Background: The tumor microenvironment (TME) is increasingly recognized as a key player in colorectal cancer biology, however, its potential for improving diagnosis, prognosis, and treatment remains unclear. The major aim of this study is to explore the prognostic value of TME related gene in colorectal cancer. Method: Expression matrices and clinical data of colorectal cancer obtained from public databases were divided into TME relevant clusters according to immune characterization. A 11-gene molecular classifier was constructed based on differentially expressed genes between TME clusters and machine learning regression processes. Results: The efficacy and effectiveness of TME based prognostic signature (TPS) were examined in both the training and validation groups. The result indicated that TPS was able to serve as a superior prognosis indicator for colorectal cancer, alone or jointly with other clinical factors. Also, the study demonstrated that high risk colorectal cancer defined by TPS was considered to link with elevated immune infiltration, increased tumor mutation, and worse overall prognosis. Finally, potential therapeutic agents specialized for different risk subgroups of TPS was also identified to improve personalized treatment for colorectal cancer in the future. Conclusions: TPS might be a novel tool to improve the prognosis judgement and personalized treatment of the colorectal cancer in the future.

BACKGROUND:Severe acute pancreatitis (SAP) has high mortality. Early identification of high-risk factors that may progress to SAP and active intervention measures may improve the prognosis of SAP patients. OBJECTIVE:Clinical data within 24 h after admission were retrospectively analyzed to provide an evidence for early screening of high-risk factors in patients with SAP. METHODS:A review of clinical data of acute pancreatitis patients from January 1, 2018, to December 31, 2022, was conducted. We compared the clinical data of SAP and non-SAP patients, and a multivariable logistic regression model was used to identify the independent predictors of SAP. The receiver operating characteristic (ROC) curve of SAP was drawn for continuous numerical variables to calculate the optimal clinical cutoff value of each variable, and the predictive value of each variable was compared by the area under the ROC curve. RESULTS:Based on the multivariate logistic regression analysis of Age (odds ratio (OR), 1.032;95% confident interval (CI),1.018-1.046, p < 0.001), body mass index (BMI) (OR, 1.181; 95% CI,1.083-1.288, p < 0.001), Non-HTGAP (nonhypertriglyceridemic acute pancreatitis) (OR, 2.098; 95% CI,1.276-3.45, p = 0.003), white blood cell count (WBC) (OR,1.072; 95% CI,1.034-1.111, p < 0.001), procalcitonin (PCT) (OR, 1.060; 95% CI, 1.027-1.095, p < 0.001), serum calcium (Ca) (OR,0.121; 95% CI, 0.050-0.292, p < 0.001), computed tomography severity index (CTSI) ≥4 (OR,12.942;95% CI,7.267-23.049, p < 0.001) were identified as independent risk factors for SAP. The area under the ROC curve (AUC) and optimal CUT-OFF values of continuous numerical variables for predicting SAP were Age (0.6079,51.5), BMI (0.6,23.25), WBC (0.6701,14.565), PCT (0.7086, 0.5175), Ca (0.7787,1.965), respectively. CONCLUSION:Age, BMI, non-HTGAP, WBC, PCT, serum Ca and CTSI≥4 have good predictive value for SAP.

Objective: The recurrence of adhesive small bowel obstruction (ASBO) limits the effectiveness of clinical treatments, making its significant clinical issues. Clinical features, perioperative parameters, and post-operative outcomes were retrospectively analyzed, to provide basis for screening the high risk factors in patients of recurrent ASBO. Methods: A review of medical records of patients with ASBO at Chongqing University Central Hospital, from 1 January 2015 to 31 December 2019 was conducted. We compared the clinical characteristics, intra-operative findings, and history surgery of ASBO "relapse-free" and relapsing patients. Logistic proportional hazard model was used to identify recurrence risks. Results: Based on specified inclusion and exclusion criteria, a total of 279 patients were included in this study. Participants' mean age was 63.0 (13.1) years; 49.4% (138 of 279) of them were male. Using multivariate Logistic regression analysis, the history of emergency abdominal surgery (hazard ratio, 0.241, p < 0.0001) was significantly associated with recurrence, as were multiple abdominal surgeries (hazard ratio, 0.250, p < 0.0001) and diabetes mellitus (hazard ratio, 0.182, p < 0.0001). Patients with recurrence, who underwent surgery had longer operative times, blood loss, and a higher incidence of wound complications than those without recurrence. Conclusion: The history of emergency abdominal surgery, multiple abdominal surgeries, and diabetes mellitus independently increased the chances of ASBO recurrence. Patients with ASBO recurrence had a higher incidence of postoperative complications. (c) 2023 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

