梗阻性大肠癌金属支架置入术后并发症的观察及护理

为提高对梗阻性大肠癌肠道内金属支架置入患者的护理水平，本文总结20例梗阻性大肠癌患者肠道内金属支架置入术后并发症的观察及护理。结果显示，本组19例患者支架扩展良好；1例患者支架置入后并发肠穿孔，发现及时，急诊行肠造口术，术后恢复良好。结果表明，梗阻性大肠癌肠道内金属支架置入患者护理重点是加强术后病情观察，及时发现术后并发症，尤其是出血、肠穿孔等严重并发症，以促进患者康复。     

结直肠癌患者围手术期并发症和病死率的研究

目的研究一家教学医院结、直肠癌患者住院期间的并发症和病死率情况。方法收集北京大学第三医院1992—2005年903例结、直肠癌患者的资料,对住院期间的并发症和病死率进行分析研究。结果903例患者中,结肠癌518例,占57.4%;直肠癌385例,占42.6%。住院期间并发症的总发生率为21.8%(197/903),结肠癌为18.3%(95/518),直肠癌为26.5%(102/385)。其中会阴部伤口感染、腹部伤口感染、肺部感染、肠梗阻较常见。吻合口漏的发生率为1.2% (8/717),在结肠癌为0.8%(4/518),直肠癌为2.0%(4/199)。2000年前、后并发症的总发生率没有明显变化。急诊手术的伤口感染、肺部感染、腹腔内感染的发生率明显高于择期手术。结、直肠癌患者住院期间病死率为1.0%。急诊手术的病死率为3.8%(3/80),择期手术为0.5%(2/438)(P= 0.028)。结论2000年后新技术的引入并没有改变结、直肠癌患者住院并发症的发生率。     

左半结肠急诊一期修补或吻合20例临床分析

目的 :探讨左半结肠急诊手术一期修补或吻合的可行性。方法 :对 2 0例左半结肠急诊一期修补或吻合的临床资料进行总结。结果 :本组共 2 0例 ,8例结肠穿孔 ,7例左半结肠癌并完全梗阻 ,5例乙状结肠扭转。术前半小时静脉注射广谱抗生素 ;术中彻底灌洗肠管 ,后一期修补或吻合 ;术后定时扩肛 ,抗感染及静脉高营养。 2 0例均未出现腹腔感染、结肠瘘等严重并发症。结论 :选择合适病例 ;术中彻底灌洗肠管 ,防止腹腔污染及加强围手术期处理 ,左半结肠急诊一期修补或吻合术是可行的 ,有利于缩短病人的住院时间 ,减轻病人痛苦 ,降低费用。     

腹腔镜在医源性结肠穿孔治疗中的应用

目的探讨腹腔镜下修补医源性结肠穿孔的可行性和手术技巧。方法回顾性分析我院2007年10月至2009年12月期间腹腔镜下修补医源性结肠穿孔手术6例患者的临床资料,其中诊断性肠镜检查结肠穿孔2例,治疗性肠镜结肠穿孔4例。结果 6例患者均顺利完成腹腔镜下手术,无中转开腹。3例患者全腹腔镜下完成结肠穿孔修补,2例因破口较大在腹腔镜辅助下完成结肠穿孔修补,1例乙状结肠癌患者肠镜检查结肠穿孔后同时行腹腔镜下乙状结肠癌根治手术,术后未发生吻合口漏、残余感染等并发症。结论腹腔镜下修补医源性结肠穿孔安全、可靠,临床效果肯定。     

特发性结肠穿孔9例报道及文献回顾

目的探讨特发性结肠穿孔的治疗方法及成因。方法结合文献分析2001～2009年期间我院收治的特发性结肠穿孔患者的诊治经过。结果共收治特发性结肠穿孔9例,占同期结肠穿孔患者的28.1%(9/32),其中5例穿孔(5/9)发生在乙状结肠。修剪破口后直接缝合者2例,行结肠双腔造瘘者7例。术后死亡3例。结论特发性结肠穿孔好发于乙状结肠,与其解剖和生理上的特点有关。不明原因结肠穿孔的患者要想到本病的可能。及时、合理的手术治疗,仔细周到的术后管理是治疗成功的关键。     

