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??Perioperative management of perforated gastroduodenal ulcer accompanied by hyperthyroidism SHAO Wei??GONG Chuan-yong. Department of Surgery Intensive Care Unit??Tianjin Nankai Hospital??Tianjin 300100??China
Corresponding author: SHAO Wei??E-mail: shaoweimaomao@126.com
Abstract Objective To summarize the therapeutic experience of perforated gastroduodenal ulcer accompanied by hyperthyroidism??Methods The clinical data of 17 cases of perforated gastroduodenal ulcer accompanied by hyperthyroidism admitted from January 2003 to December 2008 at Tianjin Nankai Hospital were analyzed retrospectively. Results Fifteen cases diagnosed as perforation accompanied by hyperthyroidism before operation were treated actively to prevent thyroid crisis during perioperative period??and no one developed it??two cases missed diagnosis and consequently thyroid crisis occurred in both of them??and 1 case died in the end??Conclusion Perforated gastroduodenal ulcer accompanied by hyperthyroidism increases the risk in perioperative peroid??Adequate preoperative preparation, simple and effective surgical procedure and prophylactic treatment after operation can prevent crisis from happening.     

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??Perioperative management of gastrointestinal neoplasms complicated with coronary artery disease: an analysis of 52 cases ZHA Yong*, CUN Ying-li, HUANG Yun-chao, et al. *Department of Abdominal Surgery, Affiliated Tumor Hospital of Kunming Medical College, Kunming 650118, China Corresponding author??HUANG Yun-chao, E-mail: huangych@yahoo.com.cn Abstract Objective To study the strategies of the perioperative management of gastrointestinal neoplasms complicated with coronary artery disease. Methods The clinical data of 52 cases of gastrointestinal neoplasms complicated with coronary artery disease admitted from July 2007 to August 2008 at the Affiliated Tumor Hospital of Kunming Medical College were analyzed retrospectively. All the cases had been assessed and managed according to ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery. Results Perioperative managements included revascularization with stents in 5 cases, revascularization with only balloon in 15 cases, systemic medical therapy in 32 cases. Postoperative 30 day complications occurred in 8 cases (15.4%), including acute congestive heart failure in 1 case ??1.9%??, acute myocardial infarction and death in 2 cases (3.8%), relapsing angina in 3 cases ??5.8%), intractable cardiac arrhythmia in 2 cases ??3.8%??. Conclusion Successful perioperative evaluation and management of high risk cardiac cases undergoing noncardiac surgery requires careful teamwork and communication between surgeon, anesthesiologist, cardiologist according to ACC/AHA 2007 Guidelines.     

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??Tactics of perioperative nutritional support in liver transplantation HUO Feng, WANG Shao-ping, LI Peng, et al. Department of Hepatobililiary Surgery and Liver Transplantation Center, Guangzhou General Hospital of Guangzhou Command, Guangzhou 510010, China
Corresponding author ??HUO Feng, E-mail??gzhuofeng@163.com
Abstract Objective To comprehend the nutritional support methods of the patients with liver transplantation during the perioperation. Methods The clinical data of 205 patients with liver transplantation performed at Guangzhou General Hospital of Guangzhou Command were analyzed retrospectively. The 205 patients were treated with the nutritional support methods and relevant index between two stages, which were Group A from the August 2003 to December 2006 and Group B from January 2007 to March 2010. Results The rate of the severe malnutrition in Group B before operation was 28.2%, which was higher significantly than Group A (18.9%). During the perioperation, the patients of Group B were paid more attention to the nutritional support, and were assisted with the nasal feeding or enteroclysis with the Chinese medicine DaHuang and pars umbilicalis spreading with the Chinese medicine WuZhuYu. The middle time of passage of gas and stool by anus after operation in Group B was 3.5 days. The incidence of the infection complications was 51.35%. There was significant difference between two groups. Conclusion During the perioperation of the liver transplantation, it could make the patients enhance the toleration, facilitate the gastrointestinal motility, and degrade the postoperative infection by the means of the nutritional support and the improvement of gastrointestinal function.     

