局部麻醉下无张力疝修补术治疗老年人腹股沟疝56例临床分析

腹股沟疝是一种外科常见病,尤其以老年人多见.手术是目前治愈腹股沟疝的唯一方法.传统的疝修补术复发率高,术后并发症多.近年来开展的无张力疝修补术,因其符合人体解剖结构和生理功能,具有创伤小、恢复快、复发率低等优点而被迅速推广普及.     

外科手术治疗分化型甲状腺癌的疗效分析

目的：分析分化型甲状腺癌患者的手术方式、生存率及并发症。方法：回顾性分析已确诊为分化型甲状腺癌的80例患者的病例,探讨手术方式,比较初次和再次手术的疗效及并发症情况。结果：80例所有纳入样本的80例患者均得到随访,随访时间1～12年,期间3例患者死亡。首次和二次手术的患者5年及10年生存率、并发症发生率比较,均无差异统计学意义。结论：对于分化型甲状腺癌,只要术式选择恰当,可降低并发症发生率,并且对于初次和再次手术的患者无明显差异,预后均良好。     

直肠神经内分泌肿瘤的临床病理特点分析

Objective To analyze the clinicopathological characteristics of rectal neuroendocrine tumors (NETs) so as to improve their understanding and diagnosis. Methods The data of 62 rectal NETs patients were retrospectively analyzed to summarize their clinical characteristics. They were categorized into 3 types based on the level of histological differentiation. And the relationship of tumor size, histological type and metastases was examined. Results The clinical presentations of rectal NETs were atypical. The main clinical presentation was change in bowel habit (n = 43, 69.4%); Ten cases (16.1%) were asymptomatic. Nine cases were found during routine digital rectal examination. In 57 cases (91.9% ), the distance was within 8cm from anorectal line. All patients had single lesion without the presence of carcinoid syndrome. 25.8% ( 16/62 ) had colonic polyps while 16. 1% ( 10/62 ) synchronous colorectal adenocarcinomas. Except for synchronous colorectal adenocarcinomas (n = 10) , among 52 cases, there were 39 cases with tumor diameter ＜ 1 cm, the main type was type Ⅰ; 7 cases with tumor diameter ＞2 cm, the main types were types Ⅱ and Ⅲ. The metastatic rates in three groups with tumor diameter ＜ 1 cm, 1-2 cm and ＞2 cm were 0, 33.3% and 71.4% respectively. Conclusion The clinical presentations of rectal NETs are non-specific. Most cases are often single lesion without the presence of carcinoid syndrome. The clinical process and prognosis of rectal NETs are closely related to tumor size, histological type, the presence of lymph node metastases and liver metastases. The routine digital rectal examination is the simplest and most effectively way of diagnosing rectal NETs. Colonoscopy is important in diagnosing the synchronous cancers and conducting a follow-up.     

消化道前肠神经内分泌肿瘤的临床特点分析

目的分析消化道前肠神经内分泌肿瘤(NET)的临床和病理特点,以提高对该类疾病的认识与诊治水平。方法对40例消化道前肠NET病人的资料进行回顾性分析,总结其临床特点。结果 40例NET病人中,胃NET25例(62.5%),十二指肠NET11例(27.5%),壶腹NET4例(10.0%)。胃、十二指肠和壶腹NET的男女比例分别为1∶1.5、1.2∶1和3∶1。90.9%的十二指肠NET位于球部和降部。胃和十二指肠NET临床表现以腹痛为最多见,分别为40.4%和45.5%;病理类型以Ⅰ型为主,分别为68.0%和63.6%,肿瘤直径<2cm时很少发生转移。壶腹NET主要表现为黄疸(75.0%),以Ⅱ型为主,占75.0%,直径<2cm即可发生转移。胃、十二指肠和壶腹NET发生转移率分别为16.0%、27.3%、75.0%。结论消化道前肠NET以胃NET为最多见。胃NET以女性为主,而十二指肠和壶腹NET男性多见。十二指肠NET好发于球部和降部。胃和十二指肠NET以上腹痛为最多见,组织学类型以Ⅰ型为主。壶腹NET主要临床表现为黄疸,以Ⅱ型为主。胃和十二指肠NET直径<2cm较少转移,而壶腹NET有转移的倾向,其肿瘤大小与转移潜能无关。     

