回肠远段环形贮袋的临床应用

目的总结回肠远段环形贮袋的临床应用经验。方法回顾性分析9例慢传输型便秘、7例家族性腺瘤性息肉病和3例溃疡性结肠炎手术治疗的临床资料。19例患者均行全结肠切除、回肠远段环形贮袋一直肠吻合术。观察术后疗效及并发症发生情况。结果 19例均手术成功,术后肛门排气时间平均3.5 d,3⁶ d排便。术后随访6个月6 d排便。术后随访6个月²年,无顽固性腹泻、吻合口漏、肠梗阻等并发症,疗效满意。结论全结肠切除、回肠远段环形贮袋一直肠吻合术是治疗慢传输型便秘、家族性腺瘤性息肉病和溃疡性结肠炎的有效措施,术后排便控制能力满意,是一种较为理想的术式。     

Relative incidence of Crohn's disease and ulcerative colitis in six Melbourne hospitals

Information on the relative incidence of Crohn's disease and ulcerative colitis was obtained by a prospective investigation at six Melbourne teaching hospitals. One hundred and eleven patients who presented with chronic inflammatory bowel diseases between 1980-1981 were admitted to the study. Forty (36%) patients were diagnosed as having Crohn's disease and 63 (57%) patients as having ulcerative colitis. The type of chronic inflammatory bowel disease could not be determined in eight (7%) patients. These findings suggest that the relative frequency of Crohn's disease and ulcerative colitis in Melbourne hospitals is within the range that is reported for northern Europe and the United States.     

慢性放射性肠炎并发小肠梗阻的外科治疗

目的：探讨慢性放射性肠炎并发小肠梗阻的外科治疗方法。方法：回顾分析4例结直肠癌术后辅助放疗后并发慢性放射性肠炎、小肠梗阻的外科治疗结果和手术失败的原因。结果：2例直肠癌和2例乙状结肠癌病人术后放疗后(间隔3．5～11个月)因慢性放射性肠炎并发小肠梗阻而接受手术治疗。手术方法均采用了短路吻合法。即将梗阻段小肠的远近端肠管侧侧吻合。2例直肠癌病人术后恢复顺利。1例乙状结肠癌病人术后早期并发旷置段小肠肠外瘘。另1例乙状结肠癌病人术后4个月并发旷置小肠肠外瘘。2例病人并发肠瘘后均发现存在降结肠梗阻。结论：慢性放射性肠炎病人并发小肠梗阻时，可能同时合并有结肠梗阻。术前需要了解有无合并结肠梗阻并同时解决结肠梗阻。短路吻合术治疗后旷置的病变小肠有并发肠穿孔、肠瘘可能，首次手术治疗宜尽量切除梗阻段病变肠管，如不能切除，应尽量将病变肠管与消化道完全隔离。     

溃疡性结肠炎367例复发患者5年随访观察

目的 分析溃疡性结肠炎(UC)患者的资料,探讨UC复发的临床特点以及复发相关因素.方法 统计分析解放军总医院1994至2005年,确诊并住院治疗的溃疡性结肠炎患者525例临床资料.分析其中367例复发患者的年龄、性别以及复发的可能因素,治疗时间和复发的时间等.结果 1994至2005年,共有525例UC住院患者,367例患者复发,复发率为69.9%,中位年龄42岁,男女比例为1∶3.13;其中263例接受随访,随访率为50.1%.分析复发因素中,UC患者女性比例明显高于男性(P≤0.05),老年人(≥60岁)比例明显低于其他年龄段(P＜0.05);C-反应蛋白(CRP)水平对复发无影响(P＞0.05).随访患者中,1年内36.5%复发,2年内75.3%复发,5年内87.8%复发,中位维持治疗时间(16.3±3.9)个月.复发组中停药后复发患者142例(61.5%);维持治疗中复发患者26例(11.3%);未治疗患者63例(27.2%).复发组和无复发组之间,病情程度(P＜0.05)、病变部位(P＜0.05)与维持治疗时间(P＜0.05)差异有统计学意义.结论 女性UC患者复发率高于男性,老年人复发率低于其他年龄段,病变部位、病情程度、维持治疗时间与UC复发相关.     

