Intestinal T-cell lymphomas:A retrospective analysis of 68 cases in China

AIM:To investigate the clinical features,diagnosis,treatment and prognosis of intestinal T-cell lymphomas(ITCL)by retrospective analysis.METHODS:Sixty-eight patients who were diagnosed with ITCL in case reports in the Chinese literature were compiled and reviewed.Age,gender,CD56 expression,surgical management,multifocal nature,perforation and cyclophosphamide chemotherapy were analyzed as the prognostic factors.The Kaplan-Meier method was adopted for the univariate analysis and the cumulative survival curve analysis.RESULTS:The male-to-female ratio was 1.52 to 1.The median age was 41.7 years.Twenty-seven patients had symptoms of abdominal pain or diarrhea.Thirty-six of60 patients with temperature records had high fevers at the onset of the illness.Twenty-six of 34 patients who underwent fiberoptic colonoscopy were misdiagnosed with Crohn’s disease,intestinal tuberculosis or cancer.Sixty-one patients underwent surgery.Twelve of 61 surgical patients required a second operation for anastomotic leakage or secondary perforation.The sites of lesion involvement were the jejunum(8.82%),ileum(29.41%),ileum and colon(4.41%),colon(55.88%)and appendix(1.47%).The median cumulative survival rate was 3 mo(3.00±0.48).CONCLUSION:Efforts should be made to correctly diagnose ITCL and select the proper operative approach that may reduce serious complications and create opportunities for further treatment.     

5例同种异体小肠移植术后移植肠造口的护理

总结了5例同种异体小肠移植术后移植肠造口的护理经验。注重肠造口局部管理,包括对早期移植肠存活、蠕动、分泌等功能的观察;在进行肠镜病理学观察时做好准备和配合工作;加强肠内营养时肠造口的管理,包括对后期移植肠消化、吸收功能及排斥反应的观察。5例患者全部存活,移植肠造口血运良好,颜色红润,且未发生移植肠造口周围皮肤破溃等并发症,患者逐步恢复经口正常饮食。     

T-tube ileostomy for intestinal perforation in extremely low birth weight neonates

To evaluate the results of use of T-tube ileostomy in selected cases of intestinal perforation in extremely low birth weight (ELBW) neonates. The records of 288 ELBW neonates treated at author’s institution, from 1998 to 2003 were retrospectively reviewed to identify neonates operated for intestinal perforation with T-tube placement. T-tube was inserted into the bowel through the site of perforation or proximally to the perforated gut via separate stab incision. T-tubes were used in five ELBW neonates (BW 600–900 g, gestational age 25–27 weeks) with intestinal perforation, in four of them at the time of primary surgery and in one neonate 8 days after primary anastomosis. All patients survived and there were no serious complications related to the T-tube insertion. Median duration of T-tube placement was 4 weeks (range 3–8 weeks), full enteral feeding after T-tube insertion was achieved in 4 weeks (range 1–6 weeks). All sites of T-tube insertion closed spontaneously. T-tube ileostomy is an effective and safe technique for treatment of selected cases of intestinal perforation in ELBW neonates. With respect to the hypoperistalsis of immature bowel, we recommend the use of T-tube in all cases of isolated intestinal perforation in ELWB neonates.     

Gastrostomy tubes: Fundamentals,periprocedural considerations,and best practices

Gastrostomy tube placement is a procedure that achieves enteral access for nutrition, decompression, and medication administration. Preprocedural evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events (AEs). Appropriate indications, contraindications, ethical considerations, and comorbidities of patients referred for gastrostomy placement should be weighed and balanced. Additionally, endoscopist should consider either a transoral or transabdominal approach is appropriate, and radiologic or surgical gastrostomy tube placement is needed. However, medical history, physical examination, and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs.     

