结直肠癌合并肠梗阻的外科治疗分析

目的探讨结直肠癌并发肠梗阻的急诊外科治疗方法及效果。方法回顾性分析1998年1月～2006年12月的150例结直肠癌并发肠梗阻行急症手术治疗患者的临床资料。结果术后出现并发症17例，切口感染14例，腹腔感染5例，吻合口瘘2例。结论术中经阑尾残端行结肠灌洗并一期切除吻合治疗结直肠癌并发急性肠梗阻，是方便可行且安全有效的。     

大肠癌合并肠梗阻的外科治疗

目的：探讨大肠癌并肠梗阻的外科治疗方法。方法：回顾性分析我院1993至2003年收治手术52例大肠癌并肠梗阻临床资料。结果：52例患者中一期右半结肠切除12例；一期左半结肠切除23例；一期左半结肠或直肠上段癌切除、近端结肠造瘘、封闭远端结肠或直肠二期吻合14例：直肠癌晚期无法切除根治行乙状结肠造瘘5例，术后并发症发生率13．46％(7／52)，围手术期死亡率3．85％(2／52)。结论：提高本病认识，合理选择外科治疗；做好围手术期处理是提高疗效和改善生活质量的关键。     

大肠癌并发急性肠梗阻的外科治疗

目的 探讨大肠癌并发急性肠梗阻的外科治疗方法及效果。方法 回顾性分析l997年l0月～2002年10月76例大肠癌并发急性肠梗阻行急症手术治疗者的临床资料，其中右半结肠癌并梗阻23例，左半结肠癌和直肠并梗阻53例。结果 76例均行手术治疗，其中行～期切除吻合55例(右半结肠一期切除吻合l9例，左半结直肠一期切除吻合36例)。术后发生吻合口瘘2例，肺部感染2例，伤口感染6例，切口裂开l例，总并发症发生率为14.5％。除l例死于多器官功能衰竭外其它病例均通过非手术治疗治愈，随访统计l，3，5年生存率分别为98．3％，55％，38．5％。结论 一期切除吻合手术治疗大肠癌并肠梗阻是可行的，而合理地选择手术方式，正确的术中操作和围手术期处理对提高疗效，改善患者生活质量有所裨益。     

高龄结直肠癌患者并急性肠梗阻的外科处理

目的　探讨高龄结直肠癌患者并急性肠梗阻的外科处理方法。方法　回顾性分析我院1 992～ 1 999年间 88例高龄结直肠癌并急性肠梗阻患者的临床资料 ,综合评价其外科处理方法。结果　 88例均在入院后 3h至 5d内进行手术。 1 0例绞窄性肠梗阻中仅 3例术前确诊 ,符合率为 30 %(3/ 1 0 ) ,肿瘤切除率为 67% (59/ 88) ,术后并发症发生率为 42 % (37/ 88) ,病死率为 1 1 .4% (1 0 / 88)。结论　对高龄结直肠癌致急性肠梗阻的患者应警惕肠绞窄的发生 ,积极处理合并症 ,合理选择手术方式 ,有效地预防和治疗术后并发症是提高疗效的关键     

大肠癌合并低位肠梗阻的I期手术治疗

报道１９８９－１９９５年采用１期手术切除吻合术治疗５０例大肠癌所致的急性低位肠梗阻，其中５例合并肠穿孔，均获痊愈，仅２例切口感我吻合漏及其他并发 ，认为只要无休克及肠坏死，术前，术中做好相应的处理，对大肠癌全刀性低位肠梗阻的Ｉ期切除吻合术是安全的。     

大肠癌致急性肠梗阻的外科治疗(178例临床分析)

目的探讨大肠癌并发急性肠梗阻的外科治疗方法及疗效。方法大肠癌致急性肠梗阻178例,一期行右半结肠切除37例,一期行左半结肠切除80例,一期行结肠次全切除、回肠-乙状结肠(或直肠上段)吻合31例,一期行左半结肠或直肠上段癌切除,近端结肠造瘘、封闭远端结肠(或直肠)、二期吻合13例,结、直肠癌晚期无法根治切除者行结肠造瘘7例,短路手术10例。结果术后并发症发生率为13.5%(24/178),围手术期死亡率为4.5%(8/178)。结论大肠癌致急性肠梗阻的外科治疗应及时并遵循个体化原则,应创造条件力争一期切除肿瘤,解除梗阻。对左半结肠癌并发急性肠梗阻病人施行一期肿瘤切除吻合术是安全有效的,但应严格掌握适应证,灵活应用不同的手术方式。     