目的 分析结构式心理干预对急腹症患者心理生理应激及疼痛的影响.方法 选取急腹症患者112例,依据随机数字表法均分为对照组和研究组,对照组给予常规心理干预,研究组给予结构式心理干预;于术前,运用焦虑自评量表(SAS)、抑郁自评量表(SDS)评价两组患者术前干预前后的心理应激反应;于术前,检测两组患者干预前后的收缩压(SBP)、舒张压(DBP)和心率(HR),比较两组患者干预前后的生理应激反应;依据视觉模拟量表(VAS)评分比较两组患者干预后24 h的疼痛缓解情况,观察并发症,记录患者对心理干预的满意度.结果 干预后两组患者SAS、SDS评分均下降,且研究组低于对照组,差异有统计学意义(t=5.610、5.747,P<0.05);干预后24 h,两组SBP、DBP、HR数值均趋于正常,且研究组SBP、DBP、HR水平均明显优于对照组,差异有统计学意义(t=8.456、2.147、8.313,P<0.05);研究组的疼痛程度明显优于对照组,满意度显著高于对照组,并发症总发生率低于对照组,差异有统计学意义(χ2=4.667,5.303,P<0.05).结论 结构式心理干预能够有效缓解急腹症患者的心理应激状态、生理应激反应和疼痛程度.

BACKGROUND:Radiotherapy is one of the essential components of breast cancer treatment. It destroys the remaining cells in the chest area after breast cancer surgery and is useful for reducing the necessity of mastectomies. As a single dose of radiation at the time of breast conserving surgery, intraoperative radiotherapy delivers radiotherapy directly and accurately to the tumor itself or the tumor bed whilst delivering minimal dose to the surrounding normal tissues. Hypofractionated postmastectomy radiotherapy with shorter and more convenient hypofractionated dose schedules might help to treat more patients and reduce cost. We will conduct a comprehensive systematic review and meta-analysis to compare the effectiveness of these 2 therapies in the management of early stage breast cancer. METHODS:Four English databases (PubMed, Embase, Cochrane Library, and Web of Science) and 3 Chinese databases (China National Knowledge Infrastructure, China Science and Technology Journal Database, and Chinese Biomedical Literature Database) will be searched from inception of databases to December 2020 without language limitation. Two reviewers will independently conduct selection of studies, data extraction and management, and assessment of risk of bias. Any disagreement will be resolved by the third reviewer. Review Manager 5.3 (The Cochrane Collaboration, Software Update, Oxford, UK) will be used for data synthesis. Cochrane risk of bias assessment tool will be used to assess the risk of bias. RESULTS:This study will provide a systematic synthesis of current published data to compare the effectiveness of intraoperative radiotherapy vs hypofractionated postmastectomy radiotherapy for early stage breast cancer. CONCLUSIONS:This systematic review and meta-analysis will provide clinical evidence for the effectiveness of intraoperative radiotherapy vs hypofractionated postmastectomy radiotherapy for early stage breast cancer, and inform our understanding of the value of intraoperative radiotherapy and hypofractionated postmastectomy radiotherapy for early stage breast cancer. STUDY REGISTRATION NUMBER:INPLASY2020110115.

Abstract Background: Radiotherapy is one of the essential components of breast cancer treatment. It destroys the remaining cells in the chest area after breast cancer surgery and is useful for reducing the necessity of mastectomies. As a single dose of radiation at the time of breast conserving surgery, intraoperative radiotherapy delivers radiotherapy directly and accurately to the tumor itself or the tumor bed whilst delivering minimal dose to the surrounding normal tissues. Hypofractionated postmastectomy radiotherapy with shorter and more convenient hypofractionated dose schedules might help to treat more patients and reduce cost. We will conduct a comprehensive systematic review and meta-analysis to compare the effectiveness of these 2 therapies in the management of early stage breast cancer. Methods: Four English databases (PubMed, Embase, Cochrane Library, and Web of Science) and 3 Chinese databases (China National Knowledge Infrastructure, China Science and Technology Journal Database, and Chinese Biomedical Literature Database) will be searched from inception of databases to December 2020 without language limitation. Two reviewers will independently conduct selection of studies, data extraction and management, and assessment of risk of bias. Any disagreement will be resolved by the third reviewer. Review Manager 5.3 (The Cochrane Collaboration, Software Update, Oxford, UK) will be used for data synthesis. Cochrane risk of bias assessment tool will be used to assess the risk of bias. Results: This study will provide a systematic synthesis of current published data to compare the effectiveness of intraoperative radiotherapy vs hypofractionated postmastectomy radiotherapy for early stage breast cancer. Conclusions: This systematic review and meta-analysis will provide clinical evidence for the effectiveness of intraoperative radiotherapy vs hypofractionated postmastectomy radiotherapy for early stage breast cancer, and inform our understanding of the value of intraoperative radiotherapy and hypofractionated postmastectomy radiotherapy for early stage breast cancer. Study registration number: INPLASY2020110115.

