胃癌术后膳食纤维和早期肠内营养与消化道并发症的关系

目的探讨胃癌术后膳食纤维和早期肠内营养(EN)与消化道相关并发症的关系。方法采用随机对照的方法,把56例胃癌术后患者随机分成能全素组和能全素加膳食纤维组,经鼻肠管进行早期肠内营养(EN),观察两组EN常见消化道并发症的发生情况。结果两组患者在临床资料方面具有可比性(P>0.05)。两组患者的术后腹胀、腹泻的发生率相似,均P>0.05,差异无统计学意义。1例能全素加膳食纤维组患者因吻合口水肿、输入袢不完全性梗阻而发生恶心、呕吐,其余患者均未发生恶心和呕吐。结论胃癌术后的早期膳食纤维EN并不增加EN消化道并发症的发生率。     

肝动脉栓塞治疗肝癌肝动脉-门静脉瘘所致的大量腹腔积液

目的:探讨肝动脉栓塞治疗肝癌肝动脉-门静脉瘘(APF)所致大量腹腔积液的临床应用价值。方法:并发高流量APF和大量腹腔积液的肝癌患者9例,以明胶海绵颗粒栓塞载瘘动脉,消除或减少APF,用碘化油尽量栓塞肝癌病灶。结果:APF消失7例,少量残留2例;门静脉血流方向全部由逆肝转为向肝;肝癌病灶内碘化油沉积良好6例;术后2周内腹腔积液完全消失5例,少量残余4例;2周后肝功复查,5例肝功能原有明显损害者全部明显改善;全部病例原有腹胀、腹痛、厌食、乏力症状不同程度缓解。结论:对肝癌并高流量APF所致腹腔积液,动脉栓塞治疗简单、安全、有效。     

结直肠癌手术死亡相关因素分析

目的:研究旨在探讨结直肠癌手术死亡相关的临床病理影响因素.方法:回顾中山大学肿瘤防治中心1964年1月至2004年12月经手术治疗的4498例结直肠癌患者的临床病理资料,应用单因素和多因素Logistic回归分析手术死亡的相关影响因素.结果:全组手术死亡者共62例,手术死亡率为1.38%,主要死亡原因为多器官功能衰竭、中毒性休克、心血管疾病、急性肾功能衰竭、吻合口漏等.单因素分析显示,性别、术前基础疾病、术前合并症、腹水、手术年代、手术性质、Dukes分期、术后并发症等为影响手术死亡的因素,而年龄、肿瘤部位、组织类型、病理分级与手术死亡无关.多因素分析表明,术前基础疾病、术前合并症、腹水、手术年代、手术性质、Dukes分期、术后并发症是结直肠癌手术死亡的独立影响因素.结论:术前基础疾病、术前合并症、腹水、手术年代、手术性质、Dukes分期、术后并发症是结直肠癌手术死亡的独立影响因素.     

陆金根运用拖线法治疗肛瘘经验探讨

介绍陆金根教授运用现代技术诊断肛瘘瘘管的走向、拖线的设置及术后创面的处理等临床经验。     

大肠癌术后早期肠梗阻的临床特点和治疗

目的：探讨大肠癌术后早期肠梗阻的诊断与治疗。方法：回顾分析在肠癌手术412例术后早期肠梗阻29例的临床资料。结果：20例经手术探查发现以机械性梗阻占多数（18/20)，手术治愈18例；死亡2例，死亡原因均为延误手术时机造成；非手术治愈9例。结论：大肠癌术后早期肠梗阻虽有梗阻症状，但由于术后诸多因素的影响，大多缺乏典型机械性肠梗阻的临床表现。处理中先进行适当时间的非手术治疗，无缓解者再手术。     

颈淋巴结清扫手术后乳糜漏的处理

目的 :探讨颈淋巴结清扫手术后乳糜漏的处理方法。方法 :回顾分析颈淋巴结清扫手术 12 85例术后发生乳糜漏 2 1例的临床资料。结果 :乳糜漏的发生率为 1.6 % ,18例经保守治疗治愈 ,3例经再次手术治愈。结论 :对颈淋巴结清扫术后的乳糜漏应及早诊断 ,术中应加强预防并及时处理     

小血管套叠粘接吻合法在血液透析者中建立动静脉内瘘的应用

慢性肾病患者常需要建立动静脉内瘘进行透析，常规间断缝合法吻合动静脉难度大、耗时长。为了缩短吻合时间，提高远期通畅率，进行了套叠粘接吻合法建立动静脉内瘘的实验研究，并将这一方法应用于透析患者建立动静脉内瘘的血管吻合。将动脉端套入静脉端，只需吻合两针，用医用胶封闭吻合口。经８个月观察，通畅率达１００％，血流量均超过３００ｍｌ／ｍｉｎ。达到了透析需要。     

