Surgical relevance of diagnostic imaging techniques in pretherapeutic staging of carcinoma of the esophagus, stomach, colon and rectum

Summary. The increasing spectrum of therapeutic options for tumors of the gastrointestinal tract has resulted in a refinement of the pretherapeutic diagnostic strategies. The diagnostic approach in surgical institutions that are focused on primary surgical resection will therefore be much less sophisticated than in institutions who propose a selective therapeutic approach based on the pretherapeutic tumor stage and prognostic parameters. Pretherapeutic assessment of the depth of tumor infiltration, i. e. the T-category, is essential because most further diagnostic and therapeutic decisions are based on this information. This can today be achieved with a high degree of accuracy by endoscopy and endoscopic ultrasonography. Early T-stages (T1–2) are usually an indication for primary surgical resection and, after exclusion of distant metastases, no further diagnostic studies are required. In patients with locally advanced esophageal, gastric or rectum tumors (T3–4) multimodal therapeutic concepts should be considered. This usually requires additional diagnostic studies. None of the available diagnostic imaging modalities today allows satisfactory pretherapeutic assessment of lymph node metastases. The assumed nodular status should therefore currently not influence therapeutic decisions. Essential is, however, the assessment of distant metastases, since the documentation of distant tumor spread will change the therapeutic approach to a palliative situation. Detailed histologic and molecular-biologic assessment of tumor characteristics is growing in importance. This not only provides therapeutically relevant information regarding tumor grading, but opens the door towards a modern molecular diagnostic approach. It can be expected that in the near future a vast amount of relevant prognostic information can be obtained from endoscopic tumor biopsies, which may soon alter our therapeutic concepts.      

Surgical metabolism

Summary. Trauma, operative interventions, infection and other disturbances of homeostasis lead to a uniform reaction of the body, namely release and activation of hormones and cytokines. Profound alterations of substrate flow result, with mobilization of energy stores and degradation of structural and functional proteins of vital organs like the gut mucosa. Due to these reactions the energy demands of the organs are met and energy-consuming synthesis of substrates is indicated. Clinically, hypermetabolism, hyperglycemia, lipolysis and increased urea production with negative nitrogen balance can be observed. The metabolic reactivity is reached by an increased substrate cycling. To avoid negative consequences such as organ dysfunction, a rational situation-adapted substrate supply is warranted as well as reduction of catabolic stimuli and stimulation of anabolic factors. The metabolic care of the surgical patient is still a basic and important task.      

胃肠道肿瘤病人围手术期细胞因子及蛋白质代谢的变化

目的 :探讨胃肠道肿瘤病人手术后肿瘤坏死因子 α (TNF α)、白介素 6 (IL 6 )、白介素 10 (IL 10 )的变化以及与蛋白质代谢的关系。　方法 :用酶联免疫法 (ELISA)检测 19例胃肠道肿瘤根治术病人术前和术后 1、3、5天血清TNF α、IL 6和IL 10水平 ,同时检测蛋白质分解代谢相关指标、2 4h尿中尿素和肌酐排泄量。　结果 :胃肠道肿瘤根治术后病人TNF α呈下降趋势 ,术后第 1天较术前明显下降 (P <0 .0 5 )。IL 6和IL 10术后升高 (P <0 .0 1) ,尤以术后第 1天升高明显。术后 2 4h尿中尿素和肌酐排泄量明显升高。　结论 :胃肠道肿瘤根治术后病人IL 6和IL 10的升高支持手术应激导致的细胞因子释放变化 ,但TNF α呈下降趋势 ,可能与胃肠道肿瘤病人术前TNF α的高表达有关。术后蛋白质分解代谢增加 ,可能与细胞因子IL 6和IL 10的升高有关。     

手术联合中药治疗激素性股骨头缺血性坏死的实验研究

目的 :初步探讨激素性股骨头缺血性坏死的发病机制 ,观察手术 +中药治疗本病的疗效。方法 :通过对新西兰大白兔联合应用马血清 +甲基强的松龙造模及手术处理 ,对正常组、模型组、手术组、手术 +中药组实验兔的血脂、血液流变学、血生化及股骨头标本切片观察 ,分析比较。结果 :手术 +中药治疗本病的疗效优于单纯保髋手术。结论 :手术 +活血化瘀补肾壮骨方法是股骨头缺血性坏死治疗的合理方法     

