Objective To observe the clinical effect of one-stage extra-dissection and loose seton operation in the treatment of complex anal fistula combined abscess. Methods From September 2008 to October 2015, eighty-eight cases of complex anal fistula were randomly divided into two groups, treatment group of 53 cases with one-stage extra-dissection and loose seton operation, control group of 35 cases with the first stage abscess dissection and the second stage extra-dissection and loose seton operation. The data between two groups including types of fistula, preoperative and postoperative anal functional status (Wexner score assessment), hospitalization time, cure time, recurrence rate and complications were compared. Results The most common type of fistula was the anal intersphincteric fistula. The apparent healing rate of treatment group and control group was 92.5%and 91.4%, respectively, with no significant difference between the two groups (c2=0.030, P=0.862). Preoperative and postoperative incontinence average credit of two groups were 1.8±1.3 and 1.9±1.3, 1.7±1.5 and 2.0±1.2 (t=0.332, 0.364, both P>0.05). Wexner incontinence scores were in the range of 0-5. There was no significant difference in complication rates (c2=0.133, P=0.998). For a 0.5-4 years follow up, the two groups showed no difference in recurrence rate (7.5%vs 8.6%, c2=0.030, P=0.862). The hospital stay and wound healing time of treatment group was (5.9±0.3) d and (6.2±1.5) d, while the control group was (20.3±1.3) d and (25.2±1.2) d, with a significant difference (t=24.351, 16.523, both P<0.01). Conclusion Compared with traditional stages, the one-stage extra-dissection and loose seton operation has advantages of less pain, shorter course, better protection of anal function for treating complex anal fistula combined abscess.

Objective To understand the actual clinical significance of early enteral nutritional supply in elderly patients with colorectal cancer after laparoscopic surgery. Methods A total of 62 elderly patients with colorectal cancer accepted laparoscopic radical surgery were alloca-ted in this study,the external nutritional supply(EN)of 32 cases in study group had been given through the nasogastric tube in the second day af-ter operation. Patients in control group(parenteral nutrition,PN,30 cases)were routinely given with mixed venous nutritional supply containing amino acids,fat emulsion,glucose and electrolytes through the central venous catherter within 2 ~ 7 d after operation. The postoperative nutritional index,fasting blood sugar,complications,first exhaust,defecation and length of hospital stay were compared between these two groups. Results The blood levels of prealbumin and albumin in patients of PN group were decreased more significantly in 3rd and 7th days after the operation. The difference in amplitude of decrease between these 2 groups in the same period was statistically significant( P < 0. 05). There was no serious gas-trointestinal complications such as anastomotic leakage,intestinal obstruction or perioperative mortality occurred. The rate of postoperative compli-cations in EN group was 12. 5% ,that in PN group was 20. 0% ,and their difference was statistically significant( P < 0. 05). The duration for postoperative first exhaust,defecation and hospital stay in patients of PN group was longer than that of patients in EN group( P < 0. 05). Conclu-sion The early application of EN in elderly patients with colorectal cancer after laparoscopic surgery is safe. It can significantly promote the recov-ery of intestinal function and reduce the malnutrition - related and other complications,in order to achieve fast track to goals for rehabilitation.

AIM:To observe the expression of β-catenin in colonic adenocarcinoma and to investigate its clinical significance and prognostic value. METHODS:The integrated clinical and follow -up data of 52 patients,who were undergone radical operation,were retrospectively analyzed from June 2000 to June 2004 in our hospital. The paraffin -embedded tissues of 52 colonic adenocarcinoma specimens and 20 cases of normal paraneoplastic colonic mucous tissues were detected for β-catenin expression by immunohistochemical method. The relationships between β-catenin and clinical variables and prognostic value were statistically analyzed. RESULTS:β-catenin was normally expressed in all 20 normal cases. In the cases of colonic adenocarcinoma,the abnormal expression rate of β-catenin was 71%. The abnormal expression of β-catenin did not correlated with gender,age,histological differentiation and blood CEA (P 0. 05),but it was correlated with lymph node metastasis and clinical stage (P 0. 05). The abnormal expression of β-catenin were also correlated with the postoperative survive time (P 0. 05). CONCLUSION:The abnormal expression of β-catenin is correlated with the lymph node metastasis and clinical stage,and the abnormal expression is an important adverse prognostic factor for survival in the patients with colonic adenocarcinoma. β-catenin may be a molecular prognostic marker in the patients with colonic adenocarcinoma.