目的 探讨甲状旁腺次全切除术治疗维持性血液透析继发甲状旁腺功能亢进的短期疗效.方法 分析25例因维持性血液透析继发甲状旁腺功能亢进并行甲状旁腺次全切除术患者的相关临床病理资料.观察手术前后患者临床症状改善情况,同时比较术前与术后1 d、1周、1个月、3个月的血清甲状旁腺激素(PTH)、血钙、血磷指标的变化.结果 甲状旁腺次全切除术后血清PTH、血钙、血磷水平均有明显下降,所有患者临床症状均有改善,临床疗效显著有效24％,有效68％,无效8％.结论 甲状旁腺次全切除术是治疗继发性甲状旁腺功能亢进的有效术式,手术的关键是彻底找到所有甲状旁腺腺体,防止遗留腺体过多.

目的 探究经鼻-空肠营养管对胃癌根治术患者营养指标、炎症反应及并发症的影响.方法 82例行胃癌根治术患者均分为实验组和对照组,实验组术后采用经鼻-空肠营养管行肠内营养支持,对照组术后采用中心静脉置管行肠外营养支持;比较2组患者术前、术后第8天时的血清白蛋白(ALB)、转铁蛋白(TFN)、前白蛋白(PA)、血红蛋白(Hb)水平等营养学指标和血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)等炎症因子水平,比较2组患者术后首次排气时间、排便时间、下床时间、住院时间、消化道出血、腹腔出血、切口感染及肺部感染等并发症发生情况.结果 术后第8天,2组患者ALB、TFN、PA、Hb水平均较术前有所提高,且实验组ALB、TFN、PA、Hb水平明显高于同时点对照组,差异有统计学意义(P<0.05);与对照组比较,实验组术后首次排气时间、排便时间及下床时间明显提前,住院时间明显缩短,差异有统计学意义(P<0.05);术后第8天,2组患者血清IL-6、TNF-α、CRP水平均高于手术前,但实验组L-6、TNF-α、CRP水平均低于对照组,差异有统计学意义(P<0.05);实验组并发症总发生率17.07％,低于对照组的26.83％,差异有统计学意义(P<0.05).结论 胃癌根治术患者行鼻-空肠营养管肠内营养支持,可改善患者营养状况、减轻炎症反应、降低并发症.

BackgroundIn this study, we investigated the molecular mechanisms of human long non-coding RNA (lncRNA) FYVE RhoGEF And PH Domain Containing 5 Antisense RNA 1 (FGD5-AS1) and its downstream epigenetic axis, human microRNA-153-3p (hsa-miR-153-3p)/Cbp/P300-interacting transactivator with Glu/Asp-rich carboxy-terminal domain 2 (CITED2) in human gastric cancer.MethodsGastric cancer cell lines and clinical tumor samples were used to assess FGD5-AS1 expression levels. Lentivirus containing FGD5-AS1 small interfering RNA (sh-FGD5AS1) was applied to knockdown FGD5-AS1 expression. Cancer cells in vitro and in vivo proliferation, and 5-FU chemoresistance were assessed, respectively. Expressions of hsa-miR-153-3p/CITED2 were also assessed in FGD5-AS1-downregulated gastric cancer cells. Hsa-miR-153-3p was knocked down and CITED2 was upregulated to assess their direct functional correlations with FGD5-AS1 in gastric cancer.ResultsBoth gastric cancer cell lines and human tumor samples showed aberrant FGD5-AS1 upregulation. Lentiviral-induced FGD5-AS1 knockdown reduced cancer proliferation, 5-FU chemoresistance in vitro, and tumorigenicity in vivo. Hsa-miR-153-3p/CITED2 axis was confirmed to be downstream of FGD5-AS1 in gastric cancer. Hsa-miR-153-3p inhibition or CITED2 upregulation reversed the tumor-suppressing effects of FGD5-AS1 downregulation on gastric cancer proliferation and 5-FU chemoresistance.ConclusionWe demonstrated that FGD5-AS1 can regulate human gastric cancer cell functions, possibly through its downstream epigenetic axis of hsa-miR-153-3p/CITED2.

