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主动脉夹层是指主动脉腔内的血液从主动脉内膜撕裂口进入主动脉壁内 ,使主动脉壁的一部分掀起形成夹层 ,并沿主动脉纵轴扩展 ,形成主动脉壁层分离状态。尽管这是一种常见的主动脉病变 ,但确切发病率尚不清楚 ,据文献报道每年每 10 0万人中 5～ 10人发病[1 ] 。这类病人常因高压动脉血进入夹层假腔而使主动脉破裂致死 ,或者是夹层隔膜将动脉分支的开口阻塞引起肢体或重要器官急性缺血未经治疗的病人 ,约 2 1%于 2 4ｈ ,6 0 %于 2周 ,90 %于 3个月内死亡。近年来 ,随着内科治疗的进步 ,外科治疗材料和方法的改进 ,特别是血管腔内技术的崛起 ,…     

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目的 探讨支架型人工血管治疗主动脉夹层的临床效果。方法 2001年3月至2003年9月间，应用支架型人工血管治疗Ⅲ型夹层44例和Ⅰ型主动脉夹层1例。45例主动脉夹层共应用56个支架型人工血管行近侧内膜破口封堵，1例同时行远侧内膜破口手术关闭，1例远侧破口以分叉的支架型人工血管封闭。结果 所有病人均获得技术成功。围手术期死亡2例，1例术后12h后死于脑出血，1例术后10d死于假腔破裂；1例手术后半年死于细菌性心内膜炎。结论 支架型人工血管行Ⅲ型主动脉夹层和破口在降主动脉的Ⅰ型主动脉夹层破口封堵术较传统手术安全，其远期疗效需进一步观察。     

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目的总结肝素化后自体血回收、回输施行布加综合征(BCS)根治术的临床治疗经验。方法回顾分析1997年11月至2011年5月简阳市人民医院心血管外科在非体外循环下实施57例BCS根治术病人的临床资料。手术要点是在全身肝素化前提下,实现下腔静脉远端球囊阻断、控制性放血、负压吸引血液回收、经右心插管血液回输等关键技术环节,同时在直视下完成对下腔静脉、肝静脉阻塞性病变的处理。结果术前下肢深静脉压力(17.5～30.3)mmHg(1mmHg=0.133kPa),平均(25.3±3.6)mmHg,术后下降为(9～13)mmHg,两者差异有统计学意义。术中回收回输自体血量600～40000mL,其中超过10000mL者8例;除1例术中发生下腔静脉破裂、大量失血而于术中、术后输异体血外,其余病人术中均未输异体血。无上消化道大出血、肝昏迷、急性肾功能衰竭、肺动脉栓塞等手术并发症。围手术期死亡1例(1.82%),死于不能有效控制的下腔静脉破裂出血。结论肝素化后自体血回收、回输技术简化了体外循环和深低温停循环下BCS根治术的手术程序,保证了手术效果。     

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??Endovascular repair of Stanford B dissection with branched stent-graft??An analysis of 11 cases YANG Jue??FU Wei-guo??XU Xin??et al. Department of Vascular surgery??Zhongshan Hospital??Fudan University??Shanghai 200032??China
Corresponding author??FU Wei-guo??E-mail??fu.weiguo@zs-hospital.sh.sn
Abstract Objective To summarize experience of thoracic endovascular aortic repair (TEVAR) in patients with proximal short landing zone with branched stent-graft. Methods A total of 11 patients with Stanford B dissection who underwent TEVAR with left subclavian artery ??LSA?? revascularization by single-branched stent-graft from July 2013 to February 2014 were retrospectively reviewed. Routine postoperative follow-up with computed tomography angiography (CTA) was performed to assess TEVAR and LSA patency??endoleak??dissection exclusion and complications in 1 and 6 months. Results TEVAR with single-branched stent-graft was successfully performed in 10 patients??and 1 patients failed by unsuccessful deployment of branched stent and replaced by another stent-graft with coverage of LSA. The mean operative time was??130.0±36.0??minutes. No major complications occurred. All patients were followed up in 1 and 6 months postoperatively. Type ?? endoleak was noted in 1 patient and 1 patient had an asymptomic LSA stent occlusion by CTA. Thrombosis formed in the aortic false lumen of the graft exclusion segment in all the patients??and the average diminution was 12mm. Conclusion Branched stent-graft is a feasible and effective option for LSA revascularization with proximal landing zone ??20 mm during TEVAR.     

