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胃肠道癌肿是我国最常见的恶性肿瘤，鉴于早期诊断的问题尚未解决，临床所见病例仍以中晚期病变为多见，因而术后复发是一个外科医师必须面对、无法避免的难题。正确处理应从两方面着手。首先，应该从预防着手。因为如果能降低术后复发率显然比出现复发后再手术处理要重要得多、有意义得多。那么有什么办法可降低术后复发率     

原发性腹膜后肿瘤复发再手术2例报告

原发性腹膜后肿瘤 ( primaryretroperionealtumor,PRT)术后复发率高 ,但部分病人仍有再次或多次切除的机会。本文报告 2例。1　病历简介例 1.病人男 ,73岁。 14年前检查发现腹膜后巨大肿瘤行首次手术治疗。术中见肿瘤巨大且与周围组织器官关系紧密 ,未能切除。病理报告 :腹膜后脂肪肉瘤。 5个月后于另一医院行第二次手术。分离包块过程中致降结肠损伤 ,肿瘤仍未切除。术后出现大肠瘘 ,6个月后肠瘘愈合。来我院行第三次手术。探查见肿瘤按常规方法无法切除 ,作者采取将肿瘤包膜打开 ,在包膜内完全切除肿瘤并包膜。切除肿瘤达 7kg。术后 7年…     

复发性胃癌再手术治疗体会

胃癌的恶性程度较高，第一次手术选择正确的手术方式和术后化疗非常重要。对复发性胃癌仍不应放弃再手术。我院对1990-2003年13年来，行再手术治疗17例，现对其早期发现、早期诊断和再手术等问题进行分析报告如下：     

腹腔镜治疗直肠癌术后局部复发的临床研究

目的 探讨腹腔镜的再次手术在直肠癌术后局部复发病例治疗中的安全性及可行性.方法 将上海市微创外科临床医学中心2004年2月-2009年9月期间17例腹腔镜治疗直肠癌局部复发病例按其盆腔内复发类型分为中央型组(n=14)和前壁型组(n=3).比较两组在一般资料、手术相关数据及总体预后方面的差异.结果 两组在术前一般资料比...     

胃癌术后复发再手术20例分析

我院自1982～1992年10年间为20名无远隔转移的复发胃癌患者行手术治疗。现就复发因素及外科治疗作如下分析。 1 资料及方法 本组20例(其中第1次手术在我院者17例,外院者3例)。男13例,女7例。年龄35～74岁,平均55岁。两次手术间隔时间最短9个月,最长6午,平均2年9个月。第1次手术行根治性胃大部切除者     

肝癌复发转移再切除治疗的疗效分析(附30例报告)

目的：评价再手术在肝癌复发治疗中的地位。方法：回顾分析1988年－1999年30例肝癌复发再手术切除的随访资料。结果：首次手术后1，2，3年和5年总生存率分别为93.3%,73.3%,56.7%和36.7%。第一次再手术后1，3和5年生存率分别为63.3%,23.3%和13.3%，肺叶切除后1，3和5年生存率分别为71．4％，42．9％和28．6％。结论：肝癌复发病人再手术后的预后与复发时肿瘤大小，数目，类型相关，再切除是肝癌复发的首选治疗方法。     

局部复发性直肠癌的再手术治疗

目的 探讨局部复发性直肠癌（直肠癌根治术后）再次手术的价值。方法 回顾性分析再手术治疗的局部复发性直肠癌４８例。结果 ３３例行根治术,１５例行姑性手术。根治术组和姑息性手术组中位生存期分别为３５．２个月（８－８２个月）、１３个月（２－２３个月）,再手术５年生存率为３４．８％。结论 对于局部复发性直肠癌仍应积极手术,有助于延长生存期,提高生存质量。     

食管癌根治量放疗后复发再手术治疗

１９８６年５月至１９９６年３月我们对６５例食管癌根治量放疗后复发者进行再手术治疗。现报告如下：临床资料本组中男５４例，女１１例；年龄３２～７２岁。病变位于食管上段１５例，中段４７例，下段３例。放疗后病变范围＜３ｃｍ４例，３～５ｃｍ３５例，６～１０ｃｍ...     