下肢创伤骨折术后并发Ogilvie综合征

急性假性结肠梗阻又称Ogilvie综合征,是创伤骨折术后一种并不常见的并发症,主要临床指征是大段结肠扩张,若不及时处理,会造成结肠穿孔,甚至死亡.自2002年5月～2007年6月,笔者收治的下肢创伤骨折手术患者538例,9例术后并发Ogilvie综合征.现报告如下.     

异物性肠穿孔10例临床分析

目的 总结消化道异物致成人肠穿孔的临床特征及诊治经验。方法 回顾性分析2011年8月至2020年10月我科收治的10例异物导致肠穿孔患者的临床资料。结果 本组异物性肠穿孔患者中十二指肠穿孔1例,空肠穿孔3例,回肠穿孔4例,乙状结肠穿孔2例。所有患者均行急诊手术治疗,其中8例行剖腹探查术,2例行腹腔镜探查术(其中1例中转开腹),均顺利完成手术并治愈,住院时间2～18 d。术后出现切口感染3例,肺部感染1例,经积极对症治疗后恢复良好出院。术后随访6个月患者均无特殊不适。结论 异物性肠穿孔临床较为少见,对病史及影像学检查可疑者应警惕异物性肠穿孔可能;治疗可根据病情选择剖腹探查或腹腔镜探查术,术中若发现可疑肠管,应进一步探查以免漏诊,其预后一般良好。     

腰椎术后伤口早期感染的治疗体会

目的探讨腰椎术后伤口早期感染的预防措施及手术治疗方法。方法对7例腰椎术后伤口感染病例拆除伤口部分缝线、及时换药,3例未形成窦道患者肉芽组织生长后清创缝合,4例形成窦道患者术前准备后行伤口切开彻底清除坏死组织、横突间植骨块,伤口一期闭合。结果除1例患者术中清创不彻底导致再次清创外,其余伤口感染患者清创后均一期愈合,随访未见感染复发。结论对早期深部感染需及时处理伤口、使用敏感抗生素,彻底清创,创口可以一期愈合,并可以保留内固定。     

脊柱术后伤口深部感染的处理

目的探讨脊柱术后深部感染的治疗措施。方法回顾性分析36例脊柱术后伤口感染患者的治疗经过。16例患者采取伤口清创换药,20例采取对口置管冲洗引流,从中总结合理的治疗方法。结果36例患者中34例获得治愈,2例死亡。对口置管冲洗组愈合时间较普通换药明显缩短。11例内固定术后伤口感染的患者9例内固定未取出。结论(1)脊柱术后伤口感染是一种严重的并发症,一旦发生应引起高度重视;(2)全身营养的支持,合理的应用抗生素,伤口对口置管冲洗引流是行之有效的方法;(3)内固定术后伤口感染,内固定取出不是治疗感染的必要条件。     

预后营养指数与结直肠癌伴急性肠穿孔一期切除并吻合后预后的相关性研究

目的 探讨预后营养指数（predictive nutritional index,PNI）能否通过术前营养和炎症状态预测结直肠癌伴急性肠穿孔病人的术后并发症及5年总生存率和无复发生存率。方法 回顾性分析2012年12月至2018年6月在北京朝阳医院普通外科住院的结直肠癌伴急性肠穿孔病例,其中接受根治性结直肠切除术并一期吻合者57例。统计病人的临床病理资料、术前PNI、术后并发症、术后生存及复发情况等;采用受试者操作特征曲线计算出病人的术前PNI截断值;采用logistic回归分析病人的PNI与术后并发症的相关性;采用Kaplan-Meier曲线分析病人的5年总生存期和无复发生存期。结果 结直肠癌伴急性肠穿孔病人的术前PNI截断值为32。低PNI组相对于高PNI组病人的年龄更大（P=0.028 5）、ASAⅢ～Ⅳ级者更多（P=0.014 7）、T4分期者更多（P=0.028 1）,而且术后吻合口漏发生率更高（P=0.031 4）、30 d死亡率更高（P=0.030 3）以及住院时间更长（P=0.024 2）。多因素分析表明低PNI是结直肠癌伴急性肠穿孔病人发生吻合口漏（OR=1.63, ...     

