先天性肠闭锁100例的外科治疗

目的分析总结先天性肠闭锁的诊断和外科治疗要点。方法对我院2001~2005年的先天性肠闭锁100例进行回顾分析。结果100例获得手术治疗的先天性肠闭锁患儿死亡7例,吻合口瘘3例。结论早期诊断、熟练经柔的手术操作及严密、高质量的术后管理是提高成功率的关键。     

先天性小肠闭锁治疗体会

目的:进一步探讨先天性小肠闭锁的术式及围术期治疗原则。方法:系统回顾我院近两年间收治的小肠闭锁患儿68例,手术采用闭锁两断肠切除,端端斜形单层一期吻合术,围术期辅以周围静脉径路全静脉营养,术后4天对28例肠功能恢复不良患儿鼻饲中药复方大承气汤。结果:本组患儿术后存活56例,治愈率82.35％,疗效满意。结论:先天性小肠闭锁治疗的关键在于选择适当的手术方式以保障吻合口通畅和良好的愈合;围术期护理和治疗是决定手术成败的关键,周围静脉径路全静脉营养即便于操作和护理,又能基本上满足患儿机体营养发育的需要,是一种既安全又有效的治疗措施。中药复方大承气汤应用于术后肠功能恢复不良患儿,对闭锁远端肠功能的恢复具有帮助。     

产前B型超声诊断并尽早手术治疗新生儿肠闭锁24例报告

目的探讨运用产前B型超声诊断以达到尽早手术治疗新生儿肠闭锁,提高治愈率。方法回顾性分析近4年共24例产前超声诊断的肠闭锁,产后及时外科干预、早期手术治疗,其中十二指肠闭锁5例,空回肠闭锁18例,结肠闭锁1例。结果24例均在出生后24h内行手术治疗,术后存活21例,占87．5％;19例术后随访6个月～2年,疗效满意。结论手术是治疗新生儿肠闭锁的唯一手段,产前明确诊断,产后及时外科干预尽早手术治疗,可减少并发症,提高治愈率。     

腹腔镜与开腹手术治疗新生儿肠闭锁的比较

目的 探讨腹腔镜手术治疗新生儿肠闭锁的疗效。方法将61例新生儿肠闭锁随机分成2组（腹腔镜组31例和开腹组30例），比较两组术中情况和预后。结果两组患儿术后存活率、术后并发症P值分别为0．973、0．862，统计学上无显著差异，但腹腔镜组有20例经脐孔拖出行肠切除、肠吻合手术患儿术后脐正常，疤痕无或很小。结论腹腔镜下治疗新生儿肠闭锁技术简单、安全、几乎无瘢痕。     

先天性宫颈闭锁的诊疗策略分析

目的：探讨先天性宫颈闭锁的术前评估、手术方案的选择及对术后的影响。方法：对2005至2008年收治的12例先天性宫颈闭锁患者的临床资料进行分析和评估,以探讨该疾病最佳的治疗方法。结果：12例患者的年龄13～19岁,12例合并阴道闭锁,其中有4例合并子宫畸形,4例合并卵巢宫内膜囊肿。对5例患者行宫颈整形及阴道成形术,4例行子宫切除术,3例行子宫内膜切除术。结论：先天性宫颈闭锁的患者术前应尽早诊断,根据子宫内膜发育情况,仔细评估手术成功率及预后,选择个性化治疗方案,恢复生育功能,减少再手术的风险,术后应定期随访是手术后成功的重要环节。     

