腹腔镜胆囊切除术后近期再手术18例分析

目的 探讨腹腔镜胆囊切除术严重并发症的防治。方法 回顾性研究我院1993年以来腹腔镜胆囊切除术后近期再次手术病例18例。结果 肝外胆管损伤、胆囊管残端漏、腹腔内残余感染、胆总管残留结石、出血是最常见并发症，18例患者经再次手术均治愈出院。结论 术前严格选择适应证、术中精细操作是减少腹腔镜胆囊切除术并发症的前提，术后严密观察病情，准确把握再次手术指征及时机是避免后遗症的关键。     

复发性胃癌再手术36例临床分析

目的探讨胃癌术后复发因素,再手术的适应证及手术方式.方法回顾性分析胃癌术后复发再手术治疗36例,对手术适应证、手术方式、术后并发症、病死率及术后病理结果进行分析.结果术后生存5年以上7例,3年以上6例,2年以上4例,1年以上6例,1年内死亡者9例,单纯探查者4例分别于3～6个月死亡.结论对胃癌术后复发者,再手术能否切除病灶主要取决于复发方式,凡证实吻合口或残胃复发者,即使侵及邻近脏器,无远处转移,且心肺功能可以耐受手术者,均应再次手术.     

腹膜后软组织肉瘤复发的再手术治疗：附25例报告

目的 探讨复发性腹膜后软组织肉瘤的诊断和再手术治疗.方法 回顾性分析收治的手术后复发并再次手术的25例复发性腹膜后软组织肉瘤的临床资料.结果 25例复发性腹膜后软组织肉瘤均经手术及病理证实,因多次复发(1～5次,平均1.68次/例),共行手术42次,包括完整切除26次,部分切除11次,探查活检5次.手术中联合脏器切除共19例,合并大血管切除共5例.末次术后1,3,5年生存率分别是52.0%,40.0%,28.0%.累及重要血管的肿瘤的完整切除率(35.7%)比未累及重要血管(75.0%)者明显降低(P=0.013),而肿瘤是否累及临近脏器对手术完整切除率没有影响(P=0.462).结论 影像学检查对术前评估和手术切除范围有重要意义.对于复发性腹膜后软组织肉瘤,只要无明显手术禁忌,就应积极予以手术切除.     

平片无张力疝修补术后再手术16例

目的探讨平片无张力疝修补术后疝复发或感染的原因及预防策略。方法分析本院2002年3月～2011年10月收治的平片无张力疝修补术后再手术的16例患者疝复发或感染的原因。结果平片无张力疝修补术后复发主要是再造内环口过大8例,补片过小5例;手术发现补片固定线为不吸收编织线,线结粗大3例,可能是导致感染的原因之一。结论为避免无张力腹股沟疝修补术后复发或感染,手术医生要充分理解无张力疝修补术的原理,提高手术技术水平,采取多种措施预防补片术后感染。     

Short term outcomes associated with patients requiring blood transfusion following elective laminectomy and fusion for lumbar stenosis: A propensity-matched analysis

Perioperative blood transfusion has been associated with poor outcomes but the impacts of transfusion after fusion for lumbar stenosis have not been well-described. We assessed this effect in a large cohort of patients from 2012 to 2018 in the National Surgical Quality Improvement Program (NSQIP). We evaluated baseline characteristics including demographics, comorbidities, hematocrit, and operative characteristics. We generated propensity scores using baseline characteristics and patients were matched to approximate randomization. We assessed odds of 30-day outcomes including prolonged length-of-stay (LOS), complications, discharge to facility, readmission, reoperation, and death using logistic regression. We identified 16,329 eligible patients who underwent lumbar fusion for stenosis; 1,926 (11.8%) received a transfusion. Before matching, there were multiple differences in baseline covariates including age, gender, BMI, ASA class, medical comorbidities, hematocrit, coagulation indices, platelets, operative time, fusion technique, number of levels fused, and osteotomy. However, after matching, no significant differences remained. In the matched cohorts, transfusion was associated with increased prolonged LOS (OR 1.66, 95% CI 1.45–1.91, p < 0.001), minor complication (OR 1.60, 95% CI 1.20–2.12, p = 0.001), major complication (OR 1.51, 95% CI 1.16–1.98, p = 0.003), any complication (OR 1.54, 95% CI 1.24–1.92, p < 0.001), discharge to facility (OR 1.70, 95% CI 1.48–1.95, p < 0.001), 30-day readmission (OR 1.56, 95% CI 1.23–1.99, p < 0.001), and 30-day reoperation (OR 1.85, 95% CI 1.35–2.53, p < 0.001). Although transfusion is performed based on perceived clinical need, this study contributes to growing evidence that it is important to balance the risks of perioperative blood transfusion with its benefits.     

