低位直肠癌保肛术后复发的再治疗研究

目的 探讨低位直肠癌保肛术后复发的治疗方式及疗效.方法 保肛术后局部复发的低位直肠癌患者共56例,其中20例行根治手术(A组),21例行姑息手术加三维适形放射治疗(B组),15例单纯采用三维适形放射治疗(C组).结果 56例患者获随访6个月至3年,A组1、2、3年生存率分别为100.0%(20/20)、80.0%(16/20)、65.0%(13/20);B组分别为90.5%(19/21)、52.4%(11/21)、33.3%(7/21);C组分别为80.0%(12/15)、40.0%(6/15)、20.0%(3/15).A组的2、3年生存率明显高于B、C组(P<0.05).结论 对于低位直肠癌保肛术后复发的患者治疗首先应该选择根治手术,不能行根治手术的患者,可行姑息手术,术后进行三维适形放射治疗.

Abstract：

Objective To investigate the treatment of local recurrence after sphincter preserving surgery for low rectal cancer. Methods Fifty-six patients with local recurrence after sphincter preserving surgery for low rectal cancer were divided into three groups, 20 cases underwent radical resection (group A), 21 cases underwent palliative resection combined with 3 dimensional conformal radiation therapy (group B), and 15 cases only received 3 dimensional conformal radiation therapy (group C). Results All the patients were followed up from 6 months to 3 years. The 1-year,2-year and 3-year survival rates were 100.0%(20/20),80.0% (16/20),65.0% (13/20) in group A,90.5% (19/21),52.4% (11/21),33.3% (7/21) in group B and 80.0%(12/15),40.0%(6/15),20.0%(3/15) in group C respectively. Both 2-year and 3-year survival rates in group A were significantly higher than those in group B and group C (P <0.05). Conclusions The first choice of patients with local recurrence after sphincter preserving surgery for low rectal cancer is radical resection. Palliative resection combined with 3 dimensional conformal radiation therapy is the second choice.     

腹腔镜下直肠癌根治术后医院感染的原因分析及护理

目的 探讨腹腔镜下直肠癌根治术患者医院感染的围手术期护理对策.方法 采用回顾性调查方法对2005年8月-2011年9月腹腔镜下直肠癌根治术患者资料进行分析研究.结果 患者有糖尿病、慢性支气管炎等基础疾病,长时间的手术是引起术后感染主要因素,而患者的一般情况、癌症的临床分期、手术方式与术后感染无明显关系.结论 术前准备工作、手术室空气质量、室温、无菌操作规程及手术时间的长短、术后切口的管理均是影响术后医院感染的主要因素.     

腹腔镜治疗直肠癌与开腹手术治疗的疗效观察

目的探讨腹腔镜手术与开腹手术治疗直肠癌的疗效及安全性。方法选取2010年2月-2012年6月来我院治疗的直肠癌患者98例,分为腹腔镜组和开腹组,42例患者采用腹腔镜直肠癌手术,56例采用开腹直肠癌手术,比较两组的手术时间、出血量、淋巴结清除数量、术中和术后并发症、术后恢复时间、住院时间及费用等。结果腹腔镜组与传统开腹手术均成功切除肿瘤部位,腹腔镜组术中出血量、住院时间与开腹组比较有显著性差异(P<0.05),但两组的手术时间、恢复时间、淋巴结清除数量、并发症等情况无统计学差异(P>0.05)。结论腹腔镜直肠癌手术不仅微创、安全、有效,而且其手术出血量少,术后恢复时间短,其根治效果与开腹手术无明显差异。     

直肠癌术后常规放射治疗摆位误差分析

目的:通过对直肠癌术后常规放射治疗重复摆位数据的测量,分析误差产生原因,并采取针对性措施减少误差.方法:13例直肠癌术后放射治疗患者,仰卧于床上,采用真空袋固定,由模拟定位机工作站采集定位图像,行等中心放射治疗.每周一、三、五采集验证片,与原定位片比较,测量摆位误差.结果:156幅验证图像与其对应的定位图像比较,X、y、Z轴误差分别为(0.32±0.17)、(0.58±0.27)、(0.53±0.31)cm,正、侧面移位旋转分别为(2.3±1.9)和(1.8±1.6)°.结论:直肠癌术后常规放射治疗中重复摆位存在一定误差,通过采取相应措施可以减小.     

