腹腔镜下缩短固定系膜治疗乙状结肠冗长合并肠扭转分析

目的探讨腹腔镜下缩短固定系膜治疗乙状结肠冗长并肠扭转的有效性、可行性和安全性。 方法选择2007年1月至2016年12月中山大学附属第五医院收治的成人乙状结肠冗长并扭转患者21例,采用腹腔镜下复位,沿肠管和系膜方向间断褥式缝合系膜,然后在左侧将乙状结肠靠近结肠带间断缝合并固定。术后随访分析患者排便改善情况和并发症,评价该术式的疗效。 结果全部病例无并发症出现,随访1年,未再发生乙状结肠扭转并肠梗阻。17例（81.0%）便秘得到不同程度改善,其中8例（38.1%）完全有效,9例（42.9%）部分有效;4例（19.0%）排便无明显改善。 结论腹腔镜下缩短固定系膜治疗乙状结肠冗长并肠扭转有效、可行、安全和简单,具有一定临床价值。     

Clinical masks of torsion of omental appendices of sigmoid colon

Twelve cases of torsion of colon's epiploic appendices (EA) are analyzed. The most often localization of the disease was sigmoid colon, female overweight patients of middle age were prevalent. As usual, this disease was masked by other acute surgical abdominal diseases, mainly by acute appendicitis. Clinical symptoms suspected for torsion of EA are analyzed, importance of diagnostic laparoscopy is discussed. The necessity of urgent surgery is emphasized. Some aspects of endoscopic surgery for these patients are also discussed.     

Results of the treatment of patients with post-traumatic osteomyelitis]

The author cites the nearest and remote (up to 13 years) results of treatment of 152 patients with posttraumatic osteomyelitis of the bones of crus and femur. On the basis of analysis of clinical data there are recommended the terms (3-6 months) of radical-restorative operations in patients with osteomyelitis and is drawn attention to the considerable frequency of the joint contractures.     

Results of the surgical treatment of patients with hematologic diseases

The article presents results of the operative treatment of 42 patients with different hematological diseases. The surgical treatment is indicated to patients resistant to cytostatic drugs and having symptoms of hyperplenism. The appearance of thrombohemorrhagic syndrome is sometimes possible in the postoperative period which can be prevented by heparin therapy.     

Results of the surgical treatment of patients with chronic duodenal obstruction

For chronic duodenal obstruction, duodenojejunostomy was performed in 12 patients, the Roux gastric resection--in 18, the Robinson operation--in 12. The Roux gastric resection has proved to be effective in patients with subcompensated and decompensated forms, the Robinson operations--in patients with compensated form of the disease. The different variants of duodenojejunostomy didn't contribute to recovery of the patients.     

Surgical treatment of the sigmoid volvulus

Sigmoid volvulus is not an uncommon cause of intestinal obstruction. The purpose of this study is to evaluate the clinical features and surgical treatment methods in patients with sigmoid volvulus. Thirty-two patients operated on between January 1991 and October 2002 were reviewed retrospectively. The demographic data of the patients, clinical features, preoperative radiological and operative findings, type of surgical procedure performed, postoperative complications, mortality and duration of hospital stay (DHS) after surgery were reviewed. There were 21 male (66%), 11 female patients (34%) and their age ranged from 61 to 87 years with a median of 73.5 +/- 8.38 years. Most frequent clinical features were abdominal pain, distension and constipation. The correct preoperative diagnosis was made in 44% (14/32) of cases. Surgical treatment consisted of sigmoidectomy with primary anastomosis (R&A) (n = 9, 28%), sigmoidectomy with colostomy (R&C) (n = 16, 50%), and detorsion with sigmoidopexy (D&P) (n = 7, 22%). Concomittant diseases were more frequent in R&C group (n = 14, 87%) and this was statistically significant as compared to R&A (n = 4, 44%) (P = 0.03). Postoperative complication rate in R&C group was more frequent and DHS longer but the difference between treatment groups was not significant statistically. Two recurrences were observed in D&P group. Sigmoidectomy should be the basic principle in management of sigmoid volvulus and primary anastomosis can be performed safely in selected patients without increasing morbidity and DHS.     

Results of treatment of patients with appendiceal infiltrate]

In the clinic a differential therapeutic tactics is employed in appendicular infiltration (570 patients). If pain attacks following appendicular infiltration are absent then only a detailed examination of a patient is able to give indications to a planned appendectomy.     

Results of treatment of 33 patients with peritoneal mesothelioma

BACKGROUND: Peritoneal mesothelioma is a rare peritoneal malignancy, representing approximately one-third of all mesotheliomas. It is regarded as a universally fatal cancer with few treatment options. METHODS: Records of 33 patients with peritoneal mesothelioma were reviewed retrospectively. Demographic, clinical and quantitative prognostic indicators were evaluated and analysed statistically using survival as endpoint. Patients were treated by a uniform strategy involving cytoreductive surgery with peritonectomy procedures and perioperative intraperitoneal chemotherapy (cisplatin, doxorubicin). RESULTS: There were ten women and 23 men; mean age was 53.0 years. Asbestos exposure was recorded in five patients and a family history of cancer in 13. Presentation was mainly abdominal distension and pain. Median survival was 31.0 months; overall projected survival at 3 years was 56 per cent. The most significant positive predictive factors of survival were: female sex (P= 0.003), low prior surgical score (P=0.002), completeness of cytoreduction (P=0.0002) and second-look surgery (P=0.019). The morbidity rate for this combined treatment was 33 per cent and the perioperative mortality rate was 3 per cent. CONCLUSION: Although peritoneal mesothelioma is rare, progress in its management has occurred. Survival has been extended and selection factors by which patients may be allocated to aggressive management strategies have been defined.     

Results in the operative treatment of elderly patients with intracranial meningioma

With life expectancy in the industrial nations increasing during recent years, the number of patients older than 70 years with intracranial tumours and, especially, meningiomas is rising. To evaluate the indications for operative treatment, we reviewed 66 patients older than 70 years who were operated upon for intracranial meningioma in our department between 1991 and 1997. The mean age was 75 years. The oldest patients were 86 years old. Thirteen patients with recurrent meningiomas were operated upon. The mortality rate was 7.6%. Neurological symptoms improved in 38 patients (57.6%), were unchanged in 11 (16.6%), and deteriorated in 12 (18.2%). Patients with recurrent meningiomas seem to have a higher operative risk and their outcome is worse than after a primary operation. In general, there were good postoperative results in patients with few concomitant diseases, small meningiomas, small edema, short time of operation, and accessible location (convexity rather than skull base). Age in general is not a contraindication for operation. In cases of incidental findings of small meningiomas, we recommend observation and MRI follow-up. Symptomatic meningiomas should be removed whenever there is an acceptable risk from an internal or anaesthesiological point of view. Received: 23 February 1999 / Accepted: 15 April 1999