保留回盲瓣之盲肠经直肠肌鞘肛管吻合术在结直肠良性病变中的应用

目的 探讨保留回盲瓣之全结肠切除、直肠粘膜剥除，盲肠经直肠肌鞘肛管吻合术在溃疡性结肠炎、家族性腺瘤性息肉病患者中的应用及效果。方法 回顾性总结1990年以来进行的8例保留回盲瓣之全结肠切除、直肠粘膜剥除，盲肠经直肠肌鞘肛管吻合患者，其中溃疡性结肠炎患者5例，家族性腺瘤性息肉病患者3例。结果 随访5～10年无1例复发，无伤口感染、肛瘘形成，排尿及性功能无影响，8～10周排便次数恢复到3～5次/d，3-4月恢复正常(1～3次，d)。结论 保留回盲瓣之全结肠切除、盲肠经直肠肌鞘肛管吻合术治疗重症溃疡性结肠炎、家族性腺瘤性息肉病初步结果满意。     

保留回盲瓣之盲肠经直肠肌鞘肛管吻合术在结直肠良性病变中的应用

目的 探讨保留回盲瓣之全结肠切除、直肠粘膜剥除,盲肠经直肠肌鞘肛管吻合术在溃疡性结肠炎、家族性腺瘤性息肉病患者中的应用及效果.方法 回顾性总结1990年以来进行的8例保留回盲瓣之全结肠切除、直肠粘膜剥除,盲肠经直肠肌鞘肛管吻合患者,其中溃疡性结肠炎患者5例,家族性腺瘤性息肉病患者3例.结果 随访5～10年无1例复发,无伤口感染、肛瘘形成,排尿及性功能无影响,8～10周排便次数恢复到3～5次/d,3～4月恢复正常(1～3次/d).结论 保留回盲瓣之全结肠切除、盲肠经直肠肌鞘肛管吻合术治疗重症溃疡性结肠炎、家族性腺瘤性息肉病初步结果满意.     

溃疡性结肠炎的手术治疗时机

目的探讨溃疡性结肠炎的手术治疗时机。方法总结52例溃疡性结肠炎的临床治疗及生化资料,分析不同病变程度之患者的临床治疗方法。结果经内科治疗后转入外科的溃疡性结肠炎患者52例,32例行结肠切除术,20例保守治疗缓解后9例复发,其小4例手术治疗。结论溃疡性结肠炎患者,在血清类粘蛋白初始值显著较高,血清白蛋白和血红蛋白初始值较低,经内科保守治疗无效者,应及早考虑某种方式的外科手术治疗。     

Toxic megacolon in ulcerative colitis: a continuing challenge.

The incidence, predisposing factors, management and outcome of toxic megacolon (TM) has been reviewed in 65 cases of severe ulcerative colitis (UC) and compared in 2 successive 6-year periods before and after January, 1973. Nineteen episodes of TM occurred in 18 patients. Despite a conscious aim towards earlier surgery in recent years this was not achieved, and despite more intensive medical therapy the incidence of TM was unchanged. Emergency operative mortality in UC fell from 36% to 21% but the mortality of TM remained at 30%. The chief cause of death was colonic perforation. Mortality was associated with increased age, longer pre-operative hospital stay and lower levels of serum albumin. These findings reemphasize the need for earlier surgery if TM is to be prevented, but such a policy must result in some unnecessary emergency colectomies.     

