结直肠癌是全球癌症特异性死亡率的第四大主要原因[1].1991年首次报道了用于结肠癌的腹腔镜辅助结肠癌手术,随后该技术被广泛用于结直肠癌根治术中.与开腹手术相比,腹腔镜辅助结直肠癌手术具有并发症发生率低、术后恢复快、术中损伤少等优点[2],但研究显示,腹腔镜辅助结直肠癌手术仍存在一定的并发症发生风险,如肠梗阻、感染、吻合口瘘等,严重影响患者术后恢复和生活质量[3].快速康复外科(enhanced recovery aftersurgery,ERAS)理念目前已在其他外科手术中普遍开展[4],对于结直肠癌患者,其与腹腔镜联合的应用效果仍然存在疑问.因此本研究了解ERAS联合腹腔镜对结直肠癌患者并发症影响,为临床治疗结直肠癌提供依据.报告如下.

随着微创外科的迅速发展,腹腔镜结直肠癌根治术(LCS)以其创伤小、患者痛苦小、恢复速度快等优点受到患者的信赖;但其操作复杂,手术技巧要求较高,且远期疗效一直存在争议[1].

目的 比较不同保肛手术治疗直肠癌的临床疗效.方法 选取2014年5月—2015年4月我院收治的直肠癌患者48例,根据手术方式的不同分为观察组与对照组.观察组采取经内外括约肌间切除术(ISR)治疗,对照组采取经腹直肠癌切除术(Dixon)治疗.比较2组患者术后正常排便恢复时间、生活质量评分并及复发情况.结果 2组患者术后都恢复良好的自主排便功能,观察组患者术后恢复正常排便时间(30.1±1.2)d,显著短于对照组的(120.5±1.3)d,差异有统计学意义(P<0.05).观察组患者术后生活质量评分(37.5±2.5)分,明显高于对照组的(26.8±2.3)分,差异有统计学意义(P<0.05).观察组术后复发率(8.33%)明显低于对照组(54.17%),差异有统计学意义(P<0.05).结论 保肛手术是治疗直肠癌的有效方式,应根据患者实际情况选择相应术式.经内外括约肌间切除术临床疗效显著,能有效改善患者生存质量,值得推广应用.

Objective:It is discussion and analysis of colorectal cancer surgery.Method:It is retrospective analysis in January 2003～December 2007 during the 100 cases of colorectal cancer patients with the implementation of total mesorectal excision(TME) of the clinical data.Results:All of 100 cases were the successful completion,no deaths.43 cases were given postoperative chemotherapy, chemotherapy before and after the implementation of adjuvant therapy in Chinese medicine.Postoperative follow-up of 6～30 months,follow-up of 94 cases(94%) patients were alive 3 months after the transfer of perineal example 1,6～15 months after intraperitoneal transfer of three cases of extensive.Conclusion:Implementation of colorectal cancer in patients with total mesorectal excision(TME) surgery can achieve radical resection of tumor security purpose,the recent results were satisfactory.

Objective To analyse the theraputic effect of Primary Incision plus Radical Operation in Perianal abscess.Methods Primary incision plus radical operation was applied in treatment in 100 cases of perianal abscess,and makes the review summary to it.Result After This surgical methord the wound after the flushing,the sitz bath,trades the medicine,the complete cure,follow-up was 0.5 ~3 years which no relapse,and incontinence,and anal deformity was found and anal function was normal.Conclusion This surgical methord has the incision,the drainage synchronization carries on,the patient pain is light,the treatment course is short,and it does not have the recrudescence,or affect the anus function.

<正>陈旧性肛裂是一种以远端肛管排粪后疼痛和便血为主要症状的肛管疾患,主要发生在肛管正中线,也有少数发生在前正中线。在裂口远端及基底部有内括约肌纤维的增生。陈旧性肛裂不经治疗不会自愈。从2003年以来,我院肛肠科采用肛裂切开加后正中位挂线术一次性治疗陈旧性肛裂150例,取得满意疗效,现报告如下。1临床资料

目的观察锡类散复方制剂治疗溃疡性结肠炎的临床疗效。方法选择有临床表现并经电子肠镜检查诊断为溃疡性结肠炎病人90例,随机分为两组,治疗组(60例)用锡类散10 g加2%利多卡因注射液20 ml加0.2%甲硝唑注射液250 ml混合液,抽取50 ml,加温至37℃,每晚8时保留灌肠2小时以上。对照组(30例)用庆大霉素注射液16万U加地塞米松注射液10mg加0.9%氯化钠注射液250ml混合液,抽取50 ml,加温至37℃,每晚8时保留灌肠2小时以上,两组疗程均为1个月。观察两组临床症状、远期疗效变化。结果锡类散复方制剂比庆大霉素注射液加地塞米松注射液能明显缓解临床症状,促进溃疡愈合,且不易复发,两组相比总效率分别为96.67%和73.33%(P<0.01)。结论锡类散复方制剂对溃疡性结肠炎病人具有改善症状,促进黏膜溃疡愈合,治愈后不易复发的作用。