老年直肠癌Dixon术后吻合口漏159例临床分析

目的 探讨老年直肠癌Dixon术后吻合口漏的发生率、危险因素和治疗方法.方法 回顾性分析159例直肠癌行Dixon术患者的临床资料.结果 年龄、肿瘤距肛缘距离、糖尿病、术前低蛋白、术前合并肠梗阻、切口感染与吻合口漏的发生密切相关,而性别与吻合口漏的发生无关.结论 吻合口漏是直肠癌Dixon术后一种常见并发症,低位直肠癌行保肛手术增加吻合口漏发生率,大部分吻合口漏经单纯引流管冲洗可治愈,少数病例需行剖腹探查肠造瘘术.     

中下段直肠癌保肛术并TME术后吻合口瘘的危险因素分析(附156例报告)

分析156例中下段直肠癌患者行保肛术并直肠全系膜切除（TME）术后吻合口瘘的影响因素。吻合口距肛缘平均3.6cm（1-5cm），吻合口瘘发生率10．3％。女性、行近段肠造口者吻合口瘘发生率低（P均〈0．01），未行近段肠造口的男性患者吻合瘘发生率较高。行近段肠造口发生吻合口瘘者无1例需再次手术。认为应用保肛术并TME术治疗中低位直肠癌时，为了预防吻合口瘘的发生，对男性患者应常规行近段肠造口术；女性患者可不需要，只有在吻合技术不理想时选择近段肠造口术。     

腹腔镜辅助直肠癌前切除术后吻合口狭窄的危险因素分析

[目的]分析影响腹腔镜辅助直肠癌前切除术后发生吻合口狭窄的危险因素。[方法]收集行直肠癌根治术的108例患者的临床资料,采用单因素分析及Logistic多因素回归分析研究直肠癌术后发生吻合口狭窄的危险因素。[结果]单因素分析结果显示,新辅助放疗、预防性末端回肠造口、不保留左结肠血管、吻合口漏是直肠癌术后吻合口狭窄的相关因素,多因素分析结果显示,新辅助放疗和吻合口漏是术后吻合口狭窄的独立危险因素。[结论]对于术前接受放疗和术后发生吻合口漏的直肠癌手术患者应重点随访,预防吻合口狭窄的发生。     

内镜直视下经肛肠梗阻减压管灌洗术的临床应用

结直肠癌急性完全性肠梗阻导致梗阻近端肠管扩张、肠壁水肿、腹压增大、局部淋巴结清扫困难、术后关腹困难、吻合口瘘发生率增加.临床常采取姑息性切除肿瘤、近端结肠造瘘、Ⅱ期或Ⅲ期肠吻合的手术方式.近年来随着内镜介入技术的发展、术前置人肠梗阻减压管灌洗引流术的应用,使急性完全性结直肠梗阻Ⅰ期肠吻合术成为可能.     

结直肠癌患者术后吻合口瘘发生的危险因素分析

目的分析结直肠癌患者术后吻合口瘘发生的危险因素。方法对该院2006-01～2018-06行结直肠癌根治术治疗的459例患者临床资料进行回顾性分析,采用单因素和多因素Logisitc回归分析探讨术后吻合口瘘发生的危险因素。结果吻合口瘘发生率为9.80%(45/459)。多因素Logistic回归分析结果显示年龄(OR=2.815)、术前合并糖尿病(OR=4.872)、术前合并低蛋白血症(OR=3.258)、肿瘤距肛门缘距离(OR=4.153)是结直肠癌术后吻合口瘘发生的危险因素。结论年龄、术前合并糖尿病、术前合并低蛋白血症、肿瘤距肛门缘距离是结直肠癌术后吻合口瘘发生的危险因素,围术期应充分考虑这些因素的影响,并采取适当的预防措施。     

腹腔镜直肠癌全系膜切除术后吻合口漏相关因素分析

目的探究腹腔镜直肠癌全系膜切除术后吻合口漏的相关危险因素,为临床预防及治疗吻合口漏提供参考依据。方法回顾性分析2013年4月至2017年3月于承德医学院附属医院行腹腔镜直肠癌全系膜切除术328例患者的临床资料,将患者按照术后是否发生吻合口漏分为吻合口漏组与无吻合口漏组,单因素分析和多因素Logistic回归分析探究术后吻合口漏的危险因素。结果 328例患者中,发生吻合口漏28例,发生率为8.54%。单因素分析显示,术后吻合口漏与年龄、营养状况、术前血红蛋白水平、术前血清白蛋白水平、吻合口距肛门距离等因素相关(P0.05);多因素Logistic回归分析显示,吻合口距肛门距离、营养状况、术前血红蛋白水平、术前血清白蛋白水平是腹腔镜直肠癌全系膜切除术后发生吻合口漏的主要危险因素(P0.05)。结论为降低患者直肠癌全系膜切除术后吻合口漏的发生率,需提高患者营养状况,并控制术前血红蛋白和血清白蛋白水平,在保证切缘足够的前提下,尽可能采用高位吻合。     

