腹腔镜、结肠镜联合治疗结肠息肉8例报告

目的：探讨腹腔镜、结肠镜联合治疗结肠息肉的可行性和安全性。方法：8例结肠镜无法切除的结肠息肉或结肠镜术中出现并发症的病例联合应用腹腔镜、结肠镜,其中1例穿孔者行腹腔镜修补术;1例术后大出血者在结肠镜指引下,用腹腔镜对病灶进行缝扎止血;1例乙状结肠广基息肉在结肠镜切除病灶后,用腹腔镜缝合修补肠管;5例切除病变肠段。结果：8例患者均顺利完成手术,无中转开腹,术后无并发症发生。结论：应用腹腔镜、结肠镜联合手术完成结肠镜无法治疗的结肠息肉,提高了手术的安全性和彻底性。     

结肠镜引导下腹腔镜治疗结肠息肉32例

目的探讨结肠镜引导下腹腔镜下治疗结肠息肉的安全性和可行性。方法 2008年4月~2009年10月32例基底直径〉1.0 cm结肠镜下无法切除的结肠息肉在结肠镜引导下行腹腔镜下切除,其中21例广基息肉在结肠镜指导下腹腔镜切除并缝合修补肠管;11例腹腔镜辅助下小切口切除病变肠段。结果 32例均顺利完成手术,无中转开腹。手术时间平均70 min（40~150 min）,肠功能恢复时间平均28 h（20~30 h）。32例术后随访平均12个月（8~14个月）,未见复发。结论在结肠镜引导下腹腔镜切除结肠镜切除困难的结肠息肉,定位准确,切除彻底,是治疗结肠息肉有效、安全可行的方法。     

表现为腹部肿块的大肠结核诊断和鉴别诊断

目的　探讨以腹块为临床表现的大肠结核的诊断和鉴别诊断。方法　报告 1987～2 0 0 0年收治的以腹部肿块为临床表现的大肠结核 15例 ,并结合文献进行回顾性分析。结果　 15例肠结核均以腹块为主诉就诊 ,其中 9例行纤维结肠镜检查 ,3例行钡灌肠。仅 3例诊断为肠结核 ,其余 12例经手术活检确诊 ;所有病例均经抗结核治疗 ,1例复发。结论　纤维结肠镜下活检和手术活检是肠结核确诊的重要手段 ,利用多聚酶链反应 (PCR)技术检测活检组织中的结核杆菌 ,以及手术时常规行肠系膜淋巴结活检 ,有助于肠结核的诊断和鉴别诊断     

心肌梗塞后室间隔穿孔的手术治疗

探讨急性心肌梗塞后室间隔穿孔的手术时机选择及影响手术疗效的因素。１６例急性心肌梗塞后室间隔穿孔病人接受了手术治疗。平均年龄５４．５岁。术前合并心源性休克５例，充血性心力衰竭伴肺水肿１例。１４例行冠状动脉造影，单支病变８例，多支病变６例，合并室壁瘤１３例。急症手术４例，择期手术１２例。行穿孔直接缝合２例，补片修补１３例，双侧补片修补１例；同期冠脉搭桥９例，室壁瘤切除或折叠１３例。术后应用主动脉内球囊反搏（ＩＡＢＰ）者８例。２例急症手术者早期死亡。结论：室间隔穿孔应先行内科治疗控制心源性休克，包括应用ＩＡＢＰ或左心室辅助等，使病人能坚持到穿孔４８小时后再积极手术。分流量小者应延至３～６周后手术。心源性休克是影响术后早期死亡率的主要因素     

十二指肠溃疡穿孔单纯缝合修补术的临床疗效观察

目的观察十二指肠溃疡穿孔行单纯缝合修补术的疗效。方法对１９９２年以来收治的十二指肠溃疡穿孔１１８例病人行手术治疗。其中行单纯缝合修补术８４例;胃大部分切除术１９例,高选择性迷走神经切除加修补术１５例。对１１８例病人的手术及术后情况做回顾性分析。结果单纯缝合修补无手术死亡,平均手术时间４２ｍｉｎ,平均住院时间９天,均显著短于后二者（Ｐ＜００１）。术后３个月溃疡愈合率为７９／８３（９５％）,术后１、３、５年溃疡复发率分别为１１％（９／８３）、２２％（１２／５４）和２５％（４／１６）,与高选择性迷走神经切除加修补相比,无显著差异（Ｐ＞００５）,远期并发症发生率为８％（７／８３）,亦低于后二者（Ｐ＜００５）。病史长短和术前治疗对术后溃疡愈合与复发有一定影响,而与溃疡穿孔的大小无关。结论十二指肠溃疡穿孔单纯缝合修补操作简单、安全、并发症少,术后结合正规内科治疗,效果满意     

