Objective To evaluate the method of preperitoneal repair for huge incisional hernia, and to provide a reasonable strategy for surgical treatment of huge incisional hernia.Methods This retrospective review included 41 patients from December 2015 to November 2016 who had huge ventral incisional hernia, the hernia defect of which was more than 10 cm, in the department of Hernia and Abdominal Wall Surgery, Lu′an Affiliated Hospital of An′hui Medical University and Beijing Chao-Yang Hospital.Results According to the individual difference, the appropriate treatment plan was designed, including the ways to lose weight and to reduce body mass index (BMI index).Component separation technique (CST), initiative volume reduction surgery (IVRS) and Sublay method were used to repair these cases.The intra-abdominal pressure (IAP) was more than 12 mmHg in 13 cases, and reached the peak at about 72 hours after operation, however, abdominal compartment syndrome (ACS) did not appear in these patients with conservative treatment.4 cases suffered with incision subcutaneous hematoma.5 cases had different degrees of discomfort.No intestinal fistula, intestinal obstruction and perioperitive mortality occurred.The mean hospitalization date was 9.5 days.All the patients were followed up for 3 to 12 months, and no recurrence occurred.Conclusion According to the different situation of the patients with huge ventral incisional hernia, designing a appropriate treatment plan: preoperative weight loss, reducing BMI and appropriate surgical procedures could effectively avoid postoperative abdominal pressure and ACS.

目的:探讨经胃造瘘管放置空肠营养管治疗上消化道穿孔老年患者的可行性及治疗价值.方法:将我院普外科2008-02/2012-07收治的38例消化道穿孔患者,根据其肠内营养方式分为2组,A组患者术后采用鼻饲管进行肠内营养,B组患者采用经胃造瘘放置空肠营养管术后予肠内营养.分析比较两组患者术后出现呼吸道、消化道及其他各类不适的比例.结果:B组患者术后排斥引流管心理、鼻咽部不适、异物感、置管营养期间恶心、呕吐、早起（＜3d）下床活动及置管后严重咳嗽、咳痰、合并肺炎等发生率与A组患者比较有明显统计学意义（P=0.036）;营养改善方面,两组手术后第9天与第1天比较白蛋白,前白蛋白等指标均明显升高（P=0.024;0.044）,但二者第9天之间比较无明显差异（P＞0.05）.结论:采用经胃造瘘管置空肠营养管,术后早期行肠内营养,患者耐受性好,并发症低,尤其适合老年上消化道穿孔患者.

目的 总结小儿脾脏外伤后保守治疗的经验,探讨小儿脾脏外伤保守治疗的适应症.方法 回顾性分析2001年1月至2009年11月本院收冶的47例外伤性脾破裂实施保守治疗的患儿临床资料,分析其诊疗经过、措施及疗效.结果 47例保守治疗患儿中,2例无效而行全脾切除术治愈;45例经保守治疗痊愈,其中3例发生脾囊肿,随访1年无并发症发生.结论 Ⅰ～Ⅱ级睥外伤患儿在做好术前准备的前提下,严密观察生命体征和血流动力学变化,采取积极保守治疗也可获痊愈.

Objective To evaluate the cosmetic effect of cosmetology surgery for breast benign tumor.Methods The clinical data of 143 cases adopted the mammary gland cosmetology margin were analyzed retrospectively from March 2003 to December 2009.Results These 143 patients basically scar to be very few,the mammary gland outward appearance achieves a better effect.Conclusion The cosmetology margin is a safe and cosmetic procedure in treating mammary benign tumor and easy to be handle and generalize in clinic.

患儿,女,5岁.因进行性阵发性腹痛1个月余,伴呕吐1 d入院.患儿1个月前在无明显诱因下出现阵发性腹痛,以脐周为主.当时未予特殊处理,后患儿症状逐渐加重,入院前一日患儿开始出现持续腹痛伴呕吐,呕吐物为胃内容物,就诊于当地医院输液治疗后未见明显好转,后转至我院,检查发现患儿盆腔可及包块,故拟盆腔包块收住,病程中,患儿无发热,有轻度咳嗽,咳痰。

小儿颈部大血管损伤临床少见,本院近期收治1例,现报道如下. 临床资料 2例均为男性,年龄分别为8岁和5岁,均为玩耍时不慎绊倒,手中所持锐器刺中颈部致伤,均表现为大量出血(当地医院未敢处理),于伤后约1 h入院.

Objective This prospective study was performed to evaluate the role of oral glucose toler-ance test(OGTF) in evaluating the preoperative status and postoperative complications of patients with hepa-tocellular carcinoma. Methods One hundred and twenty-eight patients with primary hepatic carcinoma (PHC) were divided into 3 groups according to the resection, in which the resection of no more than 1 seg-ment called group A, the resection of 1-2 segments called group B, the resection of more than 2 segments called group C. OGTT, routine liver function tests and Child-Pugh classification were performed in these pa-tients preoperatively. The postoperative complications were also recorded. Results Blood glucose lever of 60 min and 120 min after glucose loading test in Child B (11.23 mmol/L ± 2. 78 mmol/L, 11.79 mmol/L± 3.48 mmol/L) were significantly higher than that in Child A (8.56 mmol/L±2. 36 mmol/L, 6. 78 mmol/L ±1.60 mmol/L,P <0.01) ,but the blood glucose lever of 0 min and 30 min showed no difference. The rate of diagonis of DM in Child B was 28. 30% ,which was higher than Child A(13.33% ,P =0. 035). The OG-TT results for the L-shaped curve showed that postoperative complications were significantly higher than that of type I and P in group A and B. I-shaped and L-shaped were found ascites in group C. The cases with jaun-dice all showed L-shaped curve. When the patients' OGTT curve was P -shaped, the ascites production rate was no significantly different in these three groups. With the increase of the removal in liver, ascites produc-tion rate increased evidently in I-type and L-type(P < 0. 05). Conclusions OGTT is worthwhile to assess hepatic function reserve and postoperative complications for patients with PHC. Combination of OGTT and Child-Pugh classification has higher predictive value on hepatic function reserve.

<正>老年胃癌病人由于其重要脏器的储备能力下降、病情重、晚期居多、合并症多的特点,其围术期的处理直接影响手术的成败。我科自2007年1月至2008年12月共收治

闭孔疝是腹腔内脏器经过髋骨闭孔突出于股三角区而形成,占所有疝的0.05%~1.4%,占机械性肠梗阻的0.2%~1.6%[1].嵌顿率很高且易于误诊而造成治疗上的被动,故提高对本病的认识、早期诊断和治疗、降低病死率具有重要的临床意义.现将1990年1月~2008年10月我院收治闭孔疝共9例报道如下.

Objective To evaluate the causation and management of complications caused by enteral nutrition (EN)after stomach cancer surgery.Methods The clinical data of 195 gastric cancer patients which used EN after surgery were analyzed retrospectively from September 2002 to April 2008 in our hospital.Results Among the 195 patients,29(14.87%)developed abdominal distention,17(8.71%)diarrhoea,Six(3.07%)metabolic complica tions,three anastomotie leakage,1 patient with colon perforation.Conclusion These complications caused by EN after stomach cancer surgery associated with the stress of surgery,the speed and concentration of nutrition infusion, patients'metabolic conditions and other related factors.

原发性肝细胞癌(human hepatocellular carcinoma,HCC)是目前公认危害最大的恶性肿瘤之一.有资料显示,每年全球HCC新发病例的45%在中国大陆,可见HCC在我国的高发趋势已十分严峻,近20年来我国HCC的病死率增加了41.7%。