结直肠癌合并急性肠梗阻的外科治疗

结直肠癌合并急性肠梗阻是老年肠梗阻的常见原因之一,约占老年肠梗阻的半数以上,8%～29%的结肠癌病人在伴发急性或慢性梗阻后才就诊[1].由于结肠梗阻多为闭袢性梗阻,极易造成结肠坏死和穿孔,加之患者年龄大,常合并内科疾病,使得临床治疗比较复杂.[第一段]     

结肠癌致急性肠梗阻63例手术治疗体会

我院外科1978年至1992年共手术治疗结肠癌致急性肠梗阻63例。现将有关手术治疗问题分析如下。1 临床资料本组男性37例,女性26例。年龄18～89岁。40岁以上占49例(78%)。肿瘤部位与手术方法:肿癌位于右半结肠20例     

大肠癌致急性肠梗阻的诊断和治疗

目的探讨大肠癌致急性肠梗阻的诊断、围手术期处理及手术方式。方法对1998年1月至2008年10月手术治疗的37例大肠癌致急性肠梗阻病人的临床资料进行回顾性分析。结果大肠癌致急性肠梗阻的术前确诊率为78．4％（29／37）。术前应用抗生素,术中灌洗减压,行一期切除吻合术29例;近端结肠造瘘、关闭远端结肠或直肠备作二期吻合4例;肿瘤无法切除行结肠造瘘4例。术后并发症发生率为16．2％。随访统计1年、5年生存率分别为87．1％和35．7％。结论及时诊断。合理地选择手术方式,加强围手术期的处理是降低术后并发症的关键。     

95例高龄大肠癌的手术治疗

目的：探讨高龄大肠癌的外科治疗方法。方法：对95例高龄大肠癌的临床资料进行回顾性分析。本组平均年龄74．5(70—87)岁，伴肠梗阻38例，行急诊手术20例。肿瘤部位：直肠40例，乙状结肠25例，结肠肝曲7例，横结肠10例，回盲部7例，升结肠3例，结肠脾曲2例，降结肠1例。高中分化腺癌80例(84．2％)，低分化肿瘤15例(15．8％)。行Dixon术18例，Miles术10例、乙状结肠切除13例，余行左、右半结肠切除、横结肠切除、乙状结肠造瘘术等。结果：随访3年，生存3年以上65例(68．4％)，生存2年以上15例(15．80%)，2年内死亡15例(15．8％)。结论：高龄大肠癌治疗以手术为主，手术的目的是切除肿瘤，防止梗阻，提高生活质量。     

肠梗阻导管在结直肠癌性肠梗阻治疗中的应用研究

目的 探讨肠梗阻导管治疗结直肠癌性肠梗阻的临床效果.方法 对我院2005年12月至2008年12月期间收治的32例结直肠癌性肠梗阻患者先行经鼻和经肛两种途径置入肠梗阻导管,通过导管减压、引流等治疗后,再行一期根治切除吻合术.结果 32例患者中19例经鼻及经肛型肠梗阻导管双侧同时性置入成功,另13例仅完成经鼻型肠梗阻导管置入.置管12～36 h后所有患者腹痛、腹胀症状明显缓解;26例于48～96 h后腹痛、腹胀症状完全消失.比较所有患者置管前、后腹围缩小程度,置管24 h后为(81.3±19.6)%,明显小于置管前的100%(t=3.586,P=0.02).32例患者经肠梗阻导管治疗5～7 d后,均成功施行一期根治切除吻合术,术后无腹腔感染、吻合口漏等严重并发症发生.结论 经肠梗阻导管减压、引流等治疗后再行一期根治切除吻合术,是治疗结直肠癌性肠梗阻的有效方法.     