乙状结肠单腔造口术Ⅰ期开放法的探讨

作者总结了本院近１０年间３８例乙状结肠单腔造口的临床经验，其中乙状结肠造口Ⅰ期开放组２０例，Ⅲ期开放组１８例，并对两组病例的临床效果进行了对比研究。作者提出造口延期开放对患者术后恢复及造口并发症的发生有一定影响，并设计实施了造口Ⅰ期开放的方法，取得良好效果。作者认为，造口Ⅰ期开放法具有术后肠道减压好，肠功能恢复快，造口并发症少的优点，尤其适用于合并急性肠梗阻的病例。     

肠造口治疗相关手术编码探讨

肠造口治疗作为粪便转流是非常重要的消化道手术之一,但是因其临床分类的复杂性给编码工作带来一定的困难.临床上依据造口的部位、形状、功能、目的、造口的保留时间对其进行分类,而肠造口手术治疗编码主要依据肠造口的3个临床特征进行分类,分别是造口形状(是否襻式)、造口部位(回肠、结肠)和造口保留时间(暂时性、永久性),主要编码于...     

腹部闭合性损伤的诊治体会

目的总结腹部闭合性损伤的诊治体会。方法对1995年1月。2005年12月收治的76例腹部闭合性损伤病例进行回顾性分析。结果76例病人,治愈72例,死亡4例,共损伤脏器110个。结论诊断性腹腔穿刺术对腹部闭合性损伤的诊断符合率高,简单易行。在复苏的同时早期行剖腹探查术,对年老体弱、严重复合伤者行空肠造瘘,胃肠内营养支持治疗,是降低病死率、提高生存质量的重要措施。     

造口旁疝腹带的制作及应用

【目的】探讨造口旁疝腹带在永久性肠造口患者中的应用效果。【方法】选取某院胃肠外科2014年12月—2018年11月收治的63例永久性肠造口患者为试验组;2011年8月—2014年10月收治的59例永久性肠造口患者为对照组。两组在术后常规治疗、护理及健康宣教的基础上,试验组根据患者自身体形和造口位置,自行设计和制作造口旁疝腹带;对照组采用传统造口腹带。评价两组造口底盘使用时间、造口旁疝发生率及其严重程度等指标。【结果】试验组和对照组造口底盘使用时间分别为（4.86±1.79） d和（3.52±1.08） d,造口旁疝发生分别为0例和11例（18.64%）,患者满意度分别为（4.96±0.52）分和（4.04±0.73）分,患者依从性分别为96.83%和59.32%,两组差异均有统计学意义（P<0.05）。【结论】永久性肠造口患者术后应用造口旁疝腹带,可使造口底盘使用时间延长、造口旁疝发生率降低、医疗费用减少,可提高患者的满意度。     

溃疡粉联合保护膜治疗小儿肠造口术后皮肤湿疹的疗效观察

目的:评价溃疡粉联合应用保护膜治疗小儿肠造口周围皮肤湿疹的疗效。方法:采用随机双盲的方法将60例肠造口后皮肤湿疹患儿分为实验组和对照组,实验组应用溃疡粉联合保护膜,对照组应用氧化锌软膏,外加每日灯烤2次。结果:实验组显效26例,有效3例,无效1例;对照组显效10例,有效18例,无效2例,两组之间治疗效果有显著性差异,实验组治疗效果明显优于对照组(P<0.05)。结论:溃疡粉联合应用皮肤保护膜治疗小儿肠造口周围皮肤湿疹效果良好,且使用方便,值得推广。     

Laparoscopic Totally Stapled Entero-Enterostomy: A Safe and Reproducible New Technique

Background Laparoscopic gastric bypass for morbid obesity is a technically demanding procedure partially because of the necessity to construct two anastomoses. In this study, a new technique to perform the entero-enterostomy is presented. Methods We evaluated the procedure in a consecutive series of 100 patients who underwent laparoscopic gastric bypass. Intra- and postoperative complications were analyzed. Results No complications in relation to the construction of the entero-enterostomy occurred. No leakage, kinking, or stenosis was observed during a mean follow-up of 13.5 months (range 6–20 months). Conclusion This new technique for a totally stapled entero-enterostomy can be recommended. Presented at the 5th International Obesity Surgery Expert Meeting, Saalfelden, Austria, March 11, 2007.