Laparoscopic rectopexy in solitary rectal ulcer

Patients with Solitary Rectal Ulcer Syndrome (SRUS) come to a physician with passage of mucus and bloody liquid within defecation. The treatment for SRUS is depended to the severity of symptoms and the existance of rectal prolapse. This study is a report of the assessing of rectopexy as surgical modalities for 62 medical treatment resistant SRUS patients who were referred to the gastrointestinal department of Shahid Sadoughi Medical University and Mojibian hospital. The present non-randomized clinical trial was carried out in 62 SRUS patients from 1991 till 2005. In these patients SRUS was confirmed by histology. They were symptomatic after conservative therapy and referred for surgical intervention. All of them had been undergone abdominal rectopexy by two laparoscopic surgeons. In our study, rectal bleeding and history of digitalization had the highest and lowest frequency of symptoms and signs in our cases respectively. Abdominal rectopexy was done in 39 cases and complete recovery in our cases was 69.23%. Complete recovery rate in cases with dysplasia (63.8%) was significantly higher than cases without that (P=0.04). Complete recovery rate in cases that had finger defecation (85%) was significantly higher than cases without that (50%) (P=0.03). Laparoscopic rectopexy is one of the main surgical techniques for treatment of SRUS. This technique can present complete recovery for SRUS patients. Some of them include topical medications, behavior modification supplemented by fiber and biofeedback and surgery were more available and studied. But it seems that education of SRUS patient conservative treatment remain cornerstone in the SRUS management.     

Laparoscopic surgery for inflammatory bowel disease

Laparoscopic surgery for inflammatory bowel disease is an expanding field, which has physical benefits to the patient and economic benefits to the trust and community.     

Laparoscopic biliary surgery

The following article briefly sets out the possible new protocols that can be applied in biliary pathology, arising from the changes brought about by the appearance of new techniques of laparoscopic biliary surgery. It offers a synthesis of the latest and most novel articles on surgical technique and management in different biliary pathologies such as choledocholithiasis and cholecystitis. It can be concluded that management will differ greatly, depending on the technical capacities of the centre that is called upon to deal with one of these pathologies. A standard protocol for everybody cannot thus be established at present. The differences between endoscopic retrograde cholangiopancreatography and intraoperative laparoscopic cholangiography have still to be demonstrated, it is not possible to make generalisations about whether one technique is more useful than the other. The same could be said about whether access to the main biliary path should be achieved through the cystic conduct or whether, on the contrary, a choledochotomy should be performed.     

直肠癌手术切口感染的危险因素分析与预防对策

目的探讨直肠癌手术切口感染的危险因素,制定出有效的预防措施。方法回顾性分析医院2007年1月-2011年12月收治的456例直肠癌手术患者临床资料,对感染患者的相关感染因素进行单因素及多因素统计分析,以确定引起切口感染的危险因素。结果直肠癌手术患者共456例,术后发生切口感染43例,切口感染率为10.5%;合并有糖尿病、营养不良、手术切口长度>15.0cm、手术方式为APR、有术区污染、出血量>300ml、手术时间>3h、术前肠道准备不充分者及肿瘤分期较晚、伴有肠梗阻者与手术切口感染的发生具有相关性(P<0.05);合并糖尿病、白蛋白≤35g/L、Ⅲ期/Ⅳ期癌症、术式为APR、手术出血>300ml是影响SSI的独立危险因素。结论直肠癌手术切口感染,受多种因素影响,外科医师应从术前准备、手术操作因素、患者自身因素、抗菌药物应用等多方面考虑预防切口感染。     