<正>短肠综合征(short bowel syndrome,SBS)是由于大量小肠切除后,机体不能吸收足够的营养以维持生理代谢的需要,而导致整个机体处于营养不足的状况,继而出现器官功能衰退,代谢功能障碍,免疫功能下降,由此而产生的一

目的探讨胃癌患者围手术期CD4+ CD25+调节性T细胞的变化及其意义。方法应用流式细胞仪检测52例胃癌患者(胃癌组)术前、术后7 d,术后1个月CD4+ CD25+T细胞水平,并以24名健康者作为对照(对照组)。结果胃癌组外周血CD4+ CD25+T细胞较对照组明显升高;胃癌组经根治或姑息术切除肿瘤1个月后,外周血CD4+ CD25+T细胞水平较术前及术后1周明显下降,而术后1周与术前比较无统计学差异。结论胃癌组患者外周血CD4+ CD25+T细胞水平明显升高可能是机体免疫功能受抑制的重要机制。该指标可能成为胃癌免疫状态临床监测的指标。

Objective To analyse the security and treat value of intraperitoneal implanting fluorouracil-bioalbumin gel sustained slow-release in progressive gastric cancer operations. Methods 96 progressived gastric cancer patients were divided into 3 groups and followed up. Patients in test group received the combined therapy of intraoperative hypotonic petitoneal chemo-hyperthemia with implanting fluorouracil-bioalbumin gel sustained slow-release;controlled groups were given respectively intraoperative hypotonic petitoneal chemotherapy combined with early postoperatively hypotonic petitoneal chemo-hyperthemia and only peritoneal lavage with distilled water. The safety index, survival or recurrence rate of patients were compared in 1,3 ,5 years. Results There were no significant difference in safe application of three different ways. The incidence of recurrence in test group was lower significantly than those of controlled group(15.15%,36.36%,40.44%,P<0.05). The survival rate of three groups in 3 and 5 years were different significantly ( P<0.05), but difference of 1 year survival rate were no significant.Conclusion As a new kind of regional chemotherapy drug, intraperitoneal implanting fluorouracil-bioalbumin gel sustained release in progressive gastric cancer operations is a safe measure. The survival rate of the patients can be increased, and the recurrence rate decreases obviously.

淋巴结转移是胃癌转移的主要途径,胃癌根治术后因淋巴结复发死亡病例占术后总复发死亡病例20%[1].胃癌根治术时淋巴清扫具有一定的局限性和盲目性,全身化疗时局部淋巴结化疗药物浓度低,不能有效解决淋巴结转移问题.本研究以医用生物胶为载体混合丝裂霉素,对胃癌根治术后淋巴引流区行缓释化疗,探讨其临床使用安全性.

Objective To explore the managed method of traumatic colonic rupture and evaluate it's safety and efficacy of primary surgery.Methods The clinical date of 27 cases of traumatic colon injury from May 2001 to May 2007 were retrospectively analyzed.Results Among the 27 cases,21 cases were multiple organ injuries.All cases underwent an emergency operation.Primary repair or primary anastomosis after excision was performed in 23 cases(85.2%),and 2 cases of incisional infection was occurred in 17 cases of primary repair.Primary anastomosis after excision was performed in 6 cases,infection occurred in 2 cases and 1 case of anastomotic leakage.Colostomy was performed in 4 cases and incisional infection was occurred in 1 case.Conclusion Primary operation of traumatic colonic injury is safe and reliable for most patients with colonic injury.It may be used extensively in clinic.