A review of 2975 consecutive operations by one surgeon in an accredited outpatient plastic surgicentre: A Canadian experience

The present paper constitutes a retrospective review of 2975 consecutive operations performed by the author, one of the three owners of the Saskatoon Plastic Surgicentre. The unit opened in 1987; therefore, the study spans 17 years. Patients are not kept overnight, and the Surgicentre is approved and equipped as a level C facility for general anesthesia. Only patients who score 1 or 2 according to the American Association of Anesthesiologists are treated. Only certified anesthesiologists are used. Of the patients with postoperative complications, only two required transfer to a hospital. One developed a pneumothorax, which was treated on arrival at the intensive care unit with no sequelae. The other collapsed following facelift surgery. She was transferred to University of Saskatchewan hospital and died later that evening with a massive pulmonary embolus. In a properly established outpatient centre, a large number of patients can be safely treated with very few complications. However, despite placing patient safety as the first consideration and adhering strictly to the highest standards, death can occur.     

二尖瓣球囊扩张术并发心脏压塞1例的抢救与护理

目的:报告二尖瓣球囊扩张术(PBMV术)并发心脏压塞的抢救与护理.方法:主要从患者的术前准备、术中抢救与配合、术后护理介绍.结果:准备充分,抢救及时,护理得当,患者病情稳定后转心脏外科手术治疗.结论:二尖瓣球囊扩张风险大,心脏压塞是最危险、最常见的并发症之一,故加强术前准备,密切术中配合,及时抢救尤为重要.     

硬膜外腔阻滞对胸部手术应激反应的影响

目的 观察硬膜外腔阻滞对胸部手术应激激素和细胞因子的影响。方法20例食管癌手术病人,随机分为两组,每组10例,即全麻复令硬膜外腔阻滞(GEA)组和全麻(GA)组,分别测定麻醉诱导前、手术2h、手术4h、术毕、术后1d及术后3d的血浆去甲肾上腺素、肾上腺素、血清促肾上腺皮质激素(ACTH)、皮质醇、C-反应蛋白、IL-6及IL-10的水平。结果 血浆去甲肾上腺素和血清皮质醇GEA组术中术后无显著改变,但GA组术毕和术后1d显著升高(P<0.05),术后3d恢复至术前水平,组间比较前者有显著差异(P<0.05)。两组血浆肾上腺素、IL-10术中术后均无显著变化。两组血清ACTH、IL-6及CRP术中术后均显著升高(P<0.05),组间比较无显著差异。结论 硬膜外腔阻滞可以减轻胸部手术的应激反应。IL-6是较CRP更灵敏的反映组织损伤的炎性指标。     

腹式全子宫切除术不同术式对排便功能影响的探讨

目的:探讨筋膜内和筋膜外全子宫切除术对女性排便功能的影响。方法:76例全子宫切除患者分为筋膜外全切除组(A组)56例,筋膜内全子宫切除组(B组)20例,对两组术后病人的排便次数,难易程度的变化进行分析。结果:76例全子宫切除病人42.1％出现不同程度排便困难,A组52.62%,B组为10%,两组具有显著性差异(P<0.05)。结论:全子宫切除术后可影响女性排便功能,筋膜内全子宫切除术对排便功能影响小,是一种较好手术方式。     

胫后动脉内踝上皮支皮瓣的临床应用

目的　探讨一种修复足踝部软组织缺损的有效方法。　方法　从 1999年 2月～ 2 0 0 2年6月 ,采用胫后动脉内踝上皮支血管为蒂的逆行岛状小腿内侧皮瓣修复足跟后部软组织缺损 2例、内踝部软组织缺损 2例以及踝前与足背软组织缺损 4例。　结果　临床应用 8例 ,皮瓣面积最小为 7cm×5cm ,最大 2 2cm× 7cm ,术后 8例皮瓣全部成活 ,随访 3～ 2 4个月 ,皮瓣感觉恢复 ,质地良好 ,外形不臃肿。　结论　胫后动脉内踝上皮支皮瓣血运可靠 ,手术切取简便安全 ,皮瓣厚薄适中 ,质地好 ,不牺牲胫后血管 ,是一种修复足踝部软组织缺损较好方法。