左半结肠癌急性肠梗阻的外科治疗

目的：探讨左半结肠癌急性肠梗阻的合理治疗措施。方法：回顾性分析我院普外科1999年6月至2004年6月手术治疗的左半结肠癌急性肠梗阻136例的临床资料。结果：136例病人中，112例行肿瘤一期切除吻合术，切口感染4例；16例行Hartmanns手术，4例行永久性结肠造口术，无并发症；4例行捷径手术，肠吻合口瘘1例。结论：左半结肠癌急性肠梗阻病人，手术采取何种术式，要据病人具体病情，综合分析。     

右半结肠癌切除合并十二指肠缺损的处理

目的探讨右半结肠癌切除十二指肠缺损的外科处理方法。方法1990年1月~2004年1月收治右半结肠癌切除合并十二指肠缺损10例,根据缺损的程度总结为局部小缺损、巨大缺损和内瘘型缺损三种类型。采用局部切除间断缝合十二指肠局部小缺损4例;带蒂末端回肠补片修补十二指肠巨大缺损2例;内瘘型的4例分别行局部修补、十二指肠引流1例,带蒂胃壁浆肌层补片修补、十二指肠造口1例,右半结肠切除后加行胰十二指肠切除2例。结果内瘘型缺损中,行带蒂胃壁浆肌层补片修补、十二指肠造口的1例术后并发胃梗阻,2周后加作胃空肠吻合后恢复出院,行十二指肠引流的1例术后出现十二指肠漏,后因病情恶化出院,其余8例无围手术期并发症,顺利恢复。结论根据右半结肠癌切除十二指肠缺损的不同特点,积极合理的手术抉择和外科处理将有助于改善预后和减少手术风险。     

Outcomes of Surgical Management of Total Colonic Aganglionosis

Purpose The purpose of this study was to assess the long-term clinical outcomes and bowel function of patients with total colonic aganglionosis (TCA) after surgery. Methods The hospital records of 17 TCA patients treated surgically during 1985 to 2004 were reviewed. Long-term follow-up was done by telephone interviews with the parents. Results Primary enterostomy was performed in 13 (76%) patients. In three (17%) patients, TCA was not suspected initially. They underwent conservative surgery primarily, which required a second operation soon after. One had transverse colectomy with ileostomy. By pathologic review, nine (53%) patients had small bowel involvement of aganglionosis. Six (35%) patients died before corrective surgery. They all had extensive small bowel involvement. Among 11 patients who had a corrective operation, 10 were treated with Martin’s procedure. Long-term (mean 74 months) follow-up was available in seven patients, and the mean weight-for-age percentiles was 27.1% (range 5–50%), the frequency of defecation was three to five times a day in four patients (57%), one or two times a day in two patients (28%), and more than five times a day in one patient (15%). Conclusions TCA is difficult to diagnose; but once it is diagnosed correctly and treated by corrective surgery, outcomes seem promising. Martin’s operation brought about a good outcome and enabled patients to have acceptable bowel habits. The prognosis is highly dependent on the extent of aganglionosis.     

粘连性肠梗阻手术指征多因素分析

目的探讨粘连性肠梗阻手术指征的多因素预测方法。方法回顾性分析安徽医科大学第一附属医院普外科1996年1月至2010年1月期间住院的2034例粘连性肠梗阻患者(进入分析模型有1992例),利用logistic多因素回归分析法,将可能影响粘连性肠梗阻急诊手术指征的17项因素〔梗阻持续时间、发作次数、腹部手术史、持续或剧烈腹痛、剧烈或频繁呕吐、严重腹胀、便血、发热、心率、休克或低血压、触及肿大肠襻、肠鸣音减弱、腹膜炎、外周血白细胞(WBC)计数、腹部立位X线平片示梗阻肠襻固定且扩张加重、腹腔游离气体及B超提示腹腔积液〕进行logistic回归分析,根据logistic回归分析理论得出粘连性肠梗阻需急诊手术几率的预测公式。结果根据logistic多因素及逐步回归分析得出梗阻持续时间、第一次发作、出现持续或剧烈腹痛、临床体检发现心率增快、出现腹膜炎体征、腹部立位X线平片见梗阻肠襻固定且扩张加重、B超提示腹腔积液及外周血WBC计数增高8项指标可以预测粘连性肠梗阻患者是否需急诊手术。其预测公式为:logit(P)=expZ/(1+expZ),其中Z={-7.813+〔-1.942×X1(1)/2.290×X1(2)/2.765×X1(3)〕+2.801×X2+2.692×X4+10.610×X9(1)/13.279×X9(2)+3.422×X13+〔-3.048×X14(1)/16.992×X14(2)〕+6.113×X15+2×X17},式中:X1(1)=梗阻持续时间3～5d,X1(2)=梗阻持续时间5～7d,X1(3)=梗阻持续时间≥7d;X2=发作次数;X4=持续或剧烈腹痛;X9(1)=心率60～100次/min,X9(2)=心率≥100次/min;X13=腹膜炎;X14(1)=WBC计数(10～20)×109/L,X14(2)=WBC计数≥20×109/L;X15=腹部立位X线平片示梗阻肠襻固定且扩张加重;X17=B超示腹腔积液。P0.5时则需急诊手术。本组结果符合率为99.00%,敏感性为96.17%,特异性为99.53%。随后利用2010年1月至2010年4月期间收治的粘连性肠梗阻患者105例对上述预测公式进行评价,符合率为96.20%,敏感性为90.00%,特异性为96.84%。结论预测公式有较好的实用价值,公式中各项系数还可随病例数增加进行修正。     