经脐单孔腹腔镜手术治疗新生儿先天性肠闭锁和狭窄

目的总结经脐单孔腹腔镜手术治疗新生儿肠闭锁和狭窄的经验。方法回顾性分析2010年10月至2012年4月间在江苏淮安市妇幼保健院接受经脐单孔腹腔镜手术治疗的20例新生儿肠闭锁和狭窄的临床资料。结果20例新生患儿中男13例,女7例,入院时年龄出生后10min至3d,其中早产儿4例,低体质量儿（小于2500g）3例。经检查发现十二指肠闭锁1例,十二指肠狭窄1例．空肠闭锁9例．空肠狭窄2例,回肠闭锁7例。采用经脐单孔腹腔镜下进行探查．然后经稍扩大的脐孔将闭锁端肠管提致腹腔外进行吻合。20例患儿均用该方法完成手术．无中转开腹手术及常规腹腔镜手术。手术时间为35-60（平均40）min,术中出血量为出血3～5ml。2例患儿术后第2天家长放弃治疗,其余18例新生患儿术后5．10（平均7）d进流质饮食,10-20（平均13）d出院。术后随访1-11个月,1例死亡,3例因腹泻或营养不良行保守治疗好转,另14例患儿生长良好。结论经脐单孔腹腔镜治疗新生儿肠闭锁和狭窄操作简单,疗效满意。     

经脐旁单切口腹腔镜辅助肠外置治疗新生儿先天性小肠闭锁

目的 探讨经脐旁单切口腹腔镜辅助肠外置治疗新生儿先天性小肠闭锁手术的效果。方法 2019年9月～2022年9月我科对27例新生儿先天性小肠闭锁施行经脐旁单切口腹腔镜辅助手术。脐旁右侧弧形切口至1/2周径,置入3.5 cm一次性单孔多通道腹腔镜穿刺器(Port),直视下找到闭锁部位,切除近端肥厚肠管,远端肠管对系膜侧修剪切开,5-0可吸收缝线间断单层缝合,行端斜吻合术,然后建立CO₂气腹,观察整个腹腔情况,处理合并畸形。结果 27例顺利完成手术,无中转开腹。术中证实空肠闭锁15例,回肠闭锁12例;闭锁类型Ⅰ型8例,Ⅱ型5例,Ⅲa型12例,Ⅲb型2例。术中见胎粪性腹膜炎5例,胆道闭锁1例,肠旋转不良2例,梅克尔憩室1例,隐睾2例,腹股沟斜疝1例。中位手术时间110.0(90.0,122.5)min。术后中位开始喂养时间11.0(7.0,14.5)d。无吻合口漏发生。术后中位住院时间18.0(15.0,33.5)d。1例患儿再次手术。22例随访0.5～4年(平均2.3年),无再次手术患儿。结论 经脐旁单切口腹腔镜辅助肠外置治疗新生儿先天性小肠闭锁,切口无瘢痕,操作方便,...     

高原地区新生儿手术134例麻醉分析

我院对 134例新生儿急腹症进行手术治疗 ,由于采用了合适的麻醉方式 ,同时对术中各项指标进行严密监测 ,结果术中无一例死亡。我院受高原地区 (海拔 2 2 6 0m )影响 ,患儿多伴有低氧血症及不同程度的脏器损害 ,术后易发生DIC和硬肿症 ,死亡率较高。故麻醉方式的选择和术中各项指标的严密监测是手术顺利进行的关键。资料与方法一般资料　 134例中 ,男 86例 ,女 4 8例 ,1～ 3d 2 9例 ,3～ 7d36例 ,7d以上 4 8例。病种有先天性膈疝、先天性腹裂、先天性消化道畸形 (肠闭锁、肠狭窄、肠旋转不良 )、先天性巨结肠、先天性肛门直肠畸形等。体重 …     

先天性肠闭锁治疗体会

我院自1992年至1996年1月共收治先天性肠闭锁5例,除1例因就诊较晚未能手术治疗而死亡,其余4例全部治愈。随访11月至2年,4例生长发育良好。现报告如下。 一般资料 本组5例均为新生儿,男性4例,女性1例,其中早产儿2例。就诊时间最短为出生后6小时,最长为出生后4天。体重2.0～3.5kg。均以呕吐为首发症状,5例至就诊时间均无正常胎粪排出,均伴有不同程度腹胀。入院时2例确诊为肠闭锁,余3例拟诊“机械性肠梗阻”、“腹胀待查”入院。1例因就诊晚,伴严重脱水、酸中毒,未能手术治疗而死亡。4例中1例为空肠上段肠闭锁,余为回肠闭锁。均行扩张段肠切除、肠端端吻合术。吻合方法采用近端肠管裁剪术后吻合。术后7天拆线出院2例,10天1例,其中1例禁食20天、胃肠减压及胃肠道外营养治疗,     