老年低位直肠癌保肛手术与腹会阴联合切除术疗效评价

目的探讨低位直肠癌保肛术与腹会阴联合切除术对病人术后并发症和肿瘤复发影响。方法随访2009年7—12月期间我院普外科手术治疗56例低位直肠癌,对保肛手术(LAR)与经腹会阴联合切除术(APR)两组病人的临床病理指标、术后并发症和局部复发状况进行统计学分析。结果 LAR组吻合口漏发生率明显较APR组高,差异有显著性(P<0.05),两组术后局部复发率比较,差异无统计学意义(P>0.05)。结论低位直肠癌保肛术与腹会阴联合切除术并不影响低位直肠癌病人术后肿瘤复发,但LAR较易发生吻合口瘘。     

腹腔镜手术治疗贲门失弛缓症的临床研究

目的 分析腹腔镜手术治疗贲门失弛缓症的并发症以及中短期疗效.方法 回顾性分析腹腔镜手术治疗贲门失弛缓症41例患者的临床资料,观察疗效.结果 41例患者无死亡病例.所有患者均行腹腔镜Heller食管贲门肌切开术与胃底折叠术,其中39例患者行Dor前部分胃底折叠术,2例患者存在裂孔疝行Toupet胃底折叠术.手术时间平均142 min.7例发生术中并发症,其中6例为轻度并发症.术后平均随访21个月.临床疗效优27例,良7例,一般5例,差2例.结论 腹腔镜Heller食管贲门肌切开术中短期的疗效较好,并发症发生率低,可作为贲门失弛缓症的首选治疗方法.     

腹腔镜疝修补手术

1982年,Ger最早报道了腹腔镜内环口关闭术即腹股沟疝囊高位结扎术,开创了腹腔镜疝修补的先河.20世纪随着腹腔镜技术的不断成熟,其中包括医师操作技术的提高和疝治疗器械(如疝钉枪)的开发,各种补片不断面世,腹腔镜疝修补手术得到了飞速的发展.     

Laparoscopic general surgery.

Laparoscopic cholecystectomy has become the treatment of choice for symptomatic gallstones. The success of this procedure has prompted surgeons to explore the possibility of performing other procedures laparoscopically. This article describes some of these new techniques and discusses the merits of a minimally.     

预防性末端回肠造瘘在低位直肠癌保肛手术中的临床应用

目的 观察预防性末端回肠造瘘在低位直肠癌保肛手术中的应用效果.方法 将80例低位直肠癌患者随机分为观察组和对照组,各40例;两组均行前切除保肛手术,遵循全直肠系膜切除原则;观察组术中采用预防性末端回肠造瘘术,对照组不用.结果 观察组出现吻合口瘘1例(2.5％),行骶前引流管低压冲洗引流后愈合,住院时间(10±2.5)d.对照组出现吻合口瘘5(12.5％)例,其中行横结肠造瘘2例、回盲部造瘘1例、腹会阴联合切除术1例、对症处理1例,住院时间(25±5.5)d.两组吻合口瘘发生率、住院时间比较,P均＜0.05.结论 低位直肠癌保肛手术中的应用预防性末端回肠造瘘,可显著降低吻合口瘘的发生率,不需要二次手术,且住院时间明显缩短.     

Laparoscopic surgery in urology

At the present time minimally invasive surgery is present in all the standards of quality of a surgical service. Laparoscopic surgery, the basis of this minimally invasive surgery, is revolutionizing the teaching and handling of many surgical pathologies. In the urological sphere, although with a delay of 5 years with respect to neighbouring countries, laparoscopy has become established as a prevalent technique in many processes of the urinary-genital apparatus. At present it is the chosen technique for the surgical treatment of the suprarenal, and it is rapidly becoming established in different pathologies such as renal tumours, prostate tumours, staging in neoplastic diseases of the testicles, benign surgical pathology and in reconstructive surgery. Since 1995, the Urology Service at the Hospital de Navarra has been a pioneer in the employment of this type of technique, and, since 1998, it has been a pioneer of so-called advanced laparoscopic surgery, in which it is a national reference point in some of the procedures, such as laparoscopic adrenalectomy. At present, all of the laparoscopic procedures are incorporated in the service, with a learning curve that has been surpassed. All of this has made it possible to improve patient care, to obtain a reduction in postoperative pain and in length of hospital stay, and a rapid return to labour activity with oncological results that can be equivalent on those of open surgery.