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目的 探讨小肠出血的原因、诊断和治疗方法。方法 回顾性分析1988～1998年经手术及病理证实的小肠出血67例的临床资料。结果 小肠出血原因中肿瘤占首位(29例)，良、恶性肿瘤差异不明显，其他原因依次为炎性肠病(15例)、小肠憩室(12例)、血管病变(7例)及家族性肠息肉病(4例)。67例病人均经手术治疗，以肠段切除为主要手术方法。结论 小肠气钡双重造影、选择性肠系膜血管造影及核素扫描为诊断小肠出血的主要手段，对常规检查难以确诊且又高度怀疑小肠出血的病人可采用剖腹探查。     

猪小肠血管在小肠移植中的解剖研究

目的探讨小猪小肠移植时供体、受体和最佳血管的选择。方法麻醉,先后称量30头小猪及其小肠的体重与长度,测算两者比例关系;对离体小肠行造影、色料灌注、X线摄片,观测腹主动脉、肠系膜血管及其分支在体和离体的分布情况。结果小肠的长度平均为体长的11.5倍;小肠的重量平均为体重的2.3%。腹主动脉和肠系膜前动脉近段在体与离体灌注后血管外径分别为4.3/4.6mm和2.5/2.7mm左右,肠系膜前静脉较肠系膜前动脉粗1～2mm。肠系膜前动脉水平段分支多为6～8支。一般第5、6支最长[(20.0±7.0)mm和(22.0±8.2)mm],在体与离体血管外径分别达到1.9、2.2mm左右。结论腹主动脉、近段肠系膜前动脉及其第5、6分支水平肠系膜前动脉可以分别作为小猪全小肠和节段小肠移植的首选血管;在实行节段小肠移植时,可以利用肠管长度比例系数,进行初步筛选实验动物。     

术前内镜在腹腔镜结直肠微小肿瘤定位的临床价值研究

目的 探讨术前内镜在腹腔镜结直肠微小肿瘤定位的临床应用价值.方法 回顾性分析2018-06—2020-06间河南大学第一附属医院普通外科行手术治疗的63例结直肠微小肿瘤患者的临床资料.依据内镜肿瘤定位时机分为术前内镜组(38例)和术中内镜组(25例).比较2组患者的基线资料、术中情况,以及术后临床指标.结果 2组患者的...     

Surgical aspects of small intestinal neuroendocrine tumors

Small intestinal neuroendocrine tumors (NETs) are a heterogeneous group of epithelial tumors with a predominant neuroendocrine differentiation. Although NETs are usually considered rare neoplasms, small intestinal NETs are the most common primary malignancy of the small bowel, with an increasing prevalence worldwide during the course of the past few decades. The indolent nature of these tumors often leads to a delayed diagnosis, resulting in over one-third of patients presenting with synchronous metastases. Primary tumor resection remains the only curative option for this type of tumor. In this review article, the various surgical aspects for the excision of small intestinal NETs are discussed.     

胶囊内镜在小肠疾病中的临床诊断价值

目的：探讨胶囊内镜在小肠疾病中的诊断价值.方法：分析2009年9月-2012年5月114例行胶囊内镜检查患者的临床资料.结果：113例患者完成检查.胶囊内镜回盲瓣通过率为90.3%（102/113例）;胃内运行时间3～187 min,平均（55.6±26.0）min;小肠内运行时间为24～640 min,平均（303±106） min;胶囊平均排出体外的时间为9～96 h,平均（29±10）h.63例发现小肠病变（55.7%）,病变分别为非特异性炎症24例,血管畸形13例,小肠克罗恩病12例,小肠息肉7例,小肠肿瘤3例,小肠钩虫2例,小肠憩室1例.消化道出血患者小肠病因检出率最高,为80.8%（42/52例）,其次是腹痛45.2%（14/31例）,消瘦33.3%（1/3例）,腹泻20.0%（1/5例）,腹胀14.3%（1/7例）.结论：胶囊内镜对小肠疾病有较高的诊断价值.     