活动期溃疡性结肠炎临床疗效评价

目的:分析溃疡性结肠炎(UC)活动期的临床疗效及治疗转归,评价预后相关因素。方法:回顾性分析我院128例住院患者的病例资料,记录临床表现及诊疗经过,对柳氮磺吡啶(SASP)或5-氨基水杨酸(5-ASA),糖皮质激素,免疫抑制剂,灌肠,外科手术等治疗方法的疗效进行评价。结果:活动期UC患者中,轻度占25.0%(32/128),中度占53.9%(69/128),重度占21.1%(27/128);SASP或5-ASA是控制症状的主要药物,对于中度UC患者,联合用药治疗效果较为理想。而发病年龄轻、结肠病变范围大、低血红蛋白、大便以血为主、低血清白蛋白、病变伴有溃疡是提示疗效差的相关因素。结论:对于UC病变处于活动期时,应及时评估病情严重程度,选择疗效相对较好的治疗方案,并分析影响疗效相关因素。     

Management of inflammatory bowel disease

Ulcerative colitis and Crohn's disease result from an interaction between genetic and environmental factors. Only one gene, NOD2/CARD15, has been clearly identified; a minority of people with alteration of this gene develop Crohn's disease. The NOD2/CARD15 protein is thought to be involved in defence against intracellular bacteria. This supports the idea that Crohn's disease and ulcerative colitis result from altered immunological responses to the normal intestinal flora. Life expectancy is normal in ulcerative colitis and nearly so in Crohn's disease, but both conditions cause considerable morbidity. Approximately 80% of patients with Crohn's disease eventually require surgery, and about 25% of patients with ulcerative colitis require colectomy. Treatment of ulcerative colitis is generally by corticosteroids for acute disease and mesalazine for maintenance, but the range of therapies for Crohn's disease is expanding. Alternative therapies include immunosuppressives, enteral nutrition, antibiotics, anti-TNF antibody (infliximab), corticosteroids, and surgery. High dosages of corticosteroids may provide symptomatic relief in Crohn's disease but do not affect the long term natural history of the disease, and management strategies should avoid using steroids whenever possible.     

结直肠癌合并急性结肠梗阻的外科治疗(附127例临床分析)

目的探讨结直肠癌并发急性结肠梗阻病例的外科处理原则和方法。方法 回顾性分析我院自1992-2003年收治的127例结直肠癌并急性结肠梗阻病例,结合近年国内外文献,综合评价其外科处理方法。结果127例患者均经手术治疗,出现并发症13例(10.2％);死亡7例,病死率为5.5％,其余均痊愈出院。结论结直肠癌并急性结肠梗阻的处理要根据患者的全身情况和肿瘤的局部情况来进行综合判定。适应证掌握恰当,一期肿瘤切除和吻合术是安全的。     

急性肠梗阻手术时机选择探讨

目的：探讨急性肠梗阻手术治疗的最佳时机。方法回顾性分析我院2010年1月—2015年1月收治的82例急性肠梗阻患者手术治疗的临床资料。结果82例急性肠梗阻患者均给予及时手术,治愈80例,死亡2例,病死率为2.44%。结论早期诊断、及时手术治疗是提高急性肠梗阻治愈率、降低并发症及病死率的关键;而急性肠梗阻手术时机的正确选择,对患者的预后有重要意义。     

Chronic liver disease associated with childhood ulcerative colitis

In a series of 301 patients with ulcerative colitis forty-eight developed the disease before the age of 20. In this group of forty-eight patients there were four cases of serious chronic liver disease as compared with a total of seven cases of chronic liver disease in the whole series. The hepatic lesions in the patients developing colitis in childhood were unrelated to the extent, duration or severity of the colitis but colitis in very early life appeared to predispose to liver disease subsequently.     