医源性结肠穿孔32例临床分析

目的：探索医生结肠穿孔有效的诊断和治疗方法。方法：回顾性分析３２例医源性结肠穿孔的临床资料。结果：全组３２例,男性１９例,女性１３例,１８例源于结肠镜检查;１４例源于空气或钡剂灌肠,腹痛（７０％）为最常见症状,肠腔外气体或钡剂（５６％）为最常见的影像学表现,穿孔部位常见于乙状结肠和横结肠。全部病例得到手术治疗,１９例早期（２４ｈ）手术,１３例延迟（平均４ｄ）手术,１４例进行单纯修补或切除吻合,１８例进行结肠造口,４例（１２．５％）死亡。延迟手术组或结肠造口组死亡率明显增高。结论：对于没有明显腹腔污染的医源性结肠穿孔,单纯修补苛切除吻合是合理的,对于多数病例,因经过肠道准备,应避免结肠造口以减少并发症发生率和死亡率。     

结肠镜检查致肠穿孔

结肠镜检查是诊断和治疗结肠疾病的常用方法 .与其它检查方法如钡灌肠比较具有优越性 .结肠镜可以直接观察黏膜表面而明确并治疗息肉、肿瘤、血管病变和炎症性肠病。虽然是一种侵入性检查 .但主要的并发症如出血、穿孔、息肉切除术后凝固综合征很少见。根据临床经验判断 .结肠镜检查导致的肠穿孔可采用内科或外科治疗 .本研究目的是评价结肠镜检查致肠穿孔的内科和外科治疗效果。方法 ;回颐性分析 1 970～ 1 999年DchsnerClin -ic 346 2 0例结肠镜检查资料包括患者的年龄、性别、种族等人口学资料和详细的结肠镜检查报告。对所有因结肠镜检…     

壁细胞迷走神经切断术在基层医院的应用探讨

我国一些大医院开展壁细胞迷走神经切断术（ＰＣＶ）治疗十二指肠溃疡，取得了可喜成绩［１，２］，我们于１９９２年２月至１９９７年７月间对１３例十二指肠溃疡患者做了壁细胞迷走神经切断术，临床观察疗效满意。 一．临床资料 １．一般资料本组１３例，均为男性，年龄１７～３９岁，农民，溃疡病史３～５年。其中１０例有反复上消化道出血史，多次内科治疗无效，曾行胃镜或Ｘ线钡餐检查诊断为十二指肠溃疡。３例急性溃疡穿孔，穿孔时间均在１２小时内，其中１例３年前做过溃疡穿孔单纯修补术。术前测定胃液ｐＨ＜１。 ２．手术方法硬膜…     

肠结核合并穿孔31例诊治分析

目的:分析肠结核穿孔的临床特点和诊疗方法.方法:对我院诊治的31例肠结核合并穿孔患者临床资料进行总结分析.全组31例均行手术治疗.肠切除一期肠吻合术21例(3例同时辅助横结肠造口术,1膀胱部分切除术),回肠造口加引流、二期肠切除术7例,肠间短路加引流、二期肠切除术2例,穿孔修补、肠间短路并引流术1例.结果:全组24例围手术期恢复顺利,5例切口感染、延迟愈合(其中1例切口肠瘘,换药治疗9个月愈合),围手术期死亡2例,29例术后平均抗结核治疗13个月.结论:肠结核穿孔多病情危重,积极的、个性化的手术治疗和充分营养支持是抢救成功的关键.     