预防性末端回肠造瘘在超低位直肠癌保肛手术中的应用探讨

目的探讨预防性末端回肠造瘘在超低位直肠癌保肛手术中的应用效果。方法将收治并行超低位直肠癌保肛手术治疗的72例患者随机分为观察组和对照组各36例。两组患者均施行超低位直肠癌保肛手术治疗,术中严格遵循全直肠系膜切除(TME)原则。观察组在此基础上行预防性末端回肠造瘘。比较两组患者术后排气时间、拔除引流管时间、住院时间及吻合口瘘发生率等。结果观察组术后排气时间、拔除引流管时间、住院时间均明显短于对照组(P 0. 05)。观察组术后吻合口瘘发生率低于对照组,但差异无统计学意义(P 0. 05)。结论超低位直肠癌保肛手术患者术后行预防性末端回肠造瘘可促进肠道功能早期恢复、缩短住院时间,并有降低术后吻合口瘘发生率的优势。     

吻合环及传统末端吻合用于直肠癌保护性回肠造口术对患者术后恢复的影响

目的研究吻合环及传统末端吻合用于直肠癌保护性回肠造口术对患者术后恢复的影响。方法纳入2017年3月至2019年3月于空军军医大学西京医院收治的124例直肠癌患者为对象,按照抽签随机方法分为两组,各62例。其中对照组行传统保护性末端回肠造口术,观察组实施吻合环复合装置保护性回肠造口术。观察两组手术相关指标(包括手术操作时间、住院时间),分析两组手术并发症发生情况(包括吻合口瘘、造口相关并发症),并分析对照组患者术后还纳情况。结果两组所有患者均顺利完成造口手术。观察组手术操作时间显著长于对照组(P 0. 05),但住院时间较对照组比较差异无统计学意义(P 0. 05)。观察组造口相关并发症发生率为29. 03%,显著低于对照组的61. 29%(P 0. 05);观察组吻合口瘘发生率为8. 06%,对照组吻合口瘘发生率为6. 45%,差异无统计学意义(P 0. 05)。术后所有患者均随访6个月,随访期间无失访病例。对照组患者中,第1次术后3月还纳者占32. 26%,术后6月还纳者占61. 29%,未还纳者占6. 45%。结论与传统保护性末端回肠造口术比较,采用吻合环复合装置保护性回肠造口术更利于直肠癌患者术后早期康复,造口相关并发症少,无需二次还纳,临床应引起足够重视。     

手术治疗结直肠癌合并急性肠梗阻156例临床分析

目的探讨结直肠癌合并急性肠梗阻患者的手术治疗方法。方法回顾性分析156例行手术治疗的结直肠癌合并急性肠梗阻患者的临床资料。结果本组131例行结肠一期切除吻合术,其中21例行左半结肠切除,行横结肠切除8例,行右半结肠切除术61例,行乙状结肠切除26例,Dixon术15例;行分期手术13例;3例行一期造瘘、二期肿瘤切除肠吻合术;因肿瘤无法切除而行单纯造瘘术9例。本组围手术期死亡3例。153例肠梗阻得到缓解。术后发生切口感染9例,吻合口漏8例,肺部感染2例,输尿管损伤1例,经对症处理后痊愈。随访9个月～5年。术后1年生存率为90.1%(136/151),3年生存率为51.7%(78/151),5年生存率为40.4%(61/151)。结论结直肠癌合并急性肠梗阻确诊后应及早手术治疗。应根据患者的具体情况选择术式,在严格掌握适应证的情况下,尽量争取行一期肠切除吻合术。     