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我科自2002年5月起开展覆膜支架腔内修复术治疗主动脉夹层动脉瘤以来,成功治疗Stanford B型胸主动脉夹层动脉瘤病人72例。现总结报告如下。     

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??Armpit incision combined with intraoperative ultrasound positioning treatment of multiple breast fibroma: An analysis of 97 cases LI Wen-tao, ZHAI Bao-ping, JIA Lin-jiao, et al. Department of Breast Surgery, Henan Provincial People's Hospital, Zhengzhou 450003, China
Corresponding author: ZHAI Bao-ping, E-mail: zhaibaoping@163.com
Abstract Objective To explore the surgery methods for multiple fibroadenoma of breast, provide a reference for the surgical treatment of breast multiple fibroma. Methods The clinical data of 97 cases of breast multiple fibroadenoma admitted from January 2009 to April 2012 in Department of Breast Surgery, Henan Provincial People's Hospital were analyzed retrospectively. All the cases were applied intraoperative ultrasound positioning, taken the armpit incision after breast surgical approach for resection of multiple breast fibroadenoma. The surgical incision design, surgical procedures and results of operations were analyzed. Results The fibroids of 97 cases were resected guided by color Doppler ultrasound positioning with hidden incision and satisfactory breast appearance. Conclusion Approach surgery color Doppler positioning with the gap after the removal breast multiple fibroadenoma is satisfactory with short operation time and good clinical value.     

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近年来的国内外资料显示,胃上、中部癌发病率较前明显升高[1]。D2根治术仍是目前治疗Ⅱ、ⅢA期胃上、中部癌的标准术式。按日本《胃癌处理规约》之规定,就胃上、中部癌而言,脾门淋巴结(No.10)、脾动脉干周围淋巴结(No.11)属第二站淋巴结[2]。所以,完成胃上、中部癌标准的D2根治术就必须清扫No.10、No.11淋巴结。20世纪80年代以前,脾胰体尾联合切除用于清扫No.10、No.11淋巴结在日本得到广泛应用,曾一度被认为是清扫胃上、中部癌的标准术式[3]。这种术式引入我国后,也得到推广,而且目前国内的不少医院及医生仍然沿用。然而,关于胃上、中…     

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肝腺瘤是少见的肝脏良性肿瘤 ,至 1997年国外文献报道 30 0例 ,国内报道总计 42例。因本病症状无特异性 ,术前鉴别诊断时很难与肝脏恶性肿瘤相区别。为加强对该病的认识 ,现将本院收治的 4例报告如下。1　临床资料　　我院自 1990～ 1999年共诊治肝细胞腺瘤 4例。见表 1。2　讨论　　文献报告肝腺瘤几乎全部发生于女性 ,有报告 ,避孕药中所含的乙烯雌二醇甲酯与肝腺瘤的发病增多有关[1,2 ] 。但德国学者Ｈｅｉｎｅｍａｎｎ[9] 等经过 7年的多中心调查研究发现 ,长时间服用口服避孕药并未增加肝细胞腺瘤的发病率。本组中 2例女性均无长期口服…     

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重症急性胰腺炎 (SAP)的治疗仍存在一定困难。及时正确的处理包括手术干预可改善病情 ,处理不当则有可能导致严重并发症而使病情更为复杂。我院曾收治 1例胆石性胰腺炎病人 ,先后出现过许多种并发症 ,经历了 6次手术 ,艰难曲折地治疗 1年多才得以痊愈。现报道如下。1　病历简介病人男性 ,5 0岁。主诉“右上腹痛 10年 ,再发 3天 ,伴呕吐、发热、黄染” ,于 1997年 10月 3日入院。诊为“慢性胆囊炎急性发作” ,于次日急诊行胆囊切除和胆总管探查、T管引流术。术中自胆总管下端取出直径 0 8cm结石 2枚 ,胆囊内结石呈泥沙样 ,并发现胰头肿大…     

