经肛门拖出式切除并双吻合器技术在超低位直肠癌保肛术中的应用

目的探讨经肛门拖出式切除并双吻合器吻合在超低位直肠癌全直肠系膜切除术中的应用价值。方法回顾性总结19例超低位直肠癌保肛手术的经验。结果本组病例利用全直肠系膜切除技术,充分分离直肠并离断肿瘤近端后经肛门拖出,直线型闭合器切闭肿瘤远端,圆型吻合器行端端吻合,均成功保肛,术后病理检查残端无肿瘤遗留,发生吻合口漏1例（5.3%）,切口感染1例（5.3%）,无手术死亡。结论在全直肠系膜切除的基础上,经肛门拖出式切除并结合双吻合器技术行超低位直肠癌保肛术是安全可靠的,它可以大大提高超低位直肠癌保肛手术的成功率。     

经肛拖出式双吻合在低位直肠癌中的应用

目的：探讨双器械吻合技术联合全直肠系膜切除在低住直肠癌保肛手术中的应用方法和临床疗效。方法：回顾性分析利用经肛拖出式双吻合技术治疗的低位直肠癌患者，分析其疗效。结果：3、5年生存率分别为83．3％、70．8％，术后两年局部复发2例（2．1％），吻合口漏（3．1％），无死亡病例。结论：在掌握手术适应症的前提下，经肛拖出式双吻合技术行低位直肠癌保肛手术是可行的，能提高术后患者生活质量。     

套入式结肠直肠黏膜吻合保肛术治疗中低位直肠癌208例报告

目的 探讨套入式结肠直肠黏膜吻合保肛术式治疗中低位直肠癌的临床疗效。方法 对208例中低位直肠癌行套入式结肠直肠黏膜吻合保肛术式经腹肛门根治性切除病例进行回顾性分析。208例中男131例,女77例,年龄21～99岁,平均53．7岁。肿瘤下缘距齿状线6～8cm。Dukes分期A期76例,B期122例,C期10例。病理诊断直肠腺癌201例,其中高分化者86例,中分化者100例,低分化者8例,黏液腺癌7例。腺瘤癌变7例。结果 208例术后随访率为87．5％（182／208）,中位随访时间5．9年。术后发生吻合口瘘8例（3．8％）,吻合口狭窄3例（1．4％）,排便功能在术后12～24周时基本恢复到正常,每日1～3次。术后局部复发率为4．9％（9／182）,肝转移率为14．2％（26／182）,5年生存率为72．5％。结论 套入式结肠直肠黏膜吻合保肛术式既能保持良好的肛门排便控制功能,又能降低吻合口瘘发生率,局部复发率和5年生存率与Miles手术相同,是一种安全有效的保肛术式。     

低位直肠癌保肛手术治疗进展

直肠癌是外科常见的恶性肿瘤之一,而中低位直肠癌占70%[1],其术式选择是近年争论的热点之一.对直肠癌浸润转移规律的认识,双吻合器技术（Double Stapling Techniqne,DST）的出现使低位、超低位结-直肠（肛管）吻合术成为可能,拓宽了低位直肠癌保肛手术的适应证,提高了术后生存质量.     

直肠癌全系膜切除结合吻合器术后吻合口瘘的原因与防治

目前,直肠全系膜切除和应用吻合器技术治疗直肠癌不但提高了中低位直肠癌的保肛率,而且降低局部复发率。但近几年众多学者报道直肠全系膜切除术后吻合口瘘的发生率也明显增加,Carlson等研究提出传统手术后吻合口瘘的发生率为5％～8％,而直肠全系膜切除术后可增到16％。还有学者报道单用吻合器与吻合器结合直肠全系膜切除术后吻合口瘘的发生率分别为7．4％（5／68）和17．3％（8／52）。本文结合国内外文献,对我科258例直肠癌行直肠全系膜切除并应用吻合器术后发生吻合瘘的原因及防治探讨如下。     