术中B型超声检查对胰岛素瘤定位诊断的价值

目的：探讨术中Ｂ型超声检查（ＩＯＵＳ）对胰岛素瘤定位诊断的价值。方法：１９９０年１月～２０００年１０月我院共收治胰岛素瘤３２例,均采用ＩＯＵＳ进行胰岛素瘤定位及指导手术。结果：术中触摸定位胰岛素瘤病灶２７例（８４．４％）,ＩＯＵＳ定位３１例（９６．９％）。结论：ＩＯＵＳ能准确定位胰岛素瘤,并显示肿瘤与重要结构（如胆总管、胰管及重要血管等）的毗邻关系。ＩＯＵＳ不仅提高手术成功率,避免了不必要的盲目胰腺切除,并由此降低手术并发症的发生率。     

116例原发性小肠肿瘤的临床病理分析

目的提高原发性小肠肿瘤的诊断率及治疗水平。方法回顾性分析我院10年来经手术及病理证实的116例原发性小肠肿瘤(不包括十二指肠乳头肿瘤)的临床病理特点。结果原发性小肠肿瘤发病年龄40岁以上者占84.5%,良、恶性肿瘤之比1∶6.3。恶性肿瘤主要包括腺癌(48例)、恶性间质瘤(27例)和恶性淋巴瘤(20例),恶性肿瘤的直径大于良性肿瘤。隐性失血、隐匿消瘦、脐周隐痛(“三隐”症状)是小肠肿瘤的最常见表现。术前拟诊率为75.9%,确诊率为62.1%,术中肉眼判定性质正确率为92.2%。16例良性病变施行病变肠管和对应系膜切除。100例恶性肿瘤有57例施行小肠肿瘤根治、转移病灶切除,13例施行小肠肿瘤切除的减瘤荷手术,余行姑息手术。70例肿瘤切除标本中52例发生淋巴转移,14例出现远处转移。结论原发性小肠肿瘤是较少见的消化道肿瘤,应对“三隐”症状予以足够重视,上消化道内镜检查、术中快速冰冻病理检查有助于小肠肿瘤的诊断,对性质判断困难的小肠间质瘤和一些少见肿瘤施行根治性切除也是一种可取的方法。     

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目的 探讨大肠镜在不明原因和部位的急性小肠大出血手术中的应用方法和临床疗效。方法 对1995～2003年28例不明原因的急性小肠大出血病人，剖腹探查后行全小肠大肠镜检查，结合快速病理检查和外科处理，明确出血原因和部位，给予相应治疗。结果 全组28例病人均明确了出血原因和部位，十二指肠降部以下至Treitz韧带出血11例，空回肠出血17例；病理检查小肠恶性肿瘤出血7例(25．0％)，小肠良性肿瘤出血5例(18．2％)，小肠其他良性疾病16例(56．8％)。小肠壁部分切除术4例，部分小肠切除吻合术17例，根治性小肠切除吻合术7例。无手术死亡。结论 术中大肠镜检查对不明原因小肠出血诊断方便、及时、确切，可用于术前检查，如不能明确病因的小肠出血、急性大出血危及生命、急诊检查条件差时，尤其适用于不允许进行较长时间、较复杂检查的小肠出血病人。     

The role of endoscopy in the small intestinal transplant recipient: A review

Intestinal transplantation (ITx) is the treatment of choice for patients with intestinal failure who have developed life-threatening complications related to long-term parenteral nutrition. Patients may also undergo ITx as part of a combined liver-intestine or multivisceral transplant for a variety of indications, most commonly intestinal failure-associated liver disease or porto-mesenteric thrombosis. Endoscopy plays a critical role in the posttransplant management of these patients, most commonly in the diagnosis and management of rejection, which occurs in up to 30–40% of patients within the first-year posttransplant. With a lack of noninvasive biomarkers to identify the presence of rejection, endoscopy and biopsy remain the gold standard for its diagnosis. Endoscopic evaluation of the graft is also important in the identification of other complications post-ITx, including posttransplant lymphoproliferative disorder, graft-versus-host disease, and enteric infections. Each patient's posttransplant anatomy may be slightly different, making endoscopy sometimes technically challenging and necessitating clear and frequent communication with the surgical team in order to help identify the highest yield approach. Herein, we review the most common pathologies found endoscopically in the post-ITx patient and describe some of the unique challenges the endoscopist faces when evaluating these complex patients.     