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目的　探讨直肠癌术后局部复发的病因、诊断、再手术及并发症的防治。方法　对 35例直肠癌术后局部复发再手术者进行回顾性分析。结果　局部复发的 35例中 13例为吻合口复发 ,11例是远切缘距肿瘤 <3cm者。 9例盆腔淋巴复发者均是首次手术时有淋巴结转移的病例 ,其中 7例未做规范的淋巴结清扫。 12例未切除全部直肠系膜。结论　局部复发与首次手术时肠管切除不足 ,淋巴清扫不彻底 ,全直肠系膜切除不够及淋巴转移有关。定期复查 ,动态观察CEA有助于复发癌的早期发现和诊断。对能耐受手术又无广泛远处转移者给予再次手术 ,能获较好疗效     

肝细胞癌切除术后复发再手术治疗

目的　探讨肝细胞癌手术后复发的治疗经验。方法　回顾性分析 1995～ 2 0 0 3年手术治疗 38例肝癌切除术后复发的临床资料。结果　再次手术切除 32例 ,姑息性手术 6例 ,手术后平均生存期超过 14个月。结论　肝细胞癌术后复发是影响病人长期生存的重要原因 ,选择有适应证的病例再次手术切除能延长病人的生存时间。     

Independent prognostic factors for initial intravesical recurrence after laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma

ObjectiveTo elucidate clinicopathologic independent prognostic factors for intravesical recurrence after laparoscopic nephroureterectomy for primary upper urinary tract urothelial carcinoma (UUT-UC).Methods and materialsThis study included 212 consecutive patients clinically diagnosed as localized UUT-UC and treated by retroperitoneal laparoscopic nephroureterectomy between January 2002 and October 2010, after exclusion of those with a previous or concurrent history of bladder cancer. The clinicopathologic features, risk factors, and intravesical recurrence–free survival were analyzed using the Kaplan-Meier method. Univariate and multivariate analyses by Cox proportional hazards regression model was used to identify independent risk factors for intravesical tumor recurrence.ResultsOf the patients, 64/212 (30.2%) developed subsequent intravesical recurrence during a median follow-up period of 39 months (range 7–78 months). Among them, 56/64 (87.5%) developed recurrent bladder cancer within 2 years after the surgery for UUT-UC, and the median interval between surgery and intravesical recurrence was 14 months (range 7–51 months). Multifocal tumors, renal insufficiency, and immunosuppression were determined as risk factors for intravesical recurrence by univariate analysis. However, by multivariate analyses, multifocality (hazard ratio = 2.060, P = 0.006) and immunosuppression (hazard ratio = 1.915, P = 0.037) were identified as independent predictors for the development of recurrent bladder cancer.ConclusionsThe incidence of intravesical recurrence after laparoscopic nephroureterectomy for UUT-UC is high, and most subsequent bladder cancers recur within 2 years after surgery. Tumor multifocality and immunosuppression are significant independent risk factors in developing initial intravesical recurrence after laparoscopic surgery for primary UUT-UC.     

胆道再手术指征及术式选择

胆道系统因其解剖变异较多，与胰腺、十二指肠等周围器官关系密切、损伤后呈过度愈合的特殊方式，因此，再手术率高达10．9％，目前仍是腹部外科较难处理的问题。胆道再手术可因胆道手术后的并发症、原有疾病未治愈或复发而再次施行的手术，不包括其他腹部手术后针对胆道疾病所进行的再次手术。胆道再手术可依据时间的早晚、是否分期、医源性或病源性等进行分类。     

胆道手术后复发结石腹腔镜再次手术的可行性及术式探讨

目的:探讨胆道手术后复发结石再次行腹腔镜手术的可行性及术式选择。方法:回顾分析2014年9月至2019年9月收治的胆道手术后复发结石患者再次手术治疗的临床资料,将胆道手术后再次行开放与腹腔镜胆总管切开取石(开腹组与腹腔镜组)、左肝外叶切除(开腹肝组与腹腔镜肝组)患者的临床资料与疗效进行两两对比分析,总结手术经验。结果:患者均顺利治愈出院。腹腔镜组术中出血量、住院时间、切口感染率优于开腹组,差异有统计学意义(P<0.05)。腹腔镜肝组住院时间、切口感染与胸水发生率优于开腹肝组,差异有统计学意义(P<0.05);两组手术时间差异无统计学意义(P>0.05)。结论:选择合适病例经腹腔镜胆道再次手术安全、有效,可缩短住院时间,减少胆道手术后切口感染,值得在硬件设备齐全、具有熟练腹腔镜手术技巧与丰富开腹胆道手术经验的临床中心推广应用。     

Reoperation for disruption and recurrence after Nissen fundoplication.

