阑尾炎性包块194例治疗体会

我院外科1995年12月至2004年12月共施行阑尾切除1 920例,其中对194例阑尾包块施行抽“芯”一期手术切除,效果满意,现报告如下。临床资料1.一般资料:本组194例,其中男112例,女82例,发病年龄24~86岁,平均年龄50岁,体温超过39℃者78例,白细胞超过1.5×109/L者178例,194例均有腹膜刺激症,发病距手术时间72 h~2周,术前诊断为阑尾包块。2.治疗方法:连续硬膜外麻醉,取麦氏切口176例,余为右下腹直肌切口。术中见坏疽性阑尾被大网膜、盲肠、小肠、后腹膜等周围组织包裹63例,阑尾坏疽穿孔后被周围组织局限为脓肿131例,194例均不易显露阑尾。我们采用…     

阑尾包块早期手术54例分析

本文对阑尾包块早期手术５４例进行了分析，提出阑尾包块或脓肿早期手术治疗并不存在感染在腹腔内扩散的观点，及时手术，注意切口保护，充分吸尽脓液，有效使用抗生素是治疗成功的关键。     

左半结肠急症Ⅰ期手术方法的探讨(附54例报告)

目的：探讨左半结肠急症I期手术的可行性。方法：对54例左半结肠急症患采用I期手术，术前2h应用抗生素罗氏芬，术中用手工方法排空结肠内积粪，保证吻合口血供良好，缝合严密，无张力。结果：54例均未发生吻合口漏。结论：对左半结肠急症术式的选择应根据患具体情况，在病情许可下，尽可能施行I期切除吻合术。     

中西医结合治疗阑尾周围炎性包块48例

中西医结合治疗阑尾周围炎性包块４８例费伟大付守训天津市天津医院（天津３００２１１）我院自１９８８～１９９４年共收治４８例阑尾周围炎性包块患者，采用中西医结合非手术疗法治疗，收到较好效果。１临床资料本组男性３３例，女性１５例，年龄２１～６８岁，平均４０...     

卵巢癌阑尾切除临床分析

目的　探讨阑尾切除在卵巢癌不同分期和治疗中的意义。方法　对 6 6例卵巢癌手术治疗时切除阑尾患者的病理切片进行回顾性分析。结果　发生阑尾转移者 11例 (16 .7% ) ,所有阑尾转移均发生在Ⅲ、Ⅳ期患者 (2 5 .6 % )。比较卵巢癌各种组织学类型中阑尾转移率 ,差异无显著性 (P >0 .0 5 )。结论　阑尾不是卵巢癌首先转移的部位 ,对Ⅰ、Ⅱ期卵巢癌不必常规切除阑尾 ,对Ⅲ、Ⅳ期卵巢癌应常规行阑尾切除术。     

急症结肠Ⅰ期切除吻合术56例分析

我院1997年1月-2002年12月行急症结肠Ⅰ期切除吻合术56例,取得满意效果,现报告如下. 1 临床资料 本组56例中男41例,女15例;年龄8个月～76岁,平均40.5岁..发病至入院时间3 h～9 d,平均2.3 d.病变性质:肠粘连坏死29例,肿瘤继发急性肠梗阻16例,肠套叠坏死7例,乙状结肠扭转坏死4例.     

围手术期整体护理在乳腺包块患者门诊手术中的应用

目的:探讨以人为本的整体围手术期护理模式对门诊乳腺包块手术患者焦虑情绪及术中血压心率和术后康复的影响.方法:160例乳腺包块患者随机分为干预组和对照组各80例,对照组接受常规围手术期护理,干预组接受以人为本的整体围手术期护理.结果:干预组的焦虑程度明显低于对照组(P＜0.05),心率、血压有显著性差异(P＜0.05),且患者术后恢复良好.结论:以人为本的整体护理可以缓减门诊乳腺包块患者焦虑情绪、稳定生命体征、增强手术安全性、加快患者术后康复等方面具有重要意义.     

小切口双套管阑尾切除窥镜的临床应用

作者设计一种“小切口双套管阑尾切除窥镜”(专利号为ＺＬ002244664),切除阑尾42例,疗效满意,介绍如下。1　材料与方法11　小切口双套管阑尾切除窥镜的设计小切口双套管阑尾切除窥镜采用金属原料制成,包括三部分:①外套管:呈中空倒圆锥状,尖端直径2ｃｍ,底部直径3ｃｍ,长3ｃｍ;②内套管:呈中空圆柱状,尖端可伸出外套管呈斜面开口,能增大视野,直径18ｃｍ,长7ｃｍ,带一手柄,便于旋转调整斜面开口方向;③内芯:为实心,尖端呈圆弧状,直径1.6ｃｍ。12　手术方法硬膜外麻或腰麻后,在麦氏点切一长2ｃｍ皮肤切口。用止血钳钝性分离至腹膜,将腹膜切一…     

阑尾周围脓肿Ⅰ期行阑尾切除腹腔引流手术(附110例报告)

我院 2 0 0 0年以来收治急性阑尾炎病人 3 2 1例中 ,阑尾周围脓肿急诊I期行阑尾切除腹腔引流手术治疗的有 110例 ,手术效果满意。现分析报告如下。临床资料1.一般资料 :本组 110例中 ,男 87例 ,女 2 3例 ;年龄 2～ 69岁 ,平均 3 7.8岁。发病至入院时间 3d 2 3例 ;3～ 7d 5 6例     