One-stage resection without colonic lavage in emergency surgery of the left colon

OBJECTIVE: Intra-operative colonic lavage is a widespread procedure introduced to decompress and clean the colon of its faecal load during emergency surgery of the left colon in order to perform a safe anastomosis. This type of lavage is never performed at our institution. The aim of this study was to evaluate the safety and acceptability of emergency left-sided colectomy without colonic lavage in a consecutive series of patients admitted at our department for perforation and obstruction of the left colon. PATIENTS AND METHODS: All 44 patients (29 with obstruction and 15 with perforation) on whom a one-stage left-sided colon resection was performed without colonic lavage between January 1998 and June 2004 were evaluated in a retrospective review. During this period all patients with acute disease of the left colon underwent a one stage resection without colonic lavage. The only exclusion criteria for anastomosis were: haemodynamic instability, ASA > 3, unresectable tumour. Death, anastomotic leakage and wound infection were main outcome measures. RESULT: The leak rate was 4.5% and mortality 2.3% due to one case of postoperative myocardial infarction. A 16% morbidity rate was recorded due to 4 wound infections and 3 minor complications. CONCLUSION: The procedure is safe. The low morbidity and mortality of one stage resection without colonic lavage can justify future prospective studies enrolling a large number of patients to compare its results with those obtained by one stage resection with colonic lavage.     

结肠憩室炎急性穿孔的外科处理（附四例分析）

目的　探讨结肠憩室炎穿孔的临床表现与处理。方法　收治结肠憩室炎急性穿孔患者4例 ,年龄 5 5～ 71岁。 4例手术治疗。对其临床资料及外科治疗进行回顾性分析。结果　死亡 1例 ,切口感染 1例 ,3例痊愈出院。结论　结肠憩室炎急性穿孔处理应根据患者全身状况和腹腔污染等情况综合判定。关键是切除病变 ,控制脓毒败血症休克 ,防治合并症 ,引流通畅。对 4 0岁以下结肠憩室炎及顽固性便秘的多发性憩室炎患者 ,预防性结肠大部切除可防止憩室穿孔的发生     

The indications and surgical treatment in the complications of colonic diverticular disease

In this work the authors describe the different stages of diverticulosis and analyze the pathogenetic principal factors. During the period from 1979 to 1998 they observed 420 patients affected by diverticular disease (224 M; 196 F), 42 (10%) of them were operated on for complications. Fifteen patients operated on in elective time underwent a one stage procedure of resection and anastomosis with derivative colostomy; 27 patients were operated on in emergency: 6 patients had one stage procedure of resection and anastomosis with derivative colostomy, 16 patients Hartmann's procedure, 3 patients Mikulicz's procedure and 2 patients colostomy and peritoneal drainage. Two patients died from septic shock. There was absence of postoperative complications for the patients operated on in elective time, while 8 cases (29.6%) showed peritoneal sepsis and 4 cases (14.8%) infection of wound in the patients operated on in emergency. The Authors describe the different surgical options in the treatment of colonic complicated diverticular disease and conclude that the surgical treatment is not definite. A tendency is to make a one-stage procedure of resection and anastomosis and to reduce the Hartmann's procedure or the simple colostomy with drainage of abdominal cavity.     