小肠出血的病因及诊断方法分析

目的探讨小肠出血的病因和诊断方法。方法回顾性分析32例确诊的小肠出血病例的临床资料。结果病因以小肠肿瘤最为多见（46．8％）,其他依次为憩室（25．0％）、炎性疾病（15．6％）及血管畸形（12．5％）。检查方法以小肠气钡双重造影开展较普遍。小肠气钡双重造影、血管造影、核素扫描和小肠镜在小肠出血病人中阳性检查率的比较无显著性差异（X^2=3．796,P=0．284）。结论 小肠出血病例中,小肠肿瘤为最常见病因．合理应用小肠气钡双重对比造影等检查方法,是提高小肠出血诊断率的主要手段。     

Localization of bleeding small intestinal lesions using scanning techniques.

Gastrointestinal bleeding remains a major diagnostic problem, and the commonly employed techniques of contrast radiography, endoscopy, and arteriography may not successfully localize the site and/or define the cause of gastrointestinal hemorrhage. Technetium-99m pertechnetate scanning has been useful in identifying Meckel's diverticula, and modifications of this technique may successfully identify highly vascular lesions responsible for gastrointestinal bleeding. A patient with recurrent hemorrhage from a leiomyosarcoma of the ileum is described. The lesion was identified with flow studies and immediate static imaging after injection of technetium-99m pertechnetate. In addition, the lesion was demonstrated by scanning using in vivo technetium-99m pertechnetate labelled autologous erythrocytes. The potential value of these scanning techniques as noninvasive tools for the localization and identification of lesions responsible for gastrointestinal bleeding is discussed.     

腹腔镜在小肠出血诊治中的临床应用

目的:评价腹腔镜在小肠出血诊治中的临床应用价值。方法:回顾性分析2003年9月至2007年6月行腹腔镜诊治的55例小肠出血患者的临床资料,并对手术时间、术中失血、切口长度、术后排气时间、术后住院天数、并发症、术后病理和随访结果进行统计学分析。结果:腹腔镜探查不仅明确了所有患者小肠出血的原因,而且同时实施了相应的腹腔镜手术,其中包括7例完全腹腔镜下小肠肿瘤局部切除术;10例腹腔镜下小肠憩室切除术;37例腹腔镜辅助下小肠肠段切除术;1例腹腔镜辅助下右半结肠切除术。腹腔镜平均手术时间(70.0±28.6)min,术中平均失血(13.5±10.2)ml,平均切口长度(3.4±1.3)cm,平均术后排气时间为(2.2±0.8)d,术后平均住院(7.8±2.9)d。2例(3.6%)术后分别出现吻合口糜烂出血和束带粘连性小肠梗阻。术后随访29(5~50)个月,无复发病例。结论:腹腔镜技术在小肠出血诊治中具有良好效果,腹腔镜小肠手术是一种安全、有效的微创手术方法,值得临床推广应用。     