目的:探讨在普外科带实习带教中应用以问题为导向(problem-based learning,PBL)联合任务驱动教学法的价值.方法:随机数字表法选取笔者所在医院2018年5月-2019年5月进行住院医生规培教育的普外科实习医生70例,随机分为对照组和观察组,各35例,对照组实施传统教学法,观察组采取PBL联合任务驱动教学法.比较两组实习医生的理论与实践考核成绩和带教满意度.结果:观察组的实习医生总满意率(94.29％)明显高于对照组(77.14％),差异有统计学意义(P<0.05).观察组的理论考核成绩(95.32±2.18)分,实践考核成绩(94.83±1.75)分,显著高于对照组的(88.54±2.37)、(90.36±1.68)分,差异有统计学意义(P<0.05).结论:在普外科带教中应用PBL联合任务驱动教学法,可明显提高实习医生的理论与实践考核成绩,且带教满意度认可度更高.

在对何谓腹腔镜模拟训练进行简要论述基础上,重点论述住院规培医生教学中如何有效开展腹腔镜模拟训练,提出的具体教学策略为:让学生充分明晰腹腔镜模拟训练的重要意义;介绍腹腔镜模拟训练器材的构成及操作方法;有的放矢组织学生进行腹腔镜模拟训练操作;模拟训练操作过程中应适时地组织学生讨论.最后指出,为提升住院规培医生的腹腔镜模拟训练教学成效,应注意把握如下两点问题:教学节奏无须过于紧凑,应给予学生充分思考空间;营造轻松的教学氛围,让学生身心最大限度放松.

Torsion of the greater omentum is a rare condition with a low incidence. However, secondary torsion of the greater omentum caused by an incarcerated recurrent inguinal hernia is extremely rare. Such torsion is fairly difficult to diagnose preoperatively because the symptoms are not typical and can mimic those of other causes of acute abdominal disease. If only the incarcerated inguinal hernia is treated, associated torsion of the greater omentum may be missed. We herein report a case of secondary torsion of the greater omentum caused by an incarcerated recurrent inguinal hernia. Exploratory laparotomy was performed because the preoperative computed tomography findings suggested torsion of the greater omentum. The diagnosis of torsion of the greater omentum was confirmed intraoperatively. The patient developed no recurrence throughout the 5-year follow-up.

为了探讨结合正中外侧入路和前正中入路(median-to-lateral and anterior-to-median,MLAM)法沿Henle胃结肠干(gastrocolic trunk of henle,GTH)对全结肠系膜切除(complete mesocolic excision,CME)在腹腔镜右半结肠癌根治术的可行性与安全性,本实验回顾性分析2010年1月至2013年12月期间连续31例接受全结肠系膜切除的腹腔镜右半结肠癌根治术患者的数据.使用程序录像记录评估CME手术质量与完整性、手术数据、病理结果、大肠切除长度、并发症、体重指数、手术时间和外科医生的经验以及住院时间.结果 表明:所有沿外科干经大块切除包膜壁平面与淋巴结清扫术的患者无术中并发症.26例和5例患者评定为结肠系膜和内结肠系膜平面,5例、3例、11例和13例分别为T1、T2、T3和T4期肿瘤.淋巴结检出中位数为25,11位患者有淋巴结转移.大肠切除平均长度21.8 cm.平均手术时间和术中出血量为269 min和39mL.无患者发生术中并发症,3名患者有术后并发症.平均BMI为22.6 kg/m2.BMI＜22或≥-22的患者平均手术时间分别为225 min和297 min.手术时间与外科医生的经验无相关性.术后住院时间中位数为13d.腹腔镜CME通过结合MLAM法沿GTH进行融合筋膜暴露的淋巴结清扫术为一种安全可行的右半结肠癌手术.