先天性小肠闭锁25例诊治体会

目的:探讨先天性小肠闭锁的诊断及治疗。方法:对25例先天性小肠闭锁的临床资料进行回顾性总结。结果:全组病人均以呕吐为首发症状,2例生后排出少量胎粪。成活18例,治愈率72％;肠造瘘疗效差,单层粘膜外缝合肠管斜行吻合术治愈率达91.7％;肠切除肠吻合术治愈率60％。结论:肠闭锁患者应尽量切除闭锁盲端改变明显的肠管,单层粘膜外缝合肠管斜形吻合术尤适用于先天性小肠闭锁手术。     

Analysis of factors related to prognosis and curative effect for posterolateral fusion of lumbar low-grade isthmic spondylolisthesis

The objective of this study was to select factors related to the prognosis and curative effect for posterolateral fusion (PLF) of lumbar low-grade isthmic spondylolisthesis (LGIS). Of 125 patients who accepted PLF treatment, 119 obtained solid union in this prospective study. Statistical analysis was used to evaluate factors related to the prognosis and curative effect. Spondylolisthetic position (L4, L5), gender and postoperative percent disc height were not significant factors for the prognosis and curative effect. Length of disease history (LDH), preoperative Japanese Orthopaedic Association (JOA) score and postoperative percentage of slipping (% slip) were significantly related to postoperative JOA score and postoperative improved JOA score. LDH and postoperative % slip were significantly related to postoperative recovery rate. LDH, preoperative JOA score and postoperative % slip were independent related factors for the prognosis and improvement of LGIS. LDH and postoperative % slip were independent related factors for the curative effect. However, age, gender, spondylolisthetic position and postoperative percent disc height were not significant factors.     

腹腔镜下吻合术治疗新生儿十二指肠梗阻

目的探讨腹腔镜下吻合术治疗新生儿十二指肠梗阻(congenital duodenal obstruction,CDO)的疗效。方法回顾分析2008年12月～2011年9月53例CDO患者临床资料。腹腔镜组27例,Ⅱ型、Ⅲ型十二指肠闭锁及环状胰腺15例行十二指肠菱形吻合术,十二指肠狭窄及Ⅰ型十二指肠闭锁8例行十二指肠纵切横缝术,4例Ⅰ型十二指肠闭锁行十二指肠菱形吻合术;开腹组26例,以上3种术式分别为12例、8例、6例。对比2组手术时间、术后住院时间、术后进食时间、住院费用及术后并发症情况。结果与开腹组相比,腹腔镜组术后进食时间早[(5.8±1.6)d vs.(7.5±2.2)d,t=-3.060,P=0.004],但手术时间长[(113.8±39.2)min vs.(94.0±31.0)min,t=2.034,P=0.047]。2组术后住院时间和住院费用、并发症发生率差异无显著性(P>0.05)。结论腔镜下吻合术治疗新生儿十二指肠梗阻疗效肯定,在术后肠功能恢复上明显优于传统开腹手术。     

足下垂的腰间盘突出症

目的：探讨足下垂的腰间盘突出症的治疗与预后，方法：对有2年以上随访结果的18例（20足）患者作回顾性总结，分析影响其疗效的因素，结果：总优良率80．0％。治疗结果与病程长短密切相关（P＜0．05），与患者年龄，术前肌力无统计学意义（P＞0．05），结论：足下垂的腰间盘突出症一经确诊，应尽快手术，彻底减压，术式以椎板开窗为宜。     

