共 3例。例 1 男 ,65岁。系小肠多发性憩室并发粘连性肠梗阻病人 ,术中见空肠散在…     

Management of diverticulitis of the ascending colon. 10 years' experience

Diverticulitis of the ascending colon is an uncommon disease which mimics appendicitis. The correct diagnosis is rarely made, but can be suggested by the patterns of signs and symptoms and confirmed by barium contrast study. Diverticulitis of the ascending colon should be treated by the same plan as diverticulitis of the left colon. If the diagnosis is established, nonoperative management is indicated initially. Operation is indicated when the diagnosis is in doubt, when perforation has occurred, or when the patient does not respond to nonoperative treatment. At operation, ascending colon diverticulitis can be recognized as an inflammatory mass involving the wall and mesentery of the colon. The inflammatory mass is best treated by resection with primary anastomosis of the ileum to the ascending or transverse colon in an area removed from the site of infection.     

Three cases of diverticular perforation of the caecum and ascending colon

Perforation of the ascending colon secondary to diverticulitis is an uncommon surgical emergency. It is usually diagnosed during exploratory laparotomy for suspected appendicitis. We report three cases of cecal perforation due to diverticulitis. Imaging work-up, especially computed tomography can establish the preoperative diagnosis of cecal diverticulitis and guide its management.     

Metachronous ileal cancer after surgery for ascending colon cancer in a patient with Lynch syndrome: A case report

Introduction and importanceColorectal surveillance via colonoscopy in patients with Lynch syndrome reduces the mortality of colorectal cancer. On the other hand, it is unclear whether surveillance for other malignancies, including small bowel cancer, is beneficial. We report a patient with Lynch syndrome who developed ileal cancer after surgery for ascending colon cancer.Case presentationA 47-year-old man visited our hospital for a check-up for positive fecal occult blood. He was diagnosed with ascending colon cancer and met the clinical criteria for the diagnosis of Lynch syndrome based on his past and family history. The Bethesda markers demonstrated high-frequent microsatellite instability. Laparoscopy-assisted right hemicolectomy was performed. He received follow-up colonoscopy the next year, which revealed ileal cancer near the anastomosis. He underwent resection of the second cancer via a laparoscopic approach, and has been free from recurrence for five years.Clinical DiscussionSmall bowel cancer has a dismal prognosis because a high percentage of patients were diagnosed at advanced stages. The diagnosis of metachronous ileal cancer by the first follow-up colonoscopy after surgery for ascending colon cancer offered a long disease-free survival in our patient.ConclusionThe clinical course suggested the importance of inspecting the small bowel in Lynch syndrome patients, especially when colorectal cancer is diagnosed.     

结肠憩室病致急腹症的诊疗效果分析

目的探讨结肠憩室病的临床特点及腹腔镜下结肠憩室病的手术方式及疗效。 方法回顾性分析2013年6月至2018年7月在广州市花都区人民医院诊断为结肠憩室病的32例患者资料。其中男11例,女21例;憩室发生在直肠4例,乙状结肠2例,左半结肠6例,回盲部20例;2例行腹腔镜检查后因家属拒绝行肠切除,遂终止手术,接受抗感染治疗;30例行肠切除手术,包括乙状结肠切除2例,直肠切除4例,右半结肠切除11例,降结肠部分切除5例,回盲部切除+空肠结肠吻合术8例,其中7例行临时性降结肠造瘘术,半年后行降结肠造瘘回纳术。14例为腹腔镜探查后中转开腹手术,16例为腹腔镜下完成手术。 结果2例抗感染治疗后症状缓解,术后1个月随访,结肠镜检查无阳性,至今憩室炎未复发。30例手术效果满意,术后恢复良好,无手术相关并发症,随访未见腹泻、大便次数增多等不适症状。回盲部切除与右半结肠切除两种术式并发症发生率比较,差异无统计学意义（50.0% vs 36.4%,χ²=1.584,P=0.812）。腔镜手术患者术后胃肠功能恢复较中转开腹手术更快（t=8.062,P<0.01）,住院时间更短（t=8.607,P<0.01）。 结论诊断结肠憩室后一期行部分肠切除手术治疗安全、有效,腹腔镜行部分肠切除较传统手术更具优势。     

