直肠癌全系膜切除及双吻合器术后吻合口瘘的相关因素分析与防治对策

目的探讨直肠癌行全系膜切除及双吻合器手术切除后吻合口瘘的相关原因及预防、诊断、治疗措施。方法回顾性分析我院2001年1月—2009年6月252例(男159例,女93例)直肠癌患者,行直肠全系膜切除及双吻合器术后吻合口瘘的发生率及治疗情况。结果 该组病例吻合口瘘的发生率为5.6%(14/252);确诊吻合口瘘发生时间为4~9 d,平均为6.8 d。其中8例高流量瘘采用早期横结肠造瘘与腹腔冲洗引流手术;6例低流量瘘采用非手术治疗,骶前双腔管冲洗与肛管固定引流术。2次治疗至出院时间为28~80 d,平均为48.6 d。术后吻合口瘘发生与患者的全身情况、吻合技术、吻合口位置,肿瘤Dukes分期、术前放化疗、是否行预防性造瘘等有相关性。结论术前充分的评估,术中细致的操作及选择性预防性造瘘的应用和围术期合理的处理是预防术后吻合口瘘的关键;术后及时正确的判断,恰当的手术时机的把握,充分的引流、营养支持等综合性措施是治疗吻合口瘘的必要手段。     

吻合器治疗小儿低位先天性巨结肠8例

我们采用吻合器治疗先天性巨结肠8例,Ⅰ期结直肠吻合。随访3～6个月,生活质量良好。现报告如下。1 资料和方法1.1 临床资料 患者8例,男6例,女2例,年龄2～12岁,平均6.2岁。常见型5例,短段型2例,超短段型1例。其中1例常见型患者已行结肠造口。切除最长肠管40cm,最短15cm。全部病例行钡灌肠检查,明确诊断,病理证实。平均住院15 d。1.2 手术方法 常规术前准备,腹腔探查后,分离直肠至齿线附近,直肠后侧较前侧要低,吻合口通常在齿线上1～1.5cm处,故距齿线2 cm切除肠管。移出标本,远端快速冰冻病理检查,证实已存在神经节细胞,否则,继续向下切除直至神经节细胞存在。分别用10号线于结肠近端和直肠断端荷包缝合,将管状吻合器(美国强生公司生产,型号SDH25或     

双吻合器在结直肠癌并肠梗阻一期切除吻合术中的应用

目的探讨双吻合器在结直肠癌并肠梗阻行一期切除吻合术中的疗效。方法我院2005年1月～2010年12月收治结直肠癌并肠梗阻患者78例,应用双吻合器行肿瘤根治性切除一期吻合64例,总结分析其临床效果。结果 64例患者均一次性吻合成功,未发生吻合口瘘。结论双吻合器在结直肠癌并肠梗阻一期切除吻合术中应用,具有安全、省时、可靠的优点,是提高吻合成功率、减少吻合口瘘的有效方法之一。     

新生儿及小婴儿巨结肠经肛门改良Soave根治术的应用

目的：介绍经肛门改良加Soave巨结肠根治术的方法，观察术后临床疗效。方法：先天性巨结肠患儿12例，手术年龄17—90d，体重3．1—7．0kg。手术于肛门齿状线上5—10mm环形切开直肠粘膜．下拖并向上分离直肠粘膜约20—25mm，此处切断直肠肌鞘，分离直肠，将病变肠管由肛门拖出切除，近端结肠切缘于直肠粘膜齿状线上切缘吻合。结果：平均手术时间87min，术后次日开始进食，患儿恢复良好，平均出院时间为8．6d。近期随访效果良好。结论：经肛门改Soave巨结肠根治手术打击小，术后患儿恢复快，此法治疗新生儿及小婴儿巨结肠是安全可行的。     

腹腔镜辅助下改良Sovae法根治小儿先天性巨结肠

目的介绍腹腔镜辅助下改良Sovae法根治小儿先天性巨结肠的方法及疗效。方法在气管插管全麻腹腔镜辅助下,对29例先天性巨结肠均采用改良Sovae法手术治疗,在脐上缘穿刺建立气腹,设定CO2压力在10-14mmHg,沿气腹孔置入5mmTrocar后置入30°腹腔镜,左右下腹各置5mmTrocar,分别置入分离钳及超声刀。取结肠浆肌层组织做术中冰冻病检,凝切需要切除的结肠的2级系膜血管,分离直肠壁至腹膜反折处后,转经肛门直肠拖出,齿状线上0.5-1.0cm环形切开直肠黏膜及切除近端病变肠管后及大部直肠肌鞘,行一期间断缝合近端肠管全层与直肠黏膜切缘。结果所有29例均顺利完成手术,手术时间80-160min,平均100min,术中平均出血不足10ml,全部治愈,无一死亡,皮下气肿3例,术后住院5-7天,全部获随访,随访时间6-24月,术后结肠炎3例,污粪2例。疗效评判参照Heikkinen等的评分标准,"优者"为18例,"良好"为8例,"一般"为3例,"差"为0例。结论腹腔镜辅助下改良Sovae法根治小儿先天性巨结肠操作安全易行、侵袭少、切除病变准确彻底、出血少、肠功能恢复快、并发症少等优点,对短段型、常见型、长段型都有良好疗效。     

