目的:探讨腹腔镜直肠癌根治术中低位结扎肠系膜下动脉(IMA)联合自然腔道标本提取(NOSE)的临床效果.方法:回顾性分析2017年6月—2018年11月我院57例直肠癌患者临床资料,其中行低位结扎保留左结肠动脉(低位结扎组)19例,NOSE+低位结扎保留左结肠动脉18例(NOSE组),高位结扎不保留左结肠动脉20例(高位结扎组).比较3组患者术中及术后恢复情况.结果:3组患者一般资料比较差异无统计学意义(P>0.05).3组手术时间、术后疼痛评分、住院时间、预防性造瘘比率、切口感染发生比率比较差异有统计学意义(P<0.05);术中出血量、淋巴结转移数目、第3站淋巴结转移数目比较差异无统计学意义(P>0.05).NOSE组术后排气时间最短、术后疼痛评分最低、住院时间最短(P<0.05).结论:腹腔镜直肠癌根治术低位结扎IMA联合NOSE可以减少吻合口漏发生概率,淋巴清扫效果与高位结扎相当,术后疼痛更轻,有临床推广价值.

目的:分析改良经腹腹膜前修补术(transabdominal preperitoneal,TAPP)术对成人腹股沟斜疝治疗的有效性和安全性.方法:回顾分析84例腹股沟斜疝患者的临床资料,其中观察组40例采用改良TAPP术,对照组54例采用传统TAPP术.比较两组间手术时间、中转手术、手术副损伤、术后第1日疼痛评分、术后静脉止痛药使用时间、术后住院时间、术后并发症发生情况.结果:观察组手术时间单侧为57.4±18.27min,双侧为85.9±25.66 min,分别短于对照组的71.55±21.88min和144.30±37.83 min,差异均有统计学意义(P＜0.05).两组均未发生手术副损伤、中转手术和术后复发,两组间术后第1天疼痛数字评分、术后静脉止痛药使用时间、术后住院时间及术后并发症发生率比较,差异均无统计学意义(P＞0.05).结论:改良TAPP术治疗成人腹股沟斜疝缩短了手术时间,其手术疗效及并发症发生风险与传统TAPP术相当,适合临床推广.

目的:探讨腹腔镜胃癌根治术安全性及缩短腹腔镜胃癌根治术学习曲线的方法.方法:回顾性分析腹腔镜胃癌根治术37例患者的临床资料,全胃切除术20例,远端胃切除术17例.按胃肠吻合方式统计,毕氏Ⅰ式吻合1例,毕氏Ⅱ式吻合9例,RY吻合27例.结果:37例均手术顺利完成,平均手术时间196.52±51.63 min,术中出血265.50±132.76 mL,清扫淋巴结28.97±7.91个,术后肛门排气时间2.09±0.73天,住院时间10.94±5.49天.结论:腹腔镜胃癌根治术安全、可行,能达到肿瘤根治效果,通过适当的学习和训练可以缩短学习曲线.

目的:分析腹腔镜疝囊高位结扎术治疗小儿腹股沟斜疝的临床效果.方法:采用腹腔镜疝囊高位结扎术(腹腔镜组)87例,传统小切口疝囊高位结扎术(传统手术组)185例,比较两组平均手术时间、下床活动时间、住院时间、住院费用、术后疼痛评分以及术后阴囊血清肿发生率.结果:腹腔镜组平均手术时间25.00±13.66 min,下床活动时间5.14±3.73 d,分别少于传统手术组的33.29±29.97min和18.52±7.83 d,差异均有统计学意义(P<0.05);腹腔镜组住院费用4554.39±1048.67元,高于传统手术组的3422.45±1634.64元,差异有统计学意义(P<0.05);两组住院天数比较,差异无统计学意义(P>0.05);腹腔镜组术后VAS疼痛评分2.82±1.49分,低于传统手术组的4.73±1.76分,差异具有统计学意义(P<0.05);腹腔镜组无阴囊血清肿发生,而传统手术组有13例(7.03％)发生阴囊血清肿,差异具有统计学意义(P<0.05).结论:与传统小切口疝囊高位结扎术相比,腹腔镜疝囊高位结扎术手术创伤小,手术时间短,术后疼痛轻,术后并发症少,有利于发现对侧隐匿疝,具有有良好的应用前景.

