Purpose To validate the prognostic value and evaluate the predictive value of response to adjuvant chemotherapy of perineural invasion (PNI) in node-negative colon cancer using the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) 18 tumor registry database. Methods Patients diagnosed with colon cancer from the SEER database between January 1, 2010 and December 31, 2015 were identified. Chi-square analysis was performed to evaluate different demographic and clinical features of patients between PNI-negative (PNI (−)) and PNI-positive (PNI (+)) groups. Univariate and multivariate Cox proportional hazard regression models were built to examine the relationship of demographic and clinical features and survival outcomes with the hazard ratios (HRs) and 95% confidence intervals (CIs). Results In total, 57,255 node-negative colon cancer patients were extracted from the SEER database. The receipt of chemotherapy was not an independent prognostic factor for CSS in T3 colon cancer with or without the presence of PNI (P >0.05). The receipt of chemotherapy was independently associated with 34.0% decreased risk of cancer-specific mortality compared with those without the receipt of chemotherapy in T4 colon cancer without the presence of PNI (HR = 0.660, 95%CI = 0.559–0.779, P <0.001); the receipt of chemotherapy was independently associated with 36.0% decreased risk of cancer-specific mortality compared with those without the receipt of chemotherapy in T4 colon cancer with the presence of PNI (HR = 0.640, 95%CI = 0.438–0.935, P = 0.021). Conclusions The present study demonstrated the poor prognosis of PNI (+) in both stage I and II colon cancer. However, the presence of PNI was not a predictive factor of response to adjuvant chemotherapy in node-negative colon cancer.

目的 探讨腹腔镜下钬激光碎石治疗胆总管结石的疗效及临床应用价值.方法 回顾性分析2016年1月至2017年12月苏州市吴中人民医院收治的83例胆总管结石手术病例,行腹腔镜常规胆总管控查术(对照组)60例,腹腔镜联合钬激光碎石术(钬激光组)23例,分别对两组中的术前基本资料、手术时间、取石时间、术中出血量、T管放置情况、术后排气时间、术后引流管放置时间、术后疼痛评分、术后胆漏发生率、术后残余结石发生率、术后住院天数、住院费用情况等进行统计学分析.结果 两组在术前各项基本资料、术中出血量、术后排气时间、术后引流管放置时间比较,差异无统计学意义(P＞0.05).两组在手术时间、取石时间、T管放置率、术后疼痛评分(M)、术后住院天数、住院费用、术后胆漏发生率、术后残余结石发生率比较,差异均有统计学意义(P＜0.05).结论 腹腔镜下联合钬激光治疗胆总管结石是安全可行的,其具有手术时间短、取石时间短、T管放置率降低、术后疼痛轻、术后住院时间短、住院费用低等优势;对今后更好开展此类手术提供了重要的依据.

目的 探讨滑结技术在腹腔镜阑尾切除术中的效果.方法 总结2016年1月至2018年8月,应用3孔法并可吸收线滑结结扎阑尾根部的方法进行腹腔镜阑尾切除术的283例患者临床资料.结果 患者均在腹腔镜下行LA术,无中转开腹,手术平均时间(50.6±20.2)min,平均住院时间(4.5±1.8)d.结论 无钛夹滑结结扎阑尾根部法腹腔镜阑尾切除术具有结扎可靠,手术费用低,并可消除因钛夹、塑料夹留置体内等的不良影响.

目的 探讨右半结肠憩室炎误诊为阑尾炎的原因.方法 总结2016年1月至2018年8月间误诊为阑尾炎的15例右半结肠憩室炎的临床资料进行回顾性分析.结果 15例中3例误诊为慢性阑尾炎者进一步查CT及肠镜明确,12例误诊为急性阑尾炎者8例经手术中腔镜进一步探查发现,另4例通过进一步查CT及肠镜术前明确.结论 结肠憩室相关疾病临床特征不典型,容易与阑尾炎等疾病混淆,要重视相关理论的学习注意多方鉴别.

目的 总结克罗恩病外科治疗的临床体会.方法 自2000年1月至2012年6月共收治27例克罗恩病患者,均行手术治疗和病理确诊.结果 本组病例均经病理证实为克罗恩病.术后随访8个月至6年,根据克罗恩病简化CDAI评分标准判断疗效.复发9例中,再次手术5例,其他4例转内科药物治疗症状缓解,复发时间6个月至5年,平均21个月.结论 对克罗恩病无论是外科治疗,还是内科治疗均无法达到治愈,仅是对症治疗.手术治疗克罗恩病,其复发率及再手术率高是外科治疗的重点.

目的探讨以右侧腹痛为表现的疾病与急性阑尾炎的鉴别诊断要点。方法对我院2006年9月~2010年10月误诊为急性阑尾炎的9例临床资料进行回顾性分析。结果本组9例均以右下腹痛为主要症状,入院均诊断为急性阑尾炎。经手术及影像学检查确诊为小肠间质瘤2例,右侧胸膜炎伴胸腔积液、升结肠憩室炎、横结肠癌、右侧黄体囊肿破裂出血、左侧巧克力囊肿破裂、右腹部带状疱疹及回肠穿孔各l例。横结肠癌者出院后行辅助化疗,小肠间质瘤中1例行甲磺酸伊马替尼辅助治疗,另1例出院后失访,余6例良性疾病均治愈出院。结论对以右下腹痛就诊者不能轻率诊断阑尾炎,要注意与多种疾病相鉴别。

腹部刀刺伤是普通外科常见的急腹症,部分患者临床难以判断有无内脏损伤及是否需要急诊开腹探查.2006年1月至2009年12月我院用腹腔镜诊断和治疗腹部刀刺伤患者15例,效果满意.现报道如下.