目的 探讨上腹部闭合性损伤外科救治中的治疗策略及方法,降低死亡率,改善预后.方法 选取67例上腹部闭合性损伤患者,分类评估,术前诊断及外科治疗进行回顾分析.结果 患者平均有效救治时间为(49.6±15.2)min,平均住院时间为(17.6±5.2)d;67例患者救治成功率为89.5％(60/67),好转率为6％(4/67),死亡率4.5％(3/67).本组患者并发症:术口感染1.5％(1/67),术后肺部感染7.5％(5/80),术后肝脓肿1.5％(1/67),肠粘连4.5％(3/67),腹腔间隙综合征1.5％,(1/67),创伤后胰腺炎假性囊肿形成1.5％(1/67).结论 早期快速准确诊断及合理的外科治疗能够有效地降低死亡率,提高抢救成功率,改善预后,取得良好的治疗效果.

Objective:To investigate the effect of early postoperative enteral nutrition (EEN) on laparoscopic and open radical gastrectomy.Methods:From January 2015 to December 2016,68 patients with gastric cancer admited in Anqing Hospital,Anhui Medical University,were randomized into laparoscopic group (33 cases) and open group (35 cases).The following parameters were collected:(1) Surgical outcomes and complications;(2) EEN tolerance;(3) postoperative nutritional status;(4) starting time of postoperative chemotherapy.Results:There was no significant difference between groups in terms of operation time,number of lymph node,postoperative complications such as anastomotic fistula,pulmonary infection,incision infection (P ＞ 0.05);whereas the intraoperative blood loss was significantly less in laparoscopic group (P ＜ 0.01).(2) EEN tolerance:Postoperative discomforts,such as abdominal distension,diarrhea and other symptoms occurred significantly less in laparoscopic group (P ＜ 0.01),and time for TEN is significantly shorter (P ＜ 0.01).(3) Postoperative nutritional status:On the 7th day after operation,the nutrition status of the laparoscopic group improved earlier.There was significant difference regarding the detected blood level of prealbumin and C-reactive protein between the two groups (P ＜ 0.01).On the 14th day after operation,the nutritional status of the laparoscopic group improved significantly.The body weight,the right upper arm muscle circumference and the albumin were significantly different between two groups (P ＜ 0.05).(4) The number of cases receiving chemotherapy in patients with advanced gastric cancer was significantly higher in laparotomy group than that with open distal gastrectomy.Conclusion:Laparoscopic surgery for gastric cancer reduces surgical trauma,and leads to better EEN tolerance and earlier achieved TEN,which is conducive to improving postoperative nutritional status,as well as providing good conditions for adjuvant chemotherapy.

Objective To summarize the experience of combined approaches to laparoscopic splenectomy (LS) following a standardized technique by operative position changes. Methods The clinical data of 47 patients who underwent LS in Anqing Hospital from Jul. 2014 to Jun. 2017, were retrospectively analyzed. The LS was performed by adjusting the patients' operative position twice, thus realizing a combined approach, as well as by using a standardized 3-step technique. Results Forty-six patients performed LS successfully, with only one patient having an additional small incision to complete the operation. Operation duration was (91.49±11.96) min. Intraoperative bleeding was (279.89±102.44) mL and no uncontrollable bleeding was found. The postoperative time of anus aerofluxus was (2.13±0.21) d. The duration of postoperative indwelling drainage catheter was (4.77±1.52) d. No pancreatic leakage or intra-abdominal hemorrhage was found, and only reactive pleural effusion was reported in 7 cases. Postoperative hospitalization length was (7.79±1.28) d. No death was found in all patients during follow-up (1 to 35 months). Conclusion The combined approach for programmed LS has high success rate, low incidence of postsurgical complications, and short recovery time. It is a convenient and effective procedure that can be further expanded, especially in basic-level hospital.

Aim To explore the effects of mannitol on adhesive intestinal obstruction by ileus tube.Methods A total of 40 Adhesive intestinal obstruction patients were randomly divided into control group and experimental group.Patients in the control group were treated with routine therapy including fasting,nutritional support,maintaining electrolyte and acid-base balance,using somatostatin and ileus tube decompression.Patients in the experimental group received mannitol based on routine therapy.Results Experimental group had a better outcome as compared with control group,including a quick recovery of flatus and stool[95% and 35.2±1.4 h vs 75% and 43.0±3.9 h](P0.05),decreased degree of abdominal circumference[15.0±1.5 cm vs 13.2±1.4cm](P0.05),the disappearing time of gas-liquid and hospitalization time was shorter than the control group[41.7±7.0 h and 8.9±1.3 d vs 53.3±9.2 h and 13.2±1.4 d](P0.05).The rate of transferring to operation in experimental group(5%)was significantly lower than that in the control group(25%).Conclusion Using mannitol by ileus tube plus routine treatment is an effective method to treat adhesive intestinal obstruction by significantly improving clinical symptoms,increasing non-surgical cure ativerate,decreasing the rate of transferring to operation and shorten hospital stay.