左半结肠急性梗阻一期手术30例

左侧结肠梗阻 ,因腹腔污染及吻合口漏危险性较大 ,以往多主张分期手术。随着抗生素的发展 ,围手术期处理的改善 ,手术技巧的进步 ,以及对结肠病理生理的认识提高 ,人们越来越多地主张采用一期切除吻合术[1] 。我科自 1990年以来有选择地对左半结肠急性梗阻 30例施行一期切除吻合术 ,疗效满意。1　临床资料1 1　一般情况　男 18例 ,女 12例 ;年龄 36～ 70岁 ,平均 5 3岁。均有急性低位肠梗阻表现 ,梗阻时间 2～ 6ｄ ,均为急诊术前无肠道准备情况下行左半结肠切除端 端吻合术。除 2例为乙状结肠扭转外 ,余均为结肠癌 ,其中癌肿位于结肠脾曲 4…     

采用可重复使用吻合器行吻合器痔切除术并发症分析

目的评价采用国产可重复使用吻合器进行重度痔吻合器切除术的并发症及安全性。方法回顾分析2003年7月—2006年6月连续进行的135例环状脱垂痔行吻合器痔切除术的手术方法、术后疗效及并发症。结果135例中133例完成手术,2例因吻合器机械故障改行常规痔切除术。手术时间15~30 min,平均住院日5.1 d。术后并发症包括:尿潴留69例,麻醉性镇痛剂止痛33例,术后吻合口出血4例,吻合口狭窄2例。肛瘘l例。术后半年内痔核再次脱出2例,吻合口处钛钉松脱致吻合口糜烂1例。结论采用国产可重复使用吻合器行环状痔切除术安全可靠,近期总体疗效满意。应注意掌握吻合器的正确使用方法,避免与其相关的并发症。     

急性梗阻性结肠癌一期切除吻合24例报告

结肠癌引发急性肠梗阻行一期手术的报告日渐增多，自1989年至19964年对急性梗阻性结肠癌一期切除吻合24例，现总结如下。1临床资料与方法1．1一般资料24例中男17例，女7例。年龄最小31岁，最大77岁，平均54岁。24例均以急性肠梗阻入院，发病至手术时间为20小时～4天。癌肿部位：盲肠7例，升结肠6例，结肠肝曲4例，降结肠5例，乙状结肠2例。1．2手术方式24例均未做常规的肠道手术准备（因急诊人院），根据术中探查梗阻情况和病人状况以及癌肿侵犯的程度，选择手术方式。行右半结肠切除17例，左半结肠切除5例，乙状结肠切除2例，其中1例因侵犯…     

吻合器在胃癌经腹全胃切除术中的应用与评价

目的 评价吻合器在胃癌经腹全胃切狳术中应用的临床效果。方法 回顾性分析148例胃癌、贲门癌患者行全胃切除、管状吻合器消化道重建术的临床资料。结果 本组148例手术均采用管状吻合器完成食管空肠吻合术,一次性吻合成功率100％,发生吻合口漏1例(0.68％),狭窄2例(1.4％),无手术后出血,无手术死亡。吻合口漏1例,经引流等保守治疗后治愈,吻合口狭窄2例,经扩张后治愈,进食状态良好。结论 全胃切除术中使用吻合器有以下优点:简化深部操作,省时省力,具有更大的安全性,降低吻合口漏、出血、吻合口狭窄等并发症发生率。     

结直肠癌合并肠梗阻手术治疗118例临床分析

目的探讨结直肠癌合并肠梗阻的手术治疗方法。方法回顾性总结了118例结直肠癌合并肠梗阻患者的手术处理方法和治疗效果。结果右半结肠梗阻38例,36例行一期切除吻合,2例行回肠造口术;其余80例低位梗阻患者中53例行一期切除吻合,10例行Mile’s术,8例行Hartmann术,9例行结肠造口术,术后低位梗阻一期切除吻合43例患者中4例出现吻合口瘘,10例Dixon+横结肠造口术者未出现吻合口瘘。死亡2例。结论一定条件下,一期切除吻合是治疗结直肠癌并急性肠梗阻可行、有效的方法。顺行结肠灌洗可提高一期根治切除率。直肠癌行Dixon+横结肠预防造口术是值得借鉴的手术方式。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.