Bacterial Translocation as a Cause for Septic Complications in Obstructive Colonic Ileus

Abstract

Failure of intestinal barrier function and subsequent translocation of microorganisms and their degradation products play a decisive role in development of systemic septic complications for many systemic and intra-abdominal pathologies, for example, following obstructive colonic ileus (Od). This study was aimed at the evaluation of the intestinal barrier state in OCI. Sixty albino Wistar rats weighing 250 to 300 g (mean 265 g) were divided into four groups (15 animals in each). Acute colonic ileus (ACI) was modeled as follows except a control group (Group 1). Our objective was to examine changes in bacterial flora in the abdomen, mesenteric lymphatic nodes (MLN), liver, spleen, and lungs during the model of OCI after 72 hours following the beginning of experiment. The composition of parietal mucus in normal and in OCI 48 hours following the beginning of experiment examined. Interleukine (IL-VI) levels were determined in both portal and peripheral blood. The right-hand half of colon was ligated at the level of ileocaecal junction in animals of Group 2 (n = 15), whereas in animals of Group 3 (n = 15) it was ligated at the level of sigmoid colon. With the same purpose, a portion of the suspended caecal content was administered into lumen of the jejunum at a concentration of 10⁶ colony-forming units (CFU) in animals of Group 4 (n = 15). Experimentally — induced OCI causes significant bacterial translocation (BT) in rats. The process of colonization of the proximal small intestine with colonic flora takes place under the conditions of ileus. The conditions favorable for the development of BT are generated with colonization of 10⁶ CFU in volume. As a result, intestinal flora penetrates into the abdominal organs and lungs. Its highest concentrations are noted in the lymph nodes, lungs and liver. The modeling of the small intestine colonization with colonic flora (Group 4) demonstrates critical parameters of microbial semination.     

The Role for Surgical Management of HPV-Related Oropharyngeal Carcinoma

Human papillomavirus (HPV)-associated oropharyngeal carcinoma has become the predominate cause of oropharyngeal carcinoma in the United States and Europe. Management of this disease is controversial. Traditional open surgical techniques gave way to concurrent chemoradiotherapy following several American and European organ-preservation trials suggesting that both modalities were equally efficacious. More recently, minimally invasive surgical techniques have gained popularity. These techniques provide an opportunity to achieve a complete surgical resection without the treatment-related morbidity associated with open surgery. Proponents of this technique contend that transoral surgical techniques provide a means to analyze the tumor tissue, prognosticate, and personally direct therapy. Skeptics suggest that HPV-associated oropharyngeal carcinoma responds well to chemoradiotherapy and that surgery may not provide a treatment advantage. Both approaches provide a unique perspective and both are currently being studied under trial.     

肝癌合并门静脉癌栓的外科处理

目的：研究肝细胞肝癌合并门静脉癌栓患者外科治疗的效果及影响因素。方法：对３１例肝癌合并门静脉主干及其大分支癌栓患者在电凝锐性解剖肝门的基础上,采用肝叶切除加癌栓清除、门静脉主干切开取栓等术式治疗,并对癌栓的临床病理学类型进行探讨。结果：与非治疗者相比,外科治疗明显延长了患者的术后生存期,疗效最好的方法是肝叶切除加取栓术,１８例术后平均存活时间１５个月,门静脉主干切开取栓术次之,８例平均存活８个月。所有取栓成功的患者术后均无食管静脉曲张破裂出血。癌栓的病理类型以增殖型最多见,机化型罕见,但由于癌栓与门静脉壁紧密粘连,不易清除,后者不宜外科治疗。结论：外科治疗有效地防止了肝癌合并门静脉癌栓的严重并发症──急性上消化道出血,并延长、改善了患者的生存期和生命质量。