烧伤早期家兔小肠细胞凋亡的研究

目的　探讨严重烧伤早期家兔小肠粘膜上皮细胞、淋巴细胞以及蚓状突淋巴细胞凋亡及其意义。　方法　采用日本大耳白兔 2 5只 ,随机分成 5组 :正常对照组、严重烧伤 3、6、12、2 4h组 ,每组均为 5只。各烧伤组制作成 30 %TBSAⅢ度烧伤动物模型 ,于伤后相应时相点对 5个部位的肠组织取材 ,行HE染色、电镜检查及用DNA切口末端标记技术 (TUNEL)行原位细胞凋亡检测 ,TUNEL切片作统计分析。　结果　HE染色烧伤组见较多凋亡细胞单个分散在小肠及蚓状突粘膜上皮层、粘膜固有层 (部分延伸到粘膜下层 )的淋巴小结和散在淋巴组织中 ;伤后 2 4h组有少数肠粘膜断裂 ;所有切片未见明显炎症及坏死现象。电镜显示凋亡小体形成。TUNEL法见大量呈蓝黑色的阳性细胞核 ,分布位置同HE染色。伤后 3h小肠及蚓状突细胞凋亡数较对照组已有明显增多 (P<0 .0 1) ,到 6和 12h显著升高达峰值 (P <0 .0 1) ,伤后 2 4h已下降接近 3h水平 ,但仍高于对照组 (P <0 .0 1) ;烧伤组家兔中段及远端小肠粘膜上皮细胞凋亡数均高于近端小肠 (P <0 .0 5 )。　结论　严重烧伤早期家兔小肠粘膜上皮细胞、淋巴细胞以及蚓状突淋巴细胞大量凋亡 ,中远端小肠粘膜上皮细胞凋亡较近端小肠显著 ,这些变化可能是烧伤后肠道细菌及内毒素移位的细胞学基础。     

山莨菪碱对失血性休克再灌注损伤兔小肠上皮细胞超微结构的影响

目的 观察山莨菪碱对失血性休克再灌注损伤兔小肠上皮细胞超微结构的影响。方法16只大白兔随机分为山莨菪碱注射液治疗组(S组，8只)和生理盐水对照组(C组，8只)。复制兔重度失血性休克及复苏的动物模型，在休克期间分别予等容量的山莨菪碱注射液和生理盐水治疗，复苏60min后取回肠末端组织进行电子显微镜检查，并测量线粒体二维形态计量学参数和三维形态计量学参数。结果 电子显微镜显示：S组上皮细胞、微绒毛、线粒体、内质网损害明显轻于C组；上皮细胞单位胞浆内S组比C组线粒体数量多，肿胀较轻微。结论 山莨菪碱对失血再灌注损伤兔小肠上皮细胞超微结构有良好的保护作用。     

Gene transfer of human manganese superoxide dismutase protects small intestinal villi from radiation injury

Small bowel toxicity represents a major dose-limiting side effect of radiation treatment for many malignancies. We examined the effects of overexpressing human manganese superoxide dismutase (MnSOD) in the small intestine in mice to prevent radiation enteritis. Mice were treated with the human MnSOD gene delivered enterally using a nontoxic, replication-defective herpes simplex virus (HSV)-1-based vector. HSV vectors containing the human MnSOD transgene and green fluorescent protein (GFP) transgene, or GFP transgene alone, were constructed and injected intraluminally into a 2cm length of small intestine of C3H/HeNsd mice. Total body irradiation of 15 Gy was delivered to mice inoculated 24 hours earlier with either HSV-MnSOD (10³ to 10⁸ plaque-forming units), control HSV-GFP, or no vector. At 24 or 72 hours after irradiation, mice were killed and villi areas were measured from appropriate segments of the small intestine. Control irradiated mice showed a decreased villi area of 82% by day 3 after irradiation, whereas treatment of mice with HSV-MnSOD 10⁸ plaque-forming units led to only a 16% decrease in villi area (P< 0.001) before radiation. Similar findings were seen on day 3 and were associated with a significant (P< 0.001) preservation of enteric protein content in HSV-MnSOD-treated mice. A dose-dependent effect of MnSOD in preventing radiation-induced small bowel injury was evident. These data demonstrate that overexpression of human MnSOD via a replication-defective herpes viral vector is an efficacious method of protecting the small intestine from ionizing radiation damage. Presented in part at the Annual Meeting of the American Society of Hematology 2001 and at the Forty-Third Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco, California, May 19–22, 2002 (oral presentation).     

