淋巴结外窦组织细胞增生伴巨大淋巴结病3例

窦组织细胞增生伴巨大淋巴结病（Rosai—Dorfman disease，RDD）是一种病因不明的持续性组织细胞增生性疾病。RDD大多数发生于10～20岁以内的患者，但任何年龄均可发病，还可见同一家族内两个成员发病的情况。RDD大部分发生在淋巴结内，结外受累也有报道，约1/4以上的病例可累及结外组织剐，其结外表现可能是最突出甚至是唯一的表现。笔者收集了3例结外RDD病例作一分析，探讨其病理学和免疫组化特点。     

降结肠破裂误诊误治1例

降结肠破裂多由外伤等多种原因引起，目前自发性降结肠破裂已非常少见，就其解剖结构和内容物特点，临床上易误诊漏诊，笔者曾遇到1例，现报告如下。     

直肠癌局部切除术后保留灌肠化疗的护理干预

目的延长化疗药在直肠内保留的时间，提高化疗效果。方法对288例次（对照组）直肠癌局部切除术后患者用氟尿嘧啶生理盐水作保留灌肠后排便快的原因进行回顾性分析，并针对其不同原因改进护理措施，对108例次（观察组）进行针对性护理干预。结果观察组灌肠后药物保留时间显著长于对照组（P〈0．01）。结论直肠癌局部切除术后局部化疗排便快的原因是多方面的，针对性护理干预有助于延长氟尿嘧啶在直肠内的保留时间。     

浆膜受侵的结直肠癌术后腹腔化疗联合静脉化疗的临床研究

Objective To compare the clinical efficacy of postoperative intraperitoneal chemotherapy combined with systemic chemotherapy to systemic chemotherapy alone for serosa-involved colorectal cancer. Methods According to the criteria of serosa-involving in colorectal cancer, 332 cases were divided into 2 groups prospectively without randomization. Study group (n=166) was treated with intraperitoneal chemotherapy combined with systemic chemotherapy, and control group (n=166) with systemic chemotherapy alone. Incidence of local recurrence, peritoneal metastasis, hepatic metastasis, other distant metastasis and 3-year, 5-year overall survival (OS) rate of two groups were compared. Results 3-year and 5-year OS rates of stage Ⅱ B in study group were similar to those in control group (χ2=0.612,P=0.434). The above rates of stage Ⅲ in study group were higher than those in control group (χ2=3.989,P=0.046). Either the study group or the control group, the 3-year and 5-year OS rates of patients undergone laparoscopic surgery or open surgery were similar (P=0.839, P=0.172). Incidences of local recurrence, peritoneal metastasis and hepatic metastasis in study group were 1.9%, 3.8% and 3.8% respetively, lower than those in control group (8.2%,9.5% and 10.1%,P<0.05). Distant metastasis rate in study group was similar to that in control group. In study group, intraperitoneal chemotherapy regimen with Oxaliplatin had lower rates of peritoneal metastasis and hepatic metastasis as compared to that with Cisplatin (0.9% vs 8.8% ,P=0.019), while the incidences of local recurrence and other distant metastasis were similar. Conclusions Postoperative intraperitoneal chemotherapy combined with systemic chemotherapy improves 3-year and 5-year overall survival rates in patients with stage Ⅲ serosa-involved colorectal cancer, and decreases local recurrence, peritoneal metastasis and liver metastasis rate, especially when intraperitoneal chemotherapy regimen contains Oxaliphtin. Comparing with open surgery, laparoscopic surgery dose not improve 3-year and S-year overall survival rates in patients receiving combined chemotherapy or systemic chemotherapy alone.     

中西医结合加张力带固定治疗踝关节骨折23例

1996年以来我们对收治的踝关节骨折患者 2 3例进行了中西医结合加张力带固定治疗 ,收到了良好的效果。1　临床资料本组 2 3例 ,男 17例 ,女 6例 ,年龄 18～ 4 6例 ,平均年龄 2 8岁 ,按Lauge - -Hansen分类 :S—A型Ⅱ度 11例 ,S—EⅣ度 7例 ,PE型I度 2例 ,Ⅲ度 2例 ,V度 1例。2　手术方法2 .1　手术步骤 :体位 ;仰卧位 ,麻醉 :连续硬膜外麻醉。过程 :大腿扎气囊止血带 ,采用内踝前缘弧形切口 ,即切口起于内踝上方 3cm处 ,沿胫骨前缘下行至内踝下方lcm处弯向后 ,止于内踝后方 ,长约 8cm左右 ,避开大隐静脉 ,依次切开皮肤 ,皮下组织及深筋…     

低位直肠癌的内括约肌切除术:对2cm法则的挑战

R0切除、避免局部复发、保留括约肌功能是直肠癌手术追求的目标,前两者是从根治性角度来说,既往对超低位直肠癌比较注重远切缘。随着直肠癌治疗观念的发展,根治性切除远切缘已由传统的5 cm变为2 cm。但近年来更加强调侧切缘(circumferential margin,CRM)对直肠癌预后的影响。文献[2]回顾性分析686例已行手术的直肠癌患者,     

一层吻合法在直肠癌超低位直肠前切术中的应用

低位直肠癌保肛术已成为患者迫切需要。我院自2000年以来实施直肠癌超低位直肠前切除手术40例，癌肿均位于腹膜返折以下，距肛缘4.5～6cm之间，全部采用全层一层吻合法，术后均取得了满意的效果。现总结如下：     

47例左半结肠癌性梗阻行Ⅰ期肠切除吻合的临床观察

左半结肠癌性梗阻是晚期结肠癌的严重并发症，其手术方式尚有争议。１９９０～１９９６年我院对４７例左半结肠癌性梗阻病人在切除癌肿后行Ⅰ期肠吻合，疗效满意，现报道如下。１资料与方法１１临床资料本组男３１例，女１６例，年龄３１～７５（平均６０３±５２）...     

关于溃疡性结肠炎恶性转化的监测与预防

患有溃疡性结肠炎(Ulcerative Colitis,UC)和克隆氏病的患者发展成为结肠、直肠癌的危险性大大增加.病变范围越大、病程越长、并发原发性硬化性胆管炎和有肠癌家族史的病人是UC病人中恶变危险性最高的.发病年龄轻、炎症反应重也是高危因素之一.减轻结肠炎患者癌变危险的方法包括不典型监测和预防性结肠切除术,但是大部分UC和克隆氏病人不能接受手术预防.尽管很多学者推荐,但是监测并没有减少肠癌的发病率和死亡率.做监测的病理医生很难达成统一意见.病人失访、发现不典型增生后没有及时建议手术治疗等很多因素使监测很难有效发挥作用.为了弥补监测的局限性,现正在评估药物预防和内镜、分子技术能够替代传统监测,或增加传统监测的有效性.