This report deals with 25 failed Nissen operations. A method of classifying the type of failure is presented. Manometric studies document disordered motor activity in ten of these patients with return to normal activity after repair. With these difficult patients, intraoperative manometrics allowed a satisfactory antireflux barrier to be created with posterior gastropexy. Good to excellent results were achieved in 22 of 24 patients. A search of the world literature is presented with complications ranging from the well-known "gas-bloat" syndrome to potentially lethal fistulas.     

Additional surgical procedure is a risk factor for surgical site infections after laparoscopic cholecystectomy

Purpose

Surgical site infections (SSI) are associated with increased costs and length of hospital stay, readmission rates, and mortality. The aim of this study was to identify risk factors for SSI in patients undergoing laparoscopic cholecystectomy.

Methods

Analysis of 35,432 laparoscopic cholecystectomies of a prospective multicenter database was performed. Risk factors for SSI were identified among demographic data, preoperative patients’ history, and operative data using multivariate analysis.

Results

SSIs after laparoscopic cholecystectomy were seen in 0.8 % (n?=?291) of the patients. Multivariate analysis identified the following parameters as risk factors for SSI: additional surgical procedure (odds ratio [OR] 4.0, 95 % confidence interval [CI] 2.2–7.5), age over 55 years (OR 2.4 [1.8–3.2]), conversion to open procedure (OR 2.6 [1.9–3.6]), postoperative hematoma (OR 1.9 [1.2–3.1]), duration of operation >60 min (OR 2.5 [1.7–3.6], cystic stump insufficiency (OR 12.5 [4.2–37.2]), gallbladder perforation (OR 6.2 [2.4–16.1]), gallbladder empyema (OR 1.7 [1.1–2.7]), and surgical revision (OR 15.7 [10.4–23.7]. SSIs were associated with a significantly prolonged hospital stay (p?<?0.001), higher postoperative mortality (p?<?0.001), and increased rate of surgical revision (p?<?0.001).

Conclusions

Additional surgical procedure was identified as a strong risk factor for SSI after laparoscopic cholecystectomy. Furthermore, operation time >60 min, age >55 years, conversion to open procedure, cystic stump insufficiency, postoperative hematoma, gallbladder perforation, gallbladder empyema, or surgical revision were identified as specific risk factors for SSI after laparoscopic cholecystectomy.     

Comparison of post-operative intravesical recurrence and oncological outcomes after open versus laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma

Object

To retrospectively evaluate intravesical recurrence and oncological outcomes after open or laparoscopic radical nephroureterectomy (RNU) for the upper urinary tract urothelial carcinoma (UUT-UC).

Patients and methods

This study comprised 122 patients diagnosed UUT-UC and subsequently nephroureterectomy was performed on. Several clinical and pathological parameters were emphasized for comparison of clinical outcomes.

Results

Among 122 patients with UUT-UC, 101 (82.8 %) and 21 (17.2 %) underwent open or laparoscopic radical nephroureterectomy (ONU or LNU), respectively. In univariable and multivariable Cox regression models, the surgical procedure exerted an impact neither on post-operative intravesical recurrence rate (p = 0.179 and 0.213, respectively) nor on cancer-specific mortality rate (p = 0.561 and 0.159, respectively). The 1-, 2- and 5-year cancer-specific survival (CSS) rates of patients undergoing ONU or LNU were 92.1 versus 95.2 %, 87.1 versus 90.5 %, 79.2 versus 85.7 %, respectively, and the Kaplan–Meier plot illustrated that patients from two groups enjoyed an equivalent survival rate (p = 0.559). Moreover, we added that previous history of bladder tumor and pre-operative hydronephrosis was associated with intravesical recurrence, whereas three prognostic factors, including pathological tumor stage, grade, and lymphovascular invasion, showed possibility to be predictors of cancer-specific mortality.

Conclusion

There existed no significant difference of intravesical recurrence and CSS between patients after ONU and LNU. Conclusively, laparoscopic radical nephroureterectomy did not present superiority to open management for patients with UUT-UC.