目的:探讨乳腺浸润性导管癌(IDC)中乳腺癌扩增性抗原1(AIB1)和增殖细胞核抗原(Ki67)蛋白的表达及临床意义.方法:选择2012年6月到2014年6月在我院经病理检查确诊为IDC患者的组织石蜡标本160例,采用链霉素-生物素(SP)免疫组化法检测标本中AIB1和Ki67蛋白的表达,多因素Logistic回归分析二者与IDC临床病理学特征的相关性.结果:AIB1、Ki67的阳性表达率分别为75.63％和80.63％.AIB1、Ki67的表达与淋巴结转移、组织学分级及TNM分期存在相关性(P＜0.05),且随组织学分级和TNM分期的增高,阳性表达率逐渐增高(P＜0.05),Ki67的表达水平随肿瘤变大,阳性率逐渐增加(P＜0.05).淋巴结阳性组AIB1、Ki67的阳性表达率显著高于淋巴结阴性组(P＜0.05).多因素Logistic回归分析显示,AIB1、Ki67的阳性表达是淋巴结转移、病理组织学分级及TNM分期的危险因素(P＜0.05).结论:在IDC组织中AIB1和Ki67的阳性表达均增高,二者与IDC临床病理学特征有密切关系.

Objective To explore the best plan of perioperative individualized fluid therapy in the elderly patients with coronary heart disease undergoing gastrointestinal surgery.Methods Eighty elderly patients with coronary heart disease undergoing gastrointestinal surgery were divided into experimental group and control group by random digits table method with 40 cases each.Conventional capcity treatment was given during surgery and postoperative period in control group.Individualized fluid therapy was used during surgery and postoperative period in intensive care unit of 24 h in experimental group,which was determined based on target controlled fluid therapy according to the cardiac index,stroke volume,and stroke volume variation.Traditional fluid therapy was used in control group in the intraoperative and postoperative period.The two groups were compared in terms of postoperative hemodynamic parameters,total fluid volume,incidence of adverse cardiac events,and recovery of gastrointestinal function.Results The mean arterial pressure at the beginning of the operation,the cardiac index at operation begining 1 h and at the end of operation were (80.4 ± 6.4) mmHg (1 mmHg =0.133 kPa),(4.0 ± 0.6) L/(min ·m2),(4.1 ± 0.8) L/(min ·m2) in experimental group and (76.9 ± 8.0) mmHg,(3.5 ± 0.4) L/(min· m2),(3.6 ± 0.3) L/(min · mè) in control group,and there were significant differences between two groups (P ＜ 0.05).During surgery and 24±hour stay in intensive care unit,the total fluid volume,crystal usage,urine and colloid usage were (2 915 ± 650),(2 715 ± 415),(1 515 ± 315),(1 225 ± 385),(419 ± 233),(619 ± 285),(1 015 ± 220),(1 535 ± 455) ml in experimental group and (3 645 ±770),(3 355 ±750),(2 315 ±320),(1 855 ±325),(602 ±31),(875 ±423),(805 ±250),(1 135 ± 205) ml in control group,and there were significant differences between two groups (P ＜ 0.05).The perioperative adverse cardiac events rate was 30％ (12/40) in experimental group,lower than 45％ (18/40) in control group,but the difference was no statistically significance (P ＞ 0.05).Conclusion In the elderly patients with coronary artery disease undergoing gastrointestinal surgery,individualized fluid therapy can effectively decrease adverse cardiac events,improve postoperative gastrointestinal function,and reduce length of hospital stay.