非小细胞肺癌1638例治疗及预后探讨

目的 结合2009 TNM分期和患者临床资料分析探讨非小细胞肺痛的预后及其影响因素.方法 回顾性分析2001年1月至2005年1月接受手术的1638例非小细胞肺癌患者的临床资料,并对其预后及影响其预后的临床病理因素进行分析.其中男性1083例,女性555例,平均年龄59.5岁.结果 非小细胞肺癌患者术后总体1年、3年及5年生存率分别为80.0%、52.3%及39.0%.单因素分析显示影响预后的因素为支气管断端是否阳性、手术方式、T分期、N分期、淋巴结清扫个数(0～、10～及＞20个)、淋巴结清扫组数和术后放疗(P＜0.05).Cox回归多因素分析提示,手术方式(P=0.001)、T分期(P=0.000)、N分期(P=0.000)和淋巴结清扫个数(P=0.013)是独立的预后影响因素.结论 非小细胞肺癌总体预后差.手术方式、T分期、N分期及淋巴结清扫个数均是其预后的独立影响因素.

Abstract：

Objective To study the prognosis and prognostic factors of non-small-cell lung carcinoma(NSCLC)according the new TNM stage system.Methods Clinic data of 1638 inpatient cases admitted from January 2001 to January 2005 were retrospectively reviewed.There were 1083 male and 555 female patients in the study and the average age was 59.5 years.All the patients received surgical procedures.Results The overall 1,3,5-year survival rate was 80.0%,52.3%,39.0%.The main prognostic factors were bronchial stump,operation type,T stage,N stage,the number of lymph nodes (LNs)in lymph nodes dissection(1-10,11-20,and＞20),overall N stations(＜4 and ≥4)and postoperative radiotherapy(all P＜0.05).Cox regression suggested that T stage(P = 0.000),N stage (P=0.000),operation type(P=0.001)and LNs(P = 0.013)were independent factors affecting the prognosis.Conclusions The overall survival rate of NSCLC is poor.T stage,N stage,operation type and LNs are independent factors affecting the prognosis.     

结肠损伤临床特点和手术疗效分析

目的:总结结肠损伤的临床特点和预后因素,探讨提高结肠损伤手术疗效的措施。方法:回顾性总结58例结肠损伤的住院资料、剖腹探查结果、手术类型和术后恢复情况,分析临床上采纳I期或Ⅱ期手术的标准和影响手术效果的关键步骤。结果:右半结肠损伤35例,左半结肠损伤17例,左右结肠均损伤6例,54例合并有腹腔多脏器或腹部以外的损伤。27例在8h内手术治疗,20例术前术中出现低血压超过1h。56例术前术中确诊,2例剖腹探查术后漏诊。总体手术治愈率87.9%(51/58),死亡率12.1%(7/58),合并症发生率25.5%(13/51)。I期结肠修补或吻合术治愈率90.6%(29/32),死亡率8.4%(3/32),合并症发生率20.7%(6/29);Ⅱ期吻合术治愈率84.6%(22/26),死亡率15.4%(4/26),合并症发生率31.8%(7/22)。结论:准确判断结肠损伤程度、全面了解合并损伤脏器、术中仔细探查、彻底的肠道和腹腔冲洗以及损伤部位严格的清创消毒,是I期手术也是Ⅱ期手术成功的关键。     

股骨近端锁定解剖钢板治疗老年股骨粗隆部骨折

目的探讨股骨近端锁定钢板内固定术治疗老年股骨粗隆部骨折的手术方法和临床疗效。方法应用股骨近端锁定钢板治疗老年股骨粗隆部骨折35例,年龄60～85岁,平均65.6岁。骨折类型:股骨颈基底部骨折4例;股骨粗隆间骨折25例,按Evans’s标准分型:I型4例,II型5例,III型12例,IV型4例;股骨粗隆下骨折6例。术中正规微创手术操作,术后正确的康复训练,积极抗骨质疏松治疗。结果术后随访时间6～24个月,平均10个月。疗效评定,术后6个月患髋Harris评分:优20例,良13例,中2例,差0例,优良率为94.3%。术后所有患者获得骨性愈合,愈合时间为3～10个月(平均4.5个月)。结论应用股骨近端锁定解剖钢板治疗老年股骨粗隆部骨折是一种较好的手术方法,疗效满意,可以有效提高老年患者术后的生活质量。     