目的 探讨乳腺真空辅助旋切术治疗乳腺良性肿块的有效性和安全性.方法 回顾性分析2016年1 1月至2019年4月重庆市第四人民医院普外科收治的775例乳腺良性占位性病变患者的临床资料,按照手术方法的不同分为对照组(327例)和观察组(448例).对照组采用乳晕旁切口手术,观察组采用乳腺真空辅助旋切术.分析2组患者的手术相关指标、术后不良反应、切口感染及复发情况.结果 对照组患者的手术时间和瘢痕长度长于观察组患者,手术费用低于观察组患者,差异有统计学意义(t=40.789、-43.406、97.606,P＜0.05),而2组患者手术出血量比较差异无统计学意义(t=1.090,P＞0.05);对照组患者出现术后血肿、乳房畸形和术后残留的比例均高于观察组,差异有统计学意义(x2=30.933、44.487、13.749,P＜0.05);对照组患者切口感染与复发的比例高于观察组患者,差异具有统计学意义(x2=21.152、18.037,P＜0.05);对照组患者的满意率为56.57％低于观察组的93.53％,差异有统计学意义(x2=150.095,P＜0.05).结论 使用乳腺真空辅助旋切术治疗乳腺良性肿块可以减少手术时间,降低术后不良反应发生率,提升患者满意度.

目的 探讨腹腔镜胃癌根治术患者术后并发症及其危险因素.方法 回顾性分析自2014年3月至2017年5月在重庆市急救医疗中心行腹腔镜胃癌根治术的200例患者的临床资料.观察所有患者手术情况,记录并发症发生情况;收集患者性别、年龄、体质量指数(BMI)、美国麻醉师协会( ASA)评级、术前合并疾病、手术者经验、肿瘤直径、肿瘤位置、病理学分型、T分期、手术时间、术中出血量及手术方式等资料,分析术后发生并发症的危险因素.结果 所有患者均顺利完成手术,并发症发生率为25.5% (51/200).单因素分析结果显示,腹腔镜胃癌根治术术后出现并发症与年龄、术前合并疾病及手术者经验相关(P<0.05).多因素Logistic回归分析结果显示,年龄、术前合并疾病、术者手术经验是腹腔镜胃癌根治术后出现并发症的独立危险因素(P<0.05).结论 患者年龄越大、术前合并疾病和术者手术经验越少,术后发生并发症的概率越高,临床上应对具有危险因素的患者引起重视,提高治疗满意度.

AIM To comparatively investigate the cellular and molecular characteristics of low-grade slightly elevated adenomas and polypoid adenomas. METHODS Colorectal tumors were collected from 24 patients with slightly elevated adenomas and 23 patients with polypoid adenomas. Five commonly mutated genes (APC, BRAF, KRAS, NRAS, and PIK3CA) were selected for mutational analysis. Paraffin-embedded tumor sections were used to calculate the apoptotic index (AI) and Ki-67 labeling index (KLI). Two pure colorectal epithelial cell lines were created by pooling the slightly elevated and polypoid tumors. Western blots, luciferase assays for β-catenin-T-cell factor protein/β-catenin-lymphoid enhancer factor (β-catenin-TCF/LEF)-driven transcriptional activity, and caspase activity assays were conducted on the two cell lines. RESULTS Slightly elevated lesions showed a significantly lower APC mutational frequency and a significantly higher KRAS mutational frequency (both P < 0.05). Slightly elevated lesions showed a significantly lower AI (P < 0.05). β-catenin and β-catenin-TCF/LEF-driven transcriptional activity was significantly upregulated in slightly elevated lesions (both P < 0.05). In slightly elevated lesions, c-Myc was significantly downregulated, while cyclin D1 was significantly upregulated (both P < 0.05). β-catenin-TCF/LEF-driven transcriptional activity was negatively correlated with c-Myc (ρ = -0.78). Slightly elevated lesions displayed significant Bcl-2 and Bcl-xL upregulation (both P < 0.05) along with significant decreases in caspase-9 and caspase-3 activity (both P < 0.05). c-Myc was negatively correlated with Bcl-2 and Bcl-xL (ρ = -0.74 and -0.78, respectively). CONCLUSION The lower apoptotic activity of low-grade slightly elevated adenomas can be partly attributed to upregulated β-catenin pathway activity and downregulated c-Myc expression.