Objective To observe the clinical effect and the safety of propacetamol hydrochloride applied in preemptive analgesia of laparoscopic cholecystectomy. Methods 90 cases to receive laparoscopic cholecystectomy with ASA grading from I to II were ran-domly divided into 3 groups:Group A, Group B and Group C, 30 cases in each;15 minutes before anesthesia, infusion of propacetamol hydrochloride (2g diluted in 100ml saline) was made to cases in Group A, infusion of butorphanol with the dosage calculation of 20μg/kg diluted in 100ml saline was made to cases in Group B and infusion of 100ml saline was made to cases in Group C;the recovery time of spontaneous respiration after operation, the anesthesia awaking time and the extubation time of the cases in the 3 groups were ob-served and recorded;visual analogue scale(VAS) was applied in assessing the pain degrees of the cases in the 3 groups at the time point of 1 hour, 2 hours, 4 hours, 8 hours and 24 hours after operation;side effects were observed as well, such drowsiness, fidgety, nausea, vomiting and respiratory depression. Results The anesthesia awaking time and the extubation time in Group A and Group C were much shorter than that in Group B (P<0.05), there existed no statistical difference between Group A and Group C (P>0.05);the VAS scores in Group A and Group B at the time point of 2 hours, 4 hours, 8 hours and 24 hours after operation dropped down much more than those in Group C (P<0.05);the case numbers of drowsiness in Group A and Group C were obviously less than that in Group B (P<0.05);no respi-ration depression occurred in the 3 groups, and the occurrence of fidgety and vomiting was of no statistical significance (P>0.05). Con-clusions The application of propacetamol hydrochloride in preemptive analgesia of laparoscopic cholecystectomy is of obvious analge-sic effect with no impact on the awaking of patients from anesthesia after operation or occurrence of side effects.

目的：观察腹腔镜手术与传统开腹手术治疗低位直肠癌的临床疗效。方法选取2006年4月～2009年9月我院收治的低位直肠癌患者550例进行治疗观察，随机分为对照组和观察组各275例，对照组行传统开腹手术，观察组行腹腔镜手术，观察对比两组临床疗效。结果经治疗，两组患者均康复出院，无1例死亡，观察组中14例（5.1%）患者腹腔镜手术失败而转行开腹手术；两组患者在手术时间、术中出血量、功能恢复时间、住院时间、并发症发生率及局部复发情况等方面对比，差异具有统计学意义（P<0.05）。结论腹腔镜手术治疗直肠癌，疗效明显优于传统开腹手术，具有较高的临床应用价值。

目的:探讨经乳晕缘切口切除乳腺良性肿瘤的临床疗效。方法:采用回顾性分析的方法,对120例行乳晕缘切口切除乳腺良性肿瘤患者的临床资料进行分析。结果:根据分析,其中120例患者中有117例患者的伤口Ⅰ期愈合,占总治疗效果的97.5%。结论:经乳晕缘切口治疗乳腺良性肿瘤在临床上有着较好的治疗效果,不仅能完整的切除病变的肿瘤,同时还不影响患者乳房的美观,值得在临床上推广应用。

目的:探讨腹股沟复发疝行无张力疝修补术治疗经验。方法:回顾分析本院50例腹股沟复发疝行无张力疝修补术治疗的临床资料。结果:50例患者均一次性手术成功,经随访1～5年无一例复发。结论:无张力疝修补术是治疗腹股沟复发疝的理想的手术方式。

Objective:To analyze the causes of negative results in laparotomy of acute abdomen and to provide the preventive countermeasures.Methods:The medical records of 26 cases of laparotomy were analyzed to find out and classify the causes leading to negative results of laparotomy.White blood counts,C-reactive protein and ratio of neutrophils were compared and analyzed between negative and positive results of laporatomy.Results:There was no significant differences in white blood counts,C-reactive protein and ratio of neutrophils between negative and positive results of laporatomy(P>0.05).The main causes leading to negative results of laparotomy was undetailed disease history and physical examination,lack of consultation from related departments and pertinently accessory examination.Conclusion:Particular inquest,overall systematic physical examination,pertinently accessory examination and strict consultation system are important guarantee to reduce the negative results of laparotomy.