低位直肠癌不同保肛术式术后排便功能的比较

目的 探讨低位直肠癌不同保肛术式术后肛门排便功能。方法 对176例行吻合器吻合术、套入式结肠直肠黏膜吻合术及结肠套叠式原位肛门重建术的低位直肠癌病人,术后随访排便功能2～3年并进行评价。结果 176例术后排便功能优良率为94．9%。其中吻合器吻合术组排便控制优良率100％,正常便意100％。套入式结肠直肠黏膜吻合术组排便控制优良率95．8％,正常便意87．5％。结肠套叠式原位肛门重建术组排便控制优良率84．4G,排便次数无一定规律。结论 排便功能与保肛术式及吻合平面有关,保留解剖肛管者可具有良好排便控制能力。吻合器吻合术和套入式结肠直肠黏膜吻合术术后4～6个月肛门排便功能基本恢复正常。     

胃肠吻合器在直肠癌保肛手术中的应用

目的:探讨消化道吻合器在中、低位直肠癌保肛手术中的应用价值与有关问题以及注意事项。方法:回顾性分析252例直肠癌患者应用胃肠吻合器行保肛手术的临床资料。结果:本组保肛手术成功率为98.4%(248/252),吻合口瘘发生率为3.6%(9/252),吻合口狭窄发生率为2.8%(7/252)。结论:在中、低位直肠癌行直肠前切除低位或超低位吻合术中使用胃肠吻合器,吻合成功率高,并发症少,操作安全简便,具有较大的临床应用价值。     

超低位前切除肛门外吻合在低位直肠癌保肛术的应用

自 1939年Ｄｉｘｏｎ术式应用于直肠癌手术以来 ,至今仍为直肠癌保肛术的最佳术式 ,但Ｄｉｘｏｎ选择的病例多为直肠上段或直肠乙状结肠交界处的癌。我们自 1997年以来 ,采用超低位前切除肛门外吻合技术用于低位直肠癌的保肛手术 ,取得满意效果。报告如下。1　临床资料1 1　一般资料　 1997年 6月～ 1999年 5月采用超低位切除肛门外吻合术行直肠癌保肛手术 42例 ,其中男性 2 6例 ,女性 16例 ,年龄 2 4～ 72岁 (平均 5 1岁 )。肿瘤下缘距肛缘 4～ 7ｃｍ 2 8例 ,7～ 9ｃｍ 14例 ,ＤｕｋｅＡ期 8例 ,Ｂ期2 2例 ,Ｃ期 12例。1 2　手术方法　本组…     

中低位直肠癌130例保肛手术体会

目前，中低位直肠癌多采用Mifes手术。我科自1981年9月～1993年10月对130例中低位直肠癌施以乙状结肠经直肠拖出保留肛门手术，取得满意效果。1临床资料1，1一般情况130例中，男84例，女416例。年龄20～75岁，平均46．8岁。病史1个月～5年，平均8．9个月。直肠腺癌90例，粘液腺癌10例，印戒细胞癌5例，乳头状腺癌19例，息肉恶变6例。Dukes分期（全国统一分期标准）：A69例，B47问，C14例。肿瘤下缘距肛门缘＜6cm58例，＜8on。54例，＜l（。cm18例。肿瘤切除后剩余远端直肠2～6cm，平均S；5cn。。I．2干术要点腹部手术操作同M；1。。千米…     

弧形切割吻合器在低位或超低位直肠癌行前切除58例分析

目的探讨弧形切割吻合器在低位或超低位直肠癌行前切除的安全性和应用价值。方法 2006年1月—2012年2月选择58例低位或超低位直肠癌患者按全直肠系膜切除原则行前切除,采用弧形切割吻合器对直肠肛侧残端进行切割、闭合,采用33 mm管型吻合器进行低位结肠-直肠吻合术。结果 58例低位或超低位直肠癌患者中没有发生切割和闭合不全的病例,无吻合口渗漏。术后发生吻合口瘘2例(3.45%),经横结肠造口转流瘘愈合,3个月后造口还纳。无吻合口狭窄病例。结论弧形切割吻合器在低位或超低位直肠癌行前切除术中切割完全、闭合可靠、操作方便,具有安全性和应用价值。     

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,     

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.     

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.     

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.