Digestive surgery in patients over 80 years of age. Apropos of 690 operations]

Between January 1981 and December 1990, 690 patients over the age of 80 years underwent gastrointestinal surgery. These operations were performed for diseases of the biliary tract in 248 cases (28%), colon or rectum in 238 cases (27%), stomach or duodenum in 130 cases (15%), small bowel in 32 cases (1.6%), oesophagus in 16 cases (1.8%), and for peritoneal carcinologic dissemination in 26 cases (3%). Emergency operation was performed in 43% of patients. Surgery was considered to be curative in 61% of patients. Overall postoperative mortality was 23%. The six following factors were associated with increased mortality: age over 85 years, ASA categories 3, 4, 5; surgery for malignant disease, peritonitis, palliative surgery, emergency surgery.     

肝内胆管结石126例外科治疗体会

目的 探讨肝内胆管结石外科治疗的方法及效果.方法 对2005年1月至2010年10月间我院施行的126例肝内胆管结石手术患者的临床资料进行回顾性分析.结果 全组无手术死亡病例,术后发生并发症17例(13.5％),其中胆漏3例,胆道出血5例,肺部感染2例,胆道严重感染1例,切口裂开2例,切口脂肪液化4例,均经保守治疗痊愈...     

Factors affecting prognosis in patients with short bowel syndrome

Aim of the study is to analyse physiopathological implications of massive intestinal resection and factors affecting prognosis in patients with short bowel syndrome. Twenty massive intestinal resections were performed. The causes of bowel resection were: intestinal infarction (11 cases), Crohn's disease (5 cases), small bowel volvulus (4 cases). All intestinal resections were more than 50-60% of the intestinal length. In eighteen patients intestinal anastomosis was performed immediately. In all the patients postoperative therapy with parenteral nutrition (PN) was performed. The operative morbidity and thirty-day mortality were respectively 30% (6 cases) and 35% (7 cases). The diarrhea was the dominant symptom. The average weight was 20% lower compared to the initial weight. The length of residual small bowel and type of anastomosis strongly affect survival of patients underwent massive intestinal resections. Parenteral nutrition (PN) has great importance in postoperative treatment. A useful treatment, in severe short bowel syndrome, can be small bowel transplantation.     

Management of type A acute aortic dissection--results of the cases with thrombosed false lumen]

By reviewing the outcome, we studied the propriety of our principles for the treatment of type A acute aortic dissection in 45 patients, encountered during the 10-year period between 1981 and 1990. We conducted a comparative study of patients with a thrombosed false lumen (type T) and a patent false lumen (type P) to examine the effect of an acutely thrombosed false lumen on the prognosis of this disease. For the 25 patients treated in the first 6 years (1981-1986), operation was performed as soon as exact diagnosis was made, regardless of the presence of complications and the type or severity of the disease. Early death occurred in 9/20 operated cases and in 4/5 unoperated cases, so 13/25 patients died for a 52.0% mortality rate. For the 20 patients who received treatment in the latter period (1987-1990), we gave priority to conservative treatment for type T cases that were free from complications, and adopted a treatment method attaching greater importance to the resection of intimal tears. As a results, early deaths were observed in only 4 type P patients (20.0%) who underwent operation, a significant better result (p < 0.05). For patients in whom we were able to excise the intimal tear (30.0%, early mortality rate), the results were better than in those in whom the intimal tear were left alone (53.8%). The results were particularly good in type T patients (25.0% of them underwent intimal tear resection and 71.4% underwent no operation for the intimal tear).(ABSTRACT TRUNCATED AT 250 WORDS)