Postoperative Wundinfektionen

Postoperative wound infections are the third most common type of nosocomial infection in German emergency hospitals after pneumonia and urinary infections. They are associated with increased morbidity and mortality, prolonged hospital stay and increased costs. The most important risk factors include the microbiological state of the skin surrounding the incision, delayed or premature prophylaxis with antibiotics, duration of surgery, emergency surgery, poorly controlled diabetes mellitus, malignant disease, smoking and advanced age. Anesthesiological measures to decrease the incidence of wound infections are maintaining normothermia, strict indications for allogenic blood transfusions and timely prophylaxis with antibiotics. Blood glucose concentrations should be kept in the range of 8.3–10 mmol/l (150–180 mg/dl) as lower values are associated with increased complications. Intraoperative and postoperative hyperoxia with 80% O₂ has not been shown to effectively decrease wound infections. The application of local anesthetics into the surgical wound in clinically relevant doses for postoperative analgesia does not impair wound healing.     

腹腔镜与内镜联合技术治疗胃肠疾病

In recent years, the concept of minimally invasive surgery has become accepted by the surgical community, though there are limitations in locating small gastrointestinal tumors when laparoscopy is used alone. Meanwhile, endoscopy is an excellent tool for locating these small tumors, though one must take extreme care to avoid hollow viscus perforation. Combination of laparoscopy and gastroduodenoscopy has extensive application in the resection of gastrointestinal stromal tumors, sessile gastric polyps and early gastrointestinal carcinoma. During laparoscopic operation, the endoscopist can help to locate the tumor or polyp. Endoscopy can also help to determine whether or not the tumor or polyp has been resected completely. In performing traditional laparoscopic colectomy for left-sided colonic tumors, specimen retrieval necessitates a mini-incision which is often the cause of postoperative pain, wound infection, and other pain-related complications. The combination of laparoscopy with transanal endoscopic microsurgery is feasible for selected patients with left-sided colonic tumors, and complications related to mini-incision can be avoided completely. Combination of laparoscopy and gastrointestinal endoscopy also benefits patients with acute bowel obstruction prior surgical operation. With the help of perineum-bowel tube, sigmoidoscopic technique can relieve acute bowel obstruction, so that these patients may have chance for laparoscopic operation. In summary, this hybrid approach can not only decrease surgical incisions, but also avoid some of the surgical risks of emergent operations.     

Therapeutic options and postoperative wound complications after extremity soft tissue sarcoma resection and postoperative external beam radiotherapy

Soft tissue sarcomas occur most commonly in the lower and upper extremities. The standard treatment is limb salvage surgery combined with radiotherapy. Postoperative radiotherapy is associated with wound complications. This systematic review aims to summarise the available evidence and review the literature of the last 10 years regarding postoperative wound complications in patients who had limb salvage surgical excision followed by direct closure vs flap coverage together with postoperative radiotherapy and to define the optimal timeframe for adjuvant radiotherapy after soft tissue sarcomas resection and flap reconstruction. A literature search was performed using PubMed. The following keywords were searched: limb salvage, limb‐sparing, flaps, radiation therapy, radiation, irradiation, adjuvant radiotherapy, postoperative radiotherapy, radiation effects, wound healing, surgical wound infection, surgical wound dehiscence, wound healing, soft tissue sarcoma and neoplasms. In total, 1045 papers were retrieved. Thirty‐seven articles were finally selected after screening of abstracts and applying dates and language filters and inclusion and exclusion criteria. Plastic surgery provides a vast number of reconstructive flap procedures that are directly linked to decreasing wound complications, especially with the expectant postoperative radiotherapy. This adjuvant radiotherapy is better administered in the first 3–6 weeks after reconstruction to allow timely wound healing and avoid local recurrence.     