胆道结石再手术31例治疗分析

目的对胆道结石再手术发生的原因、治疗方式及疗效进行临床分析,以期避免或减少胆道残留结石的发生并提高疗效。方法总结2008年以来本院普外科收治的各类胆道结石患者术后再次胆道手术病例31例,从胆道结石手术后再次手术的原因、处理方法及治疗效果等方面进行分析。结果30例术后无并发症,痊愈出院;1例术后并发胆道感染经抗炎对症治疗后出院。结论胆道再手术主要原因是胆道残余结石,并与结石的部位、胆道的病理改变、手术方式的选择、手术的合理操作、术者的经验、探查指征的掌握、患者的全身情况等多种因素有关。其中,多次胆道再手术的原因则以胆管和胆肠吻合口狭窄为主。胆道再手术以清除结石、纠正胆管狭窄和建立通畅引流为原则。     

The survival impact of the choice of surgical procedure after ipsilateral breast cancer recurrence

BACKGROUND: Many women with breast cancer recurrence previously treated with breast-conservation therapy desire repeat lumpectomies. We hypothesized that women undergoing mastectomy for breast cancer recurrence would show superior survival. METHODS: Patients who previously received breast-conservation therapy diagnosed with an ipsilateral breast cancer recurrence between 1988 and 2004 were identified using the Surveillance, Epidemiology, and End Results database. Univariate survival analysis was performed using the Kaplan-Meier method. Cox regression was used for multivariate analysis. RESULTS: Criteria for analysis were met in 747 patients. Of those, 24% underwent lumpectomy. On univariate analysis, patients undergoing lumpectomy had worse overall survival (P = .03). Five-year survival was 67% versus 78% for the lumpectomy and mastectomy groups, respectively. On multivariate analysis, mastectomy remained significantly associated with better survival with a hazard ratio of .5 (P = .003). CONCLUSIONS: The use of lumpectomy for ipsilateral breast cancer recurrence previously treated with breast-conservation therapy should generally be discouraged.     

Whipple术后近期再手术33例临床分析

目的通过对Whipple手术后近期再手术病例的临床分析,研究Whipple手术的严重并发症及相关预防措施。方法回顾性总结355例Whipple手术后近期再手术的33例资料,分析再手术原因、诊断及处理方式。结果再手术33例中,腹腔大出血8例,上消化道大出血4例,胰漏4例,膈下脓肿5例,腹腔广泛感染4例,肠梗阻4例,胆肠吻合口狭窄1例,胃排空障碍1例,切口裂开2例。予相应处理后6例死亡,余痊愈。再手术死亡率18.18%。结论加强围手术期管理,预防和减少并发症,合理掌握再手术指征是提高Whipple手术疗效的关键。     

腹腔镜胆囊切除术后再手术的原因及防治对策

目的 探讨腹腔镜胆囊切除术（LC）后再手术的原因、预防及处理对策。方法对我院2003年3月至2008年10月收治的27例LC术后因不同原因再手术病人的临床资料进行回顾性分析。结果27例中手术技术相关性并发症再手术者19例,漏误诊8例,全组病例均一次性完成相应手术,术后恢复顺利,治愈出院。结论减少LC术后再手术的关键是掌握好LC的适应证,严格的术前检查,术中精细操作,适时中转开腹,合理放置引流管。手术后出现并发症及时再手术处理可取得良好效果。