老年重症急性胰腺炎手术治疗探讨

目的：讨论老年重症急性胰腺炎的手术治疗。方法：我院1984年1月－2000年10月共收治60岁以上手术证实的重症急性胰腺炎26例，本对其手术治疗的方法和时机以及相应的并发症和死亡率进行回顾性分析。结果：本组术后死亡6例，其中4例死于MOF，2例死于ARDS。在发病24小时内手术8例中无1例死亡，24－36小时内手术14例有2例死亡，36小时后手术4例均死亡。结论：老年重症胰腺炎患多伴有心、肺、肾等重要器官慢性疾病，脏器代偿功能差，较易出现MOF，因此如有手术指证或经短期非手术治疗效果不明显，应及时手术，并在术中和术后采用合理的治疗措施，有利于减少术后并发症，降低手术死亡率。     

Early onset high grade dysplasia in ulcerative colitis

We report a patient with ulcerative colitis who underwent colectomy when aged 25 years for multifocal high grade dysplasia which had developed within 2 years of diagnosis, and only 5 1/2 years after his first symptoms. The implications of this case for the management of ulcerative colitis are discussed.     

Analysis of complications and deaths in aged patients with obstructive jaundice]

The reasons of complications and deaths in 98 aged patients with obstructive jaundice were analysed in the paper. Among them, 52 cases were diagnosed as benign obstruction, 46 cases as malignant obstruction; 92 patients were treated by surgical management(15 died), 6 patients were treated without operation(4 died). The results showed that effective management on time and intensive perioperative care are important to minimize the mortality rate. Malignant obstructive jaundice was more harmful to the patients' renal function no the mortality rate would be increased. The operations, internal drainage and pressure reduction of biliary duct, were performed on time, thus the survival rate was improve.     

Ulcerative Colitis: Disease Patterns and Medical Management

The extent of anatomical involvement (rectosigmoid, left colon, entire colon, segmental, and enterocolon) and clinical behaviour (acute fulminating, recurrent colitis, and chronic continuous colitis) must be considered in assessing the prognosis and management of patients with ulcerative colitis. The severity of symptoms and signs is highly variable. It ranges from the virtually asymptomatic patient with mild proctitis to the patient with acute fulminating colitis with arthritis, skin lesions and “toxic megacolon” who constitutes a medical emergency. Consequently, there is no single therapeutic formula to be applied in this disease. Treatment is reviewed with reference to the recent literature.     

老年梗阻性黄疸合并症与死亡分析

对９８例老年梗阻性黄疸病人采用手术和非手术治疗。结果：手术治疗９２例,死亡１３例,非手术治疗６例,均死亡。表明病死率随着发病至手术时间的延长而增加,早期手术、加强围手术期的综合治疗是降低病死率的关键。     

Ulcerative colitis in Malaysians: a review of 23 patients

Twenty-three patients with ulcerative colitis are reported from Kuala Lumpur, Malaysia. Sixteen were newly diagnosed over a six-year period between 1982 and 1987. The disease was commoner in men (16 men : 7 women). The peak age of onset was in the third decade. The ethnic distribution of the patients was 10 Malays, eight Indians and five Chinese making the disease relatively commoner amongst Indians. The extent of colonic involvement varied and six (26%) had a total colitis. Extra-intestinal manifestations were seen in seven patients. Diagnosis was delayed for over 10 years in four. Colorectal cancer was not seen. There was no mortality. Ulcerative colitis remains an uncommon disease amongst Malaysians. During the same period, only four male patients with Crohn's colitis were seen.     

单中心胃癌围手术期死亡因素分析

回顾诊断为胃癌并行手术治疗后于住院期间或手术后<30 d死亡患者36例,同时随机调取胃癌手术后恢复良好并顺利出院且术后生存时间≥30 d的患者共230例,采用二分类非条件Logistic回归分析围手术期死亡主要影响因素。结果显示胃癌围手术期死亡率为0．50%(36/7133)。多因素Logistic回归分析提示年龄、ASA评分、合并呼吸系统疾病及肿瘤分期是导致胃癌围手术期死亡的危险因素。高龄晚期胃癌伴有合并疾病患者围手术期死亡率较高,应完善术前准备,进行术前干预,降低胃癌围手术期死亡率。