低功率电切治疗膀胱肿瘤疗效观察

目的 探讨经尿道膀胱肿瘤低功率电切术的适应症、手术方法及其疗效评估. 方法分析65例经尿道膀胱肿瘤切除术.手术时间10～90 min,平均时间41 min;膀胱穿孔1例,术后冲洗时间1～3 d,平均2 d;导尿管留置时间1～5 d,平均4 d.结果 随访0.5～3 a,48例中肿瘤复发15例,其中原位复发2例,异位多位复发13例.结论 经尿道膀胱肿瘤低功率电切可防止并明显减少闭孔神经反射的发生,具有操作简单,损伤小,出血少、恢复快等优点.     

吻合器痔上黏膜环切治疗直肠内脱垂的效果

①目的探讨直肠内脱垂的有效治疗方法。②方法对11例直肠内脱垂的病人行吻合器痔上黏膜环切术(PPH)，术后随访1～12个月。③结果全部病人术后均排便通畅，排便时间明显缩短，无明显手术并发症。④结论PPH治疗直肠内脱垂，手术操作简便、安全、疗效可靠，病人痛苦小、恢复快、并发症少，是一种值得推广的治疗方法。     

经肝裸区腔房转流术治疗布加氏综合征

本文报告2例布加氏综合征经肝裸区腔房转流术.2例均为Hirooka Ib型,术毕测下腔静脉压力,分别由术前2.75kPa和3.73kPa降至1.67kPa和1.87kPa.术后症状体征迅速消失.随访50和24个月效果良好,说明满意的压力降低是手术成功的重要标准.Hirooka Ia,Ib,Ic及Ⅳ型首选本术式的优点是:①移植人工血管短,通畅率高;②不易受压;③符合正常血液动力学;④只一个切口,创伤较小.     

早期胃癌的诊治(附15例临床分析)

目的：总结15例早期胃癌临床特点，诊治经验，探讨治疗新进展。方法：对15例早期胃癌诊治进行回顾性总结。结果：早期误诊率达66．7％，15例手术，术后存活5年以上13例（86．7％）。结论：早期胃癌缺乏特异症状，早期误诊率高，内镜下平坦型胃癌最易误诊，作认为D2术应为根治EGC的标准术式，内镜下粘膜切除术（EMR），保留迷走神经胃段切除术有利于保护患术后生存质量。     

Resection of pulmonary metastases following chemotherapy for high stage testicular tumors

BACKGROUND: Our objective was to analyze retrospectively our experience with 19 patients who had metastatic germ cell testicular tumor and had undergone resection of pulmonary metastases following chemotherapy. We wished to determine the necessity of thoracic surgery on these patients. METHODS: Of 103 patients in need of postchemotherapeutic surgery for metastatic germ cell testicular tumors, 19 patients (mean age 31) underwent surgery for thoracic masses following cis-platin based chemotherapy. Resection of pulmonary metastases was performed on patients with normal tumor markers after chemotherapy, who did not achieve complete radiological remission. Histopathological findings, correlation with the pathology of abdominal surgery and probable prognostic factors for disease-free and overall survivals were evaluated. RESULTS: Disease-free and overall survival rates were 14/19 (73%) and 16/19 (84%), respectively, within a median follow-up time of 30 months (15-212 months). Patients with and without viable tumor cells in their thoracic histopathological specimen had 40% and 85% disease-free survival rates, respectively (P < 0.05). Eight patients had both abdominal and thoracic postchemotherapy surgery. Only two (25%) of these patients had the same histopathological features at both sites. CONCLUSIONS: All patients with residual thoracic masses must be considered candidates for surgery, because there are no predictive factors to determine the thoracic pathology without surgery. With the resection of the pulmonary metastases only, surgery can be performed without significant morbidity and is essential to select patients for further chemotherapy, to remove all visible masses and to provide histopathological confirmation. Patients with viable tumor cells in the thoracic surgical specimen have a poor prognosis.     

Evaluation of an aortic stent graft for use in surgery on esophageal cancer involving the thoracic aorta

Objective: The purpose of this experimental study was to investigate whether aortic stent grafting can be applied to the treatment of an esophageal cancer involving the thoracic aorta. Methods: The canine thoracic aorta was partially resected without aorta being clamped after emplacement of an endovascular stent graft. Study I; The aortic whole layer of 1 cm in length and 1/4 of the circumference was resected and was covered by a free fascia patch of the abdominal rectal muscle immediately after stent graft placement. Study II; The aortic adventitia and the outer half of the media of the same size was resected on day 3, 7,14, 21, and on day 28, after the stent graft placement. The resected portion was covered by the free fascia patch in half experimental dogs, and was uncovered in the others. Study III; The aortic adventitia and the outer half of the media of 1 cm in length and 1/2 of the circumference was resected and was uncovered on day 7 after stent graft placement. Histological examinations were performed on day 28 and at one year after aortic resection. Results: The aortic wall could be resected in all cases with no complication, except in resection of 1/2 the circumference where the aorta had become narrow. There was no difference in healing of the resected portion of the aorta between with and without fascia covering. Conclusion: An aortic endovascular stent graft could be applied to surgery for an esophageal cancer involving the aorta.     

胆囊鳞癌6例报告

目的：探讨胆囊鳞癌的发病情况、特点、诊断、治疗、预后及预防。方法：结合有关文献复习分析6例胆囊鳞癌的病例。结果：5例行手术治疗，术后两月内死亡3例，另两例至今存活，分别为术后8个月，3个月。1例行B超引导穿刺活检，入院后两周死亡。结论：胆囊鳞癌早期无特异症状，诊断时多已属晚期，手术效果较差。早期诊断、根治性手术有助于胆囊鳞癌的预后。     

Clinical studies on the transabdominal resection of esophagocardial cancer and cervical anastomosis using bypass methods. Analysis of data on 76 patients

Transabdominal resection for esophagocardial cancer and reestablishment of alimentary continuity using bypass methods were performed in 76 patients. Thirteen underwent a bypass with a gastric tube and in 30, a colonic segment was prepared. In the remaining 33, a jejunal segment was used as a bypass organ, with considerable success. The 5 year survival rates were 68.8 per cent in those with stages (I+II), 16.5 per cent in those with stage III, 12.6 per cent in those with stage IV and 22.5 per cent in all cases, indicating similar results compared to those with cancer located in the upper third of the stomach with the limited proximal extension within the esophagocardial junction and operated on during the same period.     

经尿道电切术的内毒素血症

１９９３年１－８月测定４３例经尿道电切术患者术前、术中血内毒素浓度变化，探讨ＴＵＲ内毒素血症与临床意义。患者男性３９例，女性４例。其中良性前列腺增生１７例，ＢＴＣＣ１９例，膀胱颈口梗塞７例，年龄１７－７５岁，平均５７．１岁。随机选择分为两组，Ⅰ组２１例，仅口服抗生素；Ⅱ组２２例，静脉滴注先锋霉素Ⅵ２ｇ后方实施ＴＵＲ。