新式保护性肠造口在急诊结肠手术中的应用价值

目的 探讨新式保护性肠造口在急诊结肠手术中的应用价值.方法 回顾性分析16例急诊结肠一期切除吻合术中应用新式保护性肠造口患者的临床资料:回盲部癌合并阑尾穿孔2例;自发性乙状结肠穿孔3例;闭合性腹部外伤致降结肠、乙状结肠广泛挫裂4例;左半结肠癌、乙状结肠癌伴肠梗阻7例.造口方法:回盲部癌伴阑尾穿孔患者,切除末段回肠、部分...     

硅凝胶假体隆鼻术并发症防治体会

目的：探讨固体硅凝胶假体隆鼻术并发症的防治。方法：通过分析84例隆鼻术并发症的原因对其进行针对性的治疗修复。结果：84例就医者通过再次手术修复,使所有并发症均得到了治疗,鼻外形也有明显改善,除1例因鼻尖穿孔遗留瘢痕不满意外,其余83例均获得满意效果。结论：根据鼻畸形情况确定修复部位、选择合适的手术切口及手术方法、精细且适合就医者的假体雕刻、鼻背筋膜下的剥离、良好的美学概念、术后应用抗生素及活血化瘀药物等是降低和预防隆鼻手术并发症的关键;当隆鼻术并发症保守治疗效果不佳时,应可针对不同情况、不同原因,及时采取手术治疗,可使并发症得到控制和及早治疗。     

Laparoscopic treatment of colonic perforations related to colonoscopy

Background: Colonic perforations associated with colonoscopy are rare but major complications. Conservative treatment is less invasive than major surgery, but any case of failure leads to more extensive surgical procedures with a higher morbidity and mortality than the immediate operative repair. To reduce the invasiveness of major surgery and avoid the risk of failure, we introduced laparoscopic techniques to deal with iatrogenic colonic perforations. Methods: Each colonic perforation was identified by diagnostic laparoscopy. The perforation was then characterized by size and extent of thermal damage into one of three types, followed by type-dependent treatment (suture, tangential resection, segmental resection, or open procedure). Operative time, complications, clinical outcome, and patient satisfaction were recorded. Results: Seven patients underwent diagnostic laparoscopy for colonic perforations. Laparoscopic treatment was performed on five patients (one simple closure by suture, three tangential resections, and one segmental resection). Two cases required open procedures. There was one intraoperative complication that necessitated conversion. There were no postoperative complications. All laparoscopically treated patients were satisfied with their clinical outcome and cosmetic results. Conclusions: Laparoscopic treatment seems to reduce the invasiveness and morbidity of major surgery. At the same time, it is more definitive than conservative treatment, so that we now prefer to use laparoscopic techniques to treat colonic perforations related to colonoscopy. Received: 25 February 1998/Accepted: 22 June 1998     

Evaluation of surgical treatment of spontaneous pneumothorax--assessment of postoperative recurrence and quality of life]

To assess the effect of surgical treatment for spontaneous pneumothorax, including the evaluation of the quality of postoperative life by a questionnaire method, we examined 139 patients with spontaneous pneumothorax who underwent the surgical treatment. The operation was performed 149 times and 154 sides for these patients. Of these, 95 cases (65.2%) were the first episode of the disease, since we often chose surgical treatment even for the first attack of the disease. Postoperative recurrence was seen in only one case (0.6%). Operative complications included 4 cases of empyema (in two of them requiring reoperation) and 18 cases of wound infection. The most common postoperative complaints were post-thoracotomy pain in 12 cases (12.6%), disturbance of sensation in the scar in 9 (9.5%), and limitation of exercise in 9 (9.5%). Four patients (4.2%) suffered from these symptoms and had difficulty in daily life. Forty-seven patients (49.5%) had a fear of recurrence. Quality of postoperative life was almost satisfactory. From the viewpoints of both prevention of the recurrence and postoperative quality of life, the surgical treatment is effective and safe method. We advocate the surgical treatment as the first choice of the treatment even in case of the first episode of the disease, especially in patients with high activities in social life.