腹部淋巴管瘤5例分析

目的总结腹部淋巴管瘤的诊断与治疗经验。方法对我院自1999年-2008年间收治的5例腹部淋巴管瘤临床资料进行分析。结果5例患者首发症状多以腹部肿块及消化功能障碍为主。5例均行手术治疗。结论腹部淋巴管瘤术前确诊困难，手术切除是目前治疗的理想方法。     

踝管综合征的解剖与临床研究现状

踝管综合征是1932年首先由PolloCK和Davis提出来,此后在国内外文献中有不少记载,但所用的名称、内容描写不完全相同.现就作者所列文献,从解剖学名词、内容结构、病因、病理变化、临床表现、诊断和治疗问题进行综述.     

新生儿上消化道出血、穿孔1例

病例：患儿，男，阴道分娩（分娩时脐绕颈，Ａｐｇａｒ评分为６—８分）。出生后第１天出现呕血、黑便，在当地医院进行治疗，出生后第３天呕血停止，第６天黑便消失，出现腹部膨隆，且肛门停止排便、排气。体格检查：体温：3６．７ ℃；脉搏：１７０次／ｍｉｎ；呼吸：３０次／ｍｉｎ。腹部明显膨胀，腹肌紧张，肝、脾触诊不满意，叩诊呈鼓音。移动性浊音阴性，肠鸣音消失。 辅助检查：白细胞：１．４０ × １０９／Ｌ；中性粒细胞：4７．８％；红细胞：３．８９ × １０１２／Ｌ；血红蛋白：１３０ ｇ／Ｌ。胸腹透视示：腹部大量积气，结…     

8例胰腺损伤的诊治体会

目的:讨论胰腺损伤的临床诊断与外科治疗方法。方法:回顾我院1995年至2004年8例胰腺损伤术前诊断、手术方法和术后治疗。结果:8例中Ⅰ级、Ⅱ级损伤3例,Ⅲ级损伤3例,Ⅳ级损伤1例,Ⅴ级损伤1例。Ⅰ、Ⅱ级损伤行胰腺局部清创、止血、修补、引流,Ⅱ级以上损伤分别行胰体尾切除术,近端缝扎,远端行空肠Roux-y吻合术,胰十二指肠切除术。结论:胰腺损伤无特异性症状及体征。术前诊断困难,凡上腹部严重损伤都要考虑胰腺损伤可能。掌握剖腹指征,仔细探查,并根据不同损伤情况采取恰当术式,早诊断、早治疗,正确围手术期处理和积极防治并发症是提高治愈率,降低死亡率的关键。     

直肠神经内分泌肿瘤的临床病理特点分析

Objective To analyze the clinicopathological characteristics of rectal neuroendocrine tumors (NETs) so as to improve their understanding and diagnosis. Methods The data of 62 rectal NETs patients were retrospectively analyzed to summarize their clinical characteristics. They were categorized into 3 types based on the level of histological differentiation. And the relationship of tumor size, histological type and metastases was examined. Results The clinical presentations of rectal NETs were atypical. The main clinical presentation was change in bowel habit (n = 43, 69.4%); Ten cases (16.1%) were asymptomatic. Nine cases were found during routine digital rectal examination. In 57 cases (91.9% ), the distance was within 8cm from anorectal line. All patients had single lesion without the presence of carcinoid syndrome. 25.8% ( 16/62 ) had colonic polyps while 16. 1% ( 10/62 ) synchronous colorectal adenocarcinomas. Except for synchronous colorectal adenocarcinomas (n = 10) , among 52 cases, there were 39 cases with tumor diameter ＜ 1 cm, the main type was type Ⅰ; 7 cases with tumor diameter ＞2 cm, the main types were types Ⅱ and Ⅲ. The metastatic rates in three groups with tumor diameter ＜ 1 cm, 1-2 cm and ＞2 cm were 0, 33.3% and 71.4% respectively. Conclusion The clinical presentations of rectal NETs are non-specific. Most cases are often single lesion without the presence of carcinoid syndrome. The clinical process and prognosis of rectal NETs are closely related to tumor size, histological type, the presence of lymph node metastases and liver metastases. The routine digital rectal examination is the simplest and most effectively way of diagnosing rectal NETs. Colonoscopy is important in diagnosing the synchronous cancers and conducting a follow-up.