目的 观察胃癌组织中miR-155表达水平,分析miR-155表达与肿瘤的临床分级、分期、疗效以及预后的关系,并初步分析其可能的机制.方法 选取我院收治的胃癌患者30例,采用qRT-PCR方法检测胃癌组织与癌旁组织中miR-155表达,并分析miR-155表达水平与患者临床分级、分期、疗效以及预后的关系.选择AGS以及MKN-28两种胃癌细胞系.采用miR-155 mimics上调细胞中miR-155表达,并观察细胞的增殖能力.结果 胃癌组织中miR-155表达明显低于癌旁组织,差异有统计学意义(P<0.05).12例大小≤4.5 cm的肿瘤组织中,miR-155平均表达值为(0.4097±0.0362),明显高于18例大小>4.5 cm的肿瘤组织平均表达值,差异有统计学意义(P<0.05).TNM分期为III+IV的14例患者中,miR-155平均表达值为(0.2107±0.0164),明显低于TNM分期为I+II的16例患者.miR-155低表达组2年无疾病进展率为35.7％,总生存率为42.9％,均明显低于高表达组,差异有统计学意义(P<0.05).细胞观察结果显示,转染miR-155mimics的AGS与MKN-28细胞系在48 h、72 h、96 h的增殖能力明显降低,差异有统计学意义(P<0.05).结论 miR-155表达异常与胃癌的发生与疾病进展呈明显相关性,是一种对胃癌细胞的生长发挥抑制作用的功能基因.

Objective To investigate the regulation of axillary lymph node metastasis(ALNM) in patients with invasive breast cancer.Methods The data of 448 cases with invasive breast carcinoma confirmed by pathology was retrospectively analyzed.Results Among the 448 cases with invasive breast carcinoma,255 cases(56.9%) suffered axillary lymph node metastasis.As analysis of relationship between axillary lymph node metastasis and age,ER,PR,HER-2,molecular subtypes,tumor size and location,P values were 0.858,0.822,0.660,0.844,0.972,0.000,and 0.001,respectively.Conclusion The correlative factors with axillary lymph nodes metastasis were tumor size and location.The patients'age,ER expression,PR expression,HER-2 expression and molecular subtypes were not correlated with axillary lymph node metastasis.

Objective To explore diagnostic and therapeutic modalities of pancreatic trauma.Methods The dates of 72 patients with pancreatic injuries treated operatively during the past 10 years in chongqing emergency medical center(CEMC) were studied retrospectively.The diagnostic methods were mainly CT,MRI,and ERCP etc.Various surgical procedures included simple suture or drainage,distal pancreatectomy,distal pancreaticojejunostomy,pancreaticoduodenal repair plus a diverticularization and multiple drainage,Whipple′s procedure,and damage control surgery(DCS),etc.Results 52 patients had associated injuries of other viscera in the abdomen;of them 13(25%) were penetrating injury,and 39(75%) blunt(χ2=0.000,P>0.05).49 patients sustained simultaneity extra-abdominal injuries;of them 6(12.24%) were penetrating,and 43(87.76%) blunt(χ2=13.310,P<0.01).The overall mortality rate was 12.5%(9/72).Relatively lethal factors were associated injuries,the amount of blood loss,and preoperative time,etc.Postoperative morbidity was 25%(18/72)including bleeding,pancreatic fistula,pancreatic pseudocyst,pancreatic abscess,traumatic pancreatitis,and disfunction of internal and external secretion of the pancreas,etc.There was a significant difference of the incidence of postoperative complication between grade Ⅲ-Ⅴ(15/18) and grade Ⅰ-Ⅱ(3/18,χ2=10.667,P<0.01).Of 63 survivors,34 with pancreatic injury of grade Ⅲ-Ⅴ were followed up from 6 months to 22 years(medium was 2 years),the patients′ conditions were well.Conclusion To decrease obviously the morbidity and mortality in the patients with pancreatic injuries,it is critical that initially missed diagnosis of pancreatic injuries is avoided,massive hemorrhage from associated injuries is ceased expeditiously during the operation,and a corresponding surgical procedure is selected exactly based on the classification of pancreatic injury.

回顾性分析64例结直肠损伤的手术治疗。非全层伤17例行简单缝合。全层破裂47例中,结肠和腹膜内直肠35例,Ⅰ期手术修复28例(80.0%)、造口后Ⅱ期手术7例;腹膜外直肠损伤12例,乙状结肠造口和骶前引流10例、Ⅰ期修补2例。存活60例并局部感染5例、直肠膀胱瘘2例、黏连性肠梗阻1例,均治愈。死亡4例(6.3%)均因合并伤大失血。本组表明结肠和腹膜内直肠损伤应争取Ⅰ期手术;腹膜外直肠损伤可分期手术,做乙状结肠近端造口加骶前引流。