阑尾切除术要点解析

目的 探讨阑尾切除术的教学要点。方法 回顾分析１８３例阑尾切除术的操作要点和带教经验。结果 １８３例均治愈，无严重手术并发症，取得了满意的治疗和教学效果。结论 阑尾切除术的操作指导应当注意以下要点的解析；１．切口与入路；２．局部解剖；３．探寻阑尾；４．阑尾系膜的处理；５．阑尾根部的处理；６．防止切口感染的方法。     

不同干预方法治疗膝关节骨性关节炎的临床研究

目的对比膝关节骨性关节炎不同干预方法的疗效。方法选择诊断为膝骨性关节炎的患者共120例128关节,分为三组：关节腔内注射透明质酸钠治疗组（SH组）、关节内注射透明质酸钠的同时口服硫酸氨基葡萄糖治疗组（GS组）,关节镜下关节清理术组（AD组）。比较三组治疗后的lysholm膝关节功能评分。结果三组治疗前后膝关节功能评分均有明显改善。治疗1个月时,AD组膝关节功能评分改善明显优于SH组和GS组（P〈0.05）;治疗6个月时,AD组与GS组无明显差异,但均优于SH组（P〈0.05）。结论对于中重度患者首选方案应为关节镜清理术,有经济承受能力的患者可同时配合口服硫酸氨基葡萄糖或关节内注射透明质酸钠治疗。     

腹腔镜胃肠肿瘤联合脏器切除手术的展望

Currently adopted surgical approaches of laparoscopic combined organ resection for gastrointestinal cancer include laparoscopic pancreaticoduodenectomy and gastrectomy, laparoscopic gastrectomy combined distal pancreatectomy and splenectomy, laparoscopic gastrectomy and cholecystectomy, laparoscopic rectal anterior resection and total hysterectomy with bilateral salpingo-oophorectomy, and laparescopic colorectal and hepatic metastases resection. Satisfactory clinical outcomes of these procedures for gastrointestinal cancer were obtained in the reported cases. However, the number of cases in current studies on laparoscopic combined organ resection for gastrointestinal cancer was too small and no control groups involved, and multicenter clinical trials were not yet conducted. In conclusion, the future of laparoscopic combined organ resection for gastrointestinal cancer is promising, while its feasibility and safety require further investigation.     

细硅胶管桥接游离皮瓣移植治疗糖尿病足溃疡的实验研究

目的 应用自行设计制作的细硅胶管从兔股部动静脉桥接下腹部完全游离的皮瓣原位再植,观察皮瓣是否存活、存活情况及最长存活时间,血管蒂(细硅胶管)通畅情况,再植皮瓣内血管分布情况和细硅胶管直径最小限度和长度最大限度,尝试为修复糖尿病足溃疡创面探索一种新的治疗手段,为临床应用提供实验依据.方法 选用健康家兔10只,用制备抗凝细硅胶管桥接兔右下腹部长宽4.0 cm×3.0 cm游离皮瓣,至髂外动静脉,术毕将皮瓣原位缝合.观察项目包括皮瓣肉眼观察术后12 h、1 d、3 d、7 d、3周皮瓣色泽、肿胀程度、有无水泡、瘀斑以及血管充盈程度等,并对全部皮瓣进行解剖,观察皮瓣血管蒂通畅情况观察.结果 10块兔右下腹壁游离皮瓣中有2块最终部分成活,8块最终完全失活.结论 用细硅胶管桥接游离皮瓣移植皮瓣有可能存活,为提高皮瓣存活率必须提高桥接导管的抗凝性.     

肠系膜下血管的腔镜下解剖学观察

目的:阐明肠系膜下动脉(inferior mesenteric artery,IMA)和肠系膜下静脉(inferior mesenteric vein,IMV)的腔镜下解剖学特点,以指导腔镜下血管定位.方法:解剖和观察15具尸体;对126例接受腹腔镜左侧结肠癌和直肠癌手术的患者进行术中观察和术后录像复习.结果:IMA起自腹主动脉前壁,起点大部分平L3椎体或L3-4椎间盘,与主动脉分叉距离(42.08±6.26)mm;IMA分支有多种变异.腔镜下:系膜前,IMA表现为自主动脉前面向左下走行、乙状结肠系膜内隆起并搏动的条索;系膜后,IMA主干位于结肠系膜偏后部,IMA根部是左结肠后间隙内的固有障碍.在左髂总动脉水平,IMA位于左输尿管、左性腺血管内侧,三者位置关系恒定.IMA根部神经纤维分布少.IMV走行于IMA左侧的结肠系膜内,末段与动脉分离后,经十二指肠空肠襞左缘后方进入胰体后面.结论:正确的外科间隙(左结肠后间隙)、标志、外观和线索,是腹腔镜下IMA和IMV定位的解剖学基础.     