目的探讨术中应用纤维胆管镜的价值。方法对156例肝胆管结石患者术中应用胆管镜分析,总结评价其效果。结果全组患者156例,术后残石12例,其中10例又通过术后胆镜取净,残石率1.44%(2/139)。结论术中应用纤维胆管镜能明显减少术后残石率,能进一步明确诊断,指导手术方式,减少创伤及缩短患者术后带管时间,减轻患者痛苦。

小肠占消化道总长度的70%,其粘膜覆盖率占胃肠道总面积的90%,而小肠肿瘤的发生率仅占胃肠道肿瘤的1%～3%.小肠肿瘤良、恶性发生率的国内外报道均趋于一致,以恶性为多.

Aim To explore the feasibility and safety of distal pancreatectomy with spleen and the splenic vessels preservation for the tumor and injury of body and tail of the pancreas.Methods The clinical data of 5 cases of distal pancreatectomy with preservation of the spleen and splenic vessels from November 1997 to May 2009 in our hospital were analyzed retrospectively.Among them,there is 1 case of pancreatic injury,2 cases of pancreatic cystadenomas,2 cases of cystadenocarcinoma.The age of 3 cases in this group is from 10 to 16 years.The body and tail of pancreas was dissected carefully with the exposure of the splenic artery.The splenic vessels and gastric short vessels were not transected with the spleen no isolation.The drainage of pancreatic section was performed routinely.Results The distal pancreatectomy with spleen and splenic vessels preservation was performed in all cases successfully.The mean operation time was 236 minutes,and the mean blood loss volume was 196ml,only one patient needed the transfusion of erythrocyte suspension.The mean post-operative hospital stay was 12.6 days.The blood platelet count was from 145×109/L to 405×109/L after operation.No post-operative pancreatic fistula and other complications occurred in all cases.No recurrence and metastasis occurred in the patient with panceatic cystadenocarcinoma in 2～12 months since operation time.Conclusion Spleen preservation for children and adolescent is more signifcant.It is difficult,but feasible and safe,to do the opration of distal pancreatectomy with spleen and splenic vessels preservation,for which high operative skills are needed.This operative method would become the best choice for the treatment of injury,benign and borderline tumors and early stage carcinomas located in the body and tail of pancreas.

目的总结纤维胆道镜(纤胆镜)治疗肝胆管结石350例的经验。方法回顾性分析纤胆镜治疗肝胆管结石350例并分为两组。A组术中纤胆镜取石者98例,B组术后经T管窦道治疗者252例。结果A组配合肝段切除结石取净率为93.9%,B组结石取净率85.7%。结论纤胆镜配合手术在肝内胆管结石的治疗中具有重要作用,可提高结石取净率。

急性胆源性胰腺炎(Acute Biliary Pancreatitis,ABP)是胰腺炎中最常见的类型,而胆结石是最常见的急性胰腺炎的病因,文献报道在我国占急性胰腺炎发病因素的55%～65%[1],究其原因主要是由胆石引起壶腹部阻塞或胆石迁移过程中造成的Oddi括约肌水肿痉挛,引起胆汁胰液排泌不畅,造成高压胆汁逆流入胰管引起一系列反应所致.现回顾分析我院自2000年2月～2004年2月间收治的62例急性胆源性胰腺炎的临床资料,报告如下:

Aim To explore the clinical characteristics of small intestinal tumors and its diagnosis. Methods A retrospective analysis was made on the clinical data and followup of 18 cases of primary intestinal tumor treated from 1993. Results Leiomyoma was most common among the benign small intestinal tumors(4/11),adenocarcinoma was most common among the malignant small intestinal tumors(5/7), The feature of small intestinal tumors could be abdominal pain,gastrointestinal hemorrhge,jaundice and etc. The 16 cases underwent operation,the preoperative diagnostic rate was only 38.8%(7/18),The accuratediagnostic rate of B-ultrasound,CT scanning was lower,while digital subtract angiography (DSA) was helpful to make sure the portion. Conclusion The clinical presentation of primary small intestinal tumor is untypical and early diagnosis is quite difficult, so intensive study and recognization of this lision should be emphasized to improve the prognosis of these patients .

目的探讨纤维胆道镜辅助手术治疗胆道结石的临床效果.方法分析1996年10月～2003年1月我院纤维胆道镜诊治的250例胆道结石的临床资料.结果应用纤维胆道镜术中、术后分别发现漏诊结石2例和15例,术中发现残留结石9例,取尽4例;术后残留结石171例,取尽144例,结石总取尽率为84.2%.结论纤维胆道镜辅助外科手术是治疗肝胆管结石的有效措施.

Objectives　To study the value of choledochofiberscope in treatment of residual intrahepatic stones and the outer-scope expression of comet sign.Method　Taking stones from patients by 240 times with choledochofiberscope though T tube sinus after bile duct operation from Apr. 1996 to Dec.1999.Result　The net extraction rate is 98.1%.Conclusion　There must be residual stones while the bile is like rice-water or floccule before stones taken out.