成人结肠脾曲综合征102例的诊断与外科治疗

目的 总结成人结肠脾曲综合征(syndrome of splenic flexure of colon,SSFC)的诊断与外科治疗经验.方法 对1989年7月至2010年10月收治的102例SSFC病人的临床资料进行回顾性分析.结果 本组病人以反复发作性腹痛、腹胀及便秘并顽固性不全结肠梗阻为主要临床表现.98例X线钡剂...     

食管腐蚀性烧伤后严重狭窄的外科治疗

目的探讨食管腐蚀性烧伤后狭窄的外科治疗经验及胃或横结肠代食管重建手术的应用价值。方法对98例食管腐蚀性烧伤后狭窄的患者中72例广泛食管狭窄、病变超过食管中段以上者采用横结肠代食管、保留结肠左动脉升支、胸骨后顺蠕动吻合,其中横结肠咽腔吻合18例,横结肠食管颈部吻合54例,胸段食管旷置不切除;26例狭窄位于中下段,经胸切除瘢痕段食管用胃重建食管,胃食管胸内吻合。结果结肠食管重建72例中,术后死亡4例（5．56％）,发生颈部吻合口瘘14例（19．44％）,后期出现颈部吻合口狭窄7例,经治疗后均痊愈。胃重建食管26例无手术死亡,术后发生胸内吻合口狭窄3例,经扩张治愈。结论食管腐蚀性烧伤后狭窄在伤后20～24周可积极采取食管重建术,根据食管狭窄段严重程度及位置决定是否行狭窄段食管切除、选择食管重建替代物及吻合的位置。可采用横结肠食管颈部吻合或结肠咽腔吻合术,胸内胃食管吻合术。     

Perforated sigmoid diverticulitis: Appraisal of primary versus delayed resection

The surgical management of forty patients with perforation of the sigmoid colon secondary to diverticulitis is reviewed. A distinction is made between free perforation with diffusing peritonitis and perforation leading to pericolic and mesocolic abscess formation. Delayed resection after preliminary transverse colostomy proved to be a safe and effective procedure in twenty-four patients. Primary resection without anastomosis was used in six patients with excellent results. Primary resection with immediate anastomosis was carried out safely only in selected patients with mesocolic abscess. In patients with free perforation and diffusing peritonitis or pericolic abscess, the benefits of immediate excision of diseased perforated colon are obtained, but the hazards of an immediate anastomosis are avoided by the two stage procedure of primary resection without anastomosis.     

Acute colonic diverticulitis

Colonic diverticulosis is truly a disease of the 20th century. A direct correlation is thought to exist between the incidence of diverticular disease and the amount of dietary fiber. Acute colonic diverticulitis occurs in approximately 25 per cent of the patients with diverticula, and 20 per cent of the patients with diverticulitis will ultimately require surgical intervention. Because of the often virulent nature of the disease in younger patients and the prevalence in the geriatric population, an aggressive approach is advocated. Primary resection of the involved segment of colon is advocated in all cases requiring operation. A primary anastomosis can be constructed in stage I and some cases of stage II disease. This results in lower morbidity and mortality rates as well as fewer days of hospitalization and disability. Newer techniques such as diagnostic CT scanning, percutaneous drainage of diverticular abscess, and greater application of surgical stapling devices have done much to improve the ultimate outcome of colonic diverticulitis.     

Diverticulitis: selective surgical management.

The surgical treatment of complications of diverticulitis remains most challenging. A review of twenty years' experience with one hundred fifteen cases is presented with one proved anastomotic leak and no deaths. Interval primary resection with anastomosis for chronic recurrent disease including colovesical fistula and mesocolic abscess was proved sate with low morbidity. The three-stage procedure for perforated diverticulitis with spreading peritonitis or pericolic abscess was associated with a high rate of complications and morbidity. An aggressive approach with resection without anastomosis in two stages is indicated.