直肠癌术后吻合口瘘的防治进展

结直肠癌(colorectal cancer, CRC)是全球常见的恶性肿瘤之一,在我国其发病率和死亡率均居所有恶性肿瘤的第三位.其中直肠癌占所有CRC总发病率的60%-70%.随着对直肠癌发病机制和肿瘤转移机制的深入研究,以及手术技术方法的不断改进,中低位直肠癌保肛手术逐渐增多,患者生活质量虽然得到明显改善,但吻合口瘘仍是直肠癌保肛手术后最常见和最严重的并发症之一.研究显示直肠癌术后吻合口瘘的发生率为3%-21%,死亡率高达3%.因此,术前对患者进行全面检查,对危险因素进行综合分析,对于减少潜在吻合口瘘的风险,选择合适的手术方式和预防措施,从而有效的预防和减少吻合口瘘的发生有重要意义.本文对直肠癌术后吻合口瘘的危险因素和防治进展进行综述,以期能降低吻合口瘘的发生率.     

Options for screening for colorectal cancer

Unlike other types of cancer, there are several options for screening for colorectal cancer (CRC). The most extensively examined method, faecal occult blood testing (FOBT), has been shown, in three large randomized trials, to reduce mortality from CRC by up to 20% if offered biennally and possibly more if offered every year. Recently published data from the US trial suggest that CRC incidence rates are also reduced by up to 20%, but only after 18 years. In this study, the number of positive slides was associated with the positive predictive value both for CRC and adenomas larger than 1 cm, suggesting that the reduction in CRC incidence was caused by the identification and removal of large adenomas. In this respect, this study supports the concept that removing adenomas prevents CRC. More efficient methods of detecting adenomas include the use of colonoscopy or flexible sigmoidoscopy (FS). Considerable evidence exists from case-control and uncontrolled cohort studies to suggest that endoscopic screening by sigmoidoscopy reduces incidence of distal colorectal cancer. However, in the absence of evidence from a randomized trial, several countries have been reluctant to introduce endoscopic screening. Three trialsare currently in progress (in the UK, Italy and the US) to address this issue. Two of these trials are examining the hypothesis that a single FS screen at around age 55-64 might be a cost-effective and acceptable method for reducing CRC incidence rates. Recruitment and screening are now complete in both studies and the first analysis of results on incidence rates is expected in 2004. Colonoscopy screening at 10-year intervals has recently been endorsed in the US on the basis that the reductions in incidence observed with distal CRC screening can be extrapolated to the proximal colon. However, data are lacking and a pilot study for a trial of the acceptability and efficacy of colonoscopy screening is in progress in the US. It has also been suggested that FOBT testing should be used to detect proximal CRC missed by sigmoidoscopy screening, but the small amount of published data suggest that supplementing FS with FOBT offers very little advantage over FS alone. Other forms of CRC screening are under investigation and represent exciting options for the future. Extraction of DNA from stool is now feasible and a number of research groups have shown high sensitivity for CRC using a panel of DNA markers including mutations in k-ras, APC, p53 and BAT26. Data so far indicate that, with the exception of k-ras, these markers are highly specific and therefore represent a significant improvement over FOBT. Whether these tests will replace or supplement existing methods of screening has yet to be determined. It has been suggested that BAT26, which is a marker of microsatellite instability, a feature of proximal sporadic CRC, might be a useful adjunct to sigmoidoscopy screening. Others have suggested that a test for occult blood should be included with the DNA markers to further increase sensitivity. It is not yet known how sensitive these markers are for adenomas--it is only by detecting adenomas that CRC incidence rates can be reduced. A final exciting new option for screening is virtual colonoscopy (VC), which by screening out people without neoplasia allows colonoscopy to be reserved for patients requiring a therapeutic intervention. The sensitivity of VC for large adenomas and CRC appears to be high, although results vary by centre and there is a steep learning curve. Sensitivity for small adenomas is low, but perhaps it is less essential to find such lesions. Some groups have suggested that virtual colonoscopy might be a useful option for investigating patients who test positive with stool-based screening tests. Whichever CRC screening method is finally chosen (and there is no reason why several methods should not ultimately be available), high quality endoscopy resources will always be required to investigate and treat neoplastic lesions detected.     

Indications for surgery for aortic regurgitation

Aortic valve replacement for isolated aortic regurgitation (AR) is usually not indicated unless the regurgitation is severe. However, not all patients with severe AR require aortic valve replacement. This review focuses on the causes of AR and the pathophysiology of acute versus chronic AR, and the attendant adaptive mechanisms of the left ventricle that ultimately determine their different natural histories. Aortic valve surgery must be performed in a timely manner to prevent cardiac death, ameliorate symptoms, and limit late postoperative excess mortality.