腹腔镜下治疗小儿难复性肠套叠

目的总结腹腔镜下治疗小儿难复性肠套叠的经验。方法 2003年1月～2009年11月,对82例空气或钡剂灌肠无法成功复位的肠套叠行腹腔镜下肠套叠复位。腹腔镜直视下寻找套叠肠管部位,判断肠套叠类型及严重程度。先行腹腔镜下肠套叠复位术,如发现复位困难,挤压牵拉肠管有穿孔危险,单纯复位时间长(超过20分钟仍无法顺利复位),即行腹腔镜辅助下空气灌肠肠套叠复位术。结果 2例中转开放手术,其中1例腹腔镜下发现肠坏死、穿孔,1例腹腔镜下发现回回结肠型肠套叠并发美克氏憩室;其余80均腹腔镜下复位,包括1例开腹术后6个月复发者。82例手术时间30～40min。术后1～2天恢复排气排便。术后住院4～7d,无严重并发症发生。74例术后随访6个月～2年,其中9例因腹痛、呕吐再次住院1次,复查气钡灌肠排除肠套叠,经对症支持处理治愈出院,余65例未发现肠套叠复发、伤口感染、反复腹痛、肠管迟发性穿孔及粘连性肠梗阻等并发症。结论腹腔镜下肠套叠复位术结合空气灌肠,可复位绝大多数难复性肠套叠,安全可靠,同时具有腹腔镜手术的微创优点。     

Perforation of the large intestine by a contrast medium enema with barium

This is a report about five patients who suffered a perforation of the colon during a barium-sulfate enema. In one case, barium leaked into the intraperitoneal cavity causing a barium peritonitis. In the other four cases, leakage into the retroperitoneal cavity occurred. All patients underwent surgical removal and drainage of the barium-sulfate and subsequently required a colostomy. In two cases a bowel resection was additionally performed. In one case the defect re-sutured. Antibiotic therapy was included in all cases. All patients survived the incident and were discharged between 20 days and four months postoperatively. Publications and personal experience led us to manage intraperitoneal or large retroperitoneal perforations by prompt laparotomy with removal of barium and faeces. A proximal colostomy is also required. In smaller retroperitoneal perforations conservative management is feasible, however, if the patient's condition deteriorates, they should be treated as recommended for an intraperitoneal perforation.     

原发性小肠肿瘤的诊断与治疗

目的 提高原发性小肠肿瘤的诊治水平及疗效。方法 回顾性分析1983年3月一2000年5月我院收治经手术病理证实的原发性小肠肿瘤37例及随访资料。24例恶性肿瘤12例行根治性切除，6例行姑息性切除，4例行转流术，2例行单纯剖腹探查术；13例良性肿瘤5例行肿瘤局部切除，8例行肿瘤肠段切除。随访经X线消化道气钡双重造影或十二指肠内窥镜复查32例。结果 生存时间根治性切除为14—71个月；姑息性切除14—17个月；转流术6—13个月；单纯探查2—5个月。良性肿瘤切除5—17年均健在。结论 仔细询问病史，X线气钡双重造影及十二指肠内窥镜是诊断该病的主要方法，与B超、CT或选择性血管造影等检查相结合，可提高术前诊断率。手术切除是最有效的治疗方法。     

Atypical intussusception

A series of 257 children with intussusception was studied with special regard to so-called atypical cases. Half the children were treated as outpatients and 106 patients were operated on, with intestinal resection in 22. Two children died. The atypical cases were considered to be those with a spontaneous reduction between the attempt at barium enema reduction and the operation, a specific lesion, recurrence, and a chronic course. Spontaneous reduction was found both in cases where the barium enema reduction was considered doubtful or unsuccessful and in cases where no attempt at barium enema reduction was made because of marked intestinal obstruction or the poor general condition of the patient. Sedation may facilitate reduction and barium enema reduction probably should be tried more extensively. A specific lesion should be suspected in children older than 2 yr with small bowel obstruction. In recurrent intussusception a causative lesion was not found more frequently than at initial intussusception. Chronic intussusception was found in only two children, both with causative lesions.     

Effect of mechanical bowel preparation on anastomotic integrity following low anterior resection in dogs

To assess the effect of mechanical bowel preparation on anastomotic integrity after low anterior resection, 36 mongrel dogs were randomized to have low anterior resection with or without mechanical bowel preparation. All dogs received prophylactic antibiotics and anastomotic integrity was assessed on the ninth postoperative day by barium enema, inspection of anastomoses for defects after careful excision at laparotomy, and anastomotic bursting pressures. Bursting pressures were significantly higher (P less than 0.005) in the group with bowel preparation. Anastomotic defects were present in 13 per cent of animals with bowel preparation and 47 per cent without bowel preparation (P = 0.057). Pelvic abscess and death from peritonitis occurred in 6 per cent of the group with bowel preparation and 29 per cent of the unprepared group. Mechanical bowel preparation significantly enhanced anastomotic integrity and reduced complications in this model.     