Early laparoscopic appendectomy for appendicular mass

Background: The surgical management of acute appendicitis presenting with appendicular mass remains controversial. The aim of this study was to evaluate the role of early laparoscopy and laparoscopic appendectomy (LA) in the management of appendicular mass. Methods: During a 1-year period, 62 patients underwent LA for suspected appendicitis (n = 50), generalized peritonitis (n = 2), and an appendicular mass (n = 10). Another patient who presented with an appendicular mass was found at laparoscopy to have an ileo-ileal intussusception. Results: All appendectomies were attempted and completed laparoscopically. Postoperative complications occurred in two patients; there were no deaths. None of the patients treated for an appendicular mass developed complications. There was no difference between the patients who underwent LA during the index admission for an appendicular mass and those who had surgery for non-mass-forming appendices with regard to the operative time (median [interquartile range]: 45 [36–60] vs 40 [25–50] min, p = 0.085) and postoperative hospital stay (median [interquartile range]: 2 [1–2] vs [1–2] days, p = 0.1). Conclusion: Early LA during the index admission of patients with an appendicular mass is feasible and safe, obviates the need for a second hospital admission, and avoids misdiagnoses.     

Hepatic resection for primary liver malignancy

The results of hepatic resection for patients with primary liver malignancy seen at our clinic during the past 21 years are reported. Of 92 patients, 57 had cirrhosis in addition to hepatocellular carcinoma, and 49 (53 percent) underwent hepatic resection of various degrees from partial resection to trisegmentectomy. Resectability rates of the liver were 52 percent in 77 patients with hepatocellular carcinoma, including 19 in whom the tumor was less than 5 cm in diameter, and 60 percent in 15 patients with other malignant tumors; operative mortality rates were 15 percent in the former and 0 percent in the latter. Cumulative survival rates of all patients who underwent hepatic resection, excluding death within one month, were 55 percent at one year, 29 at 3 and 5 years. In patients with hepatocellularcarcinoma, survival rates of 15 those who had a curative resection of the tumor were 87 percent at one year and 47 percent at 3 or 5 years, there was a significant difference in survival curves between those with tumors less than 5 cm and more than 5 cm (p<0.05). On the other hand, survival rates of all patients with other malignant tumors were 78 percent at one year and 37 percent at 5 years. These results indicate the importance of performing hepatic resection for patients with small hepatocellular carcinoma associated with cirrhosis and those with other malignant tumors.     

Hepatic resection for primary liver malignancy

The results of hepatic resection for patients with primary liver malignancy seen at our clinic during the past 21 years are reported. Of 92 patients, 57 had cirrhosis in addition to hepatocellular carcinoma, and 49 (53 percent) underwent hepatic resection of various degrees from partial resection to trisegmentectomy. Resectability rates of the liver were 52 percent in 77 patients with hepatocellular carcinoma, including 19 in whom the tumor was less than 5 cm in diameter, and 60 percent in 15 patients with other malignant tumors; operative mortality rates were 15 percent in the former and 0 percent in the latter. Cumulative survival rates of all patients who underwent hepatic resection, excluding death within one month, were 55 percent at one year, 29 at 3 and 5 years. In patients with hepatocellular carcinoma, survival rates of 15 those who had a curative resection of the tumor were 87 percent at one year and 47 percent at 3 or 5 years, there was a significant difference in survival curves between those with tumors less than 5 cm and more than 5 cm (p less than 0.05). On the other hand, survival rates of all patients with other malignant tumors were 78 percent at one year and 37 percent at 5 years. These results indicate the importance of performing hepatic resection for patients with small hepatocellular carcinoma associated with cirrhosis and those with other malignant tumors.     

Surgical and pathological basis for interval appendicectomy after resolution of appendicular mass in children

BACKGROUND/PURPOSE: The role of appendicectomy after the resolution of appendicular mass is debatable. A study was conducted to evaluate whether surgical and pathological features of the excised appendices favor the operation in the quiescent period. METHODS: During a 60-month period, 59 patients were admitted in our unit with a diagnosis of appendicular mass and were treated initially with conservative management. Five patients failed to respond to this management and they were operated on immediately. RESULTS: Fifty-four patients recovered fully, and relatives were advised to bring them back to the hospital for appendicectomy on a scheduled date after 6 weeks. Fifteen of 54 (27.7%) patients did not return, but the other 7 came back because they had symptoms of recurrent appendicitis. The remaining 32 patients underwent appendicectomy as scheduled. The surgical findings and pathological features of excised appendices showed various abnormalities. CONCLUSIONS: Considering these features it could be concluded that delayed appendicectomy is unjustified in patients with absent appendix or with its lumen obliterated, whereas the other remaining patients who harbored normal, thickened, fibrotic, transected, stump, and appendix with chronic inflammation or containing fecal casts would benefit from operation. Because we have no method to date to distinguish between these variants "in situ" delayed appendicectomy seems beneficial for all the patients who respond well to the initial management of appendicular mass.     

Liver resection for primary hepatic neoplasms

Summary Subtotal hepatic resection was performed in 356 patients; 87 had primary hepatic malignancies, 108 had metastatic tumors, and 161 had benign lesions including 8 traumatic injuries. The global mortality was 4.2%. The experience has elucidated the role of subtotal hepatic resection both for benign and malignant neoplasms. Vorgetragen bei der 28. Jahrestagung der ?sterreichischen Gesellschaft für Chirurgie in Linz, 18.–20. Juni 1987.