Objective To compare the effects of early enteral nutrition(EEN) supportand total parenteral nutrition(TPN) support for the patiens with severe acute pancreatitis(SAP).Methods 42 cases of SAP were studied restrospectively and the patiens were divided into two groups randomly:early enteral nutrition group(EEN group,n=21),total parenteral nutrition group(TPN group,n=21).Pepti-2000 was transfused through nasojejunal tube in the 3rd to the 6 th day after admission in EEN group.The calory and nitrogen in both groups were 30 kcal/kg·d and 0.17 g/kg·d.Results ① The death rate in the EEN group was lower than that in the TPN group,but there were no differences between two groups(P0.05);the hospitalized days in EEN group were less than that in the TPN group(P0.05).② In the two weeks after admission :hemoglobin and body weight in EEN group were measured more than that in TPN group,but no significant difference was found;plasma total protein and albumin in EEN group were measured more than that in TPN group(P0.05);and more prealbumin was found in EEN group.Conclusions Compared to TPN support,early EEN support is more efficient to improve body nutrition condition and shortens hospitalized days.

为探讨影响直肠癌术后局部复发的因素,笔者对49例直肠癌根治术后局部复发患者的临床资料进行回顾性分析。结果示,本组男性31例(62.3%);DukesB期以上者45例(91.8%);Dixon术后复发30例(61.2%),Miles术后复发19例(38.8%);未行综合治疗或未能完成综合治疗计划者38例(77.6%)。提示术后局部复发与性别、肿瘤病期、手术方式及综合治疗有关。手术的彻底性及以手术为主的综合治疗是减少术后局部复发的可控因素。

Objective To evaluate the feasibility and efficacy of local resection for lower rectal cancer.Methods The clinical data from 42 patients with lower rectal cancer,admitted during the period 1996-2002,were retrospectively analyzed.Results Among these 42 patients,6 belonged to Tis,20 to T1,and the other 16 to T2.No perioperative mortality and severe complications were observed.Seven cases(16.7%) developed local recurrence,among which 2 belonged to stage T1 lesion,and 5 to stage T2.Gross classification,tumor size,T staging were closely related to the risk of local recurrence(P0.05).The overall 5-year survival rate was 83.3%.The survival rates in Tis,T1,and T2 tumors were 100%,90.0% and 68.8%,respectively.Conclusions Local resection is an acceptable option for well-differentiated,LN-negative early rectal cancer cases with good biological behavior.Radical resection should be considered for T2 lesions.Palliative local resection combined with adjuvant chemoradiotherapy should be reserved for patients who are unable to tolerate radical operation or refuse to accept colostomy.

目的研究结直肠癌组织中β-Catenin的异常表达及其临床病理意义。方法应用免疫组化方法对92例结直肠癌组织及20例正常结肠组织中的β-Catenin的异常表达情况进行检测并对其临床病理特征进行比较分析。结果20例正常结肠组织中100%可见连续的β-Catenin细胞膜染色,异常表达率为零。92例结直肠癌组织中β-Catenin膜表达的缺失率为72.83%,异常表达率为64.13%。结论结直肠癌组织中β-Catenin异常表达率与其临床病理特征有密切的关系。β-Catenin异常表达率高提示患者预后效果不佳。β-Catenin可能是反映结直肠癌临床病理特征、生物学行为及其预后的重要标记物。

目的探讨直肠癌前切除术后出现吻合口瘘的非手术治疗方法。方法对21例直肠癌前切除术后出现吻合口瘘患者使用思华龙引流管持续冲洗并负压吸引引流。结果21例均痊愈出院,术后随访半年以上,均无吻合口狭窄、盆腔脓肿并发症。结论使用思华龙引流管持续冲洗并负压吸引引流是治疗直肠癌前切除术后吻合口瘘简单、安全、有效的好方法。

Objective To evaluate the clinical outcome of gastric deflated mouths anastomosis. Methods The clinical data of 119 patients underwent various gastrectomy with gastric deflated mouths anastomosis were analyzed retrospectively. Results The mean anastomosis duration was 25 minutes. No death and anastomotic stoma leakage occurred. Postoperative complications occurred in 15 patients (12.6%), including incision infection in 5 cases, pulmonary infection in 4 cases, adhesiveileus in 4 cases, and reflux gastritis in 2 cases. There was no abdominal distention, anorexia, and dumping syndrome in these patients. No anastomotic stricture occurred in 101 cases with 1 to 4 year follow-up. Conclusion The surgical procedure is simple and can decrease the postoperative complications. The life qualities of these patients after operation were satisfied.