Duhamel's procedure for adult Hirschsprung's disease

An adult presented with chronic constipation and abdominal mass. Clinical features, abdominal radiographs and barium enema revealed features consistent with Hirschsprung's disease. Full-thickness rectal biopsy was planned, but patient was lost to follow-up and presented 3 years later with intestinal obstruction. Exploratory laparotomy with resection of affected sigmoid colon and end colostomy were performed. Sequential rectal biopsies were obtained during the procedure to confirm the diagnosis. Later, Duhamel's procedure with a diverting loop ileostomy was successfully performed. Ileostomy reversal was done thereafter. There was complete resolution of symptoms and dramatic improvement in bowel function.     

阑尾切除术后腹部炎症性肿块29例的诊断与治疗

目的 探讨阑尾切除术后腹部炎症性肿块的诊断与治疗。方法 回顾性分析1972—2004年阑尾切除术后腹部炎症性肿块42例的临床资料。结果 42例炎症性肿块中腹壁型26例，腹腔型16例。诊断主要依靠临床表现和钡剂灌肠透视。术前正确诊断30例；误诊12例，误诊率为29％（12／42）。非手术治疗13例，手术治疗29例。42例均痊愈。29例病理检查均为炎症性肿块。结论 腹壁型炎症性肿块保守治疗无效者应手术切除；难以与结核及肿瘤相鉴别时，应及早手术探查。     

肠结核30例诊治体会

作者报告３０例肠结核的诊治体会。诊断依据是术中见肠道及肠系成有典型干酪样改变，并经内镜活检及手术切除标本病理证实。术前胸片１６例有肺结核表现，２４例钡剂检查有异常但非特异性，２０例结肠镜所见亦非特异性。行小肠部分切除３例，右半结肠切除２０例，结肠次全切除３例，直肠前切除１例，空肠部分加右半结肠切除２例，回肠部分加右半结肠加直肠前切除１例。认为肠结核亦可呈节段性并出现粘膜桥，应与Ｃｒｏｈｎ病鉴别；一期切除吻合加术后三联抗痨是安全的。     

直肠子宫内膜异位症的诊断和手术治疗

作者报告了２６例直肠子宫内膜异位症的诊断和手术治疗的经验。该病在临床症状、体征等方面易与直肠癌相混淆，易引起误诊和误治，但在病史上有其特点，即直肠刺激征、胀痛或便血，常在月经前后加重。便血在月经期多见。直肠指检和妇科检查，直肠触及的肿块多位于粘膜下，与阴道壁和宫颈粘连。直肠镜检查直肠粘膜病变较轻，仅为充血糜烂或息肉状隆起。组织病理学检查为慢性炎症表现。手术适应证为保守治疗无效、症状明显、影响正常生活者；病灶小者行局部肠壁楔形切除，病灶大而深，位置低者可以行前切除吻合术。本组局部切除１６例，前切除吻合术１０例。术后症状消失者２１例，症状改善者５例。２例５年后症状复发，行再次手术后恢复。     

Solitary pancreatic tuberculosis mimicking advanced pancreatic carcinoma

A 40-year-old woman was referred for pancreatic head carcinoma invading the portal vein. The dichotomy between the radiological findings and the general condition of the patient, as well as the laboratory results (no evidence of cholestasis), cast doubt on the diagnosis. There was no history of tuberculosis. The chest radiograph revealed no pathological findings. The anatomic relationships of the lesion entailed a high risk of vascular injury if tissue biopsy were to be done; therefore, diagnostic laparotomy was performed. Biopsy revealed granulomas with caseous necrosis, consistent with tuberculosis. After 6 months of antituberculosis treatment, the lesions had completely resolved. Tuberculosis should be considered in the differential diagnosis of pancreatic masses, particularly in regions where the disease is endemic. The condition usually resembles an advanced pancreatic tumor. Performing a biopsy of inoperable lesions and maintaining a reasonable skepticism in regard to the evaluation of operable lesions (attention to nonexclusive but helpful clues, such as young patient age, history of tuberculosis, absence of jaundice) will lead to the diagnosis in most patients. Diagnostic laparotomy may be required in a small subset of patients. The response to antituberculosis treatment is very favorable. The role of resection (e.g., pancreatoduodenectomy) is very limited. Received: December 1, 2000 / Accepted: January 25, 2001