A Rare Case of Biliobiliary Fistula

Abstract: Biliobiliary fistula is a rare clinical entity. The case of a 72 year old female, who presented with epigastric pain and jaundice, is detailed herein. Endoscopic retrograde cholangiopancreatography (ERCP) revealed two stones, one each in the common bile duct and the gallbladder. Continuous endoscopic nasobiliary drainage (ENBD) was performed to relieve obstructive jaundice. Further study with contrast medium administered via the ENBD tube revealed a fistula between the neck of the gallbladder and the common bile duct. The cystic duct was intact. A stone was considered to have migrated into the common bile duct through the fistula. A diagnosis of biliobiliary fistula, Corlette type I was made. However, in this particular case, a biliobiliary fistula was noted at a site below the junction of the cystic duct and common bile duct. Removal of the gallbladder stones was followed by cholecystectomy. The common bile duct was then repaired by utilizing a T-tube. No evidence of malignancy was recognized in the resected gallbladder specimen. In the one year to date since surgery, the patient has been asymptomatic and without signs of biliary disease.     

BILIARY HYPERPRESSURE IN RAT EXTRAHEPATIC CHOLESTASIS ALTERS HORSERADISH PEROXIDASE BILIARY EXCRETION

1. The authors investigated the effect of two extrahepatic cholestasis models (one by bile duct ligation and the other by choledocho-jugular fistula) on the hepatic clearance of horseradish peroxidase in male Sprague-Dawley rats divided into four groups. 2. In groups A (n = 5 rats) and B (n = 5), bile duct ligation was performed, while a choledocho-jugular fistula was created in groups C (n = 5) and D (n= 7). A 10 mg intravenous bolus of horseradish peroxidase was injected after 24 h (groups A and C), 48 h (groups B and D) or 1 h (Group E; five sham-operated rats). Serum and bile samples were then serially collected for 2 h. 3. In all groups, serum horseradish peroxidase levels increased soon after injection and then rapidly decreased, the curves being similar. Biliary excretion increased for 30 min and then slowly decreased. The highest horseradish peroxidase biliary concentrations and outputs were found in Group B followed by Group A; both groups had significantly higher levels than Group E. No difference was found between horseradish peroxidase biliary excretion of groups C and D and that of sham-operated rats. 4. When each group was considered separately, sampling times correlated with the corresponding ratios of bile/ plasma HRP. Significant differences were found between the relative slopes of groups A, B and E, but not between those of groups C, D and E. 5. In conclusion, bile duct obstruction greatly affects the plasma-bile transfer of fluid phase markers, such as horseradish peroxidase, while single retention, caused by choledocho-jugular fistula, has no influence. The increased biliary hyperpressure related to the duration of cholestasis may account for the degree of horseradish peroxidase transfer which, in turn, probably depends on an enhanced paracellular passage.     

Endometrial carcinoma: Does the addition of intracavitary vault caesium to external beam therapy postoperatively result in improved control or increased morbidity?

A retrospective analysis of treatment for endometrial carcinoma is reported here. From 1987 to 1989, 138 patients were referred to the oncology department following total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometrial cancer. Forty-seven patients were not prescribed postoperative radiotherapy; 31 had Stage I well differentiated adenocarcinoma with minimal myometrial invasion, while the remaining 16 patients were considered unfit for postoperative radiotherapy. There were no instances of local relapse amongst the 31 patients with minimal myometrial invasion.The remaining 91 patients all received external beam irradiation to the pelvis and, according to the preference of the individual therapist, 51 were prescribed additional intracavitary vault caesium-137. Patients receiving postoperative radiotherapy were analysed according to whether or not they received additional intracavitary vault caesium. The two groups were also analysed for incidence of vaginal vault recurrence and treatment related morbidity.In the group receiving additional intracavitary treatment more patients had Stage II or III disease (P<0.05), and had greater depth of myometrial invasion (P<0.05). Vaginal vault recurrence was not observed in patients receiving intracavitary therapy in addition to external beam therapy. Four patients (10%) receiving external beam therapy alone developed vaginal vault recurrence.The incidence of Kottmeier-Perez grade 2 or 3 bowel toxicity following treatment was significantly higher in those patients receiving combined treatment (18% vs. 2.5%; P<0.03). There was also a higher incidence of vaginal stenosis in the group receiving both external beam and intracavitary therapy (21% vs. 3%; P<0.05). There was only one instance of grade 2 bladder toxicity in the external beam and intracavitary treatment group and none in the external beam therapy alone group.In conclusion, postoperative radiotherapy for Stages I-III endometrial carcinoma was carried out in a non-randomized manner by two regimens; either external beam therapy alone or external beam therapy with additional intracavitary vaginal caesium. The combined therapy gave significantly better local control but resulted in significantly more late bowel and vaginal morbidity.