目的探讨克罗恩病的外科治疗方法。方法回顾分析近10年来我院外科手术治疗21例克罗恩病患者的临床资料。结果本组发病表现以腹痛、腹泻为主,分别占71%和33%;腹部肿块4例;肠梗阻11例,肠穿孔4例,肠道出血4例,内瘘形成2例,腹腔脓肿形成4例。术前诊断仅2例,误诊率高;全组均经手术治疗,行右半结肠切除术13例,小肠部分切除术5例,术后并发症死亡2例,复发7例,再次手术4例。结论克罗恩病临床表现多种多样,手术是治疗克罗恩病并发症的主要手段,术后预防复发很重要。

1 引言 急性穿孔是胃溃疡最严重的并发症.由于溃疡病变向深度发展使得胃壁变薄,有时候再遇到胃内压突然增加,溃疡可向腹腔内穿破,胃内容物流入腹腔,称为胃溃疡合并穿孔.如果不及时处理,胃内容物会污染整个腹腔,产生严重的急性弥漫性腹膜炎,进而给患者带来严重后果.

患者,女,65岁.因肛周搔痒1年,红肿并疼痛3个月,便后鲜血1个月入院.1年前无明显诱因出现肛周瘙痒,自行用中药外敷后症状略有控制.3个月前自己发现肛门周围出现红肿及触痛,开始范围较小,后范围逐渐扩大.无发热等症状.就诊于当地医院,诊断为"湿疹",给予中药等外洗症状缓解不明显.1个月前发现便后鲜血并大便变细如小指粗细,并逐渐出现大便困难,就诊于本院门诊,初步诊断考虑"尖锐湿疣",行局部活检报告"肛周湿疹样癌".随即收住院治疗.

Objective To study the clinical efficacy of ultrasound-guided radiofequency ablation(RFA) in the treatment of liver metastases of colorectal carcinoma. Methods In the recent 5 years,24 patients(50 liver metastatic lesions),who were not appropriate candidates for resection were treated with RFA. Results 46 lesions were completely ablated according to the results of contrast-enhanced CT or CDFI 1 month after the RFA(effective rate,92%). There were 6 patiens with multi-focal recurrences in the liver,and treatment of 2th～4th times of RFA were performed necessarily.All patients were follew up from 3～24 months,20 patients were alive to date.The complications included swell-heat feeling in the treatment area, pain and low fever. Conclusion Ultrasound-guided radiofrequency ablation is a minimally-invasive and effective technique with low complications in the treatment of liver metastases of colorectal carcinoma.It can be performed for several times on those recurrent lesions.

Objective:To evaluate the treatment strategy for patients with perioperative risk of exo-adrenal pheochromocytoma resection. Method: Clinical result of 2 cases suffering from exo-ademal pheochromocytoma in the hospital and concerned literatures was reviewed. Result: All 2 cases could not be determined the diagnosis before operation. Noradrenaline was used to treat the hypotension in operation. No perioperative death occurred. Conclusion: Exo-adrenal pheochromocytoma was difficult to diagnose. Pheochromocytoma may be the possible cause of the hypotension in the operation, the susceptible catecholamine must be selected to control it.

Objective To explore the diagnosis and treatment of gastrointestinal stromal tumors(GISTs).Methods Clinical and pathological data of the 32 GISTs cases treated over the recent 5 years in our hospital were reviewed retrospectively.Results Stomach was the most frequent site for GISTs.Abdominal pain was the most common symptom.Before operation,81.3%(26/32) of the cases were misdiagnosed.All of the cases underwent surgical resection.10 recurrent GIST patients received a second resection,and 8 patients(underwant) three or more resections.Follow-up was made from six months to 5 years,and 8 patients died.Conclusions The diagnosis of GISTs is difficult and mainly depends on histopathology and(immunohistochemistry).Surgical resection is the principal treatment of GISTs.Reoperation is effective for the treatment of recurrent cases.