胃癌单克隆细胞球和CD44~+及CD133~+亚群成瘤能力的比较

目的研究胃癌干细胞亚群的筛选方法,探讨建立胃癌干细胞稳定亚群的可行性。方法利用流式细胞仪从MKN45、MKN25、SGC7901细胞株和人胃癌组织中分选出不同CD44和CD133表型的亚群,比较不同亚群和无血清培养基培养的单克隆细胞球细胞在裸鼠移植瘤模型中的成瘤能力。结果不同细胞的CD44+和CD133+亚群在低数量级时几乎不具有裸鼠皮下成瘤能力,在高数量级接种时成瘤能力与母系细胞差异无统计学意义;单克隆细胞球细胞在各数量级下的成瘤能力、瘤体积和生瘤速度均显著高于母系细胞。结论与CD44和CD133等细胞表面标志物筛选法相比,单克隆细胞球细胞可更好的作为胃癌干细胞研究的细胞学基础。     

前哨淋巴结导航在胃癌手术中的运用现状

所谓前哨淋巴结就是指第1个接受原发肿瘤引流的区域淋巴结,也是转移最早发生的地方,可以用于预测恶性肿瘤区域淋巴结的转移情况.前哨淋巴结导航手术（sentinel node navigation surgery,SNNS）最先被运用于乳腺癌及黑色素瘤的患者以评价淋巴结清扫范围.该项技术最近也被运用于胃肠道恶性肿瘤手术中,自2000年Miwa首次报道SNNS运用于胃癌手术至今,已有不少单中心相关研究的报道,前哨淋巴结对胃癌区域淋巴结预测准确率达到71%～100%.     

腹腔镜手术治疗合并常见慢性病老年直肠癌患者的疗效评估

目的 探讨腹腔镜手术治疗合并常见慢性病的老年直肠癌患者的可行性、安全性及疗效.方法 回顾性总结2003年1月至2008年12月南方医科大学南方医院收治的192例合并常见慢性病的老年直肠癌患者的临床资料.192例患者分为腹腔镜组(91例)和开腹组(101例),比较两组患者的手术学指标、肿瘤学指标、预后指标.计量、计数资料分别采用t检验和x2检验,患者生存情况采用寿命表法和Kaplan-Meier法.结果 腹腔镜组和开腹组患者保肛率、手术时间、术后住院时间、术后主要并发症发生率分别为85.7%(78/91)、(194±61)min、(14±8)d、24.2%(22/91)和85.1%(86/101)、(187±58)min、(14±8)d、28.7%(29/101),其差异无统计学意义(x2=0.012,t=0.874,-0.265,x2=0.505,P＞0.05);术中出血量、术后肛门排气时间、进流质饮食时间和下床活动时间分别为(108±78)ml、(3±1)d、(4±2)d、(3±1)d和(270±600)ml、(4±1)d、(5±2)d、(5±1)d,其差异有统计学意义(t=-2.650,-4.545,-4.587,-13.310,P＜0.05).腹腔镜组和开腹组患者标本切除长度、淋巴结清扫数目分别为(18±5)cm、(9±7)枚和(18±5)cm、(9±8)枚,其差异无统计学意义(t=1.457,0.021,P＞0.05);而腹腔镜组肠管远切缘长度(3.8±1.5)cm显著长于开腹组的(3.1±1.5)cm(t=0.283,P＜0.05).腹腔镜组和开腹组患者3年累积生存率、总复发率、局部复发率、远处转移率分别为76%、12.1%(11/91)、2.2%(2/91)、9.9%(9/91)和82%、14.9%(15/101)、6.9%(7/101)、7.9%(8/101),其差异无统计学意义(U=2.600,x2=0.312,2.400,0.230,P＞0.05);生存分析显示,两组TNM Ⅰ、Ⅱ、Ⅲ期和Ⅰ～Ⅲ期患者累积生存率比较,差异无统计学意义(P＞0.05).结论 腹腔镜手术治疗合并常见慢性病的老年直肠癌患者是安全可行的,在术后恢复方面显示出明显的微创价值.