Laparoscopic herniorrhaphy with porcine small intestinal submucosa: a preliminary study.

INTRODUCTION: Using mesh or a synthetic prosthesis during the laparoscopic repair of inguinal hernias has been demonstrated to be safe and effective. A new material, porcine small intestinal submucosa (SIS mesh), has been successfully used in canine and rodent animal models with excellent results. This mesh is degradable and resorbable with a marked decrease in the possibility of becoming infected. However, the amount of fibroblast ingrowth is equal to that with polypropylene mesh. METHODS: A comparison was made between this new SIS mesh to repair 15 inguinal hernias in 12 patients and polypropylene mesh used in 12 similar patients. A preperitoneal approach with balloon dissection was used in all patients. RESULTS: Demographics were similar in both groups. The results were excellent and compared equally. Complications (seroma, discomfort) were minimal in both groups and were similar. CONCLUSIONS: Porcine small intestinal submucosa, SIS mesh, can be used for laparoscopic repair of inguinal hernias. Long-term follow-up will be necessary to confirm these preliminary results.     

小肠平滑肌肿瘤与下消化道出血：附33例报告

探讨出血型小肠平滑肌肿瘤的临床特点及其诊断。方法回顾性病例分析。结果出血型小肠平滑肌肿瘤具有下列临床表现（１）反复间隙性消化道出血。（２）大多数病人的年龄在４０岁以下。（３）位于空肠部位的肿瘤约为回肠的３倍。     

小肠移植急性排斥反应中bcl-2及bax表达的意义

目的探讨bcl-2及bax的异常表达与小肠移植急性排斥反应的关系。方法选用近交系F344/N和封闭群Wistar/A大鼠建立同种异基因小肠移植模型,并随机分为同基因移植组、异基因移植组、异基因加普乐可复(FK506)治疗组和对照组,用免疫组织化学技术检测36只大鼠术后移植肠组织中bcl-2及bax在移植肠组织中的表达。结果异基因组术后第3天,bcl-2的表达显著低于对照组(P<0.05),并随着移植天数的增加,差异更加具有显著性意义(P<0.01);bax的表达与对照组比较差异无显著性意义(P>0.05);FK506治疗组bcl-2及bax表达与对照组比较,差异均无显著性意义(P>0.05)。结论移植肠组织内bcl-2表达水平可作为早期诊断急性排斥反应的一个有参考意义的指标。     

Contribution of intraoperative enteroscopy in the management of obscure gastrointestinal bleeding

Obscure gastrointestinal bleeding remains a significant diagnostic challenge. Our aims were (1) to determine the efficacy of intraoperative enteroscopy (IOE) in identifying lesions responsible for obscure gastrointestinal bleeding and (2) to determine the outcome of patients after treatment of these lesions. We retrospectively reviewed all patients who underwent IOE for obscure gastrointestinal bleeding from 1992 to 1998. Patients were divided into those with overt and those with occult gastrointestinal bleeding. Follow-up was complete in 67 patients (96%), with a median of 32 months (range 1 to 91 months). Seventy patients (52 overt and 18 occult) underwent IOE after extensive preoperative evaluation. Median duration of bleeding was 12 months, requiring a median of 14 blood transfusions. Risk factors for bleeding were identified in 46 patients (61 %). A lesion was identified and treated in 52 patients (74%)—39 in the overt group and 13 in the occult group. Lesions identified were vascular (54%), ulcerations (31%), tumors (11%), and small bowel diverticula (4%). Overall, 35 patients (52%) were found to have one or more lesions at IOE that were treated surgically and had no further bleeding. IOE, through a mid-small bowel enterotomy, has low morbidity and is effective in that it identified a treatable lesion in 74% of patients, which led to cure of bleeding in 52%. Presented at the Forty-First Annual Meeting of The Society for Surgery of the Alimentary Tract, San Diego, Calif., May 21–24, 2000, and published as an abstract in Gastroenterology 118(Suppl l):A1057, 2000.