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目的探讨肿瘤大小对早期胃癌预后的影响。方法自1995年4月至2006年6月,福建医科大学附属协和医院胃外科对159例早期胃癌病人施行根治术。应用ROC曲线选取肿瘤大小的最佳截点。对病人预后因素进行单因素及多因素分析,对影响病人预后的独立因素进行分层分析。结果通过ROC曲线筛选出早期胃癌肿瘤直径最佳截点为23mm,其中肿瘤直径<23mm病人84例(小直径组),肿瘤直径≥23mm者75例(大直径组)。小直径和大直径组的术后5年存活率分别为98.8%和80.6%,差异具有统计学意义(P<0.01)。通过COX比例风险模型分析显示,肿瘤大小、浸润深度、淋巴结转移是影响全组病人预后的独立危险因素(P<0.05)。进一步分层分析发现,无淋巴结转移或浸润黏膜下层的早期胃癌病人,大直径组的5年存活率低于小直径组(P<0.01)。结论肿瘤直径大小的截点为23mm时,可显著影响无淋巴结转移或浸润黏膜下层的早期胃癌病人的预后。     

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??Laparoscopic resection in gastric stromal tumors: a report of 32 cases ZHAO Ying??YUE Yuan-yi?? WANG Qiang??et al. Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
Corresponding author??FENG Yong??E-mail: Fengy@sj-hospital.org
Abstract Objective To study the result of laparoscopic resection in gastric stromal tumors (GSTs), and discuss the value of laparoscopic resection in GSTs. Methods The clinical data of 32 cases of GST performed laparoscopic resection from January 2009 to November 2010 at Shengjing Hospital of China Medical University were analyzed. The operative time, intraoperative blood loss, postoperative exhaust time, intake time and hospital stay were explored. Results The mean operative time of laparoscopic resection for GSTs was ??65.5±9.8??mins. The intraoperative blood loss was??49.7±7.5??mL. The exhaust time was ??24.8±3.7??hours. The time of liquid food intake was ??26.8±3.4??hours. The length of hospital stay was ??6.3±1.1??days. During the follow-up of 1-25 months, there was no postoperative recurrence. Conclusion Laparoscopic resection of GSTs could be performed safely and effectively, which is feasible choice in the treatment for GSTs.     

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??Diagnosis and treatment of aortic laceration and traumatic aortic dissection WANG Li-xin??FU Wei-guo. Department of Vascular Surgery??Zhongshan Hospital of Fudan University??Shanghai 200032??China
Corresponding author??FU Wei-guo??E-mail??fu.weiguo@zs-hospital.sh.cn
Abstract Thoracic aortic laceration and traumatic aortic dissection are highly lethal injuries due to decelerate trauma after traffic accident or falling, which often associated with other organ injury. Successful management of thoracic aortic laceration and traumatic aortic dissection depends on early diagnosis and appropriate treatment. Management of other injured organs at the same time is mandatory. Endovascular repair has its special advantages in the treatment of aortic laceration and traumatic aortic dissection. The short to middle term follow up results were satisfied. Long term follow up results are needed to assess the overall efficacy of the method.     

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??Clinical features and epidemiologyof chronic pancreatitis in china LI Zhao-shen. Department of Gastroenterology, Changhai Hospital, the Second Military Medical University of Chinese PLA, Shanghai200433, China
Abstract A paucity of reports on the etiology, clinical characteristics, natural course, and management of chronic pancreatitis (CP) are available from centers in western countries.With totally different ethnic and cultural background, as well as socioeconomic status, CP in China has shown special epidemiology characters, including pathogenesis, etiology and clinical characteristics. Recently, China has conducted a joint survey study based on multicenter, and established a database, which has made great progress. However, the incidence of CP is rising rapidly in China. Alcohol and biliary stones are becoming the main causes and disabling pain is usually the main symptom. Endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography are effective diagnostic methods with high sensitivity and specificity. Extracorporeal shock-wave lithotripsy with endoscopic clearance of stone fragments is equally effective. In comparison with western countries on the clinical features and epidemiology of CP, diagnosis and treatment suitable to the situation in China can be established.     

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??The anti-hypertensive drug treatment of aortic dissection SHU Chang??ZHANG Wen-bo. Department of Vascular Surgery??the 2nd Xiangya Hospital??Central South University??Changsha 410011??China
Corresponding author: SHU Chang??E-mail:changshu01@yahoo.com
Abstract Incidence of aortic dissection is closely related to hypertension. Once it has arotic dissection, blood pressure should be reduced quickly and effectively as far as possible during acute phase, without affecting the perfusion of some vital organs, like the heart, brain, and kidney. The systolic pressure should be controlled between 90~100mmHg, while heart rate between 60~70 times/min. It has been generally accepted that the standard antihypertensive treatment is the combined application of vasodilators like sodium nitroprusside or nitroglycerin andβ-blockers. It is the key to surgical success that blood pressure monitoring and controlled hypotension during endovascular therapy.