Abstract：

Objective To evaluate the feasibility, safety and clinical outcome of laparoscopic radical resection of rectal cancer in elderly patients with common chronic comorbidities. Methods The clinical data of 192 elderly patients with rectal cancer and common chronic comorbidities who were admitted to the Nanfang Hospital from January 2003 to December 2008 were retrospectively analyzed. All patients were divided into laparoscope group (n=91) and open group (n = 101). The operative procedures, clinicopathological data and outcomes of the two groups were collected and compared. All data were analyzed using the t test and chi-square test, and the survival of patients was analyzed using the life table and Kaplan-Meier curves. Results The sphincter preservation rate,operation time, postoperative length of hospital stay, morbidity rate were 85.7% (78/91), (194 ± 61) minutes,(14 ±8)days, 24.2% (22/91) in the laparoscope group, and they were 85.1% (86/101), (187 ±58) minutes,(14 ±8)days and 28.7% (29/101) in the open group, with no significant difference between the two groups (x2=0.012, t=0.874,-0.265, x2 =0. 505 , P ＞ 0. 05) . The intraoperative blood loss was (108 ±78)ml in the laparoscope group, which was significantly less than (270 ± 600) ml in the open group (t =-2. 650, P ＜0.05). The time to first flatus, time to liquid diet, time to out-of-bed activity were (3 ± 1) days, (4 ± 2) days and (3 ± 1)days, which were significantly shorter than (4 ± 1)days, (5 ± 2)days and (5 ± 1)days in the open group,respectively (t =-4. 545,-4. 587,-13. 310, P ＜ 0.05). The length of rectum resected and the number of lymph node dissected were (18 ± 5)cm and 9 ± 7 in the laparoscope group, and (18 ± 5)cm and 9 ± 8 in the open group, respectively, with no significant difference between the two groups (t = 1. 457, 0. 021, P ＞ 0.05), while the distance of distal resection margin to the tumors was (3.8 ± 1.5) cm, which was significantly longer than (3.1 ± 1.5) cm of the open group (t = 0. 283, P ＜ 0. 05). The 3-year cumulative survival rate, overall recurrence rate, local recurrence rate and distal metastasis rate in the laparoscope group were 76%, 12. 1% (11/91), 2.2% (2/91) and 9.9% (9/91), and they were 82%, 14.9% (15/101), 6.9% (7/101), 7.9% (8/101) in the open group, respectively, with no significant difference between the two groups (U=2. 600, x2 =0. 312, 2.400,0. 230, P ＞ 0.05). There were no significant difference in the cumulative survival rate between patients in TNM stage Ⅰ, Ⅱ and Ⅲ in the two groups (P ＞ 0.05). Conclusion Laparoscopic radical resection of rectal cancer is safe and feasible for elderly patients with common chronic comorbidities, and it has the advantages in quick recovery of patients after operaion.     

中西医结合治疗强直性脊柱炎45例临床观察

目的：观察中西医结合治疗强直性脊柱炎（AS）的临床疗效。方法：将90例强直性脊柱炎患者随机分为对照组与治疗组,每组45例。对照组仅用西药柳氮磺吡啶片治疗,治疗组采用中药与柳氮磺吡啶片联合治疗。结果：经治疗后,治疗组总有效率为97.78%,对照组为51.11%,两组比较,差异有统计学意义（P〈0.01）。结论：中药与柳氮磺吡啶片联合治疗强直性脊柱炎疗效显著,不良反应少,值得临床推广使用。     

关节镜下自体腘绳肌腱重建前交叉韧带的临床观察

目的探讨关节镜下自体腘绳肌腱重建前交叉韧带（ACL）的近期临床观察。方法 25例ACL完全断裂患者应用关节镜下自体腘绳肌腱重建ACL,其中体部断裂25例,股骨起点断裂2例,受伤至手术平均时间7d,患者均采用相同的手术方法,术后随访时通过Rolimeter实验检测膝关节前向稳定性,采用Lysholm膝关节评分。结果 25例患者术后随访13～21个月,平均21个月。Lachman实验阴性,Rolim-eter检查显示双膝关节前后松弛度差值由术前平均（7.5±2.4）mm减少至末次随访时（2.1±1.3）mm,Lysholm评分由术前平均（62.0±57.8）分改善至末次随访时（92.5±5.5）分。结论自体腘绳肌腱重建ACL具有取材部位病损少,能维持良好的膝关节前后稳定性,近期效果良好。