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1991～ 2 0 0 1年收治经手术及病理证实的胃癌 112 0例中 ,70岁以上高龄胃癌 12 2例 (10 9% )。现就其围手术期处理的体会总结分析如下。1　临床资料本组 12 2例 ,男 94例 ,女 2 8例。年龄 70～ 89岁 ,平均73 39岁。术前并存高血压、冠心病 18例 ,心电图改变 33例。其余尚有贫血 32例 ,低蛋白血症 16例 ,糖尿病 9例 ,肝硬化 7例 ,脑梗死 2例 ,肺气肿、肺心病及肺部感染 2 3例。合并大便潜血阳性 34例 ,幽门梗阻 14例 ,胃癌穿孔腹膜炎 3例。病理分型 :高分化腺癌 33例 ,中分化腺癌 2 4例 ,低分化腺癌 5 0例 ,粘液腺癌 15例。根据ＵＩＣＣ胃…     

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目的探讨腹腔镜下脾切除加贲门周围血管离断术(LSPD)联合术中胃镜治疗门静脉高压的临床效果。方法回顾性分析2011年1月至2013年7月华中科技大学同济医学院附属协和医院肝胆外科收治的37例行LSPD联合术中胃镜治疗肝硬化门静脉高压并上消化道出血的病人的临床资料,分析术中出血量、手术时间、住院时间和术后并发症发生率。结果 36例在腹腔镜下完成,1例因胃底静脉瘤破裂出血中转开腹。术毕胃镜检查23例存在残余曲张食管静脉,均行曲张静脉套扎;2例存在胃底曲张静脉,行组织胶注射。手术时间180~450 min,平均(265.2±42.5)min。术中失血100~850 m L,平均(342.0±146.5)m L。术后发生胸腔积液10例,门静脉血栓l例;难治性腹水l例,无术中及围手术期死亡。术后住院5~11 d,平均(6.5±2.0)d。随访3~29个月,6例失访,31例获得随访,无再出血发生。结论 LSPD是一种安全、微创、可行的手术方式,联合术中胃镜可减少术后近期再出血。     

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目的 探讨壶腹周围憩室（PAD）与胆道疾病的关系以及内镜诊断PAD铁应用价值。方法 选择284例经内镜逆行胰胆管造影（ERCP）检查确诊合并有PAD的病人（PAD组）与同期经ERCP检查无PAD的病人（对照组）作为对照研究。胆道疾病根据病史，体征，结合实验室检查，B超，CT以及ERCP等确诊。结果 PAD组合并胆囊结石，胆总管结石，胆总管下端括约肌功能不良病人明显多于对照组，尤以胆总管结石增多为著（P＜0．01）。结论 PAD与胆道疾病，尤其是胆管结石存在着密切关系，PAD可能是胆道疾病发生或复发的一个重要因素，对胆道疾病病人行ERCP检查以了解PAD与胆道的关系，从而选择合适的治疗方案，对提高胆道疾病的治愈率有重要意义。     

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超声检查周围血管 ,依据血管位置的深浅 ,选用 5～10ＭＨｚ的高频探头。灰阶超声观察血管的解剖形态 ,彩色多普勒超声评价血流动力学状况 ,两者结合使用 ,诊断病变具有很高的敏感性和特异性。　　正常下肢动脉为规整的管状结构 (图 1) ,在高频探头扫查下清楚可辨管壁的高 -低 -高三层回声 ,分别代表内膜、中膜和外膜。但在动脉的远端 ,这三层结构不如近端那样清晰。用频谱多普勒检测 ,表现为三相血流 ,即在正向的收缩期血流之后是一个反向的舒张期血流 ,接着又是一个正向的舒张期血流 (图 2 ) ,收缩期最大血流速度由近侧至远侧逐步递减。与…     

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大量临床实践表明 ,门静脉高压症的外科治疗 ,尤其是肝炎后肝硬化病人应以贲门周围血管离断术为首选。为提高本术式的疗效 ,达到即刻止血和降低再发出血 ,应强调完全和彻底的断流。因此 ,熟悉和掌握胃底贲门区的应用解剖和手术技巧是十分必要的。1　贲门周围血管离断术的解剖学基础胃底贲门区的解剖主要包括以下四个方面 (图 1)。术前术后　　 1 胃短静脉　 2 胃冠状静脉的胃支 (胃右静脉 )　 3 胃冠状静脉的食管支 (胃左静脉 )　 4 胃冠状静脉的高位食管支　 5 门静脉6 胃后静脉　 7 左膈下静脉　 8 胃网膜左静脉　 9 肠系膜上静脉　 10…     

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肛管、直肠周围间隙发生急、慢性化脓性感染并形成脓肿称为肛管直肠周围脓肿。通称肛周脓肿。该病是一种常见的较为复杂的外科感染 ,多见于 2 0～ 40岁的男性 ,男女发病比例为 4∶1。肛管、直肠周围有调节、控制直肠肛门功能的肌肉以及由蜂窝组织构成的多个间隙 ,后者容易感染形成脓肿。其病因多由隐窝炎经肛腺、肛腺管及其分支直接蔓延或经淋巴管向外周扩散而致。此外 ,少见的有 (1)肛裂、痔、肛门外伤、产后会阴伤等合并感染以及肛门周围皮肤病感染。 (2 )直肠炎或肿瘤破溃以及外伤感染。 (3)全身性疾病如结核病、溃疡性结肠炎、Ｃｒｏｈ…     