<正>我科2009—2010年共行直肠癌Miles术145例,经加强围手术期护理指导,效果满意,现报告如下。1临床资料本组145例,术前均由病理检查确诊,其中男性81例,女性64例,年龄28~81岁,平均(56±5)岁,均行Miles

直肠癌m i l e s手术是低位直肠癌的一种手术方式,术后患者腹部行结肠造瘘人工肛门.由于人工肛门改变肛门正常位置,不能随意控制排便.术后会给患者造成很大的心理和生理打击,特殊的身体形象给病人在日常工作生活上带来的不便,使患者在围手术期对前途及生活失去信心.

[目的]探讨结肠癌并发急性肠梗阻一期切除肠吻合手术的可行性.[方法]回顾本院2003~2009年收治的32例结肠癌并发急性肠梗阻病例资料.[结果]32例患者均手术治疗,术中30例行一期肠吻合术,2例行结肠造瘘.术后出现吻合口瘘2例(6.3%),切口感染3例(9.4%),无死亡病例,均治愈出院.[结论]结肠癌并发急性肠梗阻患者如果全身情况及肿瘤情况允许行一期切除肠吻合术是可行的,若不能切除可选择造瘘,解除梗阻.

Objective To compare the effect of enteral nutrition by indwelling nasogastric feeding tube and stoma of jejunum in patients with total gastrectomy.Methods From July 2006 to December 2010 in our hospital,57 patients with total gastrectomy were randomly divided into two groups according to different methods of enteral nutrition,30 patients with indwelling nasal jejunal feeding tube as the control group,27 patients with stoma of jejunum as the observation group,the clinical results of two groups were compared.Results The anal exhaust time,defecation and hospital stay of observation group were significantly shorter than those in the control group,and the nutritional indices 8 days after operation of the observation group were significantly better than those in the control group,the differences were statistically significant between two groups(P<0.05);The complication rate of observation group was 7.4%,slightly lower than 13.3% of the control group,but there was no significant difference between two groups(P>0.05).Conclusions Total gastrectomy patients with jejunostomy enteral nutrition is more satisfactory clinical results,can significantly improve the nutritional status of patients,and the faster recovery of gastrointestinal function in patients,is conducive to the rehabilitation of patients,is a better way of enteral nutrition.

目的:探讨肝硬化门脉高压症患者合并胆囊结石的手术治疗方法。方法:回顾淮安市第一人民医院分院普外科2002年1月—2009年10月期间手术治疗肝硬化门脉高压症合并胆囊炎、胆囊结石12例。结果:12例均行脾切除+贲门胃底周围血管离断同时行胆囊切除术,无术中死亡,术后1例。结论:对于肝功能childA级患者行一期脾切除+贲门胃底周围血管离断+胆囊切除术是可行的。

随着我国人口老龄化的加剧,老年胆囊炎患者的发病率正逐年升高,选择行腹腔镜手术(laparoscopic cholecystectomy,LC)的患者也逐渐增多.但随着年龄增大,常伴有器官功能减退,合并症增多,手术风险相应增大,围术期处理难度较大.因此,老年胆囊炎患者LC术后并发症的预防一直是临床关注的焦点.对我院2003～2008年60例老年胆囊炎患者LC围术期处理经验、腹腔镜手术的技巧及并发症的预防等情况进行了回顾性总结分析,现报告如下.

乳腺癌的发病率近50年来在全球呈上升趋势,早期诊断是降低患者病死率的重要手段.随着影像技术的进一步发展,通过超声及钼靶等影像学检查发现而早期临床不能触及肿块的乳腺病灶明显增多.笔者通过超声定位期行手术切除并对病理结果进行分析,探讨该方法的可行性及临床价值.

Object:To discuss the clinical application of US-guided preoperative localization for nonpalpalable breast lesions. Methods:The study included 50 nonpalpable breast lesions detected on US among 41 asymtomatic women who underwent US-guided localization preoperatively in the Branch of Huaian No.1 hospital from Jan. 2006 to Dec. 2009. Result:41 asymtomatic women were operated successfully. Among the 50 nonpalpable breast lesions,10(20%)were malignant,13(26%)were atypical breast hyperplasia,27(54%) were benign. Conclusion:US-guided preoperative localization to the nonpalpalable breast lesions is an easy-operated procedure and helpful to the early treatment of breast diseases.