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经过近 3 0年的临床实践和经验总结 ,目前贲门周围血管离断术已形成一套标准化、规范化的操作程序 ,成为国内治疗门静脉高压症的首选术式。其主要优点是既能即刻和确切止血 ,又能维持门脉的入肝血流 ,因而术后肝性脑病发生率低 ,生活质量较高 ,远期疗效亦较满意 ,而且手术创伤不太大 ,手术操作较简便 ,易于在基层单位推广。缺点是术后仍有一定的再出血率 ,约 10 %左右。根据我院的资料 ,再出血者多数以便血为主 ,出血量不大 ,经非手术疗法多可控制出血[1,2 ] 。1　断流不彻底是导致再出血的主要原因[3]第一次手术不彻底、不完全 ,遗漏了高位…     

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??Effect of neoadjuvant chemotherapy with oxaliplatin and S-1 regimen on perioperative period of patients with advanced stage ?? gastric cancer QU Jian-jun??ZHAI Sheng-yong??DENG Guo-peng??et al. Department of Surgical Oncology, Weifang People's Hospital, Weifang 261041, China
Corresponding author: QU Jian-jun??E-mail: urodoc@163.com
Abstract Objective To investigate the effect of neoadjuvant chemotherapy with oxaliplatin + S-1(SOX) regimens on the perioperative period of patients with advanced stage ?? gastric cancer. Methods The clinical pathology data of 161 patients with advanced stage ?? gastric cancer who were treated at the Department of Surgical Oncology, Weifang People’s Hospital of from January 2013 to January 2017 were retrospectively analyzed. The patients were divided into neoadjuvant chemotherapy group (75 cases) and traditional treatment group (86 cases).The perioperative changes in the two groups of patients were compared. The nutritional status of the patients before and after chemotherapy in the response group and non-response group was compared in further analysis. Results There was no significant difference in gender, age, pathogenesis, pathological type, preoperative staging and surgical methods between neoadjuvant chemotherapy group and traditional treatmentr goup (all P>0.05). There were no significant differences in the time of operation, intraoperative blood loss, postoperative venting time, postoperative recovery time, incision suture removal time, postoperative hospital stay, and incidence of postoperative complications (P??0.05). Analysis of neoadjuvant chemotherapy component layers showed that after neoadjuvant chemotherapy, in response group, body weight rose from (60.5±9.1) kg to (61.3±8.6) kg (t=-2.473, P=0.018), and body mass index (BMI) from 21.8±2.4 to 22.2±2.0 (t=-3.313, P=0.002); there was no significant difference in body weight and BMI in the non-response group (all P>0.05). There was no significant difference in the levels of skeletal muscle, inorganic salt, extracellular fluid, body fat, protein, upper arm circumference, and intracellular fluid before and after treatment (P>0.05). There was no significant difference in nutritional indicators before and after chemotherapy between theresponse group and the non-response group (P>0.05). Conclusion During the period of neoadjuvant chemotherapy in the SOX regimen, there is no significant change in the nutritional status of the patients, which do not aggravate malnutrition, and do not increase the risk of surgery or the incidence of perioperative complications.     

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胃肠肽类激素是指传统的激素和许多可通过旁分泌神经分泌、自分泌和外分泌等方式 ,介导细胞间信息传递 ,发挥激素和局部递质效应的胃肠肽。　　胃肠肽类激素对胃肠道运动功能的调控形式为兴奋和(或 )抑制 ,即促进和 (或 )抑制作用。胰岛素和胰高糖素虽属胃肠肽类激素 ,但由于其功能特殊 ,故不在此讨论。1　兴奋型胃肠肽类激素1 1　胃动素 (ｍｏｔｉｌｉｎ)　　胃动素是由 2 2个氨基酸组成的多肽。主要存在于十二指肠和近端空肠粘膜内分泌细胞中 ,胃底、胃窦、远端小肠粘膜以及中枢、外周和胃肠道壁内神经系统中也有胃动素存在。人类胃动素基…     

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??Perioperative complicated intra-abdominal infections??Recognition and standardized therapy WANG Ge-fei??REN Jian-an??LI Jie-shou. Clinical School of Medical College of Nanjing University, Research Institute of General Surgery, Nanjing General Hospital of Nanjing Military Command, PLA, Nanjing 210002??China
Corresponding author??REN Jian-an??E-mail??jiananr@gmail.com
Abstract Postoperative complicated intra-abdominal infections (cIAIs) are common but challenges in clinical practice, which need adequate source control procedure and antimicrobial therapy. Damage control and step-up approach should be set up during source control procedure of cIAIs. Initial minimally invasive intra-abdominal drainage like percutaneous drainage using a sump drain by trocar puncture should be performed. If minimally invasive drainage can't control infection??surgical drainage should be administrated. If complicated with abdominal hypertension??open abdomen should be taken into consideration. Empiric antimicrobial therapy should be initiated once a patient receives a diagnosis of an intra-abdominal infection according to epidemiological feature??followed by pathogen-directed antimicrobial therapy.     

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??Laparoscopic resection in gastric stromal tumors: a report of 32 cases ZHAO Ying??YUE Yuan-yi?? WANG Qiang??et al. Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
Corresponding author??FENG Yong??E-mail: Fengy@sj-hospital.org
Abstract Objective To study the result of laparoscopic resection in gastric stromal tumors (GSTs), and discuss the value of laparoscopic resection in GSTs. Methods The clinical data of 32 cases of GST performed laparoscopic resection from January 2009 to November 2010 at Shengjing Hospital of China Medical University were analyzed. The operative time, intraoperative blood loss, postoperative exhaust time, intake time and hospital stay were explored. Results The mean operative time of laparoscopic resection for GSTs was ??65.5±9.8??mins. The intraoperative blood loss was??49.7±7.5??mL. The exhaust time was ??24.8±3.7??hours. The time of liquid food intake was ??26.8±3.4??hours. The length of hospital stay was ??6.3±1.1??days. During the follow-up of 1-25 months, there was no postoperative recurrence. Conclusion Laparoscopic resection of GSTs could be performed safely and effectively, which is feasible choice in the treatment for GSTs.     

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目的探讨肿瘤大小对早期胃癌预后的影响。方法自1995年4月至2006年6月,福建医科大学附属协和医院胃外科对159例早期胃癌病人施行根治术。应用ROC曲线选取肿瘤大小的最佳截点。对病人预后因素进行单因素及多因素分析,对影响病人预后的独立因素进行分层分析。结果通过ROC曲线筛选出早期胃癌肿瘤直径最佳截点为23mm,其中肿瘤直径<23mm病人84例(小直径组),肿瘤直径≥23mm者75例(大直径组)。小直径和大直径组的术后5年存活率分别为98.8%和80.6%,差异具有统计学意义(P<0.01)。通过COX比例风险模型分析显示,肿瘤大小、浸润深度、淋巴结转移是影响全组病人预后的独立危险因素(P<0.05)。进一步分层分析发现,无淋巴结转移或浸润黏膜下层的早期胃癌病人,大直径组的5年存活率低于小直径组(P<0.01)。结论肿瘤直径大小的截点为23mm时,可显著影响无淋巴结转移或浸润黏膜下层的早期胃癌病人的预后。     

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目的：探讨胃癌No16淋巴结清扫术式的可行性和意义，提出合适的No 16淋巴结清扫术指征。方法：对1998年9月至2001年9月所行的48例No16淋巴结清扫术病例资料进行分析。结果：在48例No16淋巴结清扫术中发现有第16淋巴结转移者9例，转移率为18．6％，浸润型胃癌、肿瘤直径大于5cm、肿瘤侵及浆膜以及第2、3站淋巴结受累时，No16淋巴结转移率明显增高（P＜0．05）。全组病例无手术死亡，手术并发症也未见明显增高。结论：只要严格掌握手术适应证，No16淋巴结清扫术是安全、可行、有效的。     

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??Reoperation for recurrent gastrointestinal stromal tumors CAI Jian-qiang. Department of Abdominal Surgical Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China
Abstract Surgical resection is still the primary curative treatment for gastrointestinal stromal tumor(GIST) patients. However, postoperative recurrence and metastasis of tumors are the major causes of treatment failure and patients death. Surgery is not the best choice for recurrent GIST. It is considerable to combine surgical and molecular therapy to increase the overall survival of GIST patients.     

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目的 探讨胃癌手术后复发因素及其再手术的适应证。方法 回顾性分析1974－1998年胃癌术后复发病人进行再次手术治疗48例的临床资料，并对手术方法、要后并发症、病死率及术后病理结果进行了分析。结果 术后生存5年以上7例，3年以上8例，2听以上6例，1年以上9例，1年内死亡者12例。单纯探查者6例分别于3－6个月内死亡。结论 对胃癌术后复发者，再手术能否切除病灶主要取决于复发方式，凡证实吻合口或残胃复发者，即使侵及邻近脏器，无远处